Investigation of antiphospholipid antibody syndrome markers in the etiology of recurrent miscarriage

This study aimed to determine the markers of antiphospholipid antibody syndrome (APS), which has an important place in the etiology of recurrent miscarriage, and toprovide guidance for the treatment of the related disorders. This prospective observational study was performed on 120 female patients admitted to the Obstetrics andGynecology outpatient clinics due to recurrent pregnancy loss. Blood samples were analyzed using the Enzyme-Linked Immunosorbent Assay (ELISA) technique to findout the levels of APS-associated anticardiolipin (ACA), anti-beta2-glycoprotein I (a?2GPI), anti-annexin V (aANXV), anti-prothrombin (aPT), and antiphosphatidylserine(aPS) antibodies. A statistically significant difference was found between increased age groups and the number of miscarriages (p=0.03, p<0.05). There were no significantdifferences between the age groups by the time of miscarriage (p=0.35, p<0.05). ACA positivity (75%, n = 90) and anti-annexin V positivity (50.8%, n = 61) werehigher than the positive results found in other tests(p=0.01, p<0.05). Antiphospholipid antibodies (APAs) showed significantly different positivity levels by the age groups(p=0.01, p<0.05). The positivity levels of APAs were significantly different by the number of miscarriages (p=0.01, p<0.05). Other antibody levels were not statisticallysignificantly different. The frequency of positive APA levels increases with advancing age and a high number of miscarriages in association with the etiology of recurrentmiscarriage. Among the subgroups of these antibodies, ACA and anti-annexin V can serve as highly appropriate diagnostic markers in recurrent miscarriage

Pseudomonas aeruginosa Antimicrobial Susceptibility Results at a State Hospital in Turkey (2010-2016)

Pseudomonas aeruginosa, nozokomiyal pnömoni, dolaşım sistemi infeksiyonları, üriner infeksiyon ve deri infeksiyonları gibi sağlık hizmetleri gerektiren infeksiyon etkenlerinin önemli bir bölümünü oluşturur. Bu çalışma, yıllara göre P.aeruginosa'nın antimikrobiyal duyarlılığının değişimini belirleyerek antimikrobiyal kullanım politikasının oluşturulmasına yardımcı olmayı amaçlamıştır.Hastanemizde 2010-2016 yılları arasında izole edilen P.aeruginosa suşlarının antimikrobiyal duyarlılıkları, örnek türleri ve hastaların demografik verileri retrospektif olarak incelenmiştir. Verileri aktarmak ve analiz etmek için Windows istatistik paket programı PASW Statistics 18 kullanılmıştır. Değişkenler arasındaki ilişkiler ki-kare testi ile analiz edilmiştir.Yatarak tedavi olan, 0-92 yaş aralığında bulunan 350 (% 35.9) kadın ve 625 (% 64.1) erkek hastadan 975 P.aeruginosa suşu izole edilmiştir. Örneklerin çoğunluğunun (529, % 54.3) yoğun bakım ünitesinde yatan hastalara ait olduğu tespit edilmiştir. P.aeruginosa, en sık solunum sistem örneklerinde izole edilmiştir. Ayakta tedavi gören, yaşları 0-95 arasında değişen 127 (% 33.1) kadın ve 257 (% 66.9) erkek hastada üreme saptanmıştır. Kliniklere göre dağılımına bakıldığında en sık pediatri polikliniğinden gelen örneklerde izole edilmiştir. Ayaktan tedavi gören hastaların en sık idrar örneğinde izole edilmiştir. En etkili antibiyotiklerin ayaktan hastalarda amikasin, piperazin-tazobaktam, imipenem ve meropenem, yatarak tedavi gören hastalarda aminoglikozid ve karbapenem olduğu tespit edilmiştir. Yıllara göre yatan hastalarda seftazidim, piperasilin-tazobaktam, gentamisin ve amikasin duyarlılığında artış, ayaktan hastalarda piperasilin-tazobaktam ve siprofloksasin duyarlılığında ise azalma görülmüştür.Klinik sonuçların optimizasyonu için etkili antimikrobiyal tedavinin hızlı başlatılmasının gerekli olduğu göz önüne alındığında, her hastane duyarlılık oranlarını izlemelidir. Böylece ampirik antimikrobik seçimi ve uygun tedavinin belirlenmesi için bir kılavuz oluşturulmalıdırPseudomonas aeruginosa constitutes an important part of infections requiring health care services such as nosocomial pneumonia, circulatory infections, urinary infection and skin infections. The present study aimed to help in creating an antimicrobial usage policy by identifying the change of antimicrobial susceptibility of P.aeruginosa according to years. The antimicrobial susceptibility of P.aeruginosa strains isolated between 2010-2016 in our hospital, specimen types and demographic data of the patients were examined retrospectively. PASW Statistics 18 for Windows statistical pack age program was used to transfer and analyze the data. The relation ships among variables were analyzed with the chi-square test. Nine hundred seventy-five P.aeruginosa strains were isolated from 350 (35.9 %) female and 625 (64.1 %) male patients who were in the age range of 0 to 92 years and who were treated as in patients in our hospital between 2010-2016. The majority of the specimens (529, 54.3 %) belonged to the patients from the intensive care unit. P.aeruginosa was most frequently isolated in respiratory tract specimens of in patients. Of the out patients, 127 (33.1 %) were female and 257 (66.9 %) were male and they were aged between 0-95 years. Considering the distribution of the patients according to the outpatient clinics, P.aeruginosa was most frequently isolated in pediatrics. In respect to the out patients P.aeruginosa was most frequently isolated in urine. The most effective antimicrobials were determined to be aminoglycosides and carbapenems for the in patients while they were found to be amikacin, piperacillin-tazobactam, imipenem and meropenem for the out patients. In patients were showed increased sensitivity of ceftazidime, piperacillin-tazobactam, gentamicin and amikacin, for years and outpatients were decreased sensitivity of piperacillin-tazobactam and ciprofloxacin. Considering that the rapid initiation of effective antimicrobial treatment is necessary for the optimization of clinical outcome, each hospital should monitor their susceptibility rates. Thus, a guidelines hould be created for the selection of empirical antimicrobial therapy and determination of appropriate treatment

Determination and Genotype Distribution of Rotavirus Gastroenteritis in Pediatric Patients Admitted to a Tertiary Care Hospital

Acute infectious gastroenteritis is a prevalent disease worldwide, and most of the cases are caused by viral pathogens. Many different viruses, including Rotavirus (RV), Norovirus, Adenovirus, and Astro-viruses, are responsible for most acute viral gastroenteritis cases. According to the Centers for Disease Control and Prevention (CDC), viral gastroenteritis infections cause more than 200 000 child mortalities each year worldwide. One of the best strategies to reduce the global burden of RV gastroenteritis is the development and administration of effective vaccines. However, since there are differences in the coverage of the vaccines, the choice of appropriate vaccine for localized genotypes based on regions is important. The aim of this study was to detect the RV infections in our region and to perform genotyping using real time polymerase chain reaction (Rt-PCR) and high resolution melting (HRM) analysis. A total of 341 stool samples collected from pediatric patients were tested. Lateral flow immunochromatographic assay principle based assay was used for antigen detection. RT-PCR and HRM were applied for genotype analysis. Similar to the data from our country and Eastern Mediterranean region, RV positivity in stool samples was 23.1%. The majority of the patients (51%) were aged 0-2 years and the vast majority of the patients, with a rate of 77%, were between the ages of 0-5. Most of the cases were detected in the winter months, especially in February. The distribution of 40 samples, whose G genotype could be detected, was as follows: G2, 21 (52.5%); G1, 11 (27.5%); G9, 5 (12.5%); G3, 2 (5%); G4, 1 (2.5%). The distribution of 53 samples, whose P genotype could be detected, was as follows: P4, 44 (83.0%); P9, 8 (15.1%); P10, 1 (1.9%). Among those whose genotype could be detected, the most prevalent genotypes were G2 with 52.5% and P4 with 83%. When the distribution of 25 samples was evaluated, in which RV G and P genotypes were detected simultaneously, G1 P [4] 11 (44%), G2P[9] 5 (20%), G9P[4] 5 (20%), G2P[4] 2 (8%), G3P[10] 1 (4%), and G4P[4] 1 (4%) genotypes were determined, respectively. The most commonly observed genotype was G1 P[4]. In the HRM analysis, it was observed that the melting curve peaks were at different temperatures in nine of the G2 genotype samples and 16 of the P4 and P9 genotype samples. Thus, genotyping with HRM analysis could not be fully finalized, especially for G2 and P. Of the Rota Teq (R) and Rotarix (TM) vaccines administered on demand in our country, Rota Teq (R) is considered the vaccine that has the widest coverage for the genotypes observed in our country and region. ROTASIIL (R) vaccine, which covers all the genotypes in our region (G1, G2, G3, G4, G9) is not available in our country. The emergence of the strains with the potential to increase the current burden of RV disease should be continuously monitored, as different results are obtained by region and year, even within the same country. Thus, the emergence of vaccine-resistant strains can be followed up, especially in countries with higher viral diversity

Burkholderia cepacia complex bacteremia outbreaks among non-cystic fibrosis patients in the pediatric unit of a university hospital

Background. Burkholderia cepacia complex (Bcc) comprises multi-drug resistant, Gram-negative, motile, and aerobic bacteria. Bcc causes severe nosocomial infections particularly in patients with intravascular catheters and in those with cystic fibrosis. We studied a Bcc outbreak in non-cystic fibrosis patients. Methods. We analyzed data from six patients hospitalized at our center. Blood cultures identified as infectious were incubated onto 5% blood sheep agar, chocolate agar, and eosin methylene blue (EMB) agar. We examined possible sites that could be sources of infection at the clinic. We confirmed isolations with pulsed-field gel electrophoresis (PFGE) tests. Results. The first patient was hospitalized due to left renal agenesis, urinary tract infection, and renal failure. Bcc was isolated in blood cultures obtained due to high fever on the third day of hospitalization. We stopped new patient hospitalizations after detecting Bcc in blood cultures of other five patients. We did not detect further positive specimens obtained from other clinic and the patient rooms. PFGE patterns were similar in all clinical isolates of Bcc indicating that the outbreak had originated from the source. Conclusions. Bcc infection should be considered in cases of nosocomial outbreaks of multi-drug resistant organisms that require hospitalization at intensive care units. Control measures should be taken for prevention of nosocomial infections and required investigations should be done to detect the source of infection

A case report of brain abscess caused by carbapenem- resistant Klebsiella pneumoniae

The treatment of infections caused by carbapenem-resistant Klebsiella pneumoniae (CR-Kp) strains is difficult due to the limited antimicrobial options and high mortality. There are many reports on intracranial infections caused by CR-Kp, but only a few on brain abscesses caused by CR-Kp. Here, we present a case of brain abscess caused by CR-Kp successfully treated with combined antibiotics. A 26-year-old male patient was admitted to our hospital due to high fever and headache. His past medical history includes a surgical intervention due to an acute subdural hematoma, performed at an external healthcare center. After the current diagnosis of cerebral abscess, he underwent two surgeries. During the procedure, multiple cerebral abscesses were drained and capsulotomies were performed under ultrasound guidance. The combination of meropenem and vancomycin was started. The contents of the abscesses were sent to the microbiology and pathology laboratory. On the 3rd day of treatment, the medical team was informed that CR-Kp grew in an abscess culture. The patient's treatment was changed to meropenem + colistin + tigecycline. The patient developed electrolyte disturbances during the follow-up and this was considered an adverse effect of colistin. On the 41st day of treatment, colistin was discontinued, fosfomycin was added, and meropenem and tigecycline were maintained. Treatment was discontinued on the 68th day, when the patient was discharged. The general condition of the patient, who has been followed up for two years, is satisfactory. The treatment of CR-Kp infections should be individualized, and the pharmacokinetics and pharmacodynamics of antibiotics should be considered in each case

Curcumin-meropenem synergy in carbapenem resistant Klebsiella pneumoniae curcumin-meropenem synergy

Background and Objectives: The frequency of multiple resistant bacterial infections, including carbapenems, is increasing worldwide. As the decrease in treatment options causes difficulties in treatment, interest in new antimicrobials is increasing. One of the promising natural ingredients is curcumin. It is known to be effective in bacteria such as Pseudomonas aeruginosa, Escherichia coli, Burkholderia pseudomallei through efflux pump inhibition, toxin inhibition and enzymes. However, because its bioavailability is poor, it seffectiveness occurs in combination with antibiotics. In the study, the interaction of meropenem and curcumin in carbapenemase producing strains of Klebsiella pneumoniae was tested. Materials and Methods: Thirty-nine Klebsiella pneumoniae isolates, resistant to meropenem, were used in this study. From those 15 MBL, 6 KPC, 17 OXA-48 and 1 AmpC resistance pattern were detected by combination disk method. Meropenem and Curcumin MIC values were determined by liquid microdilution. Checkerboard liquid microdilution was used to determine the synergy between meropenem and curcumin. Results: Synergistic effects were observed in 4 isolates producing MBL, 3 isolates producing KPC, 4 isolates producing OXA-48, and 1 isolates producing AmpC (totally 12 isolates) according to the calculated FICI. No antagonistic effects were observed in any isolates. Conclusion: Curcumin was thought to be an alternative antimicrobial in combination therapies that would positively contribute to the treatment of bacterial infection. The effectiveness of this combination should be confirmed by other in vitro and clinical studies

A 5-year surveillance of healthcare-associated infections in a university hospital: A retrospective analysis

Objectives: Nosocomial infections or healthcare-associated infections are a significant public health problem around the world. This study aimed to assess the rate of laboratory-confirmed healthcare-associated infections, frequency of nosocomial pathogens, and the antimicrobial resistance patterns of bacterial isolates in a University Hospital. Methods: A retrospective evaluation of healthcare-associated infections in a University Hospital, between the years 2015 and 2019 in Tekirdag, Turkey. Results: During the 5 years, the incidence densities of healthcare-associated infections in intensive care units and clinics were 10.31 and 1.70/1000 patient-days, respectively. The rates of ventilator-associated pneumonia, central line-associated bloodstream infections, and catheter-associated urinary tract infections in intensive care units were 11.57, 4.02, and 1.99 per 1000 device-days, respectively. The most common healthcare-associated infections according to the primary sites were bloodstream infections (55.3%) and pneumonia (20.4%). 67.5% of the isolated microorganisms as nosocomial agents were Gram-negative bacteria, 24.9% of Gram-positive bacteria, and 7.6% of Candida. The most frequently isolated causative agents were Escherichia coli (16.7%) and Pseudomonas aeruginosa (I 5.7%). The rate of extended-spectrum beta-lactamase production among E. coli isolates was 51.1%. Carbapenem resistance was 29.8% among isolates of P. aeruginosa, 95.1 % among isolates of Acinetobacter baumannii, and 18.2% among isolates of Klebsiella pneumoniae. Colistin resistance was 2.4% among isolates of A. baumannii. Vancomycin resistance was 5.3% among isolates of Enterococci. Conclusion: Our study results demonstrate that healthcare-associated infections are predominantly originated by intensive care units. The microorganisms isolated from intensive care units are highly resistant to many antimicrobial agents. The rising incidence of multidrug-resistant microorganisms indicates that more interventions are urgently needed to reduce healthcare-associated infections in our intensive care units

Serology results of cystic echinococcosis between 2011-2013 in Balıkesir Atatürk State Hospital

Amaç: Echinococcus granulosus’un metasestod formunun ara konaklarda sebep olduğu kistik ekinokokkozis (KE) dünyada özellikle de hayvancılığın yaygın olduğu bölgelerde büyük bir halk sağlığı problemidir. Yüksek oranda karaciğer ve akciğerde yerleşim gösteren ekinokkokozis seyrek olarak diğer doku ve organlarda da görülebilir. KE’de klinik özelliklere dayanarak tanı koymak zor olmakta; tanı, spesifik antikor yanıtının saptanmasını amaçlayan serolojik yöntemler ile bunları destekleyen görüntüleme yöntemlerine dayanmaktadır. Bu çalışmada, hastalığın ilimizdeki durumuyla ilgili bilgi edinmek amaçlanmıştır. Gereç ve Yöntem: Ocak 2011-Aralık 2013 tarihleri arasında laboratuarımıza başvuran toplam 823 olgunun Echinococcus granulosus indirekt hemaglutinasyon testi (IHA) sonuçları retrospektif olarak incelenmiştir. Bulgular: Olguların 528’i (%64,1) kadın, 295’i (%35,9) erkekti. İncelenen 823 serum örneğinin 163’ünde (% 19,8) 1/320 titrede pozitiflik saptanmıştır. Sonuç: Elde edilen veriler, ilimizin genel durumunu yansıtmamakla birlikte fikir vereceği düşünülmüştür.Objective: Cystic echinococcosis (CE) caused by the metacestode form of Echinococcus granulosus is a major public health problem especially in animal-raising regions of the world. While there is a high rate of occurrence in the liver and lungs, Echinococcosis can occasionally be present in other tissues and organs. The diagnosis of CE is difficult using the clinical features of the disease and it depends on the combination of serological methods aimed at determining the specific antibody response and on imaging techniques that support the serology. The aim of this retrospective study was to evaluate the situation of hydatid disease in Balıkesir. Material and Methods: The specific anti-Echinococcus granulosus indirect haemagglutination test results of 823 patients, who were referred with probable CE to the Centre Laboratory of the Balıkesir Atatürk State Hospital during January 2011-December 2013 was assessed retrospectively. Results: Of the total, 528 (64,1%) were female and 295 (35,9%) were male. 823 samples were analyzed and 163 (19,8 % ) of these samples were positive. Conclusion: Although the data that are obtained from this study, does not reflect the exact situation in our region, it just gives an idea about the subject

Serology results of cystic echinococcosis between 2011-2013 in Balıkesir Atatürk State Hospital

Amaç: Echinococcus granulosus’un metasestod formunun ara konaklarda sebep olduğu kistik ekinokokkozis (KE) dünyada özellikle de hayvancılığın yaygın olduğu bölgelerde büyük bir halk sağlığı problemidir. Yüksek oranda karaciğer ve akciğerde yerleşim gösteren ekinokkokozis seyrek olarak diğer doku ve organlarda da görülebilir. KE’de klinik özelliklere dayanarak tanı koymak zor olmakta; tanı, spesifik antikor yanıtının saptanmasını amaçlayan serolojik yöntemler ile bunları destekleyen görüntüleme yöntemlerine dayanmaktadır. Bu çalışmada, hastalığın ilimizdeki durumuyla ilgili bilgi edinmek amaçlanmıştır. Gereç ve Yöntem: Ocak 2011-Aralık 2013 tarihleri arasında laboratuarımıza başvuran toplam 823 olgunun Echinococcus granulosus indirekt hemaglutinasyon testi (IHA) sonuçları retrospektif olarak incelenmiştir. Bulgular: Olguların 528’i (%64,1) kadın, 295’i (%35,9) erkekti. İncelenen 823 serum örneğinin 163’ünde (% 19,8) 1/320 titrede pozitiflik saptanmıştır. Sonuç: Elde edilen veriler, ilimizin genel durumunu yansıtmamakla birlikte fikir vereceği düşünülmüştür.Objective: Cystic echinococcosis (CE) caused by the metacestode form of Echinococcus granulosus is a major public health problem especially in animal-raising regions of the world. While there is a high rate of occurrence in the liver and lungs, Echinococcosis can occasionally be present in other tissues and organs. The diagnosis of CE is difficult using the clinical features of the disease and it depends on the combination of serological methods aimed at determining the specific antibody response and on imaging techniques that support the serology. The aim of this retrospective study was to evaluate the situation of hydatid disease in Balıkesir. Material and Methods: The specific anti-Echinococcus granulosus indirect haemagglutination test results of 823 patients, who were referred with probable CE to the Centre Laboratory of the Balıkesir Atatürk State Hospital during January 2011-December 2013 was assessed retrospectively. Results: Of the total, 528 (64,1%) were female and 295 (35,9%) were male. 823 samples were analyzed and 163 (19,8 % ) of these samples were positive. Conclusion: Although the data that are obtained from this study, does not reflect the exact situation in our region, it just gives an idea about the subject