Fungal Infections; Species Distribution and Treatment Response

Introduction: Fungal infections are rapidly progressive, life threatening, difficult to recognize and resistant to antifungals. In recent years, these infections are frequently encountered. It is aimed to determine the fungal infections and the distribution of fungal species seen in our hospital, and the antifungal treatment response of the patients. Materials and Methods: Data collected from the medical records of the patients with fungal strains included demographic characteristics, underlying diseases, invasive procedures, treatment and outcome. The strains were identified through germ tube test, clamdiospor formation and a commercial kit labeled API 20C AUX. Antifungal susceptibility was investigated by microdilution and E test methods. Results: A total of 125 fungal strains isolated from the patients (61 female and 49 male) were evaluated. 37.3% of the patients included in our study were hospitalized in the anesthesiology-reanimation intensive care unit, 18.2% of them in the internal medicine unit, and 44.5% of them in other units. Of patients’ clinics, 24.5% was found to be consistent with candidemia and 75.5% with candiduria. The distribution of the strains isolated from both clinical samples is as follows: 59.2% (74/125) of the strains was Candida albicans, 15.2% (19/25) was Candida tropicalis, 12.8% (16/125) was Candida parapsilosis, 4.8% (6/125) was Candida krusei, 4% (5/125) was Trichosporon asahii, 1.6% (2/125) was Candida kefyr, 2.4% (3/125) was Candida glabrata, Candida lipolytica and Candida lusitaniae, each with one isolate. Antifungal treatment response rate was 89.5%. Conclusion: Our results show the importance of defining the fungal agents isolated at the level of species. It is also emphasized that clinical findings along with the fungal culture results and the characteristics of the underlying disease are of great importance in deciding how to treat fungal infections

Incidence and Risk Factors for Intravascular Catheter-Related Infections

Introduction: Intravascular catheters, which are among the indispensable procedures of medical practice, are the leading cause of nosocomial infections, particularly in intensive care units. In our study, we aimed to determine the rates of intravascular catheter-related infections, risk factors and causative microorganisms. Materials and Methods: Patients admitted to the Karadeniz Technical University Faculty of Medicine Hospital between October 2003- November 2004 were followed prospectively in terms of infections and risk factors associated with intravascular catheters. Results: A total of 770 intravascular catheters inserted in 434 patients were followed for 11.385 catheter days. Overall, 116 catheter-related infections (CRIs) were determined. The rate of CRI was 10.2, and the rate of CR-blood stream infection (BSI) was 6.4. In the multivariate analysis of risk factors affecting the development of CRI, independent factors causing an increase were found to be high Acute Physiology Assessment and Chronic Health Evaluation (APACHE) II scores (OR = 1.07, 95% CI = 1.02-1.13; p< 0.0005), prolongation of the duration of catheterization (OR = 1.03, 95% CI = 1.02-1.04; p< 0.0005), use of anti-pseudomonal penicillin before and during the catheterization (OR = 4.5, 95% CI = 1.85-10.96; p< 0.0005), use of quinolones (OR = 3.1, 95% CI = 1.04- 9.13; p= 0.038), use of the catheter for total parenteral nutrition purposes (OR = 3.9, 95% CI = 2.17-7.05; p< 0.0005) or for hemodialysis purposes (OR = 6.3, 95% CI = 3.28-11.96; p< 0.0005), insertion of the catheter under emergency conditions (OR = 5.02, 95% CI = 2.65-9.49; p< 0.0005), and insertion of the catheter by inexperienced healthcare staff (OR = 1.9, 95% CI = 1.10-3.35; p= 0.030). Maintenance of hand hygiene during the insertion of the catheter and taking the maximum barrier precautions reduced the rate of CRI by 87% and 58%, respectively (OR = 0.13, 95% CI = 0.07-0.24, p< 0.0005; OR = 0.42, 95% CI = 0.24-0.73; p< 0.0005, respectively). The causative microorganisms isolated in CRIs were gram-positive microorganisms in 69 (58.5%), gram-negative microorganisms in 41 (34.8%) and Candida spp. in 8 (6.8%) of the patients. Conclusion: Our study shows that taking certain precautions against risk factors including hand washing, higher level barrier precautions, and frequent manipulation will reduce the incidence of CRIs. Furthermore, hospital staff should be well informed about catheter insertion and care in conformity with the rules of antisepsis and about intravascular CRIs

The Evaluation of Vancomycin and Daptomycin Susceptibility by E-Test Method in Methicillin-Resistant Staphylococcus aureus Isolates

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is a nosocomial pathogen that can lead to epidemics and because of its multiple antibiotic resistance, it continues to pose a serious health problem all over the world. In many cases, MRSA becomes resistant to antibiotics in use today, which results in the need for the development of new anti-staphylococcal antibiotics. The first representative of cyclic lipopeptids, daptomycin, in this context, is a new antibiotic among effective anti-staphylococcal drugs. In this study, vancomycin and daptomycin susceptibilities of MRSA strains were investigated with the E-test method. Materials and Methods: In the study, the vancomycin and daptomycin susceptibilities of 51 MRSA strains isolated as cause of infection from various clinical specimens in our hospital were investigated in vitro between the years 2000 and 2006. Susceptibility tests were performed with E-test method by using vancomycin and daptomycin strips in Mueller-Hinton agar (MHA) medium. Results: All strains of MRSA were sensitive to vancomycin and daptomycin with E-test method. Vancomycin minimal inhibitory concentration (MIC) range was 0.5-1 µg/mL and daptomycin MIC range was 0.094-0.75 µg/mL. Daptomycin MIC50 was 0.25 µg/mL and MIC90 was 0.38 µg/mL; whereas, vancomycin MIC50 was 0.75 µg/mL and MIC90 was 1 µg mL. Conclusion: MIC values determined for vancomycin were at the highest level among the results. That may be taken as a sign of alarm for the resistance and clinical treatment failure of vancomycin. With the low MIC values, daptomycin seems to be a better option in the treatment of MRSA infections

The Evaluation of Patients Colonized/Infected with Vancomycin Resistant Enterococci Between 2002-2011 in Karadeniz Technical University Hospital

Introduction: Today, vancomycin resistant enterococci (VRE) are the most important causes of epidemics in our country as in the world. The aim of this study was to investigate patients with VRE in our hospital over the last 10 years. Materials and Methods: In this study, all 60 patients infected/colonized VRE in Karadeniz Technical University Hospital between January 2002-June 2011 were evaluated retrospectively. Results: Only one of the patients was seen in 2002. A marked increase in epidemics was seen from 2002 to 2011. Seventeen of the 60 patients were seen in the first six months of 2011. Prolonged hospitalization and history of multiple antibiotic use were present in almost all index cases. VRE colonization and infection were determined in 18 (30%) and 42 (70%) of these patients, respectively. Urinary colonization and infections were the most prevalent. The second common infection was bacteremia. Perirectal/rectal colonization was only seen in 18 (30%) patients. Linezolid was used in 16 (89%), tigecycline plus amikacin in 1 (5.5%), and teicoplanin plus amikacin in 1 (5.5%) of the VRE-infected patients. Mortality was seen in 10 (17%) patients but the attributable mortality rate was 5% (3 patients). Conclusion: As indicated in our study, the most important approaches in controlling the spread of VRE are to resolve the deficiency in infrastructure and shortage of personnel. One of the important tasks of the Infection Control Committee is to review all infection control applications regarding their appropriateness, in addition to providing training

Can hantavirus infections be predicted on admission to hospital?

The aim of this study was to investigate the predictive factors which contribute to diagnosis of hantavirus infection. One hundred patients from rural areas hospitalized with a preliminary diagnosis of hantavirus infection from different hospitals in Turkey were investigated. Hantavirus infection was confirmed in 20 patients (Group 1) using immunofluorescence and immunoblot assays at the Refik Saydam National Public Health Agency. Hantaviruses were not detected in the serum of the remaining 80 patients, other infectious and non-infectious diseases being diagnosed in this group (Group 2). Patients' demographic characteristics and clinical and laboratory data on admission were examined and compared between the two groups. Fever, proteinuria, hematuria, lethargy-weakness, and nausea-vomiting were the most frequent symptoms and findings in Group 1, seen in almost all patients. Proteinuria, hematuria, muscle pain, diarrhea/abdominal pain, hypotension, shock, and sweating were observed at significantly higher levels in Group 1 compared to Group 2. Serum urea, creatinine, uric acid, lactate dehydrogenase (LDH), aspartate transaminase (AST), alkaline phosphatase (ALP), and C-reactive protein (CRP) were significantly higher, but serum platelet counts were lower in Group 1 patients. Area beneath the receiver operating characteristics (ROC) curve analysis was used to calculate the discriminative ability of various laboratory values to identify patients with hantavirus infection. This analysis revealed that, serum CRP had a 100% negative predictive value, whilst, platelet, and creatinine had 75% and 70% positive predictive values for the diagnosis of hantavirus infection. In summary, laboratory markers used in clinical practice are of great importance predicting hantavirus infections. J. Med. Virol. 84:17901796, 2012. (c) 2012 Wiley Periodicals, Inc

HANTAVIRUS INFECTION: TWO CASE REPORTS FROM A PROVINCE IN THE EASTERN BLACKSEA REGION, TURKEY

Hantaviruses which are the members of Bunyaviridae, differ from other members of this family since they are transmitted to humans by rodents. More than 200.000 cases of hantavirus infections are reported annually worldwide. Hantaviruses can lead to two different types of infection in humans, namely, hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS). HFRS is the most common type of hantavirus infection in Europe and Asia and the most common virus types are Dobrava, Puumala, Hantaan and Seoul. A total of 25 hantavirus suspected cases have been reported from the Western Black Sea region of Turkey and 12 of these were confirmed serologically as "Puumala" subtype. Serological tests such as indirect immunofluorescence assay (IFA), are used for diagnosis and typing of the hantaviruses, however, since cross-reactions are common between the subtypes, the results of these tests should be confirmed by other methods. In this report two cases with hantavirus infection defined serologically were presented. Two male patients, 55 and 50 years old, respectively, living in Giresun province of Eastern Black Sea region, Turkey, were admitted to the State Hospital with the complaints of fever, sweating and diarrhoea without blood or mucus. Since thrombocytopenia and renal failure were detected in these two cases, they were transferred to the University Hospital. Presence of fever, thrombocytopenia and renal failure, with no laboratory findings of a bacterial infection and no growth of microoorganisms in the clinical specimens, admittance of the patients during summer and history of being present in the fields, necessitated to rule out leptospirosis, Crimean Kongo hemorrhagic fever and hantavirus infection which were all endemic in our area. Further investigation of the serum samples at the National Reference Virology Laboratory by IFA (Hantavirus Mosaic-1, Euroimmun, Germany) revealed hantavirus IgM and IgG antibodies >= 1:100 titer and the results were confirmed by immunoblot test (Hantavirus Profile 1 EUROLINE IgG and IgM, Euroimmun, Germany). Hantavirus Dobrava subtype was determined in both of the cases. Reverse transcriptase real-time PCR (Hantavirus Renal Syndrome General-type I&II Real Time RT-PCR; Shanghai ZJ Bio-Tech, China) revealed negative result. The first case was discharged with complete cure, however, the second case died. These cases which were the first cases from the Eastern Black Sea Region emphasized that hantavirus infections should be taken into consideration in patients presenting with fever, thrombocytopenia and renal function disturbance