title: [Investigation of carbapenemases in carbapenem-resistant Escherichia coli and Klebsiella pneumoniae strains isolated in 2014 in Turkey].
abstract: 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.
authors.affiliation: Hacettepe University Faculty of Medicine, Department of Medical Microbiology, Ankara, Turkey. acakarunsal@yahoo.com.
authors.forename: Aslı
authors.initials: A
authors.lastname: Çakar
authors.forename: Yakut
authors.initials: Y
authors.lastname: Akyön
authors.forename: Deniz
authors.initials: D
authors.lastname: Gür
authors.forename: Onur
authors.initials: O
authors.lastname: Karatuna
authors.forename: Dilara
authors.initials: D
authors.lastname: Öğünç
authors.forename: Betil
authors.initials: B
authors.lastname: Özhak Baysan
authors.forename: Nilay
authors.initials: N
authors.lastname: Çöplü
authors.forename: Mustafa
authors.initials: M
authors.lastname: Çağatay
authors.forename: Abdullah
authors.initials: A
authors.lastname: Kılıç
authors.forename: Mehmet
authors.initials: M
authors.lastname: Baysallar
authors.forename: Zahir
authors.initials: Z
authors.lastname: Bakıcı
authors.forename: Cem
authors.initials: C
authors.lastname: Çelik
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Gülay
authors.forename: Şöhret
authors.initials: Ş
authors.lastname: Aydemir
authors.forename: Alper
authors.initials: A
authors.lastname: Tünger
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Kılıç
authors.forename: Barış Derya
authors.initials: BD
authors.lastname: Erçal
authors.forename: Zulal
authors.initials: Z
authors.lastname: Aşçı Toraman
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Zer
authors.forename: Ayşe
authors.initials: A
authors.lastname: Büyüktaş
authors.forename: Selma
authors.initials: S
authors.lastname: Ay
authors.forename: Zerrin
authors.initials: Z
authors.lastname: Aktaş
authors.forename: Çiğdem
authors.initials: Ç
authors.lastname: Kayacan
authors.forename: Gülçin
authors.initials: G
authors.lastname: Bayramoğlu
authors.forename: Faruk
authors.initials: F
authors.lastname: Aydın
authors.forename: Devrim
authors.initials: D
authors.lastname: Dündar
authors.forename: Ufuk
authors.initials: U
authors.lastname: Hasdemir
authors.forename: Ramazan
authors.initials: R
authors.lastname: Ayaş
authors.forename: Keramettin
authors.initials: K
authors.lastname: Yanık
authors.forename: Murat
authors.initials: M
authors.lastname: Günaydın
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Güdücüoğlu
authors.forename: Mehmet
authors.initials: M
authors.lastname: Parlak
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000235:genetics / Q000378:metabolism*; D015780:Carbapenems / Q000494:pharmacology*; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D000077727:Ertapenem; D004926:Escherichia coli / Q000187:drug effects / Q000201:enzymology*; D029968:Escherichia coli Proteins / Q000235:genetics / Q000378:metabolism; D006801:Humans; D015378:Imipenem / Q000494:pharmacology; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology*; D000077731:Meropenem; D008826:Microbial Sensitivity Tests; D060885:Multiplex Polymerase Chain Reaction; D010641:Phenotype; D013845:Thienamycins / Q000494:pharmacology; D014421:Turkey; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*; D047090:beta-Lactams / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D029968:Escherichia coli Proteins; D013845:Thienamycins; D047090:beta-Lactams; D015378:Imipenem; C409201:beta-lactamase IMP-1; D001618:beta-Lactamases; C000601047:beta-lactamase OXA-48, E coli; C063912:carbapenemase; D000077731:Meropenem; D000077727:Ertapenem