Extended-spectrum beta-lactamases in ceftazidime-resistant Escherichia coli and Klebsiella pneumoniae isolates in Turkish hospitals.

PURPOSE: To study the prevalence of TEM-, SHV- and GES-type beta -lactamases among Escherichia coli and Klebsiella pneumoniae strains having ceftazidime MICs higher than 2 mg/L. METHODS: A total of 63 E. coli and 41 K. pneumoniae isolated from five different university hospitals were studied for the existence of TEM-, SHV- and GES-type beta -lactamases. Susceptibility tests were carried out according to the criteria of National Committee for Clinical Laboratory Standards. MICs were obtained by agar dilution method. Existence of extended-spectrum beta -lactamases (ESBLs) were assessed by double-disc synergy test (DDST). Existence of the above-mentioned beta -lactamase genes were studied both by PCR with specific oligonucleotide primers and isoelectric focusing methods. RESULTS: None of the isolates were carbapenem-resistant. DDSTs were positive in 50 (79.3%) and 33 (80.5%) of E. coli and K. pneumoniae , respectively. TEM gene was detected in 41 (65.1%) and 19 (46.3%), whereas SHV gene in 18 (28.6%) and 20 (48.8%) of E. coli and K. pneumoniae strains, respectively. GES genes were not detected. CONCLUSIONS: TEM and SHV genes are highly prevalent among ESBL-producing E. coli and K. pneumoniae , whereas GES-type ESBLs are absent and found not to be responsible of ceftazidime resistance in Turkish hospitals.

Primary brucellar psoas abscess: presentation of a rare case of psoas abscess caused by Brucella melitensis without any osteoarticular involvement.

The psoas abscess is an entity, sometimes forgotten in our daily practice, because of infrequency and difficulties in diagnosis. Primary psoas abscess is very rare and gram-positive micro-organisms account for more than 80% of the cases. Our case, a 62-year-old man was admitted with a 5-year history of back pain and fever. Physical examination was normal, except a palpable hepatomegaly with a mild tenderness over his lower right abdominal quadrant. The Brucella agglutination test was strongly positive with a titre of 1/640, as Rose Bengal Spot test. Blood cultures for brucella were positive on the fourth day and became negative, as the specific therapy started. Further examination with ultrasonography and computed tomography revealed an abscess of 40 + 75 mm in the psoas muscle. Complete resolution of symptoms achieved within 6 weeks. Although clinical presentation of psoas abscesses is often similar and non-specific, early aetiological diagnosis is extremely important, because of high achievement with appropriate antibiotic regimens. Brucellar psoas abscess seems very rare even in Turkey, where Brucella is still highly endemic. Such a case has not been previously reported from Turkey, as far as we know.

Primary sternal tuberculosis: a rare unhealed case treated by resection and local rotational flap.

Primary sternal tuberculosis is very rare. Only few cases have been reported in the English-language literature. We present a case of primary sternal tuberculosis that had intractable drainage for 18 months. Diagnosis was confirmed with biopsy, and there were no other tuberculous foci. No improvement was achieved in the status of the wound despite 4 months of chemotherapy. We applied the principles as in bacterial osteomyelitis of sternum, resected the wound and covered it with a pectoralis major musculocutaneous rotational flap. The wound healed, and there was no recurrence 24 months after surgery.

Characterization of extended-spectrum beta-lactamase (TEM-52)-producing strains of Salmonella enterica serovar typhimurium with diverse resistance phenotypes.

Two Salmonella enterica serovar Typhimurium strains from different clonal origins, both producing an extended-spectrum beta-lactamase (TEM-52), were isolated from a patient. This enzyme was encoded on a single plasmid and was found at very low levels in one strain, while being encoded on multiple plasmids and in multiple different EcoRI fragments in the other strain.

Comparative performance of Fungichrom I, Candifast and API 20C Aux systems in the identification of clinically significant yeasts.

To compare the performance of current chromogenic yeast identification methods, three commercial systems (API 20C Aux, Fungichrom I and Candifast) were evaluated in parallel, along with conventional tests to identify yeasts commonly isolated in this clinical microbiology laboratory. In all, 116 clinical isolates, (68 Candida albicans, 12 C. parapsilosis, 12 C. glabrata and 24 other yeasts) were tested. Germ-tube production, microscopical morphology and other conventional methods were used as standards to definitively identify yeast isolates. The percentage of isolates identified correctly varied between 82.7% and 95.6%. Overall, the performance obtained with Fungichrom I was highest with 95.6% identification (111 of 116 isolates). The performance of API 20C Aux was higher with 87% (101 of 116 isolates) than that of Candifast with 82.7% (96 of 116). The Fungichrom I method was found to be rapid, as 90% of strains were identified after incubation for 24 h at 30 degrees C. Both of the chromogenic yeast identification systems provided a simple, accurate alternative to API 20C Aux and conventional assimilation methods for the rapid identification of most commonly encountered isolates of Candida spp. Fungichrom seemed to be the most appropriate system for use in a clinical microbiology laboratory, due to its good performance with regard to sensitivity, ease of use and reading, rapidity and the cost per test.

A probable case of herpes simplex encephalitis despite negative PCR findings.

A 54-year-old woman was admitted to the hospital suffering from fever and personality changes. Laboratory examination of her cerebrospinal fluid (CSF) showed 270 mononuclear cells, 30 polynuclear cells and a clinically low number of erythrocytes/mm3. Empirical clinical findings from this case suggested treatment with acyclovir. Magnetic resonance imaging (MRI) showed bilateral temporal hyperintense signals in T2-weighted images. PCR with specific primer for herpes simplex virus type 1 (HSV-1) and HSV-2 were negative. There was no elevation of oligoclonal antibodies specific to HSV in CSF after 2 weeks. Although we did not prove the presence of the agent microbiologically at the clinical onset of the disease, the MRI and electroencephalogram (EEG) findings, erythrocytes in CSF and the dramatic response to acyclovir therapy are suggestive of a diagnosis of herpes simplex encephalitis (HSE).

Transient increase in diarrheal diseases after the devastating earthquake in Kocaeli, Turkey: results of an infectious disease surveillance study.

Immediately after the devastating earthquake in Turkey in August 1999, an infectious disease surveillance system was established in Kocaeli Province (the biggest area affected). This surveillance study was mainly focused on diarrheal diseases. During a 33-day period, 1,468 stool cultures were processed. Diarrheal diseases increased step-by-step and later decreased to the initial level by the end of this period. Cases were scattered throughout the entire region, and the identified causes were various, indicating a multifocal increase. Of the identified causes, Shigella species were the most common. Nevertheless, Shigella isolates also belonged to distinct serotypes and clones. This study indicated a multifocal, multiclonal increase in diarrheal diseases after this massive disaster, thus indicating the necessity to set up infectious disease surveillance systems after such events.