Sürdürülebilir Kalkınma Amaçları
Yayınlar
- MakaleAçık Erişim2020Investigation of Fosfomycin and Chloramphenicol Susceptibility of Carbapenemase-Producing Klebsiella pneumoniae Strains
Borsa, Baris Ata; Güngördü-Dalar, Zeynep; Karakullukçu, Asiye; Özalp, Veli Cengiz; Aygün, Gokhan
Objective: Antimicrobial resistance is one of the most mportant health problems of recent years. Multidrug-resistant Klebsiella pneumoniae strains have been causing serious problems in many countries including Turkey in recent years. Aim of this study was to detect molecular mechanisms behind the carbapenem resistance in carbapenem-resistant K. pneurnoniae strains isolated from rectal swab samples and investigate the susceptibility of two potentially alternative drugs, fosfornycin, and chloramphenicol. Methods: 46 K. pneumoniae strains isolated from rectal screening cultures of intensive care unit patients by using MacConkey agar containing 2 mg/L meropenem were included in this study. Carbapenem resistance of strains were confirmed by minimum inhibitor concentrations of meropenem obtained with gradient strip test. Presence of the bla(KPC,) bla(NDM) and bla(OXA), bla(IMP) and bla(VIM) genes were investigated by the real-time polymerase chain reaction. Broth microdilution method was used to investigate chloramphenicol susceptibility, and gradient strip test was used to investigate fosfomycin susceptibility of the strains. Results: At least one carbapenemase gene was detected in all K. pneumoniae strains. While all strains were found positive for the presence of OXA-48 type carbapenemase gene, 12 (26%) out of 46 were positive for both OXA-48 and NDM-1 carbapenemase genes, and only one (2%) strain was positive for OXA-48, NDM-1, and IMP-1 carbapenemase genes. Only 3 (6%) out of 46 strains were found susceptible to fosfomycin while 23 (50%) of them were susceptible to chloramphenicol. Additionally, we observed that the resistance rates to fosfomycin and chloamphenicol tended to be higher among carbapenemase producers. Conclusions: It is estimated that fosfomycin is not going to be a good option for the treatment of infections caused by carbapenemresistant K. pneumoniae strains in Turkey since only 6% of them were susceptible. Although the chloramphenicol susceptibility rate (50%) was higher than fosfomycin, further clinical studies are required to provide a better knowledge about the usage of this antibiotic in systemic infections. Moreover, multiple carbapenemase producers tended to be more resistant to fosfomycin and also chloramphenicol.
- MakaleYalnız künye2018Karbapeneme Dirençli Enterik Bakterilerde İsepamisin, Kloramfenikol ve Minosiklin Duyarlılığının Araştırılması
Karakullukçu, Asiye; Ozalp, Cengiz; Aygün, Gökhan; Borsa, Barış Ata; Kuşkucu, Mert Ahmet; Bakir, Esra; Taner, Zeynep
Amaç: Bu çalışmada, karbapeneme dirençli enterik bakteri(KDE)’lerin direnç özelliklerinin belirlenmesi ve ileriye yönelikalternatif tedavi seçeneklerinin değerlendirilmesi amaçlanmıştır.Yöntemler: Ekim 2014-Temmuz 2015 tarihleri arasında, yatanhastalardan rutin olarak elde edilen rektal sürüntü örnekleriçalışmaya alındı. İzole edilen enterik bakteriler standard konvansiyonelmikrobiyolojik yöntemlerle idantifiye edildi. Saptanankarbapenem direnci meropenem Etest® (bioMérieux,Marcy l'Etoile, Fransa) yöntemiyle doğrulanıp, direnç mekanizmalarıMAST-ID™ Discs (Mast Diagnostics Ltd, Bootle,Merseyside, Birleşik Krallık) karbapenemaz aktivite testdiskleriyle araştırıldı. Kökenlerin duyarlılıkları, disk difüzyonyöntemiyle isepamisin, kloramfenikol ve minosiklin diskleri(Oxoid, Basingstoke, Hampshire, Birleşik Krallık) kullanılarakdeğerlendirildi.Bulgular: Çalışma dönemi içerisinde laboratuvara gönderilen3323 rektal örnekten, her hastaya ait bir köken olmak üzere toplam84 (%2.5) KDE izole edildi. Bu kökenlerin 74 (%88)'ü Klebsiellapneumoniae ve 10 (%12)'u Escherichia coli idi. Kökenlerin66 (%78.5)’sında OXA-48, 11 (%13.1)’inde OXA-48 + metallo-β-laktamaz (MBL), 1 (%1.2)’inde sadece MBL, 1 (%1.2)’inde sadeceAmpC + porin kaybı saptanırken, hiçbirinde KPC pozitifliğisaptanmadı; 5 (%6)'inde ise test edilen direnç mekanizmalarındanhiçbirine rastlanmadı. Toplam 84 KDE'nin 80 (%95.2)’iisepamisine, 77 (%91.6)’si kloramfenikole ve 14 (%16.6)’ü minosiklineduyarlı olarak saptandı.Sonuçlar: Türkiye'de endemik olan OXA-48 tipi, çalışmada daen çok tespit edilen karbapenemaz oldu. KDE'lere bağlı infekÖzgün siyonların tedavisinde isepamisin ve kloramfenikol gündemegelebilecek antibiyotikler olabilir.Klimik Dergisi 2018; 31(1): 50-5.
- MakaleAçık Erişim2018Investigation of lsepamicin, Chloramphenicol and Minocycline Sensitivity in Carbapenem-Resistant Enterobacteriaceae
Karakullukçu, Asiye; Borsa, Baris Ata; Kuskucu, Mert Ahmet; Bakir, Esra; Taner, Zeynep; Özalp, Veli Cengiz; Aygün, Gokhan
Objective: In this study, we aimed to determine the resistance mechanisms of carbapenem-resistant Enterobacteriaceae (CRE), and evaluate the prospective alternative treatment options. Methods: Between October 2014 and July 2015, rectal swabs routinely obtained from hospitalized patients were included in the study. The isolated Gram-negative enteric bacteria were identified to the species level by using standard conventional microbiological methods. Determined carbapenem resistance in enteric bacteria was confirmed by using meropenem Etest (R) (bioMerieux, Marcy l'Etoile, France), and the resistance mechanisms were investigated with MAST-ID (TM) Discs (Mast Diagnostics Ltd, Bootle, Merseyside, UK). Antibiotic susceptibilities of the CRE were determined by disk diffusion method using isepamicin, chloramphenicol, and minocycline disks (Oxoid, Basingstoke, Hampshire, UK). Results: Of the 3,323 rectal swabs sent to the laboratory during the study period, totally 84 (2.5%) CRE were isolated with one strain from each patient. Of the 84 CRE, 74 (88%) were Klebsiella pneumoniae and 10 (12%) were Escherichia coli. Among the 84 CRE, 66 (78.5%) with OXA-48, 11 (13.1%) with OXA48 + metallo-beta-lactamase (MBL), 1 (1.2%) with only MBL and 1 (1.2%) with AmpC + porin loss were detected, none of the strains were positive for KPC. In 5 (6%) strains, none of the resistance mechanisms were found. Of the 84 CRE, 80 (95.2%), 77 (91.6%) and 14 (16.6%) were found to be susceptible to isepamicin, chloramphenicol and minocycline, respectively. Conclusions: The OXA-48 type, endemic in Turkey, was also the most commonly detected carbapenemase in the study. It has been observed that isepamicin and chloramphenicol can be the potential antibiotics in the treatment of KDE-related infections.