[Investigation of carbapenemases in carbapenem-resistant Escherichia coli and Klebsiella pneumoniae strains isolated in 2014 in Turkey]. / Türkiye'de 2014 yili içinde izole edilen karbapeneme dirençli Escherichia coli ve Klebsiella pneumoniae izolatlarinda karbapenemaz varliginin arastirilmasi.

Carbapenems are the choice of treatment in infections caused by multidrug resistant Enterobacteriaceae. In recent years carbapenem-resistant Enterobacteriaceae isolates due to carbapenemases have been increasingly reported worldwide. Multicenter studies on carbapenemases are scarce in Turkey. The aim of this study was to determine the distribution of carbapenemases from different parts of Turkey as a part of the European Survey of Carbapenemase Producing Enterobacteriaceae (EuSCAPE) project. Beginning in November 2013, carbapenem-resistant isolates resistant to at least one of the agents, namely imipenem, meropenem, and ertapenem were sent to the coordinating center. Minimum inhibitory concentrations for these carbapenems were determined by microdilution tests following EUCAST guidelines. Production of carbapenemase was confirmed by combination disk synergy tests. Types of carbapenemases were investigated using specific primers for VIM, IMP; NDM, KPC and OXA-48 genes by multiplex polymerase chain reaction. In a six month period, 155 suspected carbapenemase-positive isolates were sent to the coordinating center of which 21 (13.5%) were E.coli and 134 (86.5%) were K.pneumoniae. Nineteen (90.5%) strains among E.coli and 124 (92.5%) strains among K.pneumoniae were shown to harbour at least one carbapenemase gene by molecular tests, with a total of 92.3% (143/155). Carbapenemases were determined as a single enzyme in 136 strains (OXA-48: 84.6%; NDM: 6.3%; VIM: 2.8%; IMP: 1.4%) and as a combination in seven isolates (OXA-48 + NDM: 2.1%; OXA-48 + VIM: 2.1%; VIM + NDM: 0.7%). KPC was not detected in any of the isolates. According to the microdilution test results, resistance to imipenem, meropenem and ertapenem in OXA-48 isolates were 59.5%, 52.9% and 100%, respectively. The combination disk synergy test was 100% compatible with the molecular test results. As most of the OXA-48 producing isolates were susceptible to meropenem but all were resistant to ertapenem, ertapenem seems to be the most sensitive agent in screening carbapenemases in areas where OXA-48 is prevalent and phenotypic combination tests can be useful in centers where molecular tests are not available.

Anticardiolipin antibody positivity in diabetic patients with and without diabetic foot.

Anticardiolipin (aCL) antibodies may play a role in the enhancement of platelet aggregation and/or progression of the macrovascular diabetic complications. Also, aCL antibodies may cause or promote ischemia and thrombosis. Therefore, we aimed to investigate IgG aCL and IgM aCL antibodies positivity in type 2 diabetic patients with and without ischemic diabetic foot. In this case-control study, we examined 40 diabetic patients without diabetic foot problem and 35 diabetic patients with ischemic diabetic foot. Forty diabetic patients (19 females, 21 males) without diabetic foot served as Group 1 and 35 diabetic patients (17 females, 18 males) who had ischemic diabetic foot served as Group 2. In the control group, 35 nondiabetic healthy subjects (18 females, 17 males) were included in Group 3. The groups were similar in age and sex, which is not statistically significant (P>.05). There was no difference in the IgG aCL antibodies positivity between Groups 1 and 3 (P>.05). However, IgG aCL antibodies positivity in Group 2 was significantly higher than those of the other groups (P<.05). IgG aCL antibodies were found positive in 10% (4/40) of Group 1, 34.3% (12/35) of Group 2 and 8.6% (3/35) of Group 3. When Groups 1 and 2 were compared, the odds ratio adjusted for age, gender, hypertension, coronary artery disease history, cigarette smoking, duration of diabetes mellitus, cholesterol, and haemoglobin A(1C) (HbA1c) was 6.8 [95% confidence interval (CI), 1.41-32.66; P=.016] for aCL positivity. In conclusion, although available evidence does not prove a causal association between positivity of aCL and diabetic foot, we believe that a causal association is supported by the data obtained from this study.

Effect of frequent-replacement contact lenses on normal conjunctival flora.

PURPOSE: To evaluate the effect of frequent-replacement contact lenses (FRCL) on the normal conjunctival flora. METHODS: This study included 30 patients using FRCL for refractive errors only and 32 age-matched, healthy controls. All patients replaced their lenses every 3 to 4 weeks. The samples were taken from the lower fornix with a culture swab and incubated in blood agar. RESULTS: Staphylococcus epidermidis was the predominant organism found in the conjunctival samples in the two groups. In the FRCL group, 9 (30%) S. epidermidis, 3 (10%) Acinetobacter Iwoffii, and 2 (6.7%) Moraxella spp. were isolated from the conjunctival samples. In the control group, 7 (23.3%) S. epidermidis and 2 (6.7%) A. lwoffii were isolated from the conjunctival samples. There was no statistically significant difference between two groups (P > .05). CONCLUSION: Our results show that the normal conjunctival flora was not changed by the FRCL, but there was a nonsignificant increase in the bacterial population.