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    Antibiotic Resistance and Molecular Epidemiology of Vancomycin-Resistant Enterococci in a Tertiary Care Hospital in Turkey
    (Dove Medical Press Ltd, 2020) Asgin, Nergis; Otlu, Baris
    Purpose: Vancomycin-resistant enterococci (VRE) have become a global health threat in the last two decades. In this study, we aimed to determine antibiotic resistance using phenotypic and genotypic methods in VRE strains obtained from inpatients and to investigate clonal relatedness among strains. Methods: Identification and antibiotic susceptibility of 47 VRE strains obtained from inpatients at Karabuk University Hospital from 2014 to 2015 were determined using the BD PhoenixTM automated microbiology system. Vancomycin resistance genes (Van A and B) were detected by polymerase chain reaction. Clonal relatedness among the strains was evaluated by pulsed-field gel electrophoresis (PFGE). Results: All 47 VRE strains obtained from rectal (n=35), blood (n=7), and urine (n=5) samples were confirmed as Enterococcus faecium; they were resistant to ampicillin, gentamicin, vancomycin, and teicoplanin. One E. faecium isolate was intermediately resistant to linezolid. No strain was resistant to quinupristin-dalfopristin or daptomycin. Only vanA was detected among strains. According to the PFGE results, 31 of 47 strains were clonally related with a clustering rate of 66%. No common clone was detected. Conclusion: VRE infections are associated with high mortality, morbidity, and healthcare expenditures. Increasing resistance to last-line drugs, such as linezolid and daptomycin, among VRE strains is a great concern. Therefore, comprehensive measures should be performed to reduce VRE colonization. Although there was no common clone VRE outbreak, polyclonal spread was observed in our hospital. The high clustering rate indicated cross-contamination. Thus, a more effective infection control program should be implemented.
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    Antimicrobial Resistance and Molecular Epidemiology of Corynebacterium striatum Isolated in a Tertiary Hospital in Turkey
    (Mdpi, 2020) Asgin, Nergis; Otlu, Baris
    Although Corynebacterium striatum is part of the human flora, it has recently drawn attention both for its multidrug resistance and its role as an invasive infection/outbreak agent. This cross-sectional study aimed to determine the antimicrobial resistance and clonal relationships among C. striatum strains. In total, 81 C. striatum strains were identified using Phoenix-100(TM) (BD, Sparks, MD, USA). The antimicrobial resistance of the strains was determined using the Kirby-Bauer disk diffusion method. Clonal relatedness among the strains was performed via arbitrarily primed polymerase chain reaction (AP-PCR). All 81 C. striatum strains were resistant to penicillin, cefotaxime, ciprofloxacin, and tetracycline, but susceptible to vancomycin and linezolid. The resistance rates to gentamicin, erythromycin, and clindamycin were 34.6%, 79%, and 87.7% respectively. AP-PCR results showed no predominant clone among the C. striatum strains. Corynebacterium striatum is reportedly the cause of an increasing number of invasive infections/outbreaks. Moreover, treatment options are limited. The study showed that vancomycin, linezolid, and gentamicin can be selected for the empirical treatment of C. striatum infections. Although no single-clone outbreak was observed in our hospital, small clonal circulations were observed within some units, indicating cross-contamination. Therefore, a comprehensive infection control program is warranted in future.
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    Evaluation of hepatitis B virus and Hepatitis C virus frequency in hemodialysis patients
    (2019) Asgin, Nergis; Satilmis, Serife
    Aim: This study aimed to investigate the prevalence of the hepatitis B virus and hepatitis C virus in patients undergoing hemodialysis in Karabuk city.Material and Methods: For patients presented to the Karabuk University Training and Research Hospital for hemodialysis between January 2016 and December 2018, HBsAg, anti-HBs, and anti-HCV assays were conducted using the chemiluminescence method and HBV DNA, HCV RNA and HCV genotyping tests were conducted using real-time polymerase chain reaction. The data was retrospectively evaluated.Results: Of 345 patients undergoing hemodialysis, 211 (61.2%) were male and 134 (38.8%) were female. The mean age of the patients was 62 (15–96) years. Moreover, 0.9% (n = 3) of patients were HBsAg positive and 4.3% (n = 15) were anti-HCV positive. Three patients with HBsAg positivity were also HBV DNA positive. Of the 15 patients who were anti-HCV positive, 12 were also HCV RNA positive. Of these, eight patients had the HCV genotype 1b and four patients had the genotype 4. Anti-HBs seropositivity was detected in 65.8% of patients. The highest Anti-HBs seropositivity rate was observed in patients aged 40 years (76%) and the difference between age groups was statistically significant (p = 0.002). Conclusion: In our study, the prevalence of HBsAg seropositivity in patients undergoing hemodialysis (0.9%) was lower than that reported by the Turkish Society of Nephrology (2.65%). This difference may arise from the high anti-HBs seropositivity rate. Conversely, the prevalence of anti-HCV seropositivity (4.3%) was similar to the mean prevalence in Turkey (4.2%). Infection prevention measures against viral hepatitis should be strictly implemented, especially in hemodialysis units.
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    Frequency and genotype distribution of high-risk human papilloma virus types in Karabuk province, Turkey: A hospital based cross-sectional study
    (2020) Eroglu, Semra; Asgin, Nergis
    Aim: In this cross-sectional study, we aimed to determine the prevalence and genotype distribution of high-risk human papillomavirus (HPV; HR-HPV) infection in patients admitted to the gynecology and obstetrics outpatient clinics of Karabuk University Training and Research Hospital.Material and Methods: A total of 402 women aged 18–65 years who were admitted to the gynecology and obstetrics Clinic, Karabuk University Training and Research Hospital, between October 2016 and June 2019 were included. The presence of HR-HPV and genotyping of HPV were investigated using real-time polymerase chain reaction in cervical swab samples.Results: HR-HPV infection was found in 23.9% of women. HR-HPV positivity was detected most commonly in the age group of 20–29 years. Regarding genotype distribution among HPV-positive women, the genotypes that included multiple HR-HPV infections (mixed HR-HPV) were the most common genotype (38.5%), followed by HPV-16 (13.1%) and HPV-52 (9.8%).Conclusion: Prevalence of HR-HPV infection was found to be high in our region, with the most commonly observed genotypes being those containing mixed HR-HPV. We believe that these results would be helpful during the selection of primary and secondary preventive measures for cervical cancer while planning vaccination and screening programs.
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    High prevalence of TEM, VIM, and OXA-2 beta-lactamases and clonal diversity among Acinetobacter baumannii isolates in Turkey
    (J Infection Developing Countries, 2019) Asgin, Nergis; Otlu, Baris; Cakmakliogullari, Elcin Kal; Celik, Betul
    Introduction: Acinetobacter baumannii is an opportunistic pathogen that causes nosocomial infections with high mortality. Treatment options are limited owing to its resistance to numerous antibiotics. Here, we sought to determine the antibiotic susceptibilities of A. baumannii isolates, investigate clonal relationship among the strains, and determine the frequency of beta-lactamase resistance genes. Methodology: The identification and antibiotic susceptibilities of 69 A. baumannii strains were determined using a BD-Phoenix automated system. The presence of bla(OXA-2), bla(OXA-10), bla(OXA-23), bla(OXA-24/)(40), bla(OXA-51), bla(OXA-58), bla(TEM), bla(SHV), bla(IMP), bla(VIM), and bla(GIM) genes were investigated using polymerase chain reaction (PCR), and clonal relatioships among the isolates were determined using pulsed-field gel electrophoresis (PFGE). Results: All strains were resistant to ampicillin-sulbactam, gentamicin, cefepime, ciprofloxacin, and ceftriaxone. While 65 of the 69 strains (94.2%) were resistant to piperacillin-tazobactam, amikacin, imipenem, and meropenem, all swains were susceptible to tigecycline and colistin. The frequencies of b/aoxik-51, blaoxA-23, bIa(TEM), bla(OXA-2), bla(VIM), and bla(SHV) were 100%, 94.2%, 53.6%, 21.7%, 14.5%, and 2.9%, respectively. Based on PFGE results, 56 of the 69 strains were clonally related, and the clustering rate was 81.2%. No common outbreak isolate was detected. Conclusions: The most prevalent OXA genes were bla(OXA-51), bla(OXA-23), and bla(OXA-2). Furthermore, bla(TEM), bla(SHV), and bla(VIM), which are common in Enterobacterales and Pseudomonas spp, were detected, suggesting horizontal gene transfer had occurred between bacteria. No single clone outbreak was detected by PFGE. However, multiclonal spread and the high clustering rate suggest cross-contamination. Therefore, in future, more effective infection control measures must be implemented.
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    Molecular Epidemiological Analysis of Bacillus Pseudo-Outbreak due to Contaminated Culture Tubes Containing Stuart Medium
    (Clin Lab Publ, 2022) Asgin, Nergis; Kal-Cakmakliogullari, Elcin; Otlu, Baris; Ersoy, Omer F.; Celik, Betul; Basustaoglu, Ahmet
    Background: It is challenging to determine whether Bacillus species other than Bacillus anthracis cause infections. Pseudo and true outbreaks of Bacillus spp. have been noted. Here, we present a molecular analysis of a Bacillus spp. pseudo-outbreak caused by contaminated culture tubes containing Stuart medium. Methods: Between January and March 2015, a high percentage of Bacillus spp. was isolated from the wound samples of inpatients at the Karabuk University Hospital, and an outbreak was suspected. Environmental and staff nasal samples were cultured aerobically, and Bacillus spp. were isolated from some of them. However, the isolation of Bacillus spp. in throat cultures of outpatients suggested contamination caused by culture tubes containing Stuart medium. We examined two lots of culture tubes used in the hospital. Although the culture tubes' expiry date and storage conditions were suitable, Bacillus spp. grew in one of these lots. A total of 47 Bacillus spp. isolated during this period were identified, and the clonal relationship among the isolates was investigated by arbitrarily primed polymerase chain reaction. Results: Twenty-seven strains were identified as Bacillus megaterium and 20 as Bacillus firmus. Of the four strains isolated from the Stuart medium, two were identified as B. firmus and the other two were B. megaterium. Two B. firmus strains isolated from the Stuart medium and two B. firmus strains obtained from the coronary intensive care environmental samples were matched and clustered within the same genotype. We recalled all culture tubes containing Stuart medium. After another brand's culture tubes were distributed, no growth was observed. It was then understood that the pseudo-outbreak source was contaminated culture tubes containing Stuart medium. Conclusions: Microbiological controls of medical materials and equipment should be regularly checked to prevent outbreaks (true or pseudo).
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    Üst Solunum Yolu Infeksiyonlarinda Moraxella catarrhalis’in Önemi
    (İnönü Üniversitesi Tıp Fakültesi Dergisi, 2002) Özerol, Ibrahim Halil; Asgin, Nergis; Kalcioglu, M. Tayyar
    M. catarrhalis, otitis media ve sinüzit gibi üst solunum yollari enfeksiyonlarinda etken olabilen bir patojendir. Bu çalismada üst solunum yolu enfeksiyonu ön tanisi almis 73 eriskin ve 31 çocuk olmak üzere toplam 104 hastanin nazofarinks ve bogaz sürüntü örneklerinde M. catarrhalis arastirildi. Yüz dört nazofarinks örneginin 35’inde (%33.6) ve bogaz sürüntü örneklerinin 20’sinde (%19.2) M. catarrhalis saptandi. Eriskinler için bu degerler sirasiyla 18 (%24.7) ve 13 (%17.8), çocuklar için 17 (%54.8) ve 7 (%22.6) olarak bulundu. Bu sonuçlar, ÜSYE etiyolojisinde M. catarrhalis’in önemli oranda rol oynadigini desteklemektedir.