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Copyright of Ümraniye Pediatri Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective Neonatal bloodstream infections (BSIs) due to drug-resistant pathogens are a major cause of neonatal morbidity and mortality. Unfortunately, data regarding the pathogens and their resistance profile are limited in developing countries. The aim of this study was to determine the bacteriological profile and antimicrobial susceptibility patterns in neonatal BSI at a university hospital in Türkiye. Methods Medical records of neonates with suspected sepsis were retrospectively reviewed during the study period (between January 1, 2018, and December 31, 2020) for demographic data, blood culture, and antimicrobial susceptibility test results. Results During the study period, 117 BSI episodes were encountered in 106 neonates. The most common pathogen isolated was Staphylococcus epidermidis (n = 86, 73.5%), followed by Klebsiella pneumoniae (n = 11, 9.4%). Methicillin resistance among staphylococci (77/93, 82.8%) and extended-spectrum beta-lactamase (ESBL) production among Enterobacterales (14/17, 82.4%) were common. Gentamicin resistance was detected in 70.1% (54/77) of methicillin-resistant staphylococci and 78.6% (11/14) of ESBL (+) Enterobacterales. Vancomycin and colistin resistance were not detected. Conclusion The high rate of resistant pathogens encountered in neonatal BSIs underline the importance of constant surveillance of the local pathogens and their antimicrobial susceptibility patterns, which is crucial for implementing appropriate therapy that could save lives and lower the burden of antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Background The long-standing antimicrobial resistance (AMR) pandemic has proven difficult to resolve and is becoming more complex, especially in the context of increasing forced migration, with little evidence around patterns of AMR in migrant communities. This study aimed to determine the frequency in the carriage of common types of antimicrobial-resistant bacteria between Syrian refugees and the local communities in Türkiye: extended-spectrum β-lactamase (ESBL), methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Methods We collected nasal swabs and stool samples from the study participants, the local community members, and refugees, between September 2020 and March 2021. We screened clinical samples for the presence of ESBL, MRSA and VRE. Antimicrobial-resistant bacterial isolates were tested by phenotypic analysis to determine the AMR status. Results The study included a total of 3960 participants: 1453 individuals in the local community (36.2%) and 2525 Syrian refugees (63.8%). Overall, a significantly greater proportion of refugees (6.7%) carried MRSA compared to the local community (3.2%) (P  < 0.001). The ESBL-positivity rate was 17.9% in Syrian refugees and 14.3% in the local community (P  = 0.041). Carbapenemase activity was detected in three isolates from Syrian refugees. No VRE was detected in Syrian refugees or the local community. Conclusions This large, community-based study on the frequency and the distribution of AMR among Syrian refugees and the local population is the first study in Türkiye. [ABSTRACT FROM AUTHOR]

Objective: Here, we compared the impact of different polices on the epidemiology of Vancomycin-resistant Enterococcus faecium bloodstream infections (VRE-BSIs) in a tertiary care hospital including two hospital buildings (oncology and adult hospitals) in the same campus. Material and Methods: All patients who were hospitalized in high-risk units were screened weekly for VRE colonization via rectal swab between January 2006 and January 2013. After January 2013, VRE screening was only performed in cases of suspicion of VRE outbreak and during point prevalence studies to evaluate the epidemiology of VRE colonization. Contact precautions were in place for all VRE-positive patients. The incidence density rates of hospital-acquired (HA)-VRE-BSIs were compared between two periods. Results: While the rate of VRE colonization was higher in the second period (5% vs. 9.5% (p < 0.01) for the adult hospital, and 6.4% vs. 12% (p = 0.02 for the oncology hospital), there was no increase in the incidence rate HA-VRE BSIs after the cessation of routine rectal screening in either of the hospitals. Conclusion: Screening policies should be dynamic and individualized according to the epidemiology of VRE as well as the workforce and cost. Periodical rectal screening of VRE can be discontinued if suspicion of an outbreak can be carefully monitored. [ABSTRACT FROM AUTHOR]

Copyright of Van Health Sciences Journal / Van Sağlık Bilimleri Dergisi is the property of Van Yuzuncu Yil University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Morbidity and mortality associated with antimicrobial resistance is a global public health problem. Vancomycinresistant Enterococcus faecium, which is frequently seen in healthcare-associated infections, is a Gram-positive cocci that the he World Health Organization has given high priority on its list of priority pathogens with antimicrobial resistance. Recently, the rate of vancomycin-resistant Enterococcus faecium isolation in invasive infections has been reported as 15.8% in Turkey. The main mechanism of resistance to vancomycin is alteration of the D-alanyl-D-alanine terminal molecule in the target region, and decreased affinity for the antibiotic. The van gene responsible for vancomycin resistance is either chromosomally encoded or acquired by mobile genetic elements such as plasmid and transposon. The main mechanism of its spread is that mobile genetic elements can be transferred within the same species or between different bacteria like Staphylococcus aereus. In this review, data, extracted by PubMed and Web of Science Databases searching with the terms "Vancomycin-resistant Enterococcus faecium", "Vancomycin resistance mechanisms", "vancomycin resistance in Gram-positive cocci" is summarized and briefly discussed with recommendations. [ABSTRACT FROM AUTHOR]

The emergence and spread of high-level gentamicin resistant (HLGR) enterococci have been a concern due to the eliminatation of bactericidal effect between aminoglycosides and cell-wall-active antimicrobials. Therefore, this study to determine the fecal carriage of (HLGR) enterococci in dogs and cats, to investigate the antimicrobial resistance, resistance mechanisms implicated and virulence genes of the isolates. A total of 465 rectal swab samples from dogs (n=226) and cats (n=239) from three different cities (Istanbul, Ankara and Mersin) of Turkey were used for the analysis of HLGR enterococci. The antimicrobial susceptibilities of HLGR isolates were searched by disc diffusion method, resistance and virulence genes by polymerase chain reaction (PCR) and minimum inhibitory concentration (MIC) values for gentamicin were determined by macrodilution method. HLGR enterococci were detected in 25 (11.1%) dogs and in 28 (11.7%) cats. Based on PCR results, 12 were identified as Enterococcus feacalis and 41 as Enterococcus faecium. All of the isolates showed a MIC value of ≥2048 µg/ml for gentamicin, and except one isolate, the rest of the isolates showed multidrug resistance (MDR) phenotype. None of the isolates displayed vancomycin resistance phenotype. The bifunctional enzyme encoded by aac(6)-Ie-aph(2)-Ia were detected in HLGR isolates as well as other aminoglycoside resistance genes at varying rates. Virulens genes were only detected in 11 (20.8%) E. faecalis isolates with different combinations. However, none of the isolates carried the hly gene. The results showed that both dogs and cats are a potential reservoir for MDR HLGR enterococci which may play an important role in the spread of these nosocomial pathogens. [ABSTRACT FROM AUTHOR]

In this study, antibiotic resistance in 47 vancomycin‐resistant lactic acid bacteria (VRLAB), isolated from 340 foods of animal origin obtained in Turkey, were investigated. VRLAB isolates were molecularly identified as Enterococcus gallinarum (44.68%), Pediococcus pentosaceus (25.53%), P. acidilactici (12.77%), E. casseliflavus (6.38%), E. casseliflavus/E. gallinarum (4.26%), Weissella cibaria (2.13%), W. confusa (2.13%), and W. minor (2.13%). The disk diffusion test results showed that 57.45%, 53.19%, 44.68%, and 44.68% of VRLAB were resistant to ciprofloxacin, norfloxacin, teicoplanin, and vancomycin, respectively. It was found that all the Pediococcus and Weissella isolates and 53.85% of the Enterococcus isolates had multiple antibiotic resistance. Various transferable antibiotic resistance genes were found in the VRLAB using polymerase chain reaction (PCR). The most common antibiotic resistance genes in the VRLAB isolates were vanC1 (46.81%), tetM (23.4%), and ermB (19.15%). Practical applications: Lactic acid bacteria (LAB) play a key role in food fermentations. However, antibiotic resistance in LAB is a concern because these bacteria can, potentially, be a reservoir that facilitates the spread of antibiotic resistance genes to pathogenic bacteria. Vancomycin is a glycopeptide antibiotic that is used as a last resort in the cure of multidrug‐resistant enterococci. In this study, vancomycin‐resistant Enterococcus, Pediococcus, and Weissella strains were isolated from foods of animal origin. Several transferable antibiotic resistance genes were detected in these isolates. The results of this study indicated that VRLAB strains isolated from foods of animal origin may be the reservoirs for antibiotic resistance genes. Our findings suggest that antibiotic resistance profiles and resistance genes, in addition to industrial characteristics, should be investigated when selecting LAB from foods of animal origin to be used as starter cultures. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Academic Research in Nursing (JAREN) is the property of Hemsirelikte Egitim ve Arastirma Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

There are limited data regarding the prevalence of vancomycin-intermediate Staphylococcus aureus (VISA)/heterogeneous VISA (hVISA) among pediatric population. Our objective was to determine the distribution of vancomycin and daptomycin minimum inhibitory concentrations (MICs) and explore the phenomenon of vancomycin MIC creep and the VISA/hVISA prevalence among the methicillin-resistant Staphylococcus aureus (MRSA) strains belonging to pediatric population by population analysis profile-area under the curve (PAP-AUC) and Etest macromethod. Vancomycin and daptomycin susceptibilities of 94 pediatric isolates of MRSA were tested by broth microdilution (BMD) and Etest methods. To determine the prevalence of VISA/hVISA, Etest macromethod and PAP-AUC was performed on all isolates. All isolates were susceptible to vancomycin and daptomycin by both BMD and Etest methods. Twenty-eight (29.8%) isolates had vancomycin MICs of 2 μg/ml by BMD. No increase in vancomycin MICs was observed over time. There were no VISA among 94 MRSA tested but 20 (21.3%) hVISA isolates were identified by PAP-AUC. Results of Etest macromethod were compared to PAP-AUC. Etest macromethod was 60.0% sensitive and 90.5% specific. The hVISA isolates represented 53.6% of isolates with vancomycin MICs of 2 μg/ml. Also, 75% of hVISA isolates had vancomycin MICs of 2 μg/ml. To our knowledge, this is the first study investigating the prevalence of VISA/hVISA among MRSA isolated from pediatric patients by PAP-AUC method. Based on our findings, MRSA isolates, which have vancomycin MIC of 2 μg/ml can be investigated for the presence of hVISA. In this study, daptomycin showed potent activity against all isolates and may represent a therapeutic option for MRSA infections. [ABSTRACT FROM AUTHOR]

The aims of this research were to study the prevalence of potential virulence factors, vancomycin resistance and also to evaluate a possible correlation that can exist between vancomycin resistance and potential virulence factors between 51 Enterococcus spp. isolated from food and 50 Enterococcus faecium strains from human in southern Turkey. Identification of the isolates was determined by Vitek-II system. Antimicrobial susceptibility tests were performed by Vitek-II system and disc diffusion method. The presence of vanA and vanB as well as enterococcal virulence genes of cytolysin (cylA), the aggregation substance (asa1), gelatinase (gelE), enterococal surface protein (esp), hyaluronidase (hyl) were investigated by Polymerase Chain Reaction (PCR) method. Haemolysin production was also studied phenotypic method. Apart from one isolate, none of the food originated enterococci were resistant to vancomycin, and none carried vanA and vanB resistance genes. All clinical isolates were resistant to vancomycin and 84% of them carried vanA; 2%, vanB; and 14%, neither vanA nor vanB genes. Except for the cylA gene, all other virulence genes and vancomycin resistance were higher in human strains, and a positive correlation was observed between multivirulence genes and hemolytic activity. For all strains, a positive correlation existed between the esp gene positivity and vancomycin resistance, while for only E. faecium, esp, hyl gene positivity and vancomycin resistance a positive correlation could be seen. Furthermore, "silent cylA" genes were found in two food and one intestinal strains. Based on our findings, we can suggest that virulence increases in parallel to vancomycin resistance, and food may be a potential source for dissemination of gelE, asa1 and hyl virulence genes. Finally, esp and hyl genes presence should carefully be monitored in food originated enterococci. [ABSTRACT FROM AUTHOR]

Species distribution, virulence traits and vancomycin resistance gene profiles of Enterococcus isolated from 43 home-made artisan cheese samples collected from open markets, located in Aydin region of Turkey, were investigated. Of the 129 isolates, 95 were identified as Enterococcus sp.; Enterococcus faecium being the most prevalent species (82.1%), followed by Enterococcus faecalis (13.6%) and Enterococcus durans (1.0%). None of the enterococci were harbouring vanA or vanC, while seven isolates (7.3%) were shown to harbour vanB gene by multiplex PCR. gelE (49.4%) being the most prevalent virulence factor was followed by asa1 (27.3%), esp (22.1%), cylA (4.2%) and hyl (3.1%). [ABSTRACT FROM AUTHOR]

Objectives: Vancomycin resistance is due to change in ligase enzyme that destroys the binding of the drug. The gold standard is culture; but now molecular methods have also been developed. The aim was to detect the VRE rate at ICUs by culture and BD GeneOhm™ VanR and compare the results of both assays. Methodology: 135 perianal swabs were taken from the patients at ICUs between January 1st 2009 and April 30th 2009. Samples were identified by conventional methods and BD GeneOhm VanR assay. Results: In newborn ICU, 41 patients (74.6%) were negative by both methods. Two (3.6%) were positive by both methods. Twelve (21.8%) of them were culture negative and PCR positive. In adult ICU, 73 (91.3%) patients were negative by both methods. Seven patients (8.8%) were positive by molecular method only. Conclusion: This study showed low VRE positivity due to factors like inhibition in PCR or culture negativity due low inoculum for bacterial growth. Early detection of VRE is an important issue especially in ICUs and molecular techniques are important tools; but against all, we still need to confirm this method with culture based techniques and in order to do this further studies with higher number of patients with VRE colonisation are required. [ABSTRACT FROM AUTHOR]

In the present study, the prevalence of vancomycin-resistant enterococci (VRE) in turkeys in the southwest of Germany was investigated. For this purpose, 200 cloacal swab samples and 5 environmental dust samples (tested as a pooled sample) of each of the 20 flocks (10 female and 10 male flocks) included in this study were examined. The VRE could be isolated by means of a procedure combining bacterial cultivation in an enrichment broth and on a selective solid media. Enterococci were identified biochemically and subsequently tested on the presence of the vancomycin resistance genes vanA, vanB (B1/B2/B3), and vanC (CI/ C2/C3) using real-time PCR assays. In 54 (27%) turkeys originating from 11 (55%) flocks and in 14 (70%) of the dust samples, exclusively vanA and vanCl genes could be detected. Of the turkeys examined, 46 were colonized with VRE bearing the resistance gene vanCl and 8 vanA, originating from 9 and 2 flocks, respectively. None of the birds carried vanB, vanC2, or vanCS positive VRE. The results obtained from the birds are largely confirmed by the dust samples originating from 4 vanA and 10 vanCl positive flocks. However, one flock housing animals colonized with vanCl positive VRE could not be confirmed by the dust samples that revealed vanA bearing VRE. However, in one case vanA and in 3 cases vanCl carrying VRE could be detected in dust samples of the turkey houses, but not in the turkeys of the associated flock. In 5 flocks the turkeys as well as the dust samples were free of VRE. [ABSTRACT FROM AUTHOR]

Abstract: This study was aimed to identify the incidence of vancomycin-resistant enterococcus (VRE) colonization in burn patients, to collate risk factors for colonization and to determine the VRE resistance profile to different antimicrobial agents. This prospective study was carried out on the burn unit, during the period from September 2008 to January 2010, in 128 patients who were hospitalized at least 3 weeks or more. Periodic swabs were taken from burn wound, rectal, axillary, umblicaly and throat regions of the patients on admission and 7th, 14th, 21st days of hospitalization. Demographics and known risk factors were retrieved and assessed by statistical methods. Only 20 patients (15.6%) were colonized with enterococci on admission and these strains isolated from rectal, umblical and throat samples were sensitive to vancomycin. Initial VRE isolation was made in the first samples from the rectum of two patients on the 7th day. The rates of rectal, umblical, throat and axillary colonization increased to 21.9%, 3.1%, 3.1% and 3.1% at 28th day, respectively. VRE strains were the first isolated from burn wounds of only one patient (0.8%) on the 14th day and the colonization rate increased to 7.0% at the 28th day. Our study indicated that rectal colonization was seen more than other sites of colonization and was strictly correlate to colonizing enterococci between burn wound and other body regions. Multivariate analyses showed that glycopeptide use, burn depth and total burn surface area were independent risk factors for acquisition of VRE. All VSE strains were susceptible to teicoplanin, tigecycline and linezolid. VSE strains were more resistant to gentamicin and streptomycin, and VRE strains were more resistant to penicillin and ampicillin. The present study showed tigecycline and linezolid to be most active agents against VRE strains. The determined VRE colonization and risk factors of VRE acquisition are expected to be useful in establishing guidelines for preventing VRE infection in burn unit. [Copyright &y& Elsevier]

Abstract: In the present study, chemical compositions, antimicrobial and antioxidant activities of the essential oils of Sideritis erythrantha var. erythrantha (SE) and Sideritis erythrantha var. cedretorum (SC), which are endemic taxa in Turkey, were investigated. The essential oils obtained by hydrodistillation were analyzed by gas chromatography–mass spectrometry (GC–MS). α-Pinene was the major component of the essential oils of SC and SE. SC essential oil was as effective as antibiotic against methicillin-resistant Staphylococcus aureus (MRSA), vancomycin resistant Enterococcus faecalis (VRE), ampicillin resistant Haemophilus influenzae and vancomycin sensitive E. faecalis. Similarly, SE essential oil was also as effective as antibiotic against VRE and ampicillin resistant H. influenzae. Antioxidant activities of the essential oils of SC and SE were determined by 1,1-diphenyl-2-picrylhydrazyl (DPPH), β-carotene/linoleic acid and reducing power. Both essential oils exhibited weak antioxidant activity. This is the first report on antimicrobial and antioxidant activities of the essential oils of SC and SE. [Copyright &y& Elsevier]

Reported here is the first isolation of vancomycin-resistant Enterococcus (VRE) at a hospital in northwestern Turkey and a description of the ensuing outbreak investigation. The first isolate was obtained from a wound culture of a patient in an intensive care unit. Thereafter, a total of 205 rectal swabs, 67 skin swabs and 123 environmental samples were screened, revealing five more VRE isolates. All isolates showed similar antibiotic resistance patterns, except for two that differed regarding gentamicin resistance. The vanA gene was present in all isolates. Pulsed-field gel electrophoresis demonstrated that all isolates belonged to a single clone, with the gentamicin-resistant isolates demonstrating two-band differences. This is the first outbreak to be caused by spread of a single VRE clone in Turkey; it was successfully controlled by strict adherence to appropriate infection control practices. [ABSTRACT FROM AUTHOR]

Presents several letters from various universities and hospitals about cases of infectious diseases. Characterization of a male gonococcal urethritis case that persisted despite of ciprofloxacin therapy in Israel; Bacterium identified in a male farmer who had brain abscess; Details on the first case of vancomycin-resistant enterococci bloodstream infection in a patient with an acute myelocytic leukemia in Turkey.

Introduction: Heteroresistant vancomycin intermediate Staphylococcus aureus (hVISA) testing is recommended when therapeutic failure is suspected in the clinics. In our research, we aimed to investigate the prevalence of hVISA among methicilline-resistant S. aureus (MRSA) isolates in our university hospital and compared three methods for detection of hVISA., Methodology: One hundred MRSA clinical isolates were collected in our medical microbiology laboratory between 01.04.2018 and 01.10.2019. For screening of hVISA, we used two screening agar plates and used one commercial medium; brain heart infusion agar (BHI) plates containing 4 µg/mL vancomycin and 16 g/Lt casein (BHIA-VC; Satola's test), BHI agar plates containing 4 µg/mLvancomycin (BHIAV), and commercially obtained vancomycin resistant Enterococci (VRE) agar for detetection of hVISA. Colonies which could grow on plates were counted manually at 24th and 48th hours., Results: Among 100 MRSA isolates, 43 (43%) were found as hVISA using Satola's test. BHIAV and VRE agar screening test results were found 70% and 4%, respectively. Finally, at the step, MIC values of 20 (47%) hVISA isolates reduced to 2 µg/mL after sub culturing for the gradient test., Conclusions: We found higher rates of hVISA comparing other studies in Turkey. Both VRE agar and BHIAV screening test failed to detect hVISA properly. Meropenem in combination with vancomycin inhibited the growth of 90% hVISA isolates in our study., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2021 Deniz Gazel, Mehmet Erinmez, Ayse Buyuktas Manay, Yasemin Zer.)

Background: Vancomycin-resistant enterococcus (VRE) is an infectious agent that can increase morbidity and mortality, especially in patients with neutropenia in haematology departments. We analysed VRE infections and mortality rates among VRE colonized patients with acute leukaemia, defined predisposing risk factors for infection and mortality, and investigated the influence of daptomycin or linezolid treatment on mortality., Patients-Methods: We included 200 VRE colonized adult acute leukaemia patients with febrile neutropenia between January 2010 and January 2016. Data were collected from electronic files., Results: There were 179 patients in the colonized group, and 21 patients in the infected group. Enterococcus faecium (van A) was isolated from all patients. The infection rate was 10.5 %, and the types of infections noted were as follows: bloodstream (n = 14; 66.7 %), skin and soft tissue (n = 3; 14.3 %), urinary (n = 2; 9.5 %), and others (9.5 %). In the multivariate logistic regression analysis, exposure to invasive procedures, coinfection status, and >15 days of VRE positivity were independent risk factors for VRE infections. In hospital mortality rates were 57.1 % in the infected group, and 9.5 % in the colonized group (p < 0.001). Older age, female gender, absolute neutropenia, and coinfection status were statistically significant predictor of survival., Conclusion: Vancomycin-resistant enterococcus infections are associated with high morbidity and mortality in haematology patients with neutropenia. Clinicians should be aware of predisposing risk factors for VRE infection to avoid unfavourable outcomes. We believe that larger studies are necessary regarding the influence of treatment with daptomycin and linezolid., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Hospital acquired methicillin-resistant Staphylococcus aureus (MRSA) infections are important health problems. Mortality and morbidity rates associated with MRSA infections are increasing with mortality rates being higher for MRSA bacteremia than the other clinical presentations of MRSA infections. Initiation of treatment immediately and use of appropriate antibacterial agents may lead to better clinical outcomes in MRSA bacteremia. The aims of this study were to evaluate the treatment and clinical outcomes of patients with MRSA bacteremia in a tertiary care hospital in Ankara, Turkey. Two hundred forty seven MRSA strains isolated from blood cultures at Hacettepe University Faculty of Medicine, Clinical Microbiology Laboratory between January 2000-December 2010, were evaluated retrospectively. Demographic characteristics, duration of bacteremia, types and duration of antibiotic treatment, presence of other pathogens and all other necessary information were collected from patients' registry. One hundred eighty four patients who had clinically significant bacteremia were analyzed. The mean age of the patients was 55 ± 17 years, of them 44.6% were female and 55.4% were male. The median length of hospital stay was 61 days. The median duration for the development of MRSA bacteremia from the time of admission was 23 days. Overall mortality rate was 54.9%, and mortality rate due to MRSA bacteremia was 19%. The rate of treatment success was 81%. There were 3 (1.6%) patients with vancomycin MIC value of 0.5 mg/L, 140 (76.1%) patients with 1 mg/L and 41 (22.3%) patients with 2 mg/L. The median duration from the time of MRSA bacteremia detection to the time of death was shorter in unsuccessfully treated group than successfully treated group (7 days vs. 30 days, p< 0.001). Thirty days mortality rate was higher in unsuccessfully treated group than successfully treated group (94.3% vs. 50.7%, p< 0.001). The median time interval between positive and negative cultures was 9.5 days. Number of patients with MRSA bacteremia had been decreasing for the last five years (36 patients in 2006, 18 in 2007, 16 in 2008, 12 in 2009 and one in 2010). In multivariate logistic regression analysis, it was shown that, intubation (OR: 5.086, 95% CI: 2.094-12.351; p< 0.001) and malignancy (OR: 2.789, 95% CI: 1.185-6.564; p= 0.019) were independent risk factors for mortality. In this study, it was shown that mortality rate was high in MRSA bacteremia and high MIC value was not an independent risk factor for mortality. It was also noted that when there was no clinical response to vancomycin, the therapy should be changed immediately. To decrease MRSA bacteremia rates in the hospital adherence to rules of infection control and prevention proved to be important factors.

Vancomycin-resistant enterocococci (VRE) are common pathogens that may lead to infection in intensive care units. VRE strains that colonize the hospital environment can stay alive for a long time on fomites and can easily be spread by the hands of hospital staff and by the instruments. The aim of this study was to evaluate the epidemic and sporadic VRE cases, following an epidemic at anesthesiology intensive care unit (ICU). The records of the patients hospitalized at anesthesiology ICU between October 2010-June 2011 were evaluated retrospectively. The hospitalized patients with VRE positive culture reports were included in this study. Rectal swab samples of the patients and environmental surveillance cultures were inoculated on sheep blood agar and enterococcosel agar media and incubated for 24-48 hours. The isolated strains were identified by conventional methods and automatized Vitek 2.0 system (BioMérieux, France). The molecular detection of VRE was performed by real-time polymerase chain reaction (Cepheid GeneXpert System, USA). A total of 19 VRE colonised or infected cases (11 male, 8 female; age range: 18-96 years, mean age: 60 years) that were detected sporadically or during the epidemic, were included in this study. Ten (52.6%) cases were evaluated as colonization (seven rectal, two urinary and one both urinary and rectal colonisation). Nine patients were considered as infected (five bacteremia, three catheter infections and one urinary tract infection). Five of the nine patients directly progressed to infection. Four of the nine patients progressed to infection after rectal colonization. Eight of the infected cases were treated with daptomycin and one case with linezolid. Five of the infected and treated cases died and the rate of mortality was determined as 55.6%. PCR was applied to the samples of eight cases and vanA was detected in seven of these. VRE were not grown in two of the PCR positive samples and one PCR positive sample did not yield VRE growth in culture. VRE were detected from the samples obtained from patients' monitors, infusion sets, bedside, bedstands and walls and the origin of VRE was thought to be environmental contamination. It was concluded that adherence to infection control guidelines and continuous education of the health-care personel were prerequisites for effective control of VRE colonization and infection in the health-care setting.

The incidence of infections caused by multidrug resistant gram-positive bacteria is increasing worlwide. In addition, emergence and dissemination of glycopeptide resistance in enterococci has accelerated the need for the development of new antimicrobial agents for treatment. Linezolid which is an oxazolidinone and dalbavancin which is a second-generation, semi-synthetic lipoglycopeptid are important therapeutic options for infections caused by antimicrobial-resistant gram-positive pathogens. The aim of this study was to investigate the in-vitro antimicrobial activity of linezolid and dalbavancin against vancomycin- resistant enterococci (VRE). A total of 100 VRE strains, isolated from rectal swabs of patients hospitalized in Istanbul University Faculty of Istanbul Medicine between 2006-2007 were included in the study. All strains were identified as Enterococcus spp. by conventional methods and had minimum inhibitory concentrations (MICs) of ≥ 32 µg/ml for vancomycin. Vancomycin, linezolid and dalbavancin susceptibility testing was performed by broth microdilution method. For the quality control of the tests, S.aureus ATCC 29213 and E.faecalis ATCC 29212 were included in each run. Molecular identification of linezolid-resistant strains (n= 2) were done by 16S rRNA sequencing and resistance mechanisms were tested by 23S rRNA sequencing. Against VRE strains, MIC50, MIC90 and MIC ranges of linezolid and dalbavancin were found as 4, 4, 1-16 µg/ml and 32, 64, 0.25-128 µg/ml, respectively. Linezolid susceptibility, intermediate susceptibility and resistance rates were found as 32%, 66% and 2% in the same order. Linezolid-resistant two strains were identified as E.faecium, and this data was confirmed by Pasteur Institute. Both of those isolates had G2576T mutations in 23S rRNA genes. Because susceptibility breakpoint for dalbavancin has not been established by Clinical and Laboratory Standards Institute (CLSI) yet, susceptibility and resistance rates for dalbavancin were not indicated. According to the MIC results, linezolid was found to be the most effective antibiotic against VRE strains, and dalbavancin was found more effective than vancomycin. Additionally, our results showed that routine susceptibility testing of VRE strains isolated from hospitalized patients to linezolid was required.

Thirty eight vancomycin resistant enterococci (VRE) were isolated in one year surveillance study for hospital infection control programme in a state hospital in Ankara, Turkey. All isolates were identified as Enterococcus faecium by VITEK2 system (bioMerieux, France). Vancomycin and teicoplanin resistant 30 strains were defined as vanA phenotype while vancomycin-resistant teicoplanin-susceptible eight strains were defined as vanB phenotype. vanA genes were found in 30 strains while vanB genes were found in five strains by using PCR method. Those five strains were the first vanB positive E.faecium strains in our country. VRE strains revealed six different band patterns by PFGE, while six isolates could not be classified. All isolates with vanB type resistance were found in the same cluster. Source of vanB positive strains was considered as the hemodialysis unit. When the previous national reports related to vancomycin-resistant enterococci were considered, this was the first report of vanB positive E.faecium isolates in our country. This emphasized that both the diversity of VRE and the isolation rate was increasing. In order to eliminate the spread of VRE, effective surveillance studies should be performed and protective measures should be established promptly.

Enterococci are members of normal flora of human gastrointestinal system, and occupy the first places among the agents causing nosocomial infection. The most frequent origin of vancomycin-resistant enterococcus (VRE) is the gastrointestinal colonization in hospitalized patients. Prolonged hospitalization, long-term antibiotic use and severe underlying diseases increase the risk of VRE colonization. Routine VRE surveillance of high-risk group patients is crucial for early detection and implementation of precautions to impede the development of infection and spread of VRE. The aim of this study was to evaluate the status of VRE colonization in Oncology Department of Gaziantep Children's Hospital, Turkey, following a VRE isolation from the urine sample of a patient (index case). In the first phase of this point prevalence study VRE screening was done after positive VRE result was obtained from the index case, and in the second phase VRE colonization rate was investigated after the implementation of infection control policies. Perirectal swab samples collected from patients were cultivated into supplemented VRE agar base (Oxoid, UK) including vancomycin 6 µg/ml and 5% sheep blood agar. The isolates were identified by conventional methods together with API 20 Strep (bioMerieux, France) and VITEK2 (bioMerieux, France) identification systems. Vancomycin (30 µg) and teicoplanin (30 µg) susceptibilities of the isolates were investigated by Kirby-Bauer disc diffusion method according to CLSI criteria. In addition, VITEK2 antibiogram cards, AST-592 were used to determine antibiotic susceptibilities. In the first phase of the surveillance a total of 123 perirectal swab specimens obtained from patients staying at oncology, burn, pediatric surgery and intensive care units (ICU) were investigated and the rate of VRE colonization was determined as 14.6% (18/123). Thirteen of the VRE colonized patients were from oncology wards and five were from ICU. Upon the detection of VRE colonization, contact isolation was implemented and hospital staff was educated for hand washing and restricted antibotic use policies were established. To evaluate the efficacy of infection control implementations, perirectal swab samples were collected from 242 patients under antibiotic treatment and hospitalized in several wards and ICU for ≥ 3 days. The results of this second control surveillance revealed that VRE colonization rate declined to 3.3% (8/242), and three of these VRE colonized patients were in the ICU, three in the oncology ward and one of each in burn and pediatric wards. During the study period blood stream infection developed in three of the previously colonized oncology patients of whom one patient also had simultaneous pneumoniae due to VRE. The results of this study indicated the importance of VRE surveillance at the hospital setting. The determination of the VRE colonization in the hospital will help the implementation of appropriate infection control measures and eventually decrease the rate of nosocomial VRE infection.

Infections and outbreaks of vancomycin-resistant enterococci (VRE) still appear to be rare in Turkey. In the present study, VRE strains isolated during an outbreak in a haematology unit of a training and research hospital in Turkey were typed and their antimicrobial-resistance patterns were characterized by molecular methods. Twelve vancomycin-resistant Enterococcus faecium strains isolated from patients with haematological malignancies were investigated by PCR for the presence of genes encoding resistance to vancomycin, tetracycline, chloramphenicol, gentamicin and erythromycin. Their clonal relationship was evaluated by PFGE and multilocus sequence typing. All strains were resistant to vancomycin and erythromycin, and had the vanA and ermB genes, respectively. PFGE was used to determine the presence of two pulsotypes and determine their subtypes. Pulsotype A belonged to sequence type (ST) 17 and pulsotype B belonged to ST 78. All strains with the vanA gene were not the same clone, indicating multiple acquisitions of resistant isolates, even over such a short time period.

In this work, actinomycetes isolates were isolated from rock wall and speleothem surfaces and soil samples of 19 karstic caves in Turkey. Out of 290 isolates isolated, 180 isolates (62%) exhibited antimicrobial activity against a panel of four bacteria, two yeasts and four filamentous fungi in the screening program. One of them, Streptomyces sp. 1492, was examined for antibiotic production in batch culture. The maximum of antimicrobial activity was shown at 5th day. Antimicrobial activity of the extracted active compound was recorded as dose dependent bacteriostatic or bactericidal against antibiotic resistant clinical bacteria strains; methicillin-resistant Staphylococcus aureus (MRSA), vancomycin resistant Enterobacter faecium (VRE), and Acinetobacter baumanii. Minimum inhibitor concentration and minimum bactericidal concentrations were determined as lower than standard antibiotic streptomycin; 125 microg/ml and 250-1000 microg/ml, respectively. Active component was found as heat-stable.

Background: Despite growing concern about vancomycin-resistant enterococci (VRE) as nosocomial pathogens, especially in the USA, they have been rarely isolated in Turkish hospitals. After initial description in 2001 of unrelated VRE isolates, we report now the molecular characterization of a nosocomial outbreak at the Akdeniz University Hospital, Antalya, Turkey., Methods: VRE isolates were from either clinical or rectal swab specimens. Identification, susceptibility testing and molecular characterization were performed according to standard techniques. Virulence genes (encoding aggregation substance, gelatinase, cytolysin, enterococcal surface protein and hyaluronidase) were sought by PCR., Results: Thirty-six VRE were isolated from 10 patients between June and October 2005 in the Department of Paediatrics. Six patients were only carriers, two had urinary tract infections and two had bloodstream infections. All isolates were Enterococcus faecium, of vanA genotype and belonged either to a main pulsotype (A) or to three minor pulsotypes (B, C and D). The epidemic strain A, found in eight patients, expressed high-level glycopeptide resistance (MIC of vancomycin 256 mg/L and MIC of teicoplanin 64 mg/L) and was of multilocus sequence typing sequence type (ST) 31, whereas the minor strain D, found in two patients, expressed heterogeneous glycopeptide resistance (MIC of vancomycin 8 to 256 mg/L) and was ST18. Strains B and C were only found in single patients either with strain A or alone. The two epidemic strains A and D were esp gene-positive. Their vanA genes were located on transposons similar to Tn1546, except for deletion of the transposition genes and the presence of IS1542, inserted upstream of the vanA operon, and IS1216, inserted at the 3' end of the vanX gene. VRE outbreak was contained by early identification and implementation of measures for patient isolation and of stringent hand and environmental disinfection policies., Conclusions: This work underlines the emergence in Turkey of epidemic VRE clones that belong to the clonal complex-17 (CC-17) and that are esp-positive.

The emergence of Staphylococcus aureus strains with intermediate resistance (VISA) and heterogen resistance (hVISA) to vancomycin leads to the occurence of severe therapeutic problems. The aim of this study was to investigate the vancomycin resistance in methicillin resistant S. aureus (MRSA) and coagulase-negative staphylococci (MRCoNS) isolated from clinical samples in Bacteriology Laboratory of Microbiology and Clinical Microbiology Department of Celal Bayar University Faculty of Medicine, Manisa (located in western Anatolia, Turkey). A total of 120 staphyloccoccal strains (92 MRSA and 28 MRCoNS) isolated from different clinical specimens (tracheal aspirate, blood, abscess, wound swabs, sputum, catheter tips, etc) between the period of June 2005 to December 2006 were included to the study. Vancomycin resistance were determined by agar screening method using brain hearth infusion agar plates containing 6 microg/mL vancomycin. Standard E-test and macro E-test methods were performed for 17 (14%) staphylococcal strains (10 MRSA and 7 MRCoNS) which had grown in agar screening plates. Vancomycin and teicoplanin minimal inhibitory concentration (MIC) ranges of those strains were found as 1.5-4 microg/mL and 2-4 microg/mL, respectively, by standard E-test method. In our study, no VISA and hVISA isolates were detected when MIC value of > or =8 microg/mL for vancomycin and teicoplanin, or > or =12 microg/mL for teicoplanin only were accepted as the criteria for hVISA determination. Agar screening method which is preferably used in routine laboratories for practical and economical reasons, lower sensitivity and specificity than E-test. It can be concluded that, since agar screening method is not reliable for the detection of vancomycin resistance, further multi-center studies with the use of standard methods are needed in order to clarify the vancomycin resistance patterns of staphylococci in our country.

The aims of this study were to detect the prevalence of fecal vancomycin resistant Enterococcus (VRE) colonization with high-level resistance to aminoglycoside and other antibiotics and, the risk factors related to resistance in hospitalized patients in Düzce Medical Faculty Hospital, Turkey. A total of 105 patients (61 from internal medicine, 44 from surgery clinics; 54.3% female, mean age: 47.2 +/- 24.54 years) were included to the study and a single stool sample was collected from each of the patients. Specimens were cultivated in Enterococcus selective media (BioMerieux, France), and the isolates were identified by conventional microbiological methods together with the API 20 Strep test. Beta-lactamase activities of the isolates were tested with nitrocefin disk, and antibiotic susceptibilities were determined by the disk diffusion method. Enterococcus spp. were isolated from 81 (77%) of the patients' samples and 60.5% were identified as E. faecium, 13.6% as E. faecalis, 11.1% as E. gallinarum, 7.4% as E. durans, 2.5% as E. raffinosus, 2.5% as E. mundtii, 1.2% as E. casseliflavus, and 1.2% as E. avium. High-level streptomycin and gentamicin resistance rates were found in 19.8% and 9.9% of the isolates, respectively. The resistance rates for the other antibiotics were found as follows; 18.5% to ampicillin, 27.2% to penicilin, 34.6% to nitrofurantoin, 65.4% to norfloxacin, and 70.4% to both tetracycline and ciprofloxacin. No vancomycin resistance was detected, and none of the enterococci had beta-lactamase activity. Long hospitalization period, antibiotic usage and experience of intra-abdominal operation were found as the significant risk factors for colonization of the resistant bacteria. Our results demonstrated that there was no fecal VRE carriage in our hospital during the study period, however, it was concluded that the screening tests should be done periodically in order to detect resistant strains as soon as possible.

Here we describe a case of a neuroblastoma patient with recurrent vancomycin-resistant enterococcal infection successfully treated with ciprofloxacin. This is the first case of recurrent vancomycin-resistant enterococcal infection in our hospital and Turkey.

In this study, the prevalence and risk factors of fecal carriage of vancomycin resistant enterococci (VRE) among patients in Ondokuz Mayis University Pediatric Hematology and Oncology Clinics have been investigated. During two months, rectal swab samples were collected weekly from all of the patients hospitalized in Pediatric Hematology and Oncology Clinics, for the surveillance cultures. During the study a total of 85 rectal swabs were obtained from 34 patients who had been hospitalized in the inpatient clinic with 20 bed capacity. The number of samples obtained from the patients varied between 1-6 cultures. All of the patients (100%) had peripheral venous catheters and 27(79%) of patients had used antibiotics. All of the samples were inoculated onto 8 microg/ mL gentamicin containing blood agar media, and enterococci were identified by Gram staining, catalase test and at species level by VITEK 2 (bioMérieux, France) automated system. Vancomycin resistance was screened by using 6 microg/mL vancomycin containing brain-heart infusion agar according to CLSI guidelines. The vancomycin MIC values of the strains grown in this medium were determined by microdilution test proposed by CLSI. As a result, a total of 50 samples (59%) belonging to 24 patients yielded enterococci, and the species distribution was as follows; E. faecium (in 16 cases), E. faecalis (in 8 cases), E. casseliflavus (in 6 cases), E. avium (in 3 cases) and E. durans (in 1 case). In our study no vancomycin resistance nor VRE colonization was detected in the patients.

The aim of this study was to detect the species distribution and antibiotic resistance of enterococci with a special view for vancomycin resistance, isolated from stool and rectal swab samples of cattle farmers and cattles in Denizli region, Turkey. All the specimens were inoculated onto Enterococcosel agar plate and into Enterococcosel broth supplemented with and without vancomycin (6 microg/ml). The agar plates were incubated at 37 degrees C for 24 hours, while broth cultures were incubated at 37 degrees C for 48 hours. Enterococcus spp. were isolated from 96 (86.4%) of 111 farmers' and 65 (90.2%) of 72 cattles' specimens. The most commonly isolated species from both humans and animals were E. faecalis (39.6% and %32.3%, respectively), E. faecium (28.1% and 24.6%, respectively) and E. raffinosus (8.3% and 13.8%, respectively). None of the isolates were found to be resistant to vancomycin and teicoplanin. One high-level streptomycin (300 microg) resistant E. faecium, and six (2 E. faecalis, 2 E. durans, 2 E. hirae) high-level gentamicin (120 microg) resistant strains have been isolated from the specimens of cattle farmers and cattles, respectively. There was no significant difference between the rectal swabs and stool specimens for the isolation of Enterococcus spp. (p>0.05). Enterococcosel broth was found to be more sensitive than Enterococcosel agar for the isolation of Enterococcus spp. (p=0.001). It was concluded that the lack of vancomycin resistant enterococci may be related to the prohibition of avoparcin use in our country.

Objectives: We investigated vancomycin-intermediate Staphylococcus aureus (VISA) and heterogeneously vancomycin-intermediate S. aureus (hetero-VISA) isolates from clinical specimens of hospitalized patients at Hacettepe University over a 4 year period., Methods: Strains were screened for VISA and hetero-VISA by using brain heart infusion agar containing 4 mg/L vancomycin (BHI-V4) and macro Etest. Confirmation of the isolates that were found to have intermediate susceptibility to vancomycin with either of the methods was done by population analysis of subpopulations with reduced susceptibility to vancomycin. The MIC of vancomycin for the isolates grown on BHI-V4 was determined by the microdilution method., Results: Among 256 methicillin-resistant S. aureus (MRSA) isolates, 145 grew on BHI-V4. Forty-six of these were also found to be heterogeneously vancomycin-intermediate strains when screened with the macro Etest. There were no VISA among 256 MRSA tested but 46 (17.97%) S. aureus strains with reduced susceptibility to vancomycin were identified by population analysis. Vancomycin MIC values for all isolates with reduced susceptibility were between

Vancomycin-resistant enterococci are unusual etiologic agents of bacterial meningitis and pose significant therapeutic difficulties. We report the first confirmed case of nosocomial vancomycin-resistant Enterococcus faecium meningitis in Turkey. The patient was treated with chloramphenicol and cerebrospinal fluid cultures became negative, but clinical success was not achieved. We also review the previously reported cases of vancomycin-resistant Enterococcus faecium meningitis.

The aim of this study was to determine the in vitro antimicrobial activity of recently licensed quinupristin/dalfopristin and linezolid which have not yet been in clinical use in Turkey against methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) strains isolated from various clinical specimens by using the Etest. The results showed that all MRSA strains were fully susceptible to both the new compounds. All strains were inhibited by 1 mg/l quinupristin/dalfopristin (mode MIC 0.38 mg/l) and by 3 mg/l linezolid (mode MIC 1.5 mg/l). Four strains of Enterococcus faecium showed an increase of resistance of 2-3 mg/l to quinupristin/dalfopristin (susceptible mode MIC 0.38 mg/l). With linezolid, all strains except two fell within the range 0.75-2.0 mg/l.

Enterococci have been recognized as clinically important pathogens in high-risk populations of hospitalized patients. The role of enterococci in nosocomial infections is being recognized with increasing frequency. The main source of these infections is usually fecal carriage of the microorganisms. In this study, gastrointestinal colonization with vancomycin resistant enterococci (VRE) and high-level aminoglycoside resistant enterococci among 316 high-risk hospitalized patients were investigated. One hundred and ninety-eight enterococci strains were isolated from stool specimens. All strains were identified to species level and 90 of the isolates were identified as Enterococcus faecalis (45%), 85 as E. faecium (21.5%), 14 as E. avium (7%), 7 as E. raffinosus (3.5%), 1 as E. durans (0.5%) and 1 as E. hirae (0.5%). Eleven of 198 strains were found to be moderately sensitive to vancomycin (MIC: 8-16 microg/ml) by the agar dilution method according to the National Committee for Clinical Laboratory Standards (NCCLS) recommendations, and the rest of these strains were found to be sensitive (MIC < or = 4 microg/ml). Twenty-eight strains showed high-level resistance to streptomycin (2,000 microg/ml) and 26 strains were found to have high-level resistance to gentamicin (500 microg/ml). Twelve of these strains had high-level resistance to both aminoglycosides. By the disk diffusion tests, 53 of 198 strains were found to be resistant to erythromycin, 51 to penicillin, 37 to ampicillin, 18 to ciprofloxacin, 14 to norfloxacin and 3 to nitrofurantoin. No beta-lactamase production was detected in 198 studied strains.

Twenty multidrug-resistant vancomycin-resistant Enterococcus faecium strains of the VanA phenotype were isolated over a 1 year period from five patients in the intensive care unit at the University Hospital of Antalya, Turkey. Molecular investigation showed that these strains belonged to five different pulsotypes and that the vanA gene was carried by a Tn1546-like transposon inserted onto a self-transferable plasmid of approximately 200 kb. One patient was infected by two different strains, suggesting horizontal gene transfer within that patient. This is the first documented outbreak of VRE in Turkey with concomitant spread of plasmid and strains.

We aimed to determine the types of corynebacteria isolated from the blood of patients at Gaziantep University Hospital, Turkey, and their antibiotic susceptibilities. Between February 1999 and June 2001, 3530 blood samples were cultured, of which 915 were found to be positive, and these were further investigated in the bacteriology laboratory. Among positive blood cultures, coryneform bacteria were identified in 31 (3.4%) isolates. Of these, 16 (51.6%) were Corynebacterium jeikeium, six (19.4%) were Corynebacterium striatum, four (12.9%) were Corynebacterium amycolatum, two (6.5%) were Cellulomonas species, two (6.5%) were Corynebacterium afermentans and one isolate (3.2%) was Corynebacterium propinquum. Antibiotic susceptibility tests showed that C. jeikeium was resistant to various antibiotics, whereas all isolates were susceptible to vancomycin and teicoplanin. This study illustrates the importance of taking coryneform bacteria into consideration when culturing blood samples. The need to identify the species and determine its antibiotic sensitivity is emphasized.

Fecal-oral transmission of vancomycin-resistant strains of Enterococci (VRE), which colonize the human gastrointestinal tract, has led to nosocomial epidemics in recent years. The aim of this study was to establish the incidence and associated factors of fecal colonization with VRE in neonates. In our hospital 110 rectal swab specimens collected in the neonatal intensive care unit (NICU) were examined for VRE. For comparison, rectal swabs collected from 42 healthy neonates on the obstetrics ward were also analyzed. Of the NICU patients, 8 had VRE MICs of 8-64 microg/ml for vancomycin and 2-32 microg/ml for teicoplanin, whereas none of the healthy newborns, had VRE (p < 0.05). All patients positive for VRE had factors known to be associated with VRE carriage, such as low birth weight or long-term antibiotic therapy.

The prevalence of high level aminoglycoside-resistant (HLAR) and vancomycin-resistant enterococci were investigated in this study. Enterococci were isolated from 264 of all specimens (70.9%). Thirty strains were identified as high level aminoglycoside-resistant enterococci (11.4%). Vancomycin resistant enterococcus has not been isolated in this study.