Research Article
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Methicillin-Resistant Staphylococcus Strains Isolated from Adult Intensive Care Units with E-test MIC Values of Different Antibiotic Research

Year 2019, Volume: 46 Issue: 1, 51 - 64, 03.03.2019

Narin Gündoğuş Kadri Gül Tuba Dal Nezahat Akpolat

https://doi.org/10.5798/dicletip.534830

Abstract

Objective:
Nasocomial infections are major health problems due to their high morbidity and
mortality, prolonged hospital duration and higher treatment costs.
Methicillin-resistant staphylococcus
species became one of the leading bacteria causing nasocomial infections
especially in intensive care units, recently.



The minimum
inhibitory concentration value of an antibiotic gives the concentration of
antibiotic needed to inhibit the bacteria in the infection area. Careful
monitoring of minimal inhibitory concentration (MIC) values is necessary
especially during long-term treatments of meticillin-resistant Staphylococcus aureus (MRSA) and
meticillin-resistant coagulase-negative staphylococci (MRCoNS) infections1,2.
Increasing antibiotic resistance in methicillin-resistant staphylococci, has
led to the need for different antibiotics.



Methods: A
total of 60 meticillin-resistant staphylococci strains isolated in Microbiology
Laboratory of Dicle University Hospital, from clinical specimens of patients in
adult İntensive Care Units (ICUs) between April 2013 and March 2014 were included
in this study. After identification with conventional and automated system, the
antibiotic susceptibility rates of vancomycin, teicoplanin, daptomycin,
linezolid, quinupristin/dalfopristin, tigecycline, ceftaroline were determined
by E-test method.



Results:
The majority of the samples (26.7%) were sent from Pulmonary Diseases and
Tuberculosis intensive care unit and the blood samples were the most common
materials (80%) . All staphylococcal strains in our study were determined as
susceptible to vancomycin, daptomycin, linezolid, teicoplanin and tigecycline.
One (1.6%) MRCoNS isolate was resistant to quinupristin/dalfopristin while 11
(36.6%) of the MRSA isolates were resistant to ceftaroline. In comparison with
the MIC values of MRSA and MRCoNS, only tigecycline was significantly
different. Thirty MRSA strains were evaluated in terms of
vancomycin-intermediate Staphylococcus
aureus/heteroresistant vancomycin-intermediate Staphylococcus aureus (VISA/hVISA) with macro E-test method; any
VISA/hVISA isolate was not detected.



Antibiotic
concentrations below the MIC level, not only leads to treatment failure but
also causes mutant bacteria to appear. In order to control the resistance to
antibiotics in the treatment of infections due to MRSA and MRCoNS agents, the
clinician should be notified of the MIC values of the drugs and the treatment
should be planned accordingly.



VISA/hVISA isolates
should be considered in treatment failures of infections due to MRSA which are
in vitro susceptible to vancomycin. Further testing is needed to detect these
isolates.



Despite the
fact that ceftaroline is not a drug used in our country, the high resistance
rate in our study is remarkable. This situation may be due to the intensive use
of other beta-lactam antibiotics. Therefore, antibiotic susceptibility results
should be taken into consideration during planning the treatment of infections.



The high
average MIC values of tigecycline in MRCoNS infections should also be monitored
carefully

Keywords

Methicillin-resistant staphylococci MIC E-test

References

  • 1. Sancak B . Staphylococcus aureus and Antibiotic Resistance. Mikrobiyol Bul. 2011; 45: 565-76.
  • 2. Aydogdu S, Karamese M, Altoparlak U. Evaluation of the Activities of Antimicrobial Agents on Multi-drug Resistant Gram Positive Bacteria Isolated from Intensive Care Units. SOJ Microbiol Infect Dis.2014; 2: 1-5.
  • 3. The European Committee on Antimicrbial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters Version 4, (2014). http://www. eucast. org. Erişim tarihi: 01. 02. 2014.
  • 4. Wootton M, MacGowan A. P, Walsh T. R, Howe R. A. A Multicenter Study Evaluating the Current Strategies for Isolating Staphylococcus aureus Strains with Reduced Susceptibility to Glycopeptides. Journal of Clinical Microbiology. 2007; 45: 329-32.
  • 5. Sancak B. Methicillin and Vancomycin Resistance in Staphylococcus aureus. Hacettepe Tıp Derg. 2007; 38: 127-34.
  • 6. Öksüz L. Gürler N.In Vitro Susceptibility Results of Antibiotics Used in Recent Years for Methicillin Resistant Staphylococcus Strains Isolated from Clinical Samples ANKEM Derg 2009; 23: 71-77.
  • 7. Hal S. J. van, Fowler V. G. Is it time to replace vancomycin in the treatment of methicillin-resistant Staphylococcus aureus infections. Clin Infect Dis. 2013; 56: 1779–88.
  • 8. Prakash V, Lewis II J. S, Jorgensen J. H. Vancomycin MICs for Methicillin-Resistant Staphylococcus aureus Isolates Differ Based upon the Susceptibility Test Method Used Antimicrob. Agents Chemother. 2008; 52: 4528.
  • 9. Ippolito G, Leone S, Lauria FN, et all. Methicillin-resistant Staphylococcus aureus: the superbug. Int J Infect Dis. 2010; 14: 7-11.
  • 10. Korten V., Multi-Drug Resistant Gram Positive Bacteria (MRSA and VRE): Treatment And Control. ANKEM Derg. 2013; 27(Ek 2): 57-62.
  • 11. Doğanay V, Kizirgil A. In Vitro Activity on Gram Positive Cocci of Quinupristin/dalfopristin and Other Eight Antimicrobial Agents. F.Ü. Sağ. Bil. Derg. 2007: 21: 129–32.
  • 12. Yavuz M. T, Behçet M, Öztürk C. E, et all. Susceptibilities of Staphylococcus aureus strains to quinupristin/dalfopristin. Türk Mikrobiyol Cem Derg. 2006; 36: 190-4.
  • 13. Çelik C, Bakıcı M. Z, Gözel M. G, et all. Antimicrobial resistance paternity in Staphylococcus aureus strains isolated from bloodstream infections. Genel Tıp Derg. 2013; 23: 109-13.
  • 14. Elsahn AF, Yildiz EH, Jungkind DL, et all. In vitro susceptibility patterns of methicillin-resistant Staphylococcus aureus and coagulase-negative Staphylococcus corneal isolates to antibiotics. Cornea. 2010 Dec; 29: 1470.
  • 15. Türk Dağı H, Arslan U, Tuncer İ. Antibiotic Sensitivity of Staphylococcus aureus Strains Isolated from Blood Cultures. ANKEM Derg. 2011; 25: 84-8.
  • 16. Doğan M, Feyzioğlu B, Baykan M. Change in Antibiotic Resistance of S. aureus Strains in the Decade Period. Abant Med J. 2014; 3: 237-41.
  • 17. Yanık K, Yılmaz H, Tanrıverdı Caycı Y, et all. Glycopeptıdes And Lınezolıd MIC Changes In Staphylococcus aureus And Coagulase Negatıve Staphylococcı Isolates From 2008-2011. Acta Medica Mediterranea. 2014; 30: 995.
  • 18. Kuşcu F, Öztürk D.B, Gürbüz Y, et all. Investigation of Decreased Vancomycin Sensitivity in Methicillin Resistant Staphylococci. Mikrobiyol Bul. 2011; 45: 248-57.
  • 19. Richter S. S, Diekema D.J, Heilmann K. P, et all. Activities of Vancomycin, Ceftaroline, and Mupirocin against Staphylococcus aureus Isolates Collected in a 2011 National Surveillance Study in the United States. Antimicrobial Agents and Chemotherapy. 2014; 58: 740-5.
  • 20. Celikbilek N, Ozdem B, Gürelik FC, et all. In vitro susceptibility of methicillin-resistant Staphylococcus aureus isolates to vancomycin, teicoplanin, linezolide and daptomycin. Mikrobiyol Bul. 2011; 45: 512-8.
  • 21. Aktaş G, Derbentli Ş. Daptomisinin VRE ve MRSA Suşlarına İn Vitro Etkinliği. Mikrobiyol Bul. 2014; 48: 123-8.
  • 22. Hancı H, Uyanık M. H, Bilici D, et all. Investigation of Daptomycin Activity in Methicillin Resistant Staphylococcus Strains Isolated from Clinical Samples. ANKEM Derg. 2013; 27: 64-9.
  • 23. Sader H. S., Flamm R. K., Jones R. N. Antimicrobial Activity of Ceftaroline Tested against Staphylococci with Reduced Susceptibility to Linezolid, Daptomycin, or Vancomycin from U.S. Hospitals, 2008 to 2011. Antimicrob Agents Chemother. 2013; 57: 3178–81.
  • 24. Werth B. J, Steed M. E, Kaatz G. W, Rybak M. J. Evaluation of Ceftaroline Activity against Heteroresistant Vancomycin-Intermediate Staphylococcus aureus and Vancomycin Intermediate Methicillin-Resistant S. aureus Strains in anIn Vitro Pharmacokinetic/Pharmacodynamic Model: Exploring the “Seesaw Effect”. 2013; 57: 2664-8.
  • 25. Kaya S. Treatment of Community-Acquired Methicillin Resistant Staphylococcus aureus Infections. J Med Sci. 2008; 28: 956-61.
  • 26. Adaleti R, Nakipoğlu Y, Ceran N, et all. Prevalence of phenotypic resistance of Staphylococcus aureus isolates to macrolide, lincosamide, streptogramin B, ketolid and linezolid antibiotics in Turkey. Braz J Infect Dis. 2010; 14: 11-4.
  • 27. Khalid A, Umsan J, Faiz U, et all. In-vitro susceptibility of linezolid against methicillin resistant Staphylococcus aureus at a tertiary care hospital in Pakistan. Journal of Microbiology and Infectious Diseases. 2013; 3: 203-6.
  • 28. Al F., D, Akca G, Akyan B, et all. Quinupristin/dalfopristin, Linezolide Susceptibilities and Macrolide-Linkozamide-Streptogramin B Resistance in Methicillin Resistant Staphylococcus aureus Strains. Turkish Journal of Infection. 2008; 22: 153-63.
  • 29. Ağalar C, Göçmen J. S, Kılıç D, et all. Sensitivity to methicillin-resistant staphylococcal strains isolated in a tertiary referral hospital. Journal of Clinical and Experimental Investigations. 2012; 3: 71-4.
  • 30. Efe Ş, Sınırtaş M, Özakın C. In Vitro Linezolid Sensitivity of Methicillin Resistant Staphylococcus aureus and Vancomycin Resistant Enterococcus Strains. Mikrobiyol Bul. 2009; 43: 639-43.
  • 31. Kali A, Stephen S, Umadevi S, Kumar S. Detection of quinupristin/dalfopristin resistance in methicilline-resistant Staphylococcus aureus in South İndia. İndian J Pathol Microbiol. 2013; 5: 73-4.
  • 32. Ulusoy S. Streptograminler (Kinupristin/dalfopristin). ANKEM Derg. 2004; 18 (Ek 2):174-7.
  • 33. Çalık N, Akova M. Tigesiklin. ANKEM Derg. 2007; 21(Ek 2): 29-33.
  • 34. Zorgani A, Elahmer O, Ziglam H, Ghenghesh K. S. In-vitro activity of tigecycline against methicillin-resistant Staphylococcus aureus Isolated from wounds of burn patients in Tripoli-Libya. Journal of Microbiology and Infectious Diseases (JIMD). 2012; 2: 109-12.
  • 35. Opuş A, Keşli R, Kurtoğlu M. G, Güzelant A, Uysal E. B. Investigation of tigecycline activity in methicillin-resistant staphylococcal strains. Turk Hij Den Biyol Derg: 2012; 69: 121-6.
  • 36. Manso D. M, Prado D. del, Perez A. O, et all. In vitro susceptibility to antibiotics of staphylococci in biofilms isolated from orthopaedic infections. International Journal of Antimicrobial Agents. 2013; 521–3.
  • 37. Erdinç F.Ş. Sefalotinden, seftobiprole, seftaroline. Ankem Derg 2013; 27 (Ek 2):124-6.
  • 38. Mengeloğlu F. Z, Taş T, Koçoğlu E, et all. In Vitro Activity of MRSA Isolates of Ceftarolin: A Multicenter Study. Mikrobiyol Bul. 2013; 47: 677-83.
  • 39. Flamm R. K, Sader H. S, Jones R. N. Ceftaroline activity tested against contemporary Latin American bacterial pathogens 2011. Braz j infect dis. 2014 4; 18: 187–95.

Year 2019, Volume: 46 Issue: 1, 51 - 64, 03.03.2019

Narin Gündoğuş Kadri Gül Tuba Dal Nezahat Akpolat

https://doi.org/10.5798/dicletip.534830

Abstract

References

  • 1. Sancak B . Staphylococcus aureus and Antibiotic Resistance. Mikrobiyol Bul. 2011; 45: 565-76.
  • 2. Aydogdu S, Karamese M, Altoparlak U. Evaluation of the Activities of Antimicrobial Agents on Multi-drug Resistant Gram Positive Bacteria Isolated from Intensive Care Units. SOJ Microbiol Infect Dis.2014; 2: 1-5.
  • 3. The European Committee on Antimicrbial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters Version 4, (2014). http://www. eucast. org. Erişim tarihi: 01. 02. 2014.
  • 4. Wootton M, MacGowan A. P, Walsh T. R, Howe R. A. A Multicenter Study Evaluating the Current Strategies for Isolating Staphylococcus aureus Strains with Reduced Susceptibility to Glycopeptides. Journal of Clinical Microbiology. 2007; 45: 329-32.
  • 5. Sancak B. Methicillin and Vancomycin Resistance in Staphylococcus aureus. Hacettepe Tıp Derg. 2007; 38: 127-34.
  • 6. Öksüz L. Gürler N.In Vitro Susceptibility Results of Antibiotics Used in Recent Years for Methicillin Resistant Staphylococcus Strains Isolated from Clinical Samples ANKEM Derg 2009; 23: 71-77.
  • 7. Hal S. J. van, Fowler V. G. Is it time to replace vancomycin in the treatment of methicillin-resistant Staphylococcus aureus infections. Clin Infect Dis. 2013; 56: 1779–88.
  • 8. Prakash V, Lewis II J. S, Jorgensen J. H. Vancomycin MICs for Methicillin-Resistant Staphylococcus aureus Isolates Differ Based upon the Susceptibility Test Method Used Antimicrob. Agents Chemother. 2008; 52: 4528.
  • 9. Ippolito G, Leone S, Lauria FN, et all. Methicillin-resistant Staphylococcus aureus: the superbug. Int J Infect Dis. 2010; 14: 7-11.
  • 10. Korten V., Multi-Drug Resistant Gram Positive Bacteria (MRSA and VRE): Treatment And Control. ANKEM Derg. 2013; 27(Ek 2): 57-62.
  • 11. Doğanay V, Kizirgil A. In Vitro Activity on Gram Positive Cocci of Quinupristin/dalfopristin and Other Eight Antimicrobial Agents. F.Ü. Sağ. Bil. Derg. 2007: 21: 129–32.
  • 12. Yavuz M. T, Behçet M, Öztürk C. E, et all. Susceptibilities of Staphylococcus aureus strains to quinupristin/dalfopristin. Türk Mikrobiyol Cem Derg. 2006; 36: 190-4.
  • 13. Çelik C, Bakıcı M. Z, Gözel M. G, et all. Antimicrobial resistance paternity in Staphylococcus aureus strains isolated from bloodstream infections. Genel Tıp Derg. 2013; 23: 109-13.
  • 14. Elsahn AF, Yildiz EH, Jungkind DL, et all. In vitro susceptibility patterns of methicillin-resistant Staphylococcus aureus and coagulase-negative Staphylococcus corneal isolates to antibiotics. Cornea. 2010 Dec; 29: 1470.
  • 15. Türk Dağı H, Arslan U, Tuncer İ. Antibiotic Sensitivity of Staphylococcus aureus Strains Isolated from Blood Cultures. ANKEM Derg. 2011; 25: 84-8.
  • 16. Doğan M, Feyzioğlu B, Baykan M. Change in Antibiotic Resistance of S. aureus Strains in the Decade Period. Abant Med J. 2014; 3: 237-41.
  • 17. Yanık K, Yılmaz H, Tanrıverdı Caycı Y, et all. Glycopeptıdes And Lınezolıd MIC Changes In Staphylococcus aureus And Coagulase Negatıve Staphylococcı Isolates From 2008-2011. Acta Medica Mediterranea. 2014; 30: 995.
  • 18. Kuşcu F, Öztürk D.B, Gürbüz Y, et all. Investigation of Decreased Vancomycin Sensitivity in Methicillin Resistant Staphylococci. Mikrobiyol Bul. 2011; 45: 248-57.
  • 19. Richter S. S, Diekema D.J, Heilmann K. P, et all. Activities of Vancomycin, Ceftaroline, and Mupirocin against Staphylococcus aureus Isolates Collected in a 2011 National Surveillance Study in the United States. Antimicrobial Agents and Chemotherapy. 2014; 58: 740-5.
  • 20. Celikbilek N, Ozdem B, Gürelik FC, et all. In vitro susceptibility of methicillin-resistant Staphylococcus aureus isolates to vancomycin, teicoplanin, linezolide and daptomycin. Mikrobiyol Bul. 2011; 45: 512-8.
  • 21. Aktaş G, Derbentli Ş. Daptomisinin VRE ve MRSA Suşlarına İn Vitro Etkinliği. Mikrobiyol Bul. 2014; 48: 123-8.
  • 22. Hancı H, Uyanık M. H, Bilici D, et all. Investigation of Daptomycin Activity in Methicillin Resistant Staphylococcus Strains Isolated from Clinical Samples. ANKEM Derg. 2013; 27: 64-9.
  • 23. Sader H. S., Flamm R. K., Jones R. N. Antimicrobial Activity of Ceftaroline Tested against Staphylococci with Reduced Susceptibility to Linezolid, Daptomycin, or Vancomycin from U.S. Hospitals, 2008 to 2011. Antimicrob Agents Chemother. 2013; 57: 3178–81.
  • 24. Werth B. J, Steed M. E, Kaatz G. W, Rybak M. J. Evaluation of Ceftaroline Activity against Heteroresistant Vancomycin-Intermediate Staphylococcus aureus and Vancomycin Intermediate Methicillin-Resistant S. aureus Strains in anIn Vitro Pharmacokinetic/Pharmacodynamic Model: Exploring the “Seesaw Effect”. 2013; 57: 2664-8.
  • 25. Kaya S. Treatment of Community-Acquired Methicillin Resistant Staphylococcus aureus Infections. J Med Sci. 2008; 28: 956-61.
  • 26. Adaleti R, Nakipoğlu Y, Ceran N, et all. Prevalence of phenotypic resistance of Staphylococcus aureus isolates to macrolide, lincosamide, streptogramin B, ketolid and linezolid antibiotics in Turkey. Braz J Infect Dis. 2010; 14: 11-4.
  • 27. Khalid A, Umsan J, Faiz U, et all. In-vitro susceptibility of linezolid against methicillin resistant Staphylococcus aureus at a tertiary care hospital in Pakistan. Journal of Microbiology and Infectious Diseases. 2013; 3: 203-6.
  • 28. Al F., D, Akca G, Akyan B, et all. Quinupristin/dalfopristin, Linezolide Susceptibilities and Macrolide-Linkozamide-Streptogramin B Resistance in Methicillin Resistant Staphylococcus aureus Strains. Turkish Journal of Infection. 2008; 22: 153-63.
  • 29. Ağalar C, Göçmen J. S, Kılıç D, et all. Sensitivity to methicillin-resistant staphylococcal strains isolated in a tertiary referral hospital. Journal of Clinical and Experimental Investigations. 2012; 3: 71-4.
  • 30. Efe Ş, Sınırtaş M, Özakın C. In Vitro Linezolid Sensitivity of Methicillin Resistant Staphylococcus aureus and Vancomycin Resistant Enterococcus Strains. Mikrobiyol Bul. 2009; 43: 639-43.
  • 31. Kali A, Stephen S, Umadevi S, Kumar S. Detection of quinupristin/dalfopristin resistance in methicilline-resistant Staphylococcus aureus in South İndia. İndian J Pathol Microbiol. 2013; 5: 73-4.
  • 32. Ulusoy S. Streptograminler (Kinupristin/dalfopristin). ANKEM Derg. 2004; 18 (Ek 2):174-7.
  • 33. Çalık N, Akova M. Tigesiklin. ANKEM Derg. 2007; 21(Ek 2): 29-33.
  • 34. Zorgani A, Elahmer O, Ziglam H, Ghenghesh K. S. In-vitro activity of tigecycline against methicillin-resistant Staphylococcus aureus Isolated from wounds of burn patients in Tripoli-Libya. Journal of Microbiology and Infectious Diseases (JIMD). 2012; 2: 109-12.
  • 35. Opuş A, Keşli R, Kurtoğlu M. G, Güzelant A, Uysal E. B. Investigation of tigecycline activity in methicillin-resistant staphylococcal strains. Turk Hij Den Biyol Derg: 2012; 69: 121-6.
  • 36. Manso D. M, Prado D. del, Perez A. O, et all. In vitro susceptibility to antibiotics of staphylococci in biofilms isolated from orthopaedic infections. International Journal of Antimicrobial Agents. 2013; 521–3.
  • 37. Erdinç F.Ş. Sefalotinden, seftobiprole, seftaroline. Ankem Derg 2013; 27 (Ek 2):124-6.
  • 38. Mengeloğlu F. Z, Taş T, Koçoğlu E, et all. In Vitro Activity of MRSA Isolates of Ceftarolin: A Multicenter Study. Mikrobiyol Bul. 2013; 47: 677-83.
  • 39. Flamm R. K, Sader H. S, Jones R. N. Ceftaroline activity tested against contemporary Latin American bacterial pathogens 2011. Braz j infect dis. 2014 4; 18: 187–95.
There are 39 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research Article
Authors

Narin Gündoğuş This is me 0000-0002-1046-8024

Kadri Gül This is me

Tuba Dal This is me 0000-0001-7045-1462

Nezahat Akpolat 0000-0002-8653-6046

Publication Date March 3, 2019
Submission Date July 17, 2018
Published in Issue Year 2019 Volume: 46 Issue: 1

Cite

APA Gündoğuş, N., Gül, K., Dal, T., Akpolat, N. (2019). Methicillin-Resistant Staphylococcus Strains Isolated from Adult Intensive Care Units with E-test MIC Values of Different Antibiotic Research. Dicle Tıp Dergisi, 46(1), 51-64. https://doi.org/10.5798/dicletip.534830
AMA Gündoğuş N, Gül K, Dal T, Akpolat N. Methicillin-Resistant Staphylococcus Strains Isolated from Adult Intensive Care Units with E-test MIC Values of Different Antibiotic Research. diclemedj. March 2019;46(1):51-64. doi:10.5798/dicletip.534830
Chicago Gündoğuş, Narin, Kadri Gül, Tuba Dal, and Nezahat Akpolat. “Methicillin-Resistant Staphylococcus Strains Isolated from Adult Intensive Care Units With E-Test MIC Values of Different Antibiotic Research”. Dicle Tıp Dergisi 46, no. 1 (March 2019): 51-64. https://doi.org/10.5798/dicletip.534830.
EndNote Gündoğuş N, Gül K, Dal T, Akpolat N (March 1, 2019) Methicillin-Resistant Staphylococcus Strains Isolated from Adult Intensive Care Units with E-test MIC Values of Different Antibiotic Research. Dicle Tıp Dergisi 46 1 51–64.
IEEE N. Gündoğuş, K. Gül, T. Dal, and N. Akpolat, “Methicillin-Resistant Staphylococcus Strains Isolated from Adult Intensive Care Units with E-test MIC Values of Different Antibiotic Research”, diclemedj, vol. 46, no. 1, pp. 51–64, 2019, doi: 10.5798/dicletip.534830.
ISNAD Gündoğuş, Narin et al. “Methicillin-Resistant Staphylococcus Strains Isolated from Adult Intensive Care Units With E-Test MIC Values of Different Antibiotic Research”. Dicle Tıp Dergisi 46/1 (March 2019), 51-64. https://doi.org/10.5798/dicletip.534830.
JAMA Gündoğuş N, Gül K, Dal T, Akpolat N. Methicillin-Resistant Staphylococcus Strains Isolated from Adult Intensive Care Units with E-test MIC Values of Different Antibiotic Research. diclemedj. 2019;46:51–64.
MLA Gündoğuş, Narin et al. “Methicillin-Resistant Staphylococcus Strains Isolated from Adult Intensive Care Units With E-Test MIC Values of Different Antibiotic Research”. Dicle Tıp Dergisi, vol. 46, no. 1, 2019, pp. 51-64, doi:10.5798/dicletip.534830.
Vancouver Gündoğuş N, Gül K, Dal T, Akpolat N. Methicillin-Resistant Staphylococcus Strains Isolated from Adult Intensive Care Units with E-test MIC Values of Different Antibiotic Research. diclemedj. 2019;46(1):51-64.