Ayten Kadanali

Maternal carriage and neonatal colonisation of group B streptococcus in eastern Turkey: prevalence, risk factors and antimicrobial resistance

Our object is to determine the prevalence of group B streptococcus (GBS) carriage among pregnant women, the neonatal colonisation rate and the antimicrobial susceptibility to formulate a policy for treatment and prevention regarding perinatal GBS diseases in eastern Turkey. A total of 150 pregnant women were screened for GBS colonisation. Samples were collected from the vagina and the rectum of pregnant women, and the ear canal, throat and umbilicus of the neonates of colonised mothers. Antimicrobial susceptibility of the isolates was also investigated. GBS was isolated in at least one specimen from the 150 women in 48 cases; it was estimated that, overall, about 32% of the pregnant women and 17.3% of overall newborns were colonised with GBS. The overall rate of GBS vertical transmission was 54.2% in this study. Maternal colonisation rate was significantly higher in younger ages (p < 0.01) when maternal age of 20 years was taken as a cut‐off point. All isolates were found to be sensitive to penicillin, ampicillin, cefazolin and vancomycin. Resistance to erythromycin and clindamycin were found to be 13.5 and 2.7%, respectively.

Anthrax during Pregnancy: Case Reports and Review

We review, in detail, 2 cases of anthrax during pregnancy, its maternal and perinatal complications, and its management. Patient 1 was a 33-year-old woman at 32 weeks of gestation. She had a submandibular eschar; extensive edema on her face, neck, and upper thorax that inhibited respiratory function; and fever. The patient was treated with penicillin G and prednisolone after the diagnosis of anthrax. She recovered within 10 days but delivered a preterm baby. Patient 2 was a 29-year-old woman at 33 weeks of gestation. Her anthrax lesion was on her right elbow, and therapy consisted of procaine penicillin. She also delivered a preterm baby. These 2 cases show that anthrax during pregnancy can be successfully managed, but preterm delivery could be a complication.

Genitourinary brucellosis: results of a multicentric study

This study reviewed the clinical, laboratory, therapeutic and prognostic data on genitourinary involvement of brucellosis in this largest case series reported. This multicentre study pooled adult patients with genitourinary brucellar involvement from 34 centres treated between 2000 and 2013. Diagnosis of the disease was established by conventional methods. Overall 390 patients with genitourinary brucellosis (352 male, 90.2%) were pooled. In male patients, the most frequent involved site was the scrotal area (n=327, 83.8%), as epididymo-orchitis (n=204, 58%), orchitis (n=112, 31.8%) and epididymitis (n=11, 3.1%). In female patients, pyelonephritis (n=33/38, 86.8%) was significantly higher than in male patients (n=11/352, 3.1%; p<0.0001). The mean blood leukocyte count was 7530±3115/mm3. Routine laboratory analysis revealed mild to moderate increases for erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). The mean treatment duration and length of hospital stay were significantly higher when there were additional brucellar foci (p<0.05). Surgical operations including orchiectomy and abscess drainage were performed in nine (2.3%) patients. Therapeutic failure was detected in six (1.5%), relapse occurred in four (1%), and persistent infertility related to brucellosis occurred in one patient. A localized scrotal infection in men or pyelonephritis in women in the absence of leucocytosis and with mild to moderate increases in inflammatory markers should signal the possibility of brucellar genitourinary disease.

Slime factor positivity in coagulase negative staphylococci isolated from nasal samples of haemodialysis patients

Polysaccharide slime seems to be the most important factor by which coagulase negative staphylococci (CNS) strains adheres and colonises catheters. The aim of this study was to determine the prevalence of slime‐producing CNS strains isolated from nasal samples of patients on haemodialysis and of healthy persons as a control.

Bacteremic and Nonbacteremic Brucellosis: Clinical and Laboratory Observations

Brucellosis is a highly contagious endemic zoonosis that remains synonymous with low socioeconomic status, as exemplified by its incidence in poor regions of southern countries of Europe, such as rural Greece, Sicily, and various Spanish provinces [1, 2]. It is a systemic febril infection in which any organ or system of the body can be involved [3–5]. The diagnosis of brucellosis is based on the isolation of organisms from blood and/or body tissues or on a combination of suggestive clinical symptoms upon presentation and positive serology. The rate of positive blood cultures in brucellosis ranges from 15% to 90%. The number of positive results is usually greater in acute brucellosis; however, this figure is notably reduced in the case of focal complications and chronic illness [3]. We report here epidemiological, clinical, serological, and prognostic features of bacteremic and nonbacteremic brucellosis based on our clinical experience with patients presenting with brucellosis. Between June of 2001 and 2006, we carried out a retrospective study of 123 patients with brucellosis who were diagnosed and treated at the Infectious Diseases and Clinical Microbiology Department of Ataturk University Research Hospital, a 1,200-bed tertiary hospital. A complete medical history of each patient was obtained, and a physical examination was carried out. At least three blood cultures and the standard tube agglutination test (SAT) were performed on each patient. Included in the laboratory assessments were a complete blood count (CBC), Creactive protein (CRP), and blood chemistry (including levels of ALT and AST). Our case definition was such that patients with positive culture results for Brucella spp. were grouped as having bacteremic brucellosis and those without positive culture results – and therefore diagnosed on the basis of clinical features and SAT – were grouped as having nonbacteremic brucellosis. We then evaluated the epidemiological, clinical, and serological features of bacteremic brucellosis vs nonbacteremic brucellosis. Using symptom duration as the criterium, cases were classified as acute (less than 8 weeks), subacute (from 8 to 52 weeks), or chronic (more than 52 weeks) brucellosis [1, 3]. Brucellosis was diagnosed on the basis of one of the following criteria:

Genital flora in pregnancy and its association with group B streptococcal colonization

Women colonized with group B Streptococcus (GBS) during pregnancy are at an increased risk of premature delivery and GBS amniotic infection can result in intrauterine death. GBS also infects the newborn. The vaginal flora of a healthy woman is composed of Doderlein bacilli. Bacterial vaginosis (BV) is a clinical condition caused by the replacement of these bacilli with high concentrations of aerobic and anaerobic bacteria. GBS inhibits Lactobacillus species in vitro. The main goal of this study was to assess differences in the vaginal flora of pregnant women and provide a detailed evaluation of vaginal swab for the presence of GBS and other organisms. From January 2002 to February 2003 150 healthy pregnant women were included in the study. Their mean ± S.D. age was 26.1 ± 6.7 years (range 17—45 years) and pregnancy duration was 31.4 ± 5.3 weeks (range 22—40 weeks). Vaginal fluid samples were collected with cotton swabs. The swabs were Gram-stained and placed on appropriate media. Slides were then assessed according to the criteria of Nugent et al. (excerpt)

Predictors for limb loss among patient with diabetic foot infections: an observational retrospective multicentric study in Turkey

We aimed to investigate the predictors for limb loss among patients with diabetes who have complicated skin/soft-tissue infections. In this observational study, consecutive patients with diabetic foot infection (DFI) from 17 centres in Turkey, between May 2011 and May 2013 were included. The Turkish DFI Working Group performed the study. Predictors of limb loss were investigated by multivariate analysis. In total, 455 patients with DFI were included. Median age was 61 years, 68% were male, 65% of the patients were hospitalized, 52% of the patients had used antibiotics within the last month, and 121 (27%) had osteomyelitis. Of the 208 microorganisms isolated, 92 (44.2%) were Gram-positive cocci and 114 (54.8%) were Gram-negative rods (GNR). The most common GNR was Pseudomonas; the second was Escherichia coli, with extended spectrum β-lactamase positivity of 33%. Methicillin-resistant Staphylococcus species were found in 14% (29/208). Amputations were performed in 126/455 (28%) patients, 44/126 (34%) of these were major amputations. In multivariate analysis, significant predictors for limb loss were, male gender (OR 1.75, 95% CI 1.04-2.96, p 0.034), duration of diabetes >20 years (OR 1.9, 95% CI 1.18-3.11, p 0.008), infected ulcer versus cellulitis (OR 1.9, 95% CI 1.11-3.18, p 0.019), history of peripheral vascular disease (OR 2, 95% CI 1.26-3.27, p 0.004), retinopathy (OR 2.25, 95% CI 1.19-4.25, p 0.012), erythrocyte sedimentation rate >70 mm/hr (OR 1.6, 95% CI 1.01-2.68, p 0.05), and infection with GNR (OR 1.8, 95% CI 1.08-3.02, p 0.02). Multivariate analysis revealed that, besides the known risk factors such as male gender, duration of diabetes >20 years, infected ulcers, history of peripheral vascular disease and retinopathy, detection of GNR was a significant predictor of limb loss.

Causative pathogens and antibiotic resistance in diabetic foot infections: A prospective multi-center study.

AIM Clinical practice guidelines for the management of diabetic foot infections developed by the Infectious Diseases Society of America (IDSA) are commonly used worldwide. The issue of whether or not these guidelines need to be adjusted for local circumstances, however, has seldom been assessed in large prospective trials. METHODS The Turk-DAY trial was a prospective, multi-center study in which infectious disease specialists from centers across Turkey were invited to participate (NCT02026830). RESULTS A total of 35 centers throughout Turkey enrolled patients in the trial. Overall, investigators collected a total of 522 specimens from infected diabetic foot wounds for culture from 447 individual patients. Among all isolates, 36.4% were gram-positive organisms, with Staphylococcus aureus the most common among these (11.4%). Gram-negative organisms constituted 60.2% of all the isolates, and the most commonly isolated gram-negative was Escherichia coli (15%). The sensitivity rates of the isolated species were remarkably low for several antimicrobials used in the mild infection group. CONCLUSIONS Based on our findings, several of the antimicrobials frequently used for empirical treatment, including some also recommended in the IDSA guidelines, would not be optimal for treating diabetic foot infections in Turkey. Although the IDSA guideline recommendations may be helpful to guide empiric antimicrobial therapy of DFIs, they should be adjusted to local conditions.

Extensively drug-resistant Pseudomonas aeruginosa ventriculitis and meningitis treated with intrathecal colistin

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An unusual presentation of hepatitis A virus infection : Guillain-Barré syndrome

Few cases of Guillain–Barré syndrome (GBS) that are secondary to acute hepatitis A virus (HAV) infection have been reported in the literature. Only two of them were on children. GBS, now regarded as a clinical syndrome consisting of acute weakness and reduced or absent tendon reflexes, with or without sensory loss, is often preceded by an infectious disease. Although hepatitis A (HA) itself is commonly reported, we report a case where GBS is preceded by HA.