Evaluating molecular epidemiology of carbapenem non-susceptible Klebsiella pneumoniae isolates with MLST, MALDI-TOF MS, PFGE

Background: This study aimed to evaluate antibiotic resistance genes and virulence genes and the clonal relationship of the carbapenem-nonsusceptible Klebsiella pneumoniae strains by molecular methods which are isolated from various clinical specimens from patients treated in tertiary care hospital in Turkey. Methods: Identification of 32 carbapenem non-susceptible K. pneumoniae were determined by VITEK-2 (BioMérieux, France) automated system. Thirteen colistin-resistant strains were tested with the broth microdilution method. Various antibiotic resistance genes and virulence genes frequently seen in carbapenem-resistant strains were screened by PCR. Immunochromatographic tests used in the rapid diagnosis of carbapenemases were compared with PCR results. In addition, PFGE, MLST and MALDI-TOF MS methods were used to determine the clonal relationship among these strains. Results: PCR demonstrated that 31 of the strains carried at least one of the carbapenemase genes. In one strain, the coexistence of bla OXA−48+NDM was shown. The most common resistance genes were determined as bla SHV (84.3%), bla CTX−M−1 (46.8%), bla OXA−48 (40.6%), bla KPC (40.6%), bla TEM (31.2%), bla NDM (18.8%) respectively. Among the virulence genes; magA (68.7%) was the most common, followed by kpn (59.3%) and K2 (9.3%). Immunochromatographic tests were found to be 100% compatible with PCR results. All colistin-resistant isolates were also found to be resistant by colistin broth microdilution. In PFGE analysis, 25 different genotypes were determined and clustering isolates were collected in 5 different clusters and the clustering rate was 35.4%. In MLST analysis, ST101 type was determined as the most common ST type with a rate of 29%. ST101 is followed by ST16, ST307, ST14, ST147, ST309, ST377, ST395 and ST2096, respectively. The compatibility rate between MALDI-TOF MS and VITEK-2 was found 94.3%, in bacterial identification. In MALDI-TOF MS typing, the maximum similarity between the strains was less than 70% and clustering not shown. Conclusion: In addition to OXA-48, which is endemic in our country, it has been determined that KPC, which is more common in the world, is becoming increasingly common in our region. ST101 type was determined as the most common type between the strains. To the best of our knowledge, this is the first study that compares these three methods in our country. There may be differences between bacterial identifications made with VITEK-2 and MALDI-TOF MS. In this study, it was observed that MALDI-TOF MS analyses were not compatible with the typing of strains according to PFGE and MLST analysis results.Recep Tayyip Erdogan University Scientific Research Projects Uni

Hand Hygiene Compliance in an Education and Research Hospital Intensive Care Units

Objective and Aim: Errors occurring during the provision of health services are medical errors. Hospital infections counted among these errors remain a serious health problem on the agenda. Hand hygiene is the most effective and cheapest way to prevent hospital infections, and it is also a method that can be easily applied by the healthcare worker. With hand hygiene compliance, it has been shown that one third of the hospital infections and even one third and half of the hospital infections occurring in intensive care are reduced. In this study, it was aimed to evaluate hand hygiene observation data retrospectively in intensive care units. Materials and Method: This study was carried out in Recep Tayyip Erdoğan University (RTEU) Training and Research Hospital Intensive Care Units (Internal Intensive Care, Surgical Intensive Care, Anesthesia Intensive Care, Cardiovascular Surgery Intensive Care, Coronary Intensive Care, Pediatric Intensive Care, Newborn Intensive Care) in 2016 and 2017. There were doctors, nurses and assistant health personnel among the healthcare professionals. Hand hygiene observation was made according to five basic indication rules. Results: In the Intensive Care Units (ICU), 255 health workers were evaluated in 2016 and 430 in 2017. The compliance rate in the ICU was evaluated as 86%. According to the five indication rules, the highest compliance was with 90-95% before aseptic procedures, after contamination with body fluids and after contact with the patient's environment. The least compliance was before contact with 60% of patients. According to professions, the compliance rate of physicians was 85%, nurses 95%, and assistant health personnel 90%. According to the units; The highest compliance was in the Surgical Intensive Care, Pediatrics and Neonatal Intensive Care Unit with 97%, and the least in the Anesthesia and Internal Medicine Intensive Care Units with 69% and 60% Discussion and Conclusion: Hand hygiene compliance; It is still below the desired levels, with regular training, evaluations and feedback. Hospital infections, especially for the prevention of intensive care infections, besides continuing education, rewarding practices will be more motivating for healthcare professionals here. It should develop and implement a feasible, acceptable, acceptable hand hygiene policy in hospitals.Keywords: Hand hygiene compliance, feedback, patient safety, intensive careDOI: 10.7176/JHMN/75-0

Differential antibody response to COVID-19 disease and COVID-19 vaccines

Background: In our study, antibody positivity was evaluated by two methods in vaccinated and unvaccinated people according to their demographic characteristics and history of COVID-19. Methods: In this study, venous blood samples were taken from patients who were requested to have COVID-19 antibodies from our hospital's outpatient clinics between February 2022 and March 2022. Results: There was no statistically significant difference when IgG antibody positivity was compared according to the age ranges in chemiluminescence and immunochromatographic methods. When patients were evaluated according to antibody titers, it was found that 81% of the seronegative patients were unvaccinated and had not had Covid-19, and it was found that this group was statistically significant compared to other groups. Conclusions: It has been concluded that it will be of great importance for every country, even every region, to have a test and vaccine policy for diagnosis and follow-up in the fight against COVID-19