Suna Gedikoglu

Tularemia in Bursa, Turkey: 205 cases in ten years

Tularemia is a zoonotic disease caused by the coccobacillus F. tularensis. Small epidemics and sporadic cases were seen around Bursa since November 1988. In this study, a total of 205 cases of tularemia were observed. All the cases were diagnosed on clinical, bacteriological and serological grounds. The epidemics were thought to be waterborne. The majority of the patients were young and female. In most of the cases the disease presented itself in oropharyngeal form (83%). Analysing sera from the patients with microagglutination method demonstrated that titers were ≥ 1:160 in approximately 85% of the cases, including the ones in subclinical form. Five of ten patients from who the bacteria was isolated were seronegative. Streptomycin was given to the most of the patients by combining with tetracycline, doxycycline or chloramphenicol. The early administration of these antibiotics (before the third week of disease) was found to be much more effective to resolve the infection. As a result, the main mode of transmission of F. tularensis is waterborne in our region. In our region, tularemia should be considered in differential diagnosis for the cases with fever, tonsillopharyngitis and cervical lymphadenopathy to make an early diagnosis and to design relevant treatment.

Re-emergence of tularemia in Turkey

Four tularemia epidemics were reported from three different regions of Turkey between 1936 and 1953. After a long interval, a new tularemia epidemic was reported from the area around Bursa in the northwestern part of Turkey in 1988. Following this first epidemic in Bursa, small epidemics occurred in areas around Bursa between 1988 and 2002. Other tularemia epidemics in different regions of Turkey were reported between 1988 and 2005. Almost all of the cases involved the oropharyngeal form of the disease. However, ulceroglandular and oculoglandular forms were detected in the Bursa epidemics; all of the ulceroglandular cases had dermatitis on their hands. To date, 1300 cases have been serologically confirmed. We reviewed one of the biggest tularemia epidemics in Europe.

A note on the incidences of Salmonella spp., Listeria spp. and Escherichia coli O157:H7 serotypes in Turkish sausage (Soudjouck)

The incidence of Salmonella spp., Listeria monocytogenes and Escherichia coli O157:H7 was determined in 100 Turkish sausage (soudjouck) samples collected from shops and markets in the Afyon province, Turkey. Salmonella spp. were detected in 7% of the samples. All of the isolates were S. enterica Paratyphi B. In addition, Listeria spp. were detected in 9% of the samples. Its distribution was 7% L. monocytogenes and 1% each of L. ivanovii and L. innocua. Serological study of the seven L. monocytogenes isolates showed that three of these were 1/2 ab, three were 5/6 ab and one was 1 ab. E. coli O157:H7 was not detected in any of the samples. The pH values of the samples ranged from 4.8 to 6.5. In conclusion, increasing number of listeriosis and salmonellosis cases in Turkey and the contamination levels found indicate that risk assessment and improved preventive measures are required for these sausages.

Detection of Brucella melitensis by BACTEC NR 730 and BACTEC 9120 systems

In many parts of the world, brucellosis has significantly decreased, but it is still a problem in some regions of Turkey. In our laboratory we have isolated 58 Brucella spp. through BACTEC NR 730 and 30 Brucella spp. through BACTEC 9120 systems. 31 of the 58 isolates were detected by BACTEC NR 730 system in 72 hours. The majority of the growth values were between 45–65. BACTEC 9120 system detected all the isolates in 84 hours.

Investigation of colistin sensitivity via three different methods in Acinetobacter baumannii isolates with multiple antibiotic resistance

BACKGROUND In recent years there has been an increase in life-threatening infections caused by Acinetobacter baumannii with multiple antibiotic resistance, which has lead to the use of polymyxins, especially colistin, being reconsidered. The aim of this study was to investigate the colistin sensitivity of A. baumannii isolates with multiple antibiotic resistance via different methods, and to evaluate the disk diffusion method for colistin against multi-resistant Acinetobacter isolates, in comparison to the E-test and Phoenix system. METHODS The study was carried out on 100 strains of A. baumannii (colonization or infection) isolated from the microbiological samples of different patients followed in the clinics and intensive care units of Uludağ University Medical School between the years 2004 and 2005. Strains were identified and characterized for their antibiotic sensitivity by Phoenix system (Becton Dickinson, Sparks, MD, USA). RESULTS In all studied A. baumannii strains, susceptibility to colistin was determined to be 100% with the disk diffusion, E-test, and broth microdilution methods. Results of the E-test and broth microdilution method, which are accepted as reference methods, were found to be 100% consistent with the results of the disk diffusion tests; no very major or major error was identified upon comparison of the tests. The sensitivity and the positive predictive value of the disk diffusion method were found to be 100%. CONCLUSIONS Colistin resistance in A. baumannii was not detected in our region, and disk diffusion method results are in accordance with those of E-test and broth microdilution methods.

Epidemiology of Acinetobacter baumannii in a university hospital in Turkey.

OBJECTIVE Molecular epidemiologic surveillance of Acinetobacter baumannii by polymerase chain reaction-randomly amplified polymorphic DNA analysis in a university hospital for 3 consecutive study periods. RESULTS Twelve different Acinetobacter baumannii genotypes (A-L) were detected. Although only 2 genotypes were detected during the first period and genotype A appeared to be the most common genotype, genotype D was included in these genotypes during the second study period. Genotype A completely disappeared during the third period. Although the presence of genotype C and the genotype D continued during the third period, 9 new genotypes were detected during this period. Genotype A appeared to be the most common genotype in the hospital (detected in 19 different clinics). The distribution of genotypes in clinical samples correlated with patient traffic between them. Some genotypes were found in both clinical and environmental samples. Seventeen different antibiotypes were detected, according to antibiotic susceptibility profiles. CONCLUSIONS Environmental contamination, airborne transmission, patient transfer, and cross-contamination play important roles in epidemics caused by A. baumannii in our hospital. The distribution of genotypes can change over time, so antibiotyping is not appropriate for the epidemiological analysis of A. baumanii infection.

Influences of alternate therapy protocol and continuous infectious disease consultation on antibiotic susceptibility in ICU.

Abstract In this study, the effects of alternate use of imipenem and cefoperazone/sulbactam(CFP/Sul) on antibiotic resistance in the intensive care unit (ICU) were investigated. Between 1 April 1993 and 1 April 1994, the infectious diseases consultant saw patients when required and there was no alternative therapy for antibiotics. For the following 2 years, the same consultant followed up each patient from admission to discharge by daily visits to the ICU and an alternative therapy protocol was initiated. The most common microorganisms were found to be Acinetobacter baumannii and Staphylococcus aureus, followed by Pseudomonas aeruginosa and Klebsiella pneumoniae, respectively, in the two periods. This study demonstrated that sensitivity rates of imipenem, ciprofloxacin and aminoglycosides were improved as a result of this protocol.

Colonisation in adult patients with nosocomial candidemia

The aim of this prospective study was to investigate the association between Candida spp. isolated from blood culture and the colonisation of different anatomical sites of patients with candidemia, and to evaluate the colonisation dynamics and Pittet’s index. Cultures were collected from the different anatomical sites of all the patients within 24 h of diagnosis of candidemia. Molecular similarities between identical species colonised with Candida species were evaluated via karyotyping. The colonisation index, as developed by Pittet et al. was calculated using screening culture results from patients. Among the 40 patients screened for colonisation, 35 (87.5%) had colonisation of at least one anatomical site. Twenty‐six (74.3%) of the 35 patients with colonisation in any of the three anatomical sites (respiratory, rectum and urinary sites) were shown to be colonised with the same species that caused candidemia. When the anatomical sites were compared with each other, no significant difference was observed at the species level in terms of colonisation index. The colonisation index (≥0.5) positivity rate was 74% in patients with candidemia. The investigation of Candida colonisation of at least three anatomical (respiratory, rectum and urinary) sites could help in the selection of empirical antifungal therapy when nosocomial candidemia is suspected.

Comparison of the E-test Method with an Automated Bacterial Identification and Antimicrobial Susceptibility Detection System for Screening Extended-spectrum β-Lactamase Producers

Some automated systems used in clinical microbiology laboratories are able to detect products responsible for antimicrobial resistance. In this study, 626 isolates (436 Escherichia coli, 134 Klebsiella pneumoniae and 56 Klebsiella oxytoca strains) were examined for the presumptive detection of extended-spectrum b-lactamase (ESBL) production by 2 methods: the Sceptor system (BD, Sparks, MD, USA) and the E-test. ESBL production was detected in 26 E. coli strains (5.96%), 60 K. pneumoniae strains (44.77%) and 15 K. oxytoca strains (26.78%) by ceftazidime/ceftazidime–clavulanate E-test. Using the E-test, ESBL production was detected in 25 of 201 E. coli strains (12.43%), 55 of 75 K. pneumoniae (73.33%) and 14 of 27 K. oxytoca strains (51.85%) that were alerted as ESBL-producing strains by the Sceptor system. ESBL positivity was detected in 1 E. coli, 5 K. pneumoniae and 1 K. oxytoca strains, that were not warned as being ESBL producers by the Sceptor system. These data suggest that clinical microbiology laboratories should not only rely on these rapid automated systems but also use another method for screening ESBL producers, such as the E-test. The rates of these ESBL-producing isolates in this study were lower than those in other studies reported from other parts of Turkey, but higher than those reported from the USA and Europe.