In vitro antibiotic susceptibilities in nosocomial Acinetobacter baumannii strains isolated from intensive care unit and other clinics

Ocak 2000-Arahk 2004 döneminde yoğun bakım ünitesi ve yoğun bakım dışı ünitelerden izole edilen 402 Acinetobacter baumannii susunun antibiyotiklere direnci NCCLS'in önerileri doğrultusunda disk difüzyon yöntemi ile belirlenmiştir, İzole edilen suşların % 20.9'u amikasine, %29.9'unetilmisine, % 36.3'ü meropeneme, % 40.5'i imipeneme, % 57.2'sisiprofloksasine, % 66.4'üpiperasilin-tazobaktama, % 69.4'ü seftazidime, % 69.7'si ampisilin-sulbaktama, % 71.1 'i gentamisine, % 82.6'sı seftriaksona ve % 84.6'sı aztreonama dirençli bulunmuştur. Yoğun bakım ünitesinden ve diğer servislerden izole edilen suşlardaki direnç oranları karşılaştırıldığında netilmisin ve amikasin dışındaki diğer antibiyotiklere direnç oranları yoğun bakım ünitelerinde daha yüksek bulunmuştur. Sonuç olarak elde edilen direnç oranlarının A.baumannii'nin etken olduğu infeksiyonlann tedavisinde dikkate alınması gerektiği düşünülmüştür.The antibiotic resistance of 402 Acinetobacter baumannii strains isolated from intensive care unit and other clinics between January 2000 to December 2004 was determined by disk diffusion method according to NCCLS procedures. The resistance rates of the strains against studied antibiotics were found as follows; 20.9 %for amikacin, 29.9 %for netilmicin, 36.3 % for meropenem, 40.5 % for imipenem, 57.2 % for ciprofloxacin, 66.4 % piperacillin-tazobaktam, 69.4 % for ceftazidime, 69.7 %for ampicillin-sulbactam, 71.1 %for gentamicin, 82.6 %for ceftriaxone and 84.6 %for aztreonam. When the resistances of isolates from intensive care unit were compared with those obtained from other hospital units, a significantly higher levels of resistance were found for the isolates obtained from the intensive care unit except netilmicin and amikacin. It was concluded that these results should be taken into consideration for treatment of the infections caused by A. baumannii

Investigation of Extended Spectrum and Chromosomal Beta-Lactamases in Nosocomial Gram-Negative Bacteria

Determination of resistance rates due to extended spectrum beta-lactamases (ESBL) and inducible betalactamases in nosocomial gram-negative bacteria is important both for the successful management of the patient and the survey of antibiotic resistance patern within the hospital. In this study ESBL and inducible betalactamase activity in two hundred thirty-nine, gram-negative bacteria isolated from nosocomial infections in Celal Bayar University Hospital during four years were examined. ESBL and inducible beta-lactamase activity were investigated by double disk synergy and direct induction tests, respectively. The bacteria resistant to broad spectrum cephalosporins, aztreonam, cefoxitin, beta-lactamase inhibitors and sensitive to imipenem were accepted as stabile derepressed mutant. IBL activity was detected as 48.5% in P. aeruginosa and 19.0% in Enterobacter spp. while there was ESBL activity in 41.7%, 13.4%, 4.8% of K. pneumoniae, E. coli and Enterobacter spp, respectively. Rates of stabile derepressed mutant was also determined 20.0% in Citrobacter spp, 14.3% in Enterobacter spp. and 12.1% in P. aeruginosa

Second-line drug susceptibilities of multidrug-resistant Mycobacterium tuberculosis isolates in Aegean Region - Turkey

Aim: The emergence of multidrug-resistant tuberculosis (MDR-TB) is increasing, and the standard shortcourse regimen used for the treatment of TB is likely to be ineffective against MDR-TB, leading to the need for second-line drugs. In such situations, drug susceptibility testing is necessary to select an appropriate treatment regimen. Unfortunately, there are few studies showing the pattern of the second-line drug resistance in Turkey. We aimed to analyze the resistance to second-line anti-tuberculosis drugs of MDR strains of Mycobacterium tuberculosis isolated from the Aegean region of Turkey. Materials and Methods: In this study, drug susceptibility testing of 40 MDR-TB strains isolated from the Aegean region of Turkey was performed using the BACTEC 460 TB radiometric system. Capreomycin, ethionamide, kanamycin, amikacin, clofazimine and ofloxacin were tested in 1.25 μg/ml, 1.25 μg/ml, 5.0 μg/ml, 1.0 μg/ml, 0.5 μg/ml, and 2.0 μg/ml concentrations, respectively. Results: The results showed that 37.5% of the strains were resistant to ethionamide, 25% to capreomycin, 5% to kanamycin, amikacin and ofloxacin, and 2.5% to clofazimine. One (2.5%) of the 40 MDR-TB cases was defined as extensively drug-resistant tuberculosis (XDR-TB). Conclusions: The results of the study indicate that the high rates of resistance to ethionamide and capreomycin may be a problem in the treatment of patients with MDR-TB; XDR-TB is not yet a serious problem in our region. © TÜBİTAK

Farklı ortamlardaki oyuncaklarda bakteri kolonizasyonu sıklığı

Play that is essential for physical, motor, and psychosocial development of child to become an adult requires toys as an innate tool. Toys should not be hazardous to health. the aim of this study was to search for colonisation of pathogenic microorganisms on toys in different environments. Microbial growth and antibiotic resistance in 285 cultures taken from toys used in 3 hospitals, 15 daycare centers and 25 houses were evaluated. Growth was detected in 31.6% of cultures; this rate was 39.1% in hospital toys, 26.3% in daycare center toys while 27.6 % in house toys. the difference among these values was statistically meaningful. the most common microorganisms detected were coagulase-negative staphylococci with 33.3% and Staphylococcus aureus with 24.1%. When growth was compared among different kinds of toys, it was most commonly detected in cultures taken from furry toys with 42.8%; this rate was 28.5% in washable while 39.7% in nonwashable toys. Highest resistance was against penicillin with a ratio of 90-100% while it was lowest against vancomycine and teichoplanin. It is concluded that pathogenic microorganisms can be found on toys and these toys can be infected again and again from ill children carrying the potential to transmit this infection to others. Keeping in mind the importance of nosocomial infections in today's world and the place of toys in this chain of infectious transmission, special care should be given to toys shared by many children.Oyuncaklar çocuğun fiziksel, motor ve psikososyal gelişimi ve erişkin bir birey olmasını sağlayan oyunun ayrılmaz parçasıdır. Çok çeşitli işlevleri olan oyuncakların sağlık sakıncası oluşturmaması gerekir. Bu çalışmanın amacı farklı ortamlarda bulunan ve kullanılan oyuncaklarda patojen mikro-organizma kolonizasyonunun araştırılmasıdır. Üç hastane, 15 kreş, 25 evdeki oyuncaklardan bulundukları yerlerde alınan toplam 285 sürüntü örneğinin bakteriyolojik ve mikolojik incelemesi yapılmış ve izole edilen bakterilerin antimikrobiyal direnç özellikleri standart disk difüzyon yöntemi ile araştırılmıştır. Kültür alınan 285 oyuncağın %31'inde üreme vardı; bu oran hastaneden alınanlarda %38.6, kreşten alınanlarda %28.7 iken evden alınanlarda %23.3 olarak saptandı. Bu yerler arasındaki üreme oranlarındaki farklılık anlamlı bulundu. Tüm kültürler içinde %33.3 ile koagülaz-negatif stafilokok ve %24.1 ile Staphylococcus aureus en sık üreyen mikroorganizmalardı. Oyuncak tiplerine göre ayrıldığında; %42.8 ile en sık tüylü oyuncaklardan alınan kültürlerde üreme saptandı; bu oranın yıkanamayan oyuncaklarda %39.7 iken yıkanabilen oyuncaklarda %28.5 olduğu görüldü. Kültür alınan tüm yerlerde üreyen mikro-organizmalarda en yüksek direnç oranı %90-100 ile penisiline karşıyken en az direnç oranı ise vankomisin ve teikoplanine karşıydı. Bu oranlar göz önüne alındığında, oyuncaklarda patojen mikro-organizma saptanabileceği ve bunların hastalardan tekrar tekrar infekte olarak hasta bir çocuktan diğerine İnfeksiyon taşıyıcısı potansiyeli olabileceği görülür. Oyuncakların bu İnfeksiyon zincirindeki yeri ve günümüzde hastane infeksiyonlarmın önemi akılda tutularak hasta ya da çok sayıda çocuk tarafından kullanılan oyuncaklar açısından özel çözümler getirilmelidir

Temaslılarda tüberküloz enfeksiyonunun tanısı için interferon-gama tam kan testi ile tüberkülin deri testinin karşılaştırılması

Tuberculin skin test which is used for the detection of latent tuberculosis (TB), has many disadvantages such as false positivities due to cross reactions between environmental mycobacteria and BCG strain, false negativities due to immunosuppression and malpractice, and also difficulties in application and evaluation. Recently a new diagnostic test which measures the production of interferon (IFN)-gamma in whole blood upon stimulation with specific ESAT-6 and CFP-10 antigens of Mycobacterium tuberculosis has been introduced. Since most of the mycobacteria other than tuberculosis and BCG strain do not contain these antigens, the detection of IFN-gamma levels indicates the specific T-cell response against M.tuberculosis. The aim of the study was to compare the tuberculin skin test and whole blood IFN-gamma assay (QuantiFERON;reg;-TB Gold, Cellestis Ltd, Carnegie, Victoria, Australia) for the identification of latent TB infection in the contacts with active TB patients. The tests results were evaluated by using Kappa (K) analysis, and K coefficients of ;lt;0.4, 0.4-0.75 and ;gt;0.75 were accepted as poor, moderate and excellent agreements, respectively. A total of 233 subjects from three risk groups were included to the study. Group 1 included the household members (n=133) who had contact with smear positive index cases, Group 2 included the subjects from community (n=46) who had contact with smear positive index cases, and Group 3 included health care workers (n=74) who had contact with TB patients or their specimens. The positivity rates of tuberculin skin test and IFN-gamma assay in the cases were found as 37% and 42%, respectively. There were no significant differences among the three patient groups with regard to the results of the tuberculin skin test (p;gt;0.05). However, the positive result of the IFN-gamma assay in Group 1 was found statistically higher than the other groups (51.3%, p=0.013). A poor agreement between the two tests was detected in the results taken from 233 subjects (65.7%, K=0.28), while agreement was moderate in unvaccinated group (72.7%, K=0.44). Evaluation of agreement rates of the tests according to the risk groups yielded 64.6% (K=0.3) for Group 1, 71.7% (K=0.32) for Group 2, and 63.5% (K=0.21) for Group 3, which all coefficients showed poor agreement. Although IFN-gamma blood assay has many advantages such as objective and quantitative results, no interference with vaccination due to the use of specific antigens and being practical, the high cost and the need for well-equipped laboratory are its disadvantages. As a result it was concluded that, IFN-gamma blood assay has limited value for the detection of latent TB infection in our country, since the prevalence of TB infection and BCG vaccination rates are high in Turkey.Latent tüberküloz (TB) enfeksiyonunun tanısı için kullanılan tüberkülin deri testinin, kullanılan antijenin çevresel mikobakteriler ve BCG susu ile çapraz reaksiyonuna bağlı yalancı pozitif sonuçlar vermesi, immünsüpresyon durumunda ya da yanlış uygulama sonucu yalancı negatif sonuçların alınabilmesi ve testin uygulama ve değerlendirme zorlukları gibi birçok dezavantajı vardır. Son yıllarda geliştirilen bir yöntemde ise, Mycobacterium tuberculosis'e özgül antijenlerin uyarısı ile tam kanda interferon (IFN)-gama üretimi ölçülebilmektedir. Bu yöntemde kullanılan ESAT-6 ve CFP-10 antijenleri, BCG aşı susunda ve birçok çevresel mikobakteride bulunmadığından, T hücre yanıtını belirleyen IFN-gama düzeyinin tüberküloz basiline özgül olduğu kabul edilmektedir. Bu çalışmanın amacı, temaslılarda latent tüberküloz enfeksiyonunun belirlenmesinde tüberkülin deri testi ile tam kan IFN-gama testinin (QuantîFERON®-TB Gold, Cellestis Ltd, Carnegie, Victoria, Australia) karşılaştırılmasıdır. İki test sonucunun karşılaştırılmasında Kappa (K) uyum analizi metodu kullanılmış; K değerinin 0.4 olması zayıf, 0.4-0.75 olması orta ve >0.75 olması yüksek uyum olarak kabul edilmiştir. Çalışmaya üç farklı risk grubundan toplam 233 hasta alınmıştır. Grup 1; yayma pozitif indeks olgu ile temas eden aile içi temaslılardan (n=133), Grup 2; yayma pozitif indeks olgu ile temas eden aile dışı temaslılardan (n=46) ve Grup 3; TB'lu hastalarla ya da örnekleriyle ilişkisi olan sağlık personelinden (n=74) oluşmaktadır. Çalışılan olgularda tüberkülin deri testi %37, IFN-gama testi ise %42 pozitif sonuç vermiştir. Olgu grupları arasında tüberkülin deri testi pozitifliği yönünden önemli bir fark saptanmamış (p>0.05), ancak IFN-gama kan testi pozitifliği, aile içi temaslılarda diğer iki gruptan daha yüksek (%51.3, p=0.013) bulunmuştur. Toplam 233 olgunun %65.7'sinde test sonuçları zayıf ölçüde uyumlu (K=0.28, p0.001), aşısız olgularda ise orta derecede uyumlu bulunmuştur (%72.7, K=0.44). İki test arasındaki uyum gruplara göre irdelendiğinde; Grup 1 için %64.6 (K=0.3), Grup 2 için %71.7 (K=0.32) ve Grup 3 için %63.5 (K=0.21) olmak üzere zayıf düzeyde saptanmıştır. Sonuç olarak IFN-gama kan testinin, özgülantijenlerin kullanılması nedeniyle aşılamadan etkilenmemesi, kolay uygulanabilir olması ve objektif kantitatif sonuç vermesi gibi avantajlarının yanında, maj-iyetinin yüksek olması ve laboratuvar donanımı gerektirmesi gibi dezavantajları vardır. Dolayısıyla enfeksiyon prevalansının ve aşılanma oranlarının yüksek olduğu ülkemizde, bu yöntemin değerinin sınırlı olduğu düşünülmüştür

Molecular Diversity of Drug Resistant Mycobacterium Tuberculosis Strains in Western Turkey

Objective: The aim of this study was to investigate the molecular diversity and clonal relationship of drug resistant Mycobacterium tuberculosis strains isolated in Western Turkey. Materials and Methods: A total of 87 strains isolated between 2006 and 2009, eight of which were rifampicin monoresistant and 79 were multidrug resistant, were analyzed with IS6110 RFLP and spoligotyping methods. Results: The results of spoligotyping showed that 7% of the strains were orphans, and 8% were undefined for family in the SpolDB4 database. Major families of the strains were LAM (38%), T (35%), Haarlem (7%), Beijing (2%), S (2%) and U (1%) families. The clustering rate by spoligotyping was calculated as 75%. The most predominant SIT cluster was SIT41 (29%). According to the results of IS6110 RFLP, 71 different patterns of IS6110 were observed. Low copy number was found in 26% of the strains. When the results of two methods were combined, the final clustering rate was calculated as 26%. Conclusions: The genotypical distribution of drug resistant tuberculosis isolates in our region indicates genetic diversity and the clustering rate was found low in our region. However, more comprehensive and long-term molecular epidemiological studies are needed to control the drug resistant strains

Seroprevalence of West Nile virus, Crimean-Congo hemorrhagic fever virus, Francisella tularensis and Borrelia burgdorferi in rural population of Manisa, western Turkey

Background & objectives: Zoonotic diseases are well recognised threat to public health globally. The information of regional prevalence and associated risk factors allow the national programmes to determine and frame better strategies for their control, as they also provide the actual status of zoonosis in the region. The aim of this study was to determine the seroprevalence of West Nile virus (WNV), Crimean-Congo hemorrhagic fever virus (CCHFV), Francisella tularensis and Borrelia burgdorferi among the rural residents of Manisa region, Turkey and to identify the associated risk factors. Methods: Cross sectional study was conducted in rural parts of Manisa, Aegean region of western Turkey in 2012. Blood samples from 324 randomly selected subjects were screened for the presence of IgG antibodies to WNV, CCHFV, F. tularensis and B. burgdorferi with commercially available kits. The demographic structure of the rural residents and risk factors related to lifestyle such as outdoor agriculture activities, animal husbandry, hunting and history of tick bite were questioned and their relationships with positive results were analyzed statistically. Results: It was observed that 49 subjects (15%) had IgG antibodies to at least one of the zoonotic agents studied. The seroprevalence of F. tularensis was highest with a percentage of 7.1% (n = 23). Distribution of the positive results for WNV, CCHFV and B. burgdorferi were 4.3% (n = 14), 3.7% (n = 12) and 0.9% (n = 3), respectively. Older age and uncompleted secondary education were the statistically significant risk factors for seropositivity to at least one zoonotic agent investigated. Logistic regression analyses confirmed that older age (over 50) increased the risk of WNV and CCHFV seropositivity. Interpretation & conclusion: Seropositivity rates were not found to be higher than the expected rates. Further, studies are needed to evaluate the threat of vector borne zoonoses and associated risk factors in the study area