Compliance With the Surviving Sepsis Campaign Bundle: A Multicenter Study From Turkey.

Objectives Sepsis bundle compliance is not clear. We evaluated rates of compliance with sepsis bundle protocols among health care providers in Turkey. Methods Our study was carried out retrospectively. Forty-five intensive care units (ICU) participated in this study between March 2, 2018 and October 1, 2018. Results One hundred thirty-eight ICUs were contacted and 45 ICUs agreed to participate. The time taken for the diagnosis of sepsis was less than six hours in 384 (59.8%) patients, while it was more than six hours in 258 (40.2%) patients. The median [interquartile range (IQR)] times for initial antibiotic administration, culturing, vasopressor initiation, and second lactate measurement were 120.0 (60-300) minutes, 24 (12-240) minutes, 40 (20-60) minutes, and 24 (18-24) hours, respectively. The rate of compliance with tissue and organ perfusion follow-up in the first six hours was 0%. The rates of three- and six-hour sepsis bundle protocol compliance were both 0%. The ICU mortality rates for sepsis and septic shock were 22% and 78%, respectively. The ICU mortality rates for sepsis and septic shock were 22% and 78%, respectively. Conclusions The rate of compliance with sepsis bundle protocols was evaluated in Turkey for the first time and determined to be 0%.

Seroprevalence of Crimean-Congo Hemorrhagic Fever in Turkey's Van Province.

Crimean-Congo hemorrhagic fever (CCHF) is an endemic tick-borne viral disease that affects both animals and humans. This study aims to determine the seroprevalence of CCHF in Turkey's Van province using analysis of blood samples obtained from people living in the region. Blood specimens were taken from healthy subjects living in Van province and some of the surrounding villages between January and July 2012. Blood samples were initially tested using a CCHF virus (CCHFV) IgM IgG kit for anti-CCHFV IgG, followed by anti-CCHFV IgM determination of any IgG positive blood samples. IgM-positive specimens were re-confirmed using real-time polymerase chain reaction (qPCR). One hundred and 7 men and 261 women were included in the study. Fifty-three blood specimens (14.4%) were anti-CCHFV IgG positive, and 2 of these were anti-CCHFV IgM positive. Two blood samples with anti-CCHFV IgM seropositivity tested negative using qPCR, indicating chronic infections. Locality, sex, and a history of tick bites did not significantly affect anti-CCHFV IgG seropositivity. Although the incidence of anti-CCHFV IgG in blood specimens was 14.4%, no deaths have yet been reported in Turkey's Van province. It is imperative that clinical CCHFV tests be implemented for people at high risk of developing CCHFV-related complications.

Sensitization to food and inhalant allergens in healthy children in Van, East Turkey.

BACKGROUND/AIM: The purpose of this study was to determine the most frequent food and inhalant allergens leading to allergic sensitization in children in Van Province of Turkey. MATERIALS AND METHODS: The study included 1052 serum samples with no diagnosis of allergy. The sera were tested with the Euroline Pediatric IgE test kit (EUROIMMUN, Germany). By using the EUROLineScan digital evaluation system, the intensity of bands was calculated with enzyme allergosorbent test classification. RESULTS: Out of the 1052 tested sera, 143 were found to be cross-reactive carbohydrate determinant-positive and were discarded from the study. Of the remaining 909 sera, 513 (56%) were from males and 296 (44%) were from females. Among the food allergens, specific IgE was most frequently found against codfish, potato, cow's milk, egg yolk, egg white, and rice, and among the inhalant allergens against cats, dogs, grass mix, Dermatophagoides pteronyssinus, and Aspergillus fumigatus, respectively. CONCLUSION: The finding of codfish being the most frequent allergen was related to the high consumption of trout in the region and endemicity of pearl mullet in Lake Van. The results obtained could contribute to determining the etiology of allergic diseases. Additionally, regular analysis of changes in allergen sensitization is important for prevention of allergic disease.

Antibiotics resistance of Stenotrophomonas maltophilia strains isolated from various clinical specimens.

BACKGROUND: A limited number of antibiotics are recommended for the therapy of Stenotrophomonas maltophilia infections due to therapy difficulties caused by its numerous mechanisms of resistance. OBJECTIVES: In this study conducted over a period of approximately 5 years we aimed to determine resistance rates of S. maltophilia based on drug classification recommended by Clinical and Laboratory Standards Institute. METHODS: A total of 118 S. maltophilia strains isolated from various clinical specimens between January 2006 and June 2012 were included in the study. BD Phoenixautomated microbiology system (Becton Dickinson, USA) was utilized for species level identification and antibiotic susceptibility testing. RESULTS: Sixty seven of S. maltophilia strains were isolated from tracheal aspirate isolates, 17 from blood, 10 from sputum, 10 from wound and 14 from other clinical specimens. Levofloxacin was found to be the most effective antibiotic against S. maltophilia strains with resistance rate of 7.6%. The resistance rates to other antibiotics were as follows: chloramphenicol 18.2%, trimethoprim-sulfamethoxazole 20.3% and ceftazidime 72%. CONCLUSION: The study revealed that S. maltophilia is resistant to many antibiotics. The treatment of infections caused by S. maltophilia should be preferred primarily as levofloxacin, chloramphenicol, and TMP-SXT, respectively.

[Seropositivity of Borrelia burgdorferi in risky groups in Van region, Turkey]. / Van bölgesindeki riskli gruplarda Borrelia burgdorferi seropozitifl igi.

Lyme borreliosis, which is more prevalent in the northern hemisphere, is the most common tick-borne contagious disease among people living in the North America and Europe. The causative agent of Lyme borreliosis, Borrelia burgdorferi, is transmitted by the bites of ticks of the genus Ixodes. In Turkey, the seroprevalence of Lyme disease is increased in regions where ticks and tick-bite cases are prevalent. The present study aimed to determine the seroprevalence of Lyme borreliosis in people at risk, living in the rural areas of Van province, which is located in the eastern region of Turkey. No previous study on this topic has been performed in our province. The study included a total of 446 subjects (mean age: 39.6±15.5 years), of them 139 were male and 307 were female, living in the rural areas of Van province between January 2012 and July 2012. The serum samples collected from participants after informed consent were screened for the presence of B.burgdorferi IgG antibodies by ELISA method. Western blot (WB) method was used for the confirmation of positive or borderline positive samples, and also for the investigation of IgM antibodies. During the study, the individuals from whom samples were taken, were questioned whether they have ever been exposed to tick or insect bite. B.burgdorferi IgG positivity was detected in 17 (3.8%) of the cases, whereas it was within the limit values in 14 cases. A total of 31 samples which yielded positive and borderline positive results were retested by WB and 4 (12.9%) were detected as positive while 10 (32.3%) of the samples were indeterminate. B.burgdorferi IgM antibody positivity was not detected in any of the samples. Considering the WB as reference method, the rate of B.burgdorferi IgG seropositivity was estimated as 0.9% (4/446). Three of these four cases were defined as tick or insect bites. The seroprevalence rate of B.burgdorferi detected in the present study was low as compared to the results of the other studies reported from Turkey. The reason of this result might be from the geographical characteristics and the differences of tick fauna in our region. As a result, it was concluded that our province is not endemic for Lyme borreliosis, however for the reduction of tick exposure, emphasis must be placed on preventive health services for the individuals at risk.

Detection of putative virulence genes in Aeromonas isolates from humans and animals.

INTRODUCTION: Aeromonas are food- and water-borne bacteria that are considered to be zoonotic human pathogens. This study aimed to investigate the presence of genes associated with virulence in human and animal Aeromonas isolates and the potential role of animal isolates with regards to human Aeromonas infections. METHODOLOGY: The presence of aerA, hlyA, alt, ast, laf, ascF-G, stx1 and stx2 putative virulence genes in 40 human and animal Aeromonas isolates (16 human and 24 animal isolates) were examined by polymerase chain reaction (PCR). DNA fragments of expected sizes were purified and sequenced. BLAST in the NCBI was used to verify any amplified products. RESULTS: PCR screening showed that hlyA, alt, and laf genes were determined at ratios of 6.25%, 50%, and 6.25%, respectively, in human isolates. The ratios of hlyA, alt, ascF-G, laf, stx2, and stx1 genes in animal isolates were 58.3%, 20.83%, 33.3%, 20.83%, 8.33%, and 4.17%, respectively. Neither aerA nor ast genes were detected in any isolates. Any one of eight putative virulence genes was not detected in seven human and eight animal isolates in the study. CONCLUSIONS: The current study is the first to investigate the presence of the virulence gene in gull Aeromonas isolates. The manifestation of the presence of the virulence gene and gene combinations was considerable, especially in fish and gull isolates when compared with clinical human isolates. The current study demonstrates the potential importance of fish and gulls in terms of human Aeromonas infections.

[Mycobacterium tuberculosis strains isolated from Van region four different sensitivity detection method antimycobacterial agents]. / Van yöresinde izole edilen Mycobacterium tuberculosis suslarinin dört farkli yöntemle antimikobakteriyel ajanlara duyarlilik tespiti.

INTRODUCTION: The purpose of this study is detecting the susceptibility rates of 58 Mycobacterium tuberculosis complex strains which were isolated from patient specimens sent to our mycobacteriology laboratory, for major anti-tuberculosis drugs like streptomycin, isoniazid, rifampicin and ethambutol with three different systems and agar proportion method and compare the accessibility, speed, specificity and sensitivity of these three systems. MATERIALS AND METHODS: With this purpose, 58 (96.6%) strains out of 60 which were isolated from the patients attended to the mycobacteriology laboratory were identified as M. tuberculosis complex with conventional methods. These strains susceptibilities to four major anti-tuberculosis drugs were detected with Manuel MGIT AST SIRE system, BacT/ALERT 3D system MB/BacT SIRE, TK anti-TB system and compared with reference method in Middlebrook 7H10 media. RESULTS: As a result, INH resistance in Van province with agar proportion method was detected as 12%, followed by INH + RIF resistance of 1.7% and INH + SM resistance of 1.7%. These result compared with other studies conducted country wide are in median range. The systems included in our study were determined to have 100% sensitivity for all of the drugs for detecting resistance and sensitivity rates. Specificities for INH for TK anti-TB, MGIT and MB/BacT were detected as 98%, 96% and 95% respectively. Multidrug resistance rates were detected in 100% sensitivity and specificity with all of the three systems. Only MB/BacT system gave a false negative RIF resistance for 1 strain. Fastest system according to resistance determination times is found to be the MGIT system. CONCLUSION: However, presence of INH + RIF resistance pattern, indicates inadequate treatment programs in our region. As a result these three systems are fast and reliable systems for antimicrobial susceptibility testing of Mycobacterium spp. to be used in routine mycobacteriology laboratories.

Detection of the frequency of PER-1 type extended-spectrum ß-lactamase-producing Acinetobacter baumannii clinical isolates in Turkey: a multicenter study.

BACKGROUND/AIM: ß-Lactamases are an important resistance mechanism in Acinetobacter baumannii. Pseudomonas extended-resistance (PER-1) type ß-lactamase-producing strains have been reported from various geographic locations; however, PER-1 type ß-lactamases from Turkish hospitals have not been investigated extensively. The aim of this study was to determine the prevalence of PER-1 type ß-lactamases in A. baumannii isolates in various regions of Turkey. MATERIALS AND METHODS: A total of 763 clinical A. baumannii isolates were collected from 9 university hospitals and 2 state hospitals between 2008 and 2011. Molecular amplification of the OXA-51 gene from the A. baumannii genome was performed in order to verify identification of the species. Real-time polymerase chain reaction was used to detect blaPER-1 genes. RESULTS: PER-1 was detected in 24.6% of the isolates. The annual frequencies of the PER-1 enzyme were detected as 52.2%, 35.9%, and 8.3% in 2008, 2009, and 2010, respectively. PER-1 prevalence decreased gradually over time. The differences observed in PER-1 prevalence among the regions of Turkey were statistically significant (chi-square test; P < 0.001). CONCLUSION: These data demonstrate that the frequency of detection of PER-1 type ß-lactamases in A. baumannii species has decreased in Turkey. However, the increased carbapenem resistance, together with multidrug resistance, has created a worrisome situation regarding this pathogen.

[Distribution of blaOXA genes in Acinetobacter baumannii strains: a multicenter study]. / Acinetobacter baumannii Izolatlarinda blaOXA Genlerinin Dagilimi: Çok Merkezli Bir Çalisma.

Acinetobacter baumannii is the most important agent of nosocomial infections within the Acinetobacter genus. This gram-negative coccobacillus is intrinsically resistant to many antibiotics used in antimicrobial therapy, and capable of developing resistance including carbapenems. The objective of this study was to develop a multiplex real time polymerase chain reaction (qPCR) kit for OXA subgroups in A.baumannii, and to investigate the distribution of OXA subgroups in A.baumannii strains isolated from geographically different regions of Turkey. A total of 834 A.baumannii clinical isolates collected from different state and university medical centers in 13 provinces (Afyonkarahisar, Ankara, Bolu, Elazig, Erzurum, Isparta, Istanbul, Kahramanmaras, Konya, Sakarya, Van) between 2008-2011, were included in the study. The isolates were identified by conventional methods and automated systems [Vitek2 (bioMerieux, ABD) and Phoenix (BD Diagnostic, MD)]. The susceptibility profiles of the isolates were studied with automated systems and standard disc diffusion method. All samples were subjected to qPCR to detect blaOXA-51-like, blaOXA-23-like and blaOXA-58-like genes. A conventional PCR method was also used to detect blaOXA-24-like gene. The resistance rates observed during the study period were as follows: 96.8% for amoxicillin-clavulanate, 86.8% for ciprofloxacin, 74.7% for gentamicin, 71.7% for amikacin, 73.5% for cefaperozone-sulbactam, 72.1% for imipenem and 73% for meropenem. Six hundred and two (72.2 %) isolates were resistant to both imipenem and meropenem. Colistin was found to be the most effective antibiotic against A.baumannii isolates with 100% susceptibility rate. All isolates were positive for blaOXA-51-like, however blaOXA-24-like gene could not be demonstrated in any isolate. Total positivity rates of blaOXA-23-like and blaOXA-58-like genes were found as 53.7% and 12.5%, respectively, while these rates were 74.4% and 17.3% in carbapenem-resistant isolates, respectively. Twenty-five isolates were positive for both blaOXA-23-like and blaOXA-58-like genes. All of the carbapenem-resistant isolates have OXA type genes with the exception of blaOXA-24-like gene. The positivity rates for blaOXA-23-like and blaOXA-58-like genes varied for each center. In addition, there was a decrease in the frequency of blaOXA-58-like gene, however both blaOXA-23-like gene and carbapenem resistance rates increased during the study period. In conclusion, high rates of resistance to carbapenems were also remarkable but A.baumannii strains keep on sensitivity to colistin. Both blaOXA-23-like and blaOXA-58-like genes were shown to be widespread in carbapenem-resistant A.baumannii clinical isolates. However, blaOXA-23-like gene positive strains were increased throughout the study. Currently, multiplex qPCR is the best way for rapid diagnosis of resistant bacteria for prevention of hospital-acquired infections. The multiplex qPCR kit developed in this study could be useful for rapid diagnosis and identify the frequencies of blaOXA-23-like, blaOXA-51-like and blaOXA-58-like genes in carbapenem-resistant A.baumannii clinical isolates.

Identification and determination of antibiotic susceptibilities of Brucella strains isolated from patients in van, Turkey by conventional and molecular methods.

PURPOSE: Brucellosis is a worldwide zoonotic disease and still constitutes a major public health problem. In this study, we aimed to identify biovars of Brucella strains isolated from clinical specimens taken from brucellosis patients from the Eastern Anatolia region as well determine the susceptibility of these isolates to tigecycline and azithromycin, drugs that may serve as alternatives to the conventional drugs used in the therapy. MATERIALS AND METHODS: Seventy-five Brucella spp. isolates were included in the study. All strains were identified by both conventional and molecular methods. Brucella Multiplex PCR kit (FC-Biotech, Code: 0301, Turkey) and B. melitensis biovar typing PCR kit (FC-Biotech, Code: 0302, Turkey) were used for molecular typing. Antimicrobial susceptibilities of all strains were determined by E-tests. RESULTS: By conventional biotyping, 73 strains were identified as B. melitensis biovar 3 and two strains as B. abortus biovar 3. Molecular typing results were compatible with conventional methods. The MIC50 and MIC90 values of doxycycline were 0.047 and 0.094; tigecycline 0.094 and 0.125; trimethoprim/sulfamethoxazole 0.064 and 0.19; ciprofloxacin 0.19 for both; streptomycin 0.75 and 1; rifampin 1 and 2 and azithromycin 4 and 8. According to the MIC values, doxycycline was found to be the most effective antibiotic, followed by tigecycline, trimethoprim-sulfamethoxazole and ciprofloxacin. CONCLUSION: Currently recommended antibiotics for the treatment of brucellosis such as doxycycline, rifampin, streptomycin, trimethoprim-sulfamethoxazole and ciprofloxacin were found to be still effective. While our results showed that tigecycline can be used an alternative agent in the treatment of brucellosis, azithromycin has not been confirmed as an appropriate agent for the treatment.

[Evaluation of Colistin-Ampicillin/Sulbactam Combination Efficacy in Imipenem-Resistant Acinetobacter baumannii Strains]. / Imipeneme Dirençli Acinetobacter baumannii Izolatlarinda Kolistin-Ampisilin/Sulbaktam Kombinasyonu Etkinliginin Degerlendirilmesi.

The increasing emergence of multi-drug resistant Acinetobacter baumannii strains as nosocomial pathogens lead to the use of antimicrobial combinations in the treatment of infections due to these bacteria. The aim of this study was to determine the MIC values of colistin and ampicillin/sulbactam and their in vitro synergistic activities by E-test in order to evaluate the effect of this combination against imipenem-resistant A.baumannii isolates. A total of 33 A.baumannii strains isolated from clinical specimens as etiologic agents of nosocomial infections and identified as imipenem-resistant were included in the study. Identification of the isolates was performed by conventional methods and their imipenem resistance was detected with BD Phoenix automated system (Becton Dickinson, USA). MIC values and in vitro synergistic activity of colistin and ampicillin/sulbactam combination were analyzed by E-test (AB Biodisk, Sweden) on Mueller-Hinton agar medium. Synergistic, additive, indifferent and antagonist effects of A.baumannii strains were evaluated by fractional inhibitory concentration (FIC) index. The combination was considered to be synergistic when the FIC index was ≤ 0.5, additive when it was 1- > 0.5 and antagonistic when ≥ 2. Of the 33 strains included in the study, 21 were resistant to colistin; 30 were resistant and 3 were moderately susceptible to ampicillin/sulbactam. MIC50 and MIC90 values and MIC range of A.baumannii strains for colistin were 8, 32 and 0.13-128 µg/ml; for ampicillin/sulbactam those values were 48, 256 and 12-256 µg/ml, respectively. According to the FIC indices, 15 strains showed synergistic, four additive, five indifferent and nine antagonistic activity to colistin and ampicillin/sulbactam combination. Among the 12 colistin-susceptible strains, nine showed antagonistic, two indifferent and one synergistic activity to the tested combination while among the 21 colistin-resistant strains 14 showed synergistic, four additive and three indifferent activity. As a result, the combination of colistin with ampicillin/sulbactam, demonstrated high synergistic activity in vitro. While the synergistic effect of this combination was more significant in colistin-resistant strains, antagonistic effect of colistin-susceptible strains was found to be notable. Therefore, colistin resistance should be primarily determined before using colistin and ampicillin/sulbactam combination in A.baumannii infections since this combination seemed to be more effective in case of colistin resistance. However, these data should be supported by further advanced clinical studies.

Prevalence of Cryptosporidium spp. in asymptomatic food workers.

OBJECTIVE: Cryptosporidium spp. is obligatory intracellular parasite and causes intestinal infection. In intestine infections in the form of sporadic and epidemics, food and accordingly workers in food sector may play a role as the source of infection. In this study, it is aimed to reveal the existence of asymptomatic cryptosporidiosis. METHODS: In the study, stool samples of 393 workers -employed at various branches of food sector in the region of Van- are used. In order to detect Cryptosporidium spp. oocysts, Modified Ziehl Neelsen (MZN) Staining was used. RESULTS: In this study, asymptomatic cryptosporidiosis has been detected in 5 (1.27%) of 393 workers. CONCLUSION: Epidemiological findings indicate that food workers can be source of cryptosporidiosis outbreak. Thus, searching for the existence of asymptomatic cryptosporidiosis food workers -which epidemiologically has potential significance- and taking the required measures in case of its determination are significant in respect of public health.

[Evaluation of antibiotic susceptibilities and VISA-VRSA rates among MRSA strains isolated from hospitalized patients in intensive care units of hospitals in seven provinces of Turkey]. / Türkiye'de Yedi Ildeki Hastanelerin Yogun Bakim Ünitelerinden Izole Edilen MRSA Suslarinda VISA-VRSA Arastirilmasi ve Antibiyotik Duyarlilik Durumlarinin Saptanmasi

The aim of this study was to determine whether vancomycin resistant Staphylococcus aureus (VRSA) and vancomycin intermediate susceptible S.aureus (VISA) strains were present among methicillin-resistant S.aureus (MRSA) strains isolated from patients hospitalised at intensive care units (ICU) of hospitals located at different regions of Turkey and to determine the minimum inhibitory concentration (MIC) values of teicoplanin, linezolid, tigecycline, quinupristin-dalfopristin and daptomycin, which are alternative drugs for the treatment of MRSA infections. A total of 260 MRSA clinical strains (isolated from 113 lower respiratory tract, 90 blood, 24 wound, 17 catheter, 13 nasal swabs, two urine and one CSF sample) were collected from nine health-care centers in eight provinces [Ankara (n= 52), Konya (n= 49), Antalya (n= 40), Istanbul (n= 7), Izmir (37), Diyarbakir (n= 15), Van (n= 12), Trabzon (n= 48)] selected as representatives of the seven different geographical regions of Turkey. Methicillin resistance was determined by cefoxitin disk diffusion in the hospitals where the strains were isolated and confirmed by oxacillin salt agar screening at the Refik Saydam National Public Health Agency. Screening for VISA and VRSA was conducted using the agar screening test and E-test. Susceptibility of the MRSA strains to other antibiotics was also determined by E-test method. None of the 260 MRSA strains were determined to be VRSA or VISA. All were susceptible to teicoplanin and linezolid, and susceptibility rates to daptomycin, tigecycline and quinupristin-dalfopristin were 99.6%, 96.9%, and 95%, respectively. Absence of VISA and VRSA among the MRSA strains surveyed currently seemed hopeful, however, continuous surveillance is necessary. In order to prevent the development of VISA and VRSA strains the use of linezolid, tigecycline, quinupristin-dalfopristin and daptomycin should be encouraged as alternative agents of treatment of MRSA infections.

Effect of probiotics on the treatment of children with atopic dermatitis.

BACKGROUND: Atopic dermatitis, a chronic recurrent disease, is frequently encountered in clinical practice. In the last 30 years, the prevalence of atopic dermatitis has rapidly increased due to industrialization. Therefore, there have been attempts in recent years to find new ways of treating and preventing atopic dermatitis. OBJECTIVE: In this double-blind, randomized, placebo-controlled study, a combination of Bifidobacterium bifidum, Lactobacillus acidophilus, Lactobacillus casei, and Lactobacillus salivarius strains were evaluated in the treatment of atopic dermatitis in pediatric patients. METHODS: Forty pediatric patients (23 males and 17 females) aged 1~13 years were enrolled. One eligible individual who was approached declined to participate. The probiotic group was administered a probiotic complex containing B. bifidum, L. acidophilus, L. casei, and L. salivarius for 8 weeks. The placebo group, on the other hand, was administered skim milk powder and dextrose. All of the parameters including serum cytokines, eosinophil cationic protein), SCORing Atopic Dermatitis (SCORAD) index, and total serum immunoglobulin E (IgE) were measured in both the probiotic group and the placebo group at the end of 8 weeks. RESULTS: Probiotic intervention in pediatric atopic dermatitis patients effectively reduced the SCORAD index and serum cytokines interleukin (IL)-5, IL-6, interferon (IFN)-γ, and total serum IgE levels, but did not reduce levels of serum cytokines IL-2, IL-4, IL-10, ECP, or tumor necrosis factor-α (TNF-α) compared to the placebo group. CONCLUSION: Our study found probiotics to be effective in reducing atopic dermatitis patients' SCORAD index, serum IL-5, IL-6, IFN-γ, and total serum IgE levels but not effective in reducing serum IL-2, IL-4, IL-10, ECP, or TNF-α levels.

Susceptibility to measles, rubella, mumps, and varicella-zoster viruses among healthcare workers.

BACKGROUND: It is important to identify and immunize susceptible healthcare workers to prevent and control hospital infections. Our aim was to evaluate the specific antibodies against the measles, mumps, and rubella viruses and the varicella zoster virus among healthcare workers in a tertiary-care hospital. PATIENTS AND METHODS: A total of 284 healthcare workers (89 men and 195 women; mean age, 33.5 ± 11 years), including 111 nurses, 87 physicians, 34 laboratory technicians, and 52 members of the housekeeping staff, of Van Training and Research Hospital were enrolled in this study. Antibodies were detected with an enzyme-linked immunosorbent assay. RESULTS: The numbers of workers with serological susceptibility to mumps, measles, rubella, or chicken pox were 26 (9.2%), 18 (6.3%), 7 (2.5%), and 5 (1.8%), respectively. Although the difference was not statistical significant, the rate of seroprevalence of antibodies was lowest for measles (90.8%; p>0.05). Susceptibility to measles, mumps, and rubella, and chicken pox was more prevalent among young healthcare workers (p<0.001). Not all healthcare workers born before 1957 were immune to these vaccine-preventable diseases. CONCLUSION: These data confirm that screening and vaccination of susceptible healthcare workers is essential regardless of age.

Molecular characterization of hepatitis A virus isolated from acute infections in Turkey.

BACKGROUND/AIMS: Hepatitis A virus is a global public health problem, especially in developing countries, and the most common cause of hepatitis in childhood. Hepatitis A virus is a single- stranded positive RNA virus subdivided to 6 genotypes (3 human,3 simian). The aim of this study was to determine the prevalent genotype in Turkey using sera of acute hepatitis A virus-infected patients from different geographical regions of the country. MATERIALS AND METHODS: Sera of 137 patients with acute hepatitis A virus from different geographical regions were collected for phylogenetic analysis. The VP1-2A region of the hepatitis A virus genome was amplified by real-time-polymerase chain reaction in 76 patients where possible. Amplified polymerase chain reaction fragments were sequenced, and phylogenetic analysis was done together with other reference hepatitis A virus sequences obtained from GenBank database. RESULTS: Sequencing and phylogenetic analysis of the VP1-2A junction of hepatitis A virus showed that the most prevalent genotype in Turkey is IB (100%). Comparison of Turkish isolates and reference sequences of genotype IB showed a similarity of 94.9%. The same comparison was done between Turkish isolates and reference hepatitis A virus genotype IB and HM175, and it was found that similarity between them ranged from 93.0-95.9%. When Turkish isolates were compared according to Mean Percentage Nucleotide Distance analysis, similarity ranged between 95.3%-100%. CONCLUSIONS: Phylogenetic analysis pointed out that all Turkish isolates belong to genotype IB. Sequence analysis is a useful tool in revealing hepatitis A outbreaks, and allows us to detect and distinguish the presence of epidemic and small outbreaks.

[Sepsis caused by Chryseobacterium indologenes in a patient with hydrocephalus]. / Hidrosefalisi Olan Bir Olguda Chryseobacterium indologenes ile Iliskili Sepsis.

Chryseobacterium (formerly Flavobacterium) indologenes, is a non-fermentative gram-negative bacillus which is widely found in the nature, primarily soil and water. Since it can survive in chlorine-treated municipal water supplies, and can colonize the sink basins and tap waters of the hospitals, this bacterium may be a potential infectious agent. Contamination of the medical devices containing water (respirators, intubation tubes, humidifiers, incubators for newborns, etc.) in hospital settings may lead to serious infections especially in patients with predisposing diseases, newborns and immunocompromized patients. In this report, a case of fatal C.indologenes septicemia developed in a newborn with hydrocephalus has been presented. A two-months old male infant was admitted to our hospital with the complaints of failure to suck and lethargy for five days and head enlargement. He was diagnosed as meningitis based on the clinical and laboratory findings of cerebrospinal fluid (CSF) (protein: 572 mg/dl, glucose 9.5 mg/dl, chlorine: 111 mg/dl, and presence of abundant polymorphonuclear leukocytes), and empirical antibiotic treatment (ampicillin/sulbactam and cefotaxime) had been started. Since the computerized tomography of the brain pointed out hydrocephalus, an external shunt was placed for CSF drainage on the second day of hospitalization. A total of five CSF and two blood cultures collected during the hospitalization period were inoculated into pediatric aerobic CSF and blood culture bottles (BacT/ALERT, BioMerieux, France) and incubated for 24-48 hours. The isolated bacteria from all of the cultures were identified as C.indologenes by conventional methods and BD Phoenix (Becton Dickinson, USA) system. Antibiotic susceptibility tests were performed with microdilution method according to CLSI guidelines. The isolate was found susceptible to ciprofloxacin, levofloxacin and trimethoprim/sulfamethoxazole, while it was resistant to amikacin, gentamicin, tobramycin, piperacillin, cefotaxime, ceftazidime, aztreonam, meropenem, imipenem, tetracycline, and chloramphenicol. The treatment continued with ampicillin/sulbactam and levofloxacin without removing the shunt. However, C.indologenes growth persisted in CSF and blood cultures of the patient. The general condition of the patient deteriorated on the 65. day of the hospitalization and the patient was lost due to cardiopulmonary arrest. Case reports related to isolation of C.indologenes from blood cultures are present in the literature, however, isolation of C.indologenes from central nervous system was reported previously in a single case. In conclusion, C.indologenes should be considered as opportunistic infectious agents especially in the infectious diseases that develop in immunocompromised patients with underlying disease and with foreign device implementation.

Antimicrobial susceptibilities of Brucella isolates from various clinical specimens.

PURPOSE: Brucellosis is a worldwide zoonotic disease and still constitutes a major public health problem. In the study we claimed to identify Brucella species from clinical samples of patients with active brucellosis from Van region of Eastern Anatolia and to determine in vitro antimicrobial susceptibilities of these strains to commonly used anti-Brucella agents and a possible new alternative tigecycline. MATERIALS AND METHODS: A total of 56 Brucella isolates were enrolled the study and the identification of the isolates were based on conventional methods. In vitro activities of antimicrobials were evaluated by the E test method. RESULTS: All isolates were identified as B. melitensis. MIC(90) values of doxycycline, streptomycin, rifampin, trimethoprim-sulfamethoxazole and tigecycline were 0.064 mg/L, 1 mg/L, 2 mg/L, 0.125 mg/L and 0.094 mg/L, respectively. Tigecycline had low MIC(50) and MIC(90) values against all B. melitensis strains; the highest MIC observed was 0.25 µg/mL. CONCLUSION: Our data suggest that tigecycline can be a therapeutic alternative option for the treatment of brucellosis.

[Investigation of intestinal parasites in students of Mustafa Cengiz primary school in Van]. / Van mustafa cengiz ilkögretim okulu ögrencilerinde bagirsak parazitlerinin arastirilmasi

Intestinal parasites still maintain as a major public health problem in our country. In this study, we aimed to investigate the distribution of intestinal parasites in 1st and 2nd grade students of Mustafa Cengiz Primary School, aged between 7-9 and to contribute to the parasitological data of our province. For this purpose, stool examinations of a total of 195 students, including 82 boys and 113 girls, were performed. The results of the microscopic analysis of stool samples revealed one or more parasites in a total of 117 (60%) samples including 45 male students (54.8%) and 72 female students (63.7%). The diagnosed parasites and their ratios in children were; Giardia intestinalis 36.4%, Entamoeba coli 17.9%, Blastocystis hominis 14.4%, Hymenolepis nana 10.8%, Chilomastix mesnili 3.6%, Ascaris lumbricoides 2.6%, Entamoeba hartmanni 1.5%, Trichuris trichiura 1%, Iodamoeba butschlii 0.5%, Retortamonas intestinalis 0.5% ve Endolimax nana 0.5%, respectively. From 117 positive samples for parasites, only one parasite was found in 71 (60.7%), and more than one parasites were found in 46 (39.3%). As a result, parasitic infectious diseases still maintain its importance in our region. We conclude that incidence of parasitic infectious diseases will be reduced with education about personal hygiene and improvement of physical conditions.

[Evaluation of Western Blot method for the detection of antibodies to Helicobacter pylori antigens in patients with gastric carcinoma and cases with epigastric complaints]. / Gastrik karsinomali hastalar ile epigastrik yakinmalari olan olgularda Helicobacter pylori antijenlerine karsi antikor varliginin saptanmasinda western blot yönteminin degerlendirilmesi.

Helicobacter pylori proteins CagA (cytotoxin-associated gene A) and VacA (vacuolating cytotoxin A) are among the virulence factors of this species. CagA gene carrying H. pylori strains are particularly associated with gastric adenocarsinoma. This study was conducted to evaluate Western Blot (WB) method to determine specific H. pylori antibodies in a group of patients with gastric cancer and in a control group with no malignancy. A total of 99 patients with gastric cancer (94 adenocarcinoma, 2 adenosquamous cell carcinoma, 3 non-Hodgkin lymphoma) and 150 control cases with epigastric complaints such as nausea, vomiting, diarrhea, gastroesophageal reflux and abdominal pain, were included to the study. H. pylori IgG-ELISA was positive in all study (mean age: 56.7 +/- 1.2 years, 62 male) and control (mean age: 24.2 +/- 1.3 years, 64 male) patients. Specific antibodies against CagA, VacA, OMP (outer membrane protein)-67, urease-A, urease-B, HSP (heat shock protein) and flagellin antigens determined by a commercial WB-based kit (RIDA Blot Helicobacter, R-Biopharm GmbH, Germany). Interestingly, no anti-VacA positivity was detected in none of the patient and control groups. The positivity rates for H. pylori CagA, OMP-67, urease A, urease-B, flagellin and HSP specific antibodies were as 78%, 54%, 37%, 60%, 53% and 82% in the gastric cancer group and 85%, 71%, 55%, 43%, 61% and 75% in the control group, respectively. There was no statistically significant difference (p > 0.05) between gastric carcinoma and control groups in terms of CagA, HSP and flagellin antibodies (p > 0.05). On the other hand, a statistically significant difference was found between the 2 groups in terms of urease-A, urease-B and OMP-67 (p < 0.01). These results suggested that this test should be assessed again by the manufacturer for its detection power directed towards specific H. pylori antibodies, especially for Vac-A. Further molecular and clinical studies are necessary to determine the factors that affect H. pylori virulence and disease prognosis.