Investigation of nasal carriage and antibiotic susceptibility of Staphylococcus aureus in healthcare staff

Amaç: Staphylococcus aureus hastane enfeksiyonlarında önemli bir morbidite ve mortalite nedenidir. S. aureus'un burun taşıyıcılığı enfeksiyonların gelişiminde bir risk faktörü olarak bilinmektedir. Bu çalışmanın amacı hastanemizdeki sağlık çalışanlarının burunlarında S. aureus taşıyıcılığının araştırılması ve antibiyotik duyarlılığının belirlenmesi idi.Materyal ve Metod: Çalışmaya Kayseri Kadın Doğum ve Çocuk Hastalıkları Hastanesi'nde çalışan 203 sağlık çalışanı dâhil edildi. Çalışanların burunlarından steril eküvyonla sürüntü örnekleri alındı. Numuneler %5 koyun kanlı agara ekildi ve 37ºC'de 24 saat inkübe edildi. İzolatların tanımlanması konvansiyonel yöntemler ve S. aureus latex aglütinasyon kiti kullanılarak yapıldı. S. aureus olarak tanımlanan izolatların metisilin direnci ve antibiyotiklere duyarlılığı Kirby-Bauer disk difüzyon yöntemi ile Klinik ve Laboratuvar Standartları Enstitüsü (CLSI) kriterlerine göre belirlendi. Bulgular: S. aureus'un burun taşıyıcılığı 43 kişide (%21.2) saptandı. İzolatların 2'sinde (%4.7) metisiline direnç bulundu. Tüm izolatlar gentamisin, vankomisin, teikoplanin ve trimetoprim-sülfometaksazole duyarlı bulunurken, yalnızca 1 izolatın (%2.3) hem eritromisin ve hem de klindamisine dirençli olduğu belirlendi. Sonuç: Hastane personelinde burunda S. aureus varlığının araştırılması ve antibiyotik duyarlılığının belirlenmesi, özellikle de metisilin direnci saptanarak bu kişilerin tedavi edilmesi ve hastanenin daha uygun birimlerinde çalıştırılması açısından önemlidirObjective: Staphylococcus aureus has been a major cause of morbidity and mortality in nosocomial infections. Nasal carriage of S. aureus has been suggested as a risk factor for the development of infections The purpose of this study was to determine the prevalence of nasal carriage of S. aureus in healthcare staff in our hospital and analyse antibiotic susceptibility profile. Methods: 203 healthcare staff working in Kayseri Obstetric and Children Hospital was included in the study. The samples were collected from both nasal cavities of healthcare staff with sterile cotton swabs. The nasal swabs were cultured on %5 sheep blood agar plates and incubated at 37 C for 24-hour. Identification of the isolates was carried out using conventional methods and S. aureus latex agglutination kit. The identified S aureus strains were tested for methicillin resistance and sensitivity to antibiotics by the Kirby-Bauer disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI).Results: Nasal carriage of S. aureus was defined in 43 (21,2%) personnel. 2 (4.7%) of them nasal carriage of Methicillin-resistant S. aureus (MRSA) was found positive. All the isolates of S. aureus were sensitive to gentamycin, vancomycin, teicoplanin and trimethoprim-sulphamethoxazol. One of the isolates (2.3%) was resistant to erythromycin and clindamycin.Conclusions: Investigation of the presence of nasal carriage of S. aureus in the healthcare staffand determination of antibiotic susceptibility is important because of detecting and treating methicillin resistance and transferring carrier to more approciate unit in the hospita

INVESTIGATION OF HERPES SIMPLEX VIRUS (HSV) BY THREE DIFFERENT METHODS IN THE CLINICAL SPECIMENS OF PATIENTS WITH SUSPECTED HSV INFECTIONS

Herpes simplex virus (HSV) infections are a common clinical problem worldwide. HSV infections have a severe and rapidly progressive course especially in immunocompromised patients, leading to significant morbidity and mortality. Therefore, rapid and reliable laboratory diagnosis of HSV infections is of crucial importance for the initiation of early antiviral therapy. In this study the aim was to investigate the presence of HSV type I and type 2 in clinical specimens by cell culture, in-house polymerase chain reaction (PCR) and direct fluorescein antibody (DFA) methods. The study was conducted at Erciyes University Gevher Nesibe Hospitals between March 2006 and June 2007. A total of 65 clinical specimens, 38 of them being cerebrospinal fluid (CSF) samples obtained from meningoencephalitis suspected cases and 27 being vesicular/conjunctival/genital swabs obtained from patients with different clinical presentations (13 herpes labialis, 5 keratoconjunctivitis, 4 gingivostomatitis, 3 eczama herpeticum, 1 herpetic whitlow, 1 genital ulcer). The age range of the 65 patients varied between 1-68 years, 20 being children. All the samples except CSF were investigated by 3 of the test methods, however, CSF samples were tested only by cell culture and PCR since DFA is not recommended. HSV was found positive in 48.1% (13/27) of the 27 swab specimens by DFA, in 66.6% (18/27) by PCR and in 51.8% (14127) cytopathic effect consistent with HSV was observed. HSV positivity was detected in 7.8% (3/38) of the 38 CSF specimens by cell culture and in 47.4% (18/38) by in-house PCR. Viral growth in cell cultures showing cytopathic effect were further confirmed by DFA method using HSV-1 and HSV-2 specific fluorescein monoclonal antibodies (Monofluo, Bio-Rad Laboratories, USA). Agreement between the methods were investigated by Kappa analysis. Moderate level agreement was determined for both swab (K=0.7) and CSF (K=0.6) specimens for the tested methods when cell culture was considered as the reference method. In conclusion for swab specimens, primarily DFA which is a practical and rapid method, could be applied. This step might be followed by PCR and cell culture techniques sequentially. On the other hand CSF specimens should be investigated by the rapid and more sensitive PCR method

Investigation of Cytomegalovirus Positivity in the Peripheral Blood Samples of Risky Patients by Shell-Vial Cell Culture, Antigenemia Test and Real-Time Polymerase Chain Reaction

Cytomegalovirus (CMV) infections in immunocompromised patients and congenital infections in infants have high morbidity and mortality while it may lead to asymptomatic infections in immunocompetent subjects. Serological tests, culture methods, antigenemia tests and molecular methods are applied in the diagnosis of CMV infection. The aim of this study was to investigate the presence of CMV in peripheral blood samples of patients who were at risk for CMV disease by shell vial cell culture, antigenemia test and real-time polymerase chain reaction (RT-PCR) methods. A total of 141 blood specimens obtained from 91 patients (33 female, 58 male) with suspected CMV disease were included to the study. Five of the patients were newborns and the others aged between 17-79 years old were bone morrow (n = 81), kidney (n = 4) and liver (n = 1) transplantation patients. Shell vial (Vircell, Spain) cell culture method was applied for CMV isolation from the samples, while the detection of pp65 antigen in blood leukocytes was investigated by indirect immunofluorescence method (CINAkit Argene, Biosoft, France). The presence of CMV DNA in plasma samples was detected by RT-PCR (CMV QNP 2.0 kit; Fluorion, Iontek, Turkey) method. CMV was found positive in 72 (51%) of 141 samples by shell vial, 82 (58.2%) by antigenemia test and 49 (34.8%) by RT-PCR. Considering cell culture as the gold standard, the sensitivity and specificity of antigenemia test were calculated as 81.9% and 66.6%, respectively; and for PCR those rates were 43% and 73.9%, respectively. In addition DNA sequencing (ABI Prism 310 Genetic Analyzer; Perkin Elmer, USA) was performed for the samples of randomly selected three patients out of 15, who were yielded positive results with cell culture and antigenemia tests but negative CMV DNA by RT-PCR. In this analysis CMV DNA was found positive in three of the samples that were found negative by RT-PCR in spite of CMV isolation and positive antigenemia. DNA sequencing of those samples revealed multiple mutations in the probe binding region (gB) of CMV QNP 2.0 kit. It was concluded that for the detection of CMV viremia and viral load in patients under risk for CMV disease, antigenemia and PCR based methods could be applied, however, negative results obtained by PCR targeting CMV gB gene, should remind the possible presence of mutations in the related site and the results should be confirmed by sequence analysis

A Case of Fatal Bacterial Meningitis Caused by Enterococcus Faecalis: Postmortem Diagnosis

Enterococcus species rarely cause bacterial meningitis without predisposing factors such as trauma, brain surgery, etc. In this study, we present a bacterial meningitis case caused by Enterococcus faecalis (E. faecalis) in a 13-year-old male who was found dead at home. One hundred and forty two cm tall, 37 kg weight male had admitted to hospital two days after the beginning of complaints such as weakness, headache, swelling of left eye, nausea and vomiting. Body temperature was 37.3 oC, leucocyte count 22100/ mm3, and CRP 71 g/dl at the hospital admission. Antibiotic treatment with amoxicillin/clavulanic acid (625 mg) was given to the patient but he was found dead in his house the day after. In autopsy; yellow-green purulant liquid in left frontoparietal zone, fullness of meningeal vessels and oedema was seen in brain. Isolated bacteria in cerebrospinal fluid (CSF) was identificated as E. faecalis by mini API 32 Strep®. Postmortem microbiological sampling in autopsy and defining etiologic agents is important for rare meningitis cases in which antemortem identification could not be done before death