Performance of CarbaNP and CIM tests in OXA-48 carbapenemase-producing Enterobacteriaceae

This study applied two phenotypic tests, namely “Carbapenemase Nordmann–Poirel” (CarbaNP) test and “Carbapenem Inactivation Method” (CIM), against the isolates carrying the carbapenem resistance genes. The study included 83 carbapenem-resistant Enterobacteriaceae isolates producing oxacillinase-48 (OXA-48) and 30 carbapenem-sensitive Enterobacteriaceae isolates. Out of the total isolates studied, 77 isolates (92.77%) were identified as Klebsiella pneumoniae and six isolates (7.23%) were identified as Escherichia coli by Matrix Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry. Polymerase chain reaction (PCR) method used to detect resistance genes found that 74 isolates (89.16%) produced OXA-48 carbapenemase, whereas nine isolates (10.84%) produced both OXA-48 and New Delhi metallo-beta-lactamase-1 (NDM-1). The isolates producing both OXA-48 and NDM-1 were found to be positive by both phenotypic tests. Among isolates carrying only blaOXA-48 gene alone, nine isolates (13.04%) for CarbaNP test and two isolates for CIM test (2.90%) displayed false negative results, respectively. The sensitivity of CarbaNP and CIM tests was found to be 89.16% and 97.59%, respectively, whereas the specificity was determined to be 100% for both tests. These findings suggest that CarbaNP and CIM tests are useful tools to identify the carbapenemase producers. Molecular methods like PCR are recommended to verify false negative tests predicted to have OXA-48 activity

High rate of colistin and fosfomycin resistance among carbapenemase-producing Enterobacteriaceae in Turkey

When the problem with carbapenem-resistant Enterobacteriaceae (CRE) increases, the older antimicrobial agents such as colistin and fosfomycin are used for the treatment of these infections. In this study, the broth microdilution method for colistin and the agar dilution method for fosfomycin were used for a total of 147 multidrug-resistant (MDR) or extensively drug-resistant (XDR) strains of CRE. The study included Klebsiella pneumoniae (91.16%), Escherichia coli (7.48%), Enterobacter cloacae (0.68%), and Serratia marcescens (0.68%). All these strains produce various types of carbapenemase, including OXA-48, NDM, and KPC. Some of these strains also have three different carbapenemase mechanisms, including OXA-48 (78.23%), NDM (2.04%), and KPC (0.68%) or OXA-48 and NDM (10.88%), or OXA-48 and KPC (0.68%). About 76.19% of the strains and 67.35% of the strains were resistant for colistin and fosfomycin, respectively. A total of 21 out of 35 colistin-susceptible strains were found to be susceptible to fosfomycin. This study showed that the resistance rates of colistin and fosfomycin are high. The MDR and XDR strains of CRE are spreading in our region and thus a monitoring system for CRE should be followed. Moreover, the applicability of antimicrobial stewardship programs should be increased in all inpatient and outpatient settings

The Effects Of Helicobacter Pylori Treatment On Mıcrobıota

Bağırsak florasının, insan sağlığı ve çeşitli hastalıkların patogenezi üzerindeki önemi ve etkisi insan mikrobiyom projesinin de gündeme gelmesiyle daha da önem kazanmıştır. Bağırsak mikrobiyotası hem mikroorganizma sayısı hem de türleri bakımından bireysel farklılıklar gösteren dinamik bir sistemdir. Diyet alışkanlıkları, yaşam tarzı, yaş, konağın genetik yatkınlıkları ve antibiyotik kullanımı da barsak florasını etkilemektedir. Bu çalışmanın amacı Helicobacter pylori (HP) si pozitif olan ve tetrasiklin ile metronidazol antibiyotik tedavisi alan hastalarda, antibiyotik kullanım öncesi ve sonrası bağırsak mikrobiyotasının önemli bakteri türleri olan Bifidobacterium spp, Bacteroides fragilis,Lactobacillus spp, Akkermansia mucinophilia ve Fecalobacterium prausnitzii bakımından kantitatif karşılaştırmasını yapmak ve antibiyotik kullanımının mikrobiyota değişimi üzerine etkisini belirlemektir. Çalışmaya Gazi Üniversitesi Tıp Fakültesi Gastroenteroloji kliniğine başvuran ve HP pozitif tanısı alan 39 hasta dahil edildi. Hastaların 39 u antibiyotik öncesi gaita örneği vermesine rağmen ancak 18 hasta antibiyotik sonrası gaita örneği verdi. Çalışmada hastalardan alınan 200 mg gaita örneği değerlendirmeye alındı. Gaitada fazla miktarda DNA izolasyon inhibitörlerinin varlığından dolayı DNA izolasyon işlemi için, özel gaitadan ekstraksiyon kiti kullanıldı (QIAmp DNA Stool Mini Kit, QIAgen, Almanya). Hedef bölge amplifikasyonu için çalışmada yer alan bakterilerin 16S rRNA bölgesine spesifik primerler kullanıldı. Kantitasyon işleminin optimizasyonu ve primerlerin özgüllüğünün doğrulanması için ilgili bakterilerin ATCC suşları ile değerlendirme yapıldı. Ekstraksiyon örneklerinde bakterilerin hem HP pozitif hem de sağlıklı gönüllülerden alınan gaita örneklerinden yapılan ekstraksiyon işlemi sonrası tüm bakterilerin gerçek zamanlı PZR (Polimeraz Zincir Reaksiyonu) yöntemi ile kantitasyon işlemi Rotor-Gene® 6000 cihazında (Qiagen, Almanya) yapıldı. HP tedavisi alan hastalarda antibiyotik kullanım öncesi ve sonrası yapılan kantitasyon sonucunda Bifidobacterium spp (p=0,000), Bacteroides fragilis (p=0,000), Lactobacillus spp (p=0,000), A. mucinophilia (p=0,000) ve F. prausnitzii için istatistiksel olarak anlamlı düşüş gözlendi. Elde edilen veriler doğrultusunda HP tedavisinde kullanılan tetrasiklin ve metronidazolün mikrobiyotada disbiyozise neden olabilecek bir zemin oluşturabileceğini söylemek mümkündür.The importance and effect of the intestinal flora on human health and pathogenesis of various diseases have been gained even more importance with the human microbiome project coming into the agenda.The intestinal microbiota is a dynamic system showing individual differences in both the number and species of microorganisms. Dietary habits , lifestyle, age, genetic predisposition of the host and use of antibiotics also affect the intestinal flora. The aim of this study is to carry out a quantitative comparison as regards the Bifidobacterium spp, Bacteriodes fragilis, Lactobacillus spp, Akkermansia mucinophilia and Fecalobacterium prausnitzii, which are the important bacterial species of the intestinal microbiota before and after antibiotic therapy with tetracycline and metronidazole in patients who are positive for Helicobacter pylori (HP) and to determine the effects of antibiotic use on the microbiota. 39 patients who applied to the Gastroenterology Clinic of Gazi University Medical Faculty and were diagnosed as HP-positive were included in this study. While 39 of the patients did not give stool sample before antibiotic therapy, 18 patients gave stool sample after antibiotic therapy. The stool samples of 200 mg in weight were collected from the patients who were included in the evaluation. A special extraction kit (QIAmp DNA Stool Mini Kit, QIAgen, GERMANY) was used for DNA isolation procedure because of the presence of DNA isolation inhibitors in large amount in stool. Primers specific for the 16S rRNA region of the bacteria included in the study were used for the amplification of the target region. ATCC strains of the related bacteria were evaluated for optimization of the quantification procedure and verification of the specificity of primers. Following the extraction of bacteria on the stool samples collected from both HP-positive patients and healthy volunteers, all the bacteria were subjected to real-time quantification procedure with PCR (Polymerase Chain reaction) method on Rotor-Gene® 20 device (Qiagen, Germany). As a result of the quantification before and after antibiotic use in patients receiving HP treatment, statistically significant decreases were observed in Bifidobacterium spp (p=0,000), Bacteriodes fragilis (p=0,000), Lactobacillus spp (p=0,000), A. mucinophilia (p=0,000) and F. prausnitzii. Based on the data obtained, it can be said that tetracycline and metronidazole used to treat HP can prepare the ground that could result in dysbiosis in microbiot

Bismuth-based quadruple Helicobacter pylori eradication regimen alters the composition of gut microbiota.

Microbiota is a dynamic system showing individual differences in both the number and species of microorganisms. Dietary habits, lifestyle, age, genetic predisposition of the host and use of antibiotics are effective on microbiota. The aim of our research was to carry out a quantitative comparison of Bifidobacterium spp, Bacteroides fragilis, Lactobacillus spp, Akkermansia mucinophilia and Faecalibacterium prausnitzii, important bacterial microbiota species, before and after antibiotic therapy treated with tetracycline and metronidazole in patients who are diagnosed as positive for Helicobacter pylori (HP), and to determine the effects of antibiotic use on the microbiota. Eighteen HP-positive patients were enrolled in this study. A special extraction kit (QIAmp DNA Stool Mini Kit, QIAgen, Germany) was used for the DNA isolation procedure. Primers specific to the 16S rRNA region of the bacteria included in the study were used for the amplification of the target region. All the bacteria were subjected to real-time quantification procedure with PCR method on RotorGene® 20 device (Qiagen, Germany). According to quantification before and after antibiotic use in patients receiving HP treatment, statistically significant decreases were observed in Bifidobacterium spp (p=0.001), B. fragilis (p=0.001), Lactobacillus spp (p=0.001), A. mucinophilia (p=0.001) and F. prausnitzii (p=0.001). We were unable to identify B. fragilis in the microbiota of five patients after treatment. Based on the data obtained, it can be concluded that antibiotics used to treat HP can prepare the ground that could result in dysbiosis in microbiota

The Compliance Rates of Hand Hygiene in Intensive Care Unit and Surgical Services at a State Hospital in Turkey

Objective: The most efficient and most cost effective method for preventing health care associated infections is hand hygiene. Although hand hygiene is the most effective and simple method, compliance rates are very low among health care workers. It was aimed to evaluate the rates of compliance of healthcare workers in a state hospital. Material and Method: In this study, totally 112 healthcare workers (31 doctors and 81 nurses) were evaluated with the 5-indication observation method in a period between January and July 2013. Results: A total of 754 (65.9%) out of 1.144 cases were resulted in accurate hand washing and hand-rubbing. When the intensive care unit and surgical clinics were evaluated together, it was found that hand hygiene compliance rates were 51.26% in 199 cases and 66.85% in 591 cases for doctors and nurses, respectively. Conclusion: Consequently, we think that pre-informed observations are important training instruments for hand hygiene compliance

Antibiotic consumption, resistance data, and prevention strategies

WOS: 000463053800025Dünyada ve ülkemizde antibiyotik tüketiminin artışına ilişkin veriler alarm vermektedir. Aşırı tüketim artan antibiyotik direncini tetiklemektedir. Ne yazık ki ülkemiz antibiyotik direncinin en fazla yaşandığı ülkelerdendir. Bu sorunları yenmek için son yıllarda ciddi çabalar verilse de halen alınması gereken çok yol vardır. Bugün hastanelerde antibiyotik tüketimi, tüketimin değerlendirilmesi ve strateji geliştirilmesi için antibiyotik yönetişimi kullanılmaktadır. Bu raporda, antibiyotik yönetişiminin başlıca bileşenleri, antibiyotik tüketiminin global ve ülkemiz genelindeki durumu, direnç verileri, direnci engellemeye yönelik stratejilerin değerlendirilmesi ve alınması gereken önlemlerin güncel veriler eşliğinde ortaya konulması amaçlanmıştır.Antibiotic consumption in the world and in our country. has reached alarm dimensions. This over-consumption has also made antibiotic resistance a major problem. Unfortunately, our country is one of the countries where antibiotic resistance is experienced. Serious efforts have been made in recent years to overcome these problems. However, there are still many distances to be taken. Today, evaluation of antibiotic consumption and consumption in hospitals is determined by antibiotic stewardship. In this report, antibiotics governance, antibiotic consumption in global and country-wide status, resistance data, evaluation of strategies to prevent resistance and measures to be taken are aimed