Tayfur Demiray

A Multicenter Evaluation of Blood Culture Practices, Contamination Rates, and the Distribution of Causative Bacteria

Background: The prognostic value of blood culture testing in the diagnosis of bacteremia is limited by contamination. Objectives: In this multicenter study, the aim was to evaluate the contamination rates of blood cultures as well as the parameters that affect the culture results. Materials and Methods: Sample collection practices and culture data obtained from 16 university/research hospitals were retrospectively evaluated. A total of 214,340 blood samples from 43,254 patients admitted to the centers in 2013 were included in this study. The blood culture results were evaluated based on the three phases of laboratory testing: the pre-analytic, the analytic, and the post-analytic phase. Results: Blood samples were obtained from the patients through either the peripheral venous route (64%) or an intravascular catheter (36%). Povidone-iodine (60%) or alcohol (40%) was applied to disinfect the skin. Of the 16 centers, 62.5% have no dedicated phlebotomy team, 68.7% employed a blood culture system, 86.7% conducted additional studies with pediatric bottles, and 43.7% with anaerobic bottles. One center maintained a blood culture quality control study. The average growth rate in the bottles of blood cultures during the defined period (1259 - 26,400/year) was 32.3%. Of the growing microorganisms, 67% were causative agents, while 33% were contaminants. The contamination rates of the centers ranged from 1% to 17%. The average growth time for the causative bacteria was 21.4 hours, while it was 36.3 hours for the contaminant bacteria. The most commonly isolated pathogens were Escherichia coli (22.45%) and coagulase-negative staphylococci (CoNS) (20.11%). Further, the most frequently identified contaminant bacteria were CoNS (44.04%). Conclusions: The high contamination rates were remarkable in this study. We suggest that the hospitals’ staff should be better trained in blood sample collection and processing. Sterile glove usage, alcohol usage for disinfection, the presence of a phlebotomy team, and quality control studies may all contribute to decreasing the contamination rates. Health policy makers should therefore provide the necessary financial support to obtain the required materials and equipment.

Socioeconomic indicators are strong predictors of hepatitis A seroprevalence rates in the Middle East and North Africa

The goal of this analysis was to examine the association between age-specific hepatitis A virus (HAV) seroprevalence rates and various socioeconomic indicators within the Middle East and North Africa (MENA) region. We conducted a systematic review of all recently published studies on HAV conducted in the MENA region and identified the highest quality studies for inclusion in our analysis. We calculated the age at midpoint of population immunity (AMPI) for each study and estimated seroprevalence rates at the ages of 5, 10, and 15 years. Next, we identified the correlations between these metrics and several socioeconomic variables. HAV data collected in or after 2000 were available for 14 of the 19 countries in the MENA region. Four of the 14 included countries had intermediate HAV endemicity (Algeria, Saudi Arabia, Turkey, and UAE), five had high endemicity (Iran, Jordan, Lebanon, Morocco, and Tunisia), and five had very high endemicity (Egypt, Iraq, Palestine, Syria, and Yemen). Water and sanitation were not significant predictors of AMPI or seroprevalence, most likely because most countries in this region have high rates of access to these utilities. However, gross domestic product (GDP), gross national income (GNI), and the human development index (HDI) were all highly associated with AMPI and prevalence. The observed correlations suggest that of the MENA countries without recent HAV data, Bahrain, Kuwait, and Qatar most likely have low endemicity, Oman likely has intermediate endemicity, and Libya likely has high endemicity. While it is unlikely that a single correlation model would be suitable for use in all world regions, the approach utilized in this analysis might provide a simple but accurate method for using economic data to impute the endemicity profiles of countries without recent data in regions where at least several neighboring countries have conducted recent serostudies.

Usefulness of soluble urokinase plasminogen activator receptor (suPAR) as an inflammatory biomarker in obese children

OBJECTIVE Soluble urokinase plasminogen activator receptor (suPAR) has emerged as a relatively new biomarker that reflects increased inflammatory status and been associated with cardiovascular risk. We wanted to investigate the predictive value and usefulness of suPAR as an inflammatory biomarker in obese children. METHODS AND RESULTS Of the total 136 participants, 76 (36 male, 40 female) were in obese group and 60 (24 male, 36 female) were in control group. The median age was 12.05 (6.16-17.30) years old for obese group, and 12.83 (8.00-16.75) years old for control group. Obese children had statistically significantly higher heart rate, systolic and diastolic blood pressure, EAT and LV mass than control group (p<0.01). The median suPAR level in obese group was not statistically different than in control group (0.54 vs. 0.59, p=0.26). The median hsCRP level in obese group was found statistically significantly higher than in control group (1.97 vs. 0.41, p<0.01). A significant positive correlation between hsCRP and BMI in the obese participants was found (r=0.45, p<0.01), but not a relationship between suPAR and BMI (r=-0.21, p>0.05). CONCLUSION Our research did not demonstrate the usefulness of suPAR as an inflammatory biomarker and a predictive value for future atherosclerosis in obese children. Further studies with larger sample size are required to determine whether suPAR is useful as an inflammatory biomarker in childhood obesity.

Intra-Abdominal Abscess and Primary Peritonitis Caused by Streptococcus anginosus

Introduction The Streptococcus anginosus group of bacteria are low-virulence bacteria existing as commensals in the oral flora and gastrointestinal tracts of humans. S. anginosus may spread to the blood in individuals with poor oral hygiene in cases of oral infections, such as gingivitis and tooth abscesses, that develop following the loss of mucosal unity. This may lead to infections in the whole body, primarily as brain and liver abscesses. Case Presentation A 32-year-old male patient presented with complaints of nausea, vomiting, and diffuse abdominal pain. Diffuse abdominal tenderness and rebound tenderness were detected particularly in the epigastrium and right upper quadrant. Laboratory assessment revealed a leukocyte count of 20,500/mm3. Free fluid around the liver and heterogeneous areas of abscess formation in the right lateral gallbladder were revealed on abdominal computed tomography. Diffuse adhesions between the bowel and seropurulent free liquid in the abdomen were detected on surgical exploration, and a sample was taken for cultures. The patient was discharged without complications on the sixth postoperative day and his antibiotic course was completed with 4 weeks of oral treatment. We reviewed the literature for similar cases of disseminated pyogenic infections caused by the S. anginosus group. Conclusions It should be kept in mind that the oral flora bacterium S. anginosus may cause transient bacteremia and deep-seated organ abscesses in immunodeficient patients with poor oral hygiene. Such patients with intra-abdominal abscesses should be treated with antibiotics and surgery.

Hepatitis a virus epidemiology in turkey as universal childhood vaccination begins: seroprevalence and endemicity by region

This paper presents the results of a comprehensive examination of current distribution of Hepatitis A virus (HAV) seroprevalence and endemicity in Turkey and the possible links between HAV endemicity and socioeconomic development. We performed a systematic search in online resources published between January 2000 and August 2015. The 22 provinces were able to be assigned a hepatitis A endemicity level based on this systematic review. The incidence rates for symptomatic hepatitis A infection are higher in the eastern part of Turkey than in the western and central region. These differences in socioeconomic indicators by region suggest the likelihood of lower seroprevalence rates in the western parts of the country and higher rates in the eastern region. Turkeys current policy of recommending hepatitis A immunization for all children without contraindications is an appropriate one and is likely to remain the best option for at least the next decade or two.

Ambulans kaynaklı enfeksiyonlar ve hijyen

Amac: Ilk ve acil yardim hizmetlerinde, ambulans hizmetleri vazgecilmezdir. Ambulansta hem hastanin hem de saglik personelinin, ayni kabini paylasmalari ve delici kesici aletlerle zaman zaman yaralanma risklerinin olmasi nedeniyle, saglik personelinin, ambulans hijyeninin saglanmasi ve bulasici hastaliklara karsi koruyucu onlemlerin alinmasi hakkinda egitim almasinin gerektigi aciktir. Calismamizda Sakarya il merkezi ve ilcelerinde acil hizmeti veren ambulanslarda ve acil mudahaleler sirasinda kullanilan aletlerde, enfeksiyon kaynagi olabilecek patojen mikroorganizmalarin varliginin arastirilmasi ve bu ambulanslarda gorevli personelin, ambulans hizmeti sirasinda ve sonrasinda hijyen uygulamalarina yonelik bilgi tutum ve davranislarinin degerlendirilmesi amaclanmistir. Materyal-Metod: Arastirmaya, Ocak 2016- Temmuz 2016 tarihleri arasinda, Sakarya il merkez ve ilcelerinde acil hizmeti veren, toplam 25 ambulans ve bu ambulanslarda aktif olarak calisan toplam 104 kisi dahil edilmistir. Calismada ambulans hizmeti veren saglik personeline anket uygulamasi ve ayrica ambulanslarin belirlenen riskli bolgelerinden alinan suruntu orneklerinde mikroorganizma taramalari yapilmistir. Bulgular: Calismaya 57’si kadin (% 54.8) olmak uzere toplam 104 kisi katilmis olup, 62’si (%59.6) 30 yas ve altidir. Katilimcilardan 95’i (% 91.3) 112 Acil servis ambulansinda, 9’u ise hastane ambulansinda (%8.7) calismaktadir. Ambulans calisanlarindan 83’u (%79.8) tibbi atik egitimi aldigini ifade ederken, sadece 54’u (% 51.9) arkadaslarinin el hijyenine dikkat ettigini belirtmislerdir. Ambulansin hasta kabini temizlik orani her vaka sonrasinda %29.8, gunluk % 49 olarak; kullanim sonrasi temizlik orani laringoskop gibi yuksek duzey dezenfeksiyon gerektiren aletler icin %75, tansiyon aleti gibi dusuk duzey dezenfeksiyon gerektiren aletler icin ise %28.8 olarak belirlenmistir. Suruntu ornekleri degerlendirildiginde, 20 ornekte Sphingomonas paucimobilis , 2 ornekte Acinetobacter Iwoffii , 2 ornekte Staphylococcus aureus , 2 ornekte Klebsiella pneumoniae , 20 ornekte Koagulaz negatif stafilokok saptanmistir. Sonuc: Calismamiz sonucunda; ambulans calisanlarinin, hem kendilerini ve hastalari bulasici enfeksiyon hastaliklarina karsi koruma konusunda, hem de ambulans hijyeni konusunda farkindaliklarinin artirilmasi gerekliligini ortaya koymustur. Ambulansin kontaminasyon kaynagi olmasini onlemek icin, daha siki enfeksiyon kontrolu ve izleme protokolu uygulanmalidir.

Association between biofilm and multi/extensive drug resistance in diabetic foot infection

We aimed to determine significant risk factors for biofilm production and to investigate the association between antimicrobial resistance profile and biofilm formation in the bacterial isolates obtained from patients with diabetic foot infection (DFI).

Hepatitis C testing among adults born between 1945 and 1965 in Turkey: a multicentre study

OBJECTIVE Hepatitis C virus (HCV) infection is a major public health problem and affects large populations all over the world. Serum anti-HCV level is a valuable marker to determine HCV infection. Anti-HCV testing has been recommended for high-risk population. The Center for Disease Control (CDC) and Prevention in the United States proposed a new high-risk population group - adults born between 1945-1965. Under this perspective, we designed a multicentre retrospective study to determine the seropositivity of anti-HCV among adults born between 1945 and 1965 and adults born after 1965 in Turkey. With the data collected, we aimed to determine whether there was a need for anti-HCV testing especially in people born between 1945 and 1965. METHODS We requested data from ten different medical centres in ten different provinces. Each medical centre collected the anti-HCV test results of adult patients for five-year period between 2009 and 2014 from hospital records. RESULTS A total of 974,449 anti-HCV test results were included in this study. When the seropositivity rates in the two groups of adults were compared, anti-HCV seropositivity rates were higher in nine medical centres out of ten. Anti-HCV seropositivity in adults born between 1945-1965 was significantly higher than in adults born after 1965 (p < 0.05). CONCLUSIONS We determined that the anti-HCV seropositivity rate is significantly higher in adults born between 1945-1965 compared to the younger adults as indicated in the literature. According to data from this study together with the WHO and CDC suggestions, we believe that it is appropriate to offer anti-HCV serology testing for people over 50 years of age since the anti- HCV seroprevalence in this age group is relatively high.

Nail scissors and fingernails as reservoirs of hepatitis B virus DNA: Role of nail scissors in household transmission of hepatitis B virus

Background: No study in the current literature has scientifically clarified the transmission of hepatitis B virus (HBV) via personal hygiene tools. We determined risk of household transmission of HBV via nail scissors. Moreover, we assessed whether nails from HBV‐infected people contained HBV, and evaluated correlations of HBV DNA levels of serum, nail specimens, and nail scissors. Methods: Seventy patients testing positive for the surface antigen of the hepatitis B virus (63 positive for HBV DNA) treated for HBV infection and 27 healthy individuals were included. Real‐time polymerase chain reaction method was used to detect HBV DNA levels in sera, nail, and nail scissors. Results: HBV DNA was detected on 27% of nail scissors and in 50% of nail specimens from 63 serum HBV DNA‐positive patients. Serum HBV DNA level >105 IU/mL was associated with 71.8% probability of nail scissors being HBV DNA‐positive (P < .05). Serum HBV DNA level >107 IU/mL was associated with 71.5% probability of fingernails being HBV DNA‐positive (P > .05). Shared‐use of nail scissors was correlated with surface antigen of the hepatitis B virus positivity and total hepatitis B core antibody/immunoglobulin G positivity. A high HBV DNA level was detected in nail scissors and low level HBV DNA in the nails of persons with high serum HBV DNA levels. Conclusions: Nail scissors, shared‐use of nail scissors, and duration of shared use play important roles in household transmission of HBV. Level of education within society in this regard should be increased via mass media.

Comparison of Novel Blood Culture System DL-Bt112TM with BacT/Alert 3DTM by Using Clinical Samples

BACKGROUND Blood cultures are the main diagnostic laboratory tool to detect bloodstream infections. Many clinical microbiology laboratories utilize automated blood culture systems to isolate infectious agents from blood samples. The diagnostic performance and time-to-detection values of the novel automated blood culture system, DLBt112TM (DL), was compared with BacT/Alert 3DTM (B3D) in this prospective comparative study with clinical samples. METHODS A total of 356 blood culture sets (178 sets for each system) were evaluated over a 6-month period in a university hospital. Two sets of blood culture samples (one for DL and one for B3D) were drawn from intensive care unit patients who were suspected to have bloodstream infections. BacT/ALERT FA FAN® Aerobic/Anaerobic blood culture bottles for B3D and FAN adult anaerobic/aerobic blood culture bottles for DL were used. The Vitek® 2 automated system was used for identification of the isolated bacteria. RESULTS We evaluated 178 sets from 105 patients consisting of 712 blood culture bottles in total. In total, 294 negative bottles and 47 positive bottles were detected by both systems. Recovery rate of the B3D (96.7%) was significantly higher than that of DL (79.0) (p < 0.05). We determined significant differences between DL and B3D in terms of time-to-detection values for gram negatives (p = 0.006) and contaminants (p = 0.048). Overall, B3D had shorter time-to-detection mean values. CONCLUSIONS The recovery rate of DL was unfavorably low and time-to-detection values for DL were significantly higher than that of B3D. This might result from the ingredients of the culture bottles since the detection technologies of the systems were similar.