Duygu Findik

Two outbreaks of ESBL‐producing Klebsiella pneumoniae in a neonatal intensive care unit

In the present study, two epidemic episodes of extended spectrum beta‐lactamase (ESBL)‐producing Klebsiella pneumoniae in the neonatal intensive care unit (NICU) were evaluated.

Spontaneous pneumomediastinum as a complication in human bocavirus infection

The most common causes of spontaneous pneumomediastinum (SPM) in children are asthma attack and respiratory tract infection. Here, we describe a case of SPM in a human bocavirus‐infected 2‐year‐old boy with bronchiolitis.

Detection of Methicillin Resistance and Various Virulence Factors in Staphylococcus aureus Strains Isolated from Nasal Carriers.

BACKGROUND Staphylococus aureus can be found as a commensal on skin and nasal flora or it may cause local and invasive infections. S. aureus has a large number of virulence factors. AIMS To investigate the methicillin resistance and frequency of various virulence factors in S. aureus nasal isolates. STUDY DESIGN Descriptive study. METHODS Nasal samples collected from university students were cultured in media. S. aureus was identified by conventional methods and the Staphyloslide latex test (Becton Dickinson, Sparks, USA). Antibiotic susceptibility tests were conducted, and the methicillin resistance was determined. The mecA, nuc, pvl and staphylococcal toxin genes were examined by polymerase chain reaction (PCR). RESULTS S. aureus was isolated in 104 of 600 (17.3%) nasal samples. In total, 101 (97.1%) S. aureus isolates were methicillin-sensitive and the remaining 3 (2.9%) were methicillin-resistant. Furthermore, all but five isolates carried at least one staphylococcal enterotoxin gene, with seg being predominant. The tst and eta genes were determined in 29 (27.9%), and 3 (2.9%) isolates, respectively. None of the S. aureus isolates harbored see, etb, and pvl genes. CONCLUSION A moderate rate of S. aureus carriage and low frequency of MRSA were detected in healthy students. S. aureus isolates had a high prevalence of staphylococcal enterotoxin genes and the tst gene. In this study, a large number of virulence factors were examined in S. aureus nasal isolates, and the data obtained from this study can be used for monitoring the prevalence of virulence genes in S. aureus strains isolated from nasal carriers.

Screening and genotyping of group B streptococcus in pregnant and non- pregnant women in Turkey

INTRODUCTION The purpose of this study was to investigate group B streptococcus (GBS) colonization, to compare the methods, to determine the relationship between GBS carriage and risk factors, and to genotype the GBS isolates. METHODOLOGY Recto-vaginal swab specimens were obtained from 500 women, and a questionnaire was administered to each to assess their risk factors for GBS carriage. A culture, GBS antigen test, and polymerase chain reaction (PCR) were performed on all samples. Antibiotic susceptibility testing was performed, and the clonal relationship was determined by pulsed-field gel electrophoresis (PFGE) on all viable isolates. RESULTS Of the 500 women, sixty-eight (13.6%) women were GBS carriers, of whom 9.8% were pregnant and 16.5% not. There was a significant difference between GBS carriage and history of premature rupture of membrane (PROM). GBS was isolated from 65 (13%) samples. GBS was positive in 70 (14%) samples by antigen test and in 62 (12.4%) by PCR. Sixty-eight of the 70 positive antigen tests were confirmed by PCR or culture. Fifty-five isolates were resistant to tetracycline, 16 to erythromycin and clindamycin, and 13 to levofloxacin. Thirteen different pulsotypes and 17 sporadic strains were determined by PFGE. CONCLUSIONS GBS carriage rate in non-pregnant women was higher than in pregnant women. The GBS antigen test was more sensitive than culture and PCR. GBS isolates did not originate from a single clone and contained sporadic strains. There was a significant difference between GBS carriage and history of PROM. Epidemiologic data obtained in this study will help future studies.

Akut gastroenteritli hastalarda rotavirüs ve adenovirüs antijenlerinin araştırılması

Objective: Nowadays, viruses are the most common agents of acute gastroenteritis all over the world. Acute gastroenteritis, especially in children, is an important cause of mortality and morbidity. Both the lack of effective treatments as well as due to the unnecessary use of antibiotics, detection of viral agents in stool is important in terms of the epidemiology and monitoring of the disease. The purpose of this study is to determine the frequency of rotavirus and adenovirus in patients with acute gastroenteritis admitted to our hospital. Methods: Rotavirus and adenovirus 40/41 antigens were investigated by immunochromatographic method in stool samples of 2795 patients admitted to our hospital with the diagnosis of acute gastroenteritis between January 2010December 2013. Results: Viral antigens were detected in 338 (12,1%) of the total 2795 samples. Rotavirus antigen was detected in 273 (9.8%), adenovirus in 36 (1.3%), both rotavirus and adenovirus in 29 (1.0%) of the patients. Of the cases who have positive viral antigen test, 154 (45.6%) were female, 184 (54.4%) were male and 198 (58.6%) were in the 0-2 age group. Total antigen positivity was more common in the late summer and autumn. Conclusion: Rotavirus is the most important agent in acute gastroenteritis in our hospital. More than half of patients were in the 0-2 years old group. Detection of viral agents in patients with acute gastroenteritis will allow early diagnosis and symptomatic treatment as well as will prevent empirically the use of antibiotics. J Clin Exp Invest 2014; 5 (2): 256-260

Streptococcus pyogenes İzolatlarının Virülans Faktörlerinin Araştırılması ve “Multiple Locus Variable Number Tandem Repeat Fingerprinting (MLVF)” Yöntemi ile Tiplendirilmesi

Streptococcus pyogenes is an important bacterial pathogen that colonizes the throat and skin of human beings and causes a wide variety of diseases ranging from mild infections like pharyngitis, tonsillitis and impetigo to severe invasive infections such streptococcal toxic shock syndrome, septicemia, and necrotizing fasciitis, and produces a wide variety of virulence factors. The aim of this study was to investigate the antibiotic resistance, virulence genes; [pyrogenic exotoxin genes (speA, C, G, H, I, J, K, L, M, smeZ and ssa), deoxyribonuclease genes (sdaB, spd3, sdc ve sdaD), protease genes (speB, spyCEP ve scpA) and inhibitor genes (mac and sic)] of S.pyogenes strains isolated from throat cultures of patients with symptomatic tonsillo-pharyngitis and typing by multiple locus variable number tandem repeat fingerprinting (MLVF) method. One hundred and fifty S.pyogenes isolates were identified by conventional methods and streptococcus group A latex kit (Biomerieux, France). Antibiotic susceptibility tests were performed by Kirby-Bauer disk diffusion method as recommended by Clinical and Laboratory Standards Institute. DNA isolation was performed by using a commercial DNA isolation kit (Qiagen, Germany) in accordance with manufacturers recommendations. The virulence genes were determined by multiplex PCR. MLVF method was performed with multiplex PCR using specific primers for repeated sequences within bacterial genome. All of the S.pyogenes isolates were susceptible to penicillin G, cefotaxime, ceftriaxone, chloramphenicol, clindamycin, erythromycin, levofloxacin, vancomycin and linezolid. Among streptococcal pyrogenic exotoxin genes the most frequent gene was smeZ (90.0%) followed by speG (88.0%), speC (58.7%), ssa (42.7%), speA (33.3%), speJ (24.0%), speK (18.7%), speH (14.0%), speI (13.3%), speL and speM (9.3%). Of the DNase genes, sdaB was detected in all strains (100%), spd3, sdc, sdaD genes were determined as 64.7%, 36.0%, 24.7% respectively. Protease genes (speB, spyCEP, scpA) and mac gene from the inhibitor genes were positive in all strains, and sic gene was positive in only 3 (2.0%) of the isolates. Thirty-two different patterns that contained two or more isolates were determined by MLVF analysis. Ninety one isolates were included in any of the 32 different patterns, while 59 isolates were defined as sporadic isolates. In conclusion, S.pyogenes isolates collected from throat cultures of patients with symptomatic tonsillo-pharyngitis in Konya/Turkey were susceptible to all antibiotics studied and have carried a very high rate of virulence factors. However the isolates were mostly clonally unrelated and sporadic. This study is the first report in Turkey, in which S.pyogenes isolates were typed by the MLVF method and a large number of virulence factors were investigated.

Hastane Enfeksiyonu Etkeni Klebsiella pneumoniae İzolatlarında Çeşitli Virülans Faktörlerinin Araştırılması

Klebsiella pneumoniae is an opportunistic pathogen that commonly affects immunosuppressed patients and causes nosocomial infections. K.pneumoniae has a variety of virulence factors, especially capsule polysaccharide, hypermucoviscosity (HV), fimbriae, toxins and determinants for iron acquisition. The aim of this study was to detect the virulence factors in K.pneumoniae strains isolated from nosocomial infections in two years. Fifty three K.pneumoniae strains isolated from the samples of patients with nosocomial infections in the Medical Microbiology Laboratory of Selcuk University Faculty of Medicine Hospital between 2011 and 2013 were included in the study. Identification and antimicrobial susceptibilities of the isolates were performed by VITEK 2 automatic system. Biofilm formation,α-hemolysin, capsule and HV were investigated by phenotypic methods. Polymerase chain reaction (PCR) was used to detect virulence genes encoding adhesins (fimH-1, mrkD, kpn, ycfM), siderophores (entB: enterobactin, iutA: aerobactin, irp-1, irp-2, ybtS, fyuA: yersiniabactin, iroN: catechols receptor), protectines or invasins (rmpA, magA, traT) and toxins (hlyA, cnf-1). Of the 53 K.pneumoniae isolates,12 (22.6%) were isolated from in patients of reanimation intensive care unit, 8 (15.1%) medical oncology, 7 (13.2%) newborn intensive care unit and 26 (49%) other clinics. The distribution of the isolates according to the samples was as follows: urine (n= 14), blood (n= 13), wound (n= 8), drainage fluid (n= 10), broncho-alveolar lavage (n= 7), and cerebrospinal fluid (n= 1). Isolates which were resistant to meropenem were 5.7% and production of extended spectrum beta-lactamase (ESBL) was 71.7%. The capsule, biofilm formation, and HV were observed in 100%, 79.2%, and 1.9% of the isolates, respectively. Production of α-hemolysin was not detected in any of the isolates. The genes; entB (96.2%), ycfM (86.8%), and mrkD (83.0%) showed high prevalence. The other genes were detected in different ratios: fimH-1 (64.2%), fyuA (54.7%), kpn (49.1%), ybtS (41.5%), irp-1(41.5%), irp-2 (37.7%), traT (11.3%) and iutA (5.7%). Virulence genes; iroN, rmpA, magA, hlyA and cnf-1 were not detected in any of the isolates. Enterobactin had the highest rate among siderophores, and ycfM and mrkD in adhesins. The capsule and biofilm formation were commonly found in the isolates. Hypermucoviscosity was only found in one isolate but associated genes were not detected. Alfa hemolysin production and hlyA gene were not determined. As a result, it seems that the basis of the pathogenicity of K.pneumoniae strains isolated from nosocomial infections are capsule, adhesins, enterobactin and ability of biofilm formation. There is a need for new studies for the continuous monitoring of toxin and invasion ability as well as antibiotic resistance in the control of hospital infection caused by K.pneumoniae.

Enterococcus avium Peritonitis in a Child on Continuous Ambulatory Peritoneal Dialysis

1. Brady HR, Abraham G, Oreopoulos DG, Cardella CJ. Bowel erosion due to a dormant peritoneal catheter in immunosuppressed renal transplant recipients. Perit Dial Int 1998; 8:163–5. 2. Watson LC, Thompson JC. Erosion of colon by a long dwelling peritoneal dialysis catheter. jaMa 1980; 243:2156–7. 3. Askenazi D, Katz A, Tenney F, Benfield M, Barnhart D. An unusual case of peritoneal dialysis malfunction. Kidney Int 2007; 72:524. 4. Finkle SN. Peritoneal dialysis catheter erosion into bowel: amyloidosis may be a risk factor. Perit Dial Int 2005; 25:296–7. 5. Rotellar C, Sivarajan S, Mazzoni MJ, Aminrazavi M, Mosher WF, Rakowski TA, et al. Bowel perforation in CAPD patients. Perit Dial Int 1992; 12:396–8. 6. Grzegorzewska AE. Perforation of the transverse colon caused by a permanent peritoneal dialysis catheter. Perit Dial Int 2004; 24:298. 7. Shrestha BM, Wilkie M, Raftery AT. Delayed colonic perforation caused by an unused CAPD catheter in a patient presenting with diarrhea. Perit Dial Int 2003; 23:610–11. doi:10.3747/pdi.2013.00078