Evaluation of Our Rabies Prevention Practices: Is Our Approach Correct?

Background: Rabies disease is zoonotic disease-causing encephalitis and resulting in death. It is possible to prevent the disease with suitable prophylaxis approaches. This study examined the compliance of post-exposure prophylaxis approaches with the guidelines and the reasons for non-compliance in contact cases at risk of rabies. Methods: This retrospective cross-sectional study includes patients who continued the vaccination program from 2014-2018 at the Ordu University Medical Faculty Hospital Rabies Vaccination Center in Ordu, Turkey. Cases were assessed in terms of sociodemographic features, previous rabies vaccination history, features of the contact with rabies risk, attendance duration after contact, and whether all stages of prophylaxis were completed after contact. Results: Of the 748 cases attending the vaccination center, the age range was 1- 91 yr, with a mean age of 28.12 ± 21.60 yr. Of cases, 62.3% were male (n =466) and 37.7% were female (n =282). Of risky contact, 60% comprised stray animals. Of recorded cases, 55.2% displayed approaches compatible with guidelines. Among incompliant approaches, the most frequent was administering vaccines even though observation was sufficient. (n = 174, 52%). Conclusion: Contact with risk of rabies may result in insufficient administration of the stages in prophylaxis after contact, or contrarily, mistaken administration based on acting with a sense of excessive safety. Stray dogs or domestic animals without sufficient vaccinations comprise a significant risk despite all efforts. In order to prevent risky contact, there is a need for the development of correct strategies and to ensure continuity of in-service training for health professionals.

NS5A resistance - associated substitutions in chronic hepatitis C patients with direct acting antiviral treatment failure in Turkey.

OBJECTIVES: Chronic hepatitis C (CHC) is now a more curable disease with new direct acting antivirals (DAA). Although high sustained virologic response rates, failures still occur in DAA regimens. Our objective in this study was to characterize the real-life presence of clinically relevant resistance - associated substitutions (RASs) in the HCV NS5A gene in CHC patients whose DAA regimen has failed. METHODS: The study enrolled 53 CHC patients who experienced failure with DAA regimen as the prospective longitudinal cohort between 2017-2019. Genotypic resistance testing was performed via the viral population sequencing method and The Geno2pheno HCV tool was used for RAS analysis. RESULTS: The most frequent failure category was relapse (88%) followed by non-responder (12%). For a total of 36% of patients, RASs was detected in NS5A, Y93H was the most detected RAS in GT1b infected patients (89%). CONCLUSIONS: This study establishes an HCV failure registry for Turkey in which samples were combined with clinical, virologic and molecular data of adult patients whose DAA therapy failed. RASs can occur in CHC patients with DAA treatment failures. Evaluation of RAS after DAA failure is very important before re-treatment is initiated to prevent virologic failure.

High prevalence of NDM metallo-ß-lactamase among ESBL-producing Escherichia coli Isolates.

Resistance to ß-lactams in Enterobacteriaceae has been increasing worldwide. This study aimed to determine the frequency of ß-lactamase genes and antibiotic resistance rates of 140 extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli isolates obtained from urinary tract infection in Ordu Province, Turkey. Isolates were identified by classic methods and by automated system. ESBL production was confirmed by double disk synergy test and antimicrobial susceptibility was investigated by disk diffusion method. All isolates were screened for ß-lactamase coding genes from three groups (A, B, and D) by polymerase chain reaction. The highest rate of susceptible isolates was observed for imipenem (IPM, 99.3%) and ertapenem (ETP, 97.9%), and the highest rate of resistant isolates was observed for cefuroxime (97.9%), ceftriaxone (97.2%), and cefazolin (90.7%). In our study, blaCTX-M1-like group was the most prevalent ß-lactamase (n = 109), followed by blaTEM (n = 68), blaCTX-M2 (n = 22), and blaSHV (n = 2). By contrast to low resistance rate to IPM and ETP, we determined blaNDM in 31 isolates (22.1%). In co-prevalence of blaNDM-1 and ESBL-coding genes, a low carbapenem resistance was determined. We can confirm that blaCTX-M1-types are still the most frequent ß-lactamase coding gene in Turkey. Our study showed the highest prevalence of blaNDM-1 metallo-ß-lactamase coding gene in ESBL-producing E. coli.

The investigation of oxacillinase/metallo-beta-lactamase genes and clonal analysis in carbapenem-resistant Klebsiella pneumoniae.

Infections due to carbapenem-resistant Klebsiella pneumoniae represent a growing problem nationally. In our study, we aimed to examine carbapenem-resistant K. pneumoniae with multiple resistance isolated in the intensive care unit of our hospital. Isolates were investigated for the presence of oxacillinase and metallo-beta lactamase genes with a view to determining the clonal relationship between the strains intensely over a short period. Strain identification was completed with conventional methods and automated identification kit. OXA-58, OXA-23, OXA-51, OXA-24 and OXA-48 and metallo-beta lactamase genes IPM, VIM, SPM, SIM, GIM and NDM-1 were investigated with PCR. For clonal relationships of carbapenem-resistant strains, the PFGE experiment was performed. While all of these carbapenem-resistant strains were positive for OXA-48, the resistant genes NDM-1, VIM, KPC, IPM, SPM, GIM, SIM, OXA-23, OXA-24, OXA-58 and OXA-51 were not observed. When molecular typing results were investigated, PFGE determined clonal distribution of three pulsotypes. However, it was observed that the strains intensified in a single clone and this was assessed as the outbreak isolate. The results of this study showed the primary enzyme responsible for carbapenem resistance in K. pneumoniae strains in our hospital is still OXA-48. To prevent the spread of carbapenem-resistant K. pneumoniae isolates, with epidemic potential, national-level monitoring and effective infection control precautions should be enforced.

[The epidemiology of malaria in Ordu between 2002 and 2011]. / Ordu Ilinde 2002-2011 Yillari Arasinda Sitma Epidemiyolojisi.

OBJECTIVE: Malaria is still an important public health problem both in Turkey and worldwide. In this research, we examined the epidemiology of malaria using the data provided by the Malaria Control Unit of the Infectious Disease Division of Ordu Health Directory, from the years 2002 to 2011. METHODS: The retrospective study was performed on data from the Provincial Health Directory. The cases were evaluated according to age groups, gender, locations, months and parasite species. RESULTS: In the last 10 year period, a total of 31,575 blood samples were evaluated and 6 malaria cases (0.02%) were detected. Positive cases were examined all patients aged 15 years old and over. Cases were found to be imported cases coming to Ordu from other countries. The agent in half of cases was found to be Plasmodium vivax; Plasmodium falciparum was determined in the other half. All P. falciparum cases were found to be imported cases coming to Ordu from abroad. CONCLUSION: In this study, determination of the state of information on malaria in Ordu was the target, with the aim of using these data to contribute to the epidemiological data of malaria in our country. In addition, the protective measures to be taken against the disease are thought to be helpful.