Huseyin Kilic

The relationship between Helicobacter pylori IgG titre and coronary atherosclerosis.

Objectives — The role of Helicobacter pylori (HP) in the progression of atherosclerosis is con-troversial.We investigated the relation between HP IgG antibody titres and severity and intensity of coronary atherosclerosis and also clinical presentation of coronary artery disease (CAD). Methods — The patient group consisted of 353 patients with angiographically proven CAD, which contains 3 different subgroups: 163 patients with myocardial infarction (MI), 106 patients with unstable angina (USAP) and 84 patients with stable angina (SAP). Control group included 163 subjects with angiographically proven normal coronary arteries. Helicobacter pylori IgG antibody titres were measured by an enzyme immunoassay method in all patients. Gensini and Extent scores were used to evaluate the angiographic severity and extent of atherosclerosis. C-reactive protein levels were measured by Behring nephelometry system kits. Results — Seropositivity rates for HP were similar between groups (82.7% in the patient group and 86.6% in the control group (P > 0.05)). Also HP-IgG levels were similar among the MI, USAP and SAP groups. No significant correlation was observed between CRP levels and HP-IgG level titres. There was no significant correlation between HP-IgG level (r = 0.086, P = 0.2) and Gensini score but a significant poor correlation was observed between HP-IgG level and Extent score (r = + 0.156, P = 0.03). Conclusions — Helicobacter pylori IgG titres do not play an important role in the presentation of CAD and do not increase systemic inflammatory response. However, Helicobacter pylori IgG antibody titres may be correlated with the extent of CAD.

In vitro Effectiveness of Commercial Bacteriophage Cocktails on Diverse Extended-Spectrum Beta-Lactamase Producing Escherichia coli Strains

The objective of this study is to determine the in vitro susceptibility of Georgian bacteriophage cocktails on multidrug resistant (MDR) extended-spectrum beta-lactamase producing Escherichia coli (ESBL-EC) isolated from patients’ blood and urine cultures. A total of 615 E. coli isolates were included in this study. Phene Plate (PhP)-typing and phylogenetic grouping were used for the typing. Antimicrobial resistance profiles and ESBL production of all isolates were confirmed according to Clinical and Laboratory Standards Institute (CLSI) criteria. The activities of four bacteriophage cocktails (Enko-phage, SES-bacteriophage, Pyo-bacteriophage, and Intesti-bacteriophage) were determined against 142 ESBL-EC using in vitro spot tests. According to this, Enko-phage were active against 87.3% of the tested strains while that ratio was 81.7% for Intesti-bacteriophage, 81.7% for Pyo-bacteriophage, and 59.2% for SES-bacteriophage cocktails. Based on the contingency tests, the phage cocktails were observed to be statistically significantly (p < 0.001) more effective on ESBL-EC strains belonging to phylogenetic groups D and B2. The employed phage cocktails were found to be affective against all tested resistant types. These results are promising especially for the infections that are caused by MDR pathogens that are difficult to treat. As this is a preliminary step to the potential clinical trials to be designed for the country, in vitro confirmation of their success on a MDR ESBL-EC collection should be accepted as an initial action, which is encouraging to consider clinical trials of phage therapy especially in countries which are not introduce phage therapy.

Tigecycline for the treatment of Clostridium difficile infection refractory to metronidazole in haematopoietic stem cell transplant recipients

Tigecycline for the treatment of Clostridium difficile infection refractory to metronidazole in haematopoietic stem cell transplant recipients Gökhan Metan, Zeynep Türe, Leylagül Kaynar, Elife Berk, Şebnem Gürsoy, Emine Alp, Hüseyin Kılıç, Mustafa Çetin Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey, Department of Hematology, Faculty of Medicine, Erciyes University, Kayseri, Turkey, Department of Clinical Microbiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey, Department of Gastroenterology, Faculty of Medicine, Erciyes University, Kayseri, Turkey, Infection Control Committee, Faculty of Medicine, Erciyes University, Kayseri, Turkey

An outbreak of bloodstream infection due to extensively resistant Acinetobacter baumannii among neonates

HighlightsAs described in adults, extensively resistant Acinetobacter baumannii (XDR‐AB) also causes life threading infections among neonates including pneumoniae, meningitis and bacteremia.baumannii persistently inhabits most inanimate surfaces including hospital environmentsA potential inter‐hospital transmission might have occurred among departments due to lapses in environmental cleaning and disinfection.Exposure to umbilical venous catheters was found to be associated with BSIs among neonatesThis outbreak of bacteremia due to resistant A. baumannii affected 41 infants and associated with 58% mortality. Background: Extensively resistant Acinetobacter baumannii has emerged and spread worldwide as a significant cause of health care‐associated infections and outbreaks. It also causes life‐threatening infections among neonates, including bacteremia. The aim of this study was to investigate an outbreak of A baumannii bacteremia (ABB) among neonates. Materials and methods: A retrospective, case‐control study was conducted from July 2014 to July 2015 in a neonatal intensive care unit (NICU). Risk factors associated with ABB in univariate and multivariate analysis with logistic regression was performed. Molecular typing by pulsed field gel electrophoresis was used to confirm relatedness of bacteremic A baumannii strains. Results: During the 5‐year period (2011‐2016), 68 patients in our NICU were diagnosed with BSI due to A baumannii. The case‐control study included 41 case patients within the outbreak caused by a major epidemic clone and 108 control patients. Risk factors (by univariate analysis) associated with ABB were intubation, 14‐day mortality, and use of peritoneal dialysis and an umbilical catheter. Multivariate analysis identified 14‐day mortality (odds ratio, 5.75; 95% confidence interval, 2.58‐12.79) and umbilical catheter use (odds ratio, 2.44; 95% confidence interval, 1.1‐5.4) as independent risk factors for ABB. Conclusions: This outbreak of bacteremia due to resistant A baumannii affected 41 infants and was associated with 58% mortality. Control of the outbreak was achieved by implementing long‐term sustained infection control measures within the unit.

Investigation of Epstein-Barr Virus and Parvovirus B19 DNA in Allogeneic Stem Cell Transplant Patients

Objective: We aimed to investigate posttransplant Epstein-Barr virus (EBV) and parvovirus B19 DNA in allogeneic stem cell transplant patients between 2009 and 2010. Materials and Methods: Forty-five adult patients in whom allogeneic stem cell transplantation was performed between April 2009 and November 2010 in the Erciyes University Faculty of Medicine, Department of Internal Medicine, Division of Hematology and Oncology, were included in the study. EBV and parvovirus B19 DNA positivity was investigated by using real-time polymerase chain reaction technique in 135 plasma samples obtained after transplantation at between 1 and 6 months. Pretransplant serological markers of EBV and parvovirus B19 were provided from patient files. Results: In 32 (71.1%) of the patients, EBV antibodies in the pretransplantation period were as follows: anti-EBNA-1 IgG (+), VCA IgM (-), and VCA IgG (+). In 2 patients (4.45%), these antibodies were as follows: anti-EBNA-1 IgG (+), VCA IgM (-), and VCA IgG (-). In 1 patient (2.2%), they were as follows: anti-EBNA-1 IgG (-), VCA IgM (-), and VCA IgG (+). EBV serological markers were negative in 2 (2.2%) out of 45 patients before transplantation. There was low DNA positivity (<600 copies/mL) in 4 patients (8.9%), and VCA IgM was negative and VCA IgG was positive in these same 4 patients. In spite of low viral load, there were no symptoms related to EBV, and posttransplant lymphoproliferative disorder (PTLD) did not occur. While in 44 (99.7%) of 45 patients parvovirus B19 IgM was negative and IgG was positive, parvovirus B19 IgM was positive and IgG was negative in 1 (2.3%) patient. Parvovirus B19 DNA was not identified in any of the samples obtained from these 45 patients. Conclusion: In this study, EBV and parvovirus B19 DNA were investigated in allogeneic stem cell transplant patients. None of the patients developed PTLD and parvovirus B19 DNA positivity was not detected. However, this issue needs to be further evaluated in prospective, multicenter studies with larger series of patients.

Prevalence of Helicobacter pylori Antibodies in Uremic Patients

Dr. Cengiz Utas, Erciyes Universitesi Tip Fakiiltesi, Nefroloji Bilim Dali, 38039 Kayseri (Turkey) Dear Sir, Helicobacter pylori (HP) is highly associated with histologically proven gastritis and peptic ulcer disease in patients with gastrointestinal symptoms [1]. Uremic patients are especially prone to develop dyspeptic symptoms and gastroduodenitis [2]. A high urea content of the mucus in the stomach may predispose to HP infection [3]. It has been postulated that IgG and IgA ELISA tests, used together, can diagnose HP infections with a specificity exceeding 90% [4]. Because of the excellent sensitivity, specificity and low cost we have studied IgG and IgA antibodies against HP, and the results were correlated with dialysis duration, mean blood urea nitrogen levels in 72 (52 were on chronic hemo-dialysis therapy) uremic (GFR < IO ml/min) patients and 36 agematched healthy as well as 36 nonulcer dyspepsia controls. The IgG, IgA and both antibodies against HP of the study groups are shown in figures 1 and 2. There was no correlation between dialysis duration, blood urea nitrogen levels and HP antibodies and also none between the results of dialyzed and nondialyzed patient groups. Our results are similar to the literature data based on different diagnostic methods [5-8]. In conclusion the high blood urea levels and dialysis therapy did not seem to affect the possibility of infection. To perform the nonin-vasive serological tests for HP may be particularly useful for screening a uremic population to help decide whether to perform endoscopy or not as it is known that many uremic patients suffer from dyspeptic complaints. IgA IgG + IgA Fig. 1. Prevalence of HP in healthy controls (¤), nonulcer dyspepsia (ü) and uremic patients (■). References Blaser MJ: Epidemiology of Helicobacter pylori infections; in Malfertheiner P, Ditschuneit H (eds): Helicobacter pylori, Gastritis and Peptic Ulcer. Berlin, Springer, 1990, pp 3-8. Ala-Kaila K: Upper gastrointestinal findings in chronic renal failure. Scand J Gastroenterol 1987;22:372376. Hazell SL, Lee A, Brady L, Hennessy W. Campy-lobacterpyloridis and gastritis: Association with intercellular spaces and adaptation to an environment of mucus as important factor in colonization of the gastric epithelium. J Infect Dis 1986;153:658-663.

Investigation of Rotavirus with Various Methods in Children with Acute Gastroenteritis and Determination of Its Molecular Epidemiology in Kayseri Province, Turkey

In this study, the fresh stool samples from 254 children under 5 years of age with acute gastroenteritis which were delivered between October 2012 and December 2013 were collected.

Insufficient decontamination in Sewage treatment plants induce the risk of artificial selection of extended-spectrum β-lactamase producing Escherichia coli

Quantitative data about extended-spectrum beta-lactamase producing E. coli (ESBLEC) in the wastewaters are scarce, especially in developing countries. These data could be useful to raise awareness about the potential risk of spreading ESBLEC strains in the community. Water samples were collected weekly over a 10-week period, from one urban sewage treatment plant (STP), one rural STP and one hospital complexs wastewater (HWW) in Turkey. Mean E. coli and ESBLEC loads were determined for each sampling point. For the 580 ESBLEC isolated, antimicrobial resistance profiles, phylogenetic grouping, presence of common beta-lactamese-typesand integrons were studied using PCR. The mean ESBLEC ratio was accounted for 0.58%, 0,12%, 1.53% of the total E. coli in urban, rural untreated wastewater and HWW, respectively. These values were higher for the outlets. The mean number of different antimicrobial classes to which the strains were resistant was highest in urban STP (4.0± 1.6). The antimicrobial resistance ratios of ESBLEC strains isolated from HWW were observed to be in between those of urban and rural STPs. The most common phylogenetic group was C composing (29.7%) and the most susceptible strains belonged to phylogroup B1. Wastewater treatments without sufficient decontamination, resulting in artificial selection of ESBLEC might lead to public health risk as these strains reach communities through environment. To avoid such risks and protect the human health as well as the environment, well-established decontamination measures imposing barriers against this artificial selection should be implemented.

Emergence of gut colonization of carbapenem resistant Gram negatives in intensive care unit patients: a report from a middle income country

Carbapenem resistant gram negatives (CRGN) have emerged in intensive care units (ICUs) worldwide.