The emergence of Klebsiella pneumoniae sequence type 395 non-susceptible to carbapenems and colistin from Turkey.

PURPOSE: OXA-48 producing Klebsiella pneumoniae is an emerging threat and outbreaks due to specific sequence types have been commonly reported. Here, we report an outbreak due to multidrug-resistant ST395 K. pneumoniae ST395. To the best of our knowledge, this is the first outbreak of K. pneumoniae ST395 harbouring blaOXA-48 genes in our country. METHODS: The strains were characterized by antimicrobial susceptibility, extended-spectrum ß-lactamase (ESBL) and carbapenemase production, plasmid-mediated colistin, high-level aminoglycoside, and quinolone resistance. Also multidrug efflux pumps and porin coding genes were investigated. Pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), wzi typing and plasmid analysis were used for the epidemiological relationships. RESULTS: All strains were positive for blaOXA-48 with at least one of the ß-lactamase genes (blaCTX-M, blaTEM, blaSHV) and harboured IncL plasmids. 16 of 20 (80%) isolates carried qnrA. All isolates were positive for aac(6')-1b, acrAB-tolC, ompK35, and ompK36 genes but none of them harboured 16s rRNA methyltransferase, mcr-1-5, qepA, oqxAB, and mdtK genes. All strains had the same PFGE pattern, that is, wzi type K2 and found to be ST395 with MLST. CONCLUSION: The association of ST395 with OXA-48-producers could be an emerging threat for Turkey and continuous monitoring is crucial to prevent the spread of these powerful strains.

Prevalence of HBsAg seropositivity during pregnancy and evaluation of vaccination programs: A multicenter study in Turkey.

OBJECTIVE: Hepatitis B virus (HBV) infection remains a global public health problem. Among its modes of transmission, vertical transmission from mother to child during pregnancy is exceedingly important. This study investigated seropositivity for hepatitis B surface antigen (HBsAg) among pregnant women aged 16-49 years and their pregnancy outcomes in several health institutions (university and state hospitals, family health centers) from seven cities in Turkey. METHODS: An Excel form was sent to the sites participating in the study, and the total number of pregnant women who were tested for HBsAg between 2010 and 2017, HBsAg positivity rates, and the ages of HBsAg-positive pregnant women was collected retrospectively. Serum samples were obtained from 204,865 pregnant women from four regions between 2010 and 2017, including 107,463 from Black Sea, 2306 from Marmara, 48,339 from East Anatolia, and 46,757 from Aegean. HBsAg levels were determined on automated devices using chemiluminescence. RESULTS: In the study, the data of 204,865 pregnant women from seven different provinces (Afyonkarahisar, Erzurum, Istanbul, Izmir, Manisa, Mus, and Rize) in different geographical regions were accessed, and HBsAg positivity was found in 2343 pregnant women (1.14%). The highest HBsAg seroprevalence was found in women who were older 26-40 years/1977-1991 birth year range on average. In the data of the present study, the number of pregnant women with HBsAg positivity among pregnant women born after the initiation of the national vaccination program and catch-up vaccination program is only 124 and constitutes 5.3% of all HBsAg-positive pregnant women. CONCLUSION: In this study, it has been found that HBsAg positivity in pregnant women has been decreasing in Turkey and that it is significantly lower, especially in those born after the initiation of the national vaccination program. Continuation of national neonatal HBV vaccination with high compliance is very important.

A Healthcare-Associated Outbreak of Urinary Tract Infections Due to Myroides odoratimimus.

Myroides spp. are low-grade opportunistic pathogens. Outbreaks due to Myroides spp. have rarely been described in the literature to date. We report a healthcare-associated outbreak of urinary tract infections (UTIs), caused by Myroides odoratimimus, in a Turkish hospital. As of March 2019 until May 2019, 6 strains of M. odoratimimus were isolated from the urine samples of patients, all of whom were hospitalized in intensive care units. After identification and antibiotic susceptibility testing using the VITEK 2 system, MALDI-TOF-MS and 16S rRNA-based sequencing methods were performed for confirmation and species-level identification. Pulsed-field gel electrophoresis (PFGE) was performed in order to investigate the clonal relatedness of the isolates. All the patients were immunocompromised and underwent urinary catheterization. None of the patients had urinary neoplasm, surgery, or calculi. VITEK 2 and MALDI-TOF-MS systems revealed that the isolates belonged to the Myroides genus; however, the aforementioned systems neglected to identify the isolates at the species level. The isolates were all successfully identified as M. odoratimimus through 16S rRNA-based sequencing. The isolates were resistant to every antibiotic tested. All isolates had an indistinguishable PFGE pattern, thus indicating cross-transmission between cases. Although M. odoratimimus is rarely isolated from human specimens, clinicians should be aware of its ability to cause UTIs and infectious outbreaks.

A healthcare-associated outbreak of urinary tract infections due to Myroides odoratimimus.

Myroides spp. are low-grade opportunistic pathogens. There were only a few outbreaks due to Myroides spp. described in the literature to date. We report a healthcare-associated outbreak of urinary tract infections caused by Myroides odoratimimus in a Turkish hospital. From March to May 2019, six strains of M. odoratimimus were isolated from the urine samples of patients hospitalized in the intensive care units (ICUs). After identification and antibiotic susceptibility testing with VITEK 2 system, MALDI-TOF-MS and 16S rRNA based sequencing methods were performed for confirmation and species level identification. Pulsed-field gel electrophoresis (PFGE) was used to investigate clonal relatedness of the isolates. All the patients were immunocompromised and underwent urinary catheterization. None of them had urinary neoplasm, surgery or calculi. VITEK 2 and MALDI-TOF-MS systems revealed that the isolates belong to the Myroides genus but lacked to identify the isolates at the species level. 16S rRNA based sequencing successfully identified all the isolates as M. odoratimimus. The isolates were resistant to all antibiotics tested. All isolates had indistinguishable PFGE pattern indicating cross-transmission between cases. Although M. odoratimimus is rarely isolated from human specimens, clinicians should be aware of its ability to cause UTIs and outbreaks.

[Investigation of carbapenemase genes and molecular epidemiology of Enterobacteriaceae strains isolated between 2010-2014 in a university hospitals]. / Bir üniversite hastanesinde 2010-2014 yillari arasinda izole edilen Enterobacteriaceae türlerinin karbapenemaz genlerinin arastirilmasi ve moleküler epidemiyolojisinin belirlenmesi.

The worldwide spread of carbapenemase producing Enterobacteriaceae isolates has become a major threat of public health. This worrisome situation leads the development of new methods for carbapenemase screening, detection, prevention of spread and epidemiological data collection as mandatory. In this study, it was aimed to investigate existence and distribution of carbapenemase-encoding genes (CEGs) among carbapenem-resistant Enterobacteriaceae isolated from various clinical samples in Ankara University Faculty of Medicine, Ibni Sina Hospital, Central Microbiology Laboratory between June 2010-May 2014 and detect their clonal relationship. A total of 112 non-repetitive Enterobacteriaceae isolates which were intermediate or resistant to ertapenem were identified by using Phoenix (BD Diagnostic Systems, Sparks, USA) automated microbiology system. After DNA extraction from the isolates, 11 carbapenemase-encoding genes (CEGs) (blaIMP, blaVIM, blaSPM, blaKPC, blaNDM, blaOXA-48, blaGIM, blaSIM, blaAIM, blaDIM ve blaBIC) were detected with PCR. The clonal relationship among the isolates was determined by PFGE method following digestion with Xbal DNA macrorestriction endonuclease. Among 112 isolates Klebsiella pneumoniae was the most frequent (n= 79, 70.5%) bacteria followed by Escherichia coli (n= 15, 13.4%), Enterobacter cloacae (n= 10, 8.9%), Enterobacter aerogenes (n= 4, 3.6%) and Klebsiella oxytoca (n= 4, 3.6%) respectively. blaOXA-48 was the most frequent gene detected. Among 83 (74.1%) isolates blaOXA-48 was detected alone and in 7 (6.3%) of the isolates it was identified with blaVIM gene coexistence. blaVIM gene was identified as the second most frequent CEG among the isolates. blaVIM gene was detected positive in 9 (8%) isolates. blaNDM gene was identified in 2 (1.8%) isolates. Ten of the K.pneumoniae isolates with identical PFGE pattern were named as pulsotype B. These isolates were found to be similar in terms of isolate location, isolation dates, antibiotic resistance patterns and the carbapenemase genes they carry, and are considered to be potential outbreak isolates originated from intensive care units. On the other hand CEGs were found in the clinical samples obtained from five out-patients suggesting that community-acquired infections may also arise due to carbapenemase producing Enterobacteriaceae in our country where blaOXA-48 producers are endemic. According to this study, blaOXA-48 producing gram negative bacteria were frequent in our hospital. The prevalance of blaVIM gene among metallo-beta-lactamases and coexistence with blaOXA-48 gene was remarkable. The frequency of blaNDM producing isolates in our hospital was not detected as high yet. In this study, the identification of carbapenemase producing bacteria as outbreak strains in our hospital indicated that cross-sectional surveillance for carbapenemase-producing bacteria from each patient was valuable in terms of early diagnosis of outbreaks.