title: Evaluation of carbapenem resistance using phenotypic and genotypic techniques in Enterobacteriaceae isolates.
abstract: BACKGROUND
  Bacterial resistance to antibiotics is increasing worldwide. Antibiotic-resistant strains can lead to serious problems regarding treatment of infection. Carbapenem antibiotics are the final treatment option for infections caused by serious and life-threatening multidrug-resistant gram-negative bacteria. Therefore, an understanding of carbapenem resistance is important for infection control. In the study described herein, the phenotypic and genotypic features of carbapenem-resistant Enterobacteriaceae strains isolated in our hospital were evaluated.
  
  
  METHODS
  In total, 43 carbapenem-resistant strains were included in this study. Sensitivity to antibiotics was determined using the VITEK(®)2 system. The modified Hodge test (MHT) and metallo-β-lactamase (MBL) antimicrobial gradient test were performed for phenotypic identification. Resistance genes IMP, VIM, KPC, NDM-1, and OXA-48 were amplified by multiplex PCR.
  
  
  RESULTS
  The OXA-48 gene was detected in seven strains, and the NDM-1 gene in one strain. No resistance genes were detected in the remainder of strains. A significant correlation was observed between the MHT test and OXA-48 positivity, and between the MBL antimicrobial gradient test and positivity for resistance genes (p < 0.05).
  
  
  CONCLUSIONS
  The finding of one NDM-1-positive isolate in this study indicates that carbapenem resistance is spreading in Turkey. Carbapenem resistance spreads rapidly and causes challenges in treatment, and results in high mortality/morbidity rates. Therefore, is necessary to determine carbapenem resistance in Enterobacteriaceae isolates and to take essential infection control precautions to avoid spread of this resistance.
authors.affiliation: Department of Microbiology, Medical Faculty, Recep Tayyip Erdogan University, Islampasa mah., 53000, Rize, Turkey. ksahin3@mynet.com.
authors.forename: Kazım
authors.initials: K
authors.lastname: Sahin
authors.affiliation: Department of Infectious Diseases, Cengiz Gökcek Women and Obstetrics Hospital, Osmangazi mah., 27010, Gaziantep, Turkey. aysetekin2002@yahoo.com.
authors.forename: Ayse
authors.initials: A
authors.lastname: Tekin
authors.affiliation: Department of Molecular Biology and Genetics, Medical Faculty, Istanbul Bilim University, Buyukdere cad., No: 120, Esentepe-Sisli-Istanbul, Turkey. sule.ozdas@istanbulbilim.edu.tr.
authors.forename: Sule
authors.initials: S
authors.lastname: Ozdas
authors.affiliation: Department of Pharmacology, Medical Faculty, Istanbul Bilim University, Buyukdere cad., No: 120, 34394, Esentepe-Sisli-Istanbul, Turkey. demetakin2000@yahoo.com.
authors.forename: Demet
authors.initials: D
authors.lastname: Akin
authors.affiliation: Department of Physiology, Medical Faculty, Istanbul Bilim University, Buyukdere cad., No: 120, 34394, Esentepe-Sisli-Istanbul, Turkey. hande.yapislar@istanbulbilim.edu.tr.
authors.forename: Hande
authors.initials: H
authors.lastname: Yapislar
authors.affiliation: Department of Microbiology, Medical Faculty, Recep Tayyip Erdogan University, Islampasa mah., 53000, Rize, Turkey. ar.dilek@hotmail.com.
authors.forename: Aziz Ramazan
authors.initials: AR
authors.lastname: Dilek
authors.affiliation: Department of Infectious Diseases, Medical Faculty, Recep Tayyip Erdogan University, Islampasa mah., 53000, Rize, Turkey. dreminesonmez@gmail.com.
authors.forename: Emine
authors.initials: E
authors.lastname: Sonmez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D004755:Enterobacteriaceae / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D005798:Genes, Bacterial; D005838:Genotype; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D060885:Multiplex Polymerase Chain Reaction; D010641:Phenotype; D015995:Prevalence; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems