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- MakaleAçık Erişim2020Scopus SJRQ4Investigation 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.
- MakaleAçık Erişim2018Scopus SJRQ4Investigation 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.
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