Evaluation of carbapenem-resistant e. coli and klebsiellapneumoniae isolates isolated at Zonguldak Bülent Ecevit University Health application and research center between 2015 and 2017,

Aim: The aims of this study is to investigate the carbapenem resistant E. coli and Klebsiella pneumoniae isolates and to evaluate the patients from whom these isolates were obtained in our laboratory between July 2015-December 2017. Method: The isolate information and demographic characteristics of the patients were determined using the hospital information operating system. Bacterial identification was made by conventional methods and automated system when necessary, and antimicrobial susceptibility tests were performed using Kirby-Bauer disc diffusion method and/or full automatizated bacterial identification system. Gradient test was performed to confirmation of imipenem and/or meropenem susceptibility when necessary. Arbitrarily primed PCR (AP-PCR) method was applied for epidemiological analysis of the isolates. PCR was used for determination carbapenemase enzyme types. Resuls: Carbapenem resistance was found to be 2,8% (93,4% Klebsiella spp.) in 4354 (70,9% E coli, 29% Klebsiella spp.) isolates examined within the specified dates and this resistance was found to be 0,25% and 9% in E. coli and Klebsiella spp isolates respectively. The imipenem and meropenem resistance of the isolates were 30,5% and 84,61%, respectively. The age of the patients from whom the bacteria were obtained was 5-94 years old (Mean 63 and SD ± 17), the male/female ratio was 56/41. Of the patients, 39% was intensive care unite, patient, while 16% of them received treatment in hematology-oncology unites and the rest of them received treatment in various services. The underlying diseases of the patients were cancer (36.6%), diabetes mellitus (28,7%), high blood pressure (19%) and COPD (11%), and 41,23% of the patients died during their treatment. It was observed that 44% of the patients received three or more groups of antibiotics. The clustering rate of carbapenem resistant isolates with AP-PCR was found to be quite high.The most common carbapenemase gene regions were investigated in 32 isolates selected from 21 different clusters showing similarity. Except one of the isolates which was evaluated, OXA-48 enzyme was found in all. Conclusion: Carbapenem resistance for E. coli and Klebsiella spp was found to be 0,25% and 9%, respectively in our region. Patients that the isolates were obtained were generally old, had an underlying disease, history of hospitalization and used more than one group of antibiotics. OXA-48 enzyme was found in our isolates. The high clustering rate of the isolates highlighted the importance of infection control measures. Keywords: Enterobacteriaceae, carbapenem resistance, carbapenemase