Actinotignum schaalii (formerly known as Actinobaculum schaalii) is an anaerobic or facultative anaerobic gram -positive bacillus that can be found commensally in the urogenital region. It can be overlooked because it grows slowly and is difficult to identify with classical microbiology laboratory techniques. Colonies become visible after 48-72 hours of incubation on blood agar in anaerobic or CO2-rich media. While it typically causes urinary tract infection in older individuals, cases of bacteremia, vertebral osteomyelitis, endocarditis and cellulitis have been reported. Fournier's gangrene caused by A.schaalii has been reported very rarely so far. Fournier's gangrene has been defined as necrotizing fasciitis of the external genitalia, perineal and perianal region. Diabetes, immunosuppression, peripheral vascular disease, urethral anomalies, chronic alcoholism and smoking are important predisposing factors. In addition, approximately 25% of the cases have no known or identifiable etiology. The bacteria causing the infection may originate from skin, urogenital or intestinal microbiota. In this case report, a new case of Fournier's gangrene caused by A.schaalii was presented. A 65 -year -old male patient admitted to the emergency department with the complaints of pain, swelling, redness in the left testis and also nausea, vomiting and chills that started three days ago. Physical examination revealed increased diameter of the scrotum, intense hyperemia of the skin and foci of necrosis. It was learned that the patient had no known chronic disease other than benign prostatic hyperplasia. The patient reported smoking of 25 packs of cigarettes per year. Routine laboratory tests revealed leukocyte= 32.41 x 109/L, neutrophil= 89.9%, procalcitonin= 1.62 ug/L, CRP= 265.07 mg/L and the patient was operated with the diagnosis of Fournier's gangrene. Gram staining of the abscess specimen obtained during the operation showed gram -positive bacilli both inside and outside the leukocytes. After 24 hours, grampositive bacilli were detected in the Gram staining of thin, transparent/gray colonies grown on 5% sheep blood and chocolate agar. The isolate was identified as A.schaalii by matrix -assisted laser desorption ionization -time of flight mass spectrometry (MALDI-TOF MS) VITEK (R) MS (bioMerieux, France) microbial identification system. VITEK (R) 2 ID ANC (bioMerieux, France) bacterial identification card was also used for comparison but the bacteria could be identified. As a result of the sequence analysis performed for confirmation, it was shown to be 100% homologous with Actinobaculum schaalii (GenBank accession no: FJ711193.1). For susceptibility tests, 5% sheep blood Schaedler agar was used and incubated in anaerobic environment. According to the minimal inhibitory concentration (MIC) results evaluated after 48 hours, penicillin was found to be 0.032 mg/L, clindamycin 0.125 mg/L, ciprofloxacin 0.19 mg/L, ceftazidime 4 mg/L, and amoxicillin 0.19 mg/L. The primary cause that initiated the infection in the case could not be identified, but it was thought that the presence of prostatic hyperplasia and smoking history may have contributed to the occurence or the progress of the disease. It is noteworthy that the ciprofloxacin MIC result was quite low compared to other studies. In addition, this study revealed the value of MALDI-TOF MS based methods in identification. In conclusion, it is thought that a significant proportion of A.schaalii infections may be overlooked due to the difficulty in growth and identification. Increasing the diagnostic power of clinical microbiology laboratories for poorly identified bacteria and renewing the databases of commercial identification systems are important for the early and accurate diagnosis and treatment of serious infections that may occur with such agents.

Carbapenem resistance driven by carbapenemase production in Gram-negative bacteria is a global threat. Carbapenem-resistant Acinetobacter baumannii (CRAb) is a critical priority pathogen listed by the World Health Organization (WHO). While bla _OXA-23 and bla _{OXA-24/40-like} are most frequently reported in CRAb, an increasing prevalence of bla _NDM has been noted in recent years. This study aimed to investigate the distribution of carbapenemase genes among CRAb isolates obtained from three tertiary care centres in Türkiye. A total of 336 CRAb isolates recovered from various clinical specimens (blood, respiratory samples, wound/tissue swabs, urine, and catheter tip samples) between January 2023 and October 2024 were included (Centre-1:198; Centre-2:86; Centre-3:52). Antimicrobial susceptibility testing was performed using the VITEK2 or BD Phoenix system, with additional tests carried out using the disc diffusion or broth microdilution methods. The results were interpreted in accordance with EUCAST criteria. The presence of bla _OXA-51 , bla _OXA-23 , bla _{OXA-24/40-like} , bla _OXA-58 , bla _VIM , bla _IMP , bla _NDM and bla _KPC was tested by qPCR. The clonal relationship among the isolates producing metallo-β-lactamase (MBL) was assessed using AP-PCR and PFGE methods. Our study detected bla _OXA-23 in 305 isolates (90.8%), bla _{OXA-24/40-like} in 88 (26.2%), bla _NDM in 21 (6.3%), and bla _VIM in one isolate. However, bla _OXA-58 , bla _IMP and bla _KPC were not detected. Dual gene combinations were observed in 73 isolates, while triple combinations were identified in three isolates (two bla _NDM / bla _OXA-23 / bla _{OXA-24/40-like} , one bla _VIM /bla _OXA-23 / bla _{OXA-24/40-like} ). AP-PCR/PFGE demonstrated a clonal relationship among 18 isolates, all originating from a single intensive care unit at Centre-1. Because carbapenem resistance is endemic in this unit, the cluster was indistinguishable from the background resistant population and was detected only retrospectively by molecular typing; we therefore describe it as a silent outbreak. In this study bla _OXA-23 and bla _{OXA-24/40-like} were the predominant carbapenemase genes in CRAb, with bla _NDM detected at a notable frequency. The detection of combined gene profiles and inter-centre differences highlight the potential impact of local antibiotic use and infection control practices on the dissemination of resistance, and the clonal cluster identified here shows that such dissemination can go unrecognised in endemic settings.