Hatice Turk Dagi

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.

Tigecycline Therapy in an Infant for Ventriculoperitoneal Shunt Meningitis

Shunt infections are seen in 3% to 20% of patients who have cerebrospinal fluid (CSF) shunts. Although the staphylococcal species are the most common cause of shunt-related infections, Gram-negative bacteria are increasingly reported with higher mortality rates. Tigecycline, a glycylcycline, is not approved for children. But in the era of nosocomial infections due to multidrug-resistant pathogens, it can be the life-saving option. We report an infant with ventriculoperitoneal shunt–related meningitis treated with a tigecycline combination regimen. A 5-month-old boy who had a ventriculoperitoneal shunt was admitted with meningitis. Extended spectrum β-lactamase–producing Klebsiella pneumoniae grew in the CSF. At the end of the fourth week of intravenous meropenem plus gentamicin therapy, carbapenem-resistant K pneumoniae grew in the CSF (mean inhibitory concentration value for meropenem >4 μg/mL, by E-test). The infected shunt was removed, and an external ventricular drainage catheter was inserted. With permission, intravenous tigecycline (1.2 mg/kg per dose twice a day) and intrathecal amikacin were added to the meropenem. Intrathecal amikacin could be given for only 7 days. On the sixth day of tigecycline treatment, the CSF was sterilized. Antibiotic therapy was given and consisted of a total of 60 days of meropenem and 20 days of tigecycline therapy. Because no available efficacy and safety data from randomized-controlled studies exist, tigecycline must be used only as salvage therapy, in combination with other drugs, for critically ill children who have no alternative treatment options.

Postoperative fungal endophthalmitis caused by Trichosporon asahii treated with voriconazole

Postoperative fungal endophthalmitis is a rare but devastating complication of cataract surgery. Vitrectomy and intravitreal amphotericin B injection as well as administration of systemic antifungal agents have been suggested as optimal treatments for fungal endophthalmitis. However, this therapy may fail to eliminate fungal species resistant to current antifungal agents. The saprophytic fungus Trichosporon asahii is frequently observed as a cause of endogenous endophthalmitis in immunosuppressed patients. We report a case of postoperative endophthalmitis caused by T. asahii, resistant to amphotericin B. To the best of our knowledge, this is the first report of T. asahii endophthalmitis successfully treated with intravitreal and systemic voriconazole, pars plana vitrectomy, and removal of the intraocular lens and entire lens capsule.

Distinct Campylobacter fetus lineages adapted as livestock pathogens and human pathobionts in the intestinal microbiota.

Campylobacter fetus is a venereal pathogen of cattle and sheep, and an opportunistic human pathogen. It is often assumed that C. fetus infection occurs in humans as a zoonosis through food chain transmission. Here we show that mammalian C. fetus consists of distinct evolutionary lineages, primarily associated with either human or bovine hosts. We use whole-genome phylogenetics on 182 strains from 17 countries to provide evidence that C. fetus may have originated in humans around 10,500 years ago and may have “jumped” into cattle during the livestock domestication period. We detect C. fetus genomes in 8% of healthy human fecal metagenomes, where the human-associated lineages are the dominant type (78%). Thus, our work suggests that C. fetus is an unappreciated human intestinal pathobiont likely spread by human to human transmission. This genome-based evolutionary framework will facilitate C. fetus epidemiology research and the development of improved molecular diagnostics and prevention schemes for this neglected pathogen.Human infections with Campylobacter fetus are often assumed to be derived from livestock. Here, Iraola et al. provide evidence that healthy humans may act as carriers and dispersers, and C. fetus may have originated in humans as an intestinal pathobiont and then adapted as a livestock pathogen.

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

Late-onset Streptococcus pasteurianus sepsis in a preterm baby in a neonatal intensive care unit.

Apnea, cyanosis, lethargy and prolongation in capillary filling time developed on the postnatal 37(th) day in a preterm baby who was born at the 30(th) gestational week with a birth weight of 1 300 g. Acute phase reactants and immature/total neutrophil count ratio were found to be high. The patient who was diagnosed with sepsis was successfully treated with meropenem which was started empirically. In his blood culture Streptococcus pasteurianus grew. S. pasteurianus is in the subgroup of streptococcus bovis which is one of the D group streptococci and its previous name is S. bovis type II/2. In the literature, there are very few cases of neonatal infection related with this bacterium. As far as we know, this is first case of neonatal sepsis caused by S. pasteurianus in Turkey. In addition, we tried to determine the clinical properties of neonatal infections arising from S. pasteurianus by reviewing the literature.

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