[In-vitro Activity of Ceftolozane-Tazobactam in Combination with Various Antibiotics Against Multidrug-resistant Acinetobacter baumannii Isolated from Intensive Care Patients]. / Yogun Bakim Hastalarindan Izole Edilen Çoklu Antibiyotik Dirençli Acinetobacter baumannii Izolatlarinda Seftolozan-Tazobaktamin Çesitli Antibiyotik Kombinasyonlari ile In Vitro Etkinliginin Arastirilmasi.

Acinetobacter species lead to nosocomial infections in immunocompromised patients hospitalized in intensive care units or services. Acinetobacter baumannii is a bacterium that is difficult to treat because it is intrinsically resistant to many antibiotics and can develop resistance afterwards. This situation limits the use of existing antibiotics and directs the clinician to new agents, different treatment options and the use of various antibiotic combinations. The aim of this study was to determine the sensitivities of doripenem (DOR), tigecycline (TGC), minocycline (MIN), amikacin (AK) and a newly developed agent ceftolozane-tazobactam (CT) in multidrug resistant A.baumannii strains which were isolated from inpatients in intensive care units and to investigate the in vitro interactions of CT/DOR, CT/TGC, CT/MIN and CT/AK combinations by using antibiotic gradient test method. Thirty-five A.baumannii strains isolated from various clinical specimens (blood, urine, sputum, tracheal aspirate, wound, abscess and catheter) between January 2017 and July 2017 were included in the study. Strains isolated from inpatients in intensive care units and resistant to at least three antibiotic classes were selected. The identification of A.baumannii isolates and the determination of routine antibiotic susceptibility profile were performed according to EUCAST 2017 criteria by the use of BD Phoenix 100 (Becton Dickinson, USA) automated system. Minimum inhibitor concentration values of CT, DOR, TGC, MIN, AK and combinations of CT with four other antibiotics (CT/DOR, CT/TGC, CT/MIN and CT/AK) were determined by antibiotic gradient test method. Fractional inhibitor concentration index (FICI) was used to determine the interactions of the combinations in vitro. According to the data obtained; the FICI was evaluated as synergy if FICI ≤ 0.5, additive if 0.5 > FICI ≤ 1, indifferent (unidentified interaction) if 1

[The Microbiological Analysis of a Rhizobium radiobacter Outbreak After Intravitreal Injection]. / Intravitreal Enjeksiyon Sonrasi Ortaya Çikan Rhizobium radiobacter Salgininin Mikrobiyolojik Analizi.

Rhizobium radiobacter, which is found in nature and causes tumorigenic plant diseases can lead to opportunistic infections, especially in people with underlying diseases. In our study, endophthalmitis that observed in ten patients caused by R.radiobacter bacteria after intravitreal ranibizumab injection in Ophthalmology Clinic were examined microbiologically. Vitreous fluid samples of 13 patients who received intravitreal ranibizumab injection were sent to the Microbiology Laboratory from Van Yuzuncu Yil University Faculty of Medicine's Ophthalmology Clinic for microbiological examination in December 21, 2016. Samples were examined under microscope after staining with Gram and cultured with 5% sheep blood agar and Eosin Methylene Blue (EMB) agar. The culture plates were incubated for 18-24 hours at 37°C in 5% CO2. At the end of this period, catalase, oxidase, and urease tests were performed on the colonies. The identification and antibiotic susceptibility tests of microorganisms growing in vitreous fluid samples were performed using BD Phoenix (Becton Dickinson, USA), Vitek 2 Compact (BioMerieux, France), and Vitek MS (BioMerieux, France) systems. In addition, 16S rDNA sequence analysis was performed and the pulsed field gel electrophoresis (PFGE) method was used to determine the clonal relationship between the isolates. After growing in cultures (one day after the procedure), culture samples were collected from the objects, medical tools and equipment, hands of healthcare staff and a new injection solution in the area where the procedure was performed. R.radiobacter was isolated in 10 of the vitreous fluid samples of 13 patients, and no bacterial growth was detected in 3. The microorganisms were found to be gram-negative bacilli, non-fermenter, motile, catalase/oxidase/urease positive, in compliance with R.radiobacter. All isolates were identified as R.radiobacter by BD Phoenix (Becton Dickinson, USA), Vitek 2 Compact (BioMerieux, France), and Vitek MS (BioMerieux, France) (database v2.0) systems. R.radiobacter isolates were found to be resistant to ampicillin, amoxicillin/clavulanate, trimethoprim/ sulfamethoxazole, cefotaxime and ceftazidime; susceptible to cefuroxime, cefepime, amikacin, gentamicin, imipenem, meropenem, ciprofloxacin, levofloxacin and piperacillin/tazobactam. The isolates were identified as R.radiobacter by 16S rDNA sequence analysis. PFGE showed that all isolates had the same band profile. R.radiobacter isolates with the same band profile likely revealed that the contamination was from the same source. However, the growth of R.radiobacter was not detected in the cultures made from the objects, medical instruments and supplies, the hands of healthcare professionals and the new injection solution in the area where the procedure was performed, and the source of the agent could not be determined. The results have shown that intravitreal injection procedure carries a risk for R.radiobacter infection. Disinfection and antisepsis conditions, before and during the procedure, is important for the prevention of such infections. This study is the first epidemic outbreak report of endophthalmitis caused by the same strain of R.radiobacter and the second article in which R.radiobacter was reported as the cause of endophthalmitis after intravitreal injection.

HEV seroprevalence in blood donors in Turkey by two commercial total anti-HEV Ab ELISA kits.

Previous hepatitis E virus (HEV) seroprevalence studies in Turkey have shown high variabilities, leading to conflicting results. We aimed to re-evaluate HEV seroprevalence among blood donors in Turkey using the Wantai (Beijing, China) and the Dia.Pro (Milan, Italy) total anti-HEV antibody (Ab) enzyme-linked immunosorbent assay (ELISA) kits and compare their performances and to investigate the presence of HEV RNA in blood donors. Serum total anti-HEV antibodies were determined in a total of 2011 volunteer blood donor samples collected from different regions of Turkey (807 from Ankara, 243 from Kayseri, 284 from Izmir, 200 from Malatya, 200 from Kahramanmaras, and 277 from Van). HEV RNA was evaluated by a real-time polymerase chain reaction in a total of 272 anti-HEV seropositive samples. The country-wide HEV seroprevalence was calculated as 11.5% (Dia.Pro) and 12.2% (Wantai) with seropositivity rates of 12.0%-12.5% in Ankara, 7.4%-8.2% in Kayseri, 14.5%-15.5% in Malatya, 8.1%-8.8% in Izmir, 15.0%-16.0% in Kahramanmaras, and 12.6%-13.4% in Van by Dia.Pro and Wantai kits, respectively. The lowest detectable Ab concentrations were 0.16 and 0.14 units/mL WHO, for the Dia.Pro and the Wantai assays, respectively, showing no significant difference between assays. HEV RNA was not detected in any of the anti-HEV seropositive samples. Compared with previous studies, HEV was shown to have a higher overall seroprevalence in Turkey. Despite its limitation, the current study represents the most comprehensive HEV seroprevalence study in Turkey performed with two different commercial ELISA assays with high sensitivities so far. Further investigation is required to determine HEV genotypes in Turkey.

Determinants of high-risk human papillomavirus infection in anogenital warts.

INTRODUCTION: Genital warts are benign epithelial tumours caused by human papilloma viruses (HPV), and are sexually transmitted. Genotyping of genital HPV bears great clinical significance in terms of treatment planning, follow-up, and prevention strategies. AIM: To evaluate the distribution of high-risk HPV infection types in patients diagnosed with anogenital warts. MATERIAL AND METHODS: A total of 66 patients with anogenital warts were enrolled. Punch biopsy samples were obtained from the lesions of each patient. After nucleic acid purification and DNA extraction, the presence of HPV DNA was ascertained using the PCR method, followed by HPV DNA genotyping. The relationship between HPV type distribution and age, gender, clinical location, and number of sexual partners was investigated. RESULTS: Genotyping was performed and HPV genome was detected in 50 tissue samples (75.8%). Low-risk genotypes predominated with a prevalence of 62.1% (42/66). The most prevalent genotypes were HPV-6 (47%), and HPV-11 (13.6%). Other types detected included HPV-18 and HPV-3. CONCLUSIONS: Genotyping of HPV provides significant clinical information regarding this family of viruses that play a role in the aetiology of a variety of genital cancers, as some of these malignancies are now considered preventable due to recent development of vaccines. We believe that our results may provide guidance on future vaccination programs in our country.

Hepatitis C testing among adults born between 1945 and 1965 in Turkey: a multicentre study.

OBJECTIVE: Hepatitis C virus (HCV) infection is a major public health problem and affects large populations all over the world. Serum anti-HCV level is a valuable marker to determine HCV infection. Anti-HCV testing has been recommended for high-risk population. The Center for Disease Control (CDC) and Prevention in the United States proposed a new high-risk population group - adults born between 1945-1965. Under this perspective, we designed a multicentre retrospective study to determine the seropositivity of anti-HCV among adults born between 1945 and 1965 and adults born after 1965 in Turkey. With the data collected, we aimed to determine whether there was a need for anti-HCV testing especially in people born between 1945 and 1965. METHODS: We requested data from ten different medical centres in ten different provinces. Each medical centre collected the anti-HCV test results of adult patients for five-year period between 2009 and 2014 from hospital records. RESULTS: A total of 974,449 anti-HCV test results were included in this study. When the seropositivity rates in the two groups of adults were compared, anti-HCV seropositivity rates were higher in nine medical centres out of ten. Anti-HCV seropositivity in adults born between 1945-1965 was significantly higher than in adults born after 1965 (p < 0.05). CONCLUSIONS: We determined that the anti-HCV seropositivity rate is significantly higher in adults born between 1945-1965 compared to the younger adults as indicated in the literature. According to data from this study together with the WHO and CDC suggestions, we believe that it is appropriate to offer anti-HCV serology testing for people over 50 years of age since the anti- HCV seroprevalence in this age group is relatively high.

[Investigation of carbapenemases in carbapenem-resistant Escherichia coli and Klebsiella pneumoniae strains isolated in 2014 in Turkey]. / Türkiye'de 2014 yili içinde izole edilen karbapeneme dirençli Escherichia coli ve Klebsiella pneumoniae izolatlarinda karbapenemaz varliginin arastirilmasi.

Carbapenems are the choice of treatment in infections caused by multidrug resistant Enterobacteriaceae. In recent years carbapenem-resistant Enterobacteriaceae isolates due to carbapenemases have been increasingly reported worldwide. Multicenter studies on carbapenemases are scarce in Turkey. The aim of this study was to determine the distribution of carbapenemases from different parts of Turkey as a part of the European Survey of Carbapenemase Producing Enterobacteriaceae (EuSCAPE) project. Beginning in November 2013, carbapenem-resistant isolates resistant to at least one of the agents, namely imipenem, meropenem, and ertapenem were sent to the coordinating center. Minimum inhibitory concentrations for these carbapenems were determined by microdilution tests following EUCAST guidelines. Production of carbapenemase was confirmed by combination disk synergy tests. Types of carbapenemases were investigated using specific primers for VIM, IMP; NDM, KPC and OXA-48 genes by multiplex polymerase chain reaction. In a six month period, 155 suspected carbapenemase-positive isolates were sent to the coordinating center of which 21 (13.5%) were E.coli and 134 (86.5%) were K.pneumoniae. Nineteen (90.5%) strains among E.coli and 124 (92.5%) strains among K.pneumoniae were shown to harbour at least one carbapenemase gene by molecular tests, with a total of 92.3% (143/155). Carbapenemases were determined as a single enzyme in 136 strains (OXA-48: 84.6%; NDM: 6.3%; VIM: 2.8%; IMP: 1.4%) and as a combination in seven isolates (OXA-48 + NDM: 2.1%; OXA-48 + VIM: 2.1%; VIM + NDM: 0.7%). KPC was not detected in any of the isolates. According to the microdilution test results, resistance to imipenem, meropenem and ertapenem in OXA-48 isolates were 59.5%, 52.9% and 100%, respectively. The combination disk synergy test was 100% compatible with the molecular test results. As most of the OXA-48 producing isolates were susceptible to meropenem but all were resistant to ertapenem, ertapenem seems to be the most sensitive agent in screening carbapenemases in areas where OXA-48 is prevalent and phenotypic combination tests can be useful in centers where molecular tests are not available.

[Seroprevalence of tularemia in risk groups of humans and animals in Van, eastern Turkey]. / Van ili ve çevresinde risk altindaki insan ve hayvan gruplarinda tularemi seroprevalansi.

Tularemia has become a re-emerging zoonotic disease in Turkey recently. The aims of this study were to determine the seroprevalence of tularemia in humans and their animals living in rural risky areas of our region and to investigate the risk factors. Between January and July 2012, people living in rural areas of Van province (located at eastern part of Turkey) and their domestic animals were included in the study. The sample size was determined by using cluster sampling method like in an event with known prevalence and planned as a cross-sectional epidemiological study. Proportional random sampling method was used to determine which individuals will be included in the study. Presence of tularemia antibodies in the sera of a total 495 voluntary persons (343 female, 152 male; age range: 18-79 years, mean age: 40.61) and their 171 animals (40 cattle, 124 sheep and 7 goats) were screened by microagglutination test using safranin O-stained F.tularensis antigen (Public Health Agency of Turkey). For the evaluation of cross-reactivity between Brucella spp., tularemia positive serum samples were also tested with brucella microagglutination test. Among human and animal samples, 11.9% (59/495) and 44% (76/171) yielded positive results with the titers of ≥ 1:20 in F.tularensis microagglutination test, respectively. However, 69.5% (41/59) of human sera and 78.9% (60/76) of animal sera demonstrated equal or higher titers in the brucella test, so those sera were considered as cross-reactive. After exclusion of these sera, the seroprevalence for F.tularensis were calculated as 3.6% (18/495) for humans and 9.4% (16/171) for animals. Among the 16 animals with positive results, 12 were sheep, three were cattle and one was goat. The difference between seropositivity rates among the domestic animal species was not statistically significant (p> 0.05). In addition, no statistically significant differences were found between risk factors including insect bite, tick bite, contact with rodents, eating the meat of hunted animals (rabbit), having pet (cat) in home (p> 0.05). In this study, the rate of tularemia seropositivity among humans was similar to the results of previous studies which were performed in our country; however the seropositivity rate of tularemia among domestic animals in our study was higher than the results of a few studies which were conducted on domestic animals. In conclusion, preventive procedures and precautions must be taken into consideration to control the transmission of the infection.

Antimicrobial susceptibility and resistance mechanisms of methicillin resistant Staphylococcus aureus isolated from 12 Hospitals in Turkey.

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most important nosocomial pathogens and is also emerging in Turkish hospitals. The aim of this study was to determine the antimicrobial susceptibility profiles of MRSA isolated from Turkish hospitals. MATERIALS AND METHODS: A total of 397 MRSA strains isolated from 12 hospitals in Turkey were included to present study. Antimicrobial susceptibilities were tested using agar dilution method. Presence of ermA, ermB, ermC, msrA, tetM, tetK, linA and aac-aph genes were studied by PCR. RESULTS: All strains were susceptible to vancomycin and linezolid. The susceptibility rates for fusidic acid, lincomycin, erythromycin, tetracyclin, gentamycin, kanamycin, and, ciprofloxacin were 91.9%, 41.1%, 27.2%, 11.8%, 8.5%, 8.3% and 6.8%, respectively. Lincomycin inactivation was positive for 3 isolates. Of 225 erythromycin resistant isolates 48 had ermA, 20 had ermC, and 128 had ermA-C. PCR was negative for 15 strains. Of 3 isolates with lincomycin inactivation one had linA and msrA. Of 358 gentamycin resistant isolates 334 had aac-aph and 24 were negatives. Among 350 tetracyclin resistant isolates 314 had tetM. Of 36 tetM negative isolates 10 had tetK. CONCLUSION: MRSA isolates from Turkish hospitals were multiresistant to antimicrobials. Quinolone and gentamycin resistance levels were high and macrolide and lincosamide resistance were relatively low. Susceptibility rates for fusidic asid were high. Linezolide and vancomycin resistance are not emerged. The most common resistance genes were ermA, tetM and aac-aph. Evolution of antimicrobial susceptibilities and resistance genes profiles of MRSA isolates should be surveyed at regional and national level for accurate treatment of patients and to control dissemination of resistance genes.

[Mycobacterium tuberculosis strains isolated from Van region four different sensitivity detection method antimycobacterial agents]. / Van yöresinde izole edilen Mycobacterium tuberculosis suslarinin dört farkli yöntemle antimikobakteriyel ajanlara duyarlilik tespiti.

INTRODUCTION: The purpose of this study is detecting the susceptibility rates of 58 Mycobacterium tuberculosis complex strains which were isolated from patient specimens sent to our mycobacteriology laboratory, for major anti-tuberculosis drugs like streptomycin, isoniazid, rifampicin and ethambutol with three different systems and agar proportion method and compare the accessibility, speed, specificity and sensitivity of these three systems. MATERIALS AND METHODS: With this purpose, 58 (96.6%) strains out of 60 which were isolated from the patients attended to the mycobacteriology laboratory were identified as M. tuberculosis complex with conventional methods. These strains susceptibilities to four major anti-tuberculosis drugs were detected with Manuel MGIT AST SIRE system, BacT/ALERT 3D system MB/BacT SIRE, TK anti-TB system and compared with reference method in Middlebrook 7H10 media. RESULTS: As a result, INH resistance in Van province with agar proportion method was detected as 12%, followed by INH + RIF resistance of 1.7% and INH + SM resistance of 1.7%. These result compared with other studies conducted country wide are in median range. The systems included in our study were determined to have 100% sensitivity for all of the drugs for detecting resistance and sensitivity rates. Specificities for INH for TK anti-TB, MGIT and MB/BacT were detected as 98%, 96% and 95% respectively. Multidrug resistance rates were detected in 100% sensitivity and specificity with all of the three systems. Only MB/BacT system gave a false negative RIF resistance for 1 strain. Fastest system according to resistance determination times is found to be the MGIT system. CONCLUSION: However, presence of INH + RIF resistance pattern, indicates inadequate treatment programs in our region. As a result these three systems are fast and reliable systems for antimicrobial susceptibility testing of Mycobacterium spp. to be used in routine mycobacteriology laboratories.

Identification and determination of antibiotic susceptibilities of Brucella strains isolated from patients in van, Turkey by conventional and molecular methods.

PURPOSE: Brucellosis is a worldwide zoonotic disease and still constitutes a major public health problem. In this study, we aimed to identify biovars of Brucella strains isolated from clinical specimens taken from brucellosis patients from the Eastern Anatolia region as well determine the susceptibility of these isolates to tigecycline and azithromycin, drugs that may serve as alternatives to the conventional drugs used in the therapy. MATERIALS AND METHODS: Seventy-five Brucella spp. isolates were included in the study. All strains were identified by both conventional and molecular methods. Brucella Multiplex PCR kit (FC-Biotech, Code: 0301, Turkey) and B. melitensis biovar typing PCR kit (FC-Biotech, Code: 0302, Turkey) were used for molecular typing. Antimicrobial susceptibilities of all strains were determined by E-tests. RESULTS: By conventional biotyping, 73 strains were identified as B. melitensis biovar 3 and two strains as B. abortus biovar 3. Molecular typing results were compatible with conventional methods. The MIC50 and MIC90 values of doxycycline were 0.047 and 0.094; tigecycline 0.094 and 0.125; trimethoprim/sulfamethoxazole 0.064 and 0.19; ciprofloxacin 0.19 for both; streptomycin 0.75 and 1; rifampin 1 and 2 and azithromycin 4 and 8. According to the MIC values, doxycycline was found to be the most effective antibiotic, followed by tigecycline, trimethoprim-sulfamethoxazole and ciprofloxacin. CONCLUSION: Currently recommended antibiotics for the treatment of brucellosis such as doxycycline, rifampin, streptomycin, trimethoprim-sulfamethoxazole and ciprofloxacin were found to be still effective. While our results showed that tigecycline can be used an alternative agent in the treatment of brucellosis, azithromycin has not been confirmed as an appropriate agent for the treatment.

[t030 is the most common spa type among methicillin-resistant Staphylococcus aureus strains isolated from Turkish hospitals]. / t030, Türkiye'deki Hastanelerden Izole Edilen Metisiline Dirençli Staphylococcus aureus Izolatlari Arasinda En Yaygin spa Tipidir.

Staphylococcus aureus is one of the most frequent agents causing hospital infections. S.aureus has a great ability to adapt itself to variety of conditions and successful clones can be epidemic and even pandemic by its ability spread from one continent to another. The aims of this study were to detect spa types of 397 methicillin-resistant S.aureus (MRSA) strains isolated from 12 centers in different geographical regions of Turkey from 2006 to 2008, and to investigate their clonality by PFGE and MLST typing. Additionally, 91 MRSA from four of those 12 centers isolated during 2011 were also studied for their spa types. PFGE profiles indicated the presence of a major pulsotype, namely pulsotype A with a rate of 91.4% (363/397), followed by pulsotype B (n= 18, 4.5%) and pulsotype C (n= 11, 2.8%). Among isolates tested 363 (91.4%) were SCCmec type III, 30 (7.6%) were SCCmec type IV. Sequence analysis of representative isolates revealed that ST239 (85.1%) was the most common MLST type followed by two MLST types ST737 (4%), and ST97 (2.8%), both SCCmec type IV. Two isolates were ST80 with SCCmec type IV. Of 397 isolates, 338 (85.1%) were t030, followed by t005 (2.5%) and t632 (2%). Among MRSA isolated during 2011, 64 (70.3%) of 91 were t030, 4 (4.4%) were t005, 2 (2.2%) were t015, and 2 (2.2%) were t1094. Among centers the t030 prevalence of 2006-2008 isolates ranged from 59-100%. The highest t030 prevalence was found in Ankara (100%) and lowest in Trabzon (59%) provinces which are located at central and northestern Anatolia, respectively. In Istanbul province, the prevalence of t030 was 94.5% among 2006-2008 isolates which decreased to 55.5% among 2011 isolates. Also a decrease in t030 rates was observed among samples from Konya and Trabzon but not from Aydin. Our results showed that the most common MRSA clone in Turkey is ST 239-SCCmec type III, t030 which persisted during the six years of the study period. Presence of PVL toxin gene was tested by PCR and 5 (3%) isolates found to be positive, of them two were SCCmec Type IV-ST80 and three were SCCmec Type III-ST239. This study is the largest epidemiological survey ever done in Turkey which showed presence of a hospital Turkish clone TR09 (ST239-SCCmecIII-t030) and a community clone TR10 (ST737-SCCmecIV-t005) largely disseminated in Turkey.

[Sepsis caused by Chryseobacterium indologenes in a patient with hydrocephalus]. / Hidrosefalisi Olan Bir Olguda Chryseobacterium indologenes ile Iliskili Sepsis.

Chryseobacterium (formerly Flavobacterium) indologenes, is a non-fermentative gram-negative bacillus which is widely found in the nature, primarily soil and water. Since it can survive in chlorine-treated municipal water supplies, and can colonize the sink basins and tap waters of the hospitals, this bacterium may be a potential infectious agent. Contamination of the medical devices containing water (respirators, intubation tubes, humidifiers, incubators for newborns, etc.) in hospital settings may lead to serious infections especially in patients with predisposing diseases, newborns and immunocompromized patients. In this report, a case of fatal C.indologenes septicemia developed in a newborn with hydrocephalus has been presented. A two-months old male infant was admitted to our hospital with the complaints of failure to suck and lethargy for five days and head enlargement. He was diagnosed as meningitis based on the clinical and laboratory findings of cerebrospinal fluid (CSF) (protein: 572 mg/dl, glucose 9.5 mg/dl, chlorine: 111 mg/dl, and presence of abundant polymorphonuclear leukocytes), and empirical antibiotic treatment (ampicillin/sulbactam and cefotaxime) had been started. Since the computerized tomography of the brain pointed out hydrocephalus, an external shunt was placed for CSF drainage on the second day of hospitalization. A total of five CSF and two blood cultures collected during the hospitalization period were inoculated into pediatric aerobic CSF and blood culture bottles (BacT/ALERT, BioMerieux, France) and incubated for 24-48 hours. The isolated bacteria from all of the cultures were identified as C.indologenes by conventional methods and BD Phoenix (Becton Dickinson, USA) system. Antibiotic susceptibility tests were performed with microdilution method according to CLSI guidelines. The isolate was found susceptible to ciprofloxacin, levofloxacin and trimethoprim/sulfamethoxazole, while it was resistant to amikacin, gentamicin, tobramycin, piperacillin, cefotaxime, ceftazidime, aztreonam, meropenem, imipenem, tetracycline, and chloramphenicol. The treatment continued with ampicillin/sulbactam and levofloxacin without removing the shunt. However, C.indologenes growth persisted in CSF and blood cultures of the patient. The general condition of the patient deteriorated on the 65. day of the hospitalization and the patient was lost due to cardiopulmonary arrest. Case reports related to isolation of C.indologenes from blood cultures are present in the literature, however, isolation of C.indologenes from central nervous system was reported previously in a single case. In conclusion, C.indologenes should be considered as opportunistic infectious agents especially in the infectious diseases that develop in immunocompromised patients with underlying disease and with foreign device implementation.

Evaluation of the effectiveness of current disinfection methods in complete denture patients.

OBJECTIVES: Candida adherence to the denture base is an important cause of denture stomatitis in elderly and handicapped patients where effective patient- and physician-based disinfection methods are required. The purpose of this study was to investigate the in vivo effectiveness of chemical and physicochemical methods and their combinations against common oral Candida species on denture base acrylic resin. METHOD AND MATERIALS: Patients were divided into six groups according to disinfection methods. For chemical disinfection, chlorhexidine, sodium hypochlorite, and glutaraldehyde were used by the patients. Microwave and ozone therapy were applied by physicians for physicochemical disinfection. Fungal load count was performed. This procedure was repeated before applying any disinfection procedures, at 1 week and 1 month after the patient started to use the relevant chemical disinfectant and apply physicochemical methods. A multivariate analysis test was used to determine the change in fungal load over time and whether this change led to a difference among the groups (P < .05). RESULTS: The most frequently isolated Candida strain was Candida albicans. The change in fungal load over time was significantly different (P < .001). However, the difference between the groups did not show any significant difference in the paired comparison analyses of the chemical disinfection groups (P >.05). No Candida strains were detected in either physicochemical method at any of the control time points. CONCLUSIONS: The study concluded that chemical disinfectants used by patients were effective for but total eradication of Candida adhesion requires the use of additional ozone or microwave therapy.

The evaluation of vancomycin-resistant enterococci and carbapenamase producing Klebsiella colonization among ICU-Hospitalized Patients.

Background: Multi-drug resistant organisms, especially Vancomycin-Resistant Enterococcus (VRE) and Carbapenam Resistant Klebsiella pneumoniae (KPC), are serious health threat. Early detection of resistant bacteria colonization among patients in intensive care units (ICUs) not only enables effective treatment but more importantly prevents disease and limits transmission. Therefore, we aimed to to assess the frequency of VRE and KPC colonization via rectal swab sampling. Methods: The study was carried out in ICUs of a tertiary hospital. Two rectal swab samples were collected within the first 24 hours of admission and another one was taken every subsequent 15 days to test for for VRE and KPC carriage. Results: A total 316 rectal swab samples taken from 230 patients. Forty-seven patients were screened at least 2 times. 183 patients were not further screened due to discharge, exitus or transfer to other wards. Thirty-six patients (16%) were determined to be VRE (+). The most frequently isolated strain was E. faecium (80.5%) and its most common genotype was VanA (87.5%). Seven patients (3%) were identified as KPC (+). OXA-48 type crbapenamase was confirmed in all KPC isolates. Conclusion: This study shows that VRE and KPC colonization continues to be a serious threat in ICUs.

Comparison of Conventional Methods, Automated Systems, and DNA Sequence Analysis Methods in the Identification of Corynebacterium afermentans and Corynebacterium mucifaciens Bacteria Isolated from Blood and Catheter Culture Samples.

The aim of this study is to compare different methods due to the difficulties in identifying coryneform bacteria to species level and to determine antibiotic resistance profiles. Isolates identified as Turicella otitidis (n:45) by VITEK 2 Compact and Corynebacterium mucifaciens (n:1) by matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS), isolated from blood and catheter cultures between 2015 and 2017 were included in the study. For identification of the isolates, conventional tests and 16S rDNA sequence analysis were performed. Antibiotic susceptibilities of the isolates were determined by Etest. The isolates identified as T. otitidis with VITEK 2 Compact could not be identified by MALDI-TOF MS and described as C. mucifaciens/Corynebacterium afermentans spp. by 16S rDNA sequence analysis. One isolate identified as C. mucifaciens by MALDI-TOF MS could not be identified with VITEK 2 Compact and described as C. mucifaciens by 16S rDNA sequence analysis and conventional methods. All isolates (n:45) described as C. mucifaciens/C. afermentans spp. by 16S rDNA sequence analysis were identified as C. afermentans subsp. afermentans with conventional methods. All 45 isolates identified as C. afermentans subsp. afermentans were resistant to penicillin, erythromycin, and clindamycin and were susceptible to vancomycin and daptomycin, whereas 31 (69%) were resistant to trimethoprim-sulfamethoxazole (TMP-SXT). The isolate identified as C. mucifaciens was susceptible to penicillin, vancomycin, daptomycin, and TMP-SXT; it was resistant to erythromycin and clindamycin. In this study, we reported 45 C. afermentans isolates misidentified as T. otitidis in routine laboratory processes. To our knowledge, this is the first study to include the highest number of C. afermentans blood isolates.

[Evaluation of Western Blot method for the detection of antibodies to Helicobacter pylori antigens in patients with gastric carcinoma and cases with epigastric complaints]. / Gastrik karsinomali hastalar ile epigastrik yakinmalari olan olgularda Helicobacter pylori antijenlerine karsi antikor varliginin saptanmasinda western blot yönteminin degerlendirilmesi.

Helicobacter pylori proteins CagA (cytotoxin-associated gene A) and VacA (vacuolating cytotoxin A) are among the virulence factors of this species. CagA gene carrying H. pylori strains are particularly associated with gastric adenocarsinoma. This study was conducted to evaluate Western Blot (WB) method to determine specific H. pylori antibodies in a group of patients with gastric cancer and in a control group with no malignancy. A total of 99 patients with gastric cancer (94 adenocarcinoma, 2 adenosquamous cell carcinoma, 3 non-Hodgkin lymphoma) and 150 control cases with epigastric complaints such as nausea, vomiting, diarrhea, gastroesophageal reflux and abdominal pain, were included to the study. H. pylori IgG-ELISA was positive in all study (mean age: 56.7 +/- 1.2 years, 62 male) and control (mean age: 24.2 +/- 1.3 years, 64 male) patients. Specific antibodies against CagA, VacA, OMP (outer membrane protein)-67, urease-A, urease-B, HSP (heat shock protein) and flagellin antigens determined by a commercial WB-based kit (RIDA Blot Helicobacter, R-Biopharm GmbH, Germany). Interestingly, no anti-VacA positivity was detected in none of the patient and control groups. The positivity rates for H. pylori CagA, OMP-67, urease A, urease-B, flagellin and HSP specific antibodies were as 78%, 54%, 37%, 60%, 53% and 82% in the gastric cancer group and 85%, 71%, 55%, 43%, 61% and 75% in the control group, respectively. There was no statistically significant difference (p > 0.05) between gastric carcinoma and control groups in terms of CagA, HSP and flagellin antibodies (p > 0.05). On the other hand, a statistically significant difference was found between the 2 groups in terms of urease-A, urease-B and OMP-67 (p < 0.01). These results suggested that this test should be assessed again by the manufacturer for its detection power directed towards specific H. pylori antibodies, especially for Vac-A. Further molecular and clinical studies are necessary to determine the factors that affect H. pylori virulence and disease prognosis.

Serotype distribution of Streptococcus pneumonia in children with invasive disease in Turkey: 2015-2018.

Objectives: To determine the serotype distribution of pneumococcus causing invasive pneumococcal disease (meningitidis, bacteremia and empyema) in children in Turkey, and to observe potential changes in this distribution in time to guide effective vaccine strategies. Methods: We surveyed S. pneumoniae with conventional bacteriological techniques and with real-time polymerase chain reaction (RT-PCR) in samples of cerebrospinal fluid (CSF), blood and pleural fluid. S. pneumoniae strains were isolated from 33 different hospitals in Turkey, which are giving health services to approximately 60% of the Turkish population. Results: A total of 167 cases were diagnosed with invasive pneumococcal disease between 2015 and 2018. We diagnosed 52 (31.1%) patients with meningitis, 104 (62.2%) patients with bacteremia, and 11 (6.6%) patients with empyema. Thirty-three percent of them were less than 2 years old and 56% less than 5 years old. Overall PCV13 serotypes accounted for 56.2% (94/167). The most common serotypes were 19 F (11.9%), 1 (10.7%) and 3 (10.1%). Conclusions: Besides the increasing frequency of non-vaccine serotypes, vaccine serotypes continue to be a problem for Turkey despite routine and high-rate vaccination with PCV13 and significant reduction reported for the incidence of IPD in young children. Since new candidate pneumococcal conjugate vaccines with more serotype antigens are being developed, continuing IPD surveillance is a significant source of information for decision-making processes on pneumococcal vaccination.

[First isolation and detection of multiple clones of vancomycin-resistant enterococci in the pediatric unit of Van Yuzuncu Yil University Turkey]. / Van Yüzüncü Yil Universitesi Pediatri Servisinde vankomisine dirençli enterokoklarin ilk izolasyonu ve çogul klonlarin tespiti.

Upon isolation of the first vancomycin resistant enterococcus (VRE) from the urine sample of a nine months old patient in pediatric unit of Van Yuzuncu Yil University Hospital (located in eastern part of Turkey), we aimed to search for the presence of VRE isolates in the unit, to determine the resistance genotypes and to evaluate the clonal relationships among isolates. A total of 28 rectal swabs and 28 skin swabs from the patients, 12 skin swabs from the staff giving care to the patients, 15 skin swabs from the mothers of the patients and 96 environmental samples from the pediatric unit were screened. Antibiotic susceptibilities were tested and the resistance genotypes were determined. Molecular typing of the isolates was performed using pulsed-field gel electrophoresis (PFGE). Apart from the first case, 13 more VRE isolates, one being a clinical isolate from the urine of a patient and 12 isolates from the screening samples (8 rectal swabs, one skin swab and three swabs from patients' beds) were obtained. All of the isolates were identified as Enterococcus faecium with similar antibiotic susceptibility patterns. VanA gene was present in all of the isolates. PFGE demonstrated two major clones and five clones closely related with the major ones. This was the first VRE isolation and colonization reported in our region. The isolates belonged to more than one clone. Currently, VRE did not seem to be a significant pathogen in Turkey, however, there may be an underestimation of the problem and continuous surveillance studies should be undertaken in every region.

Hospital Outbreak of a Colistin-Resistant, NDM-1- and OXA-48-Producing Klebsiella pneumoniae: High Mortality from Pandrug Resistance.

Colistin resistance causes substantial problems in the treatment of serious infections with carbapenem-resistant (CR) gram-negative bacteria. In this study, we report a fatal hospital outbreak from the spread of a pandrug-resistant Klebsiella pneumoniae clone. An outbreak investigation was conducted after consecutive isolation of nine CR-K. pneumoniae (CR-Kp) strains from eight patients in two intensive care units of a university hospital within 2 weeks. Carbapenem and colistin resistance genes were investigated with PCR, clonal relationships of isolates were studied with pulse-field gel electrophoresis, and multilocus sequence types were determined. The outcomes of the affected patients were analyzed. Genotyping showed a predominant CR-Kp clone consisting of seven strains from six patients. These strains were in ST11 type, an international high-risk clone. They were resistant to all antimicrobials, including colistin, and positive for NDM-1 and OXA-48 carbapenemases, but negative for plasmid-borne colistin resistance genes. One patient had colonization and the remaining five died due to the infection within mean 12 days. No environmental or staff links could be established, and the outbreak was stopped by augmenting infection-control measures. Colistin-resistant K. pneumoniae could clonally expand in the hospital setting, and this spread might be associated with high mortality due to the lack of an appropriate treatment option. Immediate implementation of infection-control measures may be the best way to limit fatal consequences of the spread of such incurable pathogens.