The pediatric asymptomatic SARS-CoV-2 IgG seropositivity in the Turkish Republic of Northern Cyprus.

BACKGROUND: While children were initially thought to have serious contributions to the coronavirus disease 2019 (COVID-19) transmission, recent studies suggest otherwise. However, the possible effect of asymptomatic pediatric spread still has not yet received enough attention. The aim of our study was to estimate asymptomatic infection rates among children in the Turkish Republic of Northern Cyprus, by using pediatric patients admitted to a university hospital without any COVID-19-associated symptoms. METHODS: Blood samples collected from 80 pediatric patients with no symptoms and history of COVID-19 infection, who were admitted to a university hospital between September 2020 and January 2021, were included in the retrospective study. Isolated serum samples were tested by Dia.Pro SARS-CoV-2 IgG ELISA assays. RESULTS: The patient group included 40 (50%) male and 40 (50%) female patients. The average age of children was 7.6 ± 4.0 years, with min-max ages ranging from 2 to 15 years. Among the 80 patients tested, only one (1.3%) was detected positive by the Dia.Pro IgG ELISA kit. CONCLUSIONS: The asymptomatic seropositivity reported in our study suggests the use of randomly performed serologic tests to monitor SARS-CoV-2 infection among the pediatric population in schools that would contribute to the public health fight against COVID-19.

Comparative activity of carbapenem testing (the COMPACT study) in Turkey.

BACKGROUND: Recent evidence indicates that Gram-negative bacterial pathogens, the most common of which are Pseudomonas spp., Enterobacteriaceae, and Acinetobacter baumannii, are frequent causes of hospital-acquired infections. This study aims to evaluate the in vitro activity of doripenem and comparator carbapenem antibiotics against Gram-negative clinical isolates collected from COMParative Activity of Carbapenem Testing (COMPACT) study centres in Turkey. METHODS: Ten centres in Turkey were invited to submit Pseudomonas aeruginosa, Enterobacteriaceae, and other Gram-negative isolates from intensive care unit (ICU)/non-ICU patients with complicated intra-abdominal infections, bloodstream infections, or nosocomial pneumonia, including ventilator-associated pneumonia, between May and October 2008. Susceptibility was determined by each centre using E-test. A central laboratory performed species confirmation as well as limited susceptibility and quality-control testing. RESULTS: Five hundred and ninety six isolates were collected. MIC90 values for doripenem, meropenem, and imipenem, respectively, were 32, ≥ 64, and ≥ 64 mg/L against Pseudomonas spp.; 0.12, 0.12, and 0.5 mg/L against Enterobacteriaceae; and ≥ 64 mg/L for each against other Gram-negative isolates. In determining the susceptibility of hospital isolates of selected Gram-negative pathogens to doripenem, imipenem, and meropenem, we found that against all pathogens combined, the MIC90 for ICU compared with non-ICU isolates was higher. CONCLUSIONS: Doripenem showed similar or slightly better activity than meropenem and better activity than imipenem against the Gram-negative pathogens collected in Turkey.

[The rate of inducible clindamycin resistance and susceptibilities to other antimicrobial agents in staphylococci]. / Stafilokokoklarda indüklenebilir klindamisin direnci ve diger antibiyotiklere duyarlilik oranlari.

Staphylococci are one of the most common pathogens isolated from nosocomial and community acquired infections. Antibiotics used by oral route such as erythromycin, clindamycin, trimethoprim-sulphamethoxazole (TMP-SMX) and quinolones are of value especially in the treatment of community acquired infections and resistance to those antibiotics may lead to therapeutic failure. Therefore in this study, susceptibility of staphylococci to TMP-SMX, rifampin, tetracycline, gentamicin, ciprofloxacin and vancomycin and the presence of inducible clindamycin resistance were investigated in two distinct university hospitals in Turkey. A total of 286 staphylococcus strains [184 Staphylococcus aureus, 102 coagulase negative staphylococci (CoNS)] were studied. Of the 90 hospital-acquired S. aureus, 44.6% were methicillin-resistant while all of the community acquired strains were methicillin-susceptible. All of the CoNS strains were isolated from nosocomial infections and 71.6% of them were resistant to methicillin. Inducible clindamycin resistance rate of CoNS strains (34.3%) was higher than that of S. aureus strains (7.1%) and the difference was statistically significant (p= 0.00001). Positive D-test among CoNS were significantly higher in S. hominis strains (p= 0.00001). Susceptibilities of S. aureus strains to tetracycline, rifampin, ciprofloxacin, gentamicin and TMP-SMX were 56%, 59%, 56%, 56% and 99%, respectively. Susceptibilities of CoNS strains to tetracycline, rifampin, ciprofloxacin, gentamicin and TMP-SMX were 73%, 72%, 39%, 40% and 46%, respectively. None of these strains were vancomycin resistant. Differences between tetracycline, rifampin, ciprofloxacin and gentamicin resistance rates among D-test positive and negative S. aureus strains were found statistically significant. Although among CoNS isolates, no statistically significant difference was found between the resistance rates, D-test positive strains were determined to be more resistant. Differences between tetracycline, rifampin, ciprofloxacin and gentamicin resistance rates among D-test positive S. aureus and CoNS strains were found statistically significant. It can be concluded that inducible clindamycin resistance should be tested for staphylococci during routine antibiotic susceptibility testing. According to the presented data, clindamycin still can be used empirically in methicillin-susceptible S. aureus infections in our region, however, the routine use of rapid, easy, reproducible and economic D-test for the determination of inducible clindamycin resistance in erythromycin resistant strains should be considered in clinical microbiology laboratories. Inducible clindamycin resistance must be anticipated carefully while considering therapeutic options especially for CoNS infections.

Risk of infection in health care workers following occupational exposure to a noninfectious or unknown source.

BACKGROUND: The major concern after occupational exposures is the possible transmission of blood-borne pathogens, especially hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). This study was undertaken to evaluate the risk of infection after exposure to blood or body fluids of an unknown or an HBV-, HCV-, and HIV-negative source and to determine the epidemiologic characteristics of these incidents in health care workers. METHODS: The survey was conducted over a 6-year period at a university hospital in Turkey, using a questionnaire to elicit demographic and epidemiologic information. Serologic tests for HBV, HCV, and HIV were performed and repeated after 3 months. RESULTS: Of the 449 incidents, complete follow-up was achieved in 320 (71.3%), and no seroconversion was observed for HBV, HCV and HIV. Most of the incidents occurred in medical (34.7%) and surgical (25.4%) work areas. The most frequent type of exposure was percutaneous injury (94%), most commonly caused by handling of garbage bags (58.4%), needle recapping (16.5%), and invasive interventions (13.4%). CONCLUSION: Infection risk seems to be extremely low for HCV and HIV, because of low endemicity, and for HBV in groups immunized against HBV.

[Two cases of herpes encephalitis with normal cerebrospinal fluid findings]. / Olgu sunumu: beyin omurilik sivisi bulgulari normal olan iki herpes ensefaliti olgusu.

In this report, characteristics of two cases of Herpes simplex virus (HSV) encephalitis with normal cerebrospinal fluid (CSF) findings at the time of admission have been discussed and the current literature has been reviewed. The diagnosis of the cases (one was 23 years old male, and the other was 75 years old female patient) was made on the magnetic resonance imaging (MRI) findings concordant with HSV encephalitis, together with HSV-1 DNA positivity by polymerase chain reaction (PCR). Both of the patients were treated with acyclovir (3 x 750 mg/day) lasting for 15 days and 21 days, respectively. The first male patient recovered with mild neurological defects, whereas the second female patient died because of nosocomial pneumonia and septicemia. In conclusion, even the CSF findings are normal, in cases considered to be HSV encephalitis, MRI should be the first radiological diagnostic step and the diagnosis should be confirmed by the detection of HSV DNA in CSF by PCR.

Effects of community-acquired infections on fever, leukocyte count and the length of stay in elderly. A cross-sectional study of 240 cases.

OBJECTIVE: To evaluate the relationships between community acquired infections in elderly cases (> or =65 ages) not living in a nursing home and factors such as, fever and white blood cell (WBC) counts; age, gender and the presence of underlying chronic diseases as compared to the length of stay. METHODS: We conducted this study in Dokuz Eylul University Hospital in Turkey as a defining cross-sectional research covering a 5-year period between January 1999 and December 2003. The data of 240 elderly cases were investigated, forms, which includes gender, existence of chronic diseases, fever, WBC counts, diagnosis, applied treatment and prognosis were prepared, and results were presented. RESULTS: The most frequently encountered infections were urinary system infections (35.4%), acute gastroenteritis (17.9%), pneumonia (15.9%) and soft tissue infections (13.3%). We observed that WBC counts were significantly elevated, parallel with high fever (p=0.021). In elderly cases we determined the existence of underlying disease and that living in the community lengthens the hospital staying periods (p=0.001). It was determined that elderly patients with an elevated WBC are 2.02 times more likely to have a temperature of 38.3 degrees C or higher compared with patients with a normal temperature (p<0.05). CONCLUSION: There was a strong association between leucocytosis and high fever in elderly cases. However, the absence of fever and leucocytosis in 78 (32.5%) of our cases, makes it hard for us to decide whether there was an infection or not. The most frequently encountered infections in elderly cases living in the community were similar to those living in nursing homes. These cases must be followed in the geriatric wards of hospital or geriatric hospitals whenever possible.

Nosocomial bloodstream infections associated with Candida species in a Turkish University Hospital.

In recent years, a progressive increase in the frequency of nosocomial candidaemia has been observed, especially among the critically ill or immunocompromised patients. The aim of this study was to evaluate the trend in incidence of candidaemia together with potential risk factors in an 850-bed Turkish Tertiary Care Hospital in a 4-year period. A total of 104 candidaemia episodes were identified in 104 patients. The overall incidence was 0.56 per 1000 hospital admissions and the increase in incidence of candidaemia from 2000 to 2003 was found to be statistically significant (P = 0.010). Candida albicans was the most common species (57.7%) and non-albicans species accounted for 42.3% of all episodes. The most common non-albicans Candida sp. isolated was C. tropicalis (20.2%) followed by C. parapsilosis (12.5%). The most frequent risk factors possibly associated with the candidaemia were previous antibiotic treatment (76.9%), presence of central venous catheter (71.2%) and total parenteral nutrition (55.8%). Our results show the fact that the incidence of candidaemia caused by non-albicans species is frequent and increasing significantly, although the most common isolated Candida species were C. albicans and further investigations are necessary to evaluate the mechanisms of increasing incidence of candidaemia caused by non-albicans species.

Infectious disease consultations and antibiotic usage in a Turkish university hospital.

OBJECTIVES: The aim of this study was to investigate the various features of infectious disease (ID) consultations and the usage of antibiotics in a Turkish university hospital. METHODS: A total of 395 consultation requests were recorded during a three-year period. RESULTS: The departments most frequently requesting the consultation services of the ID department were Orthopedics (29.6%), Neurology (18.5%), Cardiology (11.8%) and Internal Medicine (10.4%). The main reasons were for diagnosis of unexplained fever (42.3%) and for antibiotic modification according to culture results (18%). Diagnoses made by the ID consultant were pneumonia (16.7%), urinary tract infections (9.3%), bone and joint prosthesis infections (9.1%) and in 15.7% of the investigated patients, no infectious focus was determined. It was recognized that the use of antibiotics had already been initiated in the great majority of patients (67.1%) before the consultation request. While the current therapy was changed in 57.4% of these patients, antibiotics were not necessary for 9.8%. CONCLUSIONS: Since the most common diagnoses were respiratory and urinary tract or bone and joint prosthesis infections, the ID specialists should have detailed knowledge of these problems. Usage of antibiotics without ID consultation was prevalent, therefore a continuous educational program is a necessity for healthcare workers in the hospital.