title: Investigation of carbapenem resistance and the first identification of Klebsiella pneumoniae carbapenemase (KPC) enzyme among Escherichia coli isolates in Turkey: A prospective study.
abstract: BACKGROUND
  The aim of this study was to determine the presence of carbapenem resistance and carbapenemase production in Escherichia coli isolates from clinical samples in Turkey.
  
  
  METHODS
  The prospective study included a total of 4.052 Escherichia coli isolates collected from patients admitted to a hospital from March 2011 to May 2012. We used ertapenem disc for screening carbapenemase production, and the confirmation was performed by using Etest. The resistance mechanisms and genetic relatedness of the carbapenem resistant strains were investigated by using PCR (polymerase chain reaction) and pulsed-field gel electrophoresis (PFGE), respectively.
  
  
  RESULTS
  Among the 4.052 E. coli isolates, 24 (0.59%) were found to be carbapenem resistant. Of these, only 5 isolates were positive for OXA-48 and 2 isolates were positive for Klebsiella pneumoniae carbapenemase (KPC)-2. The KPC-2 producing E. coli strains (n = 2) were both isolated from the same patient. The blaKPCgenes were confirmed using DNA sequence analysis. The genetic relationship between the 24 E. coli strains studied by PFGE revealed that the strains were genetically unrelated.
  
  
  CONCLUSIONS
  This article confirms, to our knowledge for the first time, the detection of KPC-2-producing E. coli in Turkey, with OXA-48 being the most frequent carbapenemase in the study.
authors.affiliation: Cerrahpasa Medical School of Istanbul University, Department of Medical Microbiology, Istanbul, Turkey. Electronic address: kuskucum@gmail.com.
authors.forename: Mert Ahmet
authors.initials: MA
authors.lastname: Kuskucu
authors.affiliation: Cerrahpasa Medical School of Istanbul University, Department of Medical Microbiology, Istanbul, Turkey. Electronic address: asiyekarakullukcu@gmail.com.
authors.forename: Asiye
authors.initials: A
authors.lastname: Karakullukcu
authors.affiliation: Cerrahpasa Medical School of Istanbul University, Department of Medical Microbiology, Istanbul, Turkey. Electronic address: mailihaba.ailiken@gmail.com.
authors.forename: Mailihaba
authors.initials: M
authors.lastname: Ailiken
authors.affiliation: Inonu University Faculty of Medicine, Department of Medical Microbiology, Malatya, Turkey. Electronic address: botlu@yahoo.com.
authors.forename: Barıs
authors.initials: B
authors.lastname: Otlu
authors.affiliation: Cerrahpasa Medical School of Istanbul University, Department of Infectious Diseases, Istanbul, Turkey. Electronic address: bigimete@istanbul.edu.tr.
authors.forename: Bilgul
authors.initials: B
authors.lastname: Mete
authors.affiliation: Cerrahpasa Medical School of Istanbul University, Department of Medical Microbiology, Istanbul, Turkey. Electronic address: gokhanaygun67@yahoo.com.
authors.forename: Gokhan
authors.initials: G
authors.lastname: Aygun
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000235:genetics / Q000378:metabolism*; D015780:Carbapenems / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field; D004926:Escherichia coli / Q000187:drug effects* / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology*; D029968:Escherichia coli Proteins / Q000235:genetics / Q000378:metabolism; D006760:Hospitalization; D006801:Humans; D008826:Microbial Sensitivity Tests; D011446:Prospective Studies; D017422:Sequence Analysis, DNA; D014421:Turkey / Q000453:epidemiology; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D029968:Escherichia coli Proteins; D001618:beta-Lactamases; C000601047:beta-lactamase OXA-48, E coli; C531581:carbapenemase-2, Klebsiella pneumoniae
keywords: Carbapenem resistance; Carbapenemase; Escherichia coli; Klebsiella pneumoniae carbapenemase; OXA-48