Adil Karadag

Old agent, new experience: colistin use in the paediatric Intensive Care Unit—a multicentre study

Nosocomial infections caused by multidrug-resistant (MDR) microorganisms are a common problem around the world, especially in Intensive Care Units. The aim of this study was to investigate the efficacy and safety of colistin therapy in paediatric patients with severe nosocomial infections caused by MDR Gram-negative bacteria. There were 87 episodes in 79 paediatric Intensive Care Unit patients in five different hospitals; each patient was treated intravenously with colistin and evaluated. Of the 79 patients, 54.4% were male and the median age was 30 months. The most commonly isolated microorganism was Acinetobacter baumannii, the most common isolation site was tracheal aspirate fluid and the most common type of infection was ventilator-associated pneumonia. The mean colistin dose in patients without renal failure was 5.4 ± 0.6 mg/kg/day, the mean therapy duration was 17.2 ± 8.4 days and the favourable outcome rate was 83.9%. Serious side effects were seen in four patient episodes (4.6%) during therapy; two patients suffered renal failure and the others had convulsive seizures. Other patients tolerated the drug well. The infection-related mortality rate was 11.5% and the probability of death within the first 9 days of treatment was 10 times higher than after the first 9 days. In conclusion, this study suggests that colistin is effective in the treatment of severe nosocomial infections caused by MDR Gram-negative bacteria and is generally well tolerated by patients, even after relatively long-term use.

[Strongyloides stercoralis in a patient with ankylosing spondylitis: case report].

Strongyloidiasis is a nematode-borne disease caused by several Strongyloides species. This case was presented in order to indicate Strongyloidosis in immunocompromised patients with several clinical findings. A fifty-five year old male patient on corticosteroid medication for a long time because of ankylosing spondylitis was on infliximab medication for 5 years. He presented with swelling of his right foot for ten days, right shoulder stiffness and low back pain. The presence of anaemia was remarkable. S. stercoralis was reported in histological examination of endoscopic duodenal biopsy specimen. Peripheral blood smear showed 68.4% neutrophils, 17% lymphocytes, 7.5% monocytes, and 6.7% (normal range 2%-6.2) eosinophils. The level of IgE was raised: 285IU/mL (normal range 5-120IU/mL). A large number of S. stercoralis larvae were detected upon stool examination with saline and iodine mounts and the formaldehyde ether concentration method. After treatment with two cure albendazole 400 mg/day for 7 days, S. stercoralis larvae were not detected in stool examination. It is interesting that response to treatment was not observed on the first cure and the recovery was seen on the second cure. We suggest that hyperinfections should be taken into consideration in the diagnosis and treatment of immunocompromised patients with several complaints so that life-threatening effects of the nematode may be prevented.

[Evaluation of materials sent due to suspected cystic echinococcosis to the parasitology laboratory of Ondokuz Mayıs University Medical School between the Years 2005-2011].

OBJECTIVE Cystic echinococcosis (CE) is an important health problem common in our country. In this study, anti-Echinococcus granulosus IgG antibodies were investigated in the serum samples of 454 patients who attended the Ondokuz Mayıs University, Faculty of Medicine, Department of Parasitology between 2005 and 2011. METHODS IHA (Fumouze, France) and ELISA (R-Biopharm, Germany) tests were performed at the same time. RESULTS While serum samples from 328 patients (72%) were negative with both tests, 81 samples (18%) were found to be positive with both tests. Forty (49%) cases were female, 41 (51%) cases were male who were positive by both tests. 25 (31%) positive cases were between 31 and 50 years old. While IHA was negative for 33 patients (7%) ELISA was positive for the same samples. In 2 patients (0.4%), both tests revealed low-positivity. CONCLUSION Using these two tests together for serologic detection of cystic echinococcosis could be recommended because of the high sensitivity and specificity ratios.

Apoptosis-Related Gene Expression in an Adult Cohort with Crimean-Congo Hemorrhagic Fever

Crimean-Congo Hemorrhagic Fever (CCHF) is a life threatening acute viral infection characterized by fever, bleeding, leukopenia and thrombocytopenia. It is a major emerging infectious diseases threat, but its pathogenesis remains poorly understood and few data exist for the role of apoptosis in acute infection. We aimed to assess apoptotic gene expression in leukocytes in a cross-sectional cohort study of adults with CCHF. Twenty participants with CCHF and 10 healthy controls were recruited at a tertiary CCHF unit in Turkey; at admission baseline blood tests were collected and total RNA was isolated. The RealTime ready Human Apoptosis Panel was used for real-time PCR, detecting differences in gene expression. Participants had CCHF severity grading scores (SGS) with low risk score (10 out of 20) and intermediate or high risk scores (10 out of 20) for mortality. Five of 20 participants had a fatal outcome. Gene expression analysis showed modulation of pro-apoptotic and anti-apoptotic genes that facilitate apoptosis in the CCHF patient group. Dominant extrinsic pathway activation, mostly related with TNF family members was observed. Severe and fatal cases suggest additional intrinsic pathway activation. The clinical significance of relative gene expression is not clear, and larger longitudinal studies with simultaneous measurement of host and viral factors are recommended.

Comparison of Culture, Real-Time DNA Amplification Assay and Ehrlich-Ziehl-Neelsen for Detection of Mycobacterium tuberculosis

OBJECTIVE Mycobacterium tuberculosis is still a substantial health problem universally. Although culture is the gold standard method, reliable, rapid and new methods are required for effective struggle with disease. We retrospectively compared the results of Ehrlich-Ziehl-Neelsen (EZN) stain and real-time DNA amplification assay (BD ProbeTec ET system) with culture. STUDY DESIGN Retrospective study. MATERIAL AND METHODS A total of 703 samples, 182 pulmonary and 521 extra pulmonary, collected from 630 patients between May 2008 and February 2011 were evaluated. Culture was considered the gold standard. RESULTS For pulmonary specimens, sensitivity, specificity, positive predictive and negative predictive values of BD ProbeTec ET and EZN were calculated to be 100%, 98.8%, 87.5%, 100% and 71.4%, 98.8%, 83.3%, 97.6%, respectively. For extra pulmonary specimens, sensitivity, specificity, positive predictive and negative predictive values of BD ProbeTec ET and EZN were calculated to be 80%, 98.7%, 76.9%, 98.9% and 24%, 98.3%, 42.8%, 96.2%, respectively. CONCLUSION According to these results, we suggest that the BD ProbeTec ET system is more reliable than EZN. In addition, the BD ProbeTec ET system produces faster results. Based upon these results, we consider that the BD ProbeTec ET system may be employed in the diagnosis of M. tuberculosis.

Acinetobacter species isolated from various clinical specimens between 2006-2011 years and their susceptibilities against antibiotics

Objective: The aim of this study was to investigate the distribution and antibiotic susceptibility of Acinetobacter species isolated in our hospital in the last six years. Method: Acinetobacter species isolated from various clinical samples sent to Ondokuz Mayıs University, Medical Faculty Hospital Central Laboratory, Bacteriology Sub Discipline Laboratory between January 2006 and June 2011 were included. Conventional methods and Vitek 2 Compact (bioMérieux-SE, France) automated systems were used for the identification and antibiotic susceptibility of the isolates. Results: During the study period, a total of 3.212 Acinetobacter species were isolated. Species distribution of Acinetobacter isolates and their ratios were found as follows: Acinetobacter baumannii Acinetobacter calcoaceticus complex (n=3006; 93.6%), Acinetobacter lwoffii (n=83; 2.6%), Acinetobacter junii (n=27; 0.8%), Acinetobacter haemolyticus (n=19; 0.6%) and Acinetobacter spp. (n=77; 2.4%). Acinetobacter isolates were isolated at the most from tracheal aspirate samples (n=747; 23.2%) and samples sent from intensive care units (n=705; 21.9%). Ceftazidime resistance increased from 70.2% to 82.7%; cefepime from 26.4% to 79.7%; imipenem from 27.2% to 77.2%; meropenem from 4.5% to 77% and ciprofloxacin from 40.4% to 78.9% in the last six years. In the first six months of 2011, the resistance ratios to tigecycline and colistin were determined as 5.9% and 0.2% respectively. No significant changes were observed in ampicillin-sulbactam resistance ratios. ÖZET Amaç: Son altı yılda, hastanemizde izole edilen Acinetobacter türlerinin dağılımı ve antibiyotik duyarlılıklarının incelenmesi amaçlanmıştır. Yöntem: Çalışmaya; Ondokuz Mayıs Üniversitesi Tıp Fakültesi Hastanesi Merkez Laboratuvarı Bakteriyoloji Subdisiplin Laboratuvarına, Ocak 2006 Haziran 2011 tarihleri arasında çeşitli kliniklerden gönderilen örneklerden izole edilen Acinetobacter türleri dahil edilmiştir. İzolatların tanımlanmasında ve antibiyotik duyarlılıklarının belirlenmesinde konvansiyonel yöntemler ve Vitek 2 Compact (bioMérieux-SA, Fransa) otomatize sistemi kullanılmıştır. Bulgular: Çalışma döneminde toplam 3.212 Acinetobacter türü izole edilmiştir. Acinetobacter izolatlarının tür dağılımı ve oranları; Acinetobacter baumannii Acinetobacter calcoaceticus complex 3006 (%93,6), Acinetobacter lwoffii 83 (%2,6), Acinetobacter junii 27 (%0,8), Acinetobacter haemolyticus 19 (%0,6) ve Acinetobacter spp. 77 (%2,4) olarak bulunmuştur. En fazla Acinetobacter izolatı 747 (%23,2) trakeal aspirat örneğinden ve en çok yoğun bakım ünitesinden gönderilen 705 (%21,9) örnekten izole edilmiştir. Son altı yılda seftazidim direnci %70,2’den %82,7’e, sefepim %26,4’dan %79,7’e, imipenem %27,2’den %77,2’ye, meropenem %4,5’ten %77’ye, siprofloksasin %40,4’dan %78,9’a yükselmiştir. 2011 yılı ilk altı aylık dönemde tigesikline %5,9, kolistine %0,2 oranlarında direnç saptanmıştır. Ampisilin-sulbaktam direnç oranlarında belirgin değişim gözlenmemiştir. 1 Ondokuz Mayıs Üniversitesi Tıp Fakültesi, Tıbbi Mikrobiyoloji Anabilim Dalı, SAMSUN 2 Adana Numune Eğitim ve Araştırma Hastanesi, Mikrobiyoloji Laboratuvarı, ADANA 3 Ondokuz Mayıs Üniversitesi Tıp Fakültesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, SAMSUN 4 Yeditepe Üniversitesi Tıp Fakültesi, Tıbbi Mikrobiyoloji Anabilim Dalı, İSTANBUL 5 İstanbul Üniversitesi, Cerrahpaşa Tıp Fakültesi, Tıbbi Mikrobiyoloji Anabilim Dalı, İSTANBUL Geliş Tarihi / Received : Kabul Tarihi / Accepted : İletişim / Corresponding Author : Nevzat ÜNAL Adana Numune Eğitim ve Araştırma Hastanesi, Mikrobiyoloji Laboratuvarı, ADANA Tel : +90 532 442 61 42 E-posta / E-mail : drnevzatunal@hotmail.com 14.02.2015 28.10.2015 DOI ID : 10.5505/TurkHijyen.2016.68915 Türk Hijyen ve Deneysel Biyoloji Dergisi Eroğlu C, Ünal N, Karadağ A, Yılmaz H, Acuner İÇ, Günaydın M. Çeşitli klinik örneklerden 2006-2011 yılları arasında izole edilen Acinetobacter türleri ve antibiyotik duyarlılıkları. Turk Hij Den Biyol Derg, 2016; 73(1): 25-32. Makale Dili “Türkçe”/Article Language “Turkish”

Effectiveness of Nalidixic Acid and Commonly Used Antibiotics Against Pathogens of Urinary System

Aim: Medicines for treatment Urinary tractinfections in common population are ineffective due to long usage and developing resistance. Nowadays qui nolones are first choise for empiric treatment this infections. Nalidixic acid is first used quinolone type antimicrobial in this group. Because of developing resistance and side effects new quinolones have found treatment instead of nalidixic acid. For urinary system infections. In our study we aimed to compare resistance to nalidixic acid, fosfomycin and other frequently used oral antimicrobials. Material and Method: We studied 314 urine specimens from Medical Faculty Hospital’s various clinic in microbiology laboratory. After 24 hours incubation the bacteria’s media that cultured were examined. Bacteria were identified with conventional and automatic systems (Vitec® 2 Compact - bioMerieux, France). Antibiotic suseptibility tested were made with CirbyBauer method and evaluateda eccording to Clinical Laboratory Standards Institute standards. Results: 241 (79,8%) E.coli, 53 (16,9%) Klebsiella spp. 11 (3,5%) Proteus spp. and 9 Enterobacter spp. bacteria were identified from urine samples.. All strains resistant rate belong to Enterobacteriaceae to nalidixic acid, trimethoprim-sulfamethoxazole, cefuroxime, ciprofloxacin, norfloxacin, nitrofurantoin and fosfomycin were given 42.3% 41.4 %, 32.8 %, 28.6%, 31.5 %, 14.6% 8.5 % respectively. Mostly isolated bacterial from urine was E.coli with high potency to fosfomycin with 2.9% resistance rate was followed by nitrofurantion (resistance rate 6,9%), Cefuroxime, ciprofloxacin, norfloxacin, trimethoprim-sulfamethoxazole, nalidixic acid resistance rate were 6.2%, 30.2%, %32.3, %35.3, %46.4, %46.8 in order. Discussion: As result resistance to nalidixic acide not decreased despite not being in use for a long time and were determined that fosfomycin more susceptible fortreatment urinary tract infections.

Evaluation of the antibiotic resistance of Pseudomonas aeruginosa isolates according to the changing guidelines

Pseudomonas aeruginosa is a Gram‐negative opportunistic pathogen that commonly found in nature.[1] Resistance to antibiotics and disinfectants is a problem in healthcare settings[2] some regulations are made in susceptibility testing and interpretation of results. Clinical and Laboratory Standards Institute (CLSI) guideline changed the minimum inhibitory concentrations (MICs) of piperacillin, piperacillin tazobactam, imipenem and meropenem which are used in the treatment of Pseudomonas infections, in 2012.[3] The aim of this study was; evaluating MIC values of P. aeruginosa isolates which were isolated from clinical specimens according to the CLSI 2011.[4] CLSI 2012[3] and European Committee on Antimicrobial Susceptibility Testing (EUCAST)[5] guidelines, to reveal differences in susceptibility rates and to contribute to the debate on guide exchange.

[Evaluating of Plasmodium species isolated from peripheral blood samples in a non-endemic region].

OBJECTIVE Malaria is a parasitic disease, caused by Plasmodium species, which transmitted to humans through genus Anopheles mosquitoes. This disease widely spreaded in tropical and subtropical areas. The aim of our study is to evaluate malaria cases diagnosed by peripheral blood examination. METHODS Peripheral blood samples sent to Parasitology Laboratory between 2001 and 2013 years, were examined using thick and thin blood smear techniques. RESULTS A total of 102 blood samples obtained from suspected patients were examined and eight of them were found to be positive. All cases were male and Plasmodium falciparum and Plasmodium vivax was detected in seven (87.5%) and one (12.5%) of them, respectively. Blood samples were mainly sent from Departments of Infectious Diseases. All P. falciparum cases had a history about work or travel to different African countries. CONCLUSION We think that patients who has fever and travel history to endemic countries especially in Africa, blood examination for malaria parasites should be taken into account in differential diagnosis.