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

Community-Acquired Sepsis: Retrospective Evaluation of 125 Cases

Introduction: There are only a few studies regarding community-acquired sepsis and its epidemiology. We aimed to evaluate the cases diagnosed as community-acquired sepsis and followed in our clinic. Patients and Methods: In this study, epidemiological and clinical features of 125 adult patients with community-acquired sepsis followed in our clinic during the period 1989-2005 were retrospectively evaluated. Results: The mean age was 52.7 years; 58 patients (46.4%) were male and 67 (53.6%) were female. Anatomic site of infections included urinary tract in 56 patients (45%), respiratory system in 23 (18%), intraabdominal in 12 (9.6%), and skin and soft tissue in 6 (5%). No anatomic site of infection was found in 28 (22.4%) patients. Of the blood culture isolates, 64% were gram-negative bacteria. In-hospital mortality was 30% in patients with sepsis. The mortality rate was found to be 4.25% in 47 patients with sepsis, while it was 35.9% in 78 patients with severe sepsis on admission (p< 0.001). Conclusion: New and large studies are needed to understand the epidemiology of community-acquired sepsis