Our results suggest that the occurrence of MDR A.baumannii bacteremia was related with the usage of the wide spectrum antibiotics, and mortality rates were increased in patients that high SAPS II scores, long term hospitalization. Infection control procedures and limited antibiotic usage are very important for prevent nosocomial infections.

Ciprofloxacin seems to be more effective in conjunctival sterilization. In consideration with high variety of bacterial flora in pretreatment period in ofloxacin group, ofloxacin seems to be superior to povidone-iodine on the reduction of bacterial flora on the conjunctiva.

This study aimed to determine the presence of vancomycin resistance (vanA and vanB) and virulence genes (esp, asa1, gelE, ace, hyl, cylA, cpd and ebpA) in vancomycin-resistant Enterococcus faecium (VREfm) strains and to analyse the clonal relationships among the strains. E. faecium strains were identified from rectal and clinical specimens by biochemical tests and the API-20 Strep kit. Susceptibility testing was performed using disc-diffusion and broth-dilution methods. PFGE was used for molecular typing of the VREfm strains. The vancomycin resistance and virulence genes were amplified by two-step multiplex PCR. All 55 VREfm isolates were resistant to penicillin G, ampicillin and high-level gentamicin but were susceptible to quinupristin/dalfopristin and linezolid. Multiplex PCR analysis indicated that all isolates harboured vanA and that 41 (75 %) were positive for virulence genes. The esp gene was the most common virulence factor and was detected in nine (41 %) invasive and 32 (96.7 %) non-invasive isolates. Multiple virulence genes were observed only in two non-invasive isolates; one harboured esp and ebpA and the other harboured esp, ebpA, asa1, gelE and cpd. PFGE typing yielded 16 different types, seven of which were clusters with two to 14 strains each. The clustering rates of the rectal swab, blood and urine isolates were 72.7 %, 61.5 % and 87.5 %, respectively. The genetic similarity observed among the VREfm isolates indicated crosstransmission in the hospital. Further studies on the virulence factors present in the strains might provide insight into the acquisition of these traits and their contribution to increased prevalence of VREfm.

Introduction: In recent years, the prevalence of multidrug-resistant P. aeruginosa has remarkably increased. Thus, we wanted to investigate the carbapenem resistance mechanisms and clonal relationship among 80 carbapenem-resistant P. aeruginosa strains. Methodology: Carbapenemase production was detected using the Modified Hodge Test (MHT), EDTA combined disc method (ECD), and PCR. Expression levels of efflux and porin genes were mesured by real-time reverse transcription PCR. Clonal relationship of the isolates was investigated by pulsed-field gel electrophoresis (PFGE). Results: Carbapenemase production was detected in 7.5% of the isolates with MHT/ECD tests and in 11.3% of the isolates with PCR. Although the specificity of MHT/ECD was high, the sensitivitivity was low. oprD downregulation and mexB, mexY, and mexD overexpression were demonstrated in 55%, 16.3%, 2.5%, and 2.5% of the isolates, respectively. Multiple carbapenem resistance mechanisms were found in nearly a quarter of the isolates. PFGE typing of the 80 P. aeruginosa isolates yielded 61 different patterns. A total of 29 isolates (36.3%) were classified in 10 clusters, containing 2 to 7 strains. We could not find a strict relationship between PFGE profile and carbapenem resistance mechanisms. Conclusions: Although oprD downregulation and MexAB-OprM overexpression were the most common mechanisms, carbapenem resistance was associated with multiple mechanisms in the study. MHT/ECD tests should not be used alone for investigation of carbapenemase production in P. aeruginosa. Rapid tests with high sensitivity and specificity should be developed for the detection of carbapenemase production in P. aeruginosa.

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Background: Carbapenem-resistant Klebsiella pneumoniae isolates can spread among the hospitalized patients and result in serious infections and increase mortality. Molecular studies provide useful information about resistance mechanisms and crosstransmission among the resistant isolates. Objectives: The current study aimed at investigating phenotypic and molecular characteristics of the carbapenem resistance and clonal relationship among the K. pneumoniae isolates recovered from infection sites and rectal swabs of the patients hospitalized in a tertiary hospital. Methods: Resistance to carbapenems was investigated by disc-diffusion and E-test methods. Modified Hodge test (MHT) and ethylenediaminetetraacetic acid (EDTA)-combine disc (ECD) methods were performed to determine carbapenemases. Carbapenemase-encoding genes including blaOXA-48, blaNDM-1, blaKPC, blaIMP, and blaVIM were investigated by multiplex polymerase chain reaction (PCR). Clonal relationship among the isolates was determined by the pulsed-field gel electrophoresis (PFGE). Results: Carbapenem resistance was observed in 93 (5.8%) of the 1605 K. pneumoniae isolates. Majority (n = 66, 71%) of the resistant isolates were recovered from the patients in intensive care units (ICUs). Almost all carbapenem-resistant K. pneumoniae isolates (n = 91, 97.8%) were positive with MHT. Only 6 (6.5%) of the resistant isolates were positive with ECD method. The blaOXA-48 and blaNDM-1 were found in 90.3% (n = 84) and 6.5% (n = 6) of the resistant isolates, respectively. The pulsed-field gel electrophoresis yielded

ÖZBu çalışmanın amacı, poliklinik hastalarının idrar örneklerinden izole edilen Enterobacteriaceae ailesi üyelerindeki genişlemiş spektrumlu beta-laktamaz (GSBL) pozitifl ik oranlarının yıllar içindeki değişi-mini araştırmak ve antibiyotik direnç durumlarını inceleyerek akılcı ilaç kullanımına yardımcı olmaktır. Çalışmada, hastanemizin çeşitli polikliniklerine 2007-2013 yılları arasında başvuran hastaların idrar kül-türlerinden izole edilen 12.535 suş değerlendirilmiştir. İzolatların tanımlanması konvansiyonel yöntemler ve API 20E sistemi (BioMérieux, Fransa) ile yapılmış, antibiyotik duyarlılık testi olarak Kirby-Bauer disk difüzyon yöntemi kullanılmıştır. Standart antibiyotik duyarlılık testine ek olarak, çift-disk sinerji yöntemiy-le ve CLSI kriterleri kullanılarak GSBL varlığı araştırılmış; şüpheli GSBL pozitifl ikleri, E-test (BioMérieux, Fransa) yöntemiyle doğrulanmıştır. Ayaktan başvuran hastaların idrar kültürlerinden izole edilen suşların 8.716'sı (%69.3) E.coli, 1514'ü (%12.1) K.pneumoniae/oxytoca, 257'si (%2.1) Proteus mirabilis, 345'i (%2.8) diğer Enterobacteriaceae ailesi üyeleri, 411'i (%3.3) çeşitli non-fermentatif bakteriler ve 1.292'si (%10.3) çeşitli gram-pozitif bakteriler olarak tanımlanmıştır. İzolatlarda toplam GSBL pozitifl iği %21.8 (2.283/10.487) olarak bulunmuş; bu oran E.coli, K.pneumoniae/oxytoca ve P.mirabilis için sırasıyla %21.2, %28.2 ve %4.7 olarak belirlenmiştir. Diğer Enterobacteriaceae izolatları, standardize yöntem ve sınır değerler mevcut olmadığı için çalışma dışı tutulmuştur. GSBL pozitif izolat sayılarının yıllar içerisinde Geliş Tarihi

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