Bilge Gultepe

A case of cerebral phaeohyphomycosis caused by Fonsecaea monophora, a neurotropic dematiaceous fungus, and a review of the literature.

The Fonsecaea species, which are the leading causes of chromoblastomycosis, are not considered neurotropic fungal agents. Fonsecaea pedrosoi is the primary species in the genus and is usually isolated from chromoblastomycosis cases. However, the recently distinguished species F. monophora has been reported in a few cerebral phaeohyphomycosis cases. Here, a case of cerebral phaeohyphomycosis caused by Fonsecaea monophora is presented in a 71‐year‐old female subject with chronic diabetes mellitus and hypertension. The identification of F. monophora was made through mycological and molecular analysis, and an isolate was differentiated from the closely related F. pedrosoi by sequence data on key bases on the ribosomal internal transcribed spacer region. The case was successfully treated with surgical and medical approaches, and the patient has remained healthy and stable after a ten‐month follow up. Given the increasing incidence of this type of infection of the central nervous system (CNS), this case provides further support for the consideration that F. monophora might represent a neurotropic agent.

Mortality markers in nosocomial Klebsiella pneumoniae bloodstream infection

PurposeKlebsiella pneumoniae is the most common endogen agent for nosocomial infections. In this study, mortality markers were investigated in patients with nosocomial K. pneumoniae blood stream infection (NKp BSI).MethodsThe characteristics of patientsxa0>16xa0years who had NKp BSI diagnosis by daily active surveillance between January 2012 and January 2016 were retrospectively evaluated. Patients who died until 28th day of the clinical follow up and those who survived until this time were statistically compared in terms of various risk factors.ResultsOne hundred ninety patients were included into the study. Mortality rate was 47.9%, carbapenem resistance was 43.2%. Statistical analysis have shown that in presence of post-NKp BSI sepsis, septic shock, following in intensive care unit (ICU), meropenem resistance, kidney failure, NKp BSI secondary to pneumonia, use of invasive instruments such as central venous catheter (CVC), urinary catheter (UC) and mechanical ventilator (MV), colostomy, transfusion and hemodialysis mortality was significantly higher. In patients admitted into the hospital for neurological disorders, pancreaticobiliary tract (PBT) diseases and patients who have undergone endoscopic retrograde cholangiopancreatography (ERCP) and patients in whom NKp BSI secondary to PBT infection mortality rate was lower.ConclusionsSepsis, septic shock, clinical conditions requiring ICU treatment and meropenem resistance increase mortality rates in NKp BSI significantly. Mortality was higher also in patients with NKp BSI secondary to pneumonia, in kidney failure and when invasive instruments were used. On the other hand, in patients who were admitted to the hospital for neurological disorders and PBT diseases mortality rate was lower.

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.

Evaluation of nasal fluid β-defensin 2 levels in children with allergic rhinitis

AIMnKnowledge about the role of the innate immune system in the pathogenesis of allergic diseases has been expanding in recent years. Defensins are antimicrobial peptides that are components of the innate immune system. Defensins have strong efficacy against bacterial, viral, and fungal infections. Moreover, they have regulatory functions in many physiologic processes such as antitumoral immunity, chemotaxis, inflammation, and wound healing. In this study, we aimed to investigate β-defensin 2 levels in the nasal fluids of children with allergic rhinitis.nnnMATERIAL AND METHODSnStudy and control groups consisted of 28 patients with newly diagnosed allergic rhinitis who were not taking any medication, and 23 healthy children. Skin prick tests were performed on patients with allergic rhinitis and disease severity was assessed using the total symptom score. Nasal fluid samples were obtained using a modified polyurethane sponge absorption method from patients and control subjects. Nasal fluid β-defensin 2 levels were determined using an enzyme-linked immunosorbent assay (ELISA).nnnRESULTSnThe median value of nasal fluid β-defensin 2 levels were 173.8 pg/mL (interquartile range; 54.8-205.9 pg/mL) in allergic rhinitis group and 241.6 pg/mL (163.5-315.2 pg/mL) in the control group. There was a statistically significant difference between the two groups (p=0.01). Moreover, nasal fluid β-defensin 2 levels showed a significant negative correlation with total symptom scores (rho= -0.78, p<0.001).nnnCONCLUSIONSnChildren with allergic rhinitis have reduced nasal fluid β-defensin 2 levels compared with controls, and β-defensin 2 levels were negatively correlated with disease severity. A more definite understanding of the roles of defensins and other antimicrobial peptides in allergic inflammation can open up new horizons in the management and treatment of these common diseases.

Nasal fluid secretory immunoglobulin A levels in children with allergic rhinitis

OBJECTIVESnThere is growing knowledge about the immunoregulatory and possibly preventative roles of immunoglobulin A (IgA) in allergic diseases. This study aimed to investigate secretory immunoglobulin A (SIgA) levels in the nasal fluid of children who were either being treated for their allergic rhinitis (AR) with intranasal mometasone furoate or were not receiving treatment.nnnMETHODSnThe study population contained 55 children with persistent AR. Group I included 27 newly diagnosed AR patients not taking any medication and group II included 28 patients treated with intranasal steroids for at least 6 months. 27 healthy control subjects were also enrolled in the study. Total symptom scores (TSS) were calculated for each patient. Nasal secretions were obtained using a new modified polyurethane sponge absorption method, and samples were analysed by ELISA.nnnRESULTSnThe median value for nasal fluid SIgA level in each group was 127.2μg/ml (interquartile range; 67.3-149.6) in group I, 133.9μg/ml (102.1-177.8) in group II and 299.8μg/ml (144.5-414.0) in the control group. Groups I and II both had statistically significant reductions in nasal fluid SIgA levels compared to the control group (p<0.001). However, there was no statistically significant difference between groups I and II (p=0.35). A statistically significant and negative correlation also existed between TSS and nasal fluid SIgA levels in both groups I and II (p=0.006, rho=-0.512 and p=0.01, rho=-0.481, respectively).nnnCONCLUSIONSnSIgA levels in the nasal fluid are significantly reduced in children with AR independent of treatment and are negatively correlated with the TSS.

Temporal trends and patterns in antimicrobial-resistant Gram-negative bacteria implicated in intensive care unit-acquired infections: A cohort-based surveillance study in Istanbul, Turkey

OBJECTIVESnThis study assessed trends and patterns in antimicrobial-resistant intensive care unit (ICU)-acquired infections caused by Gram-negative bacteria (GNB) in Istanbul, Turkey.nnnMETHODSnBacterial culture and antimicrobial susceptibility data were collected for all GNB causing nosocomial infections in five adult ICUs of a large university hospital in 2012-2015. Multiresistance patterns were categorised as multidrug-resistant (MDR), extensively drug-resistant (XDR) and pandrug-resistant (PDR). Temporal patterns and trends were assessed using regression analyses.nnnRESULTSnOf 991 pathogenic GNB recorded, the most frequent were Acinetobacter baumannii (35.3%), Klebsiella spp. (26.7%), Pseudomonas aeruginosa (18.1%) and Escherichia coli (6.7%). The overall infection rate decreased by 41% from 18.4 to 10.9 cases per 1000 patient-days in 2012 compared with 2015 (P<0.001), mostly representing decreases in bloodstream infections and pneumonias by A. baumannii and P. aeruginosa. The XDR proportion in A. baumannii increased from 52.4% in 2012 to 71.7% in 2015, but only one isolate was colistin-resistant. Multiresistance patterns remained stable in Klebsiella, with overall XDR and possible PDR proportions of 14.3% and 1.9%, respectively. A back-to-susceptibility trend was noted for P. aeruginosa in which the non-MDR proportion increased from 53.3% in 2012 to 70.6% in 2015. Moreover, 87.9% of E. coli and 39.5% of Enterobacter isolates were MDR, but none was XDR.nnnCONCLUSIONSnAntimicrobial resistance patterns in pathogenic GNB continuously change over time and may not reflect single-agent resistance trends. The proportionate amount of antimicrobial-resistant GNB may persist despite overall decreasing infection rates. Timely regional surveillance data are thus imperative for optimal infection control.

Perforated appendicitis in children: Antimicrobial susceptibility and antimicrobial stewardship.

OBJECTIVESnFor perforated appendicitis in children, microbiological cultures should always be sought if an adequate sample is available. Knowledge of local epidemiology is important for optimal selection of antimicrobial therapy. The aim of this study was to evaluate the aetiology and susceptibility of pathogens in paediatric patients with perforated appendicitis.nnnMETHODSnMicrobiological results of tissue samples obtained at surgery from children with acute appendicitis over 24 months were evaluated retrospectively.nnnRESULTSnAmong 209 children operated for acute appendicitis, 62 (29.7%) were perforated appendicitis. Intraperitoneal culture results were available for 42 patients, of which 41 (97.6%) had positive microbiological growth (57 pathogens). The male:female ratio was 1.8 and the mean age at presentation was 11 years (range 4-18 years). The most common pathogen was Escherichia coli (66.7%), among which 57.9% produced an extended-spectrum β-lactamase (ESBL). All patients received initial treatment with intravenous antibiotics (ampicillin, gentamicin and metronidazole). The antibiotic regimen was modified in 22 patients (52.4%). Seven patients (16.7%) developed a post-operative complication. No significant difference was observed for development of complications between patients with ESBL-positive and -negative E. coli growth (P=0.698).nnnCONCLUSIONnThe high rate of ESBL-positive E. coli may indicate bowel colonisation with resistant bacteria even in the community setting. Prospective studies will show whether treatment options should be directed according to identified pathogens.