Pinar Zarakolu

Preliminary evaluation of an immunochromatographic strip test for specific Treponema pallidum antibodies.

ABSTRACT We evaluated a prototype immunochromatographic strip (ICS) test for qualitative detection of Treponema pallidum antibodies in 353 sera from 157 patients. For sera from 43 syphilis patients, the ICSs were reactive, while for sera from 114 patients without syphilis, including 22 with biologically false-positive Rapid Plasma Reagin test results, the ICSs were nonreactive. The ICS test may expand the available options for serological testing for syphilis.

Antimicrobial susceptibility testing of Campylobacter jejuni: a comparison between Etest and agar dilution method

The susceptibility of Campylobacter jejuni strains (n = 50) against nine antimicrobials were determined in comparison with Etest (AB BIODISK, Solna, Sweden) and agar dilution method to further investigate the correlation between the two methods. All the strains were isolated from stool samples of patients with diarrhea in 1998 and found to be highly susceptible (>84%) to ampicillin, tetracycline, gentamicin, chloramphenicol, ciprofloxacin and erythromycin. The essential agreement between two methods was 66.6% (+/-1 log(2) dilution) and 85.5% (+/-2 log(2) dilution). The agreement of susceptibility categories was higher at 94.4%.

A cluster of nosocomial Klebsiella oxytoca bloodstream infections in a university hospital.

BACKGROUND On February 19, 2003, four patients (patients 1-4) in the neurology ward underwent cranial magnetic resonance angiography (MRA) and developed fever within 1 hour afterward. Klebsiella oxytoca was isolated from blood cultures of patients 1 through 3. OBJECTIVE To identify the source of this cluster of nosocomial K. oxytoca bloodstream infections. DESIGN Outbreak investigation. SETTING A 1,000-bed university hospital. METHODS The infection control team reviewed patient charts and interviewed nursing staff about the preparation and administration of parenteral fluids. The procedure of cranial MRA was observed. Arbitrarily primed polymerase chain reaction (AP-PCR) was performed to show the clonal relationship among these three strains. RESULTS AP-PCR revealed that three K. oxytoca isolates had the same molecular profile. Cranial MRA was found to be the only common source among these patients. During MRA, before injection of the contrast medium, normal saline solution was infused to check the functioning of the intravenous catheter. Use of the solution for multiple patients was routine, but the access diaphragm of the bottle was not cleansed. The bottle of normal saline solution used on February 19 had already been discarded and the culture sample taken from the solution on the day of observation was sterile. CONCLUSIONS We speculate that normal saline solution became contaminated during manipulation and that successive uses might have been responsible for this cluster. Poor aseptic techniques employed during successive uses appear to be the most likely route of contamination. Use of parenteral solutions for multiple patients was discontinued.

Surveillance of antimicrobial resistance in Gram-negative isolates from intensive care units in Turkey: Analysis of data from the last 5 years

Abstract A multicenter antimicrobial surveillance program was established in Turkey in 1995 to monitor the predominant Gram-negative pathogens from intensive care units (ICUs) and antimicrobial resistance patterns of these isolates. Sixteen hospitals participated in the study and a total of 1479 isolates from 1100 patients were collected. The isolates were tested for their susceptibility against 13 antibiotics by E-test method. Minimum inhibitory concentrations (MICs) for each isolate were determined for imipenem, ceftazidime, cef-tazidime-clavulanate, cefoperazone-sulbactam, ceftriaxone, cefepime, cefurox-ime, piperacillin-tazobactam, ticarcillin-clavulanate, gentamicin, amikacin and ciprofloxacin. The most common isolates were Pseudomonas spp. (28.2%), Escherichia coli (19.2%) and Klebsiella spp. (19.1%). We found very high resistance rates to all major antibiotics that are used to treat serious infections. Although imipenem is the most active agent, it had an overall susceptibility rate of 68%. Half of the tested Klebsiella spp. strains were found to produce ESBL. This is a very high rate when compared with the literature. Cross-resistance among species was also investigated. 52% of ciprofloxacin-resistant strains were also resistant to imipenem, 80% to ceftazidime, 97% to ceftriaxone, 86% to amikacin and 19% of imipenem-resistant strains were susceptible to ceftazidime and 18% to amikacin. When susceptibilities of the years 1995 and 1999 were compared, the most interesting finding was the decrease in resistance to 3rd generation cephalosporins. In conclusion, this national clinical isolate database shows that resistance rates are high, the change over years is not predictable and continuous surveillance is necessary to monitor antimicrobial resistance and to guide antibacterial therapy.

Epidemiology and emerging resistance in bacterial bloodstream infections in patients with hematologic malignancies

Abstract Background: The objective of this study was determine the frequency of bloodstream infections (BSIs) and the causative bacteria and their resistance patterns in patients with hematological malignancies (HMs) in a large tertiary care university hospital in Turkey over a 5-year period. Methods: A total of 2098 patients with HMs with 3703 neutropenic episodes were included. Patients were classified as high-risk (n = 843) and low-risk (n = 1255) groups and evaluated for frequency of BSIs, causative bacteria, and their resistance patterns. Results: The frequency of BSIs was 14.5%. The frequency of gram-negative BSIs in high-risk and low-risk groups was 10.7% and 5.4% (p < 0.001), respectively. The frequency of gram-positive BSIs in high-risk and low-risk groups was 7.0% and 3.9% (p < 0.001), respectively. Gram-negative bacteria predominated (52.6%), with Escherichia coli (17.3%) and Klebsiella spp. (11.0%) as the most frequent organisms. Coagulase-negative staphylococci (10.4%) and Corynebacterium spp. (6.3%) were the most common gram-positive bacteria (35.8%). The rate of extended-spectrum beta-lactamase (ESBL) production was 45% for E. coli and 58% for Klebsiella spp. Quinolone resistance was 58% for E. coli and 11% for Klebsiella spp.. The overall frequency of ceftazidime resistance in Pseudomonas aeruginosa was 28%, and 87% of Acinetobacter spp. were multidrug-resistant. Of Staphylococcus aureus isolates, 24.8% were resistant to methicillin. Conclusion: The dominating causes of BSIs in patients with HMs in our hospital are resistant gram-negative bacteria, which has made empirical antimicrobial choice a highly challenging issue in this patient population.

Epidemiology and susceptibility of pathogens from SMART 2011–12 Turkey: evaluation of hospital-acquired versus community-acquired urinary tract infections and ICU- versus non-ICU-associated intra-abdominal infections

Objectives To describe the epidemiology and susceptibility of pathogens (including ESBL producers) from hospital-acquired (HA) versus community-acquired (CA) urinary tract infections (UTIs) and ICU- versus non-ICU-associated intra-abdominal infections (IAIs) in Turkey as a part of the SMART study. Methods : For this report, Gram-negative pathogens (363 from UTIs and 458 from IAIs) were collected in 2011 and 2012 at six hospitals in Turkey. HA versus CA UTIs and ICU- versus non-ICU-associated IAIs were compared for the species isolated, percentage of ESBL-positive isolates by species and susceptibility for overall and individual Gram-negative species. Results : Escherichia coli was the most common pathogen identified in HA (40.2%) and CA (73.9%) UTIs and ICU-associated (25.8%) and non-ICU-associated (43.3%) IAIs. The rate of ESBL-positive E. coli was significantly higher in HA than in CA UTIs (50.5% versus 38.2%, P  <   0.001) and in non-ICU-associated than in ICU-associated IAIs (52.5% versus 29.2%, P  = 0.029). Of the drugs studied, only amikacin was active against ≥90% of pathogens in UTIs, while ertapenem, imipenem and amikacin were active against ≥90% of E. coli ; and imipenem, amikacin and cefoxitin were active against ≥90% of Klebsiella pneumoniae in IAIs. Conclusions Our findings demonstrated that E. coli continues to be the principal pathogen of UTIs and IAIs in Turkey. Along with a high rate of ESBL-positive isolates, high antimicrobial resistance among Gram-negative bacilli from either UTIs or IAIs was noted particularly in the case of HA UTIs and ICU-associated IAIs, with a higher likelihood of carbapenem- or amikacin-based therapy to provide the broadest activity against bacterial pathogens.

Pregnancy complicated by Evan’s syndrome

Evans syndrome was initially diagnosed in a 26-year-old pregnant patient. Following the introduction of high dose steroid therapy, the patient developed possible disseminated gonococcal infection which was followed by preterm labor and abruptio placentae. A cesarean delivery was performed at the 34th week of pregnancy following platelet infusion. While the infant survived, the mother had delayed postpartum hemorrhage.

Susceptibility of Bacterial Isolates From Turkey - A Report From the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Program

Abstract The study monitored the susceptibility of nosocomial pathogens to meropenem and comparator antimicrobial agents isolated as part of the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Program from Turkish university hospitals. In terms of minimum inhibitory concentration 90% (MIC90) values, meropenem was two- and eight-fold more active than imipenem against Escherichia coli and Klebsiella pneumoniae, respectively. 40.5% of K. pneumoniae, 23.1% of Klebsiella oxytoca and 15.3% of E. coli isolates were extended-spectrum β-lactamase (ESBL) producers. Piperacillin/tazobactam was the most active agent against isolates of Pseudomonas aeruginosa, followed by meropenem and imipenem. Against Acinetobacter baumannii isolates, meropenem and imipenem were the most active agents. Continued surveillance by the MYSTIC Program appears to be prudent to help focus on effective empiric treatment regimens.

Epidemiology of carbapenem-resistant Klebsiella pneumoniae colonization: a surveillance study at a Turkish university hospital from 2009 to 2013.

Between June 2009 and December 2013, 4105 patients were screened for carbapenem-resistant Klebsiella pneumoniae (CR-Kp) colonization in a tertiary care university hospital. The antimicrobial susceptibility and resistance determinants of 279 (6.8%) CR-Kp isolates from single patients were investigated. Additional analysis was performed to evaluate the characteristics and various risk factors for infection in patients with colonization. Of the 279 isolates, 270 harboured OXA-48-like enzymes, and a single isolate harboured IMP-type carbapenemase. A high proportion of isolates were susceptible to carbapenems - except ertapenem. All isolates were susceptible to amikacin and most (94%) were susceptible to colistin and fosfomycin. There was consistent high-level resistance for all isolates to temocillin, piperacillin-tazobactam, amoxicillin-clavulanate and ticarcillin-clavulanate. When colonized and infected patients were compared, only prior carbapenem administration (P = 0.003), was found to be significantly associated with patients with CR-Kp infection.

Predictors of mortality in patients with bacteremia of unknown source due to extended spectrum beta-lactamase producing Escherichia coli.

fined according to the Centers for Disease Control and Prevention criteria 4. The personal and disease-related characteristics of patients with unknown source of bacteremia were recorded from patients’ charts. The severity of illness was calculated by the Acute Physiology and Chronic Health Evaluation (APACHE) ii score. The initial empirical antimicrobial therapy, which was administered within 24 h after acquisition of blood culture samples, was considered appropriate if at least one of the antibiotics was active in vitro (except ceftriaxone, cefotaxime and ceftazidime) and if the dosage and administration route conformed with current medical standards 2. Only one bacteremic episode was included in the study. The mortality rate in 14 days after the onset of bacteremia was used as the main outcome measure. identification and antibiotic susceptibilities of the bacterial species were carried out with Phoenix Automated Microbiology system (Becton Dickinson, sparks, MD, UsA) at Hacettepe Univesity Hospital and Microscan Walkaway system (Dade Behring, West sacramento, CA, UsA) at Erciyes University Hospital, respectively. EsBL production were determined by disc diffusion method in accordance with the Clinical and Laboratory standards institute (CLsi, formerly nCCLs, national Committee for Clinical Laboratory standards) recommendations 5. students t test was used to compare continuous variables, and the c2 or Fishers exact test was used to compare categorical variables. To identify the independent risk factors for mortality, a binary logistic regression analysis was used to control for the effects of confounding variables with p<0.10 and HosmerLemeshow goodness-of-fit statistics were used 6. All statistical analyses were performed by using sPss software for Windows (version 15.0; sPss, Chicago, iL). A total of 37 patients with unknown source of bacteremia due to EsBL-EC were identified in the 4 years of the study. All bacteremia episodes were nosocomial. The mean (± sD) age of the patients was 50.4±16.7 (range 20-98) and 21 of them were male. The 14-day mortality for EsBL-EC bacteremia was 43.2% (16/37). The most common underlying diseases were hematological malignancies and solid tumors (table 1). All EsBL-EC isolates were susceptible to carbapenems, whereas susceptibilities to amikacin, gentamicin, sulfamethoxazole/trimethoprim, piperacillin/ tazobactam (TZP) and ciprofloxacin were 86.4%, 35.1%, 32.4%, 21.6% and 10.8%, respectively. Only one isolate was reported as susceptible to cefepime. All patients received initial empirical antibiotics; 22 patients received carbapenems (7 of whom died), 7 received TZP (5 of whom died), 3 received cefepime with amikacin (2 of whom died), 2 received cefepime monotherapy (both of whom died). Two patients who received ceftriaxone and 1 who received ciprofloxacin bRief COmmUNiCAtiON