Risk factors associated with fluconazole resistance in Candida parapsilosis candidemia: A case-case study.

BACKGROUND: Candida species are among the most important invasive pathogens in intensive care units (ICUs). Non-albicans species including Candida parapsilosis (C. parapsilosis) has increased in recent years. Fluconazole is the leading antifungal agent but resistance is a concern among C. parapsilosis species. OBJECTIVES: The aim of this study was to determine the factors associated with fluconazole resistance in patients with candidemia due to C. parapsilosis in ICUs. METHODS: This case-case study was conducted in a 750-bed, tertiary hospital between 2015 and 2021. Patients with fluconazole-resistant C. parapsilosis candidemia constituted the 'cases of interest' group and patients with fluconazole-susceptible C. parapsilosis candidemia constituted the 'comparison cases' group. Demographic and clinical data of the patients were recorded. Logistic regression analysis was performed using the backward elimination method to determine the independent predictors of fluconazole-resistant C. parapsilosis bloodstream infections. RESULTS: The study included 177 patients. In the cultures of these patients, 76 (43%) fluconazole-resistant, 13 (7.3%) fluconazole-reduced susceptible, and 88 (49.7%) fluconazole-susceptible isolates were found. In the regression analysis the risk factors for fluconazole-resistant C. parapsilosis bloodstream infection, malignancy, immunosuppressive treatment, history of intra-abdominal surgery, hypoalbunemia, previous fluconazole use, and SOFA score were found to be associated in univariate analysis. In multivariate regression analysis, history of intra-abdominal surgery (OR: 2.16; 95% CI: 1.05-4.44), hypoalbuminemia (OR: 2.56; 95% CI: 1.06-6.17) and previous fluconazole use (OR: 3.35; 95% CI: 1.02-11) were found to be independent predictors. CONCLUSIONS: In this study, a significant correlation was found between candidemia due to fluconazole-resistant C. parapsilosis in ICUs and intra-abdominal surgery, hypoalbuminemia, and previous fluconazole use. C. parapsilosis isolates and fluconazole resistance should be continuously monitored, strict infection control measures should be taken and antifungal stewardship programs should be implemented.

Comparison of clinician preference and HIV-ASSIST recommendations in antiretroviral therapy decision-making: A single center experience from Turkiye.

Background: HIV-ASSIST is a free, continuously updated, clinically validated online algorithm tool that synthesizes participant- and virus-specific characteristics and provides ART decision support based on the goals of maximizing viral suppression and tolerability. The aim of this study was to analyze the concordance of clinicians' ART preferences with HIV-ASSIST recommendations and the influencing factors. Methods: We conducted a cross-sectional retrospective cohort study using electronic medical records of people with HIV (PWH) followed in the Infectious Diseases and Clinical Microbiology Department of Health Sciences University Izmir Tepecik Training and Research Hospital. The concordance between prescribed ART and HIV-ASSIST recommendations was evaluated. Results: The study included 101 participants (92 male, 91.1%), median age was 35 (20-67), and 24.8% of participants were treatment-experienced. The concordance between prescribed ART and HIV-ASSIST recommendations was 90.1% (absolute concordance 60.4%). The concordance rate was 89.5% (absolute concordance rate was 64.5%) in treatment-naive participants; 92% (absolute concordance rate was 48%) in treatment-experienced participants. Factors that were associated with discordance in the multivariate analysis were co-trimoxazole prophylaxis and hyperlipidemia. Conclusion: The recommendations of the HIV-ASSIST algorithm were found to be highly concordant with the ART prescriptions of our clinicians.

Erectile dysfunction prevalence and associated factors in men living with HIV from Western Turkey: A cross-sectional study.

BACKGROUND: The majority of people living with HIV in our country are younger men. However, limited data exist for the sexual health of these patients. Knowledge of the epidemiology in this population may improve health outcomes across the continuum of HIV care. The aim of this study was to determine the prevalence of erectile dysfunction (ED) and its association with some clinical and laboratory factors. METHODS: A cross-sectional study was conducted using random sampling in men living with HIV (MLWH) at a tertiary hospital in Turkey. Patients were asked to fill out the five-item International Index of Erectile Function (IIEF-5), and blood was collected for HIV viral load, CD4+ T lymphocyte count, lipids and hormone levels to assess biological aspects at the same clinical visit. RESULTS: A total of 107 MLWH were recruited. Mean age was 40.4 ± 12.4 years. ED was found in 73.8% (n = 79) of the participants. Severe ED was found in 6.3%, moderate in 5.1%, mild-moderate 35.4%, mild 53.2% of the participants, respectively. The mean age of men with erectile dysfunction was 42.5 ± 12.5 years, while those without erectile dysfunction were 34.5 ± 10 years (p:0.00). ED was detected more frequently in cases with high Low Density Lipoprotein (LDL) levels (p:0.003). There was no statistically significant difference between ED presence and having hormone abnormality. There was a moderate, negative correlation between age and ED score (r: -0.440, p < 0.001). A negative and low correlation was found between triglyceride level and ED score (r: -0.233, p:0.02). The only predictive variable was age in the multivariate analysis [B: -0.155 (95% CI -0.232 to -0.078), p: <0.001]. CONCLUSIONS: Our study revealed a high prevalence of ED in the MLWH cohort. Age was found to be the only factor associated with ED. HIV clinicians should consider routine ED screening with validated measures as a part of the follow-up scheme to improve integrated wellbeing in MLWH.

Could presepsin be an alternative marker in the early diagnosis of sepsis in COVID-19?

In critical patients with Coronavirus Disease (COVID-19), we investigated the diagnostic value of presepsin in the early diagnosis of superinfection with sepsis, and the effect of antibiotic treatment (AT) in the levels of presepsin and procalcitonin and C-reactive protein. A total of 68 critical patients with sepsis and septic shock in the intensive care unit and 20 outpatients (control group) with COVID-19 were taken. ICU patients (n = 68) were further divided into three groups. C(-)AT(-) had negative blood or tracheal aspirate cultures (C) and not AT on admission to ICU (n = 18), C(-)AT(+) had negative C and AT on admission to intensive care unit (n = 31) and C(+) had positive C (n = 19). Presepsin, procalcitonin, C-reactive protein results were compared between the groups. There were no significant relationships between presepsin levels with sepsis, septic shock, mortality, or length of stay in ICU in patients with COVID-19. For procalcitonin and C-reactive protein levels in C(-)AT(+) and C(+) groups were significantly higher than in control and C(-)AT(-) groups (p < .001). C-reactive protein levels in C(-)AT(-) group were significantly higher than in the control group (p < .001). PCT and CRP, there was no difference between C(-)AT(+) and C(+) groups, and procalcitonin there was no difference between control and C(-)AT(-) groups. Presepsin was not found as a useful biomarker for the prediction of sepsis in COVID-19 patients. These study findings indicate that procalcitonin and C-reactive protein may be an indicator of an early diagnostic marker for superinfection in critical COVID-19 patients.

The Course of COVID-19 in Four Patients with HIV During the Pandemic.

BACKGROUND: The clinical spectrum of SARS-CoV-2 infection may vary from simple colds to a severe acute respiratory syndrome, metabolic acidosis, septic shock, and multiple organ failure. Current evidence indicates that the risk of severe illness increases with age, in the male sex, and with certain chronic medical problems. Many people living with HIV have other conditions that increase their risk. ; Case presentation: In the first 3 months of the pandemic, four patients with HIV were hospitalized in our clinic because of COVID-19. The disease severity was mild in two patients with normal CD4+ T count. However, one patient with a low CD4+T count died and the other developed retinal detachment one month after discharge. The deceased patient had a malignancy. ; Conclusion: In this study, the effect of the immunological status of the patients on the course of COVID-19 and the developing vascular complications was evaluated in 4 patients with HIV.

Assessment of prophylactic antibiotic usage habits of the general surgeons in Turkey.

INTRODUCTION: One of the most important aspects of inappropriate antibiotic use among general surgeons in Turkey is the use of surgical antibiotic prophylaxis (SP). In order to shed light on the current situation, we conducted a survey of general surgeons in our country. Our aim was to evaluate the approach taken by our general surgeons in prescribing SP, while providing data pertinent to the effectiveness of the 'Rational Drug Use' (AIK) national action plan. METHODOLOGY: A questionnaire on the subject of personal SP usage and compliance with guidelines was distributed amongst general surgeons between 2018-2019. The questions related to individual approaches taken by surgeons when treating patients with either clean or clean-contaminated wounds. Results of the questionnaires were collated and compliance with ASHP guidelines was evaluated. RESULTS: A total of 317 completed questionnaires were evaluated. According to the questionnaire results, the rate of total compliance with ASHP guidelines was 26.8%. The compliance rate for preoperative SP was 69.7% in the clean wound group and 54.6% in the clean-contaminated wound group. Although 96.5% of the participants reported correct timing for the first dose of SP, this number dropped to 79.5% apropos the adminstration of further doses of prophylaxis. The percentage of surgeons prescribing continued antibiotics at discharge for clean and clean-contaminated cases was 22.7% and 38.5%, respectively. CONCLUSIONS: The results of this study indicate that inappropriate use of SP is widespread in our country, and that antibiotics continue to be prescribed at discharge.

Efficacy of tenofovir and entecavir in patients who relapsed after pegylated interferon therapy.

Hepatitis B virus (HBV) infections and sequelae present significant health problems worldwide. Two groups of medications are available for chronic HBV infection treatment: (1) interferons (IFNs) and (2) nucleos(t)ide analogues. This study aimed to evaluate entecavir (ETV) and tenofovir disoproxil fumarate (TDF) efficacies in chronic HBV patients, who achieved virological response during Peg-IFN treatment but did not sustain this response and relapsed a year after treatment end. In this study, 74 patients with chronic HBV infection who had virological responses to 180 µg/week Peg-IFNα-2a treatment were included; 38 (20 and 18 HBeAg positive and negative, respectively) of these patients were treated with 245 mg/day TDF, and 36 (20 and 16 HBeAg positive and negative, respectively) were treated with 0.5 mg/day ETV upon relapse after initial treatment discontinuation. In HBeAg-positive patients biochemical response rates were higher for TDF at weeks 96 and 144 (p = 0.044 and 0.019, respectively). However, biochemical response rates were similar for TDF and ETV in HBeAg-positive and HBeAg-negative groups at other weeks (p > 0.05). Virological and serological response rates were similar in patients treated with TDF and ETV in HBeAg-positive and HBeAg-negative groups (p > 0.05).

A new antibiotic stewardship program approach is effective on inappropriate surgical prophylaxis and discharge prescription.

INTRODUCTION: This study aims to evaluate the efficacy of a new antimicrobial stewardship program (ASP) on surgical antibiotic prophylaxis (SP) and antibiotics in discharge prescriptions used as a continuation of SP. METHODOLOGY: The study included elective patients with clean and clean-contaminated wounds. The accuracy of the assigned SP was evaluated according to international guidelines. Primary outcome measures comprised appropriateness of prophylactic antibiotic indication, correct timing of initial dose, discontinuation of SP within 24 hours, and antibiotic prescription at discharge. A secondary outcome measure was to determine whether the effect of ASP was sustained long-term. RESULTS: The total compliance rate for all stages of SP increased from 8% to 52.1% after the intervention (p < 0.05). When analyzed according to individual SP components, it was found that although ASP did not change first dose timing rates, it did affect the rates of prophylactic antibiotic indication, discontinuation of SP within 24 hours and antibiotic prescription at discharge, with statistical significance (p < 0.05). In addition, ASP continued to increase its effectiveness throughout the 3rd year. CONCLUSIONS: Based on the findings of our study, it seems clear that the modified ASP introduced in our general surgery clinic can be used effectively and simply; in addition, this ASP increases its efficacy with time.

[Investigation of bacterial and viral etiology in community acquired central nervous system infections with molecular methods]. / Toplum kökenli santral sinir sistemi enfeksiyonlarinda bakteriyel ve viral etiyolojinin moleküler yöntemlerle degerlendirilmesi.

In this multicenter prospective cohort study, it was aimed to evaluate the bacterial and viral etiology in community-acquired central nervous system infections by standart bacteriological culture and multiplex polymerase chain reaction (PCR) methods. Patients hospitalized with central nervous system infections between April 2012 and February 2014 were enrolled in the study. Demographic and clinical information of the patients were collected prospectively. Cerebrospinal fluid (CSF) samples of the patients were examined by standart bacteriological culture methods, bacterial multiplex PCR (Seeplex meningitis-B ACE Detection (Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae, Listeria monocytogenes, Group B streptococci) and viral multiplex PCR (Seeplex meningitis-V1 ACE Detection kits herpes simplex virus-1 (HSV1), herpes simplex virus-2 (HSV2), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein Barr virus (EBV) and human herpes virus 6 (HHV6)) (Seeplex meningitis-V2 ACE Detection kit (enteroviruses)). Patients were classified as purulent meningitis, aseptic meningitis and encephalitis according to their clinical, CSF (leukocyte level, predominant cell type, protein and glucose (blood/CSF) levels) and cranial imaging results. Patients who were infected with a pathogen other than the detection of the kit or diagnosed as chronic meningitis and other diseases during the follow up, were excluded from the study. A total of 79 patients (28 female, 51 male, aged 42.1 ± 18.5) fulfilled the study inclusion criteria. A total of 46 patients were classified in purulent meningitis group whereas 33 were in aseptic meningitis/encephalitis group. Pathogens were detected by multiplex PCR in 41 patients. CSF cultures were positive in 10 (21.7%) patients (nine S.pneumoniae, one H.influenzae) and PCR were positive for 27 (58.6%) patients in purulent meningitis group. In this group one type of bacteria were detected in 18 patients (14 S.pneumoniae, two N.meningitidis, one H.influenzae, one L.monocytogenes). Besides, it is noteworthy that multiple pathogens were detected such as bacteria-virus combination in eight patients and two different bacteria in one patient. In the aseptic meningitis/encephalitis group, pathogens were detected in 14 out of 33 patients; single type of viruses in 11 patients (seven enterovirus, two HSV1, one HSV2, one VZV) and two different viruses were determined in three patients. These data suggest that multiplex PCR methods may increase the isolation rate of pathogens in central nervous system infections. Existence of mixed pathogen growth is remarkable in our study. Further studies are needed for the clinical relevance of this result.

The relationship between coronal sulcus lymphangitis and IgE / Relación entre la linfangitis del surco coronario y la IgE

Objectives. To investigate whether there is a link between serum IgE levels in patients having diagnosis of coronal sulcus lymphangitis and this disease. The patients and method. The patients have been diagnosed clinically. The time of symptoms’ existence, allergy history and the history of a traumatic sexual relationship or masturbation have been investigated. The serum total IgE levels have been measured. Results. The study includes 27 patients. All patients have been diagnosed clinically. The age average is 36 (22-54). The time between the last sexual relationship or masturbation and the emergence of the symptoms is averagely 3 days (1-10). The symptoms emerged in shorter than 24 h in 6 patients. The symptoms emerged statistically earlier in patients having a traumatic sexual relationship or masturbation history (p: 0.0046). The level of serum IgE was over the threshold value in 8 patients (30%). The symptoms emerged statistically later in patients having high IgE level (p: 0.0004). Conclusions. The immunologic, traumatic and infectious reasons are responsible for the etiology of the coronal sulcus lymphangitis. In this study, the rate of the patients considered to be having immunologic reasons has been found as 30% (AU)

Objetivo. Investigar si existe una relación entre los niveles séricos de IgE en pacientes diagnosticados de linfangitis del surco coronario y este resultado. Pacientes y métodos. Los pacientes recibieron un diagnóstico clínico. Se investigaron la duración de los síntomas, antecedentes de alergias o de traumatismos durante el coito o la masturbación. Se midieron los niveles totales de IgE. Resultados. Se incluyeron 27 pacientes en el estudio. Todos habían recibido un diagnóstico clínico. La media de edad fue de 36 (22-54). El tiempo transcurrido desde la última relación sexual o masturbación y la aparición de los síntomas de 3 días de media (1-10). Los síntomas surgieron en menos de 24 horas para 6 pacientes. Los síntomas aparecieron antes de manera estadísticamente significativa en aquellos pacientes con antecedentes de coito o masturbación traumáticos (p: 0,0046). El nivel de IgE en sangre fue superior al valor de referencia en 8 pacientes (30%). Los síntomas aparecieron más tarde con significación estadística en los pacientes con niveles de IgE altos (p: 0,0004). Conclusión. Existen motivos inmunológicos, traumáticos e infecciosos que ocasionan la linfangitis del surco coronario. En el presente estudio se considera que la tasa de pacientes que contaban con motivos inmunológicos ascendía al 30% (AU)

Effect of microorganisms on etiology of hematospermia.

BACKGROUND: Hematospermia is the presence of blood in the ejaculate. Its etiology is congenital, inflammatory, infectious, obstructive, tumoral, vascular, traumatic, iatrogenic or related to systemic disease. It is a quite irritating and life-quality-disturbing condition for men. It is significant to demonstrate infectious-based hematospermia due to the fact that its treatment is easier than for other reasons. METHODS: 30 patients, having spontaneous hematospermia, were taken to our study. The serum total PSA levels of the patients were examined and microbiological examinations such as direct inspection for ejaculate, routine bacteriological and mycetes culture, Gram staining, trichrome staining and Mycoplasma hominis/Ureaplasma urealyticum culture (Mycofast Evolution 3, ELITech, France) were performed. RESULTS: Bacteria was isolated in 11 (36%) of 30 patients with hematospermia. S.aureus occurred in five patients (45.5%), U.urealyticum in three patients (27.2%) and E.coli and K.pneumoniae in one each (9.1%). U.urealyticum and S.aureus occurred together in one patient. No statistical difference of scores of National Institute of Health-Chronic Prostatitis Symptoms Index (CPSI) and serum total PSA levels between the patients with and without infection was observed. CONCLUSIONS: Hematospermia mostly affects micturition functions of young men and it can be due to infection in one-third of the cases.

Bacterial and viral etiology in hospitalized community acquired pneumonia with molecular methods and clinical evaluation.

INTRODUCTION: Polymerase chain reaction (PCR) method has improved the diagnosis rates for patients with community-acquired pneumonia (CAP). We aimed to evaluate the bacterial and viral etiology of hospitalized CAP cases and compare clinical and laboratory findings of patients with pure bacterial and bacterial and viral (mixed) infections. METHODOLOGY: A total of 55 patients hospitalized with CAP were enrolled into the prospective study between February 2010 and December 2010. Clinical and laboratory follow-up were performed on days 0, 7 and 14. Deep tracheal aspiration samples were examined for bacterial and viral pathogens by multiplex PCR, and standard bacteriological culture method. RESULTS: The etiological identification rate in 50 patients for bacteria, viruses and mixed virus-bacteria combination by PCR were 62%, 4%, 32%, respectively and 60% in 55 patients by bacterial culture method. Streptococcus pneumoniae concomitant with Haemophilus influenzae (36%) and rhinovirus (16%) was very common, whereas atypical pathogens (only Mycoplasma pneumoniae) were rare (6%). Rhinovirus was the most common viral agent (20%). Recently identified viruses, human coronavirus HKU1 and human bocavirus were not detected except for human metapneumovirus (one case). There was no significant difference in terms of mean age, immune status, leukocyte count, C-reactive protein (CRP) values, hospitalization duration and CURB-65 score between bacterial and mixed viral-bacterial detections. Advanced age (p < 0.01) and higher CURB-65 score (p = 0.01) were found to be associated with increased mortality. CONCLUSION: Concomitance of bacterial and viral agents is frequent and resemble with bacterial infections alone. Further studies are needed for the clinical significance of mixed detections.

Evaluation of the in vitro colistin susceptibility of Pseudomonas aeruginosa and Acinetobacter baumannii strains at a tertiary care centre in Western Turkey.

Multidrug-resistant gram-negative bacteria are an important issue in intensive care units worldwide. Colistin, one of the earliest polymyxin antibiotics, was once widely used for the treatment of gram-negative bacterial infections. However, its use is now limited due to concerns over nephrotoxicity. The appearance of multidrug-resistant species, including A. baumannii and P. aeruginosa, has led to the re-emergence of this class of drugs. The aim of this study was to evaluate the susceptibility of A. baumannii and P. aeruginosa isolates to colistin and other antibiotics. The antimicrobial susceptibility of A. baumannii and P. aeruginosa isolates to colistin and other antibiotics was evaluated between January 2011 and October 2012 at Tepecik Education and Research Hospital in Izmir, Turkey. Clinical isolates were identified using an automatized Vitek 2.0 system. Colistin susceptibility was measured by E-test; the susceptibility profiles of other antibiotics were evaluated using the Kirby Bauer disk-diffusion method. A total of 149 isolates were included in the study, consisting of 98 A. baumannii and 51 P. aeruginosa isolates. The MICs of colistin against A. baumannii were 0.125-2.0 mcg/mL, and 0.25-2.0 mcg/mL against P. aeruginosa; all multidrug-resistant strains examined in this study were susceptible to colistin. Recently, colistin has re-emerged as an effective treatment for infections due to multidrug-resistant A. baumannii, P. aeruginosa, and Klebsiella pneumoniae. All isolates examined in this study were susceptible to colistin, suggesting it could be a viable alternative for the treatment of infections with multidrug-resistant strains.

Prevalence of congenital toxoplasmosis among a series of Turkish women.

BACKGROUND: Toxoplasma gondii infection during pregnancy causes congenital malformations. Pregnant women should be screened for this infection since it is preventable and treatable. AIM: To study the sero prevalence of Toxoplasma gondii infection among pregnant women living in lzmir, Turkey. MATERIAL AND METHODS: A blood sample was obtained from 4651 women aged between 15 and 45 years, during their first trimester of pregnancy. IgM and IgG antibodies against Toxoplasma gondii were measured using an ELISA assay. Among women with both IgG and IgM antibodies positive, an IgG avidity test was performed, using a VIDAS kit. RESULTS: IgG antibodies were positive in 1871 (39.9%) participants. Of these, 48 (2.5%) also had positive IgM antibodies. In 41 of these 48 women, the IgG avidity test was performed and only one woman had a low avidity. This woman was treated with Spiramycin. Her offspring had an intrauterine growth retardation and oligohydramnios. A chorioretinitis was diagnosed in the offspring of other woman with both antibodies positive. CONCLUSIONS: In this series, the prevalence of congenital toxoplasmosis was low. However, women with positive antibodies against Toxoplasma Gondii should be further studied and followed during their pregnancy.

Latex-related allergy in hemodialysis patients.

BACKGROUND: Incidence of allergic reactions is increased in hemodialysis (HD) patients. However, the prevalence of latex allergy is not exactly known in HD patients. The aim of this present study is to determine the prevalence of latex allergy in HD patients. METHODS: A total of 205 adult HD patients were included in the study. Questionnaires were completed during patient interviews, and their consents were provided. Latex prick test and latex specific IgE test (HY-TEC, K82) were performed. Mean age of the patients was 52 ± 14 (25-79) years, and 61% was male. Mean dialysis duration was 38 months, and 21% of them were diabetics. Only five patients had allergic complaints in their histories, and none of them had severe anaphylaxis history. Latex prick test was positive in two patients. Latex specific IgE test was positive in five patients. Overall latex sensitivity was defined as 3.4%. CONCLUSION: No increased prevalence in latex allergy was determined in HD patients. Latex allergy incidence may be increased in atopic HD patients. Therefore, the use of latex products should be avoided as much as possible especially in atopic HD patients.

Prevalence of congenital toxoplasmosis among a series of Turkish women / Prevalencia de toxoplasmosis congénita en una serie de mujeres en Turquía

Background: Toxoplasma gondii infection during pregnancy causes congenital malformations. Pregnant women should be screened for this infection since it is preventable and treatable. Aim: To study the sero prevalence of Toxoplasma gondii infection among pregnant women living in lzmir, Turkey. Material and Methods: A blood sample was obtained from 4651 women aged between 15 and 45years, during their first trimester of pregnancy. IgM and IgG antibodies against Toxoplasma gondii were measured using an ELISA assay. Among women with both IgG and IgM antibodies positive, an IgG avidity test was performed, using a VIDAS kit. Results: IgG antibodies were positive in 1871 (39.9%) participants. Of these, 48 (2.5%) also had positive IgM antibodies. In 41 ofthese 48 women, the IgG avidity test was performed and only one woman had a low avidity. This woman was treated with Spiramycin. Her offspring had an intrauterine growth retardation and oligohydramnios. A chorioretinitis was diagnosed in the offspring of other woman with both antibodies positive. Conclusions: In this series, the prevalence of congenital toxoplasmosis was low. However, women with positive antibodies against Toxoplasma Gondii should be further studied and followed during their pregnancy.

Antecedentes: La infección por Toxoplasma gondii durante el embarazo causa malformaciones congénitas. Se debe efectuar serologíapara esta infección en mujeres embarazadas ya que es prevenible y tratable. Objetivo: Estudiar la seroprevalencia de infección por Toxoplasma gondii en mujeres embarazadas que viven en Esmirna, Turquía. Material y Métodos: Se obtuvo una muestra de sangre en 4.651 mujeres cuyas edades fluctuaban entre 15 y 45, años, durante su primer trimestre de embarazo. Los anticuerpos IgM e IgG en contra de Toxoplasma gondii se midieron por ELISA. En mujeres que tenían anticuerpos IgG e IgM positivos, un ensayo de avidez de IgG se efectuó utilizando el kit VIDAS. Resultados: Los anticuerpos IgG fueron positivos en 1.871 participantes (39,9%). De estas, 48 (2,5%) también tenían anticuerpos IgM positivos. En 41 de estas 48 mujeres, se efectuó el test de avidez y sólo una tenía una baja avidez. Esta mujer se trató con espiramicina y su producto de concepción tuvo un retardo de crecimiento intrauterino y un oligohidroamnios. Una corioretinitis se diagnosticó en el producto de concepción de otra mujer con ambos anticuerpos positivos. Conclusiones: La seroprevalencia de toxoplasmosis congénita en esta serie de pacientes fue baja, sin embargo, las mujeres con anticuerpos positivos deben ser tratadas y seguidas.

[Evaluation of vancomycin-resistant Enterococcus cases at a tertiary level hospital in Izmir, Turkey]. / Izmir'de Üçüncü Basamak Bir Hastanede Görülen Vankomisine Dirençli Enterokok Olgularinin Degerlendirilmesi.

Vancomycin-resistant enterocococci (VRE) are common pathogens that may lead to infection in intensive care units. VRE strains that colonize the hospital environment can stay alive for a long time on fomites and can easily be spread by the hands of hospital staff and by the instruments. The aim of this study was to evaluate the epidemic and sporadic VRE cases, following an epidemic at anesthesiology intensive care unit (ICU). The records of the patients hospitalized at anesthesiology ICU between October 2010-June 2011 were evaluated retrospectively. The hospitalized patients with VRE positive culture reports were included in this study. Rectal swab samples of the patients and environmental surveillance cultures were inoculated on sheep blood agar and enterococcosel agar media and incubated for 24-48 hours. The isolated strains were identified by conventional methods and automatized Vitek 2.0 system (BioMérieux, France). The molecular detection of VRE was performed by real-time polymerase chain reaction (Cepheid GeneXpert System, USA). A total of 19 VRE colonised or infected cases (11 male, 8 female; age range: 18-96 years, mean age: 60 years) that were detected sporadically or during the epidemic, were included in this study. Ten (52.6%) cases were evaluated as colonization (seven rectal, two urinary and one both urinary and rectal colonisation). Nine patients were considered as infected (five bacteremia, three catheter infections and one urinary tract infection). Five of the nine patients directly progressed to infection. Four of the nine patients progressed to infection after rectal colonization. Eight of the infected cases were treated with daptomycin and one case with linezolid. Five of the infected and treated cases died and the rate of mortality was determined as 55.6%. PCR was applied to the samples of eight cases and vanA was detected in seven of these. VRE were not grown in two of the PCR positive samples and one PCR positive sample did not yield VRE growth in culture. VRE were detected from the samples obtained from patients' monitors, infusion sets, bedside, bedstands and walls and the origin of VRE was thought to be environmental contamination. It was concluded that adherence to infection control guidelines and continuous education of the health-care personel were prerequisites for effective control of VRE colonization and infection in the health-care setting.

The evaluation of the distribution of yeast like fungi 'Candida Species' at a tertiary care center in western Turkey.

OBJECTIVE: Candida infections have increased due to transplant patients, prolonged ICU stay and invasive procedures. The most common isolated strain is C. albicans. The aim of this study was to evaluate the distribution of Candida isolates at Tepecik Education and Research Hospital. MATERIALS AND METHODS: Yeast like fungi were isolated between 13.01.2010 and 19.08.2011 at Mycology Laboratory. The identification was done by conventional methods and carbohydrate assimilation profile using the ID32C identification system (Biomerieux, France). RESULTS: Yeast like fungi were isolated from 337 clinical specimens. They consisted of urine, blood culture, respiratory specimen and wound. The most isolated yeast strains were C.albicans (38.6%), C.tropicalis (13.9%), C. parapsilosis (28.4%), C.glabrata (7.4%), C.krusei (3.8%). CONCLUSION: Recently there is an increment in Candida infections. In this study the most common strain was C.albicans and the rate C. glabrata and C. krusei isolates were lower than expected. C. parapsilosis was the most isolated strain in blood cultures and this may be due to invasive procedures and the use of indwelling catheters.

Cytomegalovirus and rubella seroprevalence in pregnant women in Izmir/Turkey: follow-up and results of pregnancy outcome.

PURPOSE: It is aimed to determine the Rubella and CMV prevalence in the pregnant women in Izmir and to research the effect of these infections on the course of pregnancy in the pregnant women exposed to infection during pregnancy. METHODS: The pregnant women applied to pregnancy outpatient department during 2001-2008 have been examined with enzyme-linked fluorescent assay (VIDAS; bioMérieux) method in terms of Rubella and CMV IgM and IgG antibodies and CMV IgG avidity test. RESULTS: Totally 5,959 pregnant women were included in the study. The seropositivity rates for Rubella and CMV were found as 97.8 and 98.3 %, IgM positivity rates were found as 0.37 and 0.18 %, respectively. Curettage was recommended to the pregnant women in which Rubella IgM positivity was detected in the first trimester of the pregnancy. Eight of the pregnant women in which IgM was found as positive after the 20th week of pregnancy were examined and three intrauterine growth retardation, one hypospadias and three normal deliveries were seen in these pregnant women. Any congenital anomaly finding was not detected in the pregnant women with positive CMV IgM. CONCLUSIONS: Seroprevalence values are high for Rubella and CMV in our region. It can be recommended not to check the pregnant women routinely for this purpose with the good implementation of Rubella vaccine programs.

Clinical and microbiological evaluation of eight patients with isolated Achromobacter xylosoxidans.

Achromobacter xylosoxidans causes infections in patients with underlying disorders. The aim of this study was to evaluate Achromobacter xylosoxidans cases. Eight patients were included, 5 infections and 3 colonizations. Three of them survived and 2 died. The predisposing factor was catheter. Infection control measures could prevent infection.