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    Molecular epidemiology of methicillin-resistant Staphylococcus aureus isolates from clinical specimens of patients with nosocomial infection
    (Edizioni Int Srl, 2007) Tekerekoglu, Mehmet Sait; Ay, Selma; Otlu, Baris; Cicek, Aysegul; Kayabas, Uener; Durmaz, Riza
    Bacteriological and epidemiological studies were carried out on 90 isolates of methicillin-resistant Staphylococcus aureus (MRSA) at Turgut Ozal Medical Center of Inonu University, (Malatya/Turkey). MRSA isolates were obtained from patients with nosocomial infections. Staphylococcus aureus clinical isolates were collected between May 2004-May 2005. Isolates were tested for resistance to methicillin. Antimicrobial susceptibility testing and slime production evaluation was performed. Genotype studies were carried out by arbitrarily primed polymerase chain reaction (APPCR) and consequent cluster analysis. All of the isolates were mecA-positive in a PCR-based assay; all exhibited resistance to oxacillin, by agar dilution (MICs >= 4mg/L) and disc diffusion methods, and multiple antibiotics. Most MRSA isolates were collected in intensive care units. Of 90 samples, 53 were found to be unrelated to the others while the remaining 37 strains were either identical or closely related, Dendrogram analysis identified nine major clusters. These data support the opinion that MRSA are significant nosocomial pathogens in intensive care units and that resistant clones may be transmitted between patients. Molecular epidemiological tools are helpful for understanding transmission patterns and sources of infection, and are useful for measuring outcomes of intervention strategies implemented to reduce nosocomial MRSA.
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    A PNEUMONIA CASE CAUSED BY CEDECEA LAPAGEI
    (Ankara Microbiology Soc, 2008) Yetkin, Guelay; Ay, Selma; Kayabas, Uener; Gedik, Ender; Gucluer, Nilay; Caliskan, Ahmet
    Cedecea spp. which are the members of Enterobacteriaceae family, are mostly isolated from sputum and their clinical importance is not yet demonstrated. This report presents a pneumonia case caused by Cedecea lapagei. A 38-years-old male patient admitted to Inonu University Faculty of Medicine Emergency department with prediagnosis of subarachnoid haemorrhage was operated and transferred to Intensive Care Unit of Reanimation where he underwent artificial ventilation. On the third day of hospitalization his temperature was 39 degrees C, white blood cell count was 27.000/ml and he was still unconscious. He had a history of chronic obstructive pulmonary disease. Chest X-ray revealed opacities in the right lower lobe and mucoid tracheal secretion ensued following tracheal entubation performed after operation. Direct microscopic examination of bronchoalveolar lavage (BAL) fluid yielded abundant number of leukocytes and gram-negative bacilli. Bacteria isolated from BAL specimen were identified as C.lapagei by Phoenix 100 (Becton Dickinson, USA) automated system and also by API 20E kit (Biomerieux, France). Upon the initiation of intravenous amikacin (1 x 1 g) and meropenem (3 x 1 g), the signs of infection decreased in intensity, however, the patient was lost due to subarachnoid hemorrhage on the 12(th) day of hospitalization. In this case it was estimated that C.lapagei pneumonia originated from the aspiration of upper airway secretion owing to unconsciousness of the patient. Although there were reports of Cedecea infections in the literature, this was the first documented case of C.lapagei pneumonia when the accessible related literature was concerned.