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    Investigation of Carbapenemases in Carbapenem-Resistant Escherichia coli and Klebsiella pneumoniae Strains Isolated in 2014 in Turkey
    (Ankara Microbiology Soc, 2016) Cakar, Asli; Akyon, Yakut; Gur, Deniz; Karatuna, Onur; Ogunc, Dilara; Baysan, Betil Ozhak; Coplu, Nilay; Cagatay, Mustafa; Kilic, Abdullah; Baysallar, Mehmet; Bakici, Zahir; Celik, Cem; Gulay, Zeynep; Aydemir, Sohret; Tunger, Alper; Kilic, Huseyin; Ercal, Baris Derya; Toraman, Zulal Asci; Zer, Yasemin; Buyuktas, Ayse; Ay, Selma; Aktas, Zerrin; Kayacan, Cigdem; Bayramoglu, Gulcin; Aydin, Faruk; Dundar, Devrim; Hasdemir, Ufuk; Ayas, Ramazan; Yanik, Keramettin; Gunaydin, Murat; Guducuoglu, Huseyin; Parlak, Mehmet
    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.
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    Low pertussis antibody levels in maternal and umbilical cord blood samples in Turkey
    (Turkish J Pediatrics, 2016) Turkoglu, Ebru; Sonmez, Cemile; Ozer, Esra; Coplu, Nilay; Kurugol, Zafer
    Pertussis continues to cause significant mortality and morbidity in many countries despite high vaccine coverage, especially among young infants. The aim of the study was to determine pertussis antibody levels in paired maternal and cord blood samples, to evaluate the placental transfer of these antibodies, and to assess whether newborn infants have adequate antibody levels against pertussis. Antibody titers to pertussis toxin (anti-PT) and filamentous hemagglutinin (anti-FHA) were measured by in-house enzyme linked immunosorbent assay (ELISA) in 251 paired maternal delivery and cord blood samples. Geometric mean concentrations (GMCs) of pertussis antibodies and cord: maternal GMC ratios were calculated. GMCs of maternal anti-PT and anti-FHA antibodies at delivery were 4.12 and 9.89 EU/ml, respectively. Cord GMCs were 133% and 131% of maternal delivery values for PT and FHA, respectively; demonstrating effective placental transfer. However, cord pertussis antibodies were at a low concentration; 5.49 EU/ml for PT and 12.73 EU/ml for FHA. Only 34.6% of infants had protective anti-PT levels (>= 10 EU/ml) at birth. Anti-pertussis antibody concentrations were extremely low in pregnant women in Turkey where childhood pertussis vaccination coverage has been high for a long time. Despite effective placental antibody transfer, umbilical cord pertussis antibody concentrations are similarly low. A majority of young infants are vulnerable to pertussis infection until the onset of primary vaccinations. These data support the need for pertussis vaccination during pregnancy to prevent infant infection in Turkey.
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    Pertussis Serosurveillance Study in Izmir, Turkey
    (Oxford Univ Press, 2015) Turkoglu, Ebru; Sonmez, Cemile; Kurugol, Zafer; Coplu, Nilay; Koturoglu, Guldane
    Pertussis is a life-threatening, vaccine-preventable infection. Adults who can be asymptomatic may infect infants. The aim of this study is to determine the IgG antibody levels against pertussis toxin (PT) and filamentous hemagglutinin from 6 months to a parts per thousand yen60 years in Izmir, Turkey. A cluster sample design developed by Expanded Programme on Immunization of the World Health Organization was carried out for the selection of the study population, which consisted of 399 healthy subjects. In-house ELISA was studied in Turkish Public Health Institution. Antibody levels of < 10 EU/ml, a parts per thousand yen10 EU/ml and a parts per thousand yen100 EU/ml were accepted as non-immune, immune and possible acute/recent infection, respectively. Anti-PT antibody levels were 8.5% < 10 EU/ml, 68.2% 10-100 EU/ml and 23.3% a parts per thousand yen100 EU/ml; the latter was correlated with possible acute/recent infection. Results showed that pertussis is endemic, particularly among adolescents and adults, which is a threat for infants who have not completed their primary immunization.