Evaluation of the synergistic effect of a combination of colistin and tigecycline against multidrug-resistant Acinetobacterbaumannii.

OBJECTIVE: Acinetobacter baumannii species cause nosocomial infections and can subsequently develop multidrug resistance (MDR). The objective of this study was to evaluate the susceptibility of A. baumannii to a novel combination of colistin and tigecycline, which may provide a faster and more efficacious treatment via a synergistic effect. METHODS: We included 50 MDR A. baumannii samples that were isolated in our clinics between 2009 and 2014. We used broth microdilution (BMD) and the E-test to evaluate the effects of colistin and tigecycline, and the E-test to assess the interaction of the colistin-tigecycline combination. The interaction between the two antibiotics was evaluated using the fractional inhibition concentration (FIC) index and was classified as follows: FIC≤0.5, synergistic; 0.5

Meningoencephalitis, pancytopenia, pulmonary insufficiency and splenic abscess in a patient with brucellosis.

A complicated case of brucellosis with some rare features is reported. Brucellosis is a multisystemic disease. However, disseminated brucellosis with cerebral, pulmonary, hematopoietic and splenic involvement in an otherwise healthy patient is a rare event. In this article, we report a case of disseminated brucellosis who was initially diagnosed as myelodysplastic syndrome MDS and meningoencephalitis, pulmonary symptoms, and splenic abscess formation occurred thereafter.

Significant elevation of serum soluble CD14 levels in patients with brucellosis.

Activation of macrophages represents one of the initial events in innate immunity to intracellular infections. CD14 is expressed principally by cells of monocyte/macrophage lineage and plays a pivotal role in innate recognition of bacterial cell wall components, particularly lipopolysaccharides. We measured serum concentrations of soluble CD14 (sCD14) in serum samples obtained from 37 patients with brucellosis and 36 healthy controls. Serum levels of sCD14 were significantly increased in patients with brucellosis compared with those in healthy controls (P < 0.001). Re-analysis of serum samples after treatment in 25 patients demonstrated that treatment did not result in any significant decline in sCD14 levels. Despite a limited study population, these findings may implicate CD14 signaling as an important component of the initial anti-brucellar host response and suggest that activation of mononuclear phagocytic system is sustained even following effective treatment.

The effect of a nationwide antibiotic restriction policy on antibiotic usage in a stem cell transplantation unit.

The Turkish Ministry of Health has released a regulation in February 2003 in order to decrease, first the antibiotic expenses and second, inappropriate use of antimicrobial agents. The aim of this study is to assess the impact of this nationwide antibiotic restriction (NAR) in the most active stem cell transplantation unit (SCTU) in Turkey. All patients followed up in SCTU and had received antimicrobial therapy in the period of four months before and after NAR were evaluated retrospectively. The appropriateness of antimicrobial treatments was assessed by two ID specialists and one ID professor. Disagreements between investigators were solved by discussion and review of published guidelines. There were 10 and 25 patients who were on antimicrobial therapy in the 1st (before NAR) and 2nd (after NAR) group, respectively. Seventeen of the patients had undergone allogeneic stem cell transplantation, while 6 were allogeneic bone marrow recipients and 12 were autologous peripheral stem cell recipients. The antibiotic days per patient was 33.4 and 19.4 in the first and second groups respectively (p=0.036). Although it was not significant, the appropriateness of antibiotic regimens used in the second group was higher than the first group (OR: 5, CI: 0.9-26.4, p= 0.059). The significantly lower antibiotic day per patient in the 2nd group may be the result of collaboration between infectious diseases and hematology physicians settled after NAR in our hospital. NAR had reduced the antimicrobial use in our unit mainly by providing collaboration between infectious diseases and hematology departments.

A case of brucellar septic arthritis of the knee with a prolonged clinical course.

Brucellosis is a systemic infectious disease with a broad spectrum of clinical manifestations. Arthritis is frequently observed in its course and may be one of the main presenting clinical features of the disease. We report a case of brucellar monoarthritis of the knee with a prolonged clinical course despite efficient antibiotic treatment.

Revised definition of 'fever of unknown origin': limitations and opportunities.

AIM: The limitations and opportunities of revised definition of fevers of unknown origin (FUO) in comparison to conventional definition were investigated, and prehospital characteristics of the patients were detailed. METHOD: The patients were grouped according to both revised and classic definitions of FUO. RESULTS: Fifty-nine of the 80 patients (74%) met the conventional definition of FUO. Before their admissions, all patients had at least one course of antibiotic therapy. The aetiology was infectious in 52%, autoimmune in 19%, and neoplastic in 17%. In 12% of the cases, the reason for high fever could not be explained. The most common infectious aetiologies were various forms of tuberculosis (12%), brucellosis (12%), salmonella (7%) and malaria (5%). The revised definition inflated the rate of infectious aetiology. CONCLUSION: A standardized set of diagnostic tools used in this study was suggested. The subjects of FUO series have to be screened for endemic infections.

[Comparison of protein profiles and antibiotic sensitivity of methicillin-resistant Staphylococcus aureus strains isolated from nasal cultures of polyclinic patients and hospital personnel]. / Poliklinik hastalari ile hastane personelinin burun kültürlerinden izole edilen metisiline dirençli Staphylococcus aureus suslarinin protein profillerinin ve antibiyotik duyarliliklarinin karsilastirilmasi.

In this study, the antibiotic susceptibilities and whole cell protein patterns of methicillin resistant Staphylococcus aureus (MRSA) strains which were isolated from nasal swabs of outpatients and healthy hospital staff, have been determined by disk diffusion test and sodium dodecyl sulfate polyacrylamide gel electrophoresis method, respectively. A total of 43 MRSA isolates of which 13 out of 500 outpatients and 30 out of 500 hospital personnel, showed the same protein profiles, and the antibiotic susceptibility patterns were found similar. These findings suggested that the strains isolated from the outpatients were originated from hospital environment.

[Thrombocytopenia cases due to acute brucellosis]. / Akut brusellozise bagli trombositopeni olgulari.

The hematological manifestations of brucellosis include anemia, leucopenia, thrombocytopenia and clotting disorders. In this case report, two patients, with clinically and serologically proven brucellosis, manifesting with thrombocytopenia were presented. The first patient who was a 32 years old man, was admitted to the hospital with the complaints of fever, malaise and night sweats. His Brucella agglutination titer was 1/1280 and thrombocyte count was 41.000/mm3. The second case was a 46 years old man with the complaints of fever and rash. His Brucella agglutination titer was 1/640, thrombocyte count was 38.000/mm3. Following treatment with doxycycline and rifampisin the thrombocyte counts of the patients returned to normal (respectively, 176.000/mm3 and 162.000/mm3. The blood cultures of both of these patients did not yield Brucella. The antibiotic therapy of patients discontinued after 6 weeks, with full recovery.

[Candida dubliniensis studies and isolation of Candida types in oropharyngeal specimens from oncologic patients]. / Onkoloji hastalarinin orofaringeal örneklerinde Candida dubliniensis arastirilmasi ve izole edilen Candida suslarinin tiplendirilmesi.

Fungal opportunistic infections, and in particular those caused by the various Candida species, have gained considerable significance as a cause of morbidity and, often, mortality. Although Candida albicans remains to be the most frequently isolated fungal species as an opportunistic oral pathogen, other yeast species are often identified in immunocompromised patients. C. dubliniensis, the recently described species, has been recovered primarily from oropharyngeal candidasis in Human Immunodeficiency Virus (HIV)-infected patients. C. dubliniensis shares many phenotypic characteristics with, and is phylogenetically closely related to, C. albicans. The aim of the present study was to investigate the colonization rates of fungal species, and especially C. dubliniensis, in the oropharyngeal samples from cancer patients. The oropharyngeal swabs of 543 patients were collected during their visits to oncology clinic in 9 months period, and a total of 209 Candida species have been isolated. Of them, 147 isolates were found to be positive for germ tube and chlamydospore formation, and they were tested for the growth inability at 42 degrees C and 45 degrees C, colony morphology in Staib agar and the intracellular beta-glucosidase activity, in order to identify C. dubliniensis. The results of these tests and carbohydrate assimilation tests by API 20C AUX yeast identification system, yielded that all these 147 (70.3%) isolates were C. albicans. The other isolates were identified as follows; 16 C. parapsilosis (7.6%), 13 C. tropicalis (6.2%), 10 C. glabrata (4.7%), 5 C. guilliermondii (2.3%), 4 C. krusei (1.9%), 3 C. keyfr (1.4%), 3 C. famata (1.4%), 2 S. cerevisiae (0.9%), 2 C. pelliculosa (0.9%), 1 C. utiles (0.4%), 1 C. neoformans (0.4%) and 1 Hansenula polymorpha (0.4%), while no C. dubliniensis was isolated.

[Case report: evaluation of two cases of tuberculoma incident to tuberculosis meningitis]. / Olgu raporu: tüberküloz menenjit sekeli olarak tüberkülom gelisen iki olgunun incelenmesi.

Intracranial tuberculoma is one of the most serious complications of tuberculous meningitis. In this report, two patients who develop intracranial tuberculoma as a complication of tuberculous meningitis have been presented. The first patient was a 35 years old male patient who were still been in therapy for cavitary tuberculosis. The other one was 42 years old male patient and have had treated for subdural empyema two years ago. There was no positivity in both of the cerebrospinal fluid (CSF) specimens of the patients by Gram and Erlich Ziehl Neelsen stained preparations, while the CSF sample of the first case yielded Mycobacterium tuberculosis in culture. The tuberculoma diagnosis of these patients managed by the help of computerized tomography (CT) and nuclear magnetic resonance imaging (NMR) methods. As a result, it was thought that CT and NMR techniques have a great role in the diagnosis and management of complications in tuberculous meningitis patients.

[Case report: brucellosis complicated by epididymo-orchitis and paravertebral abscess]. / Olgu raporu: epididimo-orsit ve paravertebral abseli brusellozis.

Brucellosis which is a zoonotic infection involving many systems, is widespread in Turkey. Although muscular and skeletal system involvements are common, genitourinary system complications (epididymo-orchitis) are observed rarely. Brucellosis accompanied by abscess formation in the vertebra is generally seen in the elderly and patients with chronic diseases, while epididymo-orchitis in young patients. However, it is very unusual to detect these two complications together. In this report, a case of 42 years old male patient with epididymo-orchitis and paravertebral abscess due to brucellosis, has been presented.

A case of anthrax meningitis.

Meningeal anthrax is a very rare complication of the cutaneous, respiratory and gastrointestinal form of anthrax infection. Anthrax bacilli, most commonly enter the body via the skin, and the organism then disseminates to the central nervous system via the hematogenous or lymphatic routes leading to fatal bacterial meningitis, even with intensive antibacterial therapy.

[Case report: a brain hydatid cyst]. / Olgu raporu: beyinde kist hidatik olgusu.

Hydatid cyst is a zoonotic infection caused by larval stage of Echinococcosis granulosus. Although any organ may be involved, bone, brain and heart involvements are uncommon. The brain involvement rate varies from 1% to 3% in hydatid disease. In this report, a 42 years old female patient has been presented in whom brain hydatic cyst was diagnosed by radiological and histopathological findings.