Bacterial vaginosis and Mycoplasma infections in reproductive-age women: Clarifying the association with risk factors / Vaginosis bacteriana e infecciones por micoplasma en mujeres en edad reproductiva: aclarando la asociación con factores de riesgo

Objectives: This study seeks to examine the association between predisposing risk factors and the prevalence of bacterial vaginosis (BV) as well as Mycoplasma hominis (MH) and Ureaplasma urealyticum (UU) infections in reproductive age women and investigate its relationship with infertility. Methods: This cross-sectional, prospective study was carried out using sexually active females who presented at the Gynaecology Clinic with complaints of vaginal discharge. Two cervical smear samples were taken from the endocervical canal using sterile cotton swabs for each patient. The patients were questioned to obtain their demographic data and potential risk factors for lower genital tract infections, and their responses were recorded. Results: Of 348 patients, BV was detected in 46.3%, UU in 26.7%, MH in 3.7% and UU and MH co-infection in 13.2%. The prevalence of BV concomitant with UU and/or MH was significantly high (p=.001). The most prominent risk factors for BV were UU and MH infection (AOR=6.79, 95% confidence interval (CI): [2.63–17.56]), vaginal douche use (AOR=6.80, 95% CI: [03.60–12.83]), abortion history (AOR=2.82, 95% CI: [1.55–5.12]) and high body mass indexes (BMI) (AOR=.81, 95% CI: [.74–.89]). The prevalence of BV, UU and MH was significantly higher in infertile patients than fertile patients (p=.002). Conclusions: Bacterial vaginosis, MH, and UU co-infection were common in patients with vaginal discharge, and it was detected considerably higher in infertile patients than in fertile patients.(AU)

Objetivos: Este estudio busca examinar la asociación entre los factores de riesgo predisponentes y la prevalencia de la vaginosis bacteriana (VB), así como las infecciones por Mycoplasma hominis (MH) y Ureaplasma urealyticum (UU) en mujeres en edad reproductiva e investigar su relación con la infertilidad. Métodos: Estudio transversal y prospectivo que se llevó a cabo con mujeres sexualmente activas que acudieron a la Clínica de Ginecología con quejas de flujo vaginal. Con hisopos de algodón estériles, se tomaron dos muestras de frotis cervical del canal endocervical. Se interrogó a las pacientes para obtener sus datos demográficos y se registraron los posibles factores de riesgo de infecciones del tracto genital inferior y sus respuestas. Resultados: Entre 348 pacientes, se detectó VB en el 46,3%, UU en el 26,7%, HM en el 3,7% y coinfección por UU y HM en el 13,2%. La prevalencia de VB concomitante con UU y/o MH fue significativamente alta (P=0,001). Los factores de riesgo más destacados para la VB fueron la infección por UU y MH (AOR=6,79, intervalo de confianza (IC) del 95%: [2,63-17,56]), uso de duchas vaginales (AOR=6,80, IC del 95%: [03,60-12,83]), antecedentes de aborto (AOR=2,82, IC del 95%: [1,55–5,12]) e índices de masa corporal (IMC) altos (AOR=0,81, IC del 95%: [0,74-0,89]). La prevalencia de BV, UU y MH fue significativamente mayor en pacientes infértiles que en pacientes fértiles (P=0,002). Conclusiones: Se encontró que la coinfección por BV, MH y UU era común en pacientes con flujo vaginal, y también este aumento fue significativamente mayor en pacientes infértiles que en pacientes fértiles.(AU)

Molecular Epidemiological Analysis of Bacillus Pseudo-Outbreak due to Contaminated Culture Tubes Containing Stuart Medium.

BACKGROUND: It is challenging to determine whether Bacillus species other than Bacillus anthracis cause infections. Pseudo and true outbreaks of Bacillus spp. have been noted. Here, we present a molecular analysis of a Bacillus spp. pseudo-outbreak caused by contaminated culture tubes containing Stuart medium. METHODS: Between January and March 2015, a high percentage of Bacillus spp. was isolated from the wound samples of inpatients at the Karabuk University Hospital, and an outbreak was suspected. Environmental and staff nasal samples were cultured aerobically, and Bacillus spp. were isolated from some of them. However, the isolation of Bacillus spp. in throat cultures of outpatients suggested contamination caused by culture tubes containing Stuart medium. We examined two lots of culture tubes used in the hospital. Although the culture tubes' expiry date and storage conditions were suitable, Bacillus spp. grew in one of these lots. A total of 47 Bacillus spp. isolated during this period were identified, and the clonal relationship among the isolates was investigated by arbitrarily primed polymerase chain reaction. RESULTS: Twenty-seven strains were identified as Bacillus megaterium and 20 as Bacillus firmus. Of the four strains isolated from the Stuart medium, two were identified as B. firmus and the other two were B. megaterium. Two B. firmus strains isolated from the Stuart medium and two B. firmus strains obtained from the coronary intensive care environmental samples were matched and clustered within the same genotype. We recalled all culture tubes containing Stuart medium. After another brand's culture tubes were distributed, no growth was observed. It was then understood that the pseudo-outbreak source was contaminated culture tubes containing Stuart medium. CONCLUSIONS: Microbiological controls of medical materials and equipment should be regularly checked to prevent outbreaks (true or pseudo).

Awareness, knowledge and risk factors of Toxoplasma gondii infection among pregnant women in the Western Black Sea region of Turkey.

Toxoplasma gondii (T. gondii) infection causes serious problems leading to maternal complications and foetal anomalies during pregnancy. The aim of this study was to identify risk factors for toxoplasmosis and to determine the seroprevalence of the disease with regard to the awareness levels of patients. A total of 214 pregnant women who were admitted to Karabuk University, Gynaecology and Obstetrics Clinic between July 2018 and November 2018 and accepted to participate were included this cross-sectional study. Venous blood samples were obtained and anti-T. gondii IgG and IgM levels were analysed. The demographic characteristics of the patients were recorded and a questionnaire investigating about T. gondii risk factors were completed. The relationship between toxoplasmosis and risk factors was evaluated using multivariate regression analysis. The prevalence of toxoplasmosis among the pregnant women was 14% (35/214). The potential risk factors of toxoplasmosis were primigravidity (AOR = 2.56 95% CI: [1.26-8.26]), cat ownership (AOR = 10.29, 95% CI: [3.58-29.60]), and sausage/salami consumption (AOR = 2.96, 95%CI: [2.10-7.46]);22.4% of the women were aware of toxoplasmosis, and awareness was significantly higher in multigravida women compared with primigravida women (p=.042). Congenital toxoplasmosis can be prevented through pregnancy screening programmes and education aimed at increasing awareness and protection.IMPACT STATEMENTWhat is already known on this subject? The seroprevalence of toxoplasmosis is very variable and may differ significantly between countries, and even different geographic regions of the same country. Raising awareness of the disease among persons in risk groups through education is a primary objective in prevention.What do the results of this study add? T. gondii seropositivity was found to be related with being primigravid, cat ownership and having close contact with cats, and consumption of meat products such as salami and sausages. In addition, primigravidity is a risk factor for toxoplasmosis because the awareness of the disease was lower than in multiparous women.What are the implications of these findings for clinical practice and/or further research? It should also be known that women of childbearing age are in the high-risk group for toxoplasmosis, and studies on preventive measures should be performed. Increased awareness can prevent infection and the possibility of complications due to congenital toxoplasmosis, especially in the reproductive period of women.

Antimicrobial Resistance and Molecular Epidemiology of Corynebacterium striatum Isolated in a Tertiary Hospital in Turkey.

Although Corynebacterium striatum is part of the human flora, it has recently drawn attention both for its multidrug resistance and its role as an invasive infection/outbreak agent. This cross-sectional study aimed to determine the antimicrobial resistance and clonal relationships among C. striatum strains. In total, 81 C. striatum strains were identified using Phoenix-100TM (BD, Sparks, MD, USA). The antimicrobial resistance of the strains was determined using the Kirby-Bauer disk diffusion method. Clonal relatedness among the strains was performed via arbitrarily primed polymerase chain reaction (AP-PCR). All 81 C. striatum strains were resistant to penicillin, cefotaxime, ciprofloxacin, and tetracycline, but susceptible to vancomycin and linezolid. The resistance rates to gentamicin, erythromycin, and clindamycin were 34.6%, 79%, and 87.7% respectively. AP-PCR results showed no predominant clone among the C. striatum strains. Corynebacterium striatum is reportedly the cause of an increasing number of invasive infections/outbreaks. Moreover, treatment options are limited. The study showed that vancomycin, linezolid, and gentamicin can be selected for the empirical treatment of C. striatum infections. Although no single-clone outbreak was observed in our hospital, small clonal circulations were observed within some units, indicating cross-contamination. Therefore, a comprehensive infection control program is warranted in future.

Antibiotic Resistance and Molecular Epidemiology of Vancomycin-Resistant Enterococci in a Tertiary Care Hospital in Turkey.

PURPOSE: Vancomycin-resistant enterococci (VRE) have become a global health threat in the last two decades. In this study, we aimed to determine antibiotic resistance using phenotypic and genotypic methods in VRE strains obtained from inpatients and to investigate clonal relatedness among strains. METHODS: Identification and antibiotic susceptibility of 47 VRE strains obtained from inpatients at Karabuk University Hospital from 2014 to 2015 were determined using the BD Phoenix™ automated microbiology system. Vancomycin resistance genes (Van A and B) were detected by polymerase chain reaction. Clonal relatedness among the strains was evaluated by pulsed-field gel electrophoresis (PFGE). RESULTS: All 47 VRE strains obtained from rectal (n=35), blood (n=7), and urine (n=5) samples were confirmed as Enterococcus faecium; they were resistant to ampicillin, gentamicin, vancomycin, and teicoplanin. One E. faecium isolate was intermediately resistant to linezolid. No strain was resistant to quinupristin-dalfopristin or daptomycin. Only vanA was detected among strains. According to the PFGE results, 31 of 47 strains were clonally related with a clustering rate of 66%. No common clone was detected. CONCLUSION: VRE infections are associated with high mortality, morbidity, and healthcare expenditures. Increasing resistance to last-line drugs, such as linezolid and daptomycin, among VRE strains is a great concern. Therefore, comprehensive measures should be performed to reduce VRE colonization. Although there was no common clone VRE outbreak, polyclonal spread was observed in our hospital. The high clustering rate indicated cross-contamination. Thus, a more effective infection control program should be implemented.

[A comparison of the costs, reliability and time of result periods of widely used methods, new molecular methods and MALDI TOF-MS in the routine diagnosis of Candida strains]. / Candida tür tayininde rutinde yaygin olarak kullanilan yöntemlerle yeni kullanilmaya baslayan MALDI TOF-MS ve moleküler yöntemlerin sonuç verme süreleri, maliyetleri ve güvenilirliklerinin karsilastirilmasi.

In recent years, the fast and accurate identification of the Candida species is of great importance as the response to antifungal treatment differs among species. Following the treatment of several immunosuppressive diseases, fungal infections can emerge. The aim of this study was to compare the accuracy, costs and time of result periods of the methods used in the identification of the most common human fungal infectious agent, Candida strains. From various clinical samples sent to the Microbiology Laboratory of Karabuk University Training and Research Hospital between July 2016-December 2017, a total of 91 yeast isolates cultivated in blood agar (Becton Dickinson, USA) and/or Sabouraud dextrose agar (SDA-Oxoid, UK), confirmed with colony morphology and microscopic appearance, identified as Candida species with a fully automated identification system (Phoenix™ Yeast ID Panel, Becton Dickinson Diagnostics, USA) were included in the study. All the samples were examined with sequence analysis using ITS1 forward 5'-TCC GTA GGT GAA CCT GCG G-3' and ITS4 reverse 5'-TCC TCC GCT TAT TGA TAT GC-3' primers (Iontek, Turkey) and the matrix-assisted laser desorption-ionisation time of flight mass spectrometry (MALDI TOF-MS) systems. Molecular sequence analysis was accepted as the gold standard method and the results were compared with those of the other methods MALDI TOF-MS and Phoenix™ Yeast ID Panel in respect of the accuracy of the identification of Candida strains. According to the results of the DNA sequence analysis of the 91 Candida isolates included in the study, 24 were identified as Candida albicans, 20 Candida tropicalis, 16 Candida parapsilosis, 13 Candida glabrata, seven Candida kefyr, six Candida krusei, two of each Candida dubliniensis, Candida guilliermondi and one Candida lusitaniae. Compared to the results of the DNA sequence analysis, the accurate identification of the fully automated Phoenix™ system and the MALDI TOF-MS system was found as 92.3% and 97.8%, respectively. In addition to accuracy, costs and time of result periods of the three methods were also compared. Disregarding the cost of the device in the 3 methods, when the comparison was made of the cost per test and the time to results after pure production in SDA agar, the MALDI TOF-MS system was determined to have the lowest costs and provided results in the shortest time. As some of the Candida strains have antifungal resistance, identification of the strains must be a priority in respect of starting early treatment. The MALDI TOF-MS system has high performance in accurate identification, low costs and the system provides the results within minutes, thereby allowing immediate decision to be made for the antifungal treatment to be started. Thus, the morbidity, mortality and cost rates will be reduced. In conclusion, as the MALDI TOF-MS is a rapid, reliable and low cost per test system, it can be considered suitable for routine use in laboratories.

High prevalence of TEM, VIM, and OXA-2 beta-lactamases and clonal diversity among Acinetobacter baumannii isolates in Turkey.

INTRODUCTION: Acinetobacter baumannii is an opportunistic pathogen that causes nosocomial infections with high mortality. Treatment options are limited owing to its resistance to numerous antibiotics. Here, we sought to determine the antibiotic susceptibilities of A. baumannii isolates, investigate clonal relationship among the strains, and determine the frequency of beta-lactamase resistance genes. METHODOLOGY: The identification and antibiotic susceptibilities of 69 A. baumannii strains were determined using a BD-Phoenix automated system. The presence of blaOXA-2, blaOXA-10, blaOXA-23, blaOXA-24/40, blaOXA-51, blaOXA-58, blaTEM, blaSHV, blaIMP, blaVIM, and blaGIM genes were investigated using polymerase chain reaction (PCR), and clonal relatioships among the isolates were determined using pulsed-field gel electrophoresis (PFGE). RESULTS: All strains were resistant to ampicillin-sulbactam, gentamicin, cefepime, ciprofloxacin, and ceftriaxone. While 65 of the 69 strains (94.2%) were resistant to piperacillin-tazobactam, amikacin, imipenem, and meropenem, all strains were susceptible to tigecycline and colistin. The frequencies of blaOXA-51, blaOXA-23, blaTEM, blaOXA-2, blaVIM, and blaSHV were 100%, 94.2%, 53.6%, 21.7%, 14.5%, and 2.9%, respectively. Based on PFGE results, 56 of the 69 strains were clonally related, and the clustering rate was 81.2%. No common outbreak isolate was detected. CONCLUSIONS: The most prevalent OXA genes were blaOXA-51, blaOXA-23, and blaOXA-2. Furthermore, blaTEM, blaSHV, and blaVIM, which are common in Enterobacterales and Pseudomonas spp, were detected, suggesting horizontal gene transfer had occurred between bacteria. No single clone outbreak was detected by PFGE. However, multiclonal spread and the high clustering rate suggest cross-contamination. Therefore, in future, more effective infection control measures must be implemented.