Türkiye'nin Güney Marmara Bölgesi'nden izole edilen Streptococcus pneumoniae suşlarında makrolid ve penisilin direnci ve makrolid direncinin moleküler özelliǧi

Aim: To determine the distribution of macrolide resistance genes as well as resistance rates in isolated Streptococcus pneumoniae strains from the southern Marmara region of Turkey. Materials and methods: Antimicrobial resistance rates and MIC values were determined by the E-test method in 300 Streptococcus pneumoniae isolates that were isolated from clinical samples. Resistance genes were determined by the polymerase chain reaction (PCR) method in erythromycin-resistant strains. Results: It was found that 11.4% of Streptococcus pneumoniae isolates were resistant to macrolides. The penicillin MIC value was >= 0.12 mu g/mL in 23% of the strains and 2 mu g/mL in 2% of the strains. The erm(B) genotype was observed in 58.8% of all macrolide-resistant strains, 38.2% were of the mef(A) genotype, and 3% were a combination of both genotypes. Conclusion: Based on the data from this study, it was concluded that the local resistance to antibiotics is not as high as that observed in other countries, and the erm(B) genotype was dominant in macrolide-resistant strains. Therefore, it is suggested that macrolide-group antibiotics still be included in treatment protocols.Son yıllarda Streptococcus pneumoniae suşlarında makrolid ve diğer antibiyotiklere giderek artan bir direnç oranı mevcuttur. Bu çalışmada Türkiye’de Güney Marmara Bölgesi’nden izole edilen S. pneumoniae suşlarında penisilin ve makrolidler için minimum inhibitör konsantrasyonlarının ve makrolid direnç mekanizmasının genetik dağılımının tespit edilmesi amaçlanmıştır. Yöntem ve gereç: Çalışmada klinik örneklerden izole edilen 300 adet S. pneumoniae izolatında E test yöntemi ile antimikrobiyal direnç oranları ve MIK değerleri ve eritromisine dirençli izolatlarda ise PCR yöntemiyle direnç genleri tespit edildi. Çalışmada makrolid direnci % 11,4 oranında bulundu. Penisilin MIC değeri 0,12 μg/mL ve üzeri olan suşlar % 23 oranında, penisilin MIC değeri 2 μg/mL olan suşlar % 2 oranında bulundu. Makrolid dirençli izolatların % 58,8’inde erm(B) genotipi, % 38,2’sinde mef(A) genotipi, ve % 3’ünde her iki direnç genotipi birden tespit edildi. Sonuç: Bölgemizde izole edilen suşlarda antibiyotik direncinin yüksek olmadığı ve makrolid direnci olan suşlarda erm(B) tipi direnç geninin hakim olduğu görüldü. Bölgemizde direnç oranlarının yüksek olmaması nedeniyle tedavi protokolünde makrolid grubu antibiyotikler kullanılabilir

An investigation of Candida species isolated from blood cultures during 17 years in a university hospital

Candidemia is the most frequent manifestation observed with invasive candidiasis. The aim of this study was to analyse the trends of candidemia in a large tertiary-care hospital to determine the overall incidence during January 1996-December 2012, as well as to determine the susceptibility of 453 isolates according to the revised Clinical and Laboratory Standards Institute (CLSI) breakpoints. Candidemia episodes in adult and paediatric patients were retrospectively analysed from the laboratory data of Uluda University Healthcare and Research Hospital. The 17-year period studied was divided into three periods (1996-2001, 2002-2007 and 2008-2012) for better comparison, and candidemia incidence was determined by the ratio of total number of patients with candidemia per 1000 patients admitted to the hospital and per 10000 patient days in these three periods. Redefined CLSI M27-A3 breakpoints were used for interpretation of antifungal susceptibility results. Candidemia incidence was determined as 2.2, 1.7 and 1.5 per 1000 admitted patients during 1996-2001, 2002-2007 and 2008-2012 respectively. A significantly decreased candidemia incidence was obtained in the third period. C. albicans (43.8%) was the most common candidemia agent, followed by C.parapsilosis (26.5%) in all three periods. According to the revised CLSI breakpoints, there was fluconazole resistance in C. albicans, C.parapsilosis, C.tropicalis and C.glabrata species (1.4%, 18.2%, 2.6% and 14.3% respectively). Almost all Candida species were found susceptible to voriconazole except one C.glabrata (7.1%) isolate. Candidemia is an important health problem. Local epidemiological data are determinative in the choice of appropriate antifungal treatment agents