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1.
Microb Drug Resist ; 2021 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-34348037

RESUMO

Citrobacter freundii has acquired resistance to several antimicrobial drugs, including last-resort antibiotics affecting, therefore, clinical efficacy and causing high rates of mortality. In this study, we investigate the whole genome sequence of a carbapenem-resistant C. freundii strain isolated from the hospital environment in Tunisia. A total of 210 samples were taken using sterile swabs, from inanimate surfaces, medical devices, and care staff, during the period extended between March and April 2019. After the microbiological analysis of samples and antimicrobial susceptibility testing, only one strain identified as C. freundii showing resistance to carbapenems was selected for the whole genome sequencing. The genome analysis revealed a high-level resistance to most antibiotics. Interestingly, we have noted the coexistence of blaNDM-1 and blaVIM-48 metallo-ß-lactamase (MBL) encoding genes conferring resistance to carbapenems. Other ß-lactamases encoding genes have also been detected, including blaTEM-1, blaCMY-48, and blaOXA-1. Moreover, genes conferring resistance to aminoglycoside [aac(3)-IId, ant(3″)-Ia, aadA, aac(6')-Ib], macrolide [mph(A)], sulfonamide (sul1), trimethoprim (dfrA1), tetracycline [tet(D)], chloramphenicol [cat(B3)], rifamycin (arr-3), and quinolone (qnrB) have been revealed. The multi-locus sequence typing analysis showed that this isolate could not be assigned to an existing sequence type (ST), but it is almost identical to ST22. The plasmid investigation revealed the presence of five plasmids belonging to diverse incompatibility groups (IncFII, IncHI1A, IncHI1B, IncN, and IncX3). To the best of our knowledge, our findings report the first detection of NDM-1 and VIM-48 coproducing C. freundii in Tunisia and the second detection in the world of the blaVIM-48.

2.
Mikrobiyol Bul ; 55(3): 342-356, 2021 Jul.
Artigo em Turco | MEDLINE | ID: mdl-34416801

RESUMO

Limited data exists to date on the predictors for the development of pneumonia in patients with mild and moderate coronavirus (COVID-19). In this study, it was aimed to evaluate the demographic characteristics and clinical findings of mild and moderate COVID-19 and to determine the risk factors for the development of COVID-19 pneumonia in patients admitted to the pandemic outpatient clinic of a university hospital. A total of 414 patients with laboratory confirmed COVID-19 were included. Of these, 220 (53.1%) were male, the mean age was 38.3 ± 12.7. Median duration of hospital admission from the onset of symptoms was three days (0-11). Of the confirmed COVID-19 cases, 154 (37.2%) had a history of family contact and the most common symptoms were weakness (68.4%), myalgia (61.8%), headache (56.5%), loss of smell (45.2%), loss of taste (43.2%) and anorexia (42.8%). Among females, weakness (p= 0.016), headache (p= 0.008), sore throat (p= 0.032), nausea (p= 0.003), anorexia (p= 0.045), loss of taste (p= 0.005) and loss of smell (p<0.001) were more common. Loss of taste (47.6% vs. 25%, p<0.001) and loss of smell (50% vs. 26.3%, p<0.001) were more common in patients with under the age of 50 and cough (43.4% vs. 29.3%, p= 0.003) was more common in patients with above the age of 40. Among 46 (11.1%) patients with asymptomatic COVID-19, there was no significant difference (p= 0.500) between the genders. Pneumonia was detected in 150 (43.8%) of 339 patients who underwent thorax computed tomography. In the univariate analysis; advanced age (p<0.001, odds ratio (OR)= 1.44), obesity (p<0.001 OR= 2.5), not being actively smoking (p<0.001, OR= 6.19), fever at first admission (p= 0.002, OR= 2.02), cough (p<0.001, OR= 3.26), shortness of breath (p<0.001, OR= 23.37), weakness (p= 0.042, OR= 1.63), anorexia (p= 0.009, OR= 1.79) and elevation of D-dimer (p= 0.014, OR= 1.92) were associated with the development of pneumonia. In multivariate analysis, obesity (p= 0.005, OR= 2.69), not being actively smoking (p<0.001, OR= 5.43), cough at first admission p= 0.017, OR= 2.16) and shortness of breath (p= 0.008, OR= 16.22) was determined as an independent risk factor for the development of pneumonia. CRP (p<0.001), D-dimer (p<0.001), ferritin (p<0.001) values among 108 (26.1%) patients with a body-mass index(BMI) >30 were high, and 60.9% of the patients had pneumonia (p<0.001) . CRP (p<0.001), D-dimer (p= 0.010) values were low, lymphocyte count (p= 0.001) was high among 106 (25.6%) active smokers, and 15.6% of the patients had pneumonia (p<0.001). Of the patients reported with persistent symptoms, 25.9% had loss of smell, 25% had weakness, and 23.1% had loss of taste on the seventh day; 21.1% had loss of smell, 21.1% had myalgia, and 19.7% had loss of taste on the 14th day. During their follow-up, the COVID-19 polymerase chain reaction (PCR) test was studied in 286 patients for control purposes. The median time of being negative for COVID-19 PCR test was eight days (3-56). In conclusion, symptoms may last longer than 14 days in 20- 30% of patients presenting with mild-moderate clinical findings. In addition, obesity should be considered as an important risk factor for COVID-19 pneumonia.


Assuntos
COVID-19 , Pneumonia , Adulto , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/epidemiologia , Pneumonia/etiologia , Fatores de Risco , SARS-CoV-2
3.
Rheumatol Int ; 41(8): 1429-1440, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34109466

RESUMO

OBJECTIVE: To assess antibody response to inactivated COVID-19 vaccine in patients with immune-mediated diseases (IMD) among hospital workers and people aged 65 and older. METHODS: In this cross-sectional study, we studied 82 hospital workers with IMD (mean age: 42.2 ± 10.0 years) and 300 (mean age: 41.7 ± 9.9 years) controls. Among + 65 aged population, we studied 22 (mean age: 71.4 ± 4.5 years) patients and 47 controls (mean age: 70.9 ± 4.8 years). All study subjects had a negative history for COVID-19. Sera were obtained after at least 21 days following the second vaccination. Anti-spike IgG antibody titers were measured quantitatively using a commercially available immunoassay method. RESULTS: Patients with IMD were significantly less likely to have detectable antibodies than healthy controls both among the hospital workers (92.7% vs 99.7%, p < 0.001) and elderly population (77.3% vs 97.9%, p = 0.011). Among patients with IMD, those using immunosuppressive or immune-modulating drugs (64/75, 85.3%) were significantly less likely to have detectable antibodies compared to those off treatment (29/29, 100%) (p = 0.029). Additionally, a negative association between age and the antibody titer categories among patients (r = - 0.352; p < 0.001) and controls (r = - 0.258; p < 0.001) were demonstrated. CONCLUSIONS: Among hospital workers, the vast majority of patients with IMD and immunocompetent controls developed a significant humoral response following the administration of the second dose of inactivated COVID-19 vaccine. This was also true for the elderly population, albeit with lower antibody titers. Immunosuppressive use, particularly rituximab significantly reduced antibody titers. Antibody titers were significantly lower among those aged ≥ 60 years both in patient and control populations. Whether these individuals should get a booster dose warrants further studies.


Assuntos
Anticorpos Antivirais/sangue , Vacinas contra COVID-19/administração & dosagem , Doenças do Sistema Imunitário/imunologia , Imunidade Humoral , Imunogenicidade da Vacina , Imunoglobulina G/sangue , Vacinação em Massa , Recursos Humanos em Hospital , Adulto , Fatores Etários , Idoso , Biomarcadores/sangue , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Doenças do Sistema Imunitário/sangue , Doenças do Sistema Imunitário/diagnóstico , Esquemas de Imunização , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Turquia , Vacinas de Produtos Inativados/administração & dosagem , Adulto Jovem
4.
Mikrobiyol Bul ; 55(2): 207-222, 2021 Apr.
Artigo em Turco | MEDLINE | ID: mdl-33882652

RESUMO

Following the emergence of severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) and using only PCR for diagnosis, antibody tests have been rapidly developed by various commercial companies. There are differences between the sensitivity and specificity of these tests due to the usage of different viral target proteins and antibody subclasses. In order to evaluate the diagnostic use of these tests, we aimed to examine the diagnostic performance, especially sensitivity and specificity, of SARS-CoV-2 IgM, IgA and IgG tests of various companies (Abbott, Roche, Euroimmun, Dia.Pro, Anshlabs, Vircell, UnScience and RedCell), which have different principles (ECLIA/CLIA, EIA, LFA). Current (n= 180) and past (n= 180) COVID-19 patients with clinical and molecular diagnosis of COVID-19 admitted to Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine Hospital, Pandemic Polyclinic with suspected COVID-19 infection, were included in our study. The patients admitted within the first 3 weeks after the onset of symptoms were included in the current patient group, and those admitted at the third and after the third week were included in the past patient group. Serum samples (n= 180) obtained from Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Blood Center between April and June 2018 before the COVID-19 pandemic were included in the study as a control group. All the tests included in our study were studied with the recommendations of the manufacturer companies. Between the IgG detection tests with different principles in patients with past COVID-19, the sensitivity and specificity values of the most effective tests were; 86.7%/99.4% (Abbott), 86.1%/98.9% (Dia.Pro), 91.3%/95% (RedCell). Between the IgM detection tests with different principles in current COVID-19 patients, the sensitivity and specificity values were; 67.8%/99.4% (Abbott), 68.9%/98.6% (Vircell), 50%/97.5% (RedCell). Abbott IgM with a kappa coefficient of 0.67 and Vircell IgM + IgA test with a kappa coefficient of 0.65 showed the best fit in patients with current COVID-19 infection. In patients with past COVID-19, Abbott IgG with 0.86 kappa coefficient and Dia.Pro IgG test with 0.85 kappa coefficient showed the best match. Due to the low sensitivity of IgM detection antibody tests, they should not be preferred instead of real-time reverse transcriptase polymerase chain reaction in routine diagnosis. IgG detection tests may be preferred to detect the antibody response and the titers in people who have had COVID-19 for population seroprevalence and especially therapeutic immune plasma production. However, it is thought that the combined use of both ECLIA/CLIA-based and EIA/ELISA-based tests together may be more effective in routine use for SARS-CoV-2 IgG tests.


Assuntos
COVID-19 , Infecções por Coronavirus , Anticorpos Antivirais , Humanos , Imunoglobulina M , Pandemias , SARS-CoV-2 , Sensibilidade e Especificidade , Estudos Soroepidemiológicos
5.
Indian J Med Microbiol ; 39(2): 228-230, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33785243

RESUMO

Candidaauris, draws attention as a new emerging antifungal resistant pathogen, leading to healthcare-associated infections and outbreaks. This is the first report of C. auris fungemia in a 81-year-old patient, confirmed by sequential analysis, from Turkey. Although the source of the isolate could not be identified, its spread in the hospital has been taken under control by effective infection control measures.

6.
Turk J Med Sci ; 51(2): 454-463, 2021 04 30.
Artigo em Inglês | MEDLINE | ID: mdl-33315348

RESUMO

Background/aim: We aimed to investigate the factors affecting the mortality of patients aged 65 years or older who were hospitalized with the diagnosis of new coronavirus pneumonia (COVID-19). Materials and methods: This is a retrospective study of patients 65 years old or older with COVID-19 who were hospitalized in Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty Hospital, between March 11 and May 28, 2020. Demographic, clinical, treatment, and laboratory data were extracted from electronic medical records. We used univariate and multivariate logistic regression methods to explore the risk factors for in-hospital death. Results: A total of 218 patients (112 men, 106 women) were included, of whom 166 were discharged and 52 died in hospital. With univariate analysis, various clinical features and laboratory variables were found to be significantly different (i.e. P < 0.05). In multivariate logistic regression analysis the following were independently associated with mortality: present malignancy [odds ratio (OR) = 4.817, 95% confidence interval (CI) = 1.107­20.958, P: 0.036]; dyspnea (OR = 4.652, 95% CI = 1.473­14.688, P: 0.009); neutrophil/lymphocyte ratio (NLR; OR = 1.097, 95% CI = 1.012­1.188, P: 0.025); the highest values of C-reactive protein (CRP; OR = 1.006, 95% CI = 1.000­1.012, P: 0.049), lactate dehydrogenase (LDH; OR = 1.002, 95% CI = 1.001­1.004, P: 0.003), and creatinine levels (OR = 1.497, 95% CI = 1.126­1.990, P: 0.006); oxygen saturation (SpO2) values on admission (OR = 0.897, 95% CI = 0.811­0.993, P: 0.036); and azithromycin use (OR = 0.239, 95% CI = 0.065­0.874, P: 0.031). Conclusion: The presence of malignancy; symptoms of dyspnea; high NLR; highest CRP, LDH, and creatinine levels; and low SpO2 on admission predicted mortality. On the other hand, azithromycin use was found to be protective against mortality. Knowing the causes predicting mortality will be important to treat future cases more successfully.


Assuntos
COVID-19/mortalidade , Neoplasias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Proteína C-Reativa/metabolismo , COVID-19/epidemiologia , COVID-19/metabolismo , COVID-19/fisiopatologia , Comorbidade , Doença da Artéria Coronariana/epidemiologia , Creatinina/metabolismo , Diabetes Mellitus Tipo 2/epidemiologia , Dispneia/fisiopatologia , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Hipertensão/epidemiologia , Hipóxia/fisiopatologia , L-Lactato Desidrogenase/metabolismo , Contagem de Leucócitos , Contagem de Linfócitos , Masculino , Neutrófilos , Prognóstico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Fatores de Risco , SARS-CoV-2 , Índice de Gravidade de Doença , Turquia/epidemiologia
7.
Mikrobiyol Bul ; 54(4): 619-628, 2020 Oct.
Artigo em Turco | MEDLINE | ID: mdl-33107291

RESUMO

CMV is a virus that is asymptomatic in healthy individuals but can cause serious mortality and morbidity in transplant patients and patients with acquired immunodeficiency syndrome (AIDS). Ganciclovir (GCV) is a nucleoside analog that significantly reduces morbidity and mortality in CMV-related infections and is used as the first choice in treatment. It is the first drug shown to be effective in the treatment of CMV disease in humans, and is also homologous to acyclovir. Long-term antiviral therapy is required to prevent or treat CMV disease, but this can cause antiviral resistance which was reported to be 8-14% in CMV. In CMV strains, GCV resistance is most common in the UL97 kinase gene region. The aim of this study was to investigate GCV resistance in CMV strains obtained from the patients with immune deficiency. A total of 49 patients, including 20 children, 29 adults, who were followed in the department of hematology were included in the study. Fifty-three samples from 49 patients with CMV DNA viral load ≥ 103 copies/ml were examined for GCV resistance. In the study, DNA sequences were determined by Sanger sequence analysis method 3500 Abi Prism Genetic Analyser (Applied Biosystems, Thermo Fisher Scientific, USA) in the 674 bp part of the UL97 gene region. The next generation sequencing (NGS) method was applied to the samples that could not be evaluated with this method. GCV resistance was not detected in 35 (66%) of 53 samples with the Sanger method. C592G, C607S and M460I GCV resistance mutation was detected in three patients. Since the sequences were mixed, resistance analysis could not be evaluated with Sanger in 15 patient samples and the resistance was not detected in these samples studied with NGS. Antiviral resistance mutation was detected in three of 49 patients (6.1%). In 20 patients included in the study, three variant sequences (A442G, C592F, A427V) reported in the literature and determined to be sensitive to drugs by phenotypic tests and 78 variant sequences that were not reported in the literature were detected. As a result, the detection of antiviral resistance is important in the follow-up of the patients and guides the clinician in planning of the treatment. It was concluded that the samples that could not be evaluated with the Sanger method should be studied with NGS and further studies are needed to determine the role of the variant sequences detected for the first time in drug resistance.


Assuntos
Infecções por Citomegalovirus , Adulto , Antivirais/farmacologia , Antivirais/uso terapêutico , Criança , Citomegalovirus/genética , Infecções por Citomegalovirus/tratamento farmacológico , Farmacorresistência Viral/genética , Ganciclovir/farmacologia , Ganciclovir/uso terapêutico , Humanos , Hospedeiro Imunocomprometido , Mutação
8.
PLoS One ; 15(9): e0238680, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881976

RESUMO

BACKGROUND: Recent data have suggested the presence of a reciprocal relationship between COVID-19 and kidney function. To date, most studies have focused on the effect of COVID-19 on kidney function, whereas data regarding kidney function on the COVID-19 prognosis is scarce. Therefore, in this study, we aimed to investigate the association between eGFR on admission and the mortality rate of COVID-19. METHODS: We recruited 336 adult consecutive patients (male: 57.1%, mean age: 55.0±16.0 years) that were hospitalized with the diagnosis of COVID-19 in a tertiary care university hospital. Data were collected from the electronic health records of the hospital. On admission, eGFR was calculated using the CKD-EPI formula. Acute kidney injury was defined according to the KDIGO criteria. Binary logistic regression and Cox regression analyses were used to assess the relationship between eGFR on admission and in-hospital mortality of COVID-19. RESULTS: Baseline eGFR was under 60 mL/min/1.73m2 in 61 patients (18.2%). Acute kidney injury occurred in 29.2% of the patients. In-hospital mortality rate was calculated as 12.8%. Age-adjusted and multivariate logistic regression analysis (p: 0.005, odds ratio: 0.974, CI: 0.956-0.992) showed that baseline eGFR was independently associated with mortality. Additionally, age-adjusted Cox regression analysis revealed a higher mortality rate in patients with an eGFR under 60 mL/min/1.73m2. CONCLUSIONS: On admission eGFR seems to be a prognostic marker for mortality in patients with COVID-19. We recommend that eGFR be measured in all patients on admission and used as an additional tool for risk stratification. Close follow-up should be warranted in patients with a reduced eGFR.


Assuntos
Injúria Renal Aguda/epidemiologia , Infecções por Coronavirus/mortalidade , Mortalidade Hospitalar , Pneumonia Viral/mortalidade , Injúria Renal Aguda/diagnóstico , Adulto , Idoso , COVID-19 , Comorbidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Prognóstico
9.
Lupus ; 29(10): 1263-1269, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32646294

RESUMO

OBJECTIVES: Clinical and laboratory investigations have revealed that Epstein-Barr virus (EBV) is involved in altered immunological response of systemic lupus erythematosus (SLE). Higher seroprevalence rates of anti-EBV antibodies and increased viral load are demonstrated in adult SLE patients. The prevalence of BK polyomavirus (BKV) reactivation is also suggested to be higher in SLE. Herein, we aimed to evaluate the immune response of children with SLE to EBV antigens in addition to EBV and BKV DNA. We also tried to evaluate whether these serological results differ from another connective tissue disease - juvenile systemic sclerosis (jSS) - and healthy individuals. METHODS: Serum levels of EBV early antigen diffuse (EA-D) IgG, EBV nuclear antigen-1 IgG, EBV viral capsid antigen (VCA), cytomegalovirus (CMV) IgG, EBV DNA, CMV DNA and urinary BKV DNA were evaluated in healthy controls and in patients with a diagnosis of juvenile SLE (jSLE) and jSS. RESULTS: A total of 70 jSLE patients, 14 jSS patients and 44 sex-matched healthy individuals were involved in the study. EBV VCA was positive in 84.2% of jSLE patients, 85.7% of jSS patients and 36.3% of healthy controls. EBV EA-D IgG positivity was significantly higher in jSLE patients compared to jSS patients and healthy controls (20% vs. 7.1% and 0%, p = 0.005). EBV VCA positivity was associated with malar rash and immunological disorder, but there was no statistical significance in other antibody positivity in terms of clinical and haemogram findings and autoantibody positivity. CMV DNA positivity was present in only 2.8% of jSLE patients. None of the jSS patients or the healthy controls had CMV DNA positivity. EBV DNA and BKV DNA were also negative in all three groups. CONCLUSION: The results of our study assume a relationship between SLE and EBV, but we could not demonstrate an association between CMV and BKV. The negative DNA results in contrast to serological positivity can be interpreted as an altered and impaired immune system and increased viral susceptibility. These results suggest that EBV contributes to disease continuity, even if it does not directly cause development.


Assuntos
Herpesvirus Humano 4/imunologia , Lúpus Eritematoso Sistêmico/virologia , Adolescente , Adulto , Anticorpos Antivirais/sangue , Antígenos Virais/sangue , Antígenos Virais/imunologia , Vírus BK/imunologia , Vírus BK/isolamento & purificação , Proteínas do Capsídeo/imunologia , Estudos de Casos e Controles , Criança , Citomegalovirus/imunologia , Citomegalovirus/isolamento & purificação , Progressão da Doença , Infecções por Vírus Epstein-Barr , Herpesvirus Humano 4/isolamento & purificação , Humanos , Lúpus Eritematoso Sistêmico/sangue , Esclerodermia Localizada/sangue , Esclerodermia Localizada/virologia , Escleroderma Sistêmico/sangue , Escleroderma Sistêmico/virologia , Carga Viral , Adulto Jovem
10.
Lab Med ; 51(6): 601-605, 2020 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-32383446

RESUMO

OBJECTIVE: The aim of this study was to investigate the prevalence of carbapenemase and CTX-M genes among 330 blood culture isolates of Enterobacterales with reduced susceptibility to at least 1 carbapenem, between 2010 and 2015. METHODS: BD Max CRE assay and in-house PCR were used to detect carbapenemase and CTX-M genes. RESULTS: At least 1 carbapenemase gene was detected among 113 (74.3%) of the 152 carbapenem resistant isolates. The OXA-48 (69.7%) was the most common carbapenemase followed by VIM, NDM and IMP, whereas no tested isolates were KPC-positive. Eighty-six isolates (56.6%) had CTX-M and 65 had both OXA-48 and CTX-M. Carbapenemase production in Enterobacterales was significantly increased in years (P < .05). CONCLUSION: Our study indicates that there is ongoing endemic circulation of the OXA-48 producing organism in our facility. It is noteworthy that more than half of the OXA-48 producing strains also produced CTX-M enzyme.

11.
Turk Arch Otorhinolaryngol ; 57(3): 117-121, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31620692

RESUMO

Objective: To investigate the prevalence of tonsillar human papillomavirus infection in Istanbul, the most populous city of Turkey. Methods: Tonsil specimens were obtained from 206 cadavers aged 18 to 89 years. Tonsillectomy was performed during routine autopsy for each subject in the 24 hours after death. After dissolution, tissues were processed with the polymerase chain reaction (PCR) method to identify HPV DNA. The data obtained from the DNA sequencer were processed in the database of GenBank®. Results: One hundred sixty-six (80.6%) male and 40 (19.4%) female cadavers were included in the study. One case demonstrated HPV-16, one had HPV-82, one had HPV-55 and one had HPV-13. All four cases were male. Prevalence of tonsillar HPV was 1.94% and of HPV 16 was 0.48%. Conclusion: The prevalence of tonsillar HPV infection was found 1.94% and of HPV 16 0.48% in our study.

12.
Diagn Microbiol Infect Dis ; 87(3): 291-294, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28012637

RESUMO

The aim of this study was to investigate the criteria used to distinguish coagulase-negative staphylococci (CoNS) bacteremia from contamination. We evaluated 162 adult patients with CoNS-positive blood cultures (BCs). Of the 162 patients, 35 (21.6%) had at least 2 positive BCs and 127 (78.4%) had a single positive BC. According to the Laboratory-Confirmed Bloodstream Infection (LCBI) criteria, 24 (14.8%) patients with the same species of CoNS had true bacteremia, and 138 (85.2%) patients had contaminants. Despite the detection of the same CoNS species, 9 of the 24 patients had different CoNS genotypes. Using clinical assessments, only 20 patients were diagnosed with true bacteremia, 8 of them had a single positive BC. We concluded that only using the LCBI criteria or clinical evaluations of a patient were not sufficient to distinguish CoNS bacteremia from contamination. Molecular identification should also be performed as a diagnostic laboratory parameter for CoNS bacteremia.


Assuntos
Bacteriemia/diagnóstico , Hemocultura , Coagulase/deficiência , Erros de Diagnóstico , Staphylococcus/classificação , Bacteriemia/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tipagem Molecular , Estudos Prospectivos , Infecções Estafilocócicas/diagnóstico , Staphylococcus/isolamento & purificação
13.
Travel Med Infect Dis ; 14(6): 572-576, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27890667

RESUMO

BACKGROUND: The aim of this study was to determine the presence of carbapenem resistance and carbapenemase production in Escherichia coli isolates from clinical samples in Turkey. METHODS: The prospective study included a total of 4.052 Escherichia coli isolates collected from patients admitted to a hospital from March 2011 to May 2012. We used ertapenem disc for screening carbapenemase production, and the confirmation was performed by using Etest. The resistance mechanisms and genetic relatedness of the carbapenem resistant strains were investigated by using PCR (polymerase chain reaction) and pulsed-field gel electrophoresis (PFGE), respectively. RESULTS: Among the 4.052 E. coli isolates, 24 (0.59%) were found to be carbapenem resistant. Of these, only 5 isolates were positive for OXA-48 and 2 isolates were positive for Klebsiella pneumoniae carbapenemase (KPC)-2. The KPC-2 producing E. coli strains (n = 2) were both isolated from the same patient. The blaKPC genes were confirmed using DNA sequence analysis. The genetic relationship between the 24 E. coli strains studied by PFGE revealed that the strains were genetically unrelated. CONCLUSIONS: This article confirms, to our knowledge for the first time, the detection of KPC-2-producing E. coli in Turkey, with OXA-48 being the most frequent carbapenemase in the study.


Assuntos
Antibacterianos/farmacologia , Proteínas de Bactérias/metabolismo , Carbapenêmicos/farmacologia , Infecções por Escherichia coli/microbiologia , Escherichia coli/efeitos dos fármacos , Escherichia coli/enzimologia , beta-Lactamases/metabolismo , Proteínas de Bactérias/genética , Farmacorresistência Bacteriana/genética , Eletroforese em Gel de Campo Pulsado , Escherichia coli/genética , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/epidemiologia , Proteínas de Escherichia coli/genética , Proteínas de Escherichia coli/metabolismo , Hospitalização , Humanos , Testes de Sensibilidade Microbiana , Estudos Prospectivos , Análise de Sequência de DNA , Turquia/epidemiologia , beta-Lactamases/genética
14.
Mikrobiyol Bul ; 50(2): 315-21, 2016 Apr.
Artigo em Turco | MEDLINE | ID: mdl-27175505

RESUMO

Aggregatibacter (Actinobacillus) actinomycetemcomitans, a small, gram-negative coccobacillus that grows slow and fastidious, is generally colonized in the oral cavity. It is a rarely seen bacterium because of the difficulty of isolation but it can be a causative agent for dental infections and infective endocarditis (IE) particularly in the persons having prosthetic heart valves. In this report, a possible IE case caused by A.actinomycetemcomitans in a patient with aortic valve replacement has been presented. A 36-year-old man has admitted to Trakya University Hospital, Health Center for Medical Research and Practice, with the complaints of chills, malaise, intermittent fever, severe arthralgia and weight loss (20 kg). During his follow-up period, the blood cultures that were obtained three week intervals yielded the identical gram-negative coccobacilli morphology. The patient was then diagnosed as possible IE on the basis of having one major (growth of the typical microorganisms that may cause IE in two different blood cultures) and two minor (presence of prosthetic valve and high fever) criterias. The isolate could not be identified with conventional methods, while it was identified as Francisella tularensis with VITEK 2 (bioMerieux, France) system. Hence this identification was not confirmed by real-time Taqman polymerase chain reaction, so MALDI-TOF mass spectrometry was used to identify this bacteria. In the first run of the study, the isolate was named as Shigella dysenteriae initially, however when it was retested the next day it was identified as A.actinomycetemcomitans. In order to enlighten these conflicting results, 16S and 23S ribosomal DNA sequence analysis was performed, and consequently the bacterium was identified as A.actinomycetemcomitans. Doxycycline (2 x 100 mg po, 20 days) and streptomycin (2 x 10 mg/kg im, 10 days) therapy were initiated, considering the initial suspicious identification (F.tularensis), and on the fifth day of therapy the blood culture was negative with the regression of patient's complaints. Therapy continued with the addition of rifampicin to doxycycline from the 21(st) day and the patient discharged with cure. As a result, the identification of an exceptional bacterium like A.actinomycetemcomitans may be difficult and time-consuming in certain laboratory facilities. So, the use of different identification methods in addition to classical methods are needed to overcome such a problem, especially for uncommon isolates and clinically discordant cases. This case was presented because A.actinomycetemcomitans is a rare etiological agent for IE patients and it could be a good example to draw attention to the problem when identifying the organism using automatized identification systems.


Assuntos
Aggregatibacter actinomycetemcomitans/isolamento & purificação , Endocardite Bacteriana/microbiologia , Infecções por Pasteurellaceae/microbiologia , Adulto , Aggregatibacter actinomycetemcomitans/genética , Antibacterianos/uso terapêutico , Bacteriemia/microbiologia , DNA Ribossômico/análise , Diagnóstico Diferencial , Doxiciclina/uso terapêutico , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Francisella tularensis/isolamento & purificação , Humanos , Masculino , Infecções por Pasteurellaceae/diagnóstico , Infecções por Pasteurellaceae/tratamento farmacológico , RNA Ribossômico 16S/genética , RNA Ribossômico 23S/genética , Análise de Sequência de DNA , Shigella dysenteriae/isolamento & purificação , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Estreptomicina/uso terapêutico
15.
Mikrobiyol Bul ; 50(4): 606-612, 2016 Oct.
Artigo em Turco | MEDLINE | ID: mdl-28124966

RESUMO

Human metapneumovirus (hMPV), formerly classified in Paramyxoviridae family is now moved into Pneumoviridae, which was described as a novel family. It causes upper and lower respiratory tract infections (LRTIs) usually in children younger than five years old. The recent epidemiological studies indicated that hMPV is the second most frequently detected virus in LRTIs of young children, following the respiratory syncytial virus (RSV). Bronchiolitis obliterans (BO) is a chronic obstructive lung disease characterized by fibrosis of the distal respiratory airways. It is usually a result of an inflammatory process triggered by a LRTI related to adenovirus, RSV, Mycoplasma pneumoniae, measles virus, Legionella pneumophila, influenza virus or Bordetella pertussis as a causative agent. In this report, a case of hMPV bronchiolitis complicated with BO has been reported to point out the complications and severity of the clinical progress belongs to this virus. A three-month-old female patient has admitted to our pediatric intensive care unit with the diagnosis of acute bronchiolitis and respiratory failure. She was born at term, weighing 2950 gram and had been hospitalized in newborn intensive care unit for 11 days with the diagnosis of transient tachypnea of the newborn and neonatal sepsis. On auscultation, there were bilateral crepitant rales, wheezing and prolonged expirium. Her oxygen saturation was 97-98% while respiratory support was given with a non-rebreathing reservoir mask. Complete blood count, procalcitonin and C-reactive protein levels were in normal ranges. The chest radiography yielded right middle lobe atalectasia, left paracardiac infiltration and bilateral air trapping. A nasopharyngeal swab sample was analyzed by a commercial multiplex real-time reverse transcriptase-polymerase chain reaction (Thermo Fisher Scientific®, USA) developed for the detection of 15 respiratory viruses. Her sample yielded positive result for only hMPV. On the 4th day of hospitalization, the patient was intubated because of respiratory failure and carbon dioxide retention. She was extubated on the 19th day but could not tolerate. In the thorax computed tomography (CT), bilateral hyperinflation, patchy infiltration, mosaic perfusion and atelectasis especially bilateral posterior areas were detected. Bronchoscopy was normal except mild bronchomalacia in right middle lobe bronchus. The patient was diagnosed as BO secondary to hMPV bronchiolitis, according to the clinical, virological, bronchoscopic and thorax CT results. On the 76th day of admission, she was discharged with respiratory support with home ventilation via a tracheostomy cannula and medical treatments of oral metilprednisolone, nebulized salbutamol and budesonide. In conclusion, hMPV should not be undervalued especially in infants with severe LRTI that can be complicated with BO.


Assuntos
Bronquiolite Obliterante/virologia , Bronquiolite Viral/complicações , Metapneumovirus/patogenicidade , Infecções por Paramyxoviridae/complicações , Insuficiência Respiratória/virologia , Feminino , Humanos , Lactente , Metapneumovirus/isolamento & purificação , Nasofaringe/virologia
16.
J Med Virol ; 88(7): 1152-8, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26680021

RESUMO

Crimean-Congo hemorrhagic fever (CCHF) is a viral infection. Circulating plasma cell-free DNA (pcf-DNA) is a novel marker indicating cellular damage. So far, the role of pcf-DNA did not investigate in CCHF patients. In the current study, pcf-DNA levels were investigated in CCHF patients with different clinical severity grades to explore the relationship between circulating pcf-DNA level, virus load, and disease severity. Seventy-two patients were categorized as mild, intermediate, and severe based on severity grading scores. The pcf-DNA level was obtained from all participants on admission and from the survivors on the day of the discharge. The controls consisted of 31 healthy. Although the pcf-DNA level at admission was higher in patients than in the controls, the difference was not statistically significant (P = 0.291). However, at admission and in the convalescent period, the difference between pcf-DNA levels in mild, intermediate, and severe patient groups was significant. The pcf-DNA level in severe patients was higher than in the others. Furthermore, compared to survivors, non-survivors had higher pcf-DNA levels at admission (P = 0.001). A direct relationship was found between the pcf-DNA level and the viral load on the day of discharge in surviving patients. ROC curve analysis identified a pcf-DNA level of 0.42 as the optimal cut-off for prediction of mortality. The positive predictive value, negative predictive value, specificity, and sensitivity for predicting mortality was 100%, 72%, 100%, and 79%, respectively. In summary, our findings revealed that pcf-DNA levels may be used as a biomarker in predicting CHHF prognosis.


Assuntos
DNA Viral/sangue , Vírus da Febre Hemorrágica da Crimeia-Congo/fisiologia , Febre Hemorrágica da Crimeia/mortalidade , Prognóstico , Carga Viral , Adulto , Idoso , Biomarcadores/sangue , Convalescença , Feminino , Vírus da Febre Hemorrágica da Crimeia-Congo/genética , Vírus da Febre Hemorrágica da Crimeia-Congo/isolamento & purificação , Febre Hemorrágica da Crimeia/diagnóstico , Febre Hemorrágica da Crimeia/epidemiologia , Febre Hemorrágica da Crimeia/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Reação em Cadeia da Polimerase em Tempo Real , Índice de Gravidade de Doença
17.
Clin Lab ; 60(5): 863-7, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24839833

RESUMO

BACKGROUND: In order to identify methicillin-resistant Staphylococcus aureus isolates quickly, automated and semiautomated systems, commercial media, and identification kits are widely used. The Phoenix system (BD, Sparks, MD, USA) has been available since 2004 in our laboratory. This study evaluated the reliability of the Phoenix system for the detection of methicillin resistance in Staphylococcus aureus isolates in comparison to BD GeneOhm MRSA assay (Becton Dickinson Diagnostics GeneOhm, CA, USA). METHODS: A total of 206 clinically significant Staphylococcus aureus isolates, submitted to the clinical microbiology laboratory between March 2011 and May 2013, were included in the study. Phoenix panels were studied for identification and susceptibility testing according to manufacturers' instructions. The detection of MRSA was performed using the BD GeneOhm MRSA assay (Becton Dickinson Diagnostics GeneOhm, CA, USA). The assay is a qualitative real-time PCR method. RESULTS: The Phoenix system results and mecA gene pozitivity were concordant for 134 methicillin-resistant and 71 methicillin-susceptible strains. One discordant isolate, identified as mecA negative by the PCR method, was methicillin-resistant Staphylococcus aureus positive by the Phoenix system (oxacilline MIC = 2 microg/mL; cefoxitin MIC = 8 microg/mL). In this study, Phoenix automated system's sensitivity, specificity, negative predictive value, and positive predictive value are found as 100%, 100%, 100%, and 100%, respectively. CONCLUSIONS: As a result of our study, use of the Phoenix automated identification method for the detection of methicillin-resistant Staphylococcus aureus isolates is a practical and reliable approach for daily clinical laboratory procedures.


Assuntos
Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Técnicas de Diagnóstico Molecular/instrumentação , Técnicas de Diagnóstico Molecular/métodos , Proteínas de Bactérias/genética , Humanos , Staphylococcus aureus Resistente à Meticilina/genética , Proteínas de Ligação às Penicilinas , Infecções Estafilocócicas/microbiologia
18.
BMC Pulm Med ; 14: 20, 2014 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-24524443

RESUMO

BACKGROUND: Endotoxins stimulate T helper 1 cell maturation and send a negative signal to T helper 2 polarisation. This causes a decrease IgE levels and prevents atopy (Hygiene hypothesis). It is shown that this response is under genetic control by polymorphisms in CD14 and TLR4 genes in some researchs. We aimed to investigate the effects of genetic variants of CD14 (-) and TLR4 (Asp299Gly, Thr399Ile) genes on asthma phenotypes in adults with asthma. METHODS: Asthma patients (n = 131) and healthy control cases (n = 75) were included in the study. Relations between CD14 C-159 T, TLR4 299 and TLR4 399 genotypes and duration of asthma history of allergic rhinitis-dermatitis, total IgE, eosinophil, skin prick test, forced expiratory volume 1 (FEV1) and severity of disease were evaluated. Real time PCR (RT-PCR) was used for genotyping. RESULTS: For CD14-159, presence of the C allele (CC + CT) was more frequent among those with low median log (logarithm) IgE levels, but no statistically significant difference in all asthma group (p = 0.09). C allele was significantly correlated with low total IgE levels and T allele with high total IgE levels in atopics (p = 0.04). CC + CT genotype was more frequent in moderate and severe asthma group in atopics (p = 0.049). TLR4 299 and TLR4 399 genotypes and asthma phenotypes were not found to be significantly correlated (p > 0.05). CONCLUSIONS: Total IgE levels were found to be low among patients with the CC + CT genotype, and high among patients with the TT genotype contrary to the results of many other studies, which is therefore an important finding. Another important finding was that the C allele is a risk factor for moderate and severe asthma.


Assuntos
Asma/genética , Receptores de Lipopolissacarídeos/genética , Polimorfismo Genético , Receptor 4 Toll-Like/genética , Adolescente , Adulto , Idoso , Asma/sangue , Feminino , Humanos , Imunoglobulina E/sangue , Masculino , Pessoa de Meia-Idade , Fenótipo , Turquia , Adulto Jovem
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