The tick fauna in Istanbul, Turkey, from 2013 to 2017 and identification of their pathogens by multiplex PCR: an epidemiological study.

Ticks may carry several pathogens as vectors and their pathogen load may vary due to differences in geography, climate and vegetation. In this study, we collected ticks from 39 districts of Istanbul (Turkey) between May and October, from 2013 to 2017, and identified them under stereo-microscope. In addition, we investigated the pathogens that the ticks carry (Borrelia burgdorferi sensu lato, Anaplasma phagocytophilum, Rickettsia sp. and Babesia sp.) by using multiplex polymerase chain reaction (PCR) method. We collected a total of 875 ticks from the ground and from various animals and kept them at 4 °C until experiments. We identified 248 Rhipicephalus bursa (28.3% of the total), 205 (23.4%) Rhipicephalus annulatus, 197 (22.5%) Haemaphysalis concinna, 149 (17.0%) Rhipicephalus sanguineus, 24 (2.7%) Hyalomma marginatum, 21 (2.4%) Ixodes ricinus, 13 (1.5%) Rhipicephalus kohlsi, 5 (0.6%) Hyalomma anatolicum, 5 (0.6%) Hyalomma aegyptium, 5 (0.6%) Dermacentor niveus and 3 (0.3%) Ixodes hexagonus. We included a total of 328 questing ticks in the study: 63 R. bursa, 63 R. sanguineus, 63 R. annulatus, 63 H. concinna, 24 H. marginatum, 21 I. ricinus, 13 R. kohlsi, 5 H. anatolicum, 5 H. aegyptium, 5 D. niveus and 3 I. hexagonus. Multiplex PCR indicated that 80 (24.4%) ticks were infected with Rickettsia sp., 5 (1.5%) with B. burgdorferi and 1 (0.3%) with Babesia sp. Our study indicated that Rickettsia is more common in ticks collected around Istanbul.

Evaluation of Infection Resistance of Biodegradable versus Conventional Annuloplasty Rings in an in vivo Rat Subcutaneous Model.

BACKGROUND: Biodegradable atrioventricular annuloplasty rings are theoretically more infection resistant due to their intra-annular implantation technique and nonporous structures (monofilament of poly-1,4-dioxanone). The aim of this study was to investigate the infection resistance of a biodegradable annuloplasty ring (Kalangos-Bioring®) in a rat subcutaneous implantation model and to compare it with a commonly used conventional annuloplasty ring (Edwards Physio II®). METHODS: This study included 32 Wistar albino rats which were divided into 2 groups according to the implantation of sterile or infected annuloplasty rings as control and study groups. Each animal had 2 implantation pockets (made on the right and left side of the dorsal median line) where 1 cm of the biodegradable annuloplasty ring was implanted into one pocket and 1 cm of the conventional annuloplasty ring was implanted into the other pocket. The infection model was created by topical inoculation of 1 mL Staphylococcus aureus strain (2 × 107 colony-forming units/mL) into the implantation pockets before skin closure. Each group was equally divided into 4 subgroups according to different follow-up schedules. The animals were inspected for local as well as systemic infection signs, and the rings were explanted at weeks 2, 4, 9, and 14 following implantation. Implantation pockets were evaluated macroscopically as well as by histopathological examinations. Microbiological analysis of the explanted implants with surrounding tissue was done by using quantitative sonication method. RESULTS: Conventional ring-implanted pockets showed a more prominent inflammation reaction than the biodegradable ring-implanted pockets, and this characteristic was found to be accentuated with bacterial contamination. The sterile rings did not reveal any positive cultures in either group. The number of positive cultures found in conventional rings contaminated with S. aureus was greater than in the biodegradable ring group (11/16 vs. 2/16 positive cultures, respectively; p = 0.0032). The amounts of growing bacteria in the culture environment were also statistically significantly higher in the conventional ring group (7,175 ± 5,936 vs. 181 ± 130 colony-forming units/mL, respectively; p < 0.0005). CONCLUSIONS: This is the first experimental study confirming the theoretical advantage of the infection resistance of the biodegradable annuloplasty ring (Kalangos-Bioring®) when implanted in an active infectious environment. Large animal models mimicking clinical scenarios and clinical comparative studies are needed to verify our results.

Characterization and toxicity of hospital wastewaters in Turkey.

The aim of the study was to present first preliminary characterization of Turkish hospital wastewaters, their environmental risk, and a method for toxicity assessment. The hospital wastewater samples were collected from two of the largest medical faculty hospitals and a training and research hospital in Istanbul, Turkey. The samples from the selected hospitals were taken as grab samples on March 2014. Overall, 55 substances including pharmaceuticals and their metabolites, pesticides, and corrosion inhibitors were analyzed in all hospital wastewaters. Analysis of toxicity and the antibiotic resistance bacteria were investigated in addition to the chemical analysis in the wastewater of one hospital. Hazard quotients (HQs) and toxic units (TUs) were calculated as basis of the environmental risk assessment. Fourteen pharmaceuticals in hospital wastewater (HWW) were classified as "high risk" with HQ > 10. HQHWW values higher than 100 were determined for five antibiotics and one analgesic, namely, ofloxacin, clarithromycin, ciprofloxacin, sulfapyridine, trimethoprim, and diclofenac. Ofloxacin with an HQHWW of 9090 was observed to be the most hazardous compound. HQ and TU values of the wastewater treatment plant (WWTP) effluent dropped significantly due to dilution in the sewer. Further elimination by biological degradation or adsorption was observed only in some cases. However, the decreased HQWWTPeffluent values do not the change environmental load significantly. Therefore, advanced treatment processes should be applied to remove the persistent compounds. In combination with the results on antibiotic resistance, we would prefer on-site treatment of hospital wastewater. Toxicological assessment was performed using cytotoxic and mutagenic screening tests. The results of the Ames assay showed that the native hospital wastewaters had strongly mutagenic activity with a ≤10-fold increase relative to negative controls. The mutagenic potentials of the samples were generally concentration and metabolic activation dependent. Multiple antibiotic resistances were demonstrated with the tested isolates to ciprofloxacin, trimethoprim, and ceftazidime. This study demonstrates that the hospital wastewaters in Istanbul exhibit strong environmental and toxicological risks, as well as high multiple drug resistance to commonly used antibiotics.

The epidemiological and molecular characterization of vancomycin-resistant enterococci isolated from rectal swab samples of hospitalized patients in Turkey.

BACKGROUND: Vancomycin-resistant enterococci (VRE) are a serious problem all over the world. The present study was conducted to investigate antimicrobial resistance patterns, genotypes, clonal relationship, and virulence fac- tors of VRE species isolated from rectal swab samples of hospitalized patients, patient's relatives, and medical staff at Istanbul University Cerrahpasa Medical School hospital. METHODS: The VRE isolates were typed with an automated VITEK system and their antibiotic sensibilities were analysed by disc diffusion and Etest® method. The molecular characterization and clonal relationships were per- formed using a PCR method and virulence genes by sequence typing. RESULTS: A total of 100 (10.3%) of the 971 patients were colonized with VRE. None of the investigated 25 patient's relatives and 45 medical staff carried VRE. All VRE strains were identified as E. faecium. They were vanA genotype and originated from a single clone. VRE strains exhibited multi-drug resistance. High-level gentamicin-resistance was 93%. However, lower resistance rates were found for linezolid (40%) and quinopristin-dalfopristin (11%). The enterococcal surface protein gene esp was found positive in 87 of 100 isolates, and four strains were positive for the cylB (cytolysin) gene. CONCLUSIONS: The identification of VRE strains to the species level and detection of virulence genes will assist in infection control practices.

Cases of active infective endocarditis in a university hospital during a 10-year period.

OBJECTIVE: To determine the features of patients with active infective endocarditis, and to identify causative microorganisms in blood and/or valve cultures. METHODS: The retrospective study was conducted at the Surgical Intensive Care Unit of Istanbul University Cardiology Institute, Istanbul, Turkey, and comprised 22 patients with clinical evidence of the affliction who underwent operation between January 2001 and December 2010. Modified Duke Criteria was used for the diagnosis of the condition. Frequencies and percentages were calculated. RESULTS: The mean age of the patients was 46.68 +/- 18 years, and 12 (54.5%) were male. Native valve endocarditis was present in 13 (59.1%) cases and prosthetic valve endocarditis was present in 9 (40.9%). Rheumatic heart disease was the commonest underlying heart disease (n = 12; 54.5%). None of patient was intravenous drug abuser and positive for human immunodeficiency virus. Operative mortality was 18% (n = 4). Vegetation and abscess formation were detected in 19 (86.3%) cases. Blood culture positivity was 50% (n =11). Staphylococci was the most common causative micro-organism (n = 4; 36.3%), followed by Streptococci (n = 3; 27.3%), and 1 (9.1%) each for Enterococci, Brucella species, Candida albicans and Stenotrophomonas maltophilia. Positive cultures from vegetations and tissue retrieved at the operation was not detected. CONCLUSION: Active IE remains a severe disease affecting the young population in our study and rheumatic heart disease continues to be the most underlying heart disease. Culture negativity was found to be very high and prior antibiotic therapy may be the prime reason.

Detailed characterization, antibiotic resistance and seasonal variation of hospital wastewater.

This study investigates the presence of the different classes of micro-pollutants such as pharmaceutical active compounds (PhACs) (20 antibiotics, 8 analgesics and anti-inflammatories, 5 cytostatic agents, 7 ß-blockers, 4 lipid regulators, 13 psychiatrics, 1 antidiabetic, 1 receptor antagonist, 1 local anaesthetic, 1 antihypertensive and their 5 metabolites), hormones (8 compounds), X-ray contrast agents (6 compounds), benzotriazoles (3 compounds) and pesticides (6 compounds), and antibiotic resistance in hospital wastewater (HWW) of a medical faculty in Istanbul, Turkey. In addition, the seasonal variations of the selected PhACs and X-ray contrast agents and antibiotic resistance were evaluated for 2 years in a total of eight samples. In the PhACs, sulfamethoxazole and its metabolite (4 N-acethyl-sulfamethoxazole) in the antibiotic group and paracetamol in the analgesic and anti-inflammatory group were found at 100% of frequency and the highest concentrations as 35, 43 and 210 µg/L, respectively. The mean concentrations of psychiatric compounds were found less than 0.25 µg/L except carbamazepine (1.36 µg/L). Bisphenol A in hormone group had the highest concentration up to 14 µg/L. In the hormone group compounds, 17-α-Ethinylestradiol and 17-ß-Estradiol were detected at lower mean concentrations of 0.2 and 0.05 µg/L, respectively. 1H-benzotriazole had the highest concentration with the mean concentration of 24.8 µg/L in benzotriazole group compounds. The compounds in X-ray contrast agents group were noted as compounds detected at the highest concentration in HWW up to 3000 µg/L. Antibiotic resistance against azithromycin, clindamycin and trimethoprim-sulfamethoxazole antibiotics was observed around 50% in the winter period. The seasonal variation was detected for the most of the investigated PhACs, especially in antibiotic group which was in line with those significant differences in antibiotic resistance rates in the studied antibiotics between winter and summer seasons.

[Comparing the occurrence of Trichomonas vaginalis infections today to ten years ago among women prostitutes and gynecology and obstetrics patients in Istanbul]. / Istanbul'da Kadin Hastaliklari Hastalari ile Hayat Kadinlarinda Trichomonas vaginalis Görülme Sikliginin 10 Yil Önceki Oranla Karsilastirilmasi

OBJECTIVE: Trichomonas vaginalis is is a monoxenous parasite which lives in human urogenital systems and causes sex transmitted disease through human sexual contact. Disease frequency has been seen at different rates in different communities or in the same community depending on people's sociocultural status. Previously we made a study for determining prevalence of T. vaginalis infection in woman living in Istanbul. We made this present study for determining any difference in prevalence in comparison to the results of ten years earlier. METHODS: A total number of 207 vaginal discharge samples which were collected from two different hospitals, (93 from Venereal Diseases Hospital [VDH] and 114 from Cerrahpasa Ob&Gyn Clinic), were evaluated under direct microscopy and were cultured for T. vaginalis in a Cystein-Peptone-Liver-Maltose (CPLM) medium. RESULTS: T. vaginalis was observed under direct microscopy and grew in culture in 2 (0.97%) of 207 vaginal discharge samples [1 (1.1%) patient from VDH and 1 (0.9%) patient from Cerrahpasa]. CONCLUSION: The incidence of trichomoniasis has significantly decreased compared to the year 2000 in both VDH and Cerrahpasa populations (p=0.038) according to X2 test results. This epidemiologic study shows the importance of social development in the incidence of infectious diseases.

Vancomycin tolerance in enterococci.

BACKGROUND: Tolerance can be defined as the ability of bacteria to grow in the presence of high concentrations of bactericide antimicrobics, so that the killing action of the drug is avoided but the minimal inhibitory concentration (MIC) remains the same. We investigated vancomycin tolerance in the Enterococcus faecium and Enterococcus faecalis strains isolated from different clinical specimens. METHODS: Vancomycin was obtained from Sigma Chemical Co. We studied 100 enterococci strains. Fifty-six and 44 of Enterococcus strains were idendified as E. feacalis and E. faecium, respectively. To determine MICs and minimal bactericidal concentration (MBC), we inoculated strains from an overnight agar culture to Muller-Hinton broth and incubated them for 4-6 h at 37 degrees C with shaking to obtain a logarithmic phase culture. The inoculum was controlled by performing a colony count for each test. We determined MBC values and MBC/MIC ratios to study tolerance to vancomycin. Vancomycin tolerance was defined as a high MBC value and an MBC/MIC ratio > or =32. RESULTS: Fifty-six and 44 of the Enterococcus strains were identified as E. faecium and E. faecalis, respectively. Thirty-one E. faecium and 48 E. faecalis were found to be susceptible to vancomycin and these susceptible strains were included in this study. The MICs of susceptible strains ranged from < or =1 to 4 mg/l, the MBCs were > or =512 mg/l. Tolerance was detected in all E. faecalis and E. faecium strains. The standard E. faecalis 21913 strain also exhibited tolerance according to the high MBC value and the MBC/MIC ratio. We defined the tolerant strains as having no bactericidal effect and MBC/MIC > or =32. We found that a 100% tolerance was present in susceptible strains. CONCLUSIONS: One of the hypotheses for tolerance is that tolerant cells fail to mobilize or create the autolysins needed for enlargement and division. Our data suggests that tolerance may compromise glycopeptide therapy of serious enterococci infections. To add an aminoglycoside to the glycopeptide therapy unless MBCs are unavailable can be useful in the effective treatment of serious Enterococcus infections.