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We aimed to investigate the clonal relationships, common sequence types, and carbapenemase genes in 177 non-repetitive blood culture isolates of Acinetobacter baumannii collected from patients at three university hospitals in Turkey in 2016. Molecular epidemiological characteristics of the isolates were examined using pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST) (Pasteur scheme-cpn60, fusA, gltA, pyrG, recA, rplB, and rpoB). Multiplex PCR was used to investigate the carbapenemase genes, including blaOXA-23-like, blaOXA-24-like, blaOXA-48-like, blaOXA-58-like, blaIMP, blaVIM, and blaNDM. PFGE genotyping yielded 92 pulsotypes with a clustering ratio of 69.7%. As per a ≥85% similarity coefficient, 159 (90.9%) isolates were found to be clonally related. The blaOXA-23-like and blaOXA-58-like genes were identified in 100% and 28.2% of the isolates, respectively. The blaNDM gene was identified in two isolates. The MLST analysis included 54 isolates with different pulsotypes, and 29 sequence types (STs). Most of the isolates (n = 36) belonged to the clonal complex (CC)2, one isolate belonged to CC1, and one isolate belonged to CC164. Sixteen new STs (ST1235-ST1250) were identified. Identifying both global ST2 and a large number of new STs, revealed high genetic diversity in A. baumannii isolates in the study population.

The Acinetobacter calcoaceticus-Acinetobacter baumannii (Acb) complex consists of phenotypically very similar nosocomial species; A.baumannii, Acinetobacter nosocomialis, Acinetobacter pittii, Acinetobacter seifertii and Acinetobacter djikshoorniae and one environmental species A.calcoaceticus. The rapid and accurate identification of the members of Acb complex is critical as these nosocomial pathogens can show differences in antimicrobial susceptibility and clinical outcomes. The conventional phenotypic methods are slow, unreliable and less efficient for the differentiation of Acb complex species, including the A.baumannii species within the Acb complex. Although various molecular methods are available, such as amplified ribosomal DNA restriction analysis (ARDRA) and blaOXA-51-like gene specific PCR, they are usually inconvenient for the routine diagnostic laboratories. Recently, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) offers an opportunity for rapid, cost-effective and convenient bacterial identification in routine diagnostic procedures conducted in clinical laboratory. In this study, we aimed to evaluate the diagnosis performance of MALDI-TOF MS system to identify blood isolates of A.baumannii. A total of 180 nonduplicate carbapenem resistant Acb complex (strain numbers; TR1-TR60) and A.baumannii (TR61-TR180) blood isolates were collected from the intensive care units of the three university hospitals in Turkey from January 2016 to December 2016. All isolates were evaluated by using blaOXA-51-like gene specific real time (Rt-PCR) analysis, ARDRA (restriction enzymes-AluI, CfoI, MboI, MspI, RsaI) method and MALDI-TOF MS (VITEK® MS, bioMerieux, France) system. All the strains except TR10, TR31, TR35 and TR52 were identified as A.baumannii by ARDRA method. Out of 177 of all the isolates, presence of blaOXA-51-like gene was found except for TR10, TR31 and TR52 isolates. However, TR31 without the presence of blaOXA-51-like gene was identified as A.pittii using the ARDRA. Totally 176 isolates which were identified as A.baumannii by both of the methods, ARDRA and Rt-PCR- blaOXA-51-like, were accepted as a reference for the evaluation of the diagnosis performance capacity of the MALDI-TOF MS. Overall, for all 176 isolates tested, the sensitivity obtained with the MALDI-TOF MS were 99.4% with 75% specificity. The accuracy value of the method was determined as 98.9% for the identification of A.baumannii to the species level. MALDI-TOF MS is increasingly used in diagnostic microbiology for the routine identification of bacteria to the genus, species or subspecies level with high rates of sensitivity and specificity. In future, by expanding the database, MALDI-TOF MS system would possibly become the ideal method for routine diagnostic laboratories that could potentially identify more species and even determine some characteristics of antimicrobial resistance and virulence determinants.

Objective Today, antibiotic resistance is increasing and evolving into an important health problem. Therefore, it is important to research on alternative therapies to antibiotics. This study aimed to investigate the inhibitory effect of four garlic derivatives on microorganisms commonly isolated in ear infections. Methods The antimicrobial activities of allicin, s-allyl cysteine (SAC), diallyl disulfide (DADS), and s-allyl mercaptocysteine (SAMC) were investigated on standard strains of commonly isolated microorganisms using the broth microdilution method. The test strains were selected among the microorganisms responsible for chronic suppurative otitis media and otitis externa. These microorganisms were Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus, Enterococcus faecium, Candida albicans, and Candida tropicalis. Results Minimum inhibitory concentration (MIC) values of allicin and SAC ranged from 0.125 to 20 μg/mL for fermentative bacteria (E. coli and K. pneumoniae), 20 to 80 μg/mL for non-fermentative bacteria (P. aeruginosa and A. baumannii), 5 to 10 μg/mL for gram-positive cocci (S. aureus and E. faecium), and 40 to 80 μg/mL for yeasts (C. albicans and C. tropicalis). MIC values of DADS ranged from 40 to 80 μg/mL for fermentative bacteria, 40 to 160 μg/mL for non-fermentative bacteria, 40 to 80 μg/mL for gram-positive cocci, and 20 to 40 μg/mL for yeasts. The MICs of SAMC were >640 μg/mL for the tested bacteria and yeasts. Conclusion Both allicin and SAC showed antimicrobial activity against the tested microorganisms, even at low concentrations. These two derivatives may be used to treat infections in the future.

Objective: Brucellosis is a zoonotic disease with various clinical presentations and early diagnosis is crucial to avoid severe complications. Due to limitations of conventional diagnostic methods, polymerase chain reaction (PCR) based approaches have gained importance in diagnosis.We aimed to evaluate diagnostic value of multiplex real time-PCR (mRT-PCR) in serum samples collected from brucellosis suspected patients by comparision sensitivity of mRT-PCR with those of conventional diagnostic methods. Material and Methods: A total of 249 serum samples collected from the suspected brucellosis patients admitted to the hospitals in three different provinces were analyzed by serological tests, culture and mRT-PCR. In laboratories of the participating hospital, serum samples were tested for the Brucella specific antibody by commercial serological kits including standart tube agglutination test (STAT), Coombs’ test, and immunocapture test (ICT). Blood culture was performed for 153 of the patients in the participating hospital. All serum samples were analyzed for the presence of Brucella DNA by mRT-PCR. Results: According to laboratory test results, 215 of the 249 suspected cases having comparible clinical data were identified as brucellosis cases. Of the 215 brucellosis cases, 36 were diagnosed as definitive cases, the remaning 179 patients were presumptive cases. Sensitivity of mRT-PCR in the samples that were positive by ICT, STAT, Coombs’ test, and blood culture was 70.2%, 77.3%, 83%, and 97.2%, respectively. By using mRT-PCR, additional 17 suspected patients were diagnosed as presumptive cases. Among the mRT-PCR positive serum samples, Brucella abortus was detected in 3 samples (1.9%), the remaining 156 samples (98.1%) had B. melitensis DNA. Conclusion: Our results indicate that mRT-PCR can be considered a useful diagnostic tool in patients who have negative serologic test results, and in detection of Brucella species. Keywords: Brucellosis, Multiplex real-time PCR, Serological diagnosis, Culture

Background/aim: This study aimed to evaluate the risk factors of patients colonized with carbapenem-resistant Enterobacteriaceae (CRE).Materials and methods: The study was conducted between January 2010 and March 2016. The colonized group consisted of patients who had a CRE strain in their rectal swab cultures, whereas patients with negative rectal surveillance cultures for CRE who were concurrently hospitalized in the same units with the colonized group patients were included in the control group.Results: The number of patients in the colonized and the control group was 71 and 120, respectively. Both groups were evaluated for demographic and healthcare-associated characteristics. Isolated microorganisms in rectal surveillance cultures for CRE were Klebsiella pneumoniae (75.5%), Escherichia coli (15.5%), Enterobacter cloacae (4.2%), Klebsiella oxytoca (1.4%), and Klebsiella terrigena (1.4%). The isolates were resistant to imipenem, meropenem, and ertapenem (52.1%, 73.2%, and 100%, respectively). In multivariate analysis, presence of decubitus, colistin usage, glycopeptide usage, and fluoroquinolone usage were found to be independent risk factors for CRE colonization. There was no significant difference between the two groups with regards to mortality (P = 0.070).Conclusion: These results are in agreement with the current literature. The findings of this study could be useful for improvement of infection control strategies related to CRE.

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 cross-transmission 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.

Objective: Aim of this study is to evaluate anti-nuclear antibody (ANA) test results obtained between 2009 and 2011.Methods: Of a totally 5068 cases tested for ANA by indirect immunofluorescence method (IIFA), randomly chosen 982 ANA-positive cases were reviewed in terms of gender, level and pattern of fluorescence, anti-dsDNA (anti-double stranded DNA) and anti-extractable nuclear antigen (ENA) profile. Anti-dsDNA levels and anti-ENA profiles were deter­mined by enzyme linked immune assay (ELISA) and immune-blotting (IB), respectively.Results: Sex distribution of ANA positive patients was determined as 756 (77%) females and 226 (23%) males. Fifty per cent of the cases were from rheumatology department, 20% from gastroenterology and 30% from other units. Fluo­rescence levels were considered borderline or weak positive in 62.6% of the samples. The most frequent patterns were homogeneous (23%), speckled (22%), homogeneous-speckled (15.5%) and nucleolar (13.5%). Anti-dsDNA were studied in 759 ANA positive patients and 66 (8.7%) samples were found positive, being 44 of them (68.8%) with homogeneous pattern and the rest with speckled, nucleolar, nuclear dots, centromeric or midbody patterns. Totally 131 (31.6%) of 414 samples studied for anti-ENA profile were found positive. The first four frequent profiles were SSA (34.4%), SSA-SSB (16.8%), Scl70 (16%) and Sm/RNP (9.2%).Conclusion: Our results are similar with the current related literature. It is known that autoantibodies can be detectable before clinical symptoms being apparent, especially in SLE. Therefore, borderline or weak fluorescence levels should also be reported and the patients having them should be followed-up carefully. J Microbiol Infect Dis 2015;5(2): 63-68Key words: Antinuclear antibody, indirect immune-fluorescence assay, extractable nuclear antigen antibodies, Amaç: Bu çalışmanın amacı 2009-2011 yıllarında laboratuvarımızda yapılan ANA (antinükleer antikor) tetkik sonuçlarının retrospektif olarak değerlendirilmesidir. Yöntemler: Bu dönemde laboratuvarımızda toplam 5068 serum örneğinde indirekt immünofloresans antikor yöntemiyle (IIFA) ANA varlığı araştırıldı. Rastgele örnekleme ile seçilen ANA-pozitif 982 olgu cinsiyet dağılımı, ışıma düzeyleri ve paternleri, dsDNA sonuçları ve ekstrakte edilebilir nükleer antijen (ENA) profilleri açısından incelendi. ANA ölçümü için doku olarak HEP-2 ve maymun karaciğeri hücrelerini birlikte içeren ticari IIFA kiti kullanıldı. Hasta serumlarının 1/100 sulandırım titresi ile çalışıldı. Sonuç verilirken ışıma titresi ve derecesi ile birlikte homojen, benek, sentromer gibi paternler de rapor edildi. Anti-dsDNA düzeylerinin tayininde Enzim İmmün Assay (ELISA) yöntemi kullanıldı. 20 IU/mL üzerindeki değerler pozitif kabul edildi. Anti-ENA profili immünoblot yöntemi ile bakıldı.Bulgular: ANA sonucu pozitif bulunan hastaların 756’sı (%77) kadın, 226’sı (%23) erkekti. Örneklerin %50’si Romatoloji, %20’si Gastroenteroloji, %30’u diğer birimlerdendi. %62.6 örnekte sınırda veya zayıf ışıma pozitifliği gözlendi. En sık 4 ışıma paterni sırasıyla homojen (%23), benek (%22), homojen-benek (%15.5) ve nükleolar (%13.5) olarak saptandı. ANA pozitif 759 hastada ELISA ile anti-dsDNA çalışılmış; 66’sı (%8.7) pozitif, 693’ü (%91.3) negatif bulundu. Anti-dsDNA pozitif 44 örnekte (%68.8) homojen ışıma paterni; kalan örneklerde ise benek, nükleolar, nükleer dots, sentromer ve midbody paternleri gözlenmiştir. ANA pozitif 414 örnekte ise immünoblot yöntemi ile anti-ENA profili çalışıldı. Bunların 131’i (%31.6) pozitif, 283’ü (%68.4) negatif bulundu. ENA pozitifliklerinde ilk dört sırayı SSA (%34.4), SSA-SSB (%16.8), Scl70(%16), Sm/RNP (%9.2) aldı.Sonuç: Sonuçlarımız ilgili literatür sonuçlarıyla benzerdir. Özellikle SLE’de, klinik semptomlardan önce otoantikorların pozitifleşebildiği bilinmektedir. Bu olasılık göz önünde bulundurularak serum örneklerinde zayıf/sınırda ışıma gözlenen hastaların yakın takibe alınmasını ve bu ışıma düzeylerinin sonuç raporunda belirtilmesi gerektiğini düşünmekteyiz

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 cross-transmission 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 55 different pulsotypes. Fifteen pulsotypes were identified as clusters with ≥ 2 isolates and a clustering rate of 57%. Based on the similarity coefficient higher than 85%, a total of 75 (80.6%) isolates were clonally related to each other. Conclusions: The high rate of carbapenem resistance and 80.6% clonal relationship between the isolates collected in a 3-year period indicated a serious potential threat for the hospital-acquired infections and pointed longtime cross-contamination.

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.

Aim: This study aimed to evaluate the alterations in the nasal flora in patients who underwent endoscopic endonasal surgery for chronic rhinosinusitis with nasal polyps (CRSwNP). Material and Methods: This prospective study included 30 patients diagnosed with CRSwNP who were resistant to medical treatment and recommended for surgery. The nasal cavity was sampled two times, first preoperatively on the day of operation and postoperatively in the 4th week. Patients were divided into two groups according to their culture results, including normal flora bacteria and potential pathogen production. Results: In the preoperative swab samples, 3 (11.1%) patients had no bacterial growth, 16 (59.3%) patients had a normal flora, and potential pathogens were detected in 8 (29.6%) patients. However, postoperatively, 3 (11.1%) patients had no bacterial growth, 13 (48.1%) patients had a normal flora, and potential pathogens were detected in 11 (40.7%) patients during the postoperative period. No significant difference was found between preoperative and postoperative culture results in terms of the number of patients with normal flora, potential pathogens, and no bacterial growth (p=0.676). The most common microorganism in the normal flora group preoperative and postoperative period was coagulase-negative Staphylococcus (77.8%, 51.9%, respectively), and the most common microorganism in the potential pathogen group was Staphylococcus aureus (18.5% and 25.9%, respectively). Comparing preoperative and postoperative culture results according to isolated potential pathogen microorganism types, no statistically significant difference was observed for any microorganism in the potential pathogen group (p>0.05).Conclusion: As a result, no correlation between nasal polyps’ surgery and potential pathogens was detected. Keywords: Chronic rhinosinusitis; culture; nasal polyps; flora; potential pathogens; bacteria; Staphylococcus aureus; coagulase; transnasal endoscopic surgery; pseodomanas.

WOS: 000384907900008, PubMed ID: 27236394, BACKGROUND: Knowing risk factors for colistin resistance is important since colistin is the only remaining choice for the treatment of infections caused by multi-drug resistant microorganisms. OBJECTIVE: Evaluate risk factors associated with infection by colistin-resistant microorganisms. DESIGN: Retrospective study. SETTINGS: Tertiary healthcare centers. PATIENTS AND METHODS: An e-mail including the title and purpose of the study was sent to 1500 infectious disease specialists via a scientific and social web portal named "Infeksiyon Dunyasi (Infection World)". Demographic and clinical data was requested from respondents. MAIN OUTCOME MEASURE(S): Colistin-resistance. RESULTS: Eighteen infectious disease specialists from twelve tertiary care centers responded to the invitation. Data was collected on 165 patients, 56 cases (39.9%) and 109 (66.0%) age-and sex-matched controls. The colistin-resistant microorganisms isolated from cases were 29 Acinetobacter baumannii (51.8%), 18 Pseudomonas aeruginosa (32.1%) and 9 Klebsiella spp. Colistin, carbapenem, and quinolone use in the last three months were risk factors for colistin resistance in the univariate analysis. Previous quinolone use in the last three months (P=.003; RR: 3.2; 95% CI: 1.5-6,7) and previous colistin use in the last three months (P=.001; RR: 3.6; 95% CI: 1.63-7.99) were significant risk factors in the multivariate analysis. CONCLUSION: Clinicians should limit the use of quinolones and remain aware of the possibility of resistance developing during colistin use. LIMITATIONS: The lack of a heteroresistance analysis on the isolates. No data on use of a loading dose or the use of colistin in combination.

Amaç: Çalışmamızın amaçları, 2011-2012 tarihleri arasında, alt üriner sistem enfeksiyonu (ÜSE) tanılı poliklinik hastalarından izole edilen mikroorganizmaların dağılımı, antibiyotik direnç profillerinin araştırılması ve uygun ampirik tedavi seçeneklerinin belirlenmesidir.Materyal ve Metot: 2011–2012 tarihleri arasında, hastanemiz polikliniklerinden alt ÜSE ön tanısı ile gönderilen 14096 idrar örneğinin kültür / antibiyogram sonuçları retrospektif olarak değerlendirildi. Tekrarlayan üremeler hariç tutularak toplam 2005 örnekteki üremeler değerlendirmeye alındı. Kültür ve identifikasyon testleri konvansiyonel/yarı otomatik ve otomatik yöntemlerle yapıldı. Antibiyotik duyarlılık testleri CLSI (Clinical Laboratory Standarts Institute) önerileri doğrultusunda Kirby-Bauer disk difüzyon yöntemiyle gerçekleştirildi.Bulgular: Örneklerin %83,7’sinde Enterobacteriaceae üyeleri üredi. Bunların 1287’si (%64,2) E.coli; 238’i (%11,9) K.pneumoniae idi. Toplam 67 (%3,3) örnekte P.aeruginosa üredi. Gram-pozitif üremelerin oranı; 55’i (%2,7) metisiline dirençli koagülaz negatif stafiolokok, 55’i (%2,7) E.faecalis, 49’u (%2,4) S.agalactia v.b. olmak üzere %12,86 idi. Genişlemiş spektrumlu beta laktamaz prevalansı E.coli izolatlarında %23,2; K.pneumonia izolatlarında %25,4 olarak belirlendi. Gerek Gram-pozitif, gerekse Gram-negatif izolatlarda, oral kullanımı olan antimikrobikler içinde nitrofurantoin (NF) en düşük direnç oranına sahipti (sırasıyla %2,7 ve %12,1). Öte yandan Gram-pozitif bakteriler için ampisilin (%6,3), Gram-negatif bakteriler için ise sefuroksim (%25,9) en düşük direnç oranlarına sahip diğer oral tedavi seçenekleri olarak belirlendi.Sonuç: Yetişkin yaş grubundaki poliklinik hastalarımızın alt ÜSE enfeksiyonlarında NF en geniş antibakteriyel etki spektrumuna sahip oral ilaç olarak öne çıkmaktadır. Ampisiline duyarlı Gram-pozitif izolatların (Enterokokspp. hariç) sefuroksime de duyarlı olacağı düşünülürse, ikinci en geniş spektrumlu oral ilacın sefuroksim olduğu söylenebilir. Sanford, IDSA v.b. tedavi kılavuzlarında NF, trimetoprim sulfametoksazol (TMP-SXT), ilk veya ikinci tedavi seçeneği olarak önerilmekle birlikte çalışmamızda bu oran %35 düzeyinde bulunduğu için TMP-SXT, hasta grubumuz için uygun bir tedavi seçeneği gibi görünmemektedir., Objectives: The aims of the study were to investigate the distribution and the antibiotic resistance profiles of the microorganisms isolated from outpatients with lower urinary tract infection (UTI) during 2011-2012 period and to determine the most appropriate empirical therapy choices.Materials and Methods: Culture and susceptibility test results of 14.096 urine samples sent from outpatient clinics with presumptive lower UTI diagnosis in the last year (2011-2012) were reviewed. Excluding the duplications, totally 2005 isolates were evaluated. Culture and identification tests were done by conventional/semi-automatic and automatic methods. Antibiotic susceptibility tests were performed by Kirby-Bauer disc diffusion method according to the recommendations of CLSI (Clinical Laboratory Standarts Institute).Results: Enterobacteriaceae spp. were isolated from 82.3% of the urine samples; 1287 (64.2%) Escherichia coli and 238 (11.9%) Klebsiella pneumonia, 67 (3.3%) Pseudomonas aeruginosa was cultivated. Totally 12.9% of the samples yielded Gram-positive bacteria including 55 (2.8%) meticillin resistant coagulase negative staphylococci, 55 (2.8%) Enterococcus faecalis and 49 (2.4%) Streptococcus agalactiae. The extended spectrum beta-lactamase (ESBL) prevalence was 23.2% in E.coli and 25.4% in K.pneumoniae. Among oral antibiotics tested, nitrofurantoin (NF) had the lowest resistance rates for both Gram-positive and Gram-negative isolates with 2.7% and 12.1%, respectively. Ampicillin for Gram-positives and Cefuroxim for Gram-negatives were other oral drugs with the lowest resistance rates with 6.3% and 25.9%, respectively.Conclusion: NF appears as the most effective oral drug for adult outpatients with UTI. Cefuroxim can be considered as the second effective choice because ampicillin-sensitive Gram-positive isolates (except Enterococcus spp) would also be sensitive to it. NF and trimethoprim-sulfamethoxazole (TMP-SMX) is suggested as first or second choice in UTI treatment in antimicrobial therapy guidelines like Sanford and IDSA. However, TMP-SMX resistance was found 35% in our population; consequently it is not a suitable option for our patients.

Introduction: Colistin use has increased over the last ten years because of multidrug-resistant microorganisms. The aim of this study was to compare the clinical and microbiological efficacy of colistin alone or in combination with sulbactam or carbapenem in the treatment of ventilator-associated pneumonia (VAP) due to multidrug-resistant (MDR) and extremely drug-resistant (XDR) A. baumannii. Methodology: Cases treated for VAP because of MDR and XDR A. baumannii between January 2011 and January 2013 were included in the study. The primary and secondary outcome for colistin alone, colistin with sulbactam, and colistin with carbapenems were evaluated. The primary outcomes were clinical efficacy and microbiological efficacy; the secondary outcomes were nephrotoxicity, length of hospitalization, and mortality. Results: A total of 70 VAP patients were evaluated. A total of 17 patients (24.3%) were administered colistin alone, 20 patients (28.6%) were administered colistin and sulbactam, and 33 patients (47.1%) were administered colistin and carbapenem. Clinical and microbiological response rates were higher in the carbapenem combination group (63.6% and 63.6% in both) than in the sulbactam combination group, which registered 55.0% and 60.0%, respectively. However, this did not represent a significant difference statistically (p > 0.05). There was also no significant difference between colistin alone and the combination groups regarding clinical and microbiological efficacy and mortality. Conclusions: Neither the administration of colistin alone nor colistin combined with either sulbactam or carbapenem had any noticeable advantage in the treatment of VAP in terms of clinical response, microbiological response, nephrotoxicity, length of hospitalization, and mortality.

Macrolide resistance in 156 consecutive group B streptococcal isolates was investigated. Thirty-five isolates (22.4%) had inducible (80%) or constitutive (20%) erythromycin resistance. The genes responsible were erm (B), erm (A) subclass erm (TR), and erm (B) plus erm (TR) in 62.9, 2.9, and 8.6% of isolates, respectively. Nine isolates (25.7%) harbored neither mef nor detectable erm genes.

Macrolide-lincosamide-streptogramin B (MLSB) resistance determinants of group A streptococci (GAS) in Ankara, Turkey, were defined for the first time. ISOLATES AND METHODS: A total of 1355 GAS isolates, collected from three different regions of Ankara, were screened for erythromycin resistance. Resistance phenotypes were determined by a triple-disc test, and the gene determinants responsible were determined by PCR. MICs of erythromycin, clindamycin and spiramycin were measured for the resistant isolates, and susceptibility rates to some further antibiotics were determined.Thirty-six isolates (2.6%) were resistant to erythromycin. Of these, 17 (47.2%) expressed macrolide-restricted resistance (M phenotype), while the remainder expressed inducible (16 isolates, 44.4%) or constitutive (three isolates, 8.3%) MLSB resistance. All isolates of the M phenotype harboured the mef(A) gene. Of non-M isolates, 14 harboured erm(A) subclass erm(TR) and five had erm(B) genes. There was a significant relationship between tetracycline resistance and the inducible phenotype (P0.05). Macrolide resistance was significantly higher in adults (P0.05), and increased more than two-fold in 2002 compared with 2001 (P0.05).The prevalence of macrolide resistance in GAS is low in Ankara; therefore, routine antimicrobial susceptibility testing against these agents seems unwarranted.