[Communication training in otorhinolaryngology education : Comparison of an online and a classroom-based training course]. / Vermittlung kommunikativer Kompetenzen in der Lehre der HNO-Heilkunde : Vergleich zwischen einer Online- und Präsenzveranstaltung.

BACKGROUND: Communication skills are among the most important key qualifications of the medical profession. To what extent these can also be acquired online in medical education in otolaryngology is investigated in this study. OBJECTIVE: A voluntary online training for the teaching of communication skills was compared with a corresponding face-to-face format. The question of the extent to which acceptance of the two formats and students' self-assessment of their communicative skills differed was investigated. MATERIALS AND METHODS: In the online training, students were prepared for the topic asynchronously via a video. Thereafter, they were able to conduct consultations with simulation patients online and synchronously. The face-to-face training was comparable in structure and duration and took place in an earlier semester. The acceptance of both seminars was assessed by a questionnaire with 19 items on a five-point Likert scale. Self-assessment of communication skills was measured by a 10-cm visual analog scale pre/post with 16 items. RESULTS: Both formats achieved high acceptance with an average score (M) of 2.08 (standard deviation, SD = 0.54) for the online format and M = 1.97 (SD = 0.48) for the face-to-face event. Students' self-assessments of communication skills showed a twofold increase in the online group (M = 1.54, SD = 0.94) compared to the face-to-face group (M = 0.75, SD = 0.87). CONCLUSION: This study shows that teaching communication skills in the online format was well accepted and resulted in significant changes in students' self-assessment of communication skills.

Resistance and heteroresistance to colistin among clinical isolates of Acinetobacter baumannii.

Colistin is one of the most effective alternatives for treating Acinetobacter baumannii infections. The aim of this study was to determine colistin resistance and heteroresistance rates in A. baumannii from clinical samples in Hacettepe University clinical microbiology laboratory between June 2016 and January 2017. A total of 200 isolates were included in the study. In vitro susceptibility to amikacin, gentamicin, ceftazidime, piperacillin/tazobactam, meropenem, ciprofloxacin, and tigecycline were determined by disk diffusion test. Most isolates were multiresistant as they exhibited resistance to aminoglycosides, ß-lactams, and fluoroquinolones. Colistin susceptibility was determined by broth microdilution (BMD) test (EUCAST standards) and was compared with E-test (bioMérieux, France) in 120 isolates. In 14 blood isolates that were susceptible to colistin (MIC ≤ 2 mg/L), heteroresistance was investigated with the population analysis profile (PAP) method. Overall resistance (n = 200) to colistin was 28% by BMD. Among the 120 isolates where the two tests were compared, resistance to colistin was 25.8% versus 4.2% with BMD and E-test, respectively. Three blood isolates (21.4%) were heteroresistant to colistin. With E-test, a majority of the resistant isolates are overlooked and in vitro susceptibility to colistin should be determined with broth dilution method. This is the first study in Turkey reporting heteroresistance in A. baumannii isolates by the PAP method and emphasizes the need to test for heteroresistance in relation to clinical outcome in serious infections due to A. baumannii.

Presence of OXA-48 Gene in a Clinical Isolate of Lactobacillus rhamnosus.

Lactobacilli are part of the microbiota and are also used as probiotics. However, in recent years they have been associated with invasive infections, especially bacteremia. Lactobacillus spp. are usually susceptible to penicillins, macrolides, and carbapenems, but Lactobacillus rhamnosus is intrinsically resistant to glycopeptides. The aim of this study was to determine the antimicrobial susceptibility profile and resistance mechanism of a clinical isolate of L. rhamnosus isolated from 10 sets of blood cultures of the same patient. The isolate was identified by Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (Bruker Daltonics; BD, Bremen, Germany) and 16S rRNA gene sequencing. In vitro susceptibilities to penicillin, ampicillin, imipenem, vancomycin, erythromycin, clindamycin, and linezolid were determined with gradient test strips (bioMérieux, France) on Mueller-Hinton agar plates supplemented with 5% defibrinated horse blood and 20 mg/L ß-NAD. The isolate was resistant to vancomycin and imipenem. Polymerase chain reaction test was positive for blaOXA-48 and the presence of this carbapenemase was confirmed by gene sequencing. Although plasmid analysis suggested that the blaOXA-48 is chromosomal in this isolate, it is still an alarming finding for potential transmission of antibiotic resistance genes to other bacteria in the gut. To our knowledge, this is the first report of the presence of blaOXA-48 in a Lactobacillus spp. and has utmost importance as these bacteria are used as probiotics. The isolation of these bacteria from sterile body sites should not go unnoticed.

[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.

Candidaemia in a paediatric centre and importance of central venous catheter removal.

The aim of this study is to identify differences in distribution of Candida species, resistance to antifungals and clinical outcome, as well as the identification of potential risk factors associated with candidaemia in children. We conducted a retrospective analysis in children ≤18 years with blood culture proven candidaemia identified between 2004 and 2012. Patients were divided into two groups (Group 1, <3 months, n = 51; Group 2, ≥3 months, n = 197) to identify any potential difference between the neonatal and early infantile periods in terms of risk factors and distribution of Candida species. A total of 248 distinct episodes of candidaemia were identified over the study period. The most frequently isolated Candida species were C. albicans (53.2%), followed by C. parapsilosis (26.2%), C. tropicalis (8.1%). Of the 248 episodes, 71 episodes (28.6%) resulted in death within 30 days from the onset of candidaemia. In Group 1, failure of central venous catheter (CVC) removal was found to be associated with a 20.5-fold increase in mortality [95% CI (3.9, 106.5); P < 0.001], compared to a 5.9-fold increased risk with hypoalbuminaemia [95% CI (1.03, 34.1); P = 0.046]. For Group 2, the increased risk was 23-fold for failure of CVC removal [95% CI (7.48, 70.77); P < 0.001], 7.4-fold for mechanical ventilation [95% CI (2.64, 21.08); P < 0.001], 4.4-fold for hypoalbuminaemia [95% CI (1.56, 12.56); P = 0.005], 3.1-fold for neutropaenia [95% CI (1.31, 7.69); P = 0.010] and 2.2-fold for male gender [95% CI (1.02, 4.71); P = 0.043]. Therapeutic choices should be guided by sound knowledge of local epidemiological trends in candidaemia. Removal of CVC significantly reduces mortality and is an essential step in the management of candidaemia.

Vancomycin and daptomycin minimum inhibitory concentration distribution and occurrence of heteroresistance among methicillin-resistant Staphylococcus aureus blood isolates in Turkey.

BACKGROUND: The aim of this study was to determine the distribution of vancomycin and daptomycin MICs among methicillin-resistant Staphylococcus aureus (MRSA) blood isolates, the prevalence of heterogeneous vancomycin-intermediate S. aureus (hVISA) and the relationship between hVISA and vancomycin MIC values. METHODS: A total of 175 MRSA blood isolates were collected from seven university hospitals in Turkey. All isolates were tested for susceptibility to vancomycin and daptomycin by reference broth microdilution (BMD) and by standard Etest method. BMD test was performed according to CLSI guidelines and Etest was performed according to the instructions of the manufacturer. All isolates were screened for the presence of the hVISA by using macro Etest (MET) and population analysis profile-area under the curve (PAP-AUC) methods. RESULTS: The vancomycin MIC50, MIC90 and MIC ranges were 1, 2, and 0.5-2 µg/ml, respectively, by both of BMD and Etest. The daptomycin MIC50, MIC90 and MIC ranges were 0.5, 1 and 0.125 -1 µg/ml by BMD and 0.25, 0.5 and 0.06-1 µg/ml by Etest, respectively. The vancomycin MIC for 40.6% (71/175) of the MRSA isolates tested was >1 µg/ml by BMD. No vancomycin and daptomycin resistance was found among MRSA isolates. Percent agreement of Etest MICs with BMD MICs within ±1 doubling dilution was 100% and 73.1% for vancomycin and daptomycin, respectively. The prevalence of hVISA among MRSA blood isolates was 13.7% (24/175) by PAP-AUC method. MET identified only 14 of the hVISA strains (sensitivity, 58.3%), and there were 12 strains identified as hVISA that were not subsequently confirmed by PAP-AUC (specificity, 92.1%). CONCLUSIONS: Agreement between BMD and Etest MICs is high both for vancomycin and daptomycin. Daptomycin was found to be highly active against MRSA isolates including hVISA. A considerable number of isolates are determined as hVISA among blood isolates. As it is impractical to use the reference method (PAP-AUC) for large numbers of isolates, laboratory methods for rapid and accurate identification of hVISA need to be developed.

Pancreatic mucinous cystic neoplasm with sarcomatous stroma metastasizing to liver: a case report and review of literature.

We report a case of mucinous cystic neoplasm of pancreas with sarcomatous stroma metastasizing to the liver. The tumor occurred in a male patient aged 46 years. Symptoms included persistent epigastric and right upper quadrant pain. Radiographically, the pancreas contained four large cystic masses located in the neck, body, and tail. Histologically, the cysts were lined with benign, mucinous epithelium with underlying bland, storiform, ovarian-like stroma. An undifferentiated focally hyalinized, sarcomatous stroma composed of bland spindle cells showing short fascicular growth pattern and focal nuclear palisading was associated with the epithelial component in one of the cysts. These cells showed strong immunoreactivity with vimentin and inhibin (weak), they were negative for CD34, estrogen receptor, progesterone receptor, androgen, calretinin, S-100, CD117, melan A, chromogranin, and synaptophysin. A morphologically and immunohistochemically identical metastatic sarcomatous focus was identified in the liver without any glandular component. This case is unique in its clinically malignant behaviour and metastatic nature despite its morphologically benign epithelial and stromal components.

Evaluation of periodontal pathogens in amniotic fluid and the role of periodontal disease in pre-term birth and low birth weight.

BACKGROUND: Pre-term birth and/or low birth weight (PTLBW) is a serious problem in developing countries. The absence of known risk factors in ≈ 50% of PTLBW cases has resulted in a continued search for other causes. The aim of this study was to examine the effect of periodontitis on pregnancy outcomes. METHODS: Samples were taken from 50 pregnant women who underwent amniocentesis. Polymerase chain reaction was performed on amniotic fluid samples obtained during amniocentesis and on subgingival plaque samples to determine the presence of Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Treponema denticola, Tannerella forsythia, Fusobacterium nucleatum, Prevotella intermedia, Campylobacter rectus and Eikenella corrodens. Plaque index, gingival index, bleeding on probing, probing depth and clinical attachment level were evaluated. Medical records were obtained after birth. RESULTS: Social and demographic variables were similar among the Gingivitis (G), Localized Periodontitis (LP) and Generalized Periodontitis (GP) groups. Four subjects gave birth to PTLBW neonates. Campylobacter rectus, T. forsythia, P. gingivalis and F. nucleatum were detected in the amniotic fluid and subgingival plaque samples of three patients who gave birth to PTLBW neonates. The amniotic fluid sample from the fourth patient was not positive for any of the tested pathogens. CONCLUSION: These findings suggest that the transmission of some periodontal pathogens from the oral cavity of the mother may cause adverse pregnancy outcomes. The results contribute to an understanding of the association between periodontal disease and PTLBW, but further studies are required to better clarify the possible relationship.

Salmonella gastroenteritis in children (clinical characteristics and antibiotic susceptibility): comparison of the years 1995-2001 and 2002-2008.

We document herein the prevalence and serotype distribution among Salmonella enterica strains isolated from children treated for diarrhea over two seven-year periods spanning 14 years. Four hundred and eight (1.38%) S. enterica cases were isolated among 29,601 diarrheal admissions. Among the Salmonella isolates, 63.7% were serogroup D and 29.9% were serogroup B. Overall, 21.7% of cases were under one year of age, with 2.1% being younger than three months. Bloody diarrhea was found in 18.8% of the cases. The resistance rates were 25.8%, 18.2%, 7.0%, 4.7%, and 0.3%, to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, ceftriaxone, and ciprofloxacin, respectively. In conclusion, our study has revealed that the predominance of Salmonella serogroup D continues. The clinical features of our patients were mostly mild, with no deaths or severe complications. While resistance to antimicrobial agents changes constantly, it is important to keep these strains under surveillance in order to formulate policies for the rational use of antimicrobial agents.

[The presence of extended spectrum beta-lactamase, KPC-type carbapenemase and plasmid-mediated AmpC beta-lactamase in E.coli and K.pneumoniae strains isolated from blood cultures]. / Kan Izolati E.coli ve K.pneumoniae Suslarinda Genislemis Spektrumlu Beta-Laktamaz, KPC-Tip Karbapenemaz ve Plazmid Aracili AmpC Beta-Laktamaz Varliginin Arastirilmasi

The aim of this study was to investigate the presence of extended spectrum beta-lactamase (ESBL), KPC-type carbapenemase and plasmid-mediated AmpC beta-lactamase (pAmpC) which have increased in incidence in recent years in Escherichia coli and Klebsiella pneumoniae strains isolated from the blood samples causing serious infections. Ninety nine E.coli and 114 K.pneumoniae strains which were isolated from the blood samples of patients admitted to Hacettepe University Medical Faculty, Ihsan Dogramaci Children's Hospital between January 2001 and March 2009 were investigated. The screening tests for ESBL, pAmpC beta-lactamase and KPC-type carbapenemase were performed on the same plate. Combined disk test was performed for ESBL and modified Hodge test was done for KPC-type carbapenemase confirmation according to Clinical and Laboratory Standards Institute (CLSI) guidelines. In addition the inhibitory-based test with boronic acid for KPC-type carbapenemase, pAmpC beta-lactamase and the modified Hodge test for pAmpC beta-lactamase were performed. Boronic acid inhibition test was performed to detect the co-presence of the three types of resistance. The frequency of the beta-lactamases in E.coli and K.pneumoniae isolates were as follows respectively: ESBL 26.2% and 61.4%; pAmpC 1% and 0.9% and ESBL + pAmpC 6% and 3.5%. ESBL was masked by pAmpC in an isolate. Ertapenem resistance was shown in three isolates and KPC-type carbapenemases were detected positive by the inhibitory- based test with boronic acid but found to be negative by the modified Hodge test. The results of modified Hodge test was considered valid according to CLSI comments. Since both ESBL and pAmpC were positive but modified Hodge test was negative in these three strains, ertapenem resistance was attributed to another mechanism. For the determination of ESBL and pAmpC beta-lactamases in the routine laboratory, reliable and sensitive susceptibility tests should be performed. The inhibitory-based test with boronic acid is easy for interpretation, and a practical method for the detremination of pAmpC beta lactamases. For KPC-type carbapenemases modified Hodge test which has been standardized by CLSI, is a reliable method. The results of this study showed that ESBL positivity rates are alarming and although the frequency of pAmpC is currently low, it is increasing together with ESBL. These data indicated the need for the establishment of urgent measures to control the increase in plasmid-mediated antibiotic resistance in gram-negative enteric bacteria.

[Comparison of culture and real-time PCR methods in the detection of Streptococcus pneumoniae and Haemophilus influenzae in acute otitis media effusion specimens]. / Akut Orta Kulak Iltihabi Örneklerinde Streptococcus pneumoniae ve Haemophilus influenzae'nin Saptanmasinda Kültür ve Gerçek Zamanli PCR Yöntemlerinin Karsilastirilmasi

Streptococcus pneumoniae and Haemophilus influenzae are the major etiologic agents of acute otitis media. This study was aimed to compare the detection rate of S.pneumoniae and H.influenzae by culture and real-time polymerase chain reaction (Rt-PCR) in the middle ear effusions of patients diagnosed as acute otitis media. A total of 60 middle ear effusion samples collected from children with acute otitis media were included in the study. The samples were inoculated and incubated in BACTEC Ped Plus blood culture bottles and BACTEC 9120 system (BD Diagnostic Systems, MD), respectively, and the isolates were identified by conventional methods. For the molecular diagnosis of H.influenzae and S.pneumoniae, ply pneumolysin gene and HIB capsule region, respectively were amplified by Rt-PCR (LightCycler, Roche Diagnostics, Germany). H.influenzae and S.pneumoniae were isolated from 5 (8.3%) and 3 (5%) of the patient samples with conventional culture methods, respectively. In addition in 11.6% of the samples other microorganisms (Staphylococcus epidermidis, Streptococcus intermedius, Streptococcus sanguinis, Moraxella catarrhalis, Pseudomonas aeruginosa, Candida albicans) were also isolated. On the other hand H.influenzae and S.pneumoniae were detected in 38 (63.3%) and 24 (40%) of the samples with Rt-PCR, respectively. There was about eight fold increase in the detection frequency of H.influenzae and S.pneumoniae with Rt-PCR compared to culture methods. When culture was accepted as the gold standard method, the sensitivity, specificity and positive predictive value of Rt-PCR in the detection of H.influenzae and S.pneumoniae were estimated as 80%, 51% and 98.2%, respectively. As a result, Rt-PCR was shown to be a sensitive method and could be preferred for the rapid diagnosis of H.influenzae and S.pneumoniae in the etiological diagnosis of acute otitis media, especially in culture negative cases.

First Detection of Klebsiella pneumoniae Isolate Co-Harboring Fosfomycin Resistance Gene fosA3 and blactx-m Among Gram Negative Urine Isolates in a Turkish Hospital.

The most common gram-negative pathogens in urinary tract infections are Escherichia coli and Klebsiella pneumoniae. Therapy that is often empirical relies on local antibiotic resistance data, hence monitorization of antimicrobial resistance periodically in each hospital is a requirement. In this study, antibiotic susceptibility profiles of consecutive urinary isolates (E. coli [n = 235] and K. pneumoniae [n = 56]) of adult patients collected between February 2018 and February 2019 from inpatients in Hacettepe University Hospital were assessed. Isolates resistant to fosfomycin (minimum inhibitory concentration >32 mg/L) were further investigated for the presence of fosA, fosA3, and fosC2. Fosfomycin susceptibility was determined by agar dilution method. Broth microdilution method was performed for amikacin, gentamicin, ceftazidime, ceftriaxone, meropenem, ciprofloxacin, tigecycline, trimethoprim/sulfamethoxazole (TMP/SMX), colistin, and piperacillin/tazobactam (PIP/TAZ). PCR method was employed to investigate fosA, fosA3, fosC2, and blaCTX-M. Existence of fosA3 gene was confirmed by sequencing. Resistance rates to amikacin, gentamicin, ceftazidime, ceftriaxone, meropenem, ciprofloxacin, tigecycline, TMP/SMX, colistin, and PIP/TAZ were 2.7%, 18.5%, 25.4%, 33.0%, 3.4%, 45.4%, 2.4%, 43.6%, 6.2%, and 23.7%, respectively. Sixteen isolates (5.5%) were resistant to fosfomycin. Resistance was most frequently observed in K. pneumoniae (n = 9). fosA3 gene was detected in one fosfomycin-resistant K. pneumoniae isolate. This isolate also carried blaCTX-M. fosC2 and fosA genes could not be detected in any of the isolates. In this study, we report for the first time the existence of fosA3 in Turkey and its association with the blaCTX-M gene. As a result of increasing blaCTX-M producing Enterobacterales isolates globally, increase in fosfomycin resistance may be expected in near future.

[Antimicrobial resistance profiles of Shigella spp. isolated from feces samples in Hacettepe University Ihsan Dogramaci Children's Hospital between 1999-2010]. / Hacettepe Üniversitesi Ihsan Dogramaci Çocuk Hastanesinde 1999-2010 Yillari Arasinda Diski Örneklerinden Izole Edilen Shigella Türlerinin Antibiyotiklere Direnç Profilleri.

The symptoms of infections caused by Shigella spp. are diverse and may change from person to person. The choice of antibiotics as well as the prevention of the loss of fluid and electrolytes are important in the clinical recovery. The local resistance rates to antibiotics should be taken into consideration when planning empirical therapy. The aims of this retrospective study were to detect the in vitro antimicrobial susceptibility of 605 Shigella spp. strains isolated from feces samples of children at Hacettepe University Ihsan Dogramaci Children's Hospital between 1999 and 2010 and to compare the resistance rates by years. Susceptibility to ampicillin, cefotaxime, trimethoprim/sulfamethoxazole (T/S), nalidixic acid, and ciprofloxacin were determined in Mueller-Hinton Agar by disk diffusion method according to CLSI criteria. Among a total of 605 Shigella strains, 526 were identified as S.sonnei, 69 as S.flexneri, nine as S.boydii and one as S.dysenteriae. Resistance rates to ampicillin, cefotaxime, T/S and nalidixic acid were 24.3%, 3.6% 74.2% and 4.6%, respectively. All of the isolates were found susceptible to ciprofloxacin. Antibiotic resistance rates of the isolates did not exhibit any differences between the years. S.dysenteriae was isolated once in 2003 throughout this 12 year survey and the isolate was found susceptible to T/S and ciprofloxacin. A significant yearly decrease was detected in the number of stool cultures and number of Shigella spp. isolated in stool (p< 0.001). Ampicillin resistance was higher in S.flexneri (77.8%) and S.boydii (62.5%) than S.sonnei (17%). However, T/S resistance was higher in S.sonnei (78.9%) than S.flexneri (52.5%) and S.boydii (11.1%). In conclusion, continuous surveillance of resistance among Shigella species in Turkey seems to be imperative for establishing empirical treatment guidelines in our country.

Risk factors in community-acquired urinary tract infections caused by ESBL-producing bacteria in children.

In this study, risk factors were investigated in children with community-acquired urinary tract infections (UTI) caused by extended-spectrum beta-lactamases (ESBL)-producing E. coli or Klebsiella spp. One hundred and fifty-five patients were diagnosed with ESBL-positive UTI (case group) in the outpatient clinics of Hacettepe University Children's Hospital between 1 January 2004 and 31 December 2006. A control group, 155 out of 4,105 children, was matched by age and sex among children with ESBL-negative UTI. A total of 310 patients' files were evaluated retrospectively. As regards the symptoms of UTI, no statistical differences were seen between the two groups. Although the most frequently isolated microorganism was E. coli in both groups, Klebsiella spp. was found to be more frequent in those diagnosed with ESBL(+) UTI (p < 0.001). Having an underlying disease and hospitalization, infections, and use of antibiotics within the last 3 months were found to be potential risk factors (p < 0.001). With conditional logistic regression analysis, having an underlying disease and hospitalization within the last 3 months were identified as independent risk factors for ESBL(+) UTI. In conclusion, the recognition of risk factors for UTI, caused by ESBL(+) bacteria in children, may aid in the identification of high-risk cases and may enable proper management of these patients.

Sensitivity and specificity of bloody diarrhea in shigella gastroenteritis.

The sensitivity and specificity of bloody diarrhea in the diagnosis of shigella gastroenteritis in a Shigella sonnei prevalent center was investigated. The shigella-proven gastroenteritis cases who were admitted to Hacettepe University Ihsan Dogramaci Children's Hospital Diarrheal Diseases Unit (Jan 2003 - Oct 2006) constituted the study group (n=65). Age- and sex-matched children admitting to the same center with non-shigella diarrhea constituted the control group (n=65). The sensitivity, specificity, and positive and negative predictive values of bloody diarrhea were found to be 30%, 100%, 100% and 58%, respectively. Sensitivity of bloody diarrhea in the diagnosis of shigella gastroenteritis was low in this center. New strategies and recommendations in the management of mild nonbloody cases are needed.

Comparative in vitro activity of plazomicin and older aminoglyosides against Enterobacterales isolates; prevalence of aminoglycoside modifying enzymes and 16S rRNA methyltransferases.

Comparative in vitro activity of plazomicin and 4 older aminoglycosides was evaluated with broth microdilution in 714 blood isolates from 14 hospitals in Turkey. Isolates included Escherichia coli (n=320), Klebsiella spp. (n=294), Enterobacter spp. (n=69), Serratia marcescens (n=20), and Citrobacter spp. (n=11). Isolates resistant to older aminoglycosides (n=240) were screened for aminoglycoside modifying enzyme genes: aac(6')-Ib, aac(3)-Ia, aac(3)-IIa, ant(2″)-Ia. Isolates with high MICs for plazomicin (n=41) were screened for 16S rRNA methyltransferase genes (armA, rmtA, rmtB, rmtC, rmtD, rmtE, rmtF, rmtG, rmtH, npmA) and 2 carbapenemase genes (blaOXA-48, blaNDM-1). Overall, resistance to plazomicin, amikacin, netilmicin, gentamicin, and tobramycin was 7.7%, 7.4%, 31.5%, 32.9%, and 34.7%, respectively. aac(6')-Ib and aac(3)-IIa were the most common AME genes. Co-occurrence of blaNDM-1 with armA and rmtC and blaOXA-48 with armA was striking. Enterobacter cloacae carrying rmtC+blaNDM-1, S. marcescens with armA+blaOXA-48, and rmtF+ blaOXA-48 in K. pneumoniae were reported for the first time.

In vitro susceptibility of OXA-48, NDM, VIM and IMP enzyme- producing Klebsiella spp. and Escherichia coli to fosfomycin.

INTRODUCTION: Infections caused by Carbapenemase-producing Enterobacterales (CPE) are an important public health issue. Intravenous fosfomycin can be considered as an alternative for the treatment of serious infections caused by CPE. In this study, in vitro activity of fosfomycin was investigated among CPE isolates. METHODOLOGY: Overall, 158 clinically relevant isolates obtained from 18 hospitals of 13 cities in Turkey with predetermined carbapenemase types were evaluated in the study, including Escherichia coli (n = 19) and Klebsiella spp. (n = 139). In vitro activity of fosfomycin was determined with agar dilution method. Among Klebsiella spp., 104 harbored blaOXA-48, 15 isolates carried both blaOXA-48 and blaNDM; three had both blaOXA-48 and blaVIM and nine isolates had blaNDM alone. Four isolates carried only blaVIM and two isolates harbored blaIMP alone. One isolate co-harbored blaVIM and blaNDM. Among E. coli isolates, blaOXA-48 and blaNDM were carried by 18 and one isolates, respectively. RESULTS: Resistance to fosfomycin was detected in 43.7% of the isolates. Among Klebsiella spp. and E. coli, these rates were 46.8% and 21.1%, respectively. In Klebsiella spp. resistance to fosfomycin was 49.5% in blaOXA-48 carriers; 26.7% in isolates co-harbouring blaOXA-48 and blaNDM and 66.7% in blaNDM carriers. In E. coli, fosfomycin resistance was detected among 16.7% of the blaOXA-48 carriers. CONCLUSIONS: High level of fosfomycin resistance in these isolates may be attributable to the fact that these isolates are multidrug resistant. The genetic background of resistance should also be investigated in order to understand the co-occurrence and transfer of resistance among the CPE.

Prevalence of O25b-ST131 clone and fosfomycin resistance in urinary Escherichia coli isolates and their relation to CTX-M determinant.

Escherichia coli ST131 clone and H30-R/H30-Rx subclones are the most common multidrug-resistant high-risk clones in UTIs. Antimicrobial susceptibility of fosfomycin was compared to five other agents in consecutively collected 299 urinary isolates using the agar dilution method. Prevalence of the ST131 clone and the occurrence of blaCTX-M were also investigated. Overall resistance to fosfomycin, cefuroxime, and ceftriaxone were 2.7%, 35.4%, and 30.1% respectively. fosA, fosA3, and fosC2 genes were not detected. In isolates resistant to ciprofloxacin (34.7%), the prevalence of ST131 clone was 31.7%, of which 81.8% belonged to H30-R and 66.7% to H30-Rx subclones. None of the isolates of the ST131 clone were resistant to fosfomycin. However, blaCTX-M occurred in 57.6% of the isolates among this clone, 62.9% in H30-R and 68.2% in H30-Rx subclones. The results of this study suggest that fosfomycin resistance is not prevalent in urinary isolates, however, blaCTX-Mpositive ST131 clone is quite common.

Characterization of extended-spectrum beta-lactamase-producing Salmonella isolates in a children's hospital in Ankara--first report of SHV-2a and SHV-9 in Salmonella spp. from Turkey.

The rate of in vitro resistance to various antimicrobials in 179 consecutive isolates of Salmonella spp., which included serogroups D (109), B (52), C1 (10) and C2 (8) isolated from children, was investigated. Production of extended-spectrum beta-lactamase (ESBL) was studied in ampicillin-resistant isolates. Antimicrobial susceptibilities were determined by disk diffusion tests and by BIOMIC video reader system. Overall resistance rates to ampicillin and amoxicillin/clavulanate were 26.3% and 10.6%, respectively. Resistance to ceftriaxone and ceftazidime was 3.3%. Resistance rates for chloramphenicol, trimethoprim-sulfamethoxazole, ciprofloxacin, amikacin and gentamicin were 40.7%, 31.3%, 2.2%, 2.2% and 6.1%, respectively. beta-lactamase production was detected in 42 isolates. Mating out experiments, isoelectric focusing, dot blot hybridization, polymerase chain reaction (PCR) and sequencing were performed on two S. paratyphi B isolates that produced ESBLs. One isolate produced SHV-2 and TEM-1 and the other produced SHV-2a, SHV-5a (SHV-9) and TEM-1. This is the first report of SHV-2a and SHV-5a (SHV-9) in S. paratyphi B in Turkey.

Comparison of nasopharyngeal culture, polymerase chain reaction (PCR) and serological test for diagnosis of pertussis.

This prospective study, which was designed to compare nasopharyngeal culture, polymerase chain reaction (PCR) and serology in the diagnosis of pertussis, covered 35 children aged between 0 and 16 who were admitted to Hacettepe University Ihsan Dogramaci Children's Hospital between 1 March 2005 and 31 August 2006 with coughing for 7 days or longer, paroxysmal cough of any duration, or cough with inspiratory whoop and/or vomiting (or apnea) after coughs. The demographic data and vaccination history of the patients were recorded. During the initial examination, samples were taken from the posterior nasopharynx for Bordetella pertussis (B. pertussis) culture and PCR analysis. In order to determine antibody positivity and antibody levels against B. pertussis antigens, serum samples were taken during the initial examination (acute phase) and two weeks later (convalescent phase). In the first serum sample, immunoglobulin M (IgM) was determined against pertussis toxin. In the first and second samples, IgA and IgG antibodies were evaluated against pertussis toxin and filamentous hemagglutinin. Culture yielded negative results in all of the patients. PCR was positive in two cases (5.7%). In the PCR-positive patients, IgM, IgA and IgG type anti-pertussis antibodies were found to be positive in the first serum samples, and IgA and IgG antibodies were found to be positive in the second serum samples. Therefore, it was considered that serology could be as sensitive as PCR when type IgM, IgA and IgG antibodies were found to be positive against a minimum of two antigens of B. pertussis. In conclusion, both PCR and serologic tests--if evaluating all types of antibodies to a minimum of two antigens of B. pertussis obtained in both acute and convalescent sera--could be more sensitive than culture in the diagnosis of pertussis.