Analysis of antibiotic resistance of KPC-2-positive Klebsiella pneumoniae strains isolated from blood cultures in Van, Turkey.

OBJECTIVE: Recently, Klebsiella pneumoniae strains causing bacteremia and showing significant antibiotic resistance have raised serious health concerns. Especially carbapenem-resistant K. pneumoniae has spread worldwide and caused an increase in mortality rates. In this study, we aimed to present information about KPC-2 carriage and molecular characteristics of K. pneumoniae strains showing multiple antibiotic resistance among patients in our hospital. PATIENTS AND METHODS: Blood samples were collected from patients hospitalized in the intensive care units (ICU) of Van Regional Training and Research Hospital between 2020-2021. Culture, biochemical tests, antibiotic susceptibility tests, and molecular tests were performed to identify K. pneumoniae strains isolated from blood culture samples. RESULTS: Two hundred and sixteen K. pneumoniae were isolated from patients with positive blood cultures. Twenty-seven of these isolates showed multidrug resistance. Carbapenem, ß-lactam, and quinolone resistance were particularly high. On the contrary, almost all of these isolates were susceptible to Amikacin (AK), Gentamicin (CN), Colistin (CT) and Tigecycline (TGC). Molecular analysis revealed that all of these isolates were KPC-2-positive and ST11 variants. CONCLUSIONS: It was observed that KPC-2- positive K. pneumoniae strains with multi-drug resistance may pose a serious risk in patients hospitalized in ICU in our hospital. It was concluded that surveillance and personnel training regarding the hospital and community-acquired infections due to these isolates that show pandemic spread would be important.

The molecular analysis of antibiotic resistance and identification of the aerobic bacteria isolated from pleural fluids obtained from patients.

OBJECTIVE: Pleural effusion is a common clinical condition due to various etiological causes. Infectious pleural effusion can be seen in 20-40% of patients. In this study, follow-up of patients admitted to our hospital and diagnosed with pleural effusion are reported. It was aimed to investigate the prevalence of bacteria isolated from patients with pleural effusion and their antibiotic resistance profiles. MATERIALS AND METHODS: The pleural fluids obtained from the patients during surgical operations were analyzed microbiologically. Conventional culture, Vitek 2, 16S rRNA, and single Polymerase Chain Reaction (sPCR) were used for microbiological analysis. RESULTS: Twenty-two (12.2%) bacteria were isolated from 180 patients. The most prominent of them were 16 (8.8%) Klebsiella pneumoniae strains. As for the antibiotic sensitivity, gram-negative bacteria showed the highest sensitivity to colistin, while Gram-positive bacteria showed sensitivity to different antibiotics. In 16S rRNA PCR, 22 samples were found to be positive. In the analysis of antibiotic resistance genes, the OXA-48 gene was determined as the highest. CONCLUSIONS: In our region, it is essential to perform a microbiological analysis of the sample in patients with pleural effusion. It was thought that revealing both the phenotype and genotype of the antibiotic resistance of the patients was important in terms of treatment. In hospital surveillance, it was considered important to reveal and record the resistance gene profiles of the patients.

Molecular analysis of oxa-48 producing k. pneumoniae strains isolated from patients with catheter-associated sepsis.

OBJECTIVE: K. pneumoniae is an important cause of hospital and community-acquired infections. In particular, carbapenem-resistant strains of K. pneumoniae spread globally, increasing the public health risk. This study aims to sequence and phylogenetically analyze K. pneumoniae strains isolated from blood cultures of patients in intensive care units in our hospital. MATERIALS AND METHODS: In this study, blood samples were collected from patients with catheter-related sepsis. Culture, biochemical, antibiotic susceptibility, and molecular tests were performed as microbiological analyses. RESULTS: Twenty-four K. pneumoniae strains showing multidrug resistance by isolating 276 K. pneumoniae were included in the study. It was determined that they showed the highest resistance against Ampicillin, Amoxicillin/ Clavulanic Acid, Ceftazidime, and Ceftriaxone. The comparison determined that K. pneumoniae isolates from different countries isolated from blood cultures had closeness and distance in OXA-48. CONCLUSIONS: After multilocus sequence typing, all of our 24 K. pneumoniae isolates were determined to be ST11.

Comparison of East and West Survival Nomograms in Turkish Gastric Cancer Patients Who Underwent Radical Surgery.

BACKGROUND AND AIM:: The clinicopathological demonstrations of gastric cancer vary widely between Eastern and Western countries. Turkey is situated in Europe and Middle East which acts as a bridge between east and west. We aimed to validate the two popular nomograms of east and west origin by means of patients who underwent curative surgery for gastric cancer in our country. MATERIAL AND METHODS:: Of the 202 patients diagnosed with gastric cancer between the years 2006 and 2013, 145 of these patients whose data were sufficient were included in the study. For all patients, demographic, laboratory, operative, and pathologic findings were documented. For each patient, prognostic factors were incorporated into the nomograms for estimating 5-year survival probability. RESULTS:: For a Turkish cohort, the western nomogram showed a better discriminative capacity (AUC = 0.721, 95% confidence interval 0.637-0.806) and was better calibrated (the Hosmer-Lemeshow goodness-of-fit test p = 0.323), as compared to the eastern nomogram with AUC = 0.615, 95% confidence interval 0.522-0.708, and p = 0.077, respectively. CONCLUSION:: Western nomogram was found to be more effective than eastern nomogram in prediction of estimating 5-year survival probability in patients with resectable gastric cancer in Turkish population.

First report on the nationwide incidence and prevalence of Type 1 diabetes among children in Turkey.

AIM: To report, for the first time, the incidence and prevalence of childhood Type 1 diabetes in Turkey using a nationwide registry. METHODS: Information on birth date, city of birth, diagnosis date and gender of all patients with Type 1 diabetes aged < 18 years were obtained from the Turkish Social Security Institute for the period from January 2011 to December 2013. RESULTS: There were 17 175 prevalent cases of Type 1 diabetes over the 3-year period. The prevalence of Type 1 diabetes was 0.75/1 000 (95% CI 0.74-0.76) and was higher in girls than in boys (0.79 vs 0.72 /1 000; P < 0.01). There were 2465 incident cases in 2013. The incidence was slightly higher among girls (50.6%) than boys (49.4%); the girl:boy case ratio was 1.02. The incidence was 10.4/100 000 for boys and 11.3/100 000 for girls. The age-standardized incidence rate was 10.8 per 100 000 (95% CI 10.1-11.5) according to the WHO standard population, estimated using the direct method. The mean patient age at diagnosis was 10.6 ± 4.6 years. The highest proportion of cases (40.6%) was diagnosed in children aged 10-14 years. CONCLUSIONS: This is the first study to report the incidence and prevalence of Type 1 diabetes in children in Turkey. The incidence of Type 1 diabetes reflects the geographical location of Turkey, bridging Asia and Europe, with the incidence being higher than in Asia but lower than in Europe.

Calcium level may be a predictive factor for pseudocyst formation after acute pancreatitis.

Pancreatic pseudocysts (PPs) are defined as fluid collections more than 4 weeks old that are surrounded by a nonepithelial wall of fibrous or granulation tissue. Many risk factors have been associated with pseudocyst development but predictive factors remain to be explored. The aim of this study was to investigate the clinical, and biochemical parameters that may predict the development of a PPs after an attack of acute pancreatitis (AP). The medical charts of 102 patients diagnosed with AP were enrolled into the study. Demographic, clinical and laboratory details were recorded at admission and at the 48(th) hour. There were several risk factors on admission and at the 48(th) hour that was predictive of PP formation when evaluated by univariate analysis such as: Alanine aminotransferase level at 48 hrs, calcium level at admission, base excess at 48 hrs, calcium level at 48 hrs, and albumin level at 48 hrs. In multivariate analysis, low calcium level at admission was the only variable that was shown to predict formation of PPs. Lower serum calcium level may be a predictive factor for the development of PPs after AP attack. We advise that patients with calcium levels below 8 mg/dl, after AP should be followed more closely.

Research on Toxocara canis antibodies obtained from patients with eosinophilia.

BACKGROUND: Eosinophils may suggest the presence of a great variety of anomalies whereupon allergies, malignancies, certain tissue disorders, idiopathic hypereosynophilic syndrome and parasitic infections (with the exception of protozoons) can be cited as a few. Although the clinical manifestations may differ, the eosinophils level is quite an important data in cases related to the helminth infections. Similarly, in parasitic infections related to larva migrans (visceral, cutaneous, ocular), the eosinophils level is again a primary indicator and its evident cause is the roundworm Toxocara spp. AIM: The aim of this study was to evaluate the significance characteristics of Toxocara spp. in patients with eosonophilia. MATERIALS AND METHODS: In our study, serums were collected from 93 patients of various age groups with eosonophilia (10% and above) while visiting Istanbul University Medical Faculty due to various complaints. RESULTS: Serum samples were treated with Toxocara IgG ready ELISA kit and Toxocara western blot IgG ready kit. Based on the ELISA method; out of 93 patients, 30 patients (32.3%) were positive. Western blot technique; 45 (48.4%) were positive with anti-toxocara IgG antibodies. CONCLUSION: Results point out to western blot technique being more sensitive and superior on a scale of (P < 0.0001) when compared with the ELISA method.

A rare case of urinary schistosomiasis in Turkey.

Schistosomiasis is a chronic, parasitic disease and is endemic in some countries, primarily in Africa, Latin America and Asia. In some regions, Schistosoma haematobium is one of the principal causes of haematuria. In Turkey, due to the increasing amount of travel to and from endemic regions, the number of cases is also rising. We report a case of a 22-year-old Nigerian male who was admitted to our hospital with haematuria. Direct microbiological examination revealed S. haematobium eggs in his urine specimen. Schistosomiasis was diagnosed by pathology testing. Schistosomiasis has not been seen frequently in Turkey, and we therefore discuss the epidemiology, treatment options and clinical importance of S. haematobium.

High BNP level as risk factor for acute kidney injury and predictor of all-cause mortality in STEMI patients.

OBJECTIVES: The aim of this study was to evaluate the predictive value of brain natriuretic peptide (BNP) in the development of acute kidney injury (AKI) and 6-month all-cause mortality after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) in a modest-risk population. BACKGROUND: The prognostic value of BNP has been well documented in patients with acute coronary syndrome. However, its value in development of AKI and 6-month all-cause mortality in patients with STEMI undergoing primary PCI remains unclear. METHODS: We prospectively enrolled 424 consecutive STEMI patients (mean age 53.6 ± 12.1 years) undergoing primary PCI. The population was divided into two groups: a high (n = 110) and a low (n = 314) admission BNP group according to the cut-off value (> 88.7 pg/ml) determined by ROC analysis to have the best predictive accuracy for 6-month all-cause mortality. The clinical characteristics as well as the in-hospital and 6-month outcomes of patients undergoing primary PCI were analyzed. RESULTS: Cox multivariate analysis showed that a high-admission BNP value (> 88.7 pg/ml) was an independent predictor of AKI development (odds ratio, 1.002; 95 % confidence interval, 1.000­1.003; p = 0.02) and 6-month all-cause mortality (odds ratio, 1.003; 95 % confidence interval; 1.001­1.004; p = 0.004). CONCLUSION: These results suggest that a high-admission BNP level is associated with an increased risk of AKI development and 6-month all-cause mortality in patients with STEMI undergoing primary PCI.

Elevated serum YKL-40 level predicts myocardial reperfusion and in-hospital MACE in patients with STEMI.

BACKGROUND: Macrophages in atherosclerotic plaques secrete YKL-40, a new biomarker of acute and chronic inflammation in patients with stable CAD. We hypothesized that YKL-40 may be a specific marker reflecting the burden of localized inflammation in myocardium and a predictor in patients with STEMI. In this study, we investigated the relationship of YKL-40 to in-hospital major adverse cardiac events (MACE), reperfusion parameters and its predictors in patients with STEMI. METHODS: In total, 80 patients with STEMI and no history of prior coronary artery disease (CAD), who underwent primary percutaneous coronary intervention (p-PCI), were enrolled consecutively. In addition, 30 patients with normal coronary arteries (NCA) were enrolled as a control group. Cardiac biomarker levels including creatinine kinase-MB fraction (CK-MB), troponin-I, admission glucose and inflammatory markers including leukocytes and YKL-40 levels were measured as admission values. RESULTS: In our study, YKL-40 levels correlated to high-sensitivity CRP levels (r = 0.333, p = 0.003), TIMI risk score (r = 0.445, p < 0.001), age (r = 0.477, p < 0.001), pain to balloon time (r = 0.432, p < 0.001), leukocyte and neutrophil count (r = 0.386, p < 0.001 and r = 0.430, p < 0.001, respectively), hemoglobin (r = - 0.345, p = 0.002), admission and fasting blood glucose (r = 0.388, p < 0.001 and r = 0.427, p < 0.001), creatinine levels (r = 0.395, p < 0.001) and myocardial blush grade (r = - 0.334, p = 0.004). When the patients were divided into two groups determined by presence or absence of MACE, the patients with MACE had significantly higher levels of YKL-40 in comparison to the patients without MACE and the control group (194 ± 104, 114 ± 61 and 110 ± 53 µg/L, p < 0.001, respectively). In multivariate logistic regression analysis in STEMI patients, only YKL-40 level (OR: 1.011, 95%CI: 1.002-1.019, p = 0.011) and leukocyte count (OR: 1.264, 95%CI: 1.037-1.540, p = 0.020) were the independent predictors for MACE. Sensitivity and specificity of YKL-40 to predict MACE, when 125 µg/l was accepted as a cut-off value, were 84% and 70%, respectively. CONCLUSION: We found that serum YKL-40 is related to older age, increased admission glucose levels, leukocyte counts and decreased hemoglobin levels; YKL-40 level and leukocyte count independently predicted MACE.

Risk of malignancy in non-diagnostic thyroid fine-needle aspiration biopsy in multinodular goitre patients.

OBJECTIVE: Although the majority of biopsies is adequate for a cytological diagnosis, 5-20 % will be insufficient or nondiagnostic. Patients with nondiagnostic FNABs (ND-FNAB) may be further managed by continued observation, repeated FNAB, or thyroidectomy. The aim of this study was to determine the risk of malignancy in ND-FNAB, and to determine if there are any clinical factors that can be used to distinguish malignant versus benign disease in multinodular goitre patients with ND-FNAB. METHODS: A total of 411 multinodular goiter patients who underwent both a FNAB and thyroidectomy was the subject of study. Seventy nine of these patients with ND-FNAB were further reviewed retrospectively, and demographical and clinical factors were investigated to determine if there is any predictor of malignancy in this group of patients. Among these patients, FNAB has been repeated one more time in 5 (6.3 %) patients, and two more times in 9 (11.3 %) patients. RESULTS: Among 79 patients with ND-FNAB, 10 patients (12.6 %) had malignancy as found postoperatively. There were no differences in age, sex, functional status of the thyroid gland, and nodule size between patients with benign versus malignant disease. CONCLUSION: Nondiagnostic FNAB remains a significant problem in the evaluation of thyroid nodules. Despite ultrasound guidance, clinicians should inform patients that there is a 5-15 % malignancy risk of initial nondiagnostic specimens.

The diagnostic values of serum, pleural fluid and urine neopterin measurements in tuberculous pleurisy.

SETTING: Pulmonary department of a medical academy in Ankara, Turkey. OBJECTIVE: Neopterin is a marker of cell-mediated immunity, and it has been demonstrated that neopterin levels of various body fluids could be elevated in tuberculosis. We aimed to investigate diagnostic values of serum, pleural fluid and urine neopterin measurements in tuberculous pleurisy (TP). DESIGN: Serum, pleural fluid and urine neopterin levels were measured in 34 patients with TP and in 29 patients with pleural effusion of non-tuberculous origin as controls. RESULTS: Neopterin levels in serum, pleural fluid and urine (38.28 +/- 14.18 nmol/l, 38.97 +/- 14.18 nmol/l and 759.15 +/- 622.74 micromol/mol, respectively) were significantly higher in patients with TP than those with non-tuberculous pleural effusion (22.57 +/- 6.02 nmol/l, 21.88 +/- 6.90 nmol/l and 343.10 +/- 233.65 micromol/mol, respectively). Pleural fluid neopterin > or =30 mol/l gave the best diagnostic yield, with 85% sensitivity, 93% specificity, 94% positive predictive value, 84% negative predictive value and 89% diagnostic accuracy, although it is not superior to pleural fluid adenosine deaminase determination. CONCLUSION: We have suggested that elevated serum, pleural fluid and urinary neopterin levels in TP with respect to pleural effusions of non-tuberculous origin may reflect activation of cell-mediated immunity and that pleural fluid neopterin measurement may be of value in the differential diagnosis of TP.

Urinary neopterin measurement as a non-invasive diagnostic method in pulmonary tuberculosis.

SETTING: Pulmonary department of a university hospital in Ankara, Turkey. OBJECTIVE: To investigate the usefulness of neopterin in pulmonary tuberculosis (PTB) as a rapid diagnostic tool. DESIGN: Neopterin concentrations in bronchoalveolar lavage fluid (BAL), serum and urine were measured in patients with PTB, with lung cancer and with pneumonia and in a healthy control group. RESULTS: In the BAL of PTB patients, serum and urine levels of neopterin were significantly higher than all the other groups (P < 0.001). Compared with the lung cancer group, PTB patients had higher neopterin in BAL and urine (P < 0.05). The PTB group had higher levels not only in BAL and urine, but also in serum, than the pneumonia group (P < 0.05). Compared with the pneumonia group and the healthy controls, neopterin levels in serum and urine were significantly higher in the lung cancer group (P < 0.05). In the PTB group, patients with moderately advanced PTB according to radiographic extent had higher levels of urine neopterin than patients with minimal disease (P = 0.01). CONCLUSION: Neopterin levels in BAL, serum and particularly in urine may reflect PTB activity before exact diagnosis of the disease by culture results, and correlates with radiological extent.