[Distribution of Yeast Species Isolated from Blood Cultures for a Six Year Period in Turkey: a Multicentre Study]. / Türkiye'de Alti Yillik Zaman Dilimi Içerisinde Kan Kültürlerinden Soyutlanan Maya Mantarlarinin Tür Dagilimi: Çok Merkezli Bir Çalisma.

Bloodstream infections due to yeast species especially Candida spp. have been reported to be important healthcare associated infections with high mortality and morbidity rates. Candidemia causes prolonged hospital stays as well as increased cost. In order to prevent or treat these life-threatening bloodstream infections successfully, nationwide epidemiological data should be available about the etiological agents of these infections. Multi-centre national epidemiological data on yeast bloodstream infections in Turkey is lacking. A retrospective study was designed and data from six different centres in Turkey between 2011 and 2016 years were gathered and analysed for the distribution and frequency of yeast species in order to assist clinicians in their choice of early and appropriate antifungal therapy. All laboratories used automated blood culture systems for the isolation of blood strains. All the participating centres performed the identification of their own isolates by conventional methods using germ tube test, morphology on corn meal agar with tween 80 and chromogenic media and the identification was confirmed by API 20C AUX, API ID 32C or matrix-assisted laser desorption/ionization time of flight mass spectrophotometry (MALDI-TOF MS) systems. The analysis of the results was performed on the basis of intensive care units (ICUs), other inpatient clinics (OICs) and totally all clinics (ACs). Totally 2547 yeast isolates were determined from six participating centres during six years. According to the total ACs results, Candida albicans was the most prevalent species (43.1%), followed by Candida parapsilosis complex (29.1%), Candida glabrata (10.1%), Candida tropicalis (7.5%), Candida krusei (2.4%) and Candida kefyr (1.6%) and the remaining (6.2%) of them consisted of other yeast species. The distribution of the Candida species did not show statistically significant difference between the years, however the increase of C.parapsilosis complex in 2016 was statistically significant, (p= 0.02). During the study period, totally 1054 yeast isolates were obtained from the ICUs of the centres. C.albicans predominated with 476 (45.2%) isolates and C.parapsilosis complex (28.7%), C.glabrata (10.7%) and C.tropicalis (7.3%) were the other leading species in ICUs. Among 1493 isolates of the OICs of six centres participated in the study, C.albicans was the most prevalent species with 622 (41.7%) isolates. The other frequent species of OICs were C.parapsilosis complex (29.5%), C.glabrata (9.6%) and C.tropicalis (7.6%) resembling ICU results. It can be concluded that C.albicans is still the leading cause of bloodstream infections in the six different centres located in various geographical areas of Turkey.

Preparation of nature inspired indicator based agar for detection and identification of MRSA and MRSE.

Natural indicator, red cabbage extract (RCE) incorporated agars were developed, for the first time, as colorimetric sensors for identification of MRSA and MRSE. These strains were differentiated in RCE media with addition of plasma due to coagulase positive property of MRSA, they were differentiated by manipulating NaCl and introducing gelatin in RCE agar. RCE agar was examined based on concentration of NaCl and MRSA concentrations and incubation time for detection of MRSA. RCE agar was prepared mixing 10g peptone, 1g beef extract, NaCl, 15 mg/mL agar and 25% RCE in distilled water and sterilized in autoclave at 121°C for 15 min. 4 µg/mL cefoxitin was added to mixture based on experiment. The color of RCE agar including 50 mg/mL NaCl was turned to pink dependent upon growth of MRSA, MRSE and MSSA, growth of E. coli was inhibited due to its salt intolerance property. Introducing 4 µg/mL cefoxitin, growth of MRSA was not observed. 1 CFU/mL, 10 CFU/mL, 100 CFU/mL and 1000 CFU/mL of MRSA inoculated on the RCE agar showed growth and led color change in 24 hrs. Additionally, slight pink spots on RCE agar and pale pink color on whole RCE agar were appeared in 8th hrs and 11th hrs of inoculation, respectively when 1000 CFU/mL of MRSA used. The RCE agar was successfully used for detection of MRSA and differentiation of them. Finally, the RCE agar can be implemented in clinics and may alleviate incubation time and cost compared to the chromogenic agars.

Assessing the risk of false positive serum galactomannan among patients receiving piperacillin/tazobactam for febrile neutropenia.

Galactomannan (GM) assay is commonly used as an early diagnostic tool for invasive fungal infection (IFI) in high-risk hematology patients. False positivity is frequently observed in GM with the use of piperacillin/tazobactam. The usage of generic drugs over the original brand has a significant cost advantage. The aim of this study was to assess the performance of GM test among patients receiving original and generic piperacillin/tazobactam formulations. The study included 85 adult patients; 62.4% were male with hematological malignancy currently receiving piperacillin/tazobactam. The study group was divided into two groups: patients receiving original and generic piperacillin/tazobactam. Serum GM index was positive in one of 35 patients receiving original piperacillin/tazobactam, whereas it was positive in 46 out of 50 patients receiving generic piperacillin/tazobactam (P < .001). However, the patients receiving generic piperacillin/tazobactam underwent computed tomography (CT) scans more frequently than those receiving original piperacillin/tazobactam (P = .047). In addition, in vitro analysis of GM was performed in two generics and one original piperacillin/tazobactam vials. One generic piperacillin/tazobactam vial included high GM level. False positivity of serum GM with generic formulations of piperacillin/tazobactam is still an ongoing issue in hematology patients. A high rate of serum GM index false positivity may unexpectedly lead to a higher rate of CT scan. Selected piperacillin/tazobactam vials in each batch should be checked for GM to identify a false positivity of GM before purchase.

Molecular epidemiology and antifungal susceptibility of Saprochaete capitata (Blastoschizomyces capitatus) isolates causing nosocomial infection in Kayseri/Turkey.

BACKGROUND: Saprochaete capitata isolates have emerged as important nosocomial pathogens, among immunosuppressed or neutropenic patients, and a rare cause of nosocomial infection in the hematology-bone marrow unit (HBMU) and the intensive care unit (ICU). The purpose of this study was to molecular epidemiology and antifungal susceptibility of S. capitata (Blastoschizomyces capitatus) isolates causing nosocomial infection at Kayseri in Turkey. METHODS: During a period from 2012 to 2015, a total of 20 S. capitata strains were obtained from patients hospitalized at Erciyes University Hospital. The identification of S. capitata was performed by phenotypic and biochemical methods; this was confirmed by molecular methods by DNA sequencing analysis. Genotyping of S.capitata isolates from different patients was determined to by the repetitive sequence PCR (repPCR) using the DiversiLab System (BioMerieux). RESULTS: More than half of the patients with S. capitata infections were hospitalized in the hematology-oncology unit (60%). The patients mainly included those using intravascular devices (90%), and receiving parenteral antibiotics (85%); the mortality rate was 55%. The microbiological investigation failed to identify S. capitata in the hospital environment. All isolates were resistant to caspofungin (>32). However, the MIC90 values for voriconazole, amphotericin B, and fluconazole against all of the isolates were 0.125, 0.25, and 1µg/ml, respectively. The S. capitata strains belonged to five clones (A-E) which were determined by the use of rep-PCR and Clone C was found to be predominant. CONCLUSIONS: S. capitata isolates are an important cause of nosocomial infection in the HBMU and ICUs.