The epidemiological and molecular characterization of vancomycin-resistant enterococci isolated from rectal swab samples of hospitalized patients in Turkey.

BACKGROUND: Vancomycin-resistant enterococci (VRE) are a serious problem all over the world. The present study was conducted to investigate antimicrobial resistance patterns, genotypes, clonal relationship, and virulence fac- tors of VRE species isolated from rectal swab samples of hospitalized patients, patient's relatives, and medical staff at Istanbul University Cerrahpasa Medical School hospital. METHODS: The VRE isolates were typed with an automated VITEK system and their antibiotic sensibilities were analysed by disc diffusion and Etest® method. The molecular characterization and clonal relationships were per- formed using a PCR method and virulence genes by sequence typing. RESULTS: A total of 100 (10.3%) of the 971 patients were colonized with VRE. None of the investigated 25 patient's relatives and 45 medical staff carried VRE. All VRE strains were identified as E. faecium. They were vanA genotype and originated from a single clone. VRE strains exhibited multi-drug resistance. High-level gentamicin-resistance was 93%. However, lower resistance rates were found for linezolid (40%) and quinopristin-dalfopristin (11%). The enterococcal surface protein gene esp was found positive in 87 of 100 isolates, and four strains were positive for the cylB (cytolysin) gene. CONCLUSIONS: The identification of VRE strains to the species level and detection of virulence genes will assist in infection control practices.

Fascioliasis: 3 cases with three different clinical presentations.

Fascioliasis, which is a zoonotic infestation caused by the trematode Fasciola hepatica (liver fluke), is primarily a disease of herbivorous animals such as sheep and cattle. Humans become accidental hosts through ingesting uncooked aquatic plants such as watercress. It presents a wide spectrum of clinical pictures ranging from fever, eosinophilia and vague gastrointestinal symptoms in the acute phase to cholangitis, cholecystitis, biliary obstruction, extrahepatic infestation, or asymptomatic eosinophilia in the chronic phase. However, it may often be overlooked, especially in the acute phase, because of vague symptoms. As a result of newly introduced serological assays facilitating the diagnosis, there has been an increase in the number of reported cases. Here, we report the clinical and laboratory assessment and therapeutic approach of a series of three cases diagnosed (in order of) one week, three months and one and a half years after presentation of the first symptoms of the disease.

[A retrospective evaluation of the prevalence of intestinal parasites in Istanbul, Turkey]. / Istanbul'da bagirsak parazitlerinin sikligi bakimindan retrospektif bir degerlendirme.

The aim of this study is to estimate the prevalence of intestinal parasites, in comparison to previous studies in Istanbul and different geographic regions of Turkey. Between January 1999-December 2009, a total of 27664 stool samples from patients with suspicious intestinal parasitic infections who were admitted to Istanbul University Cerrahpasa Medical School Hospital were examined for intestinal parasites by using native lugol and formalin-ethyl acetate concentration technique, in adition to the scotch cellophane tape that was adapted to 1423 children to investigate the Enterobius vermicularis infection. Intestinal parasites were found in 1114 (4%) out of 27664 stool samples examined. The prevalence of intestinal parasites is as follows: Blastocystis hominis in 2.1%, Giardia intestinalis in 1.4%, Taenia saginata in 0.2%, Entamoeba histolytica/dispar in 0.05% and Ascaris lumbricoides in 0.03%. Hymenolepis nana (6), Trichuris trichiura (3), Strongyloides stercoralis (2), Fasciola hepatica (1), Dicrocoelium dendriticum (1) and Isospora belli (1) were found in small numbers. Furthermore Entamoeba coli (119), Iodamoeba bütschlii (5), Trichomonas hominis (2), Chilomastix mesnili (1), parasites which exist as commensals in the intestines were also determined. Enterobius vermicularis was detected in 129 (9%) out of 1423 cellophane tape samples. This study showed that the intestinal parasites are still an important public health problem in Istanbul.

External ophthalmomyiasis caused by Oestrus ovis in Istanbul.

Ophthalmomyiasis externa is mainly caused by the sheep botfly Oestrus ovis; therefore, it is usually seen in rural areas. We report here a case of ophthalmomyiasis externa in a young man from Istanbul. The patient had no known history of exposure to farm animals or rural areas.

Otomyiasis by Wohlfahrtia magnifica.

Myiasis has been defined as the infestation of tissue with dipterous larvae that feed on the host's dead or living tissue. A new clinical report of otomyiasis in a 57-year-old woman caused by Wohlfahrtia magnifica was reported. A review of the English language literature reveals 5 articles on otomyiasis cases caused by W. magnifica. Although it is not a frequent manifestation in otorhinolaryngology, the opportunity of its occurrence always exists. In the treatment, a combination of suctioning and alligator forceps was used to remove larvae. Also, tympanoplasty was performed for the reconstruction of perforated ear.

Causative agents of superficial mycoses in Istanbul, Turkey: retrospective study.

The aim of the present study was to determine the percentage of agents, which can give rise to superficial fungal infections in Istanbul, Turkey. Between 2000 and 2007, the clinical samples collected from 8,200 patients attending the outpatient Dermatology Clinic at Mihrimahsultan Medical Center were examined by direct microscopy and culture. Pathogen fungi were detected in 5,722 of the patients. Of the isolates were 4,218 (74%) dermatophytes, 1,196 (21%) Candida sp., 170 (3%) Malassezia furfur, and 138 (2%) Trichosporon sp. Among the dermatophytes, Trichophyton sp. was the most common isolate followed by Epidermophyton floccosum (243) and Microsporum sp. Among the Candida species, C. albicans (549) was also frequently found. Onychomycosis was the most prevalent type of infection, followed by tinea pedis, tinea cruris, tinea corporis, and tinea capitis. In conclusion, our study showed that the most common isolated agents from superficial infections were T. rubrum being Candida sp. the second most prevalent.

Prevalence and antimicrobial resistance patterns of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae isolated from blood cultures in an Istanbul University Hospital.

Between January 2001 and September 2006, a total of 459 Escherichia coli and 226 Klebsiella pneumoniae strains were isolated from blood samples of patients with bacteremia who were hospitalized at the Istanbul University Cerrahpasa Medical Faculty. Blood cultures were analyzed with the Bactec 9120 system (Becton Dickinson, USA). Antimicrobic resistance of the E. coli or K. pneumoniae strains was determined by the disk diffusion method according to the Clinical and Laboratory Standards Institute criteria. Extended spectrum beta-lactamase (ESBL) production was examined with the double-disk synergy test. The percentage of ESBL was 40% (182/459) for E. coli and 49% (111/226) for K. pneumoniae. ESBL-producing E. coli and K. pneumoniae were highly resistant to trimethoprim/sulfamethoxazole (60 and 40.5%), amoxicillin/clavulanic acid (56.5 and 48.6%), ciprofloxacin (57.6 and 35%) and gentamicin (38 and 40.5%), respectively; however, lower resistance rates were found for amikacin (19.7 and 16%) and piperacillin/tazobactam (29.6 and 24%). None of the strains were resistant to imipenem. Our data indicated that prevalence of ESBL-producing E. coli and K. pneumoniae strains isolated from blood cultures is high and antimicrobial resistance increases. Considerable effort should be made to decrease the ESBL-positive organisms.

Abiotrophia defectiva: a rare cause of infective endocarditis.

A case of Abiotrophia defectiva-caused infective endocarditis is described. The patient was successfully treated with penicillin combined with gentamicin. Due to the fastidious nature of the agent, there is a need for special media for isolation and moreover, there is a need for a future development of susceptibility assays applicable to the organism.