Changes in antimicrobial resistance and outcomes of health care-associated infections.

To describe the change in the epidemiology of health care-associated infections (HAI), resistance and predictors of fatality we conducted a nationwide study in 24 hospitals between 2015 and 2018. The 30-day fatality rate was 22% in 2015 and increased to 25% in 2018. In BSI, a significant increasing trend was observed for Candida and Enterococcus. The highest rate of 30-day fatality was detected among the patients with pneumonia (32%). In pneumonia, Pseudomonas infections increased in 2018. Colistin resistance increased and significantly associated with 30-day fatality in Pseudomonas infections. Among S. aureus methicillin, resistance increased from 31 to 41%.

Negative serology: could exclude the diagnosis of brucellosis?

Two cases of brucellar spondylodiscitis of the lumbar area were presented. Although both cases showed typical radiological changes, serological tests could not detect Brucella agglutinating antibodies. One of the patients was bacteremic and Brucella spp. was identified from blood culture. In the second patient needle biopsy was required for definite diagnosis. Although small, serologic tests have a certain rate of false negative results in brucellosis. Thus, a negative serology should not exclude the diagnosis of brucellosis, as it is demonstrated in the current cases.

CTX-M type extended spectrum beta-lactamases in Escherichia coli isolates from community acquired upper urinary tract infections at a university in the European part of Turkey.

Extended spectrum beta-lactamase (ESBL) producing Escherichia coli has been an emerging etiologic agent in the community acquired infections. We investigated the occurrence of ESBL producing E. coli isolated from patients admitted with community acquired urinary tract infection (UTI) to the hospital of the Trakya University, Turkey during 2006. Eleven single patient isolates of E. coli harboring ESBL were identified among 30 E. coli isolated from patients admitted with symptoms corresponding to upper UTI. CTX-M type ESBLs were detected in all 11 ESBL-producers by isoelectric focusing and polymerase chain reaction screening. Sequence analysis revealed CTX-M-1 in one isolate, CTX-M-3 in three isolates and CTX-M-15 in seven isolates. ESBL-producing E. coli isolated from community acquired UTIs are widespread in the European part of Turkey.

[Hepatitis E virus epidemiology in adult population in Edirne province, Turkey]. / Edirne'de eriskinlerde hepatit e virus enfeksiyonu epidemiyolojisi.

Hepatitis E virus (HEV) clinical presentations range from asymptomatic infection to fulminant hepatitis which is frequently seen in pregnant women. Epidemics due to HEV mostly originate from contaminated water and the virus is transmitted by fecal oral way. Its frequency is closely related to the socioeconomical status of the community. The aim of this first community-based study performed in Edirne province (located at Trace region of Turkey) was to determine the seroprevalence of HEV and the risk factors in the city center. Five hundred eighty two people (273 men, 309 women) over age 15 years, representing the population of Edirne city center were included in the study. Anti-HEV IgG antibodies were investigated in the serum samples by ELISA method. Anti-HEV antibodies were detected in a total of 14 cases (11 women, 3 men) and HEV infection prevalence was found to be 2.4%. The mean age of seropositive people was 50.86 +/- 16.76 years while it was 40.7 +/- 16.9 years in seronegative people (p = 0.027). This result was attributed to the better water supply and sanitation conditions in Edirne province in comparison to other parts of Turkey and shift of HEV seropositivity in older ages. No statistically significant difference was detected between seropositive and seronegative cases in terms of socioeconomical conditions, both groups being in high socioeconomical level. The analysis of the risk factors revealed that the rate of people living in houses built with materials other than reinforced concrete (p = 0.044), dealing with stockbreeding (p = 0.046) and consuming fruits and vegetables without proper washing (p = 0.015) were significantly higher in the seropositive group. No statistically significant difference was detected for the other risk factors such as the number of household, presence of city water supply and sewage system in the house, location of the water closet outside house, lack of hand-washing habits, sharing utensils, consumption of raw vegetables, history of blood transfusion, surgery, dental intervention, jaundice, contact with a case of hepatitis, abortion/stillbirth and suspicious sexual contact. While the HEV seropositivity rate (2.4%) detected in Edirne was lower than the average of Turkey (6%), it was similar to the results reported from western part of the country. High rates of seropositivity among people with individual incompatibility to the hygiene rules denotes that personal hygiene is an important factor for prevention from HEV infection. High rate of seropositivity among people dealing with stockbreeding also suggests that there may be different ways of HEV transmission other than contaminated water in sporadic cases.

[Staphylococcus aureus hepatic abscess associated with cervical lymphadenitis]. / Servikal lenfadenit esliginde gelisen Staphylococcus aureus'un etken oldugu karaciger apsesi.

Pyogenic liver abscesses usually develop secondary to biliary tract and intraabdominal infections and members of the Enterobacteriaceae family are usually implicated as the etiologic agents. In this report a case of hepatic abscess devoloped secondary to cervical lymphadenitis caused by Staphylococcus aureus, was presented. Twenty-one years old male patient was admitted to the hospital with complaints of fever, swelling and pain at the right side of the neck and difficulty in swallowing. Physical examination revealed painful submandibular lymphadenopathy with hyperemia. Upon demonstration of cystic lymphadenopathy by magnetic resonance imaging of the neck, the mass was aspirated. Gram-positive cocci with abundant leucocytes were detected in Gram stained smears of the aspiration material and methicillin-susceptible S. aureus (MSSA) was identified in the culture. Treatment with ampicillin/sulbactam (4 x 1.5 g/day) was initiated. However, since patient still had fever and abdominal pain, nausea and vomitting were also added to his complaints, abdominal ultrasonography and computerized tomography (CT) were done and abscesses were demonstrated in liver. The abscesses were drained under CT guidance and the fever of the patient resolved. Treatment with ampicillin/sulbactam was continued for 6 weeks. Although it was considered that the hematogenous spread of MSSA that led to cervical lymphadenitis caused the hepatic abscesses, the agent was neither isolated from the blood culture nor from the hepatic abscess material. It should always be taken into consideration that liver abscesses might accompany distant infections and antibiotic therapy alone might not be sufficient for the complete resolution of such infections.

Community-based seroepidemiology of diphtheria and tetanus in Edirne, Turkey.

The aim of this study was to evaluate the seroprevalence and correlates of diphtheria and tetanus in Edirne, Turkey. Tetanus and diphtheria antitoxin levels were determined by enzyme-linked immunosorbent assay. Among 99 participants, a diphtheria antitoxin level of >or=0.1 IU/mL was found in 97 (98%), while 2 (2%) had antitoxin levels of 0.011-0.099 IU/mL. The geometric mean titres (GMTs) in men were statistically higher. Among 295 participants, a tetanus antitoxin level of >or=0.1 IU/mL was found in 291 (98.6%), while 4 (1.4%) had antitoxin levels of 0.011-0.099 IU/mL. Participants who had completed secondary school or higher education showed higher GMT values. Additionally, participants vaccinated within the previous 5 years had higher GMT values and the percentage of participants who had completed secondary school or higher education was higher among them. GMTs decrease with increasing age and increase as the poverty index increases. The average socioeconomic status index of the participants was high for both diphtheria and tetanus seroepidemiology. In this community-based study, antitoxin levels of diphtheria and tetanus were high. However, revaccination of adults with tetanus-diphtheria toxoids at every opportunity (military service, pregnancy, post-injury prophylaxis, etc.) together with a single booster every 10 years should be considered as an immunization policy.

Acute onset myositis associated with brucellosis, quite a rare diagnosis.

Brucellosis is a zoonosis that is transmissible to humans. It is a disease with multi-systemic involvement caused by the genus Brucella. Neurological complications, including meningitis, meningo-encephalitis, myelitis-radiculoneuritis, brain abscess, epidural abscess and meningo-vascular syndromes, are rarely encountered. We present a patient presenting with acute onset myositis. This kind of presentation has not previously been reported in the English language literature. We conclude that the diagnosis of neuro-brucellosis should be considered in patients presenting with muscle weakness.

[Retrospective evaluation of the cases prediagnosed as viral encephalitis in Trace University Hospital between the period of 2000-2005]. / Trakya üniversitesi tip fakültesi hastanesinde 2000-2005 yillari arasinda viral ensefalit ön tanili olgularin retrospektif degerlendirilmesi.

In this study, a total of 17 adult patients ((> or =18 years old; 12 male, 5 female) with encephalitis followed up in neurology and infectious diseases clinics of Trace University Hospital between the years 2000-2005 were retrospectively analyzed. The most common signs and symptoms were confusion (n: 13; 76.4%), nausea and vomiting (n: 13; 76.4%), disorientation (n: 12; 70%), fever and headache (n: 11; 64.7%), amnesia (n: 10; 58.8%), convulsions (n: 9; 52.9%), agitation (n: 7; 41%), dysphasia and aphasia (n: 6; 35.2%), nuchal stiffness (n: 5; 29.4) and focal neurological signs (n: 1; 5.8%). Six of the patients were admitted to the hospital during summer, six during winter, four during spring and one during autumn. Eleven (64.7%) of the patients had electroencephalographic signs compatible with encephalitis. Encephalitis related signs were detected in 83.3% (10/12) of the patients by cranial magnetic resonance imaging and in 58.3% (7/12) by computerized tomography. Cerebrospinal fluid (CSF) examination revealed low glucose levels in 17.6% (3/17), high protein levels in 47% (8/17) and increased white blood cells with a predominance of lymphocytes in 41.2% (7/17) of the cases. CSF findings were within normal limits in 23.5% (4/17) of the patients. Empirical acyclovir treatment was given to all patients. One patient died at the acute phase of the infection while all the other 16 recovered. Since none of the CSF samples yielded bacterial growth, all of the patients were diagnosed as viral encephalitis. However, no investigation was performed to identify the viral etiology and this was the major limitation owing to the inadequacy of laboratory facilities during the study period and/or unawareness of the physicians about viral identification methods.

[Short communication: Evaluation of the flu vaccine administered to health care workers in Trakya University Hospital in 2006]. / Kisa bildiri: Trakya Universitesi Hastanesi saglik Calisanlarina 2006 yilinda uygulanan grip asisinin degerlendirilmesi.

After the detection of human cases of highly pathogenic avian influenza A (H5N1) virus in Eastern Turkey in January 2006, Turkish Ministry of Health has had declared "National Plans of Activity for Pandemic Influenza". All health-care facilities were recommended to develop contingency plans. Then the essential activities were started in August 2006 in Trakya University, Faculty of Medicine (Edirne, Trace region of Turkey), and institutional education about pandemic influenza and preventive measures was implemented to health care workers (HCWs). In November 2006, health care workers were offered inactivated flu vaccine (Vaxigrip, Sanofi Pasteur, France) supplied by the Ministry of Health. The aim of this questionary survey was to evaluate the visions and conceptions of health care workers about influenza vaccination during the vaccination campaign. All the participants were informed by using an information form including the indications, contraindications and possible adverse reactions of flu vaccine, and were requested to complete the questionnaire about influenza vaccination according to their own perception before vaccination. Vaccine recipients were also invited to the vaccination unit if they had any adverse reaction. A total of 1041 HCWs (560 female, 481 male; mean age: 32.8 +/- 8.2 years) completed the questionnaire. Of them 884 subjects (85%) have accepted to be vaccinated, while 157 subjects (15%) have not. It was determined that 72 HCWs (6.9%) had been administered flu vaccine in 2005, and 38 (3.7%) have had an underlying chronic disease requiring medical therapy. Six subjects (16%) with an underlying chronic disease were vaccinated in 2005, while 66 HCWs (6.6%) without any chronic disease received vaccination voluntarily. Seven workers (0.7%) declined vaccination as they defined hypersensitivity to egg, and 84 workers (8%) had influenza vaccine voluntarily before the campaign in 2006. Sixty six workers (6.3%) have refused to be vaccinated as they considered influenza vaccination ineffective to protect against flu. Two workers (0.2%) had allergic skin reactions such as erythema and itching after vaccination. It can be concluded that influenza vaccination of the health care workers is a part of infection control policies and it is also a matter of patient safety. The implementation of necessary education programmes and attempts to emphasize the importance of vaccination of health care workers especially dealing with high risk patients, would be of crucial importance to decrease the morbidity and mortality due to influenza infections.

Response to interferon-alpha in chronic hepatitis B patients with and without precore mutant strain and effects on HBsAg titers.

BACKGROUND: Chronic hepatitis B (CHB) affects 400 million people worldwide and is a major cause of morbidity and mortality. It is known that HBV DNA sequences were detected after the clearance of serum hepatitis B surface antigen (HBsAg) often in serum, liver and peripheral blood mononuclear cells. The objectives of our study were to evaluate the previous measurements of HBsAg titers versus. quantitative hepatitis B virus (HBV) DNA and ALT measurements in order to predict the nonresponse and response in interferon-alpha (IFN-alpha)-treated HBeAg-positive and HBeAg-negative chronic HBV patients. METHODS: We investigate whether the presence of precore mutant affects the response to IFN-alpha therapy and on the titer of HBsAg or not. Twenty-one HBeAg-positive (group 1), 38 HBeAg-negative (group 2), and 47 healthy inactive carriers (group 3) made up this study. Liver biopsy showed chronic hepatitis, there was no cirrhosis and none of the patients had IFN-alpha therapy before. RESULTS: The decrease in HBsAg titers was found as statistically not significant in groups 1 (p = 0.192) and 3 (p = 0.236) and statistically significant in group 2 (p = 0.0001) within a 6-month interval. CONCLUSION: HBsAg titer may be a factor to predict the primary responders and nonresponders specially in HBeAg-negative patients.

[Dermatophyte species isolated from patients prediagnosed as onychomycosis and the value of fungal culture]. / Onikomikoz ön tanili olgulardan izole edilen dermatofit türleri ve mantar kültürünün tanisal degeri.

In this study, the clinical specimens taken from 390 patients who were prediagnosed as onychomycosis have been investigated by direct microscopy and culture methods, in the Mycology Unit of Central Laboratory of Kocaeli University Medical Faculty. Twenty-one (41.2%) of the 51 microscopically positive samples revealed positive cultures for dermatophytes, whereas 32 (9.4%) samples were culture positive among the 399 samples which were microscopically negative. The most frequently isolated dermatophyte was found to be Trichophyton rubrum (73.6%), followed by Trichophyton mentagrophytes (24.5%) and Microsporum canis (1.9%).