Risk factors for carbapenem-resistant Klebsiella pneumoniae infections in Intensive Care Units: a multicentre case-control study with a competing-risks analysis.

Aim: This study investigated the risk factors for the development of carbapenem-resistant Klebsiella pneumoniae (CRKP) infections in adult patients in Intensive Care Units (ICUs). Methods: A multicentre case-control study was conducted in ICUs in three tertiary hospitals in Turkey. The cases were patients culture-confirmed CRKP and a condition associated with healthcare-associated infections. Two controls were randomly selected for each case from among all other patients with an ICU stay at least as long as that of the corresponding case-patient. A proportional semiparametric subdistribution hazards regression model was used to assess risk factors for CRKP infection. ICU discharge and non-CRKP-related deaths were treated as competing risks. Results: A total of 120 patients, 44 cases and 76 controls were included in the analysis. Of the controls, 32 were discharged from the ICU and 44 died without acquiring CRKP infection. Endotracheal intubation (hazard ratio [HR]: 1.96, 95% confidence interval [CI]: 1.00-3.868) and type 2 diabetes mellitus (HR: 1.57, 95% CI: 0.888-2.806) were associated with an increased risk of CRKP infection, whereas carbapenem exposure (HR: 0.47, 95% CI: 0.190-1.1175) and the presence of a nasogastric tube (HR: 0.49, 95% CI: 0.277-0.884) were associated with a decreased risk of CRKP infection. Conclusions: Enteral nutrition support via a nasogastric tube may be associated with a reduced risk of CRKP-resistant infections in ICU patients. This hypothesis should be tested with a well-designed study.

Mitogenome Phylogeny Including Data from Additional Subspecies Provides New Insights into the Historical Biogeography of the Eurasian lynx Lynx lynx.

Previous molecular studies of the wide-ranging Eurasian lynx Lynx lynx focused mainly on its northern Palearctic populations, with the consequence that the reconstruction of this species' evolutionary history did not include genetic variation present in its southern Palearctic distribution. We sampled a previously not considered Asian subspecies (L. l. dinniki), added published data from another Asian subspecies (L. l. isabellinus), and reassessed the Eurasian lynx mtDNA phylogeny along with previously published data from northern Palearctic populations. Our mitogenome-based analyses revealed the existence of three major clades (A: Central Asia, B: SE Europe/SW Asia, C: Europe and Northern Asia) and at least five lineages, with diversification in Lynx lynx commencing at least 28kyr earlier than hitherto estimated. The subspecies L. l. isabellinus harbors the most basal matriline, consistent with the origin of Lynx lynx in this subspecies' current range. L. l. dinniki harbors the second most basal matriline, which is related to, and may be the source of, the mtDNA diversity of the critically endangered Balkan lynx L. l. balcanicus. Our results suggest that the Anatolian peninsula was a glacial refugium for Eurasian lynx, with previously unconsidered implications for the colonization of Europe by this species.

Identification of tick-borne pathogens in ticks collected from wild animals in Turkey.

Many enzootic life cycles involving wild animals and non-nidicolous ixodids are still unknown. Therefore, the aim of this study was to report the identified tick species collected from seven different animal species (red deer, brown bear, gray wolf, Eurasian lynx, red fox, European hare, and Mediterranean spur-thighed tortoise) living in the wild in Turkey and to investigate the presence of a wide range of tick-borne microorganisms in the tick samples obtained from these animals. The collected ticks (n = 98) were identified as Dermacentor reticulatus, Haemaphysalis parva, Hyalomma aegyptium, Hyalomma excavatum, Hyalomma marginatum, Ixodes ricinus, and Rhipicephalus turanicus. All engorged ticks collected from the wild animals and unfed larvae (n = 30) obtained from a single Rh. turanicus female were also analyzed individually for tick-borne bacterial and protozoan agents via PCR-sequencing. The molecular analyses revealed the presence of Babesia sp. tavsan2, Theileria capreoli, four Hepatozoon spp. (Hep. ursi, Hep. canis, Hep. felis, and Hepatozoon sp.), Hemolivia mauritanica, and three SFG rickettsiae (Candidatus Rickettsia barbariae, Ca. R. goldwasserii, and Rickettsia hoogstraalii) in the collected ticks. This represents the first report of Th. capreoli, Hep. ursi, and Ca. R. barbariae in ticks from Turkey. The evolutionary relationships of microbes in the different host and tick species are also discussed. Multiple novel tick-host associations in the tick life cycle were also revealed.

Diet and wild ungulate preferences of wolves in northwestern Anatolia during winter.

The gray wolf (Canis lupus) is making a comeback in many habitats in central Europe, where it has been once extirpated. Although densities are still low to moderate, this comeback already raises management concerns. In Anatolia, the gray wolf is one of the most common predator species occupying almost all kind of habitats. Although its numbers were reduced in some parts of the country, it has never been extirpated and lived in sympatry with humans. In this study we investigated, for the first time, the winter diet of wolves in north-west Anatolia, where a multispecies wild ungulate community occurs in sympatry with high density livestock. We selected two geographically close but different habitats (steppe and forest) with different wild prey availabilities and compositions. In both areas ungulate contribution to winter diet biomass was more than 90%. Wolf pack size (four to eight wolves) were higher in the study area where livestock numbers and human disturbance were lower and wild prey were more available. In both study areas, wild boar (Sus scrofa) was the main and most preferred food item (Chesson's α = 0.7 - 0.9) and it occurred at higher density where wolf pack size was smaller. We could not find a high preference (Chesson's α = 0.3) and high winter predation pressure on the reintroduced Anatolian wild sheep (Ovis gmelinii anatolica) population that occurs in the study area covered by steppe vegetation. Contribution of livestock and food categories other than wild ungulates to wolf diet stayed low. Wolves can help mitigate human-wildlife conflict regulating wild boar numbers, the most common conflict-causing ungulate species in Anatolia. Instead of managing wolf numbers in human dominated landscapes, we recommend reintroduction of wild ungulates to the areas where they became locally extinct and replaced by livestock.

Ticks threatening lineage of Anatolian wild sheep (Ovis gmelinii anatolica) and determination of their tick-borne pathogens.

We aimed to determine the ticks of the Anatolian wild sheep and to define their tick-borne pathogens while molecularly studying their relationships with those of the domestic sheep. Furthermore, another aim of this study is to investigate tick paralysis resulting in the death of the Anatolian wild sheep. Ticks and blood samples were collected from the wild sheep whilst tick samples were also collected from hares, guinea fowls, chickens, and a turkey living in the Anatolian wild sheep breeding area. While PCR amplification was carried out for the detection of Babesia spp., Theileria spp. and Anaplasma spp. in blood samples, CCHF virus was screened in the tick samples in addition to the above-mentioned pathogens. Theileria spp. was detected in blood samples of 45 wild sheep. A total of 3494 ticks were collected from 52 Anatolian wild sheep, 5 hares, 5 guinea fowls, 2 chickens, and 1 turkey whereas 98 ticks were collected from the ground. B. ovis and T. ovis were detected in tick pools (Rh. bursa and H. excavatum) that were collected from the wild sheep. The paralysis was diagnosed in both of the hind legs of the newborn lambs infested with a great number of ticks. We also report that the tick species (H. excavatum and Rh. bursa) are determined to cause tick paralysis and tick toxicosis, which are associated with mortality especially in lambs. T. ovis and B. ovis were detected and studied for the first time in Anatolian wild sheep and in their ticks. The results of phylogenetic analyses showed that T. ovis and B. ovis isolates are genetically very close to the isolates that were previously obtained from the domestic small ruminants. We show that the Anatolian wild sheep can play the role of a reservoir for T. ovis. The presence of the CCHF virus has also been clearly shown and it has been observed that this virus, which is very pathogenic for humans, is anywise circulating in the region.