Investigation of SARS-CoV-2 antibody levels after COVID-19 vaccine in chronic hepatitis B patients.

AIM: The aim was to compare SARS-CoV-2 IgG antibody levels in chronic hepatitis B patients and healthcare personnel selected as the control group and to determine factors such as age, gender, vaccine type, and number of vaccines that may affect the antibody levels. MATERIALS AND METHODS: 87 chronic hepatitis B (CHB) patients followed in Ankara Training and Research Hospital Infectious Diseases Clinic and Mamak State Hospital Infectious Diseases outpatient clinic and 89 healthcare personnel selected as the control group were included in the study.SARS-CoV-2 IgG antibody levels in the serum samples of patients and healthcare personnel who received the COVID-19 vaccine were studied with the ELISA method in the Microbiology Laboratory of Ankara Training and Research Hospital, using a commercial ELISA kit (Abbott, USA) in line with the recommendations of the manufacturer. In the study, SARS-CoV-2 IgG levels were compared in CHB patients and healthcare personnel. In addition, the relationship between SARS-CoV-2 antibody level, gender, average age, natural history of the disease, number of vaccinations, vaccine type (Coronavac TM vaccine alone, BNT162b2 vaccine alone or Coronavac TM and BNT162b2 vaccine (heterologous vaccination)), treatment duration of CHB was investigated. Statistical analyses were made in the SPSS program. A value of p≤ 0.05 was considered statistically significant. FINDINGS: A total of 167 people, including 87 CKD patients and 80 healthcare personnel as the control group, were included in the study. SARS-CoV-2 IgG antibody levels were detected above the cut-off level in the entire study group, regardless of the vaccine type. No difference was detected in SARS-CoV-2 IgG titers after COVID-19 vaccination between CHB patients and healthcare personnel. There was a statistically significant difference in SARS-CoV-2 IgG antibody levels among individuals participating in the study according to vaccine types. Compared to those who received Coronavac TM vaccine alone, the average SARS-CoV-2 IgG level was found to be statistically significantly higher in those who received BNT162b2 vaccine alone or heterologous vaccination with Coronavac TM + BNT162b2 vaccine. There was no difference between the groups in terms of age, gender, number of vaccinations, natural transmission of the disease, and duration of antiviral therapy in the CHD patient group. CONCLUSION: As a result, SARS-CoV-2 IgG antibody levels above the cut-off value were achieved with Coronavac TM and BNT162b2 vaccines in both CHD patients and healthy control groups. however, both CHD patients and healthcare personnel had higher antibody levels than those who received BNT162b2 alone or those who received heterologous vaccination had higher antibody levels than those with Coronavac TM alone. Therefore, if there are no contraindications, BNT162b2 vaccine may be preferred in CHB and health personnel (Tab. 2, Ref. 14).

[Comparision of Colistin Broth Disc Elution, Rapid Resapolymyxin NP and Broth Microdilution Methods in Determining Colistin Sensitivity in Acinetobacter, Pseudomonas and Enterobacterales species]. / Acinetobacter, Pseudomonas ve Enterobacterales Türlerinde Kolistin Duyarliliginin Belirlenmesinde Kolistin Sivi Disk Elüsyon, Hizli Resapolimiksin NP ve Sivi Mikrodilüsyon Yöntemlerinin Karsilastirilmasi.

In recent years, with the increase of carbapenem resistance in Acinetobacter, Pseudomonas, Enterobacterales species, the use of colistin in treatment has gradually increased. Since the broth microdilution method which is recommended as a reference method in colistin susceptibility tests, is laborious and expensive and other susceptibility tests do not give reliable results, all these cause laboratories to search for new methods for the determination of colistin susceptibility testing. In this study, it was aimed to compare the broth microdilution method which is the reference method with the colistin broth disc elution and rapid resapolymyxin NP tests for the determination of the susceptibility of colistin in Acinetobacter, Pseudomonas, Enterobacterales species which are common healthcare-associated infection agents.Colistin susceptibility of a total of 157 isolates isolated from patients hospitalized in Ankara City Hospital [Klebsiella pneumoniae (n= 74), Acinetobacter spp. (n= 33), Escherichia coli (n= 26), Pseudomonas aeruginosa (n= 24)] were tested by broth microdilution, colistin broth disc elution and rapid resapolymixin NP methods. The categorical and basic agreement was evaluated by comparing the broth microdilution results with the rapid resapolymyxin NP results and the colistin broth disc elution. When compared with broth microdilution, the categorical agreement of colistin broth disc elution test for Enterobacterales, Acinetobacter, Pseudomonas species was found to be 93%, 48%, 100%, respectively. When the essential agreement was evaluated the values of 95%, 45%, 100% were found, respectively. Very major error rates were found to be 10%, 70% and 0%, respectively. The categorical agreement of the rapid resapolymyxin test for Enterobacterales, Acinetobacter, Pseudomonas species was 85%, 36%, 100%, while very major error rates were found to be 10%, 88% and 0%, respectively. When compared with the reference method, both tests showed high categorical and essential agreements for P.aeruginosa. Accepted level of categorical and essential agreement was found in colistin broth disc elution method for Enterobacterales species, and low categorical agreement was found in rapid resapolymyxin NP test. For Acinetobacter species, both tests detected low categorical agreement and high rate of very major error. In addition, compared to the broth microdilution method, both colistin broth disc elution and rapid resapolymyxin NP tests were found to be cost-effective and easy to prepare. It was considered to be an additional advantage to have the results in rapid polymyxin NP test in four hours. In conclusion, in our study, it was shown that both colistin broth disc elution and rapid resapolymyxin NP test methods can be used in determining the susceptibility of colistin for P.aeruginosa and Enterobacterales species but both methods were found to be unsuccessful for Acinetobacter species.

[Direct identification and determination of antimicrobial susceptibility of gram negative bacilli using the PhoenixTM FX system in blood cultures flagging positive]. / Gram negatif basillerin PhoenixTM FX sistemi ile pozitif sinyal veren kan kültürü siselerinden direkt tanimlanmasi ve antimikrobiyal duyarliliklarinin belirlenmesi.

Bloodstream infections are one of the main causes of morbidity and mortality worldwide. Shortening the turnover time of microbiological analysis leads to a significant reduction of patient morbidity, mortality and medical care expenses. This study aimed to evaluate the performance of Phoenix 100 Instrument (Becton Dickinson, Sparks, MD, USA) system in bacterial identification and the evaluation of antibiotic susceptibility directly taken from positive blood culture bottles in BD BACTEC™ FX (Becton Dickinson, USA) system in patients with the suspicion of bacterial sepsis. In this study, blood culture bottles with a positive signal in BD BACTEC™ FX (Becton Dickinson, USA) system, and in which gram negative bacilli or coccobacilli was observed in Gram staining were evaluated. In our study, direct inoculation to the Phoenix panel from the blood culture bottles giving positive signal was defined as "direct Phoenix method". The blood culture bottles which were taken from hospitalized patients with a suspicion of sepsis, were analyzed comparatively by using BD Phoenix™ (Becton Dickinson, USA) automated microbiology system and "Bruker Biotyper matrix-associated laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS)" (Bruker Daltonics, Germany) in the bottles of patients with the positive signals between August 10, 2015, and December 05, 2015. The effect of the "direct Phoenix method" on the duration of the test and the harmony with conventional methods was demonstrated. A total of 122 gram negative bacteria comprising 95 bacteria in Enterobacteriaceae family, 26 non-fermenting gram negative bacteria (NFGNB) and one Aeromonas spp. were included in the study. In our study, the reporting time of the identification of gram negative bacteria after inoculation with direct Phoenix method ranged from 2.25 hours to 7.84 hours (mean 2.56 hours). When the identification of 122 gram negative bacteria by direct Phoenix method was compared with the identification of Maldi Biotyper (Bruker Daltonics, Germany), an agreement was detected in 96.7% (118/122) of the samples at the genus level and in 86.0% (105/122) of the samples at the species level. Ninety-five bacteria belonging to Enterobacteriaceae family demonstrated an agreement of 95.7% (91/95) and 93.6% (89/95) at the genus and species levels with Maldi Biotyper respectively. Twenty-five NFGNB had an agreement of 96.1% (25/26) and 61.5% (16/26) at genus and species levels with Maldi Biotyper respectively. In our study, the reporting time of antibiotic susceptibility test results of gram negative rods after direct Phoenix method ranged from 7.42 hours to 15.85 hours (mean 12.9 hours). In our study, 2.159 antimicrobial agents were tested for 120 gram negative bacteria (95 strains belonging to Enterobacteriaceae family and 25 NFGNB). Minor error rate was found to be 2.0% with the direct Phoenix method, 1.1% major error rates, and 1.2% very major error rates; making a total of 4.4% (96/2.159). Since error rates in all categories < 10%, very major error rate was < 1.5% and major error rate was < 3%, the direct Phoenix method had an acceptable agreement with the conventional Phoenix method. The direct inoculation of the Phoenix system with culture suspension obtained from positive blood culture bottles decreased reporting time of the identification and determination of the antibiotic susceptibilities for gram negative rods that cause bacteraemia. This result could be important in the clinical benefits for the patients as well as financial savings for the hospital.

[The significance and place of HBsAg neutralization test in the diagnosis and algorithm of hepatitis B infection]. / HBsAg nötralizasyon testinin hepatit B hastaliginin tani algoritmasindaki yeri ve önemi.

The diagnosis of hepatitis B virus infection is evaluated serologically, virologically, biochemically, and with histologic liver indicators. The aim of this study was to investigate the place and significance of the HBsAg neutralization test in the diagnostic algorithm for hepatitis Binfection. From the venous blood samples sent to Ankara Numune Education and Research Hospital Medical Microbiology Laboratory between September 2014 and May 2016 for HBsAg test, serum samples regarded each patient as reactive (≥ 0.9 S\CO) , 9 ≤ S ≤ CO ≤ 30) were studied twice. A total of 105 samples which were reactive in both analyses were included in the study. After the evaluation of these samples by neutralization confirmation test, which is routinely performed in our laboratory, the samples were stored under optimal conditions and studied for HBV DNA with the real-time PCR and for HBeAg, anti-HBeAg, anti-HBc IgM, and anti-HBc total antibody assays by ELISA. The 105 samples, in which HBsAg was detected, were analyzed with the neutralization test. The presence of HBsAg was confirmed by neutralization test in 67 of 105 samples (63.8%), and of these patients, two patients (2.3%) had negative HBV DNA and anti-HBc total antibody test (false positive neutralization test). Of the 105 samples included in the study, the anti-HBc total antibody test was positive in 78 patients (74.3%). However, out of these 78 patients who were positive for the anti-HBc total antibody test, there were 13 patients (16.7%) with negative neutralization and HBV DNA test results (false positive anti-HBc total antibody test). The HBV DNA positivity was detected significantly lower in samples with HBsAg level ≤ 5 S/CO compared to the samples with HBsAg level > 5 S/CO (p= 0.020). Also, if the unit price of the neutralization test used in our study was considered, the cost was 17,00 TL while the unit price of HBV DNA test was 55,00 TL. Utilization of the neutralization test instead of HBV DNA test provides a saving of 38,00 TL per patient. The use of the neutralization test as a validation test when the HBsAg titre was less than or equal to 5S/CO will significantly reduce the cost of the test without the need for HBV DNA test. We suggest that if both the neutralization test and the anti-HBc total antibody test is negative in a sample with an HBsAg titration higher than 5 S/CO, the decision can be made without the need for HBV DNA test. However; if the neutralization test is negative, but the anti-HBc total antibody test is positive, then HBV DNA needs to be determined to eliminate the inconsistency between neutralization and anti-HBc total antibody assays. At the same time, we found that the use of anti-HBc total antibody test along with HBsAg as a screening test did not provide any advantage since the anti-HBc total antibody test was detected to have a high false positivity (16.7%) rate.

Breast abscess due to Salmonella Typhimurium in a patient with rheumatoid arthritis: a case report.

BACKGROUND: This is the first report of breast abscess due to Salmonella enterica serotype Typhimurium. Staphylococcus aureus is known as the most common cause of breast abscess. Salmonella spp. may occasionally form localized abscesses after dissemination to various organ systems following a bacteraemia. But breast abscess related to Salmonella spp is a very rare complication. CASE PRESENTATION: A 43-year-old female patient referred to our hospital with a lump, fever and mild pain in her breast. The patient was not pregnant or lactating at that time. She had a history of rheumatoid arthritis for 5 years and was under immunosuppressive therapy. Ultrasonography of the breast revealed an abscess. The abscess was drained and sent for culture to medical microbiology laboratory. The microorganism was identified as Salmonella enterica serotype Typhimurium and found to be sensitive to all antibiotics tested. The patient was cured after surgical debridement and antibiotic therapy. The abscess did not recur again. CONCLUSIONS: This case is presented to draw attention to non-typhoidal Salmonella as rare causes of breast abscess and submission of specimens to the microbiology laboratory for accurate diagnosis and treatment especially in patients with underlying immunosuppressive diseases.

Impact of Laboratory Test Use Strategies in a Turkish Hospital.

OBJECTIVES: Eliminating unnecessary laboratory tests is a good way to reduce costs while maintain patient safety. The aim of this study was to define and process strategies to rationalize laboratory use in Ankara Numune Training and Research Hospital (ANH) and calculate potential savings in costs. METHODS: A collaborative plan was defined by hospital managers; joint meetings with ANHTA and laboratory professors were set; the joint committee invited relevant staff for input, and a laboratory efficiency committee was created. Literature was reviewed systematically to identify strategies used to improve laboratory efficiency. Strategies that would be applicable in local settings were identified for implementation, processed, and the impact on clinical use and costs assessed for 12 months. RESULTS: Laboratory use in ANH differed enormously among clinics. Major use was identified in internal medicine. The mean number of tests per patient was 15.8. Unnecessary testing for chloride, folic acid, free prostate specific antigen, hepatitis and HIV testing were observed. Test panel use was pinpointed as the main cause of overuse of the laboratory and the Hospital Information System test ordering page was reorganized. A significant decrease (between 12.6-85.0%) was observed for the tests that were taken to an alternative page on the computer screen. The one year study saving was equivalent to 371,183 US dollars. CONCLUSION: Hospital-based committees including laboratory professionals and clinicians can define hospital based problems and led to a standardized approach to test use that can help clinicians reduce laboratory costs through appropriate use of laboratory tests.

[Evaluation of the toxoplasmosis seroprevalence in pregnant women and creating a diagnostic algorithm]. / Gebelerde toksoplazmoz seroprevalansinin degerlendirilmesi ve bir tani algoritmasinin olusturulmasi

Toxoplasma gondii, an obligatory intracellular protozoon is widely distributed around the world and can infect all mammals and birds. While acquired toxoplasmosis is usually asymptomatic in healthy subjects, acute infection during pregnancy may lead to abortion, stillbirth, fetal neurological and ocular damages. For the prevention of congenital toxoplasmosis it is recommended that a screening programme and a diagnostic algorithm in pregnant women should be implemented while considering the cost effectiveness. Thus, it is necessary to determine the seroprevalence of toxoplasmosis in pregnant women and the actual risk of T.gondii transmission during pregnancy in a certain area. The aims of this study were to detect the T.gondii seropositivity in the pregnant women admitted to our hospital and to create a diagnostic algorithm in order to solve the problems arising from interpretation of the serological test results. A total of 6140 women aged 15-49 years who were admitted to our hospital between April 1st, 2010 to July 31st, 2013, were evaluated retrospectively. In the serum samples, T.gondii IgM, IgG and IgG avidity tests were performed by VIDAS automated analyzer using TOXO IgM, TOXO IgG II and TOXO IgG avidity kits (bioMerieux, France). It was noted that, both T.gondii IgM and IgG tests were requested from 4758 (77.5%) of the pregnant women, while only IgM test from 1382 (22.5%) cases. Sole IgM positivity was found as 0.2% (11/6140), IgG as 26.4% (1278/4758) and both IgM + IgG as 0.9% (44/4758). T.gondii IgG avidity tests were requested from 12 of 44 women who were found both IgM and IgG positive and eight of them revealed high avidity and four low avidity. Avidity test was ordered for the 91 (7.1%) of 1278 sole IgG positive cases and four of them were found to have low avidity. IgG avidity test was ordered for 554 (16.2%) of IgM and/or IgG negative subjects, however, the test was not performed according to rejection criteria of the laboratory. It was noticed that no re-testing was requested for none of the seronegative cases (3428/4758; 72%) during their follow-up. In our study, total Toxoplasma seropositivity rate among pregnant women was detected as 28% (1330/4758), showing statistically significant increase (p< 0.05) with age. There was no significant difference (p> 0.05) in the seropositivity rate between the years (2010-2013). Following the evaluation of the test orders, the problems related to test orders and interpretation of the test results were determined and a diagnostic algorithm to be used in our hospital, was established to minimize such problems in toxoplasma serology. It was concluded that a diagnostic algorithm related to toxoplasmosis serology should be implemented for the appropriate evaluation of the risk of acute toxoplasmosis during pregnancy. Such an approach is necessary to support the clinical diagnosis and to minimize the anxiety in pregnant women about congenital toxoplasmosis.

The prevalence of enterotoxigenic E. coli isolated from the stools of children aged 0-10 years with diarrhea in mid-anatolia region, Turkey

The stool samples from 245 patients with diarrhea were tested for heat labile toxin (LT) and heat stable toxins (ST) by passive latex agglutination and enzyme immunoassay methods respectively. Twelve (4.9 percent) enterotoxigenic E. Coli ETEC strains were isolated. Five strains (2 percent) expressed ST, and 7 (2.8 percent) expressed LT.

The prevalence of enterotoxigenic e. Coli isolated from the stools of children aged 0-10 years with diarrhea in mid-anatolia region, Turkey.

The stool samples from 245 patients with diarrhea were tested for heat labile toxin (LT) and heat stable toxins (ST) by passive latex agglutination and enzyme immunoassay methods respectively. Twelve (4.9%) enterotoxigenic E. Coli ETEC strains were isolated. Five strains (2%) expressed ST, and 7 (2.8%) expressed LT.

In vitro antibacterial effects of topical local anesthetics.

BACKGROUND: The antibacterial activities of local anesthetics are recognized. OBJECTIVE: To investigate in vitro the activity of topical local anesthetic ointments at clinical doses. METHODS: The activity of two different local anesthetic ointments including lidocaine 5% and lidocaine/prilocaine 2.5% was tested against Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa, Streptococcus pyogenes and Enterococcus faecalis by the disc-diffusion method. Sterile discs containing topical local anesthetic drugs were prepared taking into account the doses of ointments used in clinical practice. The validity of the methodology was confirmed using topical antibacterial mupirocin. The inhibition zones of the discs were measured. RESULTS: Mupirocin inhibited all the bacteria. Both local anesthetic ointments were found to be most effective on E. coli, whereas they had no effects on P. aeruginosa. Lidocaine 5% revealed antibacterial activity against S. aureus, S. epidermidis, E. coli, S. pyogenes and E. faecalis, but lidocaine/prilocaine 2.5% showed no activity on E. faecalis and inhibited S. pyogenes only at double doses. It was also observed that the antibacterial activity was in a dose-dependent manner. CONCLUSION: In the light of these findings, it might be concluded that topical local anesthetic ointments in routine settings may have a preventive role against some bacteria.

Evaluation of rapid urine screening tests to detect asymptomatic bacteriuria in pregnancy.

In order to compare the performance of leukocyte esterase and nitrite urine dipstick tests with enhanced urinalysis (uncentrifuged urine white blood cell count/mm(3) plus Gram stain) in detecting asymptomatic bacteriuria in obstetric patients, clean-catch midstream urine specimens were collected from 250 consecutive asymptomatic pregnant women. Ten of the women (4.0%) showed urine culture results indicating significant bacteriuria. The nitrite test was the most specific (99.2%) of these tests, however, its sensitivity was found to be the lowest (60.0%). The sensitivity of the leukocyte esterase test was 70.0%, on the other hand, while its positive predictive value was 28.0%. The sensitivity and specificity of enhanced urinalysis were found to be 50.0 and 96.7%, respectively. None of the rapid tests was found to be a reliable alternative for culture screening of all pregnant women. Nitrite tests are useful screening tests for detecting asymptomatic bacteriuria only if their limitations are fully understood, while leukocyte esterase and enhanced urinalysis tests are not suitable for screening for asymptomatic bacteriuria. Our findings support previous conclusions that quantitative urine cultures are required to rule out asymptomatic bacteriuria in pregnant women.

Antimicrobial resistance of enterococci in Turkey.

Susceptibility to ampicillin, penicillin, vancomycin and teicoplanin, high-level resistance to aminoglycosides (gentamicin and streptomycin) and beta-lactamase production were investigated among 264 consecutive clinical enterococcal isolates in Turkey. Disc diffusion test was used to detect resistance to ampicillin, penicillin, vancomycin and teicoplanin. High-level resistance to aminoglycosides was determined both by standard agar screening and by disc diffusion methods. The values of minimum inhibitory concentration (MIC) of each isolate for ampicillin, vancomycin and teicoplanin were determined by the microbroth dilution technique. The isolates were found to consist of Enterococcus faecalis (78%), Enterococcus faecium (9%) and Enterococcus spp. (12%). In all strains, the penicillin and ampicillin resistance ratios were 27% and 26%, respectively. Enterococcus faecalis was more susceptible to penicillin and ampicillin than the other strains. None of the strains were resistant to glycopeptides. High-level aminoglycoside resistance was found in 16% E. faecalis and 88% E. faecium for gentamicin, and 35% and 44%, respectively, for streptomycin. There were no differences between the two methods used to determine the aminoglycoside resistance rates in the enterococcal isolates. No beta-lactamase-producing isolates were detected in either species. In conclusion, to determine the resistance of enterococci to the penicillin group of drugs by the disc diffusion method, both penicillin and ampicillin discs should be evaluated. In serious enterococcal infections, before starting combined therapy, high-level aminoglycoside resistance should be investigated.

Prevalence of Helicobacter pylori in patients with nasal polyps: a preliminary report.

OBJECTIVES: The aim of the study is to determine the presence of H. pylori in nasal polyps by both immunohistochemical staining with H. pylori antibody of biopsy specimens and enzyme-linked immunoadsorbent assay (ELISA) of sera. STUDY DESIGN: A prospective, controlled, clinical trial. METHODS: We enrolled 30 patients with nasal polyps and 20 controls with middle concha bullosa undergoing endoscopic sinus surgery (ESS). Blood samples of both the study and control groups were evaluated for anti-H. pylori specific immunoglobulin (Ig)G antibodies by ELISA. In addition, biopsy specimens of the removed polyps and the mucosal part of middle conchas were examined by the immunohistochemical analysis with H. pylori antibody. RESULTS: In the blood samples, specific IgG antibodies to H. pylori were found in 26 (86.7%) of 30 polyp patients and 17 (85%) of 20 controls. In 6 (20%) of the 30 patients, H. pylori was identified in the nasal polyp tissue, but it was not detected in the mucosal part of the middle concha specimens. No significant statistical difference was observed for H. pylori antibodies by ELISA among the patients with nasal polyps and the control group (Fisher's exact test, P = .59). However, there was a statistical difference between the polyp biopsy specimens and the control biopsy specimens by immunohistochemical staining (Fisher's exact test, P = .037). CONCLUSIONS: This study indicates that H. pylori was found in increased prevalence in the nasal polyps. However, further controlled epidemiologic studies would be necessary to confirm our results and clarify the potential underlying pathogenetic mechanisms.