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Annamária Főldes, Doina-Veronica Bilca and Edit Székely

Abstract

Introduction: Infections due to carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CPCRE) are an emerging global public health threat. The purpose of this study was to investigate phenotypic and genotypic features of CP-CRE strains isolated from hospitalized patients. Material and methods: Between 1st of January - 1st of July 2017, in the Department of Microbiology, “Dr. Constantin Opriş” County Emergency Hospital Baia Mare, Romania, 1110 strains of Enterobacteriaceae were isolated from bronchial secretions, urine, wounds and blood cultures. Bacterial identification and antimicrobial susceptibility tests were performed by conventional methods, Vitek 2 Compact and M.I.C.E. strips. We analysed all Enterobacteriaceae strains non-susceptible to carbapenems according to CLSI 2017 criteria. The modified Hodge test (MHT), the modified carbapenem inactivation method (mCIM) and the combination disks test (KPC, MBL, OXA-48 Confirm kit, Rosco Diagnostica) were used for phenotypic confirmation, whereas a multiplex PCR assay for genes blaKPC, blaNDM and blaOXA-48 was used for genetic confirmation. Results: 19 non-duplicate strains isolated from 16 patients were phenotypically identified as CP-CRE: Klebsiella pneumoniae (n=14), Escherichia coli (n=2), Providencia stuartii (n=2) and Serratia marcescens (n=1). Most strains were isolated from bronchial secretions (n=9). The carbapenem-hydrolizing enzymes were identified by the combination disks test as: KPC (n=9), OXA-48-like (n=5) and MBL (n=5). Molecular confirmation was performed in 18 phenotypically positive isolates with 100% concordant results with mCIM and combination disks test. Discrepant results were noticed with the MHT in case of 4 NDM-producers confirmed by PCR. All CP-CRE strains were resistant to all tested cephems. Three out of 9 K. pneumoniae strains tested against colistin were found resistant. Conclusions: The most common carbapenemase detected was KPC. Therapeutic options were limited in all positive cases. Rapid and reliable detection of CP-CRE is critical for preventing the spread of these pathogens

Open access

Brindusa Tilea, Edit Szekely, Simona Teches and Ioan Tilea

Abstract

Morganella morganii (M. morganii) is a Gram-negative aerobic and facultative anaerobic rod, belonging to the Enterobacteriaceae family. This pathogen is uncommon in community-acquired infections, most often being found in postoperative nosocomial and urinary tract infections. Infection of the central nervous system with this pathogen is rare. We present the case of a 66-year-old patient who underwent colon cancer surgery, chemotherapy and radiotherapy, had left iliac anus, type 2 diabetes and developed acute meningoencephalitis caused by M. morganii. Cerebrospinal fluid examination revealed increased number of polymorphonuclear neutrophils, modified biochemistry and AmpC beta-lactamase producing M. morganii strain. After initiation of antibiotic treatment, initially with empirical therapy represented by meropenem and vancomycin, afterwards adjusted to meropenem and ciprofloxacin, according to the stain’s susceptibility to antimicrobials the patient’s evolution was favourable, in spite of the existence of two immune suppressing conditions.

Open access

Krisztina Eszter Vas, Izabella Szász, Szabolcs Molnár, Lilla Lőrinczi and Edit Székely

Abstract

The clinical relevance of Staphylococcus aureus strains with heterointermediate susceptibility to vancomycin (hVISA) is still controversial, however they could be responsible for treatment failures in patients treated with vancomycin. The lack of standardization and the complexity of testing methods are the main challenge in indentifying such strains. The aim of our study was to evaluate the frequency of hVISA strains in Targu-Mures Clinical Emergency Hospital. One hundred twenty-two, non-duplicate, methicillin-resistant S. aureus (MRSA) isolates susceptible to vancomycin using standard E-test (MIC≤2 mg/L) were screened for heteroresistance with Glycopeptide Resistance Detection test (E-test GRD). Population analysis profile-area under the curve (PAP/AUC) method was used for confirmation. Twenty-four strains (19.5%) were found positive with the screening method. Two of them (1.63%) were confirmed having hVISA phenotype and no strains with intermediate vancomycin susceptibility (VISA) were detected. In conclusion, the rate of MRSA strains with reduced vancomycin susceptibility was low. However, their monitoring may be useful, taking into consideration the wide usage of glycopeptides in the treatment of serious MRSA infections.

Open access

Sóki József and és Székely Edit

Abstract

The Bacteroides and Parabacteroides species are important obligate anaerobic bacteria that are significant constituents of normal flora (microbiota), and opportunistic pathogens with special biological background. They are highly resistant to antibiotics and monitoring their resistance levels is important for their empiric therapy. Several antibiotic resistance studies were conducted in the USA and Europe and we have data for the region involved in this study showing comparable trends. Multidrug-resistant strains are emerging among Bacteroides too, where the proper antibiotic tests and treatments may be life-saving.