The Relationship of Comorbid Diseases and Empirical Antibiotic Usage with Superinfection in COVID-19 Patients.

OBJECTIVE: To identify the microorganisms responsible for superinfections in patients admitted with COVID-19 and evaluate the impact of empirical antibiotic regimen and comorbid disease on superinfections comparing COVID-19 patients with and without secondary infection. STUDY DESIGN: A descriptive study. Place and Duration of the Study: Department of Microbiology, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkiye, from March to July 2020. METHODOLOGY: This study was conducted with patients diagnosed with COVID-19 disease based on radiological or quantitative RT-PCR test results. Culture results, demographic characteristics, clinical variables, and therapeutic regimen were collected from medical records. RESULTS: Superinfection developed in 48 (26.96%) of 178 cultures (24 of 101 patients) followed up in the COVID-19 clinics. Infections were determined as 25 (52.08%) bloodstream, 11 (22.9%) urinary tract, 10 (20.8%) respiratory tract and 2 (4.16%) soft tissue infections, respectively. Secondary infectious agents were E.coli in 11 (22.9%), A.baumannii in 8 (16.7%), S.homminis in 7 (14.6%), S.epidermidis in 6 (12.5%), K.pneumoniae in 4 (8.3%), C.albicans in 2 (4.1%), and other bacterial and fungal agents in 10 (20.8%). The median range from admission to the hospital to detecting microorganism growth was the longest with piperacillin/tazobactam with moxifloxacin and azithromycin. Secondary microorganism detection was delayed, mostly due to the empirical use of moxifloxacin, azithromycin, and piperacillin/tazobactam. CONCLUSION: Demographic characteristics, comorbidity and antibiotic use of patients were not directly related to secondary infections. In addition, the empirical use of azithromycin and moxifloxacin with piperacillin/tazobactam appeared to delay the development of superinfection. KEY WORDS: Superinfection, COVID-19, Comorbidity.

Molecular Characterization and Cluster Analysis of SARS-CoV-2 Viral Isolates in Kahramanmaras City, Turkey: The Delta VOC Wave within One Month.

The SARS-CoV-2 pandemic has seriously affected the population in Turkey. Since the beginning, phylogenetic analysis has been necessary to monitor public health measures against COVID-19 disease. In any case, the analysis of spike (S) and nucleocapsid (N) gene mutations was crucial in determining their potential impact on viral spread. We screened S and N regions to detect usual and unusual substitutions, whilst also investigating the clusters among a patient cohort resident in Kahramanmaras city, in a restricted time span. Sequences were obtained by Sanger methods and genotyped by the PANGO Lineage tool. Amino acid substitutions were annotated comparing newly generated sequences to the NC_045512.2 reference sequence. Clusters were defined using phylogenetic analysis with a 70% cut-off. All sequences were classified as Delta. Eight isolates carried unusual mutations on the S protein, some of them located in the S2 key domain. One isolate displayed the unusual L139S on the N protein, while few isolates carried the T24I and A359S N substitutions able to destabilize the protein. Phylogeny identified nine monophyletic clusters. This study provided additional information about SARS-CoV-2 epidemiology in Turkey, suggesting local transmission of infection in the city by several transmission routes, and highlighting the necessity to improve the power of sequencing worldwide.

Antifungal efficacy of pure boron on yeast and mold isolates causing superficial mycosis.

OBJECTIVE: To examine the in vitro antifungal effects of water-soluble pure elemental boron with an alkaline solution against Candida species, Trichophyton species, and Aspergillus fumigatus that cause superficial mycosis. METHODS: The study was conducted at the microbiology laboratory of Kahramanmaras Sutcu Imam University Hospital, Kahramanmaras, Turkey, from June to December 2018, and comprised fungal strains isolated from patients with superficial mycosis who visited the dermatology clinic. The in vitro antifungal effects of the boron solution at various concentrations were determined using the microbroth dilution method. Candida albicans ATTC 90028 and Candida albicans MYA 274 served as the quality control strains, while fluconazole and amphotericin B were used as comparator antifungal agents. Data was analysed using SPSS 22. RESULTS: Of the 58 strains, 28(48.3%) were Candida albicans, 9(15.5%) non-Candida albicans, 12(20.7%) Trichophyton rubrum, 4(6.9%) Trichophyton mentagrophytes, 2(3.4%) Trichophyton species and 3(5.2%) were Aspergillus fumigates. Boron at a concentration of 78.125 µg/mL inhibited the growth of Candida albicans. The 50% and 90% minimum inhibitory concentrations of the solution in non-Candida albicanswere 78.125 and 312.5 µg/mL, respectively, whereas those in Trichophyton rubrum were 312.5 and 625 µg/mL, respectively. The 50% minimum inhibitory concentration of the solution in Aspergillus fumigatus was 625 µg/mL, whereas the 90% minimum inhibitory concentration could not be determined. CONCLUSIONS: Boron is an inexpensive, non-antibiotic element with potential uses as an antifungal agent.