Serotypes of Streptococcus pneumoniae isolates from children with invasive pneumococcal disease in Turkey: baseline evaluation of the introduction of the pneumococcal conjugate vaccine nationwide.

Before use of the pneumococcal conjugate vaccine PCV7 became widespread in Turkey, 202 invasive pneumococcus isolates were analyzed. The most common serotypes were 19F and 6B. In children ≤2 years of age, the potential coverage rate of PCV7 was 69.5%. The most frequent non-PCV7 serotypes were 19A, 3, 1, 6A, and 8.

Investigation of bacteremia following insertion of orthodontic mini-implants.

AIM: To investigate the incidence of bacteremia in the bloodstream immediately after orthodontic mini-implant insertion, which can be an invasive procedure. METHODS: Blood samples (10 mL) were taken before and after mini-implant insertion from 40 patients (18 males, 22 females; mean age 21.3 ± 7.7 years). These samples were inoculated into BacT/Alert aerobic and anaerobic blood culture bottles and processed in a BacT/Alert 9240 Blood Culture System. The findings were analyzed with the McNemar test. RESULTS: No bacteremia was detected in the pretreatment samples, but it was in one of the postprocedure samples. The respective bacteria was Streptococcus sanguinis, which is strongly associated with bacterial endocarditis. CONCLUSION: Orthodontic mini-implant placement might possibly be correlated to transitory bacteremia. Therefore, a very careful approach seems indicated when dealing with patients who are at risk for cardiopathic complications.

In vitro pharmacodynamic activities of root canal sealers on Enterococcus faecalis.

AIM: The aim of this study was to evaluate the antimicrobial efficiency of different root canal sealers on Enterococcus faecalis (E. Faecalis) at different time intervals. METHODS AND MATERIALS: All sealers used were mixed according to the manufacturers' instructions then 75 mg of each sealer was added to different sterile tubes and evaluated at 20 minutes, 24 hours, 7 days, and 30 days. A time-kill assay (TKA) was used to determine the antimicrobial efficiency of the sealers. RESULTS: AH Plus and MCS were found to be bactericidal at 20 minutes and 24 hours, but only MCS was bactericidal at the seventh and thirtieth days. Epiphany and Sealapex were found to be bacteriostatic at the seventh and thirtieth days but indifferent at 20 minutes and 24-hours. MCS and AH Plus were both found to be bactericidal in freshly mixed samples, but only MCS was bactericidal at longer time periods. Epiphany Sealer and Sealapex were found to be bacteriostatic at longer time periods but indifferent at 20 minutes and 24 hours. CONCLUSION: The antibacterial effect of MCS was greater than the other sealers evaluated. CLINICAL SIGNIFICANCE: Sealers containing eugenol and epoxy resin might be preferable due to their antibacterial effect.

Melatonin reduces bacterial translocation and apoptosis in trinitrobenzene sulphonic acid-induced colitis of rats.

AIM: To investigate the effects of exogenous melatonin on bacterial translocation and apoptosis in a rat ulcerative colitis model. METHODS: Rats were randomly assigned to three groups: group I: control, group II: experimental colitis, group III: colitis plus melatonin treatment. On d 11 after colitis, plasma tumor necrosis factor-alpha, portal blood endotoxin levels, colon tissue myeloperoxidase and caspase-3 activity were measured. Bacterial translocation was quantified by blood, lymph node, liver and spleen culture. RESULTS: We observed a significantly reduced incidence of bacterial translocation to the liver, spleen, mesenteric lymph nodes, portal and systemic blood in animals treated with melatonin. Treatment with melatonin significantly decreased the caspase-3 activity in colonic tissues compared to that in trinitrobenzene sulphonic acid- treated rats (16.11 +/- 2.46 vs 32.97 +/- 3.91, P < 0.01). CONCLUSION: Melatonin has a protective effect on bacterial translocation and apoptosis.

Sepsis and meningitis due to Listeria monocytogenes.

PURPOSE: This study focused on the effect of immuno-compromising conditions on the clinical presentation of severe listerial infection. PATIENTS AND METHODS: Nine human listeriosis cases seen from 1991-2002 were reviewed. All adult patients, from whose blood, peritoneal fluid or cerebrospinal fluid (CSF) the L. monocytogenes was isolated, were included in this retrospective study. RESULTS: Listeriosis presented as primary sepsis with positive blood cultures in 5 cases and meningitis with positive CSF cultures in 4 cases. All of these patients had at least one underlying disease, most commonly, hematologic malignancy, diabetes mellitus, amyloidosis and hepatic cirrhosis; 55.6% had received immunosuppressive or corticosteroid therapy within a week before the onset of listeriosis. The patients were adults with a mean age of 60 years. Fever, night sweats, chills and lethargy were the most common symptoms; high temperature (> 38 degrees C), tachycardia, meningeal signs and poor conditions in general were the most common findings on admission. The mortality rate was 33.3% and was strictly associated with the severity of the underlying disease. Mortality differences were significant between sepsis (20%) and meningitis (50%) patients. CONCLUSION: Listeriosis as an uncommon infection in our region and that immuno- suppressive therapy is an important pre-disposing factor of listeriosis. Sepsis and meningitis were more common in this group of patients and had the highest case-fatality rate for food-borne illnesses.

Genotypic analysis of Acinetobacter bloodstream infection isolates in a Turkish university hospital.

Acinetobacter baumannii is a significant pathogen of bloodstream infections in hospital patients that frequently causes single clone outbreaks. We aimed to evaluate the genetic relatedness and antimicrobial susceptibility of Acinetobacter spp. bloodstream isolates, in order to obtain insight into their cross-transmission. This prospective study was conducted at the Erciyes University Hospital. During a 1-y period, all patients with nosocomial BSI caused by Acinetobacter spp. were included in the study. All data with regard to the patients, underlying diseases and risk factors for BSI and the severity of disease were collected. Blood culture isolates of Acinetobacter spp. were identified according to their morphology and biochemical reactions. The antimicrobial susceptibility was determined using the Kirby-Bauer disk diffusion test according to the NCCLS; the genetic relatedness of isolates was determined by RAPD-PCR analysis and pulsed-field gel electrophoresis (PFGE). 41 patients acquired a nosocomial bloodstream infection caused by A. baumanii during this period. 88% of these infections (36 of 41) occurred while the patients were treated in the intensive care unit. Nearly 80% of the isolates belonged to 3 genotypes, suggesting cross-transmission in ICU settings where infection control practices are poor. All Acinetobacter isolates were multidrug-resistant and the crude mortality of patients infected with A. baumanii was 80.5%. We concluded that the genetic relatedness of Acinetobacter spp. causing BSI was very high, indicating cross-transmission within the ICU setting. Essential components of an infection control programme to prevent nosocomial transmission of A. baumannii are early detection of colonized patients, followed by strict attention to standard precautions and contact isolation.

Brucella melitensis in blood cultures of two newborns due to exchange transfusion.

Brucellosis is a zoonotic infection, transmitted to humans primarily by consumption of unpasteurized milk and milk products. Transmission by blood transfusion is possible but very unusual. Herewith we present two newborns with positive blood cultures for Brucella melitensis after exchange transfusions. However, the standard tube agglutination titers against Brucella were not elevated and the newborns did not develop brucellosis. It is suggested that, in areas endemic for brucellosis, blood donors should be questioned about symptoms of brucellosis, and if suspected, serological tests for brucellosis should be indicated before blood transfusion. At the same time, the prevalence of the disease among animals should be reduced with effective animal disease control programs.

Antistaphylococcal activity of DX-619, a new des-F(6)-quinolone, compared to those of other agents.

The in vitro activity of DX-619, a new des-F(6)-quinolone, was tested against staphylococci and compared to those of other antimicrobials. DX-619 had the lowest MIC ranges/MIC(50)s/MIC(90)s (microg/ml) against 131 Staphylococcus aureus strains (32), and ciprofloxacin (>32/>32). Raised quinolone MICs were associated with mutations in GyrA (S84L) and single or double mutations in GrlA (S80F or Y; E84K, G, or V) in all S. aureus strains tested. A recent vancomycin-resistant S. aureus (VRSA) strain (Hershey) was resistant to available quinolones and was inhibited by DX-619 at 0.25 microg/ml and sitafloxacin at 1.0 microg/ml. Vancomycin (except VRSA), linezolid, ranbezolid, tigecycline, and quinupristin-dalfopristin were active against all strains, and teicoplanin was active against S. aureus but less active against coagulase-negative staphylococci. DX-619 produced resistant mutants with MICs of 1 to >32 microg/ml after <50 days of selection compared to 16 to >32 microg/ml for ciprofloxacin, sitafloxacin, moxifloxacin, and gatifloxacin. DX-619 and sitafloxacin were also more active than other tested drugs against selected mutants and had the lowest mutation frequencies in single-step resistance selection. DX-619 and sitafloxacin were bactericidal against six quinolone-resistant (including the VRSA) and seven quinolone-susceptible strains tested, whereas gatifloxacin, moxifloxacin, levofloxacin, and ciprofloxacin were bactericidal against 11, 10, 7, and 5 strains at 4x MIC after 24 h, respectively. DX-619 was also bactericidal against one other VRSA strain, five vancomycin-intermediate S. aureus strains, and four vancomycin-intermediate coagulase-negative staphylococci. Linezolid, ranbezolid, and tigecycline were bacteriostatic and quinupristin-dalfopristin, teicoplanin, and vancomycin were bactericidal against two, eight, and nine strains, and daptomycin and oritavancin were rapidly bactericidal against all strains, including the VRSA. DX-619 has potent in vitro activity against staphylococci, including methicillin-, ciprofloxacin-, and vancomycin-resistant strains.

The efficacy of intravitreal piperacillin/tazobactam in rabbits with experimental Staphylococcus epidermidis endophthalmitis: a comparison with vancomycin.

BACKGROUND: To investigate the efficacy of intravitreal piperacillin/tazobactam in rabbit eyes with experimental S. epidermidis endophthalmitis and to compare the outcomes with intravitreal vancomycin application. MATERIAL AND METHODS: Twenty-four New Zealand white albino rabbits were divided into three equal groups (n=8 in each), and the right eyes received 0.1-ml intravitreal injections of S. epidermidis suspension. The left eyes served as uninfected controls and were injected with 0.1 ml of saline solution. The right eyes of rabbits in group 1 were treated with intravitreal injection of 250 microg/0.1 ml piperacillin/tazobactam 24 h after intravitreal inoculation of S. epidermidis whereas group 2 eyes received intravitreal 1 mg/0.1 ml vancomycin. Group 3 eyes received no treatment and served as infected controls. Clinical examination of the eyes in each group was performed on the 1st, 3rd and 6th day after the inoculation of S. epidermidis. On the 6th day, 0.1-ml vitreous aspirates were obtained for microbiological analysis, and then the eyes were enucleated for histopathological evaluation. RESULTS: There were no statistically significant differences in mean clinical scores between the groups on the first day after S. epidermidis inoculation (p>0.05). On the 6th day, the mean clinical score of group 3 was significantly higher (p<0.001), but the mean clinical scores of groups 1 and 2 were similar (p=0.812). The mean logarithmic value of colony-forming units per milliliter of groups 1, 2 and 3 were 0.6+/-1.3, 0.5+/-1.5 and 5.3+/-0.7, respectively. Mean histopathological scores of the groups were 8.3+/-0.9, 7.5+/-1.3 and 15.6+/-1.2, respectively. Group 3 eyes had significantly more colony-forming units per milliliter and a higher histopathological score (for each, p<0.001), and there were no statistically significant differences in microbiological and histopathological scores between groups 1 and 2 (for each, p>0.05). CONCLUSION: Intravitreal application of 250 microg/0.1 ml piperacillin/tazobactam seems to be approximately equally effective with intravitreal 1 mg/0.1 vancomycin application in the treatment of experimental S. epidermidis endophthalmitis. Therefore, intravitreal piperacillin/tazobactam may be an alternative therapeutic option in the treatment of S. epidermidis endophthalmitis.

The efficacy of piperacillin/tazobactam in experimental Pseudomonas aeruginosa endophthalmitis: a histopathological and microbiological evaluation.

PURPOSE: To investigate the efficacy of intravitreal piperacillin/tazobactam (250 microg/0.1 ml) in the treatment of experimental Pseudomonas aeruginosa endophthalmitis in rabbits. MATERIALS AND METHODS: Twenty New Zealand White albino rabbits were used in this study. The rabbits were divided into two groups (10 rabbits in each), and the right eyes were treated with 0.1 ml intravitreal injections of P. aeruginosa suspension (ATCC 27853, 2 x 10(4) CFU); the left eyes served as uninfected control and were injected with 0.1 ml of saline solution. The right eyes of rabbits in group 1 (n = 10) received intravitreal injection of 250 microg piperacillin/tazobactam 24 h after intravitreal inoculation of P. aeruginosa. Group 2 eyes (n = 10) received no treatment and served as infected controls. Clinical examination of the eyes in each group was performed on the first, third, and sixth day after the inoculation of P. aeruginosa. After the last ophthalmic examination, 0.1 ml vitreous aspirates were obtained for microbiological analysis, and then the eyes were enucleated for histopathological evaluation. RESULTS: The mean clinical scores of group 1 and group 2 at the first day after P. aeruginosa inoculation were similar (p > 0.05). At the sixth day, the mean clinical score of group 1 was significantly lower when compared with group 2 eyes (p < 0.001). Microbiological analysis revealed that group 2 had a significantly more cfu/ml than group 1 (p < 0.001), and the mean histopathological score of group 2 was significantly higher than group 2 (p = 0.009). CONCLUSIONS: Intravitreal application of 250 microg/0.1 ml piperacillin/tazobactam seems to be effective in the treatment of P. aeruginosa endophthalmitis in rabbits. Intravitreal piperacillin/tazobactam combination may be a new therapy for P. aeruginosa endophthalmitis.

A comparison of intravitreal piperacillin/tazobactam with ceftazidime in experimental Pseudomonas aeruginosa endophthalmitis.

In the present study, we aimed at comparing the efficacies of intravitreal piperacillin/tazobactam and ceftazidime applications in the treatment of experimental Pseudomonasaeruginosa endophthalmitis in rabbit eyes. Twenty-four New Zealand white albino rabbits were divided into three groups (n=8 in each), and the right eyes received 0.1 ml intravitreal injections of P. aeruginosa suspension. The left eyes served as uninfected control and were injected with 0.1 ml of saline solution. The right eyes of rabbits in group 1 were treated with intravitreal injection of 250 microg/0.1 ml piperacillin/tazobactam 24 hr after intravitreal inoculation of P. aeruginosa, whereas group 2 eyes received intravitreal 1 mg/0.1 ml ceftazidime. Group 3 eyes received no treatment and served as infected controls. Clinical, microbiological and histopathological evaluations of the eyes in each group were performed on the 1st, 3rd, and 6th day after the inoculation of P. aeruginosa. The mean clinical scores of each group were similar at the first day after P. aeruginosa inoculation (P>0.05). At the 6th day, there was no statistically significant difference in mean clinical scores between group 1 and 2, but mean clinical score of group 3 was significantly higher (P<0.001). Microbiological analysis and histopathological scoring demonstrated no statistically significant difference between group 1 and 2 (for each, P>0.05). Group 3 eyes had a significantly more CFU/ml and higher histopathological score (for each, P<0.001). In conclusion, intravitreal application of 250 microg/0.1 ml piperacillin/tazobactam seems to be effective in the treatment of P. aeruginosa endophthalmitis in rabbits, but is not superior to intravitreal ceftazidime application. Therefore, intravitreal piperacillin/tazobactam may be a useful alternative to ceftazidime for pseudomonal endophthalmitis.

[Salmonella enteritidis: an unusual meningitis agent in an adult patient]. / Salmonella enteritidis: eriskin hastada nadir bir menenjit etkeni.

Salmonella species may cause wide spectrum of infections changing from enterocolitis to sepsis. However, Salmonella meningitis in adults is a rare but important clinical condition with a high mortality rate. In this report, a 71 years old male patient with Salmonella enteritidis meningitis who was followed-up with the diagnosis of immune thrombocytopenic purpura and had been administered azothioprin and prednisolone, has been presented and similar cases in the literature have been reviewed. The cerebrospinal fluid culture yielded S. enteritidis, and the isolate was intermediate susceptible to ampicillin, susceptible to cefotaxime, trimethoprim-sulphametoxasole, ciprofloxacin and chloramphenicol. Our patient was successfully treated with ceftriaxone (2 x 2 gr i.v.) and discharged with total cure.

[Molecular characterization of Listeria monocytogenes and the significance for food hygiene]. / Zur lebensmittelhygienischen Bedeutung der molekularen Charakterisierung von Listeria monocytogenes.

Research on the pathogen Listeria monocytogenes is a key issue both for the clinical and the food microbiologist owing to the unique pathway of infection and the exposure of humans via contaminated foods. Although, in Austria, the incidence of listeriosis is about 870-fold lower than the incidence for Salmonella infection, the food law manages both foodborne pathogens with a comparable stringency. The current risk management is based on the assumption that environmental L. monocytogenes isolates, from which the pool of "foodborne" isolates is recruited, are of similar pathogenicity compared to clinical and outbreak isolates. This verdict became doubted in the recent years. Characterization of L. monocytogenes by virulence gene sequencing, virulence studies in vivo and in vitro and by molecular typing was considerably stimulating the discussion on virulence variability in L. monocytogenes. This article provides insights in the value of epidemiological follow-up studies by presenting a typing study on 15 cases of listeriosis observed in a district hospital in Turkey. Furthermore results from typing L. monocytogenes either by virulence gene sequencing, mismatch amplification mutation assay or by pulsed field gel electrophoresis are discussed. The close interaction of molecular microbiology with food microbiology both in applied and basic science is currently creating a new discipline of molecular food microbiology. We are convinced that veterinary medicine will contribute to this exiting development in a fruitful way.

Antibacterial susceptibility of a vancomycin-resistant Staphylococcus aureus strain isolated at the Hershey Medical Center.

Staphylococcus aureus strain HMC3 isolated at the Hershey Medical Center, was resistant to vancomycin (VRSA) through the presence of the vanA resistance gene; it also contained mecA, erm(A), erm(B), tet(K) and aac(6')-aph(2"), conferring resistance to licensed beta-lactams, macrolides, tetracycline and aminoglycosides. HMC3 also had alterations in GyrA and GrlB and was resistant to available quinolones. Experimental drugs with low MICs (<2 mg/L) for VRSA HMC3 included cephalosporins BAL9141 and RWJ-54428; glycopeptides oritavancin and dalbavancin; the lipopeptide daptomycin; the glycolipodepsipeptide ramoplanin; new fluoroquinolones WCK 771 A, WCK 1153, DK-507k and sitafloxacin; and the DNA nanobinder GS02-02. These agents were all bactericidal as were trimethoprim/sulfamethoxazole and teicoplanin (MIC 4 mg/L). Oxazolidinones linezolid and ranbezolid; the injectable streptogramin quinupristin/dalfopristin; DNA nanobinders GS2-10547 and GS02-104; peptide deformylase inhibitors NVP-PDF713 and GS02-12; tetracycline derivative tigecycline; the antifolate iclaprim; mupirocin and fusidic acid were all active in vitro but bacteriostatic.

Antimicrobial susceptibilities of 40 isolates of Bacillus anthracis isolated in Turkey.

Forty clinical isolates of Bacillus anthracis were studied. The MIC(90) values of penicillin G, doxycycline, ciprofloxacin, gatifloxacin, and levofloxacin were 0.016, 0.03, 0.06, 0.06 and 0.12 mg/l, respectively. Susceptibilities suggest that the quinolones may also be considered as an alternative therapy for anthrax.