Strain relatedness in gram-negative bacteremia: Cause or contamination?

Aim: Bloodstream infections are a major cause of mortality, 25% of which are associated with gram-negative bacteremia. To avoid the inappropriate use of antibiotics, it is important to differentiate the bacteremia from contamination. In general, gram-positive bacteria were more likely to be contaminants than gram-negative-bacteria. There is little information in the literature concerning the epidemiology of gram-negative bacteria isolated from sequential blood cultures. Therefore, we aimed to examine the molecular epidemiology of gram-negative bacteria isolated from sequential blood cultures. Material and Methods: A total of 56 patients (112 samples and strains) with two or more sequential positive blood cultures for gram-negative bacteria with the same antibiogram were included in the study. Pulsed-field gel electrophoresis (PFGE) and arbitrarily primed PCR (AP-PCR) were performed for the determination of strain relatedness. Results: While PFGE analysis demonstrated relatedness in 6 isolates, AP-PCR demonstrated 9 relatedness in 112 isolates. Discussion: The results of our study suggest that, although the possibility of contamination is very low in gram-negative bacteremia, this can still take place, as shown in sequential blood cultures with the same antibiogra

Polyclonal outbreak of bacteremia caused by Burkholderia cepacia in the intensive care unit

Aim: Burkholderia cepacia is a multidrug-resistant, opportunistic pathogen of humans and outbreaks of infection in hospitals have been described. In this study, we aimed to report an outbreak in patients without cystic fibrosis or chronic granulomatous disease involving different species of Burkholderia cepacia. Material and Methods: A small outbreak of nosocomial Burkholderia cepacia complex occurred in a 6-bed intensive care unit. We isolated Burkholderia cepacia from blood cultures of the patients admitted to our intensive care unit. All isolates from patients and the environment were identified by standard microbiological techniques and VITEK system. Antibiotic susceptibility testing was performed using Kirby Bauer's disk diffusion method and the VITEK system Results: All isolates exhibited identical patterns of antibiotic susceptibility and all isolates were sensitive to trimethoprim-sulfamethoxazole, ceftazidime and meropenem. The isolates were typed using pulsed-field gel electrophoresis using the restriction enzymes XbaI and SpeI. Accordingly, while 4 strains were similar, one was different. Discussion: The experience from this outbreak reminded us of the importance of outbreak investigation in such small outbreaks and keeping the health care workers educated and constant attention on this issue. The results of this study emphasized once again the necessity to maintain our sensitivity to the basic principles of sanitation and to raise our awareness of such outbreaks

COVID-19 infection in pregnancy: A single-center experience in Rize in the Eastern Black Sea Region

Aim: In this study, it was aimed to share the clinical experiences of mothers and their babies (perinatal, natal) who encountered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy. Material and Methods: The study was carried out retrospectively, 62 pregnant individuals were diagnosed with the 2019 coronavirus disease (COVID-19). Demographic characteristics, clinical course, laboratory and radiological findings and clinical results of the baby were evaluated by examining electronic and file records. Results: The average age of the 62 pregnant women included in the study was 29.8 +/- 4.7 (19-42) years, and the average gestational week at the time of admission was 28.5 +/- 10.4 (5-40) weeks. More than half of the patients (80,6%) on admission were in their third trimester. The most common initial symptoms were cough (45.2%), myalgia (43.5%),) fever (21%). In total, 15 of the pregnant women had evidence of COVID-19 pneumonia in lung involvement. The PCR test results of all pregnant women were positive. There were three cases admitted to the intensive care unit, one of whom was due to gestational diabetes. No maternal mortality was recorded. One gestation ended in a miscarriage and two women gave birth prematurely. One stillbirth occurred at the 33h week of gestation. Among 22 neonates, two were admitted to the neonatal intensive care unit. Neonatal mortality, congenital malformation, and mother- to- child transmission were not observed in newborns. Discussion: The results of our study suggest that the clinical course of COVID-19 infection in pregnant women was mostly asymptomatic/mild

Distribution and antimicrobial susceptibilities of stenotrophomonas maltophilia strains ısolated from various clinical samples: an 8-year study

Amaç: Hastane enfeksiyonları ve buna bağlı mortalitenin artması çoklu ilaç direncine sahip fırsatçı patojenleri her zamankinden daha fazla gündeme getirmiştir. Bunlar arasında yer alan stenotrophomonas maltophilia önemi giderek artan fırsatçı bir patojendir. Bu çalışmanın amacı,sekiz yıllık süre boyunca hastanemizde çeşitli klinik örneklerden izole edilmiş S. maltophilia izolatlarının dağılımını ve antimikrobiyal duyarlılıklarını araştırmaktır. Yöntemler: Ocak 2011-Aralık 2019 tarihleri arasında çeşitli klinik örneklerden izole edilen toplam 149 S. maltophilia suşunun antimikrobiyallere direnç oranları araştırıldı. Bakteri identifikasyonu ve antibiyotik duyarlılığı rutin konvansiyonel mikrobiyolojik yöntemler ve VİTEK 2 kompakt otomatize sistem (BioMerieux, France) ile yapılmıştır. Bulgular: S. maltophilia en sık yoğun bakım ünitelerinde izole edilirken 50 (%33,5), en az 1 örnekle ( %0,6) Kardiyovasküler cerrahi servisi, Pediatri servisinden izolasyon gerçekleşmiştir. Örneklerin 85’i (%57,) solunum yolu izolatları olurken (trakeal aspirat, lavaj, balgam), en az 1 örnek ( %0,6) ile plevra ve eklem sıvısı olmuştur. Karbapenemlere doğal direnç gösteren S. maltophilia’da levofloksasin direnci % 6 iken, trimetoprim/sulfametoksazol’de %12, seftazidim’de %45 olarak tespit edilmiştir. Tartışma ve Sonuç: Çalışmada saptanan yüksek direnç oranları nedeniyle, S. maltophilia suşlarının etken olduğu nozokomiyal enfeksiyonların tedavisinde mümkün olduğunca in vitro duyarlılık testlerinin yapılması gerekir. Bunun yapılamadığı durumlarda ise tedavi planlamasında trimetoprim-sulfametoksazol ve levofloksasin iyi birer tedavi seçeneğidir. Ayrıca tedaviye başlamadan önce kolonizasyon - etken ayrımı klinik bulgularda göz önünde tutularak birlikte karar verilmelidirObjective: Hospital infections which associated with increased mortality have brought opportunistic pathogens like Stenotrophomonas maltophilia, with multiple drug resistance into focus. The aim of this study was to investigate the distribution and antimicrobial susceptibility of S. maltophilia isolates obtained from various clinical samples in our hospital for a period of eight years. Method: Antimicrobial resistance rates of 149 strains of S. maltophilia isolated from various clinical samples between January 2011 and December2019 were investigated. Bacterial identification and antibiotic susceptibility were performed with routine conventional microbiological methods and the VITEK 2 compact automated system (BioMerieux, France). Results: While S. maltophilia was most frequently isolated in intensive care units, from a total of 50 samples (33.5%), the rate was 0.6% (1 sample) the cardio vascular surgery service and pediatrics services. 85 (57%) of the samples were respiratory tract isolates (tracheal aspirate, lavage, sputum) with at least 1 (0.6%) pleural and joint fluid. Among these isolates of S maltophilia, which shows natural resistance to carbapenems, resistance for levofloxacin was 6% and for trimethoprim/ sulfamethoxazole was 12%. Conclusion: Due to the high resistance rates observed in the study, in vitro susceptibility tests should be used as much as possible in the treatment of nosocomial infections caused by S. maltophilia strains. In cases where this is not possible and empirical treatment is required, trimethoprim-sulfamethoxazole and levofloxacin are reasonable treatment options. Also, before starting treatment, the separation between colonization and agent should be decided in accordance with the clinical findings

Secondary bacterial infection rates among patients with COVID-19

Objective The aim of this study was to determine the factors and rates of secondary bacterial infections developed in patients after the diagnosis of COVID-19 and antimicrobial susceptibility to guide the empirical treatment and contribute to epidemiological data. Materials and Methods In our study, 1,055 patients diagnosed with COVID-19, hospitalized at Recep Tayyip Erdogan University Training and Research Hospital, Rize, between the dates March 24, 2020 and December 31, 2020, were recruited. The diagnoses of all patients were confirmed by positive SARS-CoV-2 polymerase chain reaction (PCR) tests. In addition, the blood and respiratory tract cultures of the patients recruited in the study were analyzed retrospectively. Results Ninety-two (8.7%) patients were found to have microbiologically proven respiratory or circulatory tract infections via microbial culture results. Respiratory tract infections were detected as monomicrobial in 44 patients and as polymicrobial in 17 patients, among a total of 61 patients. In addition, 59 (64.1%) patients were male patients, and 33 (35.9%) were female patients. Among the microorganisms grown in blood cultures, coagulase-negative staphylococci with a percentage of 31% and Acinetobacter baumannii with a percentage of 27.5% were prominent. In respiratory tract cultures, A. baumannii constitutes the majority with a percentage of 33.3%, followed by Staphylococcus aureus and Klebsiella pneumoniae with a percentage of 9.5% each. The most resistant bacteria were A. baumannii, resistant to all antibiotics other than colistin. Conclusion Secondary bacterial infection rates in patients with COVID-19 are lower than influenza pandemic. However, the frequency of empirical antibiotics use seems relatively high

Knowing the ABCs: Teaching the principles of radiology to medical students in Turkey

Background: Radiology education in Turkey is mainly taught during clinical years of medical school and often lacks main principles. Exposure to the fundamentals of radiology at an early stage of medical education may drastically help students generate a better understanding of radiology and expand their interest in the specialty. With the Principles of Radiology Course that we provided, pre- and post-session tests, and assessment survey at the end of the course, we aimed to evaluate the effectiveness of such an online course among Turkish medical students. Methods: A total of nine online sessions on imaging modalities principles was developed by radiology professors. Each session was given through Zoom by radiologists from different U.S.-institutions to Turkish medical students from state (n = 33) and private (n = 8) universities. Pretests and post-tests were given to participants via Qualtrics before and after each session, respectively. Paired two-sample t-tests were conducted to detect the variance and p=-.05 was used as the significance level. An evaluation survey was distributed at the end of the course to collect their feedback through SurveyMonkey. Results: A total of 1,438 predominantly Turkish (99.32%) medical students engaged with this course. An average of 506 students completed both pre-test and post-test. There was a statistically significant (p <.001) increase in the scores in post-test (mean[range]:7.58[5.21–8.53]) relative to pre-test (mean[range]:5.10[3.52–8.53]). Four hundred and thirty-nine participants (F/M:63.33%/35.54%) completed the end-of-course survey. A total of 71% and 69.70% of the participants strongly agreed that the course would be useful in their clinical practice and had increased their understanding of radiology. They also reported that their level of confidence in the subjects had increased 68% and reached a weighted average of 3.09/4. The survey revealed that 396 (90.21%) of the participants strongly or somewhat agree that introductory principles and concepts should be presented in earlier years of medical education. Compared to in-person education, 358 (81.55%) found the course extremely or very convenient. Conclusion: Online lecture series consisting of the principles of the radiological imaging modalities can be offered to Turkish medical students to enhance their grasp of the various imaging modalities and their correct clinical application

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Gençlerin Seçilme Yaşının 18’e İndirilmesi Konusundaki Görüşlerinin İncelenmesi

Bu araştırmanın amacı gençlerin seçilme yaşının 18'e indirilmesi konusundaki görüşlerini incelemektir. Bu araştırmanın örneklemini, 2016-2017 eğitim-öğretim yılında Kırşehir Ahi Evran Üniversitesi'nde ve Ankara Yıldırım Beyazıt Üniversitesi'nde öğrenim gören 60 öğrenci oluşturmaktadır. Nitel veri toplama tekniği ile gerçekleştirilen bu araştırmada, yarı yapılandırılmış görüşme tekniği kullanılmıştır. Araştırmada veri toplama aracı olarak araştırmacılar tarafından geliştirilen yarı yapılandırılmış görüşme formu kullanılmıştır. Bu çalışma, üniversite öğrencilerinin seçilme yaşının 18'e indirilmesi konusundaki görüşlerini ve yapılan bu değişikliğin onların gelecek hedeflerini nasıl etkilediğini incelemiştir. Araştırma sonucu, üniversite öğrencilerinin seçilme yaşının 18'e indirilmesi ve gelecek hedeflerini etkilemesi konusunda farklı görüşlere sahip olduğunu ortaya koymuşturThe purpose of research what the views of young people on the reduction of their elected age to 18. The sample of this research consists of 60 students studying in Kırşehir Ahi Evran University and Ankara Yıldırım Beyazıd University in the academic year of 2016-2017. Semi-structured interview technique was used in this research which was dealt with by qualitative data collection technique. The semi-structured interview form developed by the researchers was used as data collection tool in the research. This study examined the views of university students on the issue of reducing the age of elected to 18, and at the same time examined how this change affected young people’s future plans. The outcome of the study revealed that the reduction of university students’ age of election to 18 had different views on influencing their current and future goal

Molecular prevalence of canine hepatozoonosis in owned-dogs in central part of Turkey

Canine hepatozoonosis is a tick-borne disease caused by Hepotozoon canis and Hepotozoon americanum. H. canis is widespread almost all over the world, while H. americanum exists only in the continental of America. The aim of this study was to determine the prevalence of canine hepatozoonosis from blood samples of 150 owned-dogs in central part of Turkey using polymerase chain reaction (PCR). Sixty seven out of 150 (44.67%) samples were PCR positive for Hepatozoon spp. Five out of 67 positive PCR products were sequenced to determine Hepatozoon species. Partial nucleotide sequences of 18S small subunit ribosomal RNA gene were compared to Hepatozoon spp. sequences registered in GenBank. Nucleotide sequencing resulted in three samples of the Hepatozoon spp.; two samples were determined to be H. canis. Five nucleotide sequences detected in this study were deposited in GenBank under accession numbers MW350127, MW350128 (Hepatozoon canis), MW350129- MW350131 (Hepatozoon spp.). In this study, canine hepatozoonosis infection rate was found to be very high (44.67%), resulting in a high rate of infection among the owned-dog populations in the study areas. To the best of our knowledge, it is the first study on the etiology and epidemiology canine hepatozoonosis in Sivas province in Turkey