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Öğe Distribution of emm Genotypes and Antibiotic Susceptibility of Streptococcus pyogenes Strains: Analogy with the Vaccine in Development(ANKARA MICROBIOLOGY SOC, 2013) Arslan, Ugur; Oryasin, Erman; Eskin, Zeynep; Turk Dagi, Hatice; Findik, Duygu; Tuncer, Inci; Bozdogan, BulentStreptococcus pyogenes is the most common bacterial pathogen causing pharyngotonsillitis, and also can lead to diseases such as otitis media, impetigo, necrotizing fasciitis, bacteremia, sepsis and toxic shock-like syndrome. M protein encoded by emm gene is an important virulence factor of S.pyogenes and it is used for genotyping in epidemiological studies. The aims of this study were to determine the M protein types of group A streptococci (GAS) by using emm gene sequence analysis method, to compare the M types in terms of analogy with the vaccine in development and to determine the antibiotic susceptibilities of the isolates. A total of 35 GAS strains isolated from various clinical specimens in our laboratory were included in the study. Strains growing in blood culture were considered as invasive, strains growing in throat and abscess cultures were considered as non-invasive. The isolates have been identified by conventional methods and 16S rRNA sequence analysis at species level. emm genotyping of strains identified as S.pyogenes, was performed by PCR method as proposed by the CDC. Amplicons were obtained and sequenced in 23 out of 35 isolates. The results were compared with CDC emm sequence database. Antibiotic susceptibility of the isolates was performed by agar dilution method and evaluated as recommended by CLSI. Twenty-three out of 35 isolates could be typed and 15 different emm genotypes were detected. The most common emm types were emm1 (22%), emm89 (13%), emm18 (9%) and emm19 (9%). The detection rate of other emm types (emm5, 12, 14, 17, 26, 29, 37, 74, 78, 92, 99) was 47%. Types emm1, 12, 19, 74, 89 and 99 were observed in strains isolated from blood cultures. It was detected that nine of the 15 (60%) emm types are within the contents of 26 valent vaccine (emm 1, 5, 12, 14, 18, 19, 29, 89, 92). It was also observed that 17 (74%) of the 23 cases were infected by vaccine types and the four emm types (emm1, 12, 19, 89) identified in blood samples were among the vaccine types. All of the strains were found susceptible to penicillin, ampicillin, erythromycin, lincomycin, gentamicin, chloramphenicol, vancomycin and linezolid, however six isolates were resistant to levofloxacin (MIC=4 and 16 mu g/ml) and one isolate was resistant to tetracycline (MIC= 16 mu g/ml). In conclusion, this preliminary local study with limited number of invasive and non-invasive S.pyogenes isolates, emphasized the need for larger scale multi-center studies to determine the analogy and efficacy of the vaccine in development.Öğe Enterococcus avium Peritonitis in a Child on Continuous Ambulatory Peritoneal Dialysis(MULTIMED INC, 2014) Ugur, Ayse Ruveyda; Findik, Duygu; Dagi, Hatice Turk; Tuncer, Inci; Peru, Harun[Abstract not Available]Öğe Extended-spectrum beta-lactamase production in Klebsiella pneumoniae strains isolated from blood cultures and their antibiotic susceptibilities(ANKARA MICROBIOLOGY SOC, 2008) Isik, Ferhat; Arslan, Ugur; Tuncer, InciThis study was carried out to detect the extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae strains isolated from blood cultures of hospitalized patients, and to determine their antimicrobial susceptibilities. A total of 102 K.pineumoniae strains isolated from blood samples were taken in the study, and ESBL production and susceptibilities to amikacin, gentamicin, imipenem, ciprofloxacin, amoxicillin/clavulonate (AMX/CA), ceftazidime, ceftriaxone, trimethoprim/sulphametoxazole (TMP-SMX), piperacilin-tazobactam (PIP/TAZ) and chloramphenicol were investigated by using E-test (AB Biodisk, Sweden). ESBL positivity was observed in 65 (63.7%) of the isolates, and all of the strains were found susceptible to imipenem. The resistance rates of ESBL-producing isolates were detected as 27.7% for amikacin, 41.5% for chloramphenicol, 49.2% for TMP-SMX, 55.4% for ciprofloxacin and 60% for PIP/TAZ; whereas these rates for ESBL non-producers were 2.7%, 5.4%, 5.4%, 2.7%, and 13.5%, respectively. Both the resistance rates and MIC values (MIC50 and MIC90) of the tested antimicrobial agents except imipenem, were found higher in ESBL positive strains than the ESBL negative strains (p < 0.05). The results of this study, in accordance with the previous national and international reports, indicated high rate of ESBL positive K.pneumoniae and also increased rate of antimicrobial resistance in such strains. Clinical microbiology laboratories should put ESBL detection tests into practice and each hospital should determine their antibiotic treatment policies according to their data.Öğe First case report of neurobrucellosis associated with hydrocephalus(ELSEVIER SCIENCE BV, 2008) Guney, Figen; Gumus, Haluk; Ogmegul, Aysegul; Kandemir, Bahar; Emlik, Dilek; Arslan, Ugur; Tuncer, InciBrucellosis is a common zoonosis in many parts of the world, including Mediterranean and Middle Eastern countries. The disease is primarily related to occupations at risk, such as veterinarians, farmers, laboratory technicians, abattoir workers, and others working with animals and their products. Neurologic complications of brucellosis are quite rare, ranging from 1.7 to 10% of those infected. To date, no cases of neurobrucellosis with hydrocephalus have been reported. A 38-year-old right-handed farmer complained of headaches, nausea, vomiting, gait disturbance, and sweating for 2 days. He also complained of bilateral hearing loss of 4 months duration. On neurologic examination, dysmmetry, dysdiadochokinesis, ataxia on the left, and bilateral sensorineural hearing loss existed. On cranial MRI, a communicating hydrocephalus was noted. Because the patient consumed fresh sheep cheese and was a farmer, brucellosis was considered in the differential diagnosis. Brucella agglutination was positive with a 1/320 titer in the blood and a 1/80 titer in the cerebrospinal fluid. Ceftriaxone, doxycycline, and rifampicin were administered and by the fourth week of treatment, the ataxia was markedly improved, and the patient was able to walk without support. His cranial MRI demonstrated a total regression of the hydrocephalus. As a result, we suggest that neurobrucellosis should be considered in patients with hydrocephalus, especially if they live in an endemic area for brucellosis, even in the absence of other systemic signs. (c) 2008 Elsevier B.V. All rights reserved.Öğe Genotype distribution of extended Spectrum beta-Lactamase producing Escherichia coli and Klebsiella pneumoniae.(ALLIED ACAD, 2015) Dagi, Hatice Turk; Al Dulaimi, Dhay Ali Azeez; Kus, Halit; Seyhan, Tuba; Findik, Duygu; Tuncer, Inci; Arslan, UgurExtended-spectrum beta-lactamase (ESBL) production is the most important cause of beta-lactam resistance in Gram-negative bacteria. Although it may also be found in other Gram-negative bacteria, ESBL is most commonly produced by Escherichia coli and Klebsiella pneumoniae strains. In this study, we aimed to investigate the distribution of beta-lactamase genes in ESBL-producing E. coli and K. pneumoniae strains. One hundred and twenty isolates of E. coli and K. pneumoniae isolated from clinical samples were used in this study. The identification and the antibiotic susceptibility tests were performed by VITEK 2 system in accordance with the manufacturer's instructions. ESBL production was determined accoring to Clinical and Laboratory Standards Institute guidelines. The DNA isolation was performed with a commercial kit following company recommendations. (TEM)-T-bla, (SHV)-S-bla and (CTX)-C-bla-M genes were amplified by multiplex PCR with specific primers. Of the 120 isolates collected, 84 isolates were of E. coli and 36 isolates were of K. pneumoniae. (TEM)-T-bla gene was the most prevalent type (85.8%) followed by (CTX)-C-bla-M (83.3%) and (SHV)-S-bla (24.2%). No blaSHV gene was detected in the E. coli strains. Among 120 ESBL-producing strains, 10.8% were susceptible to cefepime, 10.0% to ceftazidime, while 5.0% to ceftriaxone. In conclusion, (TEM)-T-bla gene was the most frequently encountered ESBL of E. coli and K. pneumonia in our hospital. Further molecular surveillance and epidemiological studies of such resistant bacteria are recommended for monitoring and controlling the spread of ESBL producing strains.Öğe In Vitro Synergistic Activity of Sulbactam in Combination with Imipenem, Meropenem and Cefoperazone Against Carbapenem-Resistant Acinetobacter baumannii Isolates(ANKARA MICROBIOLOGY SOC, 2014) Dagi, Hatice Turk; Kus, Halit; Arslan, Ugur; Tuncer, InciAcinetobacter baumannii which is an opportunistic pathogen leading to nosocomial epidemics, exhibit high rates of antimicrobial resistance. Treatment of Acinetobacter infections is a challenge since most of the isolates are multiple antibiotic resistant. The aim of this study was to investigate minimum inhibitory concentrations (MICs) of sulbactam, imipenem, meropenem, and cefoperazone and in vitro synergistic activity of sulbactam in combination with imipenem, meropenem and cefoperazone against A.baumannii isolates of hospitalized patients. Forty A.baumannii strains isolated from various clinical specimens and found to be resistant to carbapenems by disc diffusion method, were included in the study. The isolates were identified by conventional methods and VITEK 2 (bioMerieux, France) automated identification system. MICs of sulbactam, imipenem, meropenem, and cefoperazone were determined by the broth nnicrodilution method according to the standards of CLS1 and in vitro synergy test was performed using the checkerboard microdilution method. Synergistic, partial synergistic, additive, indifferent and antagonistic effects of drug combinations were evaluated with the fractional inhibitory concentration index (FICI). Interpretation of the FICI was as follows: 0.5 synergy; <= 0.5 to < 1 partial synergy; 1 additive; > 1 to < 4 indifference; and >= 4 antagonism. Forty A.baumannii isolates were resistant to imipenem and cefoperazone, but two were susceptible, seven were moderately susceptible and 31 were resistant to meropenem with the microdilution method. MIC values of the isolates for sulbactam were found to be 4 mu g/ml in two, 8 mu g/ml in five, 16 mu\g/ml in three, 32 mu g/ml in 13, 64 pg/ml in three, 128 pg/ml in six and > 128 pg/ml in eight isolates. According to the FICI; imipenem/sulbactam combination exhibited synergy in 18 (45%), partial synergy in 4 (10%) and indifferent effect in 2 (5%) isolates, the combination of meropenem and sulbactam showed synergy in 19 (48%), partial synergy in 3 (7.5%), and indifferent effect in 3 (7.5%) isolates, the combination of cefoperazone/sulbactam demonstrated synergy in 18 (45%), partial synergy in 2 (5%), and indifferent effect in 2 (5%) isolates. There was no antagonistic effect with the tested combinations. In conclusion, MIC values of sulbactam were generally high in carbapenem-resistant A.baumannii strains. However, synergistic effect was detected in approximately half of the strains with the sulbactam/carbapenem combinations. The data obtained in this study should be supported by further advanced in vitro and clinical studies to predict the accurate clinical efficacy of sulbactam containing combinations on A.baumannii infections.Öğe INVESTIGATION OF THE CLONALITY AND PANTON-VALENTINE LEUKOCIDIN TOXIN AMONG NOSOCOMIAL METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS STRAINS(ANKARA MICROBIOLOGY SOC, 2009) Kirdar, Sevin; Arslan, Ugur; Tuncer, Inci; Findik, Duygu; Bozdogan, BuelentMethicillin-resistant Stapyhlococcus aureus (MRSA) is one of the major causes of morbidity and mortality in hospitalized patients. This study was aimed to investigate the clonality of the MRSA strains isolated from patients with nosocomial infection and also to determine the presence of Panton-Valentine leukocidin (PVL) toxin in these isolates. A total of 37 samples (31 isolated from surgical wound samples, 2 them from abscess and 4 from drainage samples) obtained from patients hospitalized at surgery, internal medicine and intensive care units, were included to the study. The clonality among MRSA strains was demonstrated by pulsed-field gel electrophoresis (PFGE) and the presence of PVL by polymerase chain reaction using luk-PV-1 and luk-PV-2 primers. PFGE revealed that 31 of 37 strains were A pulsotype and subtypes, 3 strains were B pulsotype and the last 3 were C pulsotype. Pulsotype A has been isolated especially from cardiovascular surgery and other surgery departments and intensive care units, pulsotype B from orthopedic and pulsotype C from neurology and neurosurgery wards. PVL gene was not identified in any of the isolates. These results indicated the presence of a dominant clone among MRSA strains in our hospital, however, different pulsotypes may also be present in different surgery units. Continuous molecular epidemiological surveillance of nosocomial MRSA strains and their PVL positivity supply valuable clinical and epidemiological data for infection control and patient follow-up.Öğe MLST Types of Vancomycin-Resistant Enterococcus faecium Strains Isolated from Blood Cultures(ANKARA MICROBIOLOGY SOC, 2013) Arslan, Ugur; Demir, Esra; Oryasin, Erman; Dagi, Hatice Turk; Tuncer, Inci; Findik, Duygu; Bozdogan, BulentEnterococci, particularly vancomycin-resistant enterococci (VRE), are important nosocomial pathogens with limited treatment options. Enterococci have low-level resistance to penicillins and aminoglycosides and are intrinsically resistant to cephalosporins. In addition, they can acquire high-level resistance to beta-lactam antibiotics, aminoglycosides and glycopeptides. The aim of this study was to determine glycopeptide resistance mechanisms and genetic relationships of vancomycin-resistant E.faecium strains isolated from blood cultures between 2003-2009 years by molecular epidemiologic methods. A total of 38 VRE strains isolated from blood cultures were included in this study. The isolates were identified by conventional methods and Phoenix 100 BD automated system (Becton Dickinson Diagnostic Systems, USA) and confirmed by sequence analysis of 16S rRNA amplicons. Antibiotic susceptibility tests were performed by the Kirby-Bauer disk diffusion method accor-ding to the CLSI standards. MIC values of vancomycin were determined in vancomycin resistant strains by E-test (AB Biodisk, Sweden) method. Vancomycin resistance genes included vanA, vanB, vanC, and vanD were investigated by polymerase chain reaction (PCR) method. Clonal relationship between strains was determined by pulsed-field gel electrophoresis (PFGE). Sequence analysis was performed for examples selected for multilocus sequence typing (MLST) of each pulsotype and subtype. Thirty eight strains of enterococci isolated from blood cultures were defined as E.faecium by phenotypic methods and confirmed by 16S rRNA sequence analysis. Vancomycin MIC values of strains were determined as > 256 mu g/ml by E test. The vanA gene was detected in all isolates. Clonal relationship of 38 isolates E.faecium carrying the vanA gene was determined by PFGE and MLST methods. PFGE detected four pulsotypes (A-D) and one sporadic isolate. Twenty nine strains belonged to A pulsotype, three strains belonged to B pulsotype, two strains belonged to C pulsotype and three strains belonged to D pulsotype. Out of 29 isolates, eight strains were type A1, nine strains were type A2, six strains were type A3, two strains were type A4 and four strains were type A5. MLST identified four different sequence types (STs). Twenty nine A pulsotype and its subtypes belonged to ST117 (76.3%), three B pulsotype belonged to ST280 (7.9%), two C pulsotype belonged to ST18 (5.2%) and three D pulsotype belonged to ST17 (7.9%). In conclusion, bloodstream infections caused by VRE in our hospital arose from a dominant strain belonged to ST117. However, presence of different pulsotypes of this strain indicated that the strain had been present in the hospital for a long time and had accumulated genetic variations. In addition, infections caused by minor pulsotypes were also detected. Therefore for prevention and control of the spread of nosocomial infections caused by VRE, it is crucial to identify resistance patterns and clonal relationship of these organisms.Öğe Pleuropulmonary and soft tissue Nocardia cyriacigeorgici infection in a patient with Behcet's disease(SAUDI MED J, 2007) Arslan, Ugur; Tuncer, Inci; Uysal, Elif B.; Inci, RamazanInfections with Nocardia species are generally seen in immunocompromised subjects. In this report, we present a case of pleuropulmonary and skin Nocardia cyriacigeorgici infection in a male patient with Behcet's disease who used corticosteroids and immunosupressives for a long period of time. He died before the diagnosis of Nocardia infection was made.Öğe Two outbreaks of ESBL-producing Klebsiella pneumoniae in a neonatal intensive care unit(WILEY-BLACKWELL, 2014) Sumer, Sua; Dagi, Hatice Turk; Findik, Duygu; Arslan, Ugur; Demir, Nazlim Aktug; Ural, Onur; Tuncer, InciBackgroundIn the present study, two epidemic episodes of extended spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae in the neonatal intensive care unit (NICU) were evaluated. MethodsRoutine and surveillance culture samples were taken from seven neonates with signs of infection in the NICU of Selcuk University Faculty of Medicine between 10 March and 25 April 2011, and between 11 June and 30 September 2011. ResultsESBL-producing K.pneumoniae strains were isolated in six different samples (one wound, one blood, and four cerebrospinal fluid cultures) of the three neonates in the first episode and in 11 different samples (seven blood and four cerebrospinal fluid cultures) of the four neonates in the second episode. ESBL-producing K.pneumoniae was isolated from inguinal, axillar region, and stool samples of the nine colonized neonates in the second episode. It was determined on pulse field gel electrophoresis that all strains originated from two clones. ConclusionsThe deficiencies in the infection control measures in an NICU may transform into an epidemic rapidly. Therefore, periodic training, observation, and monitoring of compliance are important.
