[A New Case of Fournier's Gangrene Caused by Actinotignum schaalii]. / Actinotignum schaalii'nin Etken Oldugu Yeni Bir Fournier Gangreni Olgusu.

Actinotignum schaalii (formerly known as Actinobaculum schaalii) is an anaerobic or facultative anaerobic gram-positive bacillus that can be found commensally in the urogenital region. It can be overlooked because it grows slowly and is difficult to identify with classical microbiology laboratory techniques. Colonies become visible after 48-72 hours of incubation on blood agar in anaerobic or CO2-rich media. While it typically causes urinary tract infection in older individuals, cases of bacteremia, vertebral osteomyelitis, endocarditis and cellulitis have been reported. Fournier's gangrene caused by A.schaalii has been reported very rarely so far. Fournier's gangrene has been defined as necrotizing fasciitis of the external genitalia, perineal and perianal region. Diabetes, immunosuppression, peripheral vascular disease, urethral anomalies, chronic alcoholism and smoking are important predisposing factors. In addition, approximately 25% of the cases have no known or identifiable etiology. The bacteria causing the infection may originate from skin, urogenital or intestinal microbiota. In this case report, a new case of Fournier's gangrene caused by A.schaalii was presented. A 65-year-old male patient admitted to the emergency department with the complaints of pain, swelling, redness in the left testis and also nausea, vomiting and chills that started three days ago. Physical examination revealed increased diameter of the scrotum, intense hyperemia of the skin and foci of necrosis. It was learned that the patient had no known chronic disease other than benign prostatic hyperplasia. The patient reported smoking of 25 packs of cigarettes per year. Routine laboratory tests revealed leukocyte= 32.41 x 109/L, neutrophil= 89.9%, procalcitonin= 1.62 ug/L, CRP= 265.07 mg/L and the patient was operated with the diagnosis of Fournier's gangrene. Gram staining of the abscess specimen obtained during the operation showed gram-positive bacilli both inside and outside the leukocytes. After 24 hours, grampositive bacilli were detected in the Gram staining of thin, transparent/gray colonies grown on 5% sheep blood and chocolate agar. The isolate was identified as A.schaalii by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) VITEK® MS (bioMérieux, France) microbial identification system. VITEK®2 ID ANC (bioMérieux, France) bacterial identification card was also used for comparison but the bacteria could be identified. As a result of the sequence analysis performed for confirmation, it was shown to be 100% homologous with Actinobaculum schaalii (GenBank accession no: FJ711193.1). For susceptibility tests, 5% sheep blood Schaedler agar was used and incubated in anaerobic environment. According to the minimal inhibitory concentration (MIC) results evaluated after 48 hours, penicillin was found to be 0.032 mg/L, clindamycin 0.125 mg/L, ciprofloxacin 0.19 mg/L, ceftazidime 4 mg/L, and amoxicillin 0.19 mg/L. The primary cause that initiated the infection in the case could not be identified, but it was thought that the presence of prostatic hyperplasia and smoking history may have contributed to the occurence or the progress of the disease. It is noteworthy that the ciprofloxacin MIC result was quite low compared to other studies. In addition, this study revealed the value of MALDI-TOF MS based methods in identification. In conclusion, it is thought that a significant proportion of A.schaalii infections may be overlooked due to the difficulty in growth and identification. Increasing the diagnostic power of clinical microbiology laboratories for poorly identified bacteria and renewing the databases of commercial identification systems are important for the early and accurate diagnosis and treatment of serious infections that may occur with such agents.

[The Importance of Mycological Diagnosis: A Scedosporium apiospermum Complex Mycetoma Case Neglected For 20 Years]. / Mikolojik Taninin Önemi: 20 Yil Ihmal Edilen Bir Scedosporium apiospermum Kompleks Miçetoma Olgusu.

Scedosporium apiospermum complex members are opportunistic fungi that can be found in environments such as soil and polluted water. In this report, we aimed to present a case of mycetoma caused by Scedosporium apiospermum complex that developed in a 40-year-old female patient with immunocompetent system and diagnosed by fungal culture. In the anamnesis of the patient who admitted in 2015 with the complaint of more than one fistulized discharge wound, pain and swelling in the dorsal of the right hand and wrist; it was learned that her complaints started about 20 years ago with a slight swelling on the back of the wrist, and when it worsened, the abscess was drained and antibiotic treatment was initiated in a private surgical center. However, it was learned that she did not benefit from the treatments, and over time, fistulized, yellow-discharged wounds appeared on the back of her hand and wrist, and she had undergone various surgical interventions and used antibiotics. Routine laboratory tests of the patient, who did not have an underlying chronic disease, were normal. Magnetic resonance imaging (MRI) and X-ray findings were compatible with osteomyelitis and 'dot in circle' sign seen on MRI was characteristic for mycetoma. Pathological examination was interpreted as active chronic inflammatory reaction in the soft tissue and chronic osteomyelitis. Mycobacteria, bacteriological and fungal cultures of the two biopsy samples taken during surgical debridement and one month later were performed. Bacteriological and mycobacterial cultures were negative, while Scedosporium genus grew in the fungal cultures of the both samples. Isolates were identified as Scedosporium apiospermum/Pseudallescheria boydii with MALDI Biotyper (Bruker Daltonics, Bremen, Germany) system and Scedosporium boydi by sequence analysis of the ITS region. The antifungal susceptibility tests were performed according to CLSI M38-A2 criteria, and were evaluated at the 72nd hour. The minimum inhibitory concentration (MIC) values of fluconazole, caspofungin, amphotericin B, itraconazole, vorikonazole, posaconazole and isavuconazole were > 64 µg/ml, 16 µg/ml, 4 µg/ml, 16 µg/ml, 0.25 µg/ml, 2 µg/ml and 0.25 µg/ml, respectively. Voriconazole and terbinafine treatment was initiated. In the control performed in the 9th month of the treatment, it was observed that the complaints of discharge, pain and swelling were resolved, pain and swelling complaints were recovered, fistula tracts were closed and joint movements were painless. In the control MRI performed at 15th and 18th months, it was observed that there was no soft tissue involvement and the findings were compatible with osteoarthritis after infective osteomyelitis. This case whose longterm complaints improved with mycological diagnosis and appropriate treatment; reveals the importance of keeping mycological diagnosis in mind in chronic bone and soft tissue infections. Identifying the fungus to the genus and species level and arranging the treatment according to the antifungal susceptibility test results are very important in patient management.

Evaluation of Teicoplanin Resistance Detected by Automated System in Coagulase Negative Staphylococci: A Comparison with Gradient Test and Broth Microdilution Methods.

Upon the observation of an increase in teicoplanin resistance rates in coagulase negative staphylococci (CoNS) isolates determined by the automated system, we aimed to compare the automated system and gradient test methods with the gold standard broth microdilution method. In addition, the effect of standard antimicrobial susceptibility guidelines on teicoplanin susceptibility test results in CoNS was investigated. A total of 81 CoNS isolates, 52 resistant and 29 susceptible to teicoplanin determined by automated system (Phoenix, Becton Dickinson, USA), were tested. The minimum inhibitory concentration (MIC) values were determined by gradient test (M.I.C. Evaluators, OXOID, UK) and broth microdilution methods. Susceptibility categories were determined according to EUCAST and CLSI criteria and the results were compared. Among 29 isolates found to be susceptible by automated system, one isolate was found resistant by gradient and broth microdilution tests. Of the 52 resistant isolates determined by automated system, 12 (23%) were found to be resistant by gradient test and 22 (42.3%) were resistant by broth microdilution. According to CLSI criteria, no resistant isolates were detected by broth microdilution and six isolates were intermediately susceptible while, two isolates were detected to be resistant and five isolates were found to be intermediately susceptible by the gradient test. In conclusion, compared to microdilution, teicoplanin resistance was detected at a higher rate in CoNS isolates by the automated system used. On the other hand, the gradient test method which is frequently used for confirmation was not reliable in MIC values close to the EUCAST breakpoint values (4 µg/mL). In addition, lower resistance rates were observed when the CLSI breakpoints were used in gradient test and broth microdilution methods.

Comparison of the Sensititre YeastOne antifungal method with the CLSI M27-A3 reference method to determine the activity of antifungal agents against clinical isolates of Candidaspp.

Background and aim: Infections caused by Candida species are significantly increasing today, and invasive Candida infections are generally associated with high mortality. Early diagnosis and identification of Candida spp. is important for the determination of antifungal agents that will be used for treatment. The aim of the present study was to provide a better regimen for Candida infections in the future. Materials and methods: TheSensititre YeastOne (SYO) method was compared with The Clinical Laboratory Standards Institute (CLSI) reference broth microdilution (BMD) testing method. Endpoints of minimal inhibitory concentrations (MICs) were determined for both methods. Results: By using both methods, MIC values of micafungin, caspofungin, voriconazole, and fluconazole were lower than amphotericin B. The values obtained with the SYO method were in high categorical agreement for ecinocandins and amphotericin B. The results of voriconazole and fluconazole were in low categorical agreement. The categorical agreement between the SYO and the BMD results at 24 h was 82.1% for VORI and 98.4% for AMB. Values obtained with SYO method for all antifungal agents were in high essential agreement with the data of the CLSI reference BMD method. The essential agreement between the SYO and the BMD results at 24 h was 94.0% for MFG and 99.0% for AMB. Conclusions: The SYO method was ready-to use, so it appeared to be easier and more efficient for Candida isolates.

The frequency, antifungal susceptibility and enzymatic profiles of Candida species in cases of onychomycosis infection.

Although the frequency of candidal onychomycosis is increasing daily, there is little information in literature about the epidemiology, pathogenesis, and antifungal susceptibility of this dermatological disease. This study aimed to provide information about the epidemiology, pathogenesis, and azole susceptibility of Candida species isolated from patients living in a region with continental climate. After identification of the isolated strains using conventional methods, proteinase and phospholipase activities were determined by a plate method and biofilm-forming ability was determined using the microplate method. Susceptibility of the same species to fluconazole (FLU), voriconazole (VRC), miconazole (MNZ), itraconazole (ITZ), and ketoconazole (KTZ) were determined by microdilution method. The 50 Candida isolates included 23 C. parapsilosis (46%), 13 C. albicans (26%), 4 C. guilliermondii(8%), 4 C.tropicalis (8%), 2 C.krusei(2%), 1 C.lusitaniae (2%), 1 C. sake (2%), and 1 C. kefyr (2%) isolates. The geometric mean (GM) of the minimum inhibitory concentration (MIC) for FLU, KTZ, VRC, MNZ, and ITZ was 0.4 µg/mL, 0.08 µg/mL, 0.08 µg/mL, 0.2 µg/mL, and 0.6 µg/mL, respectively. Proteinase, phospholipase, and biofilm-forming ability were detected in 18%(9/50), 20%(10/50), and 6%(3/50) of the Candida isolates, respectively. We found that the most frequently isolated species is C.parapsilosis. On the basis of the GM values, the most effective azoles are ketoconazole and voriconazole. The isolated Candida species exhibited low phospholipase, proteinase, and biofilm formation activities.

The use of rapid antigen testing and matrix-assisted laser desorption/ionization-time of flight mass spectrometry in the diagnosis of group A beta-hemolytic streptococci in throat swab samples

Background/aim: We aimed to evaluate the efficacy of a rapid antigen test in detecting group A beta-hemolytic streptococci (GAS) in throat samples in comparison with the culture method and to compare the efficiency of matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) and traditional methods in identifying GAS in cultures. Materials and methods: A total of 3668 throat samples from patients with a prediagnosis of tonsillopharyngitis were assessed by the QuickVue+Strep A antigen test and culture. For GAS identification from cultures, bacitracin sensitivity, PYR, and latex agglutination tests and MALDI-TOF MS were used. Results: A total of 567 (15.5%) and 536 (14.6%) of the samples were positive for GAS culture and rapid antigen testing, respectively. The sensitivity and specificity of the rapid antigen test compared to culture was 89.07% and 99%, respectively, while positive and negative predictive values were 94.22% and 98.02%. Traditional methods were in full concordance with MALDI-TOF-MS for all 567 isolates. In all densities of growth in culture, the time to diagnosis with MALDI-TOF MS was significantly lower than with traditional identification tests. Conclusion: This study shows that both the rapid antigen testing of samples and bacterial identification with MALDI-TOF MS contribute much to the rapid diagnosis of GAS tonsillopharyngitis.

[Evaluation of Mascia Brunelli rapid antigen test in the diagnosis of group A streptococcal pharyngitis]. / A grubu beta-hemolitik streptokok farenjiti tanisinda Mascia Brunelli hizli antijen testinin degerlendirilmesi.

Pharyngitis in most cases is due to viral microorganisms however drug therapy without the detection of etiological agent leads to unnecessary use of antibiotics. On the other hand, when the etiologic agent is group A beta-hemolytic streptococci (GAS) it is important to identify the etiologic agent rapidly which will guide the treatment with appropriate antibiotics. The use of highly sensitive rapid tests will contribute significantly to early diagnosis and appropriate therapy. The aim of this study is to evaluate the efficacy of Mascia Brunelli rapid antigen test for the detection of GAS in throat swab samples. A total of 833 throat swab samples submitted to our laboratory with pre-diagnosis of pharyngitis were assessed between June 2016 and August 2016. The samples were simultaneously cultured and tested by rapid Mascia Brunelli Strep-A Card (Mascia Brunelli S.p.a, Italy). For identification, bacitracin sensitivity, PYR test and latex agglutination test in addition to Bruker MALDI-TOF MS (Daltonics, Germany) system were used. The density of GAS growth in the culture was noted. The samples that were false negative with Mascia Brunelli test were re-tested with QuickVue + Strep A Test (Quidel Corporation, San Diego, USA) rapid antigen test. A total of 833 patients, 376 (45.2%) female and 457 (54.8%) male were included in the study. The age range was between 0-94 years with a mean value of 7.86 ± 6.72. 125 (15%) and 94 (11.28%) of the samples were positive with culture and rapid antigen test, respectively. Mascia Brunelli antigen test gave negative results for 31 culture positive samples. Of these 31 samples, 28 were found positive by QuickVue + Strep A antigen test. As a result, the sensitivity of the test was found to be independent of the inoculum effect. The culture positivity rate in patients between 5-15 years was 18.4%. The sensitivity, specificity, positive predictive value, negative predictive value and the accuracy of Mascia Brunelli antigen test, with respect to culture, were 75.2%, 100%, 100%, 95.81% and 96.28%, respectively. In conclusion, the selection of rapid antigen tests with high sensitivity in the diagnosis of GAS pharyngitis will contribute to the prevention of resistance development by appropriate use of antibiotics as well as early diagnosis and appropriate treatment. However, confirmation of negative rapid antigen test results by culture is very important in terms of false diagnosis and prevention of incomplete treatment.

Fatal panresistant Lomentospora prolificans fungemia in a patient with aplastic anemia: First report from Türkiye.

Lomentospora prolificans is an opportunistic pathogen that can cause invasive lomentosporiosis in immunocompromised patients. Patients with hematological malignancies and those who have undergone stem cell or solid organ transplantations are in the highest risk group. In addition to the limitations and delays in diagnostic possibilities, L. prolificans has a high mortality due to its resistance to all available antifungal drugs. In a patient diagnosed with aplastic anemia, we described the first case of L. prolificans in Türkiye. L. prolificans was identified in the blood culture, and despite the initiation of antifungal treatments, the fungemia resulted in mortality on the 7th day of intensive care hospitalization. This case highlights the importance of early recognition and prompt initiation of appropriate antifungal therapy to improve the outcome of patients with rare mold infections.

Infective endocarditis caused by Chaetomium globosum.

Chaetomium globosum is a dematiaceous, filamentous fungus belonging to the large genus saprobic ascomycetes and is rarely involved in human infection. We present the case of a 25-year-old man undergoing tricuspid valve replacement due to recurrent prosthetic ring endocarditis. Initially, it was considered culture-negative endocarditis; however, the diagnosis of Chaetomium globosum could only be provided by DNA isolation of the mold isolate grown in culture and the valve tissue samples taken from the patient. This report describes the first documented tricuspid endocarditis caused by Chaetomium species and discusses the importance of molecular tools to enhance the diagnostic process in culture-negative endocarditis, especially for fastidious and nonculturable microorganisms.

The effects of measures taken during the COVID-19 pandemic on the seasonal dynamics of respiratory viruses in children.

BACKGROUND: We aimed to evaluate the effects of public health measures taken during the COVID-19 pandemic on respiratory viruses. METHODS: The study was conducted between February 1, 2021 and December 1, 2022. Patients aged 1 month to 18 years hospitalized for infectious diseases were tested for SARS-CoV-2 and respiratory viruses by multiplex PCR. RESULTS: Of the total 1173 patients, 56.2% were male and 43.8% were female, and 47.5% of the patients were under 24 months of age. The viruses detected were SARS-CoV-2 31.9%, human rhinovirus/enterovirus 19.4%, respiratory syncytial virus (RSV) 9.3%, parainfluenza virus 7%, adenovirus 6%, seasonal coronavirus 5.2%, bocavirus 3.8%, influenza 3.1%, and metapneumovirus 2.8%. Among the patients, 386 were hospitalized with lower respiratory tract infections, 238 with upper respiratory tract infections, 202 to evaluate fever etiology, 111 with acute gastroenteritis and 236 with other diagnoses. Of these patients, 113 were admitted to the intensive care unit. Intensive care unit admission rates were statistically significantly higher for bocavirus and RSV, in those hospitalized between July 1, 2021 and July 1, 2022 (first period when schools were held full-time face-toface at all grades) and in children aged 1-24 months. CONCLUSIONS: Public health measures taken during the COVID-19 pandemic have affected the seasonal distribution of respiratory viruses and the severity of illness in children.

Species distribution of the Mycobacterium tuberculosis complex in clinical isolates from 2007 to 2010 in Turkey: a prospective study.

The Mycobacterium tuberculosis complex (MTBC) consists of a group of closely related species that differ in their epidemiological profiles, host ranges, pathogenicities, geographic distributions, and drug resistances. Identification of members in the MTBC is essential for monitoring the epidemiology of tuberculosis (TB) and implementing appropriate public health control measures. In this study, 188 consecutive MTBC clinical isolates from 2007 to 2010 were evaluated to determine the prevalence of MTBC species in Turkey. PCR and restriction fragment length polymorphism analysis (PCR-RFLP) of the gyrB gene were used, and results for species other than M. tuberculosis were confirmed using the GenoType MTBC assay (Hain Lifescience, Nehren, Germany). Most of the strains were found to be M. tuberculosis (94.1%). The prevalences of M. bovis and M. caprae were 4.3% and 1.6%, respectively. Only one M. bovis BCG strain was identified. Overall, the frequency of bovine tuberculosis in humans was 5.3%. We had assumed that bovine TB infection was under control in animal herds, but primary M. bovis infections in humans caused by transmission from infected animals are still an issue in Turkey. Our results indicate that the frequent identification of M. bovis in routine mycobacteriological laboratory work has further importance due to the well-known resistance of this species to pyrazinamide.

Comparative evaluation of the Bruker Biotyper and Vitek MS matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) systems for non-albicans Candida and uncommon yeast isolates.

INTRODUCTION: Rapid and accurate diagnosis is critically important in invasive and disseminated fungal infections for appropriate antifungal treatment. HYPOTHESIS: MALDI-TOF MS systems are effective for fast and accurate identification of Candida species. AIM: We aimed to compare two MALDI-TOF MS systems for the rapid identification of non-albicans Candida and rare clinical yeast species. METHODOLOGY: This study included 157 isolates representing 23 yeast species. All isolates were identified using Bruker MALDI Biotyper and VITEK MS systems. If both MALDI-TOF MS systems yielded the same results for a certain isolate, the identification is regarded as correct. We performed internal transcribed spacer (ITS) DNA sequencing on five fungal isolates with discordant species names or that were unidentified by the two MALDI-TOF MS systems. RESULTS: The yeast identification sensitivity of MALDI Biotyper was 98.7%, whereas that of VITEK MS was 96.8%. Both MALDI-TOF MS systems correctly identified all strains belonging to four prevalent species, namely, Candida parapsilosis, Candida tropicalis, Candida glabrata, and Candida krusei. For the 19 rare clinical yeast species, identification rates were 96.7% for MALDI Biotyper and 91.7% for VITEK MS. The ITS sequence analysis of five isolates yielded two Meyerozyma caribbica, two Cyberlindnera fabianii, and one Candida dubliniensis. CONCLUSIONS: This study showed the high performance of both MALDI-TOF MS systems, identifying over 90% of yeast isolates in a short time. The disadvantages of these systems are that some species are not present in the databases and it cannot distinguish closely related species. The sensitivity of MALDI-TOF MS systems constantly improves with the expansion of databases in parallel with taxonomic developments for the identification of rare clinical yeast species.

Effects of calcineurin inhibitors, cyclosporine A and tacrolimus (FK506), on the activity of antifungal drugs against Candida spp.

Introduction. The simultaneous use of antifungals with immunosuppressive agents has become a necessity for patients taking immunosuppressive therapy. However, antifungal drugs are problematic because of their limited target.Hypothesis. Scientists have been searching for new antifungals and some compounds with at least additive effects on antifungals. Calcineurin inhibitors used as immunosuppressive agents also attract attention due to their antifungal property.Aim. To evaluate the activity of two calcineurin inhibitors alone and in combination with amphotericin B (AMB), caspofungin (CAS), itraconazole (ITR), voriconazole (VOR) and fluconazole (FLU).Methodology. MICs of AMB, CAS, ITR, VOR, FLU and cyclosporine A (CsA) and tacrolimus (TAC) as calcineurin inhibitors were evaluated by the broth microdilution method against Candida albicans (n=13), C. krusei (n=7) and C. glabrata (n=10). Checkerboard and time-kill methods were performed to investigate the activity of combining calcineurin inhibitors with antifungal drugs.Results. The lowest MIC values were detected with VOR for all Candida isolates tested. Although we did not detect any inhibition for CsA or TAC alone at concentrations tested in this study, the combinations of CAS with CsA showed the highest synergistic activity (36.7%) by the checkerboard method, and CAS with CsA and ITR with TAC combinations exhibited apparent synergistic interaction by the time-kill method. However, the combinations of both CsA and TAC with AMB resulted in antagonistic interactions, especially against C. krusei isolate in time-kill testing.Conclusion. Synergistic interactions in the combinations of TAC or CsA with antifungal drugs, except for AMB, in many concentrations was found to be promising in terms of the treatment of patients with fungal infections.

Candida auris Fungemia and a local spread taken under control with infection control measures: First report from Turkey.

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.

Identification of the Mycobacterial Strains Isolated From Clinical Specimens Using hsp65 PCR-RFLP Method.

OBJECTIVES: It is important to identify mycobacteria at the species level, to distinguish pathogen from non-pathogenic species, to choose the appropriate treatment regimen and to collect epidemiological data. For the identification of mycobacteria, which are time-consuming and laborious with traditional methods, faster, more sensitive and reliable methods are needed. This study aims to investigate the suitability of the hsp65 Polymerase chain reaction-restriction fragment polymorphism (PCR-RFLP) method for routine laboratory use. METHODS: In this study, 141 mycobacterial isolates were obtained from 1632 samples, which were sent to the Medical Microbiology Laboratory. RESULTS: In the culture, mycobacteria were identified as 138 M. tuberculosis complex (MTBC) and three non-tuberculosis mycobacteria (NTM) by conventional methods. Using the hsp65 PCR-RFLP method, 137 isolates were identified as MTBC, four isolates as NTM. An isolate that was evaluated as MTBC because it was PNB sensitive by the conventional method was determined as NTM with the hsp65 method. In the identification of non-tuberculosis mycobacteria with the hsp65 PCR-RFLP method, one isolate was identified as M. abcessus and three isolates were identified as M. avium complex. CONCLUSION: In our study, it was concluded that the hsp65 PCR-RFLP method, which allows identification of mycobacteria, including NTMs, is a method that is cheap, easy and suitable for routine use to provide rapid information to the clinic. The scope of the agar and database used in the method is effective in the definition of the correct species.

Comparison of Carba NP-Direct, Carbapenem Inactivation Method, and ß-CARBA Tests for Detection of Carbapenemase Production in Enterobacteriaceae.

Rapid and accurate detection of carbapenemase-producing isolates are extremely important for management of antimicrobial therapy and the implementation of infection control measures. We evaluated the performance of Carba NP-direct, carbapenem inactivation method (CIM), and the commercial ß-CARBA tests for detection of carbapenemase production in Enterobacteriaceae. Enterobacteriaceae isolates with previously characterized carbapenemase types (n = 110) and non-carbapenemase-producing Escherichia coli (n = 15) isolates were tested. Sensitivities of Carba NP-direct, CIM, and ß-CARBA tests were 99.0%, 92.7%, and 93.6%, respectively, while specificity was 100% for all three tests. For ß-CARBA test, a 60-min incubation time instead of 30 increased the sensitivity to 98.1%, and lessened false negativity, particularly with OXA-48-like producers. Our results showed that Carba NP-direct, CIM, and ß-CARBA tests are useful tools for the reliable detection of carbapenemase activity in enterobacterial isolates. Carba NP-direct is a simple, rapid, and low-cost test for routine use.

In vitro susceptibility of seven antifungal agents against dermatophytes isolated in Istanbul

Background/aim: Dermatophytes are the causative agents of dermatophytosis, which is a common disease worldwide that affects the hair, skin, and nails. Dermatophytes comprise more than 40 species in 3 genera: Microsporum, Trichophyton, and Epidermaphyton. In this study, we aimed to determine the effectiveness of seven antifungal agents: amphotericin B, terbinafine, itraconazole, voriconazole, ketoconazole, miconazole, and fluconazole. Materials and methods: A sensitivity study was performed using a microdilution method in accordance with the CLSI M38-A2 standards using isolates of Trichophyton rubrum (n = 55), Microsporum canis (n = 9), and Trichophyton interdigitale (n = 2), which were identified by sequencing the internal transcribed spacer region of the rDNA. Results: According to the results of antifungal sensitivity tests, the geometric mean (GM) minimum inhibitory concentration (MIC) against T. rubrum was 0.10 µg/mL for ketoconazole, 0.20 µg/mL for itraconazole, 0.07 µg/mL for miconazole, 0.48 µg/mL for fluconazole, 2.27 µg/mL for amphotericin B, 0.06 µg/mL for voriconazole, and 0.06 µg/mL for terbinafine. Conclusion: The most effective antifungal drugs were voriconazole and terbinafine, both of which had a GM MIC of 0.06 µg/mL.

Magnusiomyces capitatus Peritonitis in a Child With Acute Lymphocytic Leukemia as a Breakthrough Infection During Caspofungin Therapy.

Magnusiomyces capitatus is an emerging opportunistic fungal pathogen particularly in immunocompromised patients. We report a case of a M. capitatus peritonitis in child with acute lymphocytic leukemia as a breakthrough infection during caspofungin therapy. The possibility of breakthrough infections caused by M. capitatus must be taken into consideration, particularly in immunosupressed patients being treated for systemic fungal infections by caspofungin. Although there are no defined breakpoints for susceptibility testing of M.capitatus, minimal inhibitory concentration results can be helpful for therapy. Antifungal treatment with amphotericin B lipid complex plus flucytosine can be effective against infections caused by M. capitatus.