disease is a multisystemic disease caused by Borrelia species, and it is transmitted to humans by ticks of the species Ixodes. There are three genotypes of the Lyme disease agent: Borrelia burgdorferi sensu stricto, Borrelia garinii, and Borrelia afzelii. They are grouped together under the name B. burgdorferi sensu lato (1). The causative agent of Lyme disease, B. burgdorferi, was isolated in 1982 (2). Lyme disease is evident in three stages. The first stage includes erythema migrans (EM) and needs no serological testing. Diagnosis becomes more difficult in the second and third stages. In such cases, two-step diagnosis is necessary. The first step is based on an enzymelinked immunosorbent assay (ELISA) test, and positive results should be confirmed by Western blot (WB) (3). Cross-reactions have been found between antibodies to syphilis, leptospirosis, relapsing fever, varicella, infectious mononucleosis, and some autoimmune diseases (systemic lupus erythematosus, rheumatoid arthritis), and ELISA tests may provide false positive results so the results should be confirmed by WB (4). This disease is a common tick-borne zoonosis in European countries and the United States. In Turkey, the first cases were reported in 1990 in the Black Sea and Aegean regions (1). Because Lyme disease is not a compulsory notification disease in Turkey and due to confusion with clinical signs of other diseases, the exact prevalence is not known.In the present study, the aim was to determine the seroprevalence of Borrelia burgdorferi sensu lato in the city center and the province of Bolu, Turkey.
Aim: Carbapenem-resistant Klebsiella pneumoniae infection has become an important clinical problem with reduced therapeutic options. This study aimed to investigate the carbapenem resistance rates and responsible resistance genes in K. pneumoniae isolates derived from clinical samples collected in Istanbul. Materials and Methods: This prospective study included a total of 1452 K. pneumoniae isolates from patients admitted to our hospital between July 2013 and July 2014. VITEK-2 (bioMérieux, Marcy-I'Ѐtoile, France) was used for microbial identification and antimicrobial susceptibility testing. The carbapenem-resistant isolates identified by VITEK-2 were also found to be resistant to ertapenem by the ertapenem gradient test. Resistance mechanisms of the carbapenem-resistant isolates were investigated using real time-polymerase chain reaction. Results: Of the 1452 K. pneumoniae isolates, 45 (3.1%) were carbapenem-resistant. Of these, 32 (71.1%) were bla OXA-48-positive, 9 (20%) bla NDM-positive, and 1 (2.2%) bla VIM-1-positive. None had the genes bla KPC and blaI MP-1. The greatest susceptibility by the isolated carbapenemase-producing K. pneumoniae was shown to the antimicrobials amikacin and gentamicin. Discussion and Conclusion: In our hospital, there are several mechanisms causing carbapenem resistance, and the bla OXA-48 positivity rate of 71.1% is significant. This resistance may spread rapidly and, through enzymatic resistance gene transfer, lead to hospital epidemics difficult to manage. For this reason, accurate and rapid laboratory diagnosis is important in infection control. For faster results, molecular methods, as well as phenotypic methods, must be included in the hospital infrastructure.
Background/aim: β-Lactamases are an important resistance mechanism in Acinetobacter baumannii. Pseudomonas extended-resistance (PER-1) type β-lactamase-producing strains have been reported from various geographic locations; however, PER-1 type β-lactamases from Turkish hospitals have not been investigated extensively. The aim of this study was to determine the prevalence of PER-1 type β-lactamases in A. baumannii isolates in various regions of Turkey. Materials and methods:A total of 763 clinical A. baumannii isolates were collected from 9 university hospitals and 2 state hospitals between 2008 and 2011. Molecular amplification of the OXA-51 gene from the A. baumannii genome was performed in order to verify identification of the species. Real-time polymerase chain reaction was used to detect bla PER-1 genes.
lactamase (ESBL), are isolated, leading to the further use of carbapenem group antibiotics (2). Carbapenem resistance is mainly caused by two mechanisms: (i) overproduction of ESBL and/or AmpC along with the loss of porin, (ii) production of carbapenemase (3). Carbapenemases ABSTRACT Objective: Resistant Gram-negative bacteria isolated from health-related infections are a worldwide problem. Increasing frequency of infections particularly caused by Enterobacteriaceae producing expanded spectrum beta lactamase, leads to the use of more carbapenem group antibiotics which, in turn, leads to bacterial resistance. In this study, we aimed to evaluate carbapenem resistance in Klebsiella pneumoniae (K. pneumoniae) isolates, the mechanisms causing this resistance and the clonal relationship between these isolates. Methods: Ninety-one K. pneumoniae strains isolated from clinical samples obtained in our laboratory were included to the study. The identification of the bacteria was performed with Matriks assisted laser desorption ionization time of flight mass spectrometry (bioMérieux, Marcy-I'Étoile, France) and antimicrobial susceptibility with VITEK-2 (bioMérieux), and the carbapenem resistance was confirmed by ertapenem E-test (bioMérieux). Reverse transcription polymerase chain reaction method was used for the investigation of genes causing carbapenemase production (bla OXA-48 , bla NDM-1 , bla KPC , bla IMP, bla VIM-1). The clonal relationship between isolates was investigated by pulsed-field jel elektroforez. Results: In carbapenem resistant isolates, bla OXA-48 positivity was found to be 55%, bla NDM-1 positivity 37.4%, bla KPC and bla VIM-1 positivity 1.1%. A total of 10 isolates was identified with different resistance genes. In 73 of the isolates included in the study, the clonal relationship was examined, and 16 different groups were identified. Twenty isolates were not clonally associated with any other isolates. The most common resistance mechanism causing the carbapenem resistance was bla OXA-48 gene that is known to be endemic in Turkey. Conclusion: As a result, the carbapenem resistance that we found as 3.13% in our study is similar to the rates obtained in other studies performed in our country which indicates that this resistance is not at a high level yet in our country. However, the ability of carbapenem resistance genes to spread between strains can be a major problem in the near future. Molecular methods are gold standard in carbapenemase detection, but because of having high cost they can not be used in laboratories routinely. Modified Hodge test or carbapenemase inactivation test are alternative tests with low costs that can be used in the determination of carbapenemase.
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