Çoğul İlaç Dirençli Acinetobacter baumannii İzolatlarının Pulsed-Field Gel Elektroforezis İle Klonal İlişkisinin Araştırılması
Öz
Amaç: Bu çalışma ile, yoğunbakım ünitelerinde yatan hastalardan izole edilen A. baumannii suşlarının antibiyotiklere direnç oranının saptanması ve hastane enfeksiyonu etkeni çoklu ilaç direncine sahip izolatların klonal ilişkisinin, pulsed-field jel elektroforez (PFGE) yöntemi kullanılarak gösterilmesi amaçlandı.
Materyal ve Metod: Bir üniversite hastanesi; Anesteziyoloji ve Reanimasyon Yoğunbakım Ünitesi (AYBÜ), Göğüs Hastalıkları Yoğunbakım Ünitesi ve Pediatri Yoğun Bakım Ünitesi’ nde Ocak 2010-Ekim 2011 tarihleri ve AYBÜ’de Temmuz-Kasım 2012 tarihleri arasında takip edilen, A. baumanii ile oluşan, Ventilatör İlişkili Pnömoni (VİP) ve Primer Kan Dolaşımı Enfeksiyonu (PKDE) tanısı alan 69 hasta ve aynı sayıda izolat çalışmaya alındı.
Bulgular: Hastaların 63 (%91) tanesi VİP, 6 (%9) tanesi ise PKDE tanısı almıştı. Tüm hastalara YBÜ yatışı boyunca en az iki invaziv girişim uygulanmıştı. Üriner kateterizasyon (%100), mekanik ventilasyon (%94,2) ve periferik venöz kateterizasyon (%91,3) en sık uygulanan invaziv girişimlerdi. Antibiyotik duyarlılıkları imipenem, kolistin ve tigesiklin için E-test, diğer antibiyotikler için disk difüzyonla çalışıldı. Tüm suşlar için en etkili antibiyotik kolistin (%98,6) idi. Daha sonra tigesiklin (%97,1) ve levofloksasin (%69,6) gelmekteydi. Suşların tamamı seftriakson, piperasilin/tazobaktam, meropenem ve imipeneme dirençli bulundu. A. baumannii izolatlarının ApaI ile kesilen genomik DNA’sına yapılan PFGE analizi ile, 69 A. baumannii suşunun 62 (%89,9)’sinin küme içinde olduğu saptandı. Bu suşlar 16 küme içinde yer almakta idi. Suşların 7 (%10,1)’si özgül PFGE profili gösterdi ve suşlar arasında 23 pulsotip saptandı.
Sonuç: Çoğul ilaç dirençli A. baumannii izolatlarının kümeleşme oranının yüksek bulunması ve benzer genotipteki izolatların farklı ünitelerdeki hastalardan izole edilmesi bu bakterinin hastanemiz YBÜ’ lerinde endemik duruma geçtiğinin göstergesidir. Önlem alınmadığı takdirde A. baumannii uzun yıllar boyunca hastanelerde kalabilmekte ve hastalar arasında kolaylıkla bulaş olabilmektedir. Özellikle çapraz bulaşın önlenmesi için enfeksiyon kontrol programlarının gerekliliği ve önemi bir kez daha vurgulandı.
Anahtar Kelimeler
Destekleyen Kurum
Yüzüncü Yıl Üniversitesi Bilimsel Araştırma Projeleri Başkanlığı
Proje Numarası
2012-TF-U037
Kaynakça
- Peleg A.Y, Seifert H and Paterson D.L.: Acinetobacter baumannii: emergence of a successful pathogen. Clinical Microbiology Reviews. 2008; 21(3):538-82.
- Allen M.D., Hartman B.J., Acinetobacter spp, In: Mandell, Douglas and Bennett's principles and practice of infectious diseases, Mandell G.L., Bennett J.E., Dolin R., (Eds), 7th ed., Churchill Livingstone, Philadelphia, 2010: 2881-85.
- Fournier P.E, Richet H, and Weinstein R.A The epidemiology and control of Acinetobacter baumannii in health care facilities. Clinical infectious diseases. 2006;42(5):692-99,
- Seifert H, Dijkshoorn L, Gerner-Smidt P, Pelzer N, Tjernberg I, Vaneechoutte M, Distrubution of Acinetobacter species on human skin: comparison of phenotypic and genotypic identification methods. Journal of Clinical Microbiology. 1997; 35(11): 2819-25.
- Corbella X, Pujol M, Ayats J, Sendra M, Ardanuy C, Domínguez MA, ‘et al.’ Relevance of digestive tract colonization in the epidemiology of nosocomial infections due to multiresistant Acinetobacter baumannii. Clinical infectious diseases, 1996;23(2), 329-34.
- T.C. Sağlık Bakanlığı, Sağlık Hizmetleri Genel Müdürlüğü, Sağlık Hizmet Standartları Dairesi Başkanlığı Ulusal Hastane Enfeksiyonları Sürveyans Ağı (UHESA) Raporu, Özet Veri 20, 2012. https://docplayer.biz.tr/108543950-Ulusal-hastane-enfeksiyonlari-surveyans-agi-uhesa-raporu-ozet-veri-2012.html
- Schulte B, Goerke C, Weyrich P, Gröbner S, Bahrs C, Wolz C, et al. Clonal spread of meropenem-resistant Acinetobacter baumannii strains in hospitals in the Mediterranean region and transmission to South-west Germany. Journal of Hospital Infection. 2005; 61(4):356-57.
- Souli M, Galani I, and Giamarellou H, Emergence of extensively drug-resistant and pandrug-resistant Gram-negative bacilli in Europe. İn:Euro surveillance: bulletin européen sur les maladies transmissibles= European communicable disease bulletin, Kristinsson, K.G., Monnet, D.L.(Eds), 2008; 13(47):30-40
- Ruiz J, Núñez ML, Pérez J, Simarro E, Martínez-Campos L, and Gómez J, Evoluation of resistance among clinical isolates of Acinetobacter over a 6-year period, European Journal of Clinical Microbiology and Infectious Diseases. 1999; 18(4):292-95. Corbella X, Montero A, Pujol M, Domínguez MA, Ayats J, Argerich MJ, ‘et al.’ Emergence and rapid spread of carbapenem resistance during a large and sustained hospital outbreak of multiresistant Acinetobacter baumannii. Journal of clinical microbiology, 38(11): 4086-4095, 2000.
- Karahocagil MK, Yaman G, Göktaş U, Sünnetçioğlu M, Çıkman A, Bilici A. ve ‘ark.’ Hastane enfeksiyon etkenlerinin ve direnç profillerinin belirlenmesi, Van Tıp Dergisi, 2011; 18(1):27-32, Leblebicioglu H, Rosenthal VD, Arıkan ÖA, Özgültekin A, Yalcin AN, Koksal I, ‘et al.’ Device-associated hospital-acquired infection rates in Turkish intensive care units. Findings of the International Nosocomial Infection Control Consortium (INICC). Journal of Hospital infection, 2007; 65(3): 251-57. Dikmen Y, Aygün G, Öztürk R. Yoğun bakım ünitesinde ventilatör ilişkili pnömonilerin değerlendirilmesi. Klimik Dergisi, 2004; 17(2):117-19, Meric M, Willke A, Caglayan C, Toker K. Intensive care unit-acquired infections: incidence, risk factors and associated mortality in a Turkish university hospital. Japanese journal of infectious diseases. 2005;58(5):297-302.
- Goering, R.V.: Molecular epidemiology of nosocomial infection: analysis of chromosomal restriction fragment patterns by pulsed-field gel electrophoresis. Infection Control and Hospital Epidemiology, 1993; 14(10): 595-600
- CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. American Journal of Infection Control. 2008; 36: 309‐32, Performance Standards for Antimicrobial Disk Susceptibility Tests; Approved Standard—Eleventh Edition. CLSI document M02-A11 (ISBN 1-56238-781-2 [Print]; ISBN 1-56238-782-0 [Electronic]). 2012; 32(1): 44-45, Clinical and Laboratory Standards Institute, Wayne, Pennsylvania, USA,
- Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Third Informational Supplement. CLSI document M100-S23 (ISBN 1-56238-865-7 [Print]; ISBN 1-56238-866-5 [Electronic]). 2013; 33(1):66-67, Clinical and Laboratory Standards Institute, Wayne, Pennsylvania, USA
- Navon-Venezia S, Leavitt A, Carmeli Y, High tigecycline resistance in multidrug-resistant Acinetobacter baumannii, Journal of Antimicrobial Chemotherapy 2007; 59(4):772-74
- Seifert H, Dolzani L, Bressan R, van der Reijden T, van Strijen B, Stefanik D, ‘et al.’ Standardization and interlaboratory reproducibility assessment of pulsed-field gel electrophoresis-generated fingerprints of Acinetobacter baumannii. Journal of clinical microbiology, 2005; 43(9): 4328-35,
- Durmaz R, Otlu B, Koksal F, Hosoglu S, Ozturk R, Ersoy Y, ‘ve ark.’ The optimization of a rapid pulsed-field gel electrophoresis protocol for the typing of Acinetobacter baumannii, Escherichia coli and Klebsiella spp. Jpn J Infect Dis, 2009; 62(5), 372-7.
- Tenover FC, Arbeit RD, Goering RV, Mickelsen PA, Murray BE, Persing DH, ‘et al.’ Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. Journal of clinical microbiology, 1995; 33(9): 2233-9
- Taşova Y, Akgün Y, Saltoğlu N, Yılmaz G, Kara O, Dündar İH, Nozokomiyal Acinetobacter infeksiyonları. Flora. 1999; 4(3):170–6
- Xu T, Xia W, Rong G, Pan S, Huang P, Gu B, A 4-year surveillance of antimicrobial resistance patterns of Acinetobacter baumanni in a university-affiliated hospital in China. Journal of thoracic disease, 2013; 5(4): 506-12
- Eren OÖ, Kalyoncu U, Andıç N, Şardan YÇ, Yoğun bakım ünitesinde hasta maliyetini etkileyen faktörler. Selçuk Tıp Dergisi, 2009; 25(4):195-202,
- İnan A, Özgultekin A, Akçay SS, Engin DÖ, Turan G, Ceran N, ‘et al.’ Alterations in bacterial spectrum and increasing resistance rates in isolated microorganisms from device-associated infections in an intensive care unit of a teaching hospital in İstanbul (2004-2010). Japanese journal of infectious diseases, 2012; 65(2), 146-151 Katsaragakis S, Markogiannakis H, Toutouzas KG, Drimousis P, Larentzakis A, Theodoraki EM, ‘et al.’ Acinetobacter baumannii infections in a surgical intensive care unit: predictors of multi-drug resistance. World journal of surgery, 2008; 32(6), 1194-1202
- Falagas ME, and Kopterides P, Risk factors for the isolation of multi-drug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa: a systematic review of the literature. Journal of Hospital Infection. 2006; 64(1):7-15,
- Abbo A, Carmeli Y, Navon-Venezia S, Siegman-Igra Y, Schwaber MJ, Impact of multi-drug-resistant Acinetobacter baumannii on clinical outcomes. European Journal of Clinical Microbiology and Infectious Diseases, 2007; 26(11): 793-800
- Wróblewska M, Novel therapies of multidrug-resistant Pseudomonas aeruginosa and Acinetobacter spp. infections: the state of the art. Archivum immunologiae et therapiae experimentalis, 54(2): 113-120, 2006.
- Brahmi N, Beji O, Abidi N, Kouraichi N, Blel Y, El Ghord H, ‘et al.’ Epidemiology and risk factors for colonization and infection by Acinetobacter baumannii in an ICU in Tunisia, where this pathogen is endemic. Journal of Infection and Chemotherapy, 2007; 13(6): 400-4
- Dede B, Kadanalı A, Karagöz G, Çomoğlu Ş, Bektaşoğlu MF, Yücel F, M. Investigation of antibiotic resistance of Acinetobacter baumannii strains isolated from various clinical samples in intensive care unit. Bakırköy Tıp Dergisi, 2013; 9(1): 20-23,
- Koeleman JG, van der Bijl MW, Stoof J, Vandenbroucke-Grauls CM, Savelkoul PH, Antibiotic resistance is a major risk factor for epidemic behavior of Acinetobacter baumannii. Infection control and hospital epidemiology, 2001; 22(5), 284-8
- Durmaz R. Direnç gelişimini önlemede moleküler mikrobiyolojinin katkısı. Ankem Dergisi, 2009; 23(Ek 2):111-115,
- Wang JT, Lin SF, Chiu HL, Wang LC, Tai HM, Jiang CF, ‘et al.’ Molecular epidemiology and control of nosocomial methicillin-resistant Staphylococcus aureus infection in a teaching hospital. Journal of the Formosan Medical Association= Taiwan yi zhi, 2004; 103(1): 32-36,
- Wang H, Guo P, Sun H, Wang H, Yang O, Chen M, ‘et al.’ Molecular Epidemiology of Clinical Isolates of Carbapenem-Resistant Acinetobacter spp. from Chinese Hospitals. Antimicrobial Agents and Chemotherapy. 2007; 51(11), 4022–4028,
- Rosenthal V, Guzmán S, Crnich C, Device-associated nosocomial infection rates in intensive care units of Argentina. Infection control and hospital epidemiology, 2004; 25(3): 251-5,
The Investigation of Clonal Relationship Among Multiple Drug Resistant Acinetobacter baumannii Isolates with Pulsed-Field Gel Electrophoresis
Öz
Aim: With this study, the detection of the resistance rates of A. baumannii strains isolated from the patients in the intensive care units to the antibiotics and the demonstration of the clonal relationship of the isolates with multi-drug resistant of the factor of nosocomial infection were aimed by using the method of pulsed-field gel electrophoresis (PFGE).
Material and Methods: A university hospital, 69 patients followed between January 2010-October 2011 at the Intensive Care Unit of Anesthesiology and Reanimation (ICUAR), Intensive Care Unit of Chest Diseases and Pediatric Intensive Care Unit and July-November 2012 at ICUAR and the same number of isolates formed with A. baumannii, Ventilator-Associated Pneumonia (VAP) and diagnosis of Primary Bloodstream Infection (PBI) were enrolled to the study.
Findings: 63 (91%) of the patients were diagnosed with VAP and 6 (9%) of them with PBI. At least two invasive interference had been performed to all patients during the staying at the ICU. Urinary catheterization (100%), mechanical ventilation (94.2%), and peripheral venous catheterization (91.3%) were the most frequently performed invasive interferences. Antibiotic susceptibilities to imipenem, colistin and tigecycline were studied with the E-test and to the other antibiotics with the disk diffusion. Colistin was the most effective antibiotic for all of the strains (98.6%). Then, tigecycline (97.1%) and levofloxacin (69.6%) were in second place. All of the strains were resistant to ceftriaxone, piperacillin/tazobactam, meropenem, and imipenem. With the PFGE analysis of A. baumannii isolates performed to the genomic DNA cut with ApaI, it was found that 62 of the 69 A. baumannii strains (89.9%) were within the cluster. These strains were located within 16 clusters. 7 of the strains (10.1%) showed the profiles of specific PFGE and 23 pulsotypes were detected among the strains.
Result: Being high of clustering rate of multidrug-resistant A. baumannii isolates and isolating the isolates in similar genotypes from the patients in different units is the indicator of these bacteria to be an endemic situation in the ICUs of our hospital. If precautions are not taken, A. baumannii has been able to remain in the hospitals for many years and can be easily transmitted among the patients. Especially for the prevention of cross-contamination, the necessity and importance of infection control programs have once again emphasized.
Anahtar Kelimeler
Proje Numarası
2012-TF-U037
Kaynakça
- Peleg A.Y, Seifert H and Paterson D.L.: Acinetobacter baumannii: emergence of a successful pathogen. Clinical Microbiology Reviews. 2008; 21(3):538-82.
- Allen M.D., Hartman B.J., Acinetobacter spp, In: Mandell, Douglas and Bennett's principles and practice of infectious diseases, Mandell G.L., Bennett J.E., Dolin R., (Eds), 7th ed., Churchill Livingstone, Philadelphia, 2010: 2881-85.
- Fournier P.E, Richet H, and Weinstein R.A The epidemiology and control of Acinetobacter baumannii in health care facilities. Clinical infectious diseases. 2006;42(5):692-99,
- Seifert H, Dijkshoorn L, Gerner-Smidt P, Pelzer N, Tjernberg I, Vaneechoutte M, Distrubution of Acinetobacter species on human skin: comparison of phenotypic and genotypic identification methods. Journal of Clinical Microbiology. 1997; 35(11): 2819-25.
- Corbella X, Pujol M, Ayats J, Sendra M, Ardanuy C, Domínguez MA, ‘et al.’ Relevance of digestive tract colonization in the epidemiology of nosocomial infections due to multiresistant Acinetobacter baumannii. Clinical infectious diseases, 1996;23(2), 329-34.
- T.C. Sağlık Bakanlığı, Sağlık Hizmetleri Genel Müdürlüğü, Sağlık Hizmet Standartları Dairesi Başkanlığı Ulusal Hastane Enfeksiyonları Sürveyans Ağı (UHESA) Raporu, Özet Veri 20, 2012. https://docplayer.biz.tr/108543950-Ulusal-hastane-enfeksiyonlari-surveyans-agi-uhesa-raporu-ozet-veri-2012.html
- Schulte B, Goerke C, Weyrich P, Gröbner S, Bahrs C, Wolz C, et al. Clonal spread of meropenem-resistant Acinetobacter baumannii strains in hospitals in the Mediterranean region and transmission to South-west Germany. Journal of Hospital Infection. 2005; 61(4):356-57.
- Souli M, Galani I, and Giamarellou H, Emergence of extensively drug-resistant and pandrug-resistant Gram-negative bacilli in Europe. İn:Euro surveillance: bulletin européen sur les maladies transmissibles= European communicable disease bulletin, Kristinsson, K.G., Monnet, D.L.(Eds), 2008; 13(47):30-40
- Ruiz J, Núñez ML, Pérez J, Simarro E, Martínez-Campos L, and Gómez J, Evoluation of resistance among clinical isolates of Acinetobacter over a 6-year period, European Journal of Clinical Microbiology and Infectious Diseases. 1999; 18(4):292-95. Corbella X, Montero A, Pujol M, Domínguez MA, Ayats J, Argerich MJ, ‘et al.’ Emergence and rapid spread of carbapenem resistance during a large and sustained hospital outbreak of multiresistant Acinetobacter baumannii. Journal of clinical microbiology, 38(11): 4086-4095, 2000.
- Karahocagil MK, Yaman G, Göktaş U, Sünnetçioğlu M, Çıkman A, Bilici A. ve ‘ark.’ Hastane enfeksiyon etkenlerinin ve direnç profillerinin belirlenmesi, Van Tıp Dergisi, 2011; 18(1):27-32, Leblebicioglu H, Rosenthal VD, Arıkan ÖA, Özgültekin A, Yalcin AN, Koksal I, ‘et al.’ Device-associated hospital-acquired infection rates in Turkish intensive care units. Findings of the International Nosocomial Infection Control Consortium (INICC). Journal of Hospital infection, 2007; 65(3): 251-57. Dikmen Y, Aygün G, Öztürk R. Yoğun bakım ünitesinde ventilatör ilişkili pnömonilerin değerlendirilmesi. Klimik Dergisi, 2004; 17(2):117-19, Meric M, Willke A, Caglayan C, Toker K. Intensive care unit-acquired infections: incidence, risk factors and associated mortality in a Turkish university hospital. Japanese journal of infectious diseases. 2005;58(5):297-302.
- Goering, R.V.: Molecular epidemiology of nosocomial infection: analysis of chromosomal restriction fragment patterns by pulsed-field gel electrophoresis. Infection Control and Hospital Epidemiology, 1993; 14(10): 595-600
- CDC/NHSN surveillance definition of health care–associated infection and criteria for specific types of infections in the acute care setting. American Journal of Infection Control. 2008; 36: 309‐32, Performance Standards for Antimicrobial Disk Susceptibility Tests; Approved Standard—Eleventh Edition. CLSI document M02-A11 (ISBN 1-56238-781-2 [Print]; ISBN 1-56238-782-0 [Electronic]). 2012; 32(1): 44-45, Clinical and Laboratory Standards Institute, Wayne, Pennsylvania, USA,
- Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Third Informational Supplement. CLSI document M100-S23 (ISBN 1-56238-865-7 [Print]; ISBN 1-56238-866-5 [Electronic]). 2013; 33(1):66-67, Clinical and Laboratory Standards Institute, Wayne, Pennsylvania, USA
- Navon-Venezia S, Leavitt A, Carmeli Y, High tigecycline resistance in multidrug-resistant Acinetobacter baumannii, Journal of Antimicrobial Chemotherapy 2007; 59(4):772-74
- Seifert H, Dolzani L, Bressan R, van der Reijden T, van Strijen B, Stefanik D, ‘et al.’ Standardization and interlaboratory reproducibility assessment of pulsed-field gel electrophoresis-generated fingerprints of Acinetobacter baumannii. Journal of clinical microbiology, 2005; 43(9): 4328-35,
- Durmaz R, Otlu B, Koksal F, Hosoglu S, Ozturk R, Ersoy Y, ‘ve ark.’ The optimization of a rapid pulsed-field gel electrophoresis protocol for the typing of Acinetobacter baumannii, Escherichia coli and Klebsiella spp. Jpn J Infect Dis, 2009; 62(5), 372-7.
- Tenover FC, Arbeit RD, Goering RV, Mickelsen PA, Murray BE, Persing DH, ‘et al.’ Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. Journal of clinical microbiology, 1995; 33(9): 2233-9
- Taşova Y, Akgün Y, Saltoğlu N, Yılmaz G, Kara O, Dündar İH, Nozokomiyal Acinetobacter infeksiyonları. Flora. 1999; 4(3):170–6
- Xu T, Xia W, Rong G, Pan S, Huang P, Gu B, A 4-year surveillance of antimicrobial resistance patterns of Acinetobacter baumanni in a university-affiliated hospital in China. Journal of thoracic disease, 2013; 5(4): 506-12
- Eren OÖ, Kalyoncu U, Andıç N, Şardan YÇ, Yoğun bakım ünitesinde hasta maliyetini etkileyen faktörler. Selçuk Tıp Dergisi, 2009; 25(4):195-202,
- İnan A, Özgultekin A, Akçay SS, Engin DÖ, Turan G, Ceran N, ‘et al.’ Alterations in bacterial spectrum and increasing resistance rates in isolated microorganisms from device-associated infections in an intensive care unit of a teaching hospital in İstanbul (2004-2010). Japanese journal of infectious diseases, 2012; 65(2), 146-151 Katsaragakis S, Markogiannakis H, Toutouzas KG, Drimousis P, Larentzakis A, Theodoraki EM, ‘et al.’ Acinetobacter baumannii infections in a surgical intensive care unit: predictors of multi-drug resistance. World journal of surgery, 2008; 32(6), 1194-1202
- Falagas ME, and Kopterides P, Risk factors for the isolation of multi-drug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa: a systematic review of the literature. Journal of Hospital Infection. 2006; 64(1):7-15,
- Abbo A, Carmeli Y, Navon-Venezia S, Siegman-Igra Y, Schwaber MJ, Impact of multi-drug-resistant Acinetobacter baumannii on clinical outcomes. European Journal of Clinical Microbiology and Infectious Diseases, 2007; 26(11): 793-800
- Wróblewska M, Novel therapies of multidrug-resistant Pseudomonas aeruginosa and Acinetobacter spp. infections: the state of the art. Archivum immunologiae et therapiae experimentalis, 54(2): 113-120, 2006.
- Brahmi N, Beji O, Abidi N, Kouraichi N, Blel Y, El Ghord H, ‘et al.’ Epidemiology and risk factors for colonization and infection by Acinetobacter baumannii in an ICU in Tunisia, where this pathogen is endemic. Journal of Infection and Chemotherapy, 2007; 13(6): 400-4
- Dede B, Kadanalı A, Karagöz G, Çomoğlu Ş, Bektaşoğlu MF, Yücel F, M. Investigation of antibiotic resistance of Acinetobacter baumannii strains isolated from various clinical samples in intensive care unit. Bakırköy Tıp Dergisi, 2013; 9(1): 20-23,
- Koeleman JG, van der Bijl MW, Stoof J, Vandenbroucke-Grauls CM, Savelkoul PH, Antibiotic resistance is a major risk factor for epidemic behavior of Acinetobacter baumannii. Infection control and hospital epidemiology, 2001; 22(5), 284-8
- Durmaz R. Direnç gelişimini önlemede moleküler mikrobiyolojinin katkısı. Ankem Dergisi, 2009; 23(Ek 2):111-115,
- Wang JT, Lin SF, Chiu HL, Wang LC, Tai HM, Jiang CF, ‘et al.’ Molecular epidemiology and control of nosocomial methicillin-resistant Staphylococcus aureus infection in a teaching hospital. Journal of the Formosan Medical Association= Taiwan yi zhi, 2004; 103(1): 32-36,
- Wang H, Guo P, Sun H, Wang H, Yang O, Chen M, ‘et al.’ Molecular Epidemiology of Clinical Isolates of Carbapenem-Resistant Acinetobacter spp. from Chinese Hospitals. Antimicrobial Agents and Chemotherapy. 2007; 51(11), 4022–4028,
- Rosenthal V, Guzmán S, Crnich C, Device-associated nosocomial infection rates in intensive care units of Argentina. Infection control and hospital epidemiology, 2004; 25(3): 251-5,
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Proje Numarası | 2012-TF-U037 |
| Yayımlanma Tarihi | 20 Ağustos 2020 |
| Gönderilme Tarihi | 24 Haziran 2020 |
| Kabul Tarihi | 14 Ağustos 2020 |
| Yayımlandığı Sayı | Yıl 2020 Cilt: 17 Sayı: 2 |
Harran Üniversitesi Tıp Fakültesi Dergisi / Journal of Harran University Medical Faculty