No abstract

The aim of this qualitative study was to explore the factors that affect the choices of nursing students who chose a psychiatric nursing internship. The sample group of the study consisted of 13 students who listed psychiatric nursing as their first choice and 11 students who listed psychiatric nursing as their last choice. Four themes were determined: personal reasons, stigmatization, experiences related to psychiatric nursing, and perception of care. Providing activities in nursing education to reduce stigmatization and increasing the time allocated for psychiatric nursing theory and practice are recommended.

Carbapenem resistance due to OXA-type carbapenemases seriously limits therapeutic options in nosocomial infections caused by Acinetobacter baumannii. Previous studies have shown the presence of OXA-51, OXA-58, and OXA-23 carbapenemases but not OXA-24/40 in A. baumannii in Turkey. In this study, we investigated carbapenem-hydrolyzing class D b-lactamases (CHDLs) in A. baumannii and the molecular epidemiology of CHDL producers at the Dokuz Eylul Hospital, Izmir Turkey, and detected bla OXA-24/40 in a clinical isolate from a patient in the medical intensive care unit (ICU). The specific enzyme type was OXA-72. Additional studies revealed 22 more isolates from 20 patients and that the OXA-72-producing strain caused an outbreak in the medical ICU from September 2012 to March 2013, which still continues. To our knowledge, this is the first report of OXA-24/40 carbapenemases in A. baumannii in Turkey. Emergency infection control should be implemented following the arrival of a new OXA at a hospital where A. baumannii is highly endemic. Acinetobacter baumannii is an opportunistic pathogen, which causes nosocomial infections and outbreaks worldwide, particularly in the intensive care units (ICUs) (1,2). Although carbapenems are frequently used for the treatment of infections due to multidrugresistant (MDR) A. baumannii isolates, the increasing resistance to these antimicrobial agents has significantly limited treatment options (3,4). The underlying resistance mechanisms may be related to efflux pump overexpression, decreased permeability, and carbapenemase production. Among the carbapenemases, carbapenem-hydrolyzing class D b-lactamases (CHDLs) are considered the most prevalent cause of carbapenem resistance in A. baumannii (4-6). The CHDLs in A. baumannii can be grouped into six subclasses: chromosomal OXA-51-like, acquired OXA-23-like, OXA-24/40-like, OXA-58-like, OXA-143-like, and OXA-235-like b-lactamases (7,8). OXA-23-like enzymes are the most prevalent CHDLs and have been reported worldwide (1-9). In Turkey, data regarding CHDLs and their epidemiology in A. baumannii are limited. Outbreaks due to OXA-23-like and OXA-58-like enzyme-producing strains were reported in 2008-2010 (10-12). Previous reports have shown that OXA-58-like enzymes were the most prevalent b-lactamases in Turkish strains; however, a recent study reported that OXA-23-like enzymes have become more prevalent since 2010 (13). There is no report regarding OXA-24/40-like enzymes in A. baumannii isolates from Turkey. Here, we describe a small outbreak caused by MDR A. baumannii that produced OXA-72, a member of

Colistin is a polymyxin antibiotic which is considered as one of the last line agents against infections due to multidrug resistant or carbapenem resistant gram-negative pathogens. Colistin resistance is associated with chromosomal alterations which can usually cause mutations in genes coding specific two component regulator systems. The first plasmid-mediated colistin resistance gene, mcr-1 was described in Escherichia coli and Klebsiella pneumoniae isolates in December 2015 and followed by another plasmid-mediated colistin resistance gene mcr-2 in 2016. The rapid and interspecies dissemination of plasmid-mediated resistance mechanisms through horizontal gene transfer, have made these genes considerably threatening. After the first reports, although mcr-1/mcr-2 producing Enterobacteriaceae isolates have been reported from many countries, there have been no reports from Turkey. Thus, the aim of this study was to investigate the presence of mcr-1/mcr-2 in clinical Enterobacteriaceae isolates from different parts of our country. A total of 329 Enterobacteriaceae isolates from 22 laboratories were collected which were isolated between March, 2015 and February, 2016. mcr-1/mcr-2 were investigated by polymerase chain reaction during February-March, 2016. Two hundred and seventeen of Klebsiella pneumoniae (66%), 75 of Salmonella spp. (22.8%), 31 of Esherichia coli (9.4%), 3 of Enterobacter cloacae (0.9%), 2 of Klebsiella oxytoca (0.6%) and 1 of Enterobacter aerogenes (0.3%) isolates were included to the study. Agarose gel electrophoresis results of PCR studies have shown expected band sizes for positive control isolates as 309 bp for mcr-1 and 567 bp for mcr-2. However, the presence of mcr-1/mcr-2 genes was not detected among the tested study isolates of Enterobacteriaceae. Although mcr-1/mcr-2 were not detected in our study isolates, it is highly important to understand the mechanism of resistance dissemination and determine the resistant isolates by considering that colistin is a last-line antibiotic against infections of multidrug or carbapenem resistant gram-negative bacteria. Thus, it is suggested that these mechanisms should be followed-up in both clinical and non-clinical (e.g. isolates from food animals, raw meats and environment) isolates of special populations.