Time kill-assays of antibiotic combinations for multidrug resistant clinical isolates of OXA-48 carbapenemase producing Klebsiella pneumoniae

Treatment of infections caused by OXA-48 carbapenemase producing multidrug-resistant isolates often necessitates combination therapy. In vitro effect of different antibiotic combinations against multidrug-resistant (MDR) Klebsiella pneumoniae isolates were evaluated in this study.Meropenem-tobramycin (MER+TOB), meropenem-ciprofloxacin (MER+CIP), colistin-mer-openem (COL+MER), colistin-ciprofloxacin (COL+CIP) and colistin-tobramycin (COL+TOB) combinations were tested by time kill-assays. Each antibiotic alone and in combination at their Cmax values were tested against 4 clinical K. pneumoniae isolates at 1, 2, 4, 6, 8, 12 and 24 h. Effect of colistin and its associations were also assessed at 30 min. Bactericidal activity was defined as >= 3log10 CFU mL-1 decrease compared with initial inoculum. Synergy was defined as >= 2log10CFU mL-1 decrease by the combination compared with the most active single agent. Presence of blaOXA-48, blaNDM, blaVIM, blaIMP, blaKPC and blaCTX-M-1 genes was screened by PCR using specific primers.The blaOXA-48 gene was identified together with blaCTXM-1 group gene in all isolates. COL+MER demonstrated to be synergistic and bactericidal. MER+TOB showed synergistic and bactericidal effect on two strains although, regrowth was seen on other two strains at 24 h. MER+CIP exhibited indif-ferent effect on the strains.Combination therapy could be a potential alternative to treat MDR K. pneumoniae infections. This combination might prevent resistance development and secondary effects of colistin monotherapy. MER+TOB and MER+CIP might have an isolate-dependent effect, that may not always result in synergism

Serotype Distribution and Antibiotic Resistance of Streptococcus pneumoniae Strains Isolated from the Adult Patients in a Turkish University Hospital

Infections caused by Streptococcus pneumoniae are the most important cause of morbidity and mortality worldwide. S. pneumoniae is the most common cause of community-acquired pneumonia, especially in adults. Invasive pneumococcal disease can usually occur in the elderly, children and immunocompromised individuals. Usage of the vaccines for the protection against S. pneumoniae infections, is an effective method to reduce the burden of disease in both children and adults. Serotypes frequently isolated from purified capsular polysaccharides of S. pneumoniae are used in polyvalent vaccines. Significant differences are observed between countries and regions in serotypes and antibiotic resistance of S. pneumoniae strains. For this reason, each country and region should determine their own serotypes and antibiotic resistance. The aim of this study was to determine serotype distribution, antibiotic resistance and vaccine coverage rates in S. pneumoniae strains isolated from invasive and non-invasive samples of adult patients in our hospital. A total of 100 S. pneumoniae isolates from invasive and non-invasive samples of adult patients between March 2007 and August 2014 were used in this study. S. pneumoniae strains were identified by conventional methods. Serogrouping was performed with the latex particle agglutination and serotyping was made with the conventional Quellung reaction using a commercial type-spesific antisera (Statens Serum Institute, Copenhagen, Denmark). Antibiotic susceptibility testing for penicillin G, cefotaxime and erythromycin was performed by gradient test and evaluated according to the breakpoints of Clinical and Laboratory Standards Institute (CLSI). Sixty four percent of of the S. pneumoniae strains were isolated from non-invasive and 36% were isolated from invasive samples. Serotype 3 (20%), 19F (9%), 8 (7%), 14 (7%), 23F (6%), 6A (6%) were most common determined serotypes among all strains. Among S. pneumoniae strains isolated from invasive samples serotype 3 (22%), 14 (14%), 1 (8%) and in S. pneumoniae strains isolated from non-invasive samples 3 (19%), 19F (11%), 6A (9%), 23F (8%) were the most common serotypes. Among all isolates 2% penicillin and 3% cefotaxime intermediate resistance were detected. Erythromycin resistance was detected in 25% of invasive, 37% of non-invasive strains and a total of 33% in all of the isolates. Vaccine coverage rates were found to be 68% for PCV13 and 78% for PPV23 among all isolates. In our study penicillin resistance was lower compared with the other similar studies in the world, but resistance against erythromycin was almost similar. This study is important to show that serotype 3 predominated in serious pneumococcal infections in the adult population of our hospital. For this reason, administration of routine pneumococcal vaccination program in adults and especially in the elderly is recommended. In conclusion, it is important to know the serotype distribution and antibiotic resistance of S. pneumoniae to monitor the empirical treatment in serious pneumococcal infections

Susceptibility of clinical methicillin-resistant Staphylococci isolates to new antibiotics

Background: The treatment of methicillin-resistant staphylococcal infections has been a growing problem both in and out of hospitals for the past 30 years. Therefore, there is a need for other antibiotics as an alternative to glycopeptides in the treatment of methicillin-resistant staphylococcal infections. This study investigated the in vitro susceptibility of 49 methicillin-resistant Staphylococcus aureus (MRSA) and 59 methicillin-resistant coagulase negative staphylococci (MRCNS) clinical isolates to daptomiycin, telithromycin, tigecyclin, quinupristin/dalfopristin, and linezolid

Investigation of Seropositivity of Bordetella pertussis in Adults in A University Hospital

Whooping cough is a vaccine-preventable infectious diseases caused by Bordetella pertussis/parapertussis. Despite of routine immunization programs in the world, pertussis still remains endemic. Recently unvaccinated or partially immunized infants have infected with this pathogen and also increase of incidence was observed in adolescents and adults. The source of pertussis in newborns are attributed to household, especially due to the family members. Theaim of this study was to determine B.pertussis IgG antibody positivity by ELISA method in adults. Eighty-four of the total study population (39.6%) were anti-pertussis IgG positive, 128 (60.4%) were negative. The samples included in the study (n=212) were divided into three groups according to ages: 19-35 years (Group 1, n=61), 36-50 years (Group 2, n=58), 51-65 years (Group 3, n=93). Anti-pertussis IgG antibody positivity was 26.2% (n=22) in Group 1, 26.2% (n=22) in Group 2 and 47.6% (n=40) in Group 3. According to the anti-pertussis IgG positivity results, no significant difference was observed between genders. The results were obtained as absorbance values by ELISA test, then transformed into semi-quantitative values as NovaTec Test Unit (NTU). NTU positive values were between 11.01-39.4. Ninety four percent of NTU values were in the range of 11.01 to 28.01 and 6% were between 28.01 to 39.4. It was observed that seropositivity rates peaked at ages of 27, 55 and 65. The highest NTU values were observed in the age of 32 in females and in the age of 24 in males. Relatively, low seropositivity values (NT=15-20) were observed in both females and males to the age of 45 in Group 2. However a slight increase was observed in females after the age of 45. An increase (NTU >= 20) was determined in the age of 49 in males. The seropositivity rates were generally low (NT = 30) were observed in 55 and 65 years of age in males in this group. The highest seropositivity (NTI >= 30) were in 55 and 65 years of age (NTI >= 30) in males and 27 years of age (NTU >= 30) in females while in 36-50 age range, it was relatively low (NTI <= 20). Routine pertussis vaccination program is not yet implemented for adults in our country. However, the causes more clearly demonstrate the need for adult pertussis vaccination since adults may be incompletely vaccinated or not vaccinated in the childhood, current vaccinations are not available in the childhood of adults, adults become more susceptible to infections as the age increases, life expectancy increases and the likelihood of encountering infections, and childhood vaccination antibodies diminish over time. According to the results of this study, a single dose of pertussis vaccine is recommended to implement for adults in our country

Investigation of Seropositivity of Bordetella pertussis in Adults in A University Hospital

Whooping cough is a vaccine-preventable infectious diseases caused by Bordetella pertussis/parapertussis. Despite of routine immunization programs in the world, pertussis still remains endemic. Recently unvaccinated or partially immunized infants have infected with this pathogen and also increase of incidence was observed in adolescents and adults. The source of pertussis in newborns are attributed to household, especially due to the family members. Theaim of this study was to determine B.pertussis IgG antibody positivity by ELISA method in adults. Eighty-four of the total study population (39.6%) were anti-pertussis IgG positive, 128 (60.4%) were negative. The samples included in the study (n=212) were divided into three groups according to ages: 19-35 years (Group 1, n=61), 36-50 years (Group 2, n=58), 51-65 years (Group 3, n=93). Anti-pertussis IgG antibody positivity was 26.2% (n=22) in Group 1, 26.2% (n=22) in Group 2 and 47.6% (n=40) in Group 3. According to the anti-pertussis IgG positivity results, no significant difference was observed between genders. The results were obtained as absorbance values by ELISA test, then transformed into semi-quantitative values as NovaTec Test Unit (NTU). NTU positive values were between 11.01-39.4. Ninety four percent of NTU values were in the range of 11.01 to 28.01 and 6% were between 28.01 to 39.4. It was observed that seropositivity rates peaked at ages of 27, 55 and 65. The highest NTU values were observed in the age of 32 in females and in the age of 24 in males. Relatively, low seropositivity values (NT=15-20) were observed in both females and males to the age of 45 in Group 2. However a slight increase was observed in females after the age of 45. An increase (NTU >= 20) was determined in the age of 49 in males. The seropositivity rates were generally low (NT = 30) were observed in 55 and 65 years of age in males in this group. The highest seropositivity (NTI >= 30) were in 55 and 65 years of age (NTI >= 30) in males and 27 years of age (NTU >= 30) in females while in 36-50 age range, it was relatively low (NTI <= 20). Routine pertussis vaccination program is not yet implemented for adults in our country. However, the causes more clearly demonstrate the need for adult pertussis vaccination since adults may be incompletely vaccinated or not vaccinated in the childhood, current vaccinations are not available in the childhood of adults, adults become more susceptible to infections as the age increases, life expectancy increases and the likelihood of encountering infections, and childhood vaccination antibodies diminish over time. According to the results of this study, a single dose of pertussis vaccine is recommended to implement for adults in our country

Computer-assisted flapless implant placement reduces the incidence of surgery-related bacteremia

Bacteremia-the access of bacterium to the bloodstream-may yield life-threatening complications. The aim of this study was to compare the incidence, duration, and type of bacterium leading to bacteremia with relation to conventional and computer-assisted flapless implant surgery

Procalcitonin and C-reactive protein in differantiating to contamination from bacteremia

Procalcitonin (PCT) and C-reactive protein (CRP) are important biological markers used in the diagnosis of severe infections. The aim of this study was to evaluate the consistency of blood culture with PCT and CRP in differentiating contamination and non-bacteremia from true bacteremia. In this study blood samples were obtained from 809 febrile patients and analyzed using BACTEC 9120 system. All of positive blood cultures were performed Gram staining. The microorganisms were identified with conventional methods and automated systems. Antibiotic susceptibility tests were made by disc diffusion. PCT levels were analyzed by mini VIDAS device and PCT kit. PCT and CRP levels were analyzed with blood cultures in same times. Kruskal Wallis test, Mann-Whitney U test, Spearman's rho test and ROC curve were used for statistical analyses. The bacteremia group was found to be significantly different from non-bacteremia group and contamination group in terms of both PCT and CRP (p<0.0001). The p values of PCT and CRP in differentiating bacteremia from non-bacteremia were p<0.001 for PCT, p=0.002 for CRP and in differentiating bacteremia from contamination were p<0.001 for PCT, p<0.001 for CRP. PCT is a more useful marker than CRP in the differentiating of true bacteremia from contamination according to the results of this study

Procalcitonin and C-reactive protein in differantiating to contamination from bacteremia

Procalcitonin (PCT) and C-reactive protein (CRP) are important biological markers used in the diagnosis of severe infections. The aim of this study was to evaluate the consistency of blood culture with PCT and CRP in differentiating contamination and non-bacteremia from true bacteremia. In this study blood samples were obtained from 809 febrile patients and analyzed using BACTEC 9120 system. All of positive blood cultures were performed Gram staining. The microorganisms were identified with conventional methods and automated systems. Antibiotic susceptibility tests were made by disc diffusion. PCT levels were analyzed by mini VIDAS device and PCT kit. PCT and CRP levels were analyzed with blood cultures in same times. Kruskal Wallis test, Mann-Whitney U test, Spearman's rho test and ROC curve were used for statistical analyses. The bacteremia group was found to be significantly different from non-bacteremia group and contamination group in terms of both PCT and CRP (p<0.0001). The p values of PCT and CRP in differentiating bacteremia from non-bacteremia were p<0.001 for PCT, p=0.002 for CRP and in differentiating bacteremia from contamination were p<0.001 for PCT, p<0.001 for CRP. PCT is a more useful marker than CRP in the differentiating of true bacteremia from contamination according to the results of this study

The High Diversity of MRSA Clones Detected in a University Hospital in Istanbul

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Endogenous <i>Brucella</i> endophthalmitis: A case report.

Brucellosis may be associated with a wide range of ophthalmic manifestations including endophthalmitis, which is a sightthreatening condition that needs to be rapidly recognized and treated to avoid permanent visual loss. A 26-year-old female with a 6-month history of vision loss in the left eye was treated with high dose systemic corticosteroids and azathioprine with an initial misdiagnosis elsewhere. A dense vitreous haze with opacities at the posterior hyaloid and a wide area of retinochoroiditis led to the diagnosis of endogenous endophthalmitis at presentation to us. The vitreous sample and blood cultures demonstrated growth of Brucella melitensis. She received 6 months of systemic antibiotherapy, which resulted in resolution of inflammation; however, visual acuity remained poor due to irreversible damage. Infectious etiology, including brucellosis in endemic countries, has to be considered in the differential diagnosis before administering immunomodulatory therapy in patients with panuveitis of unknown origin