Carbapenem and Colistin Resistance, Integrons and Plasmid Replicon Types in Multi-Drug Resistant Klebsiella Strains Isolated in Turkey.

BACKGROUND: Multidrug-resistant (MDR) Klebsiella is a globally important nosocomial pathogen. In the present study, 101 multidrug-resistant Klebsiella strains isolated from various clinical specimens obtained from two different Medical Faculties' hospitals were involved. We aimed to find out the prevalence of carbapenemase, mobile colistin resistance genes, and integrons in MDR Klebsiella strains. METHODS: The antibiotic susceptibilities of strains were determined by Kirby Bauer disc-diffusion method and resistance to colistin was confirmed by detection of minimum inhibitory concentrations. The prevalence of carba-penemase genes (blaOXA-48, blaNDM, blaIMP, blaVIM, blaKPC), mobile colistin-resistance genes (mcr-1 and mcr-2), and integrons (class I, II and III) were examined in Klebsiella strains by polymerase chain reaction. RESULTS: All strains were resistant to ß-lactam antibiotics, carbapenems, and quinolones. On the other hand, only nine (8.9%) strains were resistant to colistin. The most common carbapenemase genes were blaNDM (64.3%) and blaOXA-48 (53.5%). Besides, 28 (27.7%) strains were found to harbor both blaNDM and blaOXA-48. These 28 strains be-longed to the IncA/C (18.7%), IncL/M (7.7%), and IncFIIs (1.1%) plasmid replicon types. No strain was positive for blaIMP, mcr-1, and mcr-2. Class I and Class II integrons were shown to be harbored in 83.2% and 63.3% of strains, respectively. In total, 63 (63.6%) of strains harbored both classes I and II integrons. Class III integron was not detected. There was a statistically significant relationship between the presence of integrons and antibiotic resistance for cefotaxime (p = 0.024), ciprofloxacin (p < 0.001) trimethoprim/sulfamethoxazole (p < 0.001) and levofloxacin (p = 0.002). To our knowledge, this study represents the first report of a human isolate for the co-presence of blaNDM, blaOXA-48 and both Class I and Class II integrons, from Turkey. CONCLUSIONS: Our findings also highlight the dissemination of integrons and carbapenemases and the importance of surveillance on emerging antibiotic resistance.

The Prevalence of Protein S Variant in Patients Diagnosed with COVID-19.

BACKGROUND: The rapid spread of the new severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) which causes the coronavirus disease 2019 (COVID-19) facilitated the emergence of numerous variants. The present study aimed to investigate the prevalence and change of important "S" protein variants such as N501Y, DelH69/ 70, and E484K in SARS CoV-2 PCR positive patients diagnosed with COVID-19 who have referred to a private hospital within the period that mutations were detected during COVID-19 pandemic. METHODS: One hundred and eighty-seven patients who have been referred due to the suspicion of COVID-19 between December 2020 and April 2021 and in whom SARS-CoV-2 was detected positive in the PCR test were enrolled into the study. These patients were randomly selected among 285 patients detected in these months, among those with the most accurate graphics and data. The RNA material extracted from the nasopharyngeal swab samples taken from the patients was analyzed and specifically N501Y, del69-70, and E484K mutations were investigated through the Real-Time PCR method. RESULTS: The mean age of the patients was 37.5 ± 14.1 years. Mutations were detected in 84 (44.9%) samples in total (N501Y + DelH69/70 by 81%, DelH69/70 by 7.1%, E484K by 7.1% and N501Y + E484K by 4.8%). There was no sample detected with the N501Y mutation. The mutation rate between December - February was detected between 1% and 8%, and the mutation rate increased to 39% to 44% in April and March. While DelH69/70 mutation was detected in December 2020 only, it was observed that N501Y + DelH69/70 variants became dominant as of February 2021, and E484K and N501Y + E484K variants started to appear in March and April. It was observed that the variant rates included DelH69/70 (p < 0.001), N501Y (p < 0.001), N501Y + DelH69/70 (p < 0.001), and N501Y + E484K (p = 0.01) mutations increased significantly according to the months. The E484K mu-tation was significantly higher in males (p = 0.037). There was no differences between mutation rates between the age groups. CONCLUSIONS: Our findings indicate that the appearance of important SARS-CoV-2 variants gradually increases, that rates of mutation increase up to 40% within several months, that the N501Y + DelH69/70 variant gradually becomes to be dominant, and that different variations appear along with mutations.

Changes in acute viral hepatitis epidemiology in the Turkish adult population: A multicenter study.

BACKGROUND/AIMS: The present study aimed to determine the changes in the epidemiology of hepatitis in recent years in an adult Turkish population. MATERIALS AND METHODS: Overall, 852 patients with acute viral hepatitis from 17 centers were included in this study. Their sociodemographic characteristics, clinical courses, treatments, and laboratory findings were retrospectively analyzed. RESULTS: The most commonly found microorganisms were the hepatitis B virus (55.2%) and hepatitis A virus (37.6%), and the types of acute viral hepatitis differed significantly according to the age group (p≤0.001). The most frequently reported symptom was fatigue (73.7%), and the most common complications were cholecystitis (0.4%) and fulminant hepatitis (0.4%). The median hospital stay was 9 days (range 1-373). In total, 40.8% patients with acute hepatitis B virus developed immunity. CONCLUSION: In Turkey, there are significantly large adolescent and adult populations susceptible to acute viral hepatitis. Therefore, larger vaccination programs covering these age groups should be implemented.