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Genişlemiş Spektrumlu Beta-Laktamazlar GSBL ve Tanı Yöntemleri

Yıl 2012, Cilt: 1 Sayı: 1, 1 - 9, 01.04.2012

Öz

Klasik TEM ve SHV türü enzimlerden nokta mutasyonu ile gelişmiş olan Genişlemiş Spektrumlu Beta-Laktamazlar GSBL , son 30 yılda önemli bir direnç mekanizması olarak ortaya çıkmış olup tanımlanan enzim sayısı 200’e ulaşmıştır. Bu enzimleri kodlayan genlerin çoğu plazmidler ile yayılım göstermekte ve genellikle beraberinde beta-laktam yapısında olmayan diğer antibiyotiklere karşı da direnç genleri taşımaktadır. En uygun tedavi seçeneklerinin belirlenmesi için Clinical and Laboratory Standards Institute CLSI ve diğer standart rehberlerde özellikle Escherichia coli ve Klebsiella pneumoniae izolatları için rutin olarak GSBL varlığının tarama ve doğrulama testleri ile araştırılması önerilmektedir. Bu amaçla geliştirilen testlerin çoğu üretilen enzimin klavulanik asit varlığında inhibisyonunun gözlenmesi esasına dayanır. Rutin laboratuar uygulamalarında yaygın olarak kullanılan Çift Disk Sinerji yöntemi, ucuz ve uygulaması kolay bir yöntem olarak tatmin edici sonuçlar vermektedir. Ancak bu testte sonuç alınması için en az 18-24 saat gerekmekte ve bazı enzim türleri saptanamayabilmektedir. Son yıllarda geliştirilen kromojenik testler ve moleküler yöntemlerle kısa sürede sonuç alınabilse de uygulama zorlukları nedeniyle yaygın kullanımları sınırlı kalmaktadır. Bu derlemede GSBL enzimlerinin klinik önemi, türleri ve in vitro tanıda kullanılan yöntemler üzerinde durulacaktır

Kaynakça

  • 1. Roy C, Foz A, Segura C, Tirado M, Fuster C, Reig R. Plasmid-determined identified in a group of 204 ampicillin-resistant Enterobacteriaceae. J Antimicrob Chemother 1983; 12: 507-10.
  • 2. Sirot D. Extended-spectrum plasmid mediated beta-lactamases. J Antimicrob Chemother 1995; 36: 19-34.
  • 3. Jacoby GA. Genetics of extended-spectrum betalactamases. Eur J Clin Microbiol Infect Dis 1994; 13(1): 2-11.
  • 4. Jacoby G, Bush K. Lahey clinic page on amino acid sequence for TEM, SHV and OXA extendedspectrum and inhibitor resistant beta-lactamases. http://www.lahey.org/Studies
  • 5. Mac Kenzie FM, Gould IM. Extended spectrum βlactamases. J Infect 1998; 36: 255-58.
  • 6. Gür D. Beta-laktamazlar. Flora Dergisi 1997; 2:3-18.
  • 7. Jacoby GA, Medeiros AA. More extendedspectrum β-lactamases. Antimicrob Agents Chemother 1991; 35: 1697–704.
  • 8. Ambler RP. The structure of beta lactamases. Philos Trans R Soc Lond B Biol Sci 1980; 289: 321-31.
  • 9. Bush K, Jacoby GA, Medeiros AA. A functional classification scheme for beta-lactamases and its correlation with molecular structure. Antimicrob Agents Chemother 1995; 39: 1211-33.
  • 10. Knothe H, Shah P, Kremery V, Antal M, Mitsuhashi S. Transferable resistance to cefotaxime, cefoxitin, cefamandole and cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens. Infection 1983; 11: 315-7.
  • 11. Winokur PL, Brueggemann, DeSalvo DL, et al. Animal and human multidrug resistant, cephalosporin-resistant Salmonella isolates expressing a plasmid-mediated CMY-2 AmpC beta-lactamase. Antimicrob Agents Chemother 2000; 44: 2777-83.
  • 12. Nordmann P, Guibert M. Extended spectrum betalactamases in Pseudomonas aeruginosa. J Antimicrob Chemother 1998; 42: 128-31.
  • 13. Gür D. ESBL’ların Genel Özellikleri ve ESBL Tipleri. Yeni ve Yeniden Gündeme Gelen İnfeksiyonlar. Bilimsel Tıp Yayınevi, Ankara, 2004.
  • 14. Canton R, Morosini MI, de la Maza OM, de la Pedrosa EG. IRT and CMT beta lactamases and inhibtor resistance. Clin Microbiol Infect 2008; 14: 53-62.
  • 15. Stürenburg E, Mack D. Extended spektrum beta lactamases: Implications for the clinical microbiology laboratory, therapy and infection control. J Infect 2003; 47: 279-95.
  • 16. Livermore D. CTX-M: changing the face of ESBLs in Europe. J Antimicrob Chemother 2007; 59(2): 165-74.
  • 17. Livermore DM. Beta-lactamases in laboratory and clinical resistance. Clin Microbiol Rev 1995; 8: 557-84.
  • 18. Walter RJ, Hoiby N. OXA-type carbapenemases. J Antimicrob Chemother 2006; 57: 373-83.
  • 19. Nordman P, Guibert M. Extended spektrum beta lactamases in Pseudomonas aeuroginosa. Microbiology 1998; 42: 128-31.
  • 20. Aubert D, Poirel L, Chevalier J, Leotard S, Pages JM. Oxacillinase-mediated resistance to cefepime and susceptibility to ceftazidime in Pseudomonas aeuroginosa. Antimicrobial Agents Chemother 2001; 45: 2615-20.
  • 21. Nordmann P, Naas T. Sequence analysis of PER-1 extended spectrum beta-lactamase from Pseudomonas aeruginosa and comparison with class A beta-lactamases. Antimicrob Agents Chemother 1994; 38: 104-14.
  • 22. Bauernfeind A, Stemplinger I. Characterization of beta-lactamase gene blaPER-2, which encodes an extended-spectrum class A beta-lactamase. Antimicrob Agents Chemother 1996; 40: 616-20.
  • 23. Nordman P, Ronco E, Naas T, Duport C, MichelBriand Y, Labia R. Characterization of a novel extended-spectrum β-lactamase from Pseudomonas aeruginosa. Antimicrob Agents Chemother 1993; 37: 962–9.
  • 24. Paterson DL, Bonomo RA. Extended spectrum beta-lactamases: a clinical update. Clin Microbiol Rev 2005;18: 657-86.
  • 25. Vahaboğlu H, Öztürk R, Aygün G, et al. Widespread detection of PER-1 type extended spectrum beta-lactamases among nosocomial Acinetobacter and Pseudomonas aeruginosa isolates in Turkey: a nationwide multicentre study. Antimicrob Agents Chemother 1997; 41: 2265-9.
  • 26. Poirl L, Naas T, Guibert M, Chaibi B, Labia R, Nordmann P. Molecular and biochemical characterization of VEB-1, a novel class A extended-spectrum beta-lactamase encoded by an E. coli integron gene. Antimicrob Agents Chemother 1999; 43: 573-81.
  • 27. Poirl L, Le Thomas I, Naas T, Karim A, Nordmann P. Biochemical sequence analyses of GES-1, a novel class A extended-spectrum beta-lactamases, and the class 1 integron In52 from Klebsiella pneumoniae. Antimicrob Agents Chemother 2000; 44: 622-32.
  • 28. Naas T, Poirel L, Nordmann P. Minor extendedspectrum beta-lactamases. Clin Microbiol ınfect 2008; 14(S1): 42-52.
  • 29. Winokur PL, Canton R, Casellas JM, Legakis N. Variations in the prevalence of strains exspressing an extended-spectrum β-lactamase phenotype and characterization of isolates from Europe the Americans, and the Western Pasific Region. Clin Infect Dis 2001; 32(Suppl2): 94-103.
  • 30. Beindenbach DJ, Moet G J, Jones R. Occurence and antimicrobial resistance pattern comparisions among bloodstream infection isolates from the SENTRY Antimicrobial surveillance program (1997-2002). Diag Microb Infect Dis 2004; 50: 59- 69.
  • 31. Tonkic M, Barisic I. Prevalence and antimicrobial resistance of extended spectrum beta lactamases producing E. coli and K. pneumoniae strains isolated in a university hospital in Split. Int Microbiol 2005; 8: 119-24.
  • 32. Işık F, Arslan U, Tuncer İ. Klinik örneklerden soyutlanan Klebsiella türlerinde genişlemiş spektrumlu beta-laktamaz varlığı ve antibiyotik duyarlılığı. İnfeksiyon Dergisi 2007; 21: 33-8.
  • 33. Gülay Z. Gram negatif çomaklarda antibiyotik direnci: 2003-2004 Türkiye Haritası. ANKEM 2005; 19: 66-77.
  • 34. Gür D, Gülay Z, Akan Arıkan Ö ve ark. Türkiye’de hastane izolatı gram-negatif bakterilerde yeni betalaktam antibiyotiklere direnç ve GSBL tipleri: çok merkezli HİTİT sürveyansının sonuçları. Mikrobiyol Bul 2008; 42: 537-44.
  • 35. T M Coque, F Baquero, R Canton. Increasing prevalance of ESBL producing Enterobacteriaceae in Europe. Eurosurveillance 2008; 13: 47: 1-11.
  • 36. Tzouvelekis LS, Tzelepi E, Tassios PT, Legakis NJ. CTX-M type beta lactamases: an emerging group of extended spectrum enzymes. Int J Antimicrob Agents 2000;14:137-142.
  • 37. Çelebi S, Yüce N, Çakır D, Hacımustafaoğlu M, Özkaya G. Çocuklarda Genişlemiş Spektrumlu βLaktamaz Üreten E. coli Enfeksiyonlarında Risk Faktörleri ve Klinik Sonuçları; Beş Yıllık Çalışma Çocuk Enf Derg 2009; 3: 5-10.
  • 38. Bradford PA, Cherubin CE, Idemyor V, Rasmussen BA, Bush K. Multiply resistant Klebisella pneumoniae from two Chicago hospitals: idenitification of the extended spectrum TEM-12 and TEM-10 ceftazidime-hydrolyzing beta-lactamases in a single isolates. Antimicrob Agents Chemother 1994; 38: 761-6.
  • 39. Gülay Z. ESBL’lerin tanı yöntemleri. Ünal S, Vahaboğlu H, Leblebicioğlu H, Öztürk R, Köksal İ (eds). Yeni ve Yeniden Gündeme Gelen İnfeksiyonlar: Genişlemiş Spektrumlu BetaLaktamazlar. Bilimsel Tıp Yayınevi, Ankara, 2004.
  • 40. Clinical Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; twenty first informational supplement. M100-S21. Wayne, Philedelphia, 2009.
  • 41. Jarlier V, Nicolas MH, Fournier G, Philippon A. Extended broad-spectrum beta-lactamases conferring transferable resistance to newer betalactam agents in Enterobacteriaceae: hospital prevalence and susceptibility patterns. Rev Infect Dis 1988; 10(4): 867-78.
  • 42. Barroso H, Freitas VA, Lito LM. Survey of Klebsiella pneumoniae producing extendedspectrum β-lactamases at a Portuguese hospital: TEM-10 as the endemic enzyme. J Antimicrob Chemother 2000; 45: 611-6.
  • 43. Patel JB, Rasheed JK, Kitchel B. Carbapenemases in Enterobacteriaceae: activity, epidemiology, and laboratory detection. Clin Microbiol Newsletter 2009; 31(8): 55-62.
  • 44. Endimiani A, Perez F, Bajaksouzian S, Windau AR, Good CE, Choudhary Y, Hujer AM, Bethel CR, Bonomo RA, Jacobs MR. Evaluation of updated interpretative criteria for categorizing Klebsiella pneumoniae with reduced carbapenem susceptibility. J Clin Microbiol 2010; 48(12): 4417-25.
  • 45. Tenover FC, Rajinder K, Williams PP. Carbapenem resistance in Klebsiella pneumoniae not detected by automated susceptibility testing. Emerg Infect Dis 2006; 12(8): 1209–13.
  • 46. Jain S, Andrews J, Fraise A, Brenwald N. Rapid detection of extended spectrum beta-lactamase producing Gram-negative bacilli in blood cultures. J Antimicrob Chemother 2007; 60(3): 652-4.
  • 47. Réglier-Poupet H, Naas T, Carrer A, et al: Performance of chromID ESBL, a chromogenic medium for detection of Enterobacteriaceae producing extended-spectrum beta-lactamases, J Med Microbiol 2008; 57(3): 310-5.
  • 48. Randall LP, Kirchner M, Teale CJ, Coldham NG, Liebana E, Clifton-Hadley F: Evaluation of CHROMagar CTX, a novel medium for isolating CTX-M-ESBL positive Enterobacteriaceae while inhibiting AmpC- producing strains, J Antimicrob Chemother 2009;63(2):302-8.
  • 49. Matthew M, Harris AM, Marshall MM, Ross GW. The use of analytical isoelectric focusing for detection and identification of beta-lactamases. J Gen Microbiol 1975; 88: 169-78.
  • 50. Tham TN, Mabilat C, Courvalin P, Guesdon JL. Biotinylated oligonucleotide probes for the detection and the characterization of TEM-type extended broad spectrum ß-lactamases in Enterobacteriaceae. FEMS Microbiol Lett 1990; 69: 109-16.

Extended Spectrum Beta-Lactamases ESBLs and Identification Methods

Yıl 2012, Cilt: 1 Sayı: 1, 1 - 9, 01.04.2012

Öz

Extended Spectrum Beta-Lactamases ESBLs which develop from classic TEM and SHV beta-lactamases by point mutations have been emerged as significant resistance mechanisms for last 30 years, and their number has reached about 200. The most of the genes encoding these enzymes are transferred on the plasmids and they frequently co-transfer some genes that are responsible for the resistance to other antimicrobials which are not in beta-lactam structure. To select the most appropriate therapy choices, some guidelines including Clinical and Laboratory Standards Institute CLSI have recommended to routinely determine the production of ESBLs with applying screening and confirmative tests for Escherichia coli and Klebsiella pneumoniae isolates. Majority of the tests for ESBLs detection are based on the visualization of the enzyme inhibition in the presence of clavulonic acid. Double Disc Synergy test, one of the most widespreadly used in the routine laboratory interventions, is a cheap and easy-to-apply method, and gives satisfactory results. However, in this test, 18-24 hours are required to obtain the result, and some types of enzymes can not be identified. The chromogenic tests and molecular methods which are developed in the recent years may give result in a shorter time, but their usages are limited due to difficulties for application. In this review, clinical importance of ESBL enzymes, their types and in vitro diagnostic methods will be discussed

Kaynakça

  • 1. Roy C, Foz A, Segura C, Tirado M, Fuster C, Reig R. Plasmid-determined identified in a group of 204 ampicillin-resistant Enterobacteriaceae. J Antimicrob Chemother 1983; 12: 507-10.
  • 2. Sirot D. Extended-spectrum plasmid mediated beta-lactamases. J Antimicrob Chemother 1995; 36: 19-34.
  • 3. Jacoby GA. Genetics of extended-spectrum betalactamases. Eur J Clin Microbiol Infect Dis 1994; 13(1): 2-11.
  • 4. Jacoby G, Bush K. Lahey clinic page on amino acid sequence for TEM, SHV and OXA extendedspectrum and inhibitor resistant beta-lactamases. http://www.lahey.org/Studies
  • 5. Mac Kenzie FM, Gould IM. Extended spectrum βlactamases. J Infect 1998; 36: 255-58.
  • 6. Gür D. Beta-laktamazlar. Flora Dergisi 1997; 2:3-18.
  • 7. Jacoby GA, Medeiros AA. More extendedspectrum β-lactamases. Antimicrob Agents Chemother 1991; 35: 1697–704.
  • 8. Ambler RP. The structure of beta lactamases. Philos Trans R Soc Lond B Biol Sci 1980; 289: 321-31.
  • 9. Bush K, Jacoby GA, Medeiros AA. A functional classification scheme for beta-lactamases and its correlation with molecular structure. Antimicrob Agents Chemother 1995; 39: 1211-33.
  • 10. Knothe H, Shah P, Kremery V, Antal M, Mitsuhashi S. Transferable resistance to cefotaxime, cefoxitin, cefamandole and cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens. Infection 1983; 11: 315-7.
  • 11. Winokur PL, Brueggemann, DeSalvo DL, et al. Animal and human multidrug resistant, cephalosporin-resistant Salmonella isolates expressing a plasmid-mediated CMY-2 AmpC beta-lactamase. Antimicrob Agents Chemother 2000; 44: 2777-83.
  • 12. Nordmann P, Guibert M. Extended spectrum betalactamases in Pseudomonas aeruginosa. J Antimicrob Chemother 1998; 42: 128-31.
  • 13. Gür D. ESBL’ların Genel Özellikleri ve ESBL Tipleri. Yeni ve Yeniden Gündeme Gelen İnfeksiyonlar. Bilimsel Tıp Yayınevi, Ankara, 2004.
  • 14. Canton R, Morosini MI, de la Maza OM, de la Pedrosa EG. IRT and CMT beta lactamases and inhibtor resistance. Clin Microbiol Infect 2008; 14: 53-62.
  • 15. Stürenburg E, Mack D. Extended spektrum beta lactamases: Implications for the clinical microbiology laboratory, therapy and infection control. J Infect 2003; 47: 279-95.
  • 16. Livermore D. CTX-M: changing the face of ESBLs in Europe. J Antimicrob Chemother 2007; 59(2): 165-74.
  • 17. Livermore DM. Beta-lactamases in laboratory and clinical resistance. Clin Microbiol Rev 1995; 8: 557-84.
  • 18. Walter RJ, Hoiby N. OXA-type carbapenemases. J Antimicrob Chemother 2006; 57: 373-83.
  • 19. Nordman P, Guibert M. Extended spektrum beta lactamases in Pseudomonas aeuroginosa. Microbiology 1998; 42: 128-31.
  • 20. Aubert D, Poirel L, Chevalier J, Leotard S, Pages JM. Oxacillinase-mediated resistance to cefepime and susceptibility to ceftazidime in Pseudomonas aeuroginosa. Antimicrobial Agents Chemother 2001; 45: 2615-20.
  • 21. Nordmann P, Naas T. Sequence analysis of PER-1 extended spectrum beta-lactamase from Pseudomonas aeruginosa and comparison with class A beta-lactamases. Antimicrob Agents Chemother 1994; 38: 104-14.
  • 22. Bauernfeind A, Stemplinger I. Characterization of beta-lactamase gene blaPER-2, which encodes an extended-spectrum class A beta-lactamase. Antimicrob Agents Chemother 1996; 40: 616-20.
  • 23. Nordman P, Ronco E, Naas T, Duport C, MichelBriand Y, Labia R. Characterization of a novel extended-spectrum β-lactamase from Pseudomonas aeruginosa. Antimicrob Agents Chemother 1993; 37: 962–9.
  • 24. Paterson DL, Bonomo RA. Extended spectrum beta-lactamases: a clinical update. Clin Microbiol Rev 2005;18: 657-86.
  • 25. Vahaboğlu H, Öztürk R, Aygün G, et al. Widespread detection of PER-1 type extended spectrum beta-lactamases among nosocomial Acinetobacter and Pseudomonas aeruginosa isolates in Turkey: a nationwide multicentre study. Antimicrob Agents Chemother 1997; 41: 2265-9.
  • 26. Poirl L, Naas T, Guibert M, Chaibi B, Labia R, Nordmann P. Molecular and biochemical characterization of VEB-1, a novel class A extended-spectrum beta-lactamase encoded by an E. coli integron gene. Antimicrob Agents Chemother 1999; 43: 573-81.
  • 27. Poirl L, Le Thomas I, Naas T, Karim A, Nordmann P. Biochemical sequence analyses of GES-1, a novel class A extended-spectrum beta-lactamases, and the class 1 integron In52 from Klebsiella pneumoniae. Antimicrob Agents Chemother 2000; 44: 622-32.
  • 28. Naas T, Poirel L, Nordmann P. Minor extendedspectrum beta-lactamases. Clin Microbiol ınfect 2008; 14(S1): 42-52.
  • 29. Winokur PL, Canton R, Casellas JM, Legakis N. Variations in the prevalence of strains exspressing an extended-spectrum β-lactamase phenotype and characterization of isolates from Europe the Americans, and the Western Pasific Region. Clin Infect Dis 2001; 32(Suppl2): 94-103.
  • 30. Beindenbach DJ, Moet G J, Jones R. Occurence and antimicrobial resistance pattern comparisions among bloodstream infection isolates from the SENTRY Antimicrobial surveillance program (1997-2002). Diag Microb Infect Dis 2004; 50: 59- 69.
  • 31. Tonkic M, Barisic I. Prevalence and antimicrobial resistance of extended spectrum beta lactamases producing E. coli and K. pneumoniae strains isolated in a university hospital in Split. Int Microbiol 2005; 8: 119-24.
  • 32. Işık F, Arslan U, Tuncer İ. Klinik örneklerden soyutlanan Klebsiella türlerinde genişlemiş spektrumlu beta-laktamaz varlığı ve antibiyotik duyarlılığı. İnfeksiyon Dergisi 2007; 21: 33-8.
  • 33. Gülay Z. Gram negatif çomaklarda antibiyotik direnci: 2003-2004 Türkiye Haritası. ANKEM 2005; 19: 66-77.
  • 34. Gür D, Gülay Z, Akan Arıkan Ö ve ark. Türkiye’de hastane izolatı gram-negatif bakterilerde yeni betalaktam antibiyotiklere direnç ve GSBL tipleri: çok merkezli HİTİT sürveyansının sonuçları. Mikrobiyol Bul 2008; 42: 537-44.
  • 35. T M Coque, F Baquero, R Canton. Increasing prevalance of ESBL producing Enterobacteriaceae in Europe. Eurosurveillance 2008; 13: 47: 1-11.
  • 36. Tzouvelekis LS, Tzelepi E, Tassios PT, Legakis NJ. CTX-M type beta lactamases: an emerging group of extended spectrum enzymes. Int J Antimicrob Agents 2000;14:137-142.
  • 37. Çelebi S, Yüce N, Çakır D, Hacımustafaoğlu M, Özkaya G. Çocuklarda Genişlemiş Spektrumlu βLaktamaz Üreten E. coli Enfeksiyonlarında Risk Faktörleri ve Klinik Sonuçları; Beş Yıllık Çalışma Çocuk Enf Derg 2009; 3: 5-10.
  • 38. Bradford PA, Cherubin CE, Idemyor V, Rasmussen BA, Bush K. Multiply resistant Klebisella pneumoniae from two Chicago hospitals: idenitification of the extended spectrum TEM-12 and TEM-10 ceftazidime-hydrolyzing beta-lactamases in a single isolates. Antimicrob Agents Chemother 1994; 38: 761-6.
  • 39. Gülay Z. ESBL’lerin tanı yöntemleri. Ünal S, Vahaboğlu H, Leblebicioğlu H, Öztürk R, Köksal İ (eds). Yeni ve Yeniden Gündeme Gelen İnfeksiyonlar: Genişlemiş Spektrumlu BetaLaktamazlar. Bilimsel Tıp Yayınevi, Ankara, 2004.
  • 40. Clinical Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; twenty first informational supplement. M100-S21. Wayne, Philedelphia, 2009.
  • 41. Jarlier V, Nicolas MH, Fournier G, Philippon A. Extended broad-spectrum beta-lactamases conferring transferable resistance to newer betalactam agents in Enterobacteriaceae: hospital prevalence and susceptibility patterns. Rev Infect Dis 1988; 10(4): 867-78.
  • 42. Barroso H, Freitas VA, Lito LM. Survey of Klebsiella pneumoniae producing extendedspectrum β-lactamases at a Portuguese hospital: TEM-10 as the endemic enzyme. J Antimicrob Chemother 2000; 45: 611-6.
  • 43. Patel JB, Rasheed JK, Kitchel B. Carbapenemases in Enterobacteriaceae: activity, epidemiology, and laboratory detection. Clin Microbiol Newsletter 2009; 31(8): 55-62.
  • 44. Endimiani A, Perez F, Bajaksouzian S, Windau AR, Good CE, Choudhary Y, Hujer AM, Bethel CR, Bonomo RA, Jacobs MR. Evaluation of updated interpretative criteria for categorizing Klebsiella pneumoniae with reduced carbapenem susceptibility. J Clin Microbiol 2010; 48(12): 4417-25.
  • 45. Tenover FC, Rajinder K, Williams PP. Carbapenem resistance in Klebsiella pneumoniae not detected by automated susceptibility testing. Emerg Infect Dis 2006; 12(8): 1209–13.
  • 46. Jain S, Andrews J, Fraise A, Brenwald N. Rapid detection of extended spectrum beta-lactamase producing Gram-negative bacilli in blood cultures. J Antimicrob Chemother 2007; 60(3): 652-4.
  • 47. Réglier-Poupet H, Naas T, Carrer A, et al: Performance of chromID ESBL, a chromogenic medium for detection of Enterobacteriaceae producing extended-spectrum beta-lactamases, J Med Microbiol 2008; 57(3): 310-5.
  • 48. Randall LP, Kirchner M, Teale CJ, Coldham NG, Liebana E, Clifton-Hadley F: Evaluation of CHROMagar CTX, a novel medium for isolating CTX-M-ESBL positive Enterobacteriaceae while inhibiting AmpC- producing strains, J Antimicrob Chemother 2009;63(2):302-8.
  • 49. Matthew M, Harris AM, Marshall MM, Ross GW. The use of analytical isoelectric focusing for detection and identification of beta-lactamases. J Gen Microbiol 1975; 88: 169-78.
  • 50. Tham TN, Mabilat C, Courvalin P, Guesdon JL. Biotinylated oligonucleotide probes for the detection and the characterization of TEM-type extended broad spectrum ß-lactamases in Enterobacteriaceae. FEMS Microbiol Lett 1990; 69: 109-16.
Toplam 50 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Derleme
Yazarlar

Duygu Dağlar Bu kişi benim

Gözde Öngüt Bu kişi benim

Yayımlanma Tarihi 1 Nisan 2012
Yayımlandığı Sayı Yıl 2012 Cilt: 1 Sayı: 1

Kaynak Göster

APA Dağlar, D., & Öngüt, G. (2012). Genişlemiş Spektrumlu Beta-Laktamazlar GSBL ve Tanı Yöntemleri. Annals of Health Sciences Research, 1(1), 1-9.
AMA Dağlar D, Öngüt G. Genişlemiş Spektrumlu Beta-Laktamazlar GSBL ve Tanı Yöntemleri. Ann Health Sci Res. Nisan 2012;1(1):1-9.
Chicago Dağlar, Duygu, ve Gözde Öngüt. “Genişlemiş Spektrumlu Beta-Laktamazlar GSBL Ve Tanı Yöntemleri”. Annals of Health Sciences Research 1, sy. 1 (Nisan 2012): 1-9.
EndNote Dağlar D, Öngüt G (01 Nisan 2012) Genişlemiş Spektrumlu Beta-Laktamazlar GSBL ve Tanı Yöntemleri. Annals of Health Sciences Research 1 1 1–9.
IEEE D. Dağlar ve G. Öngüt, “Genişlemiş Spektrumlu Beta-Laktamazlar GSBL ve Tanı Yöntemleri”, Ann Health Sci Res, c. 1, sy. 1, ss. 1–9, 2012.
ISNAD Dağlar, Duygu - Öngüt, Gözde. “Genişlemiş Spektrumlu Beta-Laktamazlar GSBL Ve Tanı Yöntemleri”. Annals of Health Sciences Research 1/1 (Nisan 2012), 1-9.
JAMA Dağlar D, Öngüt G. Genişlemiş Spektrumlu Beta-Laktamazlar GSBL ve Tanı Yöntemleri. Ann Health Sci Res. 2012;1:1–9.
MLA Dağlar, Duygu ve Gözde Öngüt. “Genişlemiş Spektrumlu Beta-Laktamazlar GSBL Ve Tanı Yöntemleri”. Annals of Health Sciences Research, c. 1, sy. 1, 2012, ss. 1-9.
Vancouver Dağlar D, Öngüt G. Genişlemiş Spektrumlu Beta-Laktamazlar GSBL ve Tanı Yöntemleri. Ann Health Sci Res. 2012;1(1):1-9.