Investigation of some changes and clonal relationship in enterococci isolates due to relocation of a hospital.

Objectives: To investigate the isolation rates, antimicrobial resistance rates, minimum inhibitory concentration values of antimicrobial agents, and clonal relationships of Enterococcus faecalis and Enterococcus faeciumdue to the relocation of a hospital to a newly constructed building. METHODS: The comparative, prospective study was conducted at adult general intensive care units of the Mus State Hospital, Mus, Turkey, in two phases; before the relocation from January 25 to December 1, 2014, and after the relocation from February 10 to May 24, 2015. Rectal swab samples were collected 72 hours post-hospitalisation. Identification of Enterococcus faecalis and Enterococcus faeciumisolates was determined by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, and antimicrobial resistance with minimum inhibitory concentration values was detected with Vitek 2 system. The clonal relatedness among the strains was investigated by pulsed-field gel electrophoresis. Data was analysed using SPSS 23. RESULTS: Of the 69 patients, 37(53.62%) were related to pre-relocation phase; 20(54.1%) females and 17(45.9%) males with mean age 62.81±21.71 years. There were 32(46.37%) patients in the post-relocation phase; 13(40.6%) females and 19(59.4%) males with mean age 62.69±21.35 years (p>0.05). Of the 84 enterococci strains isolated, 51(60.7%) were Enterococcus faecium; 28(55%) before relocation and 23(45%) after relocation (p=0.77). The remaining 33(39.3%) isolates were Enterococcus faecalis; 16(48.5%) before relocation and 17(51.5%) after relocation (p=0.73). Multiple strains were located in 7(18.9%) patients before relocation and in 7(21.9%) after relocation. In 1(3.1%) patient after relocation, 2(8.7%) Enterococcus faecium isolates with different resistance and pulsed-field gel electrophoresis patterns were detected. There were no significant differences between the isolation and antibiotic resistance rates before and after relocation (p>0.05), and a clonal relation between the isolates was not detected (p>0.05). Decreased minimum inhibitory concentration values were noted for some antibiotics. CONCLUSIONS: Clonal relationship between the isolates and change in the rates of isolation and antimicrobial resistance of Enterococcus faecalis and Enterococcus faecium was not detected due to relocation. Minimum inhibitory concentration values could be used to reveal relocation-related changes in isolates obtained from patients hospitalised in intensive care units.

[Genotyping of Giardia intestinalis isolates in the Thrace Region, Turkey]. / Trakya Bölgesi'ndeki Giardia intestinalis izolatlarinin genotiplendirilmesi.

Giardia intestinalis is a common protozoon that infects humans and may cause water and food-borne outbreaks. It is regarded as a major public health problem worldwide and in Turkey as well. Molecular techniques are widely used to determine the epidemiology, genetic populations and taxonomy of G.intestinalis. It has two genotypes including genotype A and genotype B in humans. The purpose of the present study is to implement the molecular analysis and genotyping of the isolates of G.intestinalis obtained from human stool samples. A total of 39 isolates obtained from the stool samples of persons (30 male, 9 female; age range: 1-74 years, median age: 20) who have admitted to Trakya University Medical Research and Practice Health Center and Edirne State Hospital between September 2011- April 2013 were included in the study. The average number of cysts were identified both with native and lugol methods among all microscopically detected samples by screening at least 50 field with x400 magnification. The samples were then analyzed through loop-mediated isothermal amplification method (LAMP) for the presence of elongation factor-1 alpha (EF-1α) gene, and polymerase chain reaction (PCR) method for the presence of beta-giardin (bg) gene regions. In addition, sequence analysis of bg gene was performed. Of 39 samples, 32 (82%) and 19 (48.7%) were found to be positive for G.intestinalis EF-1α and bg genes by LAMP and PCR methods, respectively. Genotyping was implemented in 17 out of 19 samples yielding nine genotype A and eight genotype B strains. The sub-genotypes of these strains were identified as A2 (n= 6), A3 (n= 3), B2 (n= 6), B3 (n= 1) and B4 (n= 1). In eight isolates that could be typed among 21 symptomatic patients, genotype B (n= 5) and in nine isolates that could be typed among 18 asymptomatic patients, genotype A (n= 6) were more frequently observed. There was no significant association between symptomatic or asymptomatic status and genotypic patterns of the cases (p= 0.347). The PCR positivity rate showed a significant difference between patients with higher cyst density and lower cyst density (p= 0.0001). In conclusion, molecular methods such as LAMP and PCR might have the potential to provide a substantial guidance for the analysis of outbreaks. In addition, the determined subtypes of G.intestinalis in our region is expected to contribute to the global epidemiological data.