Microbial contamination and infection risks of narghile besides hazards of tobacco.

OBJECTIVE: Water-pipe smoking has become a serious public health threat worldwide. In order to raise awareness of adverse effects and transmission of bacteria via water-pipe smoking, we aimed to identify the bacteria and their antimicrobial resistance profiles that colonize different parts of waterpipes. METHODS: We examined totally 182 water pipes from 7 lounges (in Turkey) used in public places and we collected 728 culture samples in total by microbiological methods. We used disposable sterile swabs to sample the inside and outside of the mouthpiece, and the handling piece and sterile injectors were used to collect 5 mL of water from the water pipe bowl. RESULTS: There was a significant (p < 0.05) difference in microbial contamination (growth/presence of bacteria and fungi) among the parts of the water pipes sampled. There was a significant (p < 0.05) difference in the number of bacteria growing (microbial load) among the parts of the water pipes. Only one narghile lounge out of seven, which had 13 water pipes, had a hygiene procedure. The water jars are often contaminated with Gram-negative bacteria. CONCLUSION: Water pipes, especially the interior and outer part of the mouthpieces and the handle, are colonized by microbes and pose a risk of infection. Procedures for water pipe hygiene should be developed, periods should be defined, and the owners and employees of establishments and water-pipe smokers should be educated in this regard. Water-pipe smoking is a threat to public health and should be regulated by the state.

[Employee Safety and Biosafety Applications in Microbiology Laboratories; A Multicenter Evaluation in Turkey]. / Mikrobiyoloji Laboratuvarlarinda Çalisan Güvenligi ve Biyogüvenlik Uygulamalari Açisindan Türkiye'de Çok Merkezli Bir Degerlendirme.

Medical laboratory personnel may be exposed to various hazards, especially biological and chemical, during their routine activities. In this multicenter study, which could reflect the nation wide results, it was aimed to determine the safety and biosecurity practices of the employee working in medical microbiology laboratories and to reveal the current situation. A total of 1072 personnel working in the Medical Microbiology Laboratory of 23 hospitals (14 medical faculty hospitals, seven ministry of health training and research hospitals and two state hospitals) from different provinces were provided with a questionnaire consisting of 33 questions inquiring about the rules, opinions, attitudes and behaviors regarding safety and biosafety practices. Statistical analyses were made with institutions, age groups, gender, educational background, working time and occupational groups in terms of exposure to biological and chemical hazards. It was determined that approximately 50% personnel of the university/ training and research hospitals and 2/3 of the state hospitals personnel consumed food and beverages in the laboratories (p<0.05). Compared with other hospitals, it was determined that in state hospitals; the absence of separate resting room (35%), the personnel finding their own knowledge and practices inadequate (28.9%), laboratory coats washed at home (95%), educational organization and participation rates (90%) and medical waste information levels of the personnel were higher (p< 0.05). It was determined that as the age progresses, the rate of education, food and beverage consumption in the laboratory, not being outside the laboratory with protective equipment (gloves, masks and laboratory coats) and the history of laboratory acquired infections were increased (p< 0.05). It was observed that washing the laboratory coats at home was higher in the younger age group and hospital washing was higher in the elderly group (p< 0.05). There was no significant difference between the genders in terms of food and beverage consumption in the laboratory (p= 0.09). It was determined that periodic health checks were not performed in 1/3 of both sexes, but the use of gloves and compliance with medical waste rules was lower in men. Female employees find themselves inefficient in terms of knowledge and practices (p< 0.05). The rate of those who did not have their periodic checkups at regular intervals was higher in the high school and master of science education groups; While non-compliance with medical waste rules, food and beverage consumption in the laboratory was highest in the primary and high school graduates, the lowest rates were found in the master and doctorate groups (p< 0.05). The rate of those who had regular health checkups was higher in the group of specialist physicians and technicians (p< 0.05). It was observed that the rule of not going out of the laboratory with protective equipment was fully observed in the 35+ years working group, while compliance was 70-85% in other groups (p< 0.05), hepatitis B vaccination rate was highest in specialist doctors and lowest in cleaning and other personnel group (p< 0.05). Highest non-compliance rate with medical waste rules was observed in the cleaning personnel group (p< 0.05). As a result, although advances have been made in employee safety practices in medical microbiology laboratories in our country in recent years, it has been found that it is not yet sufficient. The results indirectly reflected the profile of medical laboratories in our country. In the laboratories, physical space and equipment deficiencies should be eliminated, periodic health checkups and vaccination should be provided, non-staff entrance to the laboratory and food, beverage and cigarette consumption should be prevented, laboratory coats should be washed in the hospital, in-service trainings, including medical waste training, should be conducted and these trainings should be developed through mechanisms that will change the behavior.

Comparison of the Xpert CARBA-R Test and Phenotypical Tests for Detection of Carbapenemases Types in Multidrug Resistant K. pneumoniae Isolates.

BACKGROUND: The objective of this study is to evaluate the performance of the Xpert CARBA-R Test and the phenotyping confirmation tests (MHT, CIM, Mastdiscs, and Carba NP) for the detection of carbapenemases in multidrug resistant (MDR) Klebsiella pneumoniae isolates. METHODS: A total of 68 MDR K. pneumoniae isolates isolated from various clinical samples, were included in the study. The identification and antibiotic susceptibility tests of these isolates were performed using the VITEK®2 (BioMérieux, France) automated system. The Xpert CARBA-R test was used as the molecular method. The combined disc method was performed using Mastdiscs Combi-D70C that includes four antibiotic discs with specific in-hibitors. The modified Hodge test was performed on all isolates. Carbapenemase inactivation method (CIM) and Carba NP test was used for carbapenemase enzyme production. RESULTS: Of the 50 isolates detected to produce carbapenemase by the molecular method (Xpert CARBA-R Test), 45 (90%) were detected by MHT, 39 (78%) were detected by CIM, and 42 (84%) were detected by Mastdiscs, while all the 50 isolates were detected by the Carba NP test. When the Xpert CARBA-R Test was taken as a reference, significant differences were found between the Carba NP and Xpert CARBA-R Test. There was no significant difference between the other phenotypic methods and Xpert CARBA-R Test. The sensitivity of the MHT, CIM, combined disc, and Carba NP tests was calculated as 0.90, 0.78, 0.84, and 1 and their specificity was calculated as 0.83, 0.83, 0.83 and 0, respectively. According to the gold standard, the predictive power of MHT, CIM, and MAST methods was found to be statistically significant. CONCLUSIONS: There are various methods of carbapenemase detection, including phenotypic and molecular methods. There is no single detection method that is valid and usable in all conditions. Laboratories should choose a suitable carbapenemase detection and confirmation method in line with their needs, economic conditions, and infrastructures. Although the detection of the presence of carbapenemase by molecular methods is fast and reliable, low-cost phenotypic tests can be used in laboratories that do not have this possibility. It is an important advantage that the combined disc method can also determine the enzyme type.

Detection and Evaluation of Escherichia coli O157:H7 and Shiga-toxin Genes stx1, stx2 in Cattle Meat Samples.

Background: Screening of transmission routes and routine control of the food for foodborne-pathogens are vital in terms of public health. In this study, we aimed to investigate and evaluate the presence of E. coli O157:H7 strains and toxins in the cattle meat samples collected from different markets and butchers. Methods: We collected 116 raw minced cattle beef samples from the supermarkets and the butcher stores. We used bacterial culture-based conventional isolation methods as recommended by the CDC and FDA determination of STEC in the minced cattle beef samples. Then we used PCR to detect stx genes in sorbitol negative E. coli. This way, we indirectly demonstrated the presence of the stx genes in meat samples. Additionally, we used an agglutination test for the detection of E. coli O157:H7. Results: E. coli O157-suspected isolates were found in 17 (14.6%) out of 116 raw minced meat samples examined with tests. STEC stx toxin gene was found in 14 (12.06%) of the sorbitol-negative E. coli isolates tested with real-time PCR method. There was no statistical difference between samples collected from markets and butchers according to STEC stx toxin gene positivity rate. Latex agglutination method performed very poor results in suspected strains compared the PCR results (p < 0.05). Conclusions: Meat products sold in markets and butchers carry low but similar risks for infections and epidemics in our region. In the studies that evaluate the presence of the STEC, agglutination methods cannot be trusted alone and, therefore, this test should be combined with at least one of the conventional microbiological or molecular methods.

Association between biofilm and multi/extensive drug resistance in diabetic foot infection.

PURPOSE: We aimed to determine significant risk factors for biofilm production and to investigate the association between antimicrobial resistance profile and biofilm formation in the bacterial isolates obtained from patients with diabetic foot infection (DFI). METHODS: Demographic, clinical, laboratory and outcome data of 165 patients, prospectively recorded and followed between January 2008 and December 2015 by a multidisciplinary committee, were analysed. Standard microbiological methods were adopted. Risk factors associated with biofilm were determined by univariate and multivariate analyses. RESULTS: The overall rate of biofilm production among 339 wound isolates was 34%. The biofilm production rate was significantly higher in Gram-negative micro-organisms (39%) in comparison with Gram positives (21%) (P = .01). A. baumannii presented the highest biofilm production (62%), followed by P. aeruginosa (52%) and Klebsiella spp. (40%). On univariate analysis, significant factors associated with biofilm were antibiotic use within last 3 months (OR:2.94, CI: 1.5-5.75, P = .002), recurrent DFI within last 6 months (OR:2.35, CI: 1.23-4.53, P = .01), hospitalisation within last 3 months due to ipsilateral recurrent DFI (OR:2.44, CI: 1.06-5.58, P = .03), presence of amputation history (OR: 2.20, CI: 1.14-4.24, P = .01), multidrug-resistant (MDR) micro-organism (OR: 7.76, CI: 4.53-13.35, P<.001) and extensively drug-resistant (XDR) micro-organism (OR:11.33, CI:4.97-26.55, P<.001). Multivariate regression analysis revealed two variables to be significant factors associated with biofilm: MDR micro-organism (OR: 3.63, CI: 1.58-8.33, P = .002) and XDR micro-organism (OR:4.06, CI: 1.25-13.1, P = .01). CONCLUSIONS: Multi/extensive drug resistance and previous recurrent DFIs were significantly associated with biofilm formation in patients with diabetic foot.

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.

Comparison of Novel Blood Culture System DL-Bt112TM with BacT/Alert 3DTM by Using Clinical Samples.

BACKGROUND: Blood cultures are the main diagnostic laboratory tool to detect bloodstream infections. Many clinical microbiology laboratories utilize automated blood culture systems to isolate infectious agents from blood samples. The diagnostic performance and time-to-detection values of the novel automated blood culture system, DLBt112TM (DL), was compared with BacT/Alert 3DTM (B3D) in this prospective comparative study with clinical samples. METHODS: A total of 356 blood culture sets (178 sets for each system) were evaluated over a 6-month period in a university hospital. Two sets of blood culture samples (one for DL and one for B3D) were drawn from intensive care unit patients who were suspected to have bloodstream infections. BacT/ALERT FA FAN® Aerobic/Anaerobic blood culture bottles for B3D and FAN adult anaerobic/aerobic blood culture bottles for DL were used. The Vitek® 2 automated system was used for identification of the isolated bacteria. RESULTS: We evaluated 178 sets from 105 patients consisting of 712 blood culture bottles in total. In total, 294 negative bottles and 47 positive bottles were detected by both systems. Recovery rate of the B3D (96.7%) was significantly higher than that of DL (79.0) (p < 0.05). We determined significant differences between DL and B3D in terms of time-to-detection values for gram negatives (p = 0.006) and contaminants (p = 0.048). Overall, B3D had shorter time-to-detection mean values. CONCLUSIONS: The recovery rate of DL was unfavorably low and time-to-detection values for DL were significantly higher than that of B3D. This might result from the ingredients of the culture bottles since the detection technologies of the systems were similar.

A rare cause of infection, Raoultella planticola: emerging threat and new reservoir for carbapenem resistance.

BACKGROUND: Severe cases of infections caused by Raoultella planticola are constantly being reported from all over the world with the increase in drug-resistance patterns. In this study, we retrospectively evaluated the clinical characteristics of R. planticola infections with patients' demographics and antimicrobial susceptibilities of the R. planticola isolates. METHODS: R. planticola isolates were retrospectively evaluated. VITEK 2® automated system was used for identification and antimicrobial susceptibility testing. Verification of the low-discriminated isolates was analyzed with MALDI-TOF method using VITEK MS® system. Gene-Xpert® system was used for detection of bla IMP-1-, bla KPC-, bla NDM-1-, bla OXA-48- and bla VIM-type carbapenemases. The data of the patients with R. planticola infection were collected from hospital records. RESULT: During the 4-year period, 42 episodes of R. planticola infections were detected. MALDI-TOF was used for 11 of the low-discriminated isolates, and 1 of which identified as R. terrigena was excluded. Carbapenems and aminoglycosides were the most effective antimicrobial agents. Extended spectrum beta-lactamases were detected in seven of the isolates. Three carbapenem-resistant isolates were detected as bla OXA-48-type carbapenemase carrier. Nosocomial R. planticola infections constituted 80.9 % (n = 34) of the infections. Most common infections related with R. planticola were blood stream infections (n = 24) (p < 0.005). The presence of indwelling catheter and intensive care unit stay were the most common detected risk factors (p < 0.005). Diabetes mellitus and chronic renal insufficiency commonly accompanied the infections (p > 0.005). CONCLUSIONS: Challenging infections caused by Raoultella spp., like those of multidrug resistant Klebsiella spp., will probably become a concern for clinicians as well as microbiologists . In literature, there were few cases, but we believe that the incidence of Raoultella spp. infections, which may result from misidentification, are more common than expected , and it is not unlikely that there will be a gradual increase and spread in multidrug-resistant isolates.

Time-to-Detection Comparison for a Novel Blood Culture System Using Simulated Blood Cultures: DLTM versus BacT/ALERTTM and BACTECTM.

BACKGROUND: Automated blood culture systems are routinely used in microbiology laboratories to isolate bacteria and fungi causing bloodstream infections. A novel automated blood culture system, DL-Bt112TM (DL) was compared with the BACTEC 9050TM (BCT) and BacT/Alert 3DTM (B3D) systems for time-to-detection (TTD) using 10 different clinical bacteria that commonly cause bloodstream infections. METHODS: Simulated blood cultures were used to compare the three automated blood culture systems. Blood drawn from healthy donors was inoculated with known concentrations of 10 different species of commonly isolated bacteria and analysed using the automated systems. TTD values for the three systems were recorded and analysed. RESULTS: Significant differences in the TTD were observed among the three systems. The DL system exhibited the longest detection time of all the systems (p < 0.0001). The BCT and B3D systems were superior to the DL system for all Gram-positive and most Gram-negative bacteria. No significance difference was observed between the BCT and the B3D systems when overall TTD values were evaluated; however, the BCT system yielded significantly better results than did the B3D system for the Gram-positive bacteria. CONCLUSIONS: TTD values were longer for the DL system than for the two commonly used blood culture systems when tested on simulated blood cultures. Thus, clinical laboratories considering the DL system should take its long TTD into consideration.

The Predictive Role of MMP-2, MMP-9, TIMP-1 and TIMP-2 Serum Levels in the Complete Response of the Tumor to Chemotherapy in Breast Cancer Patients.

OBJECTIVE: We investigated the serum levels of MMPs and TIMPs in breast cancer (BC) patients to predict the response rate to/after treatment with or without neoadjuvant chemotherapy. BC is the most common cancer in women and MMPs are responsible for the breakdown of ECM proteins during organogenesis and TIMPs are restricted the ECM destruction by MMPs. However, the predictive role of MMPs and TIMPs in the treatment response of BC patients has not identified. METHODS: This study consisted of 96 BC patients (34 neoadjuvant treatment and 62 surgically treated) and 35 healthy individuals. ELISA was used to determine the level of MMP-2, MMP-9, TIMP-1, and TIMP-2 from serum samples of BC patients. RESULTS: The mean levels of MMP-9 and TIMP-2 were significantly increased in all BC patients at diagnosis and after chemotherapy, but MMP-2 was considerably lower at diagnosis. There was only a significant difference in the TIMP-1 levels after chemotherapy as well as HER2 and ER status in the neoadjuvant and surgically treated group. Additionally, MMP-2 and MMP-9 serum levels negatively correlated with tumor size and metastatic lymph nodes in BC patients after chemotherapy. CONCLUSIONS: BC patients with high levels of MMP-9 and TIMP-2 can be used to predict the stage of the tumor and CR to chemotherapy and higher TIMP-1 serum level after chemotherapy could be related to better response to chemotherapy.

Nail scissors and fingernails as reservoirs of hepatitis B virus DNA: Role of nail scissors in household transmission of hepatitis B virus.

BACKGROUND: No study in the current literature has scientifically clarified the transmission of hepatitis B virus (HBV) via personal hygiene tools. We determined risk of household transmission of HBV via nail scissors. Moreover, we assessed whether nails from HBV-infected people contained HBV, and evaluated correlations of HBV DNA levels of serum, nail specimens, and nail scissors. METHODS: Seventy patients testing positive for the surface antigen of the hepatitis B virus (63 positive for HBV DNA) treated for HBV infection and 27 healthy individuals were included. Real-time polymerase chain reaction method was used to detect HBV DNA levels in sera, nail, and nail scissors. RESULTS: HBV DNA was detected on 27% of nail scissors and in 50% of nail specimens from 63 serum HBV DNA-positive patients. Serum HBV DNA level >105 IU/mL was associated with 71.8% probability of nail scissors being HBV DNA-positive (P < .05). Serum HBV DNA level >107 IU/mL was associated with 71.5% probability of fingernails being HBV DNA-positive (P > .05). Shared-use of nail scissors was correlated with surface antigen of the hepatitis B virus positivity and total hepatitis B core antibody/immunoglobulin G positivity. A high HBV DNA level was detected in nail scissors and low level HBV DNA in the nails of persons with high serum HBV DNA levels. CONCLUSIONS: Nail scissors, shared-use of nail scissors, and duration of shared use play important roles in household transmission of HBV. Level of education within society in this regard should be increased via mass media.

Usefulness of soluble urokinase plasminogen activator receptor (suPAR) as an inflammatory biomarker in obese children.

OBJECTIVE: Soluble urokinase plasminogen activator receptor (suPAR) has emerged as a relatively new biomarker that reflects increased inflammatory status and been associated with cardiovascular risk. We wanted to investigate the predictive value and usefulness of suPAR as an inflammatory biomarker in obese children. METHODS AND RESULTS: Of the total 136 participants, 76 (36 male, 40 female) were in obese group and 60 (24 male, 36 female) were in control group. The median age was 12.05 (6.16-17.30) years old for obese group, and 12.83 (8.00-16.75) years old for control group. Obese children had statistically significantly higher heart rate, systolic and diastolic blood pressure, EAT and LV mass than control group (p<0.01). The median suPAR level in obese group was not statistically different than in control group (0.54 vs. 0.59, p=0.26). The median hsCRP level in obese group was found statistically significantly higher than in control group (1.97 vs. 0.41, p<0.01). A significant positive correlation between hsCRP and BMI in the obese participants was found (r=0.45, p<0.01), but not a relationship between suPAR and BMI (r=-0.21, p>0.05). CONCLUSION: Our research did not demonstrate the usefulness of suPAR as an inflammatory biomarker and a predictive value for future atherosclerosis in obese children. Further studies with larger sample size are required to determine whether suPAR is useful as an inflammatory biomarker in childhood obesity.

Socioeconomic indicators are strong predictors of hepatitis A seroprevalence rates in the Middle East and North Africa.

The goal of this analysis was to examine the association between age-specific hepatitis A virus (HAV) seroprevalence rates and various socioeconomic indicators within the Middle East and North Africa (MENA) region. We conducted a systematic review of all recently published studies on HAV conducted in the MENA region and identified the highest quality studies for inclusion in our analysis. We calculated the age at midpoint of population immunity (AMPI) for each study and estimated seroprevalence rates at the ages of 5, 10, and 15 years. Next, we identified the correlations between these metrics and several socioeconomic variables. HAV data collected in or after 2000 were available for 14 of the 19 countries in the MENA region. Four of the 14 included countries had intermediate HAV endemicity (Algeria, Saudi Arabia, Turkey, and UAE), five had high endemicity (Iran, Jordan, Lebanon, Morocco, and Tunisia), and five had very high endemicity (Egypt, Iraq, Palestine, Syria, and Yemen). Water and sanitation were not significant predictors of AMPI or seroprevalence, most likely because most countries in this region have high rates of access to these utilities. However, gross domestic product (GDP), gross national income (GNI), and the human development index (HDI) were all highly associated with AMPI and prevalence. The observed correlations suggest that of the MENA countries without recent HAV data, Bahrain, Kuwait, and Qatar most likely have low endemicity, Oman likely has intermediate endemicity, and Libya likely has high endemicity. While it is unlikely that a single correlation model would be suitable for use in all world regions, the approach utilized in this analysis might provide a simple but accurate method for using economic data to impute the endemicity profiles of countries without recent data in regions where at least several neighboring countries have conducted recent serostudies.

A severe Morganella morganii endophthalmitis; followed by bacteremia.

Morganella morganii is rarely isolated from nosocomial infections. However, postoperative infections due to Morganella spp. were documented in literature and eye involvements of the infections usually result in severe sequels. We present a severe case infection, which was caused by M. morganii subsp. morganii, firstly appearing as conjunctivitis and complicated by bacteremia. The infectious agent isolated from both conjunctival and consecutive blood cultures. Identification and antimicrobial susceptibility tests were performed with the Vitek 2(®) automated system. The isolate was resistant to cephalosporins and carbapenems and it had ability to produce extended spectrum beta-lactamases. Patient was successfully treated with intravenous ciprofloxacin according to susceptibility test results. This is the first report of M. morganii infection detected as a local infection then complicated by bacteremia.

Hepatitis A virus epidemiology in Turkey as universal childhood vaccination begins: seroprevalence and endemicity by region.

This paper presents the results of a comprehensive examination of current distribution of Hepatitis A virus (HAV) seroprevalence and endemicity in Turkey and the possible links between HAV endemicity and socioeconomic development. We performed a systematic search in online resources published between January 2000 and August 2015. The 22 provinces were able to be assigned a hepatitis A endemicity level based on this systematic review. The incidence rates for symptomatic hepatitis A infection are higher in the eastern part of Turkey than in the western and central region. These differences in socioeconomic indicators by region suggest the likelihood of lower seroprevalence rates in the western parts of the country and higher rates in the eastern region. Turkey's current policy of recommending hepatitis A immunization for all children without contraindications is an appropriate one and is likely to remain the best option for at least the next decade or two.

Intra-Abdominal Abscess and Primary Peritonitis Caused by Streptococcus anginosus.

INTRODUCTION: The Streptococcus anginosus group of bacteria are low-virulence bacteria existing as commensals in the oral flora and gastrointestinal tracts of humans. S. anginosus may spread to the blood in individuals with poor oral hygiene in cases of oral infections, such as gingivitis and tooth abscesses, that develop following the loss of mucosal unity. This may lead to infections in the whole body, primarily as brain and liver abscesses. CASE PRESENTATION: A 32-year-old male patient presented with complaints of nausea, vomiting, and diffuse abdominal pain. Diffuse abdominal tenderness and rebound tenderness were detected particularly in the epigastrium and right upper quadrant. Laboratory assessment revealed a leukocyte count of 20,500/mm(3). Free fluid around the liver and heterogeneous areas of abscess formation in the right lateral gallbladder were revealed on abdominal computed tomography. Diffuse adhesions between the bowel and seropurulent free liquid in the abdomen were detected on surgical exploration, and a sample was taken for cultures. The patient was discharged without complications on the sixth postoperative day and his antibiotic course was completed with 4 weeks of oral treatment. We reviewed the literature for similar cases of disseminated pyogenic infections caused by the S. anginosus group. CONCLUSIONS: It should be kept in mind that the oral flora bacterium S. anginosus may cause transient bacteremia and deep-seated organ abscesses in immunodeficient patients with poor oral hygiene. Such patients with intra-abdominal abscesses should be treated with antibiotics and surgery.

A Multicenter Evaluation of Blood Culture Practices, Contamination Rates, and the Distribution of Causative Bacteria.

BACKGROUND: The prognostic value of blood culture testing in the diagnosis of bacteremia is limited by contamination. OBJECTIVES: In this multicenter study, the aim was to evaluate the contamination rates of blood cultures as well as the parameters that affect the culture results. MATERIALS AND METHODS: Sample collection practices and culture data obtained from 16 university/research hospitals were retrospectively evaluated. A total of 214,340 blood samples from 43,254 patients admitted to the centers in 2013 were included in this study. The blood culture results were evaluated based on the three phases of laboratory testing: the pre-analytic, the analytic, and the post-analytic phase. RESULTS: Blood samples were obtained from the patients through either the peripheral venous route (64%) or an intravascular catheter (36%). Povidone-iodine (60%) or alcohol (40%) was applied to disinfect the skin. Of the 16 centers, 62.5% have no dedicated phlebotomy team, 68.7% employed a blood culture system, 86.7% conducted additional studies with pediatric bottles, and 43.7% with anaerobic bottles. One center maintained a blood culture quality control study. The average growth rate in the bottles of blood cultures during the defined period (1259 - 26,400/year) was 32.3%. Of the growing microorganisms, 67% were causative agents, while 33% were contaminants. The contamination rates of the centers ranged from 1% to 17%. The average growth time for the causative bacteria was 21.4 hours, while it was 36.3 hours for the contaminant bacteria. The most commonly isolated pathogens were Escherichia coli (22.45%) and coagulase-negative staphylococci (CoNS) (20.11%). Further, the most frequently identified contaminant bacteria were CoNS (44.04%). CONCLUSIONS: The high contamination rates were remarkable in this study. We suggest that the hospitals' staff should be better trained in blood sample collection and processing. Sterile glove usage, alcohol usage for disinfection, the presence of a phlebotomy team, and quality control studies may all contribute to decreasing the contamination rates. Health policy makers should therefore provide the necessary financial support to obtain the required materials and equipment.

The first case of Raoultella terrigena infection in an infant.

Raoultella terrigena, formerly known as Klebsiella terrigena is Gram-negative, non-motile, facultative anaerobic, encapsulated bacilli and is a very rare cause of infections in humans. Until now, only two cases of actual clinical infection caused by R. terrigena were reported in adults. This report is the first case of neonatal infection with this microorganism, which was isolated from the urinary tract of a premature newborn followed in Neonatal Intensive Care Unit. Vitek 2® automated system had identified the bacteria as R. planticola. The result was duplicated with a new urine sample. Although Vitek 2® automated system identified the isolates as R. planticola, 16S rRNA sequencing and blast analysis of the bacterium had figured out that the bacterium was R. terrigena with 92% identicality. The bacterium was resistant to empirically given antibiotics, ampicillin and gentamicin. The patient was successfully treated with cephaperazone/ sulbactam according to antimicrobial susceptibility test result.

Investigation of clonal relationships of K. pneumoniae isolates from neonatal intensive care units by PFGE and rep-PCR.

INTRODUCTION: Clonal relationships of Klebsiella pneumoniae strains obtained during an epidemic and after a one-year post-epidemic (non-epidemic) period in the same neonatal intensive care unit (NICU) using pulsed-field gel electrophoresis (PFGE) and repetitive polymerase chain reaction (rep-PCR) by the DiversiLab (DL) system were investigated, and the results of both molecular techniques were evaluated. METHODOLOGY: Fifteen K. pneumoniae strains were included in this study. All identified bacterial strains were confirmed by 16S rDNA sequencing and analyzed by PFGE and the DL system. RESULTS: According to the PFGE results, 15 isolates showed 10 different band profiles. Nine of these 15 isolates were included in one of the formed clusters, and the remaining six isolates were not included in any of them. According to the DL system results, 15 isolates showed two different clusters, with three strains in one cluster and four strains in the other. The remaining strains could not be placed any one of the clusters. PFGE was used as the gold standard based on its strong genetic discriminatory power. The DL system results showed that  PFGE missed the relationship of the two epidemic-related strains and demonstrated one epidemic-unrelated strain to be epidemic related. CONCLUSIONS: Both systems may easily be used for clonal relationships of K. pneumoniae strains. The DL system was clearly more rapid and convenient than PFGE, but its discriminatory power seemed to be inferior to that of PFGE based on 15 K. pneumoniae strains.

[Comparison of adenoid and tonsil core cultures in chronic adenotonsillitis]. / Kronik adenotonsillitli olgularda adenoid ve tonsil merkez kültürlerinin karsilastirilmasi.

OBJECTIVES: Tonsil and adenoid core cultures were compared and beta-lactamase producing bacteria were determined in patients with chronic adenotonsillitis. PATIENTS AND METHODS: Thirty-two patients (21 boys, 11 girls; mean age 5 years) with chronic adenotonsillitis underwent elective adenotonsillectomy. The core swaps of tonsil and adenoid tissues were obtained under sterile conditions and were inoculated in 5% sheep blood agar, eosin methylene blue agar, and chocolate agar plates. The frequency of beta-lactamase producing isolates were assessed. RESULTS: Staphylococcus aureus was the most common pathogen both in tonsil and adenoid core cultures. Among pathogenic bacteria isolated from tonsil (n=27) and adeonid (n=22) cultures, the same strains were isolated in 20 cultures (75%). The frequencies of beta-lactamase producing bacteria were 44% and 41% in tonsil and adenoid core cultures, respectively. S. aureus was associated with beta-lactamase production in 88% and 100% in tonsil and adenoid tissues, respectively. CONCLUSION: Differences between tonsil surface and core bacterial flora may have implications in the etiopathogenesis and treatment of chronic tonsillitis. The range of species isolated seems to be similar for both chronic tonsillitis and adenoiditis.