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Öğe Colistin resistance in Carbapenem-resistant Klebsiella pneumoniae strains.(ALLIED ACAD, 2016) Kalem, Fatma; Ergun, Ayse Gul; Ertugrul, Omur; Ozcimen, Serap; Simsek, Husniye; Suzuk, Serap; Unaldi, OzlemObjective: Because of the increase in the infections caused by carbapenem-resistant Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae; nowadays colistin is used more frequently. In this study, the firstly detected colistin resistance in carbapenem-resistant KPC-producing K. pneumoniae strains were evaluated. Material and methods: For identification and susceptibility testing; VITEK 2 Compact (bioMerieux, France) have been used. Because of resistance; MICs were studied with gradient test method in Microbiology Reference Laboratory, Public Health Institution of Turkey, Ministry of Health, Ankara, Turkey for confirmation. The presence of carbapenem resistance genes (OXA23, NDM1, OXA48, KPC, VIM ve IMP) was investigated by Polymerase Chain Reaction (PCR) method. Pulsed Field Gel Electrophoresis (PFGE) method was used to determine the clonal relationships between strains. PCR and PFGE tests have been studied in Molecular Microbiology Research and Application Laboratory Department of Microbiology Reference Laboratories, Public Health Institution of Turkey, Ministry of Health, Ankara, Turkey. Results: All strains were resistance for carbapenems and colistin Two of four strains were isolated from patients hospitalized in intensive care and two of them were isolated from patients hospitalized in clinics. Resistance to carbapenems were confirmed genotypically. Two strains isolated from patients in clinics were positive for NDM1 and OX-48, and isolates from patients in intensive care unit were positive for only OXA-48 carbapenem genes. PFGE typing method described two clones that have a relationship with each other. The strains in which NDM1 and OXA-48 were together positive were in one clone and OXA-48-positive strains were in other clone. Conclusion: The emergence of colistin resistant strains is a very important problem due to decrease of treatment options for infections caused by carbapenem-resistant KPC producing K. pneumoniae. Colistin should not be used alone, combination therapy should be preferred.Öğe Evaluation of Antibiotic Susceptibilities and VISA-VRSA Rates Among MRSA Strains Isolated from Hospitalized Patients in Intensive Care Units of Hospitals in Seven Provinces of Turkey(ANKARA MICROBIOLOGY SOC, 2012) Cesur, Salih; Irmak, Hasan; Simsek, Husniye; Coplu, Nilay; Kilic, Hasan; Arslan, Ugur; Bayramoglu, GulcinThe aim of this study was to determine whether vancomycin resistant Staphylococcus aureus (VRSA) and vancomycin intermediate susceptible S.aureus (VISA) strains were present among methicillin-resistant S.aureus (MRSA) strains isolated from patients hospitalised at intensive care units (ICU) of hospitals located at different regions of Turkey and to determine the minimum inhibitory concentration (MIC) values of teicoplanin, linezolid, tigecycline, quinupristin-dalfopristin and daptomycin, which are alternative drugs for the treatment of MRSA infections. A total of 260 MRSA clinical strains (isolated from 113 lower respiratory tract, 90 blood, 24 wound, 17 catheter, 13 nasal swabs, two urine and one CSF sample) were collected from nine health-care centers in eight provinces [Ankara (n=52), Konya (n=49), Antalya (n=40), Istanbul (n=7), Izmir (37), Diyarbakir (n=15), Van (n=12), Trabzon (n=48)] selected as representatives of the seven different geographical regions of Turkey. Methicillin resistance was determined by cefoxitin disk diffusion in the hospitals where the strains were isolated and confirmed by oxacillin salt agar screening at the Refik Saydam National Public Health Agency. Screening for VISA and VRSA was conducted using the agar screening test and E-test. Susceptibility of the MRSA strains to other antibiotics was also determined by E-test method. None of the 260 MRSA strains were determined to be VRSA or VISA. All were susceptible to teicoplanin and linezolid, and susceptibility rates to daptomycin, tigecycline and quinupristin-dalfopristin were 99.6%, 96.9%, and 95%, respectively. Absence of VISA and VRSA among the MRSA strains surveyed currently seemed hopeful, however, continuous surveillance is necessary. In order to prevent the development of VISA and VRSA strains the use of linezolid, tigecycline, quinupristin-dalfopristin and daptomycin should be encouraged as alternative agents of treatment of MRSA infections.