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We aimed to investigate the clonal relationships, common sequence types, and carbapenemase genes in 177 non-repetitive blood culture isolates of Acinetobacter baumannii collected from patients at three university hospitals in Turkey in 2016. Molecular epidemiological characteristics of the isolates were examined using pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST) (Pasteur scheme-cpn60, fusA, gltA, pyrG, recA, rplB, and rpoB). Multiplex PCR was used to investigate the carbapenemase genes, including blaOXA-23-like, blaOXA-24-like, blaOXA-48-like, blaOXA-58-like, blaIMP, blaVIM, and blaNDM. PFGE genotyping yielded 92 pulsotypes with a clustering ratio of 69.7%. As per a ≥85% similarity coefficient, 159 (90.9%) isolates were found to be clonally related. The blaOXA-23-like and blaOXA-58-like genes were identified in 100% and 28.2% of the isolates, respectively. The blaNDM gene was identified in two isolates. The MLST analysis included 54 isolates with different pulsotypes, and 29 sequence types (STs). Most of the isolates (n = 36) belonged to the clonal complex (CC)2, one isolate belonged to CC1, and one isolate belonged to CC164. Sixteen new STs (ST1235-ST1250) were identified. Identifying both global ST2 and a large number of new STs, revealed high genetic diversity in A. baumannii isolates in the study population.

The Acinetobacter calcoaceticus-Acinetobacter baumannii (Acb) complex consists of phenotypically very similar nosocomial species; A.baumannii, Acinetobacter nosocomialis, Acinetobacter pittii, Acinetobacter seifertii and Acinetobacter djikshoorniae and one environmental species A.calcoaceticus. The rapid and accurate identification of the members of Acb complex is critical as these nosocomial pathogens can show differences in antimicrobial susceptibility and clinical outcomes. The conventional phenotypic methods are slow, unreliable and less efficient for the differentiation of Acb complex species, including the A.baumannii species within the Acb complex. Although various molecular methods are available, such as amplified ribosomal DNA restriction analysis (ARDRA) and blaOXA-51-like gene specific PCR, they are usually inconvenient for the routine diagnostic laboratories. Recently, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) offers an opportunity for rapid, cost-effective and convenient bacterial identification in routine diagnostic procedures conducted in clinical laboratory. In this study, we aimed to evaluate the diagnosis performance of MALDI-TOF MS system to identify blood isolates of A.baumannii. A total of 180 nonduplicate carbapenem resistant Acb complex (strain numbers; TR1-TR60) and A.baumannii (TR61-TR180) blood isolates were collected from the intensive care units of the three university hospitals in Turkey from January 2016 to December 2016. All isolates were evaluated by using blaOXA-51-like gene specific real time (Rt-PCR) analysis, ARDRA (restriction enzymes-AluI, CfoI, MboI, MspI, RsaI) method and MALDI-TOF MS (VITEK® MS, bioMerieux, France) system. All the strains except TR10, TR31, TR35 and TR52 were identified as A.baumannii by ARDRA method. Out of 177 of all the isolates, presence of blaOXA-51-like gene was found except for TR10, TR31 and TR52 isolates. However, TR31 without the presence of blaOXA-51-like gene was identified as A.pittii using the ARDRA. Totally 176 isolates which were identified as A.baumannii by both of the methods, ARDRA and Rt-PCR- blaOXA-51-like, were accepted as a reference for the evaluation of the diagnosis performance capacity of the MALDI-TOF MS. Overall, for all 176 isolates tested, the sensitivity obtained with the MALDI-TOF MS were 99.4% with 75% specificity. The accuracy value of the method was determined as 98.9% for the identification of A.baumannii to the species level. MALDI-TOF MS is increasingly used in diagnostic microbiology for the routine identification of bacteria to the genus, species or subspecies level with high rates of sensitivity and specificity. In future, by expanding the database, MALDI-TOF MS system would possibly become the ideal method for routine diagnostic laboratories that could potentially identify more species and even determine some characteristics of antimicrobial resistance and virulence determinants.

We aimed to investigate the clonal relationships, common sequence types, and carbapenemase genes in 177 non-repetitive blood culture isolates of Acinetobacter baumannii collected from patients at three university hospitals in Turkey in 2016. Molecular epidemiological characteristics of the isolates were examined using pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST) (Pasteur scheme-cpn60, fusA, gltA, pyrG, recA, rplB, and rpoB). Multiplex PCR was used to investigate the carbapenemase genes, including bla

Introduction: The purpose of this study was to evaluate and compare two manual isolation and real-time (RT) polymerase chain reaction (PCR) kits (RTA RT-PCR with RTA isolation kit and Artus RG RT-PCR with QIAamp isolation kit) for molecular diagnosis of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. Methodology: The study was conducted on 121 and 54 clinical samples for the detection of HBV DNA and HCV RNA, respectively, with an additional 8 HCV RNA external quality control samples. Results: Though a high correlation was observed between the two kits for the HBV DNA (r = 0.955, p = 0.001) and HCV RNA quantifications (r = 0.828, p = 0.001), discordant results were found in nine of the HBV DNA and in six of the HCV RNA samples. The mean difference between the two systems was found to be 0.4 log IU/mL in Quality Control for Molecular Diagnostics (QCMD) HCV RNA samples by Bland-Altman analysis. Conclusions: Although there was a high correlation between HBV DNA and HCV RNA tests according to the results of the study, the RTA system requires improvement for the determination of HCV RNA.

Background Detection of anti-tetanus antibody levels is necessary for both determination of the immune status of individuals and also for planning preventive measures. ELISA is the preferred test among in vitro tests however it can be affected by the cross reacting antibodies. A previously developed in-house ELISA test was found not reliable for the antibody levels ≤ 1.0 IU/ml. A new method was developed to detect low antibody levels correctly. The aim of the present study was to compare the results of the newly developed in-house biotin-avidin tetanus IgG ELISA test with the in vivo mouse neutralization test, for the antibody levels ≤ 1.0 IU/ml. Methods A total of 54 serum samples with the antibody levels of three different levels, = 0.01 IU/ml, 0.01–0.1 IU/ml, 0.1–1 IU/ml, which were detected by in vivo mouse neutralization test were studied by the newly developed in-house biotin-avidin tetanus IgG ELISA test. Test was validated by using five different concentrations (0.01 IU/ml, 0.06 IU/ml, 0.2 IU/ml, 0.5 IU/ml, 1.0 IU/ml). Results A statistically significant correlation (r2 = 0.9967 p = 0,001) between in vivo mouse neutralization test and in-house biotin-avidin tetanus IgG ELISA test, was observed. For the tested concentrations intra-assay, inter-assay, accuracy, sensitivity, specificity and coefficients of variations were determined as ≤ 15%. Conclusion In-house biotin-avidin tetanus IgG ELISA test can be an alternative method to in vivo mouse neutralization method for the detection of levels ≤ 1.0 IU/ml. By using in-house biotin-avidin tetanus IgG ELISA test, individuals with non protective levels, will be reliably detected.

Pertussis is a vaccine-preventable disease that is transmitted from infected to susceptible individuals by respiratory route. Bordetella pertussis infection may occur at any age as neither vaccine nor natural infection induced immunity lasts life-long. This study was planned to demonstrate the serological evidence of infection among adults, to raise awareness among clinicians and to provide data for the development of strategies to protect vulnerable infants. A total of 538 patients (345 female, 193 male) ages between 18-87 years who had a complain of prolonged cough for more than two weeks were included in the study. Antipertussis toxin (PT) IgG and anti-filamentous hemagglutinin (FH) IgG levels from single serum samples were measured by an in-house ELISA test which was standardized and shown to be efficient previously. Anti-PT IgG antibody levels of >= 100 EU/ml were considered as acute/recent infection with B. pertussis. In our study, 9.7% (52/538) of the patients had high levels of anti-PT IgG (>= 100 EU/ml) and among those patients 43 (43/52; 82.7%) also had high (>= 100 EU/ml) anti-FHA IgG levels. There were no statistically significant differences in terms of age, gender, education level, DPT (diphtheria-pertussis-tetanus) vaccination history, smoking history or average daily cigarette consumption (p> 0.05) between the cases with high antibody levels (n=52). When the symptoms and the presence of cases with high antibody levels were evaluated, it was detected that no one parameter was significantly different from others, except that 24.1% of the cases with inspiratory whooping had high anti-PT levels. There was also no statistically significant difference between high anti-PT levels >= 100 EU/ml and the patients with risk factors [smoking (21/200; 10.5%), presence of disease that cause chronic cough and/or drug usage (19/171; % 11.1), and whole factors which cause chronic cough (32/306; % 10.5)] and without risk factors (p=0.581; p=0.357; p=0.249, respectively). The distribution of anti-PT IgG geometric mean titer (GMT) according to the age groups, was as follows; 32.41 in 18-30 years; 36.28 in 31-50 years; 36.82 in 51-70 years and 31.15 in >= 71 years. Our results indicated that B. pertussis infections are also present among adult population with a frequency not to be underestimated (9.7%) and the results also emphasized that since typical whooping cough symptoms may not be seen in adults, pertussis infection should be considered as a differential diagnosis in adults with prolonged cough, even if there are some other underlying factors of cough. The data obtained from this study was also considered to be helpful in the development of adult vaccination policies for the protection of infants who have not completed the vaccination schedule yet.

BRAF(V600E) mutation was analyzed by real-time polymerase chain reaction in 96 consecutive cases with classical variant papillary thyroid cancer, and immunohistochemical staining of Na+/I- symporter (NIS) protein was evaluated. Localization (intracellular or membranous), density, and the intensity of cytoplasmic staining were characterized semiquantitatively. Extrathyroidal invasion, surgical margin positivity, and lymph node metastasis were compared with BRAF(V600E) mutation and NIS expression. Eighty-eight patients who had at least 24-month follow-up were also included in survival analysis. BRAF(V600E) mutation was determined in 78.1% (75/96) and functional NIS activity in 74% (71/96) of the cases. There were statistically significant differences in mean ages between BRAF(V600E) mutation-positive (48.6) and BRAF(V600E) mutation-negative cases (37.3; Levene test, P=.419; Student t test, P=.001). The surgical margin positivity (46.7%) and extrathyroidal extension percentage (54.7%) in the BRAF(V600E) mutation-positive group were higher than the negative (28.6% and 33.3%, respectively) group, without statistical significance (P=.138 and P=.084, respectively). Functional NIS activity was higher in BRAF(V600E) mutation-positive cases (78.1%) than mutation-negative ones (57.1%; P=.047). The possibility of moderate and intense cytoplasmic staining in BRAF(V600E) mutation-positive cases (72%) was 6.3 times higher than the possibility of weak staining (28%) in the mutation-positive cases (95% confidence interval, 2.2-18.8; P=.001). Functional NIS expression is higher in patients with classical variant papillary thyroid cancer with BRAF(V600E) mutation. However, the clinical features were not found to be associated with NIS expression. There may be different mechanisms determining the outcome of therapy.

This study obtained information on the serotypes and molecular typing characteristics of Streptococcus pneumoniae strains causing invasive diseases in Turkey. Sixty-eight S. pneumoniae isolates causing invasive pneumococcal diseases were collected from different regions of Turkey from 2009 to 2011. The isolates were characterized by performing multilocus sequence typing (MLST), pulsed-field gel electrophoresis (PFGE), and capsular serotyping, and 25 different serotypes were identified. Serotypes 19F, 23F, 1, 14, and 7F were common and accounted for 52.9% of all the serotypes. In addition, 54 different PFGE profiles (pulsotypes) were observed. Twenty-three of the 68 (33.8%) isolates were clustered into 9 pulsotypes. MLST analysis yielded 36 sequence types, of which 12 (33.3%) were novel. A comparison of results with the global pneumococcal MLST database by performing eBURST analysis showed that our strains belonged to 20 different clonal complexes and 5 singletons. In addition, we identified 4 new alleles: 2 gdh, 1 xpt, and 1 ddl. Thus, the results of this study highlighted a high level of diversity among pneumococcal isolates. In addition, the study identified a case of possible capsular switching.

This study aimed to determine the presence of vancomycin resistance (vanA and vanB) and virulence genes (esp, asa1, gelE, ace, hyl, cylA, cpd and ebpA) in vancomycin-resistant Enterococcus faecium (VREfm) strains and to analyse the clonal relationships among the strains. E. faecium strains were identified from rectal and clinical specimens by biochemical tests and the API-20 Strep kit. Susceptibility testing was performed using disc-diffusion and broth-dilution methods. PFGE was used for molecular typing of the VREfm strains. The vancomycin resistance and virulence genes were amplified by two-step multiplex PCR. All 55 VREfm isolates were resistant to penicillin G, ampicillin and high-level gentamicin but were susceptible to quinupristin/dalfopristin and linezolid. Multiplex PCR analysis indicated that all isolates harboured vanA and that 41 (75 %) were positive for virulence genes. The esp gene was the most common virulence factor and was detected in nine (41 %) invasive and 32 (96.7 %) non-invasive isolates. Multiple virulence genes were observed only in two non-invasive isolates; one harboured esp and ebpA and the other harboured esp, ebpA, asa1, gelE and cpd. PFGE typing yielded 16 different types, seven of which were clusters with two to 14 strains each. The clustering rates of the rectal swab, blood and urine isolates were 72.7 %, 61.5 % and 87.5 %, respectively. The genetic similarity observed among the VREfm isolates indicated cross-transmission in the hospital. Further studies on the virulence factors present in the strains might provide insight into the acquisition of these traits and their contribution to increased prevalence of VREfm.

Background: Carbapenem-resistant Klebsiella pneumoniae isolates can spread among the hospitalized patients and result in serious infections and increase mortality. Molecular studies provide useful information about resistance mechanisms and cross-transmission among the resistant isolates. Objectives: The current study aimed at investigating phenotypic and molecular characteristics of the carbapenem resistance and clonal relationship among the K. pneumoniae isolates recovered from infection sites and rectal swabs of the patients hospitalized in a tertiary hospital. Methods: Resistance to carbapenems was investigated by disc-diffusion and E-test methods. Modified Hodge test (MHT) and ethylenediaminetetraacetic acid (EDTA)-combine disc (ECD) methods were performed to determine carbapenemases. Carbapenemase-encoding genes including blaOXA-48, blaNDM-1, blaKPC, blaIMP, and blaVIM were investigated by multiplex polymerase chain reaction (PCR). Clonal relationship among the isolates was determined by the pulsed-field gel electrophoresis (PFGE). Results: Carbapenem resistance was observed in 93 (5.8%) of the 1605 K. pneumoniae isolates. Majority (n = 66, 71%) of the resistant isolates were recovered from the patients in intensive care units (ICUs). Almost all carbapenem-resistant K. pneumoniae isolates (n = 91, 97.8%) were positive with MHT. Only 6 (6.5%) of the resistant isolates were positive with ECD method. The blaOXA-48 and blaNDM-1 were found in 90.3% (n = 84) and 6.5% (n = 6) of the resistant isolates, respectively. The pulsed-field gel electrophoresis yielded 55 different pulsotypes. Fifteen pulsotypes were identified as clusters with ≥ 2 isolates and a clustering rate of 57%. Based on the similarity coefficient higher than 85%, a total of 75 (80.6%) isolates were clonally related to each other. Conclusions: The high rate of carbapenem resistance and 80.6% clonal relationship between the isolates collected in a 3-year period indicated a serious potential threat for the hospital-acquired infections and pointed longtime cross-contamination.

The target of radioiodine ablation therapy (RIAT) after complete tumor removal is the nontumoral remnant tissue. We aimed to evaluate sodium iodide symporter (NIS) expression in nontumoral thyroid tissue in differentiated thyroid cancer (DTC) patients who have complete but delayed structural response (DSR) to RIAT after surgery. Preoperative thyroid characteristics such as volume and nontumoral histology were also investigated for both DSR and its control group as potential predictors of insufficient NIS activity in this study. Total of 600 patients with postoperative remnant thyroid tissue and who were in remission after RIAT spontaneously, were included in the study. Patients with positive diagnostic whole body scan (DxWBS) with thyroid bed uptake and stimulated serum Tg level

The aim of this prospective single-center study was to determine the changings in incidence of invasive pneumococcal disease (IPD), serotype distribution and the antimicrobial resistance patterns of S. pneumoniae in children with IPD after the period (1 to 7 years) of vaccination with PCV7 (2008) and PCV13 (2011).The study was conducted on 39 Turkish children with IPD between ages 1 month and 18 years in Ankara, Turkey. Streptococcus pneumoniae was identified using standard laboratory procedures from blood, cerebrospinal fluid (CSF), pleural fluid, and other sterile body fluids and tissues. S. pneumoniae isolates were tested for resistance to penicilin and ceftriaxone using the E-test methodology. Serotypes of the isolates were determined by Quellung reaction.The overall annual incidence rate of IPD decreased significantly from 7.71 (95% CI, 1.99-13.4) to 1.58 (95% CI, 0.6-3.77; RRR=-79.5; p=0.006) per 100 000 population among ≤5 years of age without underlying disease. During the overall study period, the PCV7-serotypes and PCV13-serotypes represented 27.8% and 63.8% of isolates, respectively. PCV13-serotypes made up 81.8% of cases of IPD in the pre-PCV13 era and decreased to 56% in the 4 years after PCV13. The penicillin and ceftriaxone (for meningitis) resistance rates were 48.5% and 9.1%, respectively.This is the first study about the changing pattern of the incidence of IPD in Turkish children after the implementation of the PCV7 and PCV13 in Turkish national vaccine schedule and a prominent decrease in incidence of IPD has seen after the implementation of PCV13.Nuestro objetivo fue determinar los cambios en la incidencia de enfermedad neumocócica invasiva (ENI), la distribución de serotipos y patrones de resistencia antibiótica del Streptococcus pneumoniae en niños con ENI tras el período de vacunación (de1 a 7 años) con vacuna neumocócica de 7 serotipos (VCN7) (2008) y de 13 serotipos (VCN13) (2011).El estudio se realizó en 39 niños con ENI de 1 mes a 18 años de edad en Angora, Turquía. Se identificó Streptococcus pneumoniae en sangre, líquido cefalorraquídeo, líquido pleural, y otros tejidos y líquidos corporales estériles mediante procedimientos estándar.Se analizó la resistencia de cepas aisladas de S. pneumoniae a penicilina y ceftriaxona con la prueba de epsilometría (E-test). Los serotipos de las cepas se determinaron con la reacción de Quellung.La incidencia anual de ENI disminuyó significativamente de 7,71 (intervalo de confianza [IC] del 95%: de 1,99 a 13,4) a 1,58 (IC del 95%: de 0,6 a 3,77; reducción del riesgo relativo=-79,5; p=0,006) cada 100 000 habitantes de ≤ 5 años de edad sin enfermedad preexistente. Durante todo el período del estudio, los serotipos en la VCN7 y en la VCN13 representaron el 27,8% y el 63,8% de las cepas aisladas, respectivamente. Los serotipos en la VCN13 correspondían al 81,8% de los casos de ENI en la era previa a la introducción de esta vacuna, y disminuyeron al 56% en los cuatro años posteriores. Las tasas de resistencia a penicilina y ceftriaxona (en el caso de la meningitis) fueron del 48,5% y el 9,1%, respectivamente.Este estudio observó una disminución significativa en la incidencia de ENI después de la introducción de la VCN13.

The aim of this study was to detect the presence of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Mycoplasma hominis, Trichomonas vaginalis, and Ureaplasma urealyticum in genital specimens of symptomatic patients. This study also examined the role of U. urealyticum in infections of the lower genital tract. Cervical and urethral samples from 96 patients (46 males, 50 females) were tested using the Seeplex(

Acute pertussis infection among adults can cause its transmission to the larger population, especially to infants and young children, who can develop severe disease. In order to determine an age‐dependent pertussis immune response, anti‐pertussis toxin (PT) antibody was detected by the indirect enzyme‐linked immunosorbent assay (ELISA) method in serum samples from 2,085 healthy subjects ranging in age from 6 months to ≥60 years. Also included in the evaluation were responses to a questionnaire including sociodemographic characteristics, vaccination, and infection history. Titers of 50–99 ELISA units (EU)/mL and of ≥100 EU/mL were accepted as indicative for recent exposure or infection. In addition, 30 EU/mL was estimated to be a sufficient titer in women of childbearing age to protect their newborns until administration of their first dose of pertussis vaccine. After the age of 4–5 years, presence of high‐titered antibodies that increase with age might be a reflection of circulating infection and indicate the magnitude of the threat to infants. According to the questionnaires, in the groups younger than 15 years old, three to four doses of diphtheria toxoid‐whole cell pertussis‐tetanus toxoid (DwPT) were administered in 47.2 to 77.4%, 91.2 to 100.0%, and 83.5 to 100.0% of participants in Diyarbakir, Samsun, and Antalya, respectively. In addition, up to half of the expectant mothers we studied lacked a sufficient level of estimated antibody titers. To protect infants from life‐threatening pertussis infection, improving vaccination coverage to ensure herd immunity and uniformly establishing coverage throughout the country are essential. Furthermore, revaccination with acellular vaccine for schoolchildren as well as for the households of pregnant women is recommended. J. Clin. Lab. Anal. 21:154–161, 2007. © 2007 Wiley‐Liss, Inc.

Amaç: Çalışmamızın amaçları, 2011-2012 tarihleri arasında, alt üriner sistem enfeksiyonu (ÜSE) tanılı poliklinik hastalarından izole edilen mikroorganizmaların dağılımı, antibiyotik direnç profillerinin araştırılması ve uygun ampirik tedavi seçeneklerinin belirlenmesidir.Materyal ve Metot: 2011–2012 tarihleri arasında, hastanemiz polikliniklerinden alt ÜSE ön tanısı ile gönderilen 14096 idrar örneğinin kültür / antibiyogram sonuçları retrospektif olarak değerlendirildi. Tekrarlayan üremeler hariç tutularak toplam 2005 örnekteki üremeler değerlendirmeye alındı. Kültür ve identifikasyon testleri konvansiyonel/yarı otomatik ve otomatik yöntemlerle yapıldı. Antibiyotik duyarlılık testleri CLSI (Clinical Laboratory Standarts Institute) önerileri doğrultusunda Kirby-Bauer disk difüzyon yöntemiyle gerçekleştirildi.Bulgular: Örneklerin %83,7’sinde Enterobacteriaceae üyeleri üredi. Bunların 1287’si (%64,2) E.coli; 238’i (%11,9) K.pneumoniae idi. Toplam 67 (%3,3) örnekte P.aeruginosa üredi. Gram-pozitif üremelerin oranı; 55’i (%2,7) metisiline dirençli koagülaz negatif stafiolokok, 55’i (%2,7) E.faecalis, 49’u (%2,4) S.agalactia v.b. olmak üzere %12,86 idi. Genişlemiş spektrumlu beta laktamaz prevalansı E.coli izolatlarında %23,2; K.pneumonia izolatlarında %25,4 olarak belirlendi. Gerek Gram-pozitif, gerekse Gram-negatif izolatlarda, oral kullanımı olan antimikrobikler içinde nitrofurantoin (NF) en düşük direnç oranına sahipti (sırasıyla %2,7 ve %12,1). Öte yandan Gram-pozitif bakteriler için ampisilin (%6,3), Gram-negatif bakteriler için ise sefuroksim (%25,9) en düşük direnç oranlarına sahip diğer oral tedavi seçenekleri olarak belirlendi.Sonuç: Yetişkin yaş grubundaki poliklinik hastalarımızın alt ÜSE enfeksiyonlarında NF en geniş antibakteriyel etki spektrumuna sahip oral ilaç olarak öne çıkmaktadır. Ampisiline duyarlı Gram-pozitif izolatların (Enterokokspp. hariç) sefuroksime de duyarlı olacağı düşünülürse, ikinci en geniş spektrumlu oral ilacın sefuroksim olduğu söylenebilir. Sanford, IDSA v.b. tedavi kılavuzlarında NF, trimetoprim sulfametoksazol (TMP-SXT), ilk veya ikinci tedavi seçeneği olarak önerilmekle birlikte çalışmamızda bu oran %35 düzeyinde bulunduğu için TMP-SXT, hasta grubumuz için uygun bir tedavi seçeneği gibi görünmemektedir., Objectives: The aims of the study were to investigate the distribution and the antibiotic resistance profiles of the microorganisms isolated from outpatients with lower urinary tract infection (UTI) during 2011-2012 period and to determine the most appropriate empirical therapy choices.Materials and Methods: Culture and susceptibility test results of 14.096 urine samples sent from outpatient clinics with presumptive lower UTI diagnosis in the last year (2011-2012) were reviewed. Excluding the duplications, totally 2005 isolates were evaluated. Culture and identification tests were done by conventional/semi-automatic and automatic methods. Antibiotic susceptibility tests were performed by Kirby-Bauer disc diffusion method according to the recommendations of CLSI (Clinical Laboratory Standarts Institute).Results: Enterobacteriaceae spp. were isolated from 82.3% of the urine samples; 1287 (64.2%) Escherichia coli and 238 (11.9%) Klebsiella pneumonia, 67 (3.3%) Pseudomonas aeruginosa was cultivated. Totally 12.9% of the samples yielded Gram-positive bacteria including 55 (2.8%) meticillin resistant coagulase negative staphylococci, 55 (2.8%) Enterococcus faecalis and 49 (2.4%) Streptococcus agalactiae. The extended spectrum beta-lactamase (ESBL) prevalence was 23.2% in E.coli and 25.4% in K.pneumoniae. Among oral antibiotics tested, nitrofurantoin (NF) had the lowest resistance rates for both Gram-positive and Gram-negative isolates with 2.7% and 12.1%, respectively. Ampicillin for Gram-positives and Cefuroxim for Gram-negatives were other oral drugs with the lowest resistance rates with 6.3% and 25.9%, respectively.Conclusion: NF appears as the most effective oral drug for adult outpatients with UTI. Cefuroxim can be considered as the second effective choice because ampicillin-sensitive Gram-positive isolates (except Enterococcus spp) would also be sensitive to it. NF and trimethoprim-sulfamethoxazole (TMP-SMX) is suggested as first or second choice in UTI treatment in antimicrobial therapy guidelines like Sanford and IDSA. However, TMP-SMX resistance was found 35% in our population; consequently it is not a suitable option for our patients.

The first cases of Hantavirus infection in Turkey were reported in early 2009 in the Zonguldak and Bartin provinces. The aim of this study was to investigate the presence of Hantavirus antibodies in patients who had clinical and laboratory findings that were potentially associated with Hantavirus infection prior to the epidemic in Bartin in 2009. After screening 314,577 medical records from between 2007 and 2009, the clinical and laboratory data for 442 patients meeting the criteria of coexistent thrombocytopenia, and elevated urea and creatinine levels were transferred to a statistical program. Home visits were made to 170 patients, 84 of whom consented to participate in the study. The participants completed a questionnaire and provided a blood sample. Commercial anti-Hantavirus IgG and IgM ELISA and immunoblotting assays were used, with seropositive samples being confirmed by focus reduction neutralization tests (FRNT). ELISA and/or immunoblotting assays detected 10 positive samples; however, only 7 of these were recorded as positive by FRNT. FRNT positivity was significantly associated with female sex, the presence of a barn near to the house, and working in a forest (P < 0.05). In a Hantavirus endemic region, physicians must keep in mind that thrombocytopenia, and elevated urea and creatinine levels may indicate Hantavirus infection.

The immune status against tetanus in relation to vaccination was investigated among healthy populations in 3 selected provinces in Turkey (n=2094). In-house ELISA supplemented with the particle agglutination test was performed for this purpose. An exact correlation was found between vaccination status and immunity against tetanus. The immunity was high among children and sharply decreased with age among adults. The primary vaccination for children increased the immunity, reaching a geometric mean titer (GMT) of 6.2 IU/ml at the fourth dose. There was a reduction of immunity during the next y, followed by an increase with a booster injection at primary school age. Among adolescents and adults, the GMTs after the last vaccination fell off exponentially with a slope of -0.068 log10 IU/ml per y. Extrapolation of the regression line predicted that the minimum protective level (> or =0.01 IU/ml) would be maintained for approximately 30 y on average after the last vaccination. Diyarbakir, 1 of the selected provinces, had lower immunity than the other 2 provinces with poor immunization. Adult females tended to show slightly higher GMTs than males, probably due to the neonatal tetanus elimination program. Reinforcement of immunization against tetanus for adults is recommended.

This study was designed to assess reliability of interpretation of Gram-stained vaginal smears by using Nugent's scoring system for diagnosis of bacterial vaginosis (BV) across three different centers in Turkey: two in Ankara and one in Trabzon. The vaginal smears were collected from clients attending a family planning clinic in Trabzon, Turkey during October-December 1997. One slide taken from each client was prepared according to the standard methods and enumerated. One evaluator from each center examined the slides independently for the presence of BV and none of them had access to the evaluation of the others. Out of 372 slides, 301 (81%) were found to be satisfactory for scoring by all three evaluators and included in the analysis. Nugent's scores from 1-10 reported from each evaluator were compared by Spearman correlation coefficients and Kappa statistics. The difference in the proportions of BV diagnosis in three centers was evaluated by chi2 test. There was good agreement for the interpretation of Gram-stained vaginal smears by Nugent's scoring system for diagnosis of BV. These results indicate that it is a reliable method in diagnosis of BV at different settings.

Co-trimoxazole resistance inEscherichia coli isolates from urinary tract infections (UTI) was assessed in 382 strains from 1995 and 510 strains from 2005. The strains were collected from five microbiology laboratories in Ankara, Turkey. Documentation on patient gender, age and outpatient/inpatient status was collected in 2005, but not in 1995. The resistance percentages were 751% in 1995 and 55.5% in 2005. This reduction in resistance percentage was statistically significant, overall in all except two of the participating laboratories. The resistance percentage in 2005 was 61.1% for children (n=208) and 51.2% for adults (n=258), 53.7% for females (n=380) and 60.8% for males (n=130), and 55.3% for outpatients (n=400) and 56.4% for inpatients (n=110). The reduction in resistance is believed to be a consequence of reduced usage. Although decreased, the level of co-trimoxazole resistance remains high, and continued avoidance of its use for empiric treatment of UTI in Turkey appears to be an appropriate strategy.

WOS: 000329272100020, PubMed ID: 24377763, In 2009, human Dobrava-Belgrade virus (DOBV) infections were reported on the Black Sea coast of Turkey. Serologic and molecular studies of potential rodent reservoirs demonstrated DOBV infections in Apodemus flavicollis and A. uralensis mice. Phylogenetic analysis of DOBV strains showed their similarity to A. flavicollis mice borne DOBV in Greece, Slovenia, and Slovakia., Provinancial Health Directorate in Bartin, We thank the Provinancial Health Directorate in Bartin for their support and help, and thank the laboratory personnel of Virology Laboratory of Refik Saydam National Public Health Agency, Ankara, Turkey, for excellent technical assistance. We also thank Manfred Weidmann (Gottingen) for his kind support by providing the DOBV S-segment-containing plasmid.

Unal, Belgin/0000-0002-4354-8266; Caglayik, Dilek Yagci/0000-0003-3473-8073 WOS: 000314364100006 PubMed: 23289396 This study was carried out to better understand the epidemiology of hantaviruses in a province of Turkey (Giresun) where human hantavirus disease has recently been detected. In this cross-sectional study, a total of 626 blood samples from healthy people aged 15 and 84 years old were collected both in urban and rural areas in 2009. The sera were tested by enzyme-linked immunosorbent assay (ELISA), immunoblotting assay, and the focus reduction neutralization test (FRNT). We screened the samples by an ELISA and found that 65/626 samples reacted positively for the presence of hantavirus-reactive immunoglobulin G (IgG). Twenty of the 65 ELISA-positive samples could be confirmed by an immunobloting assay, and the overall seroprevalence was thereby calculated to 3.2% (20/626). The seroprevalence of the people living in wood areas or adobe houses 9/17 (52.9%) was significantly higher than among people living in concrete houses 10/47 (21.3%) (p = 0.014). Finally, 3 of the 20 immunoblot-positive sera were confirmed as specific for the Puumala hantavirus serotype by FRNT, 1 serum was confirmed as Dobrava virus-specific, whereas 1 serum was found to be equally reactive to Dobrava and Saaremaa viruses. We will now focus on further investigations of the ecology and epidemiology of hantaviruses in humans and their carrier animals in Turkey, studies that have already been started and will be further intensified. Refik Saydam National Public Health Agency in Ankara and TurkeyRefik Saydam Hifzissihha Merkezi Baskanligi; Swedish Research CouncilSwedish Research Council [121 77]; European UnionEuropean Union (EU) [FP7-261504EDENext] This study was supported with a grant by the Refik Saydam National Public Health Agency in Ankara and Turkey, the Swedish Research Council (Project Number 121 77), and the European Union grant FP7-261504EDENext. The paper is catalogued by the EDENext Steering Committee as EDENext 00xx (http://www.edenext.eu).

Q fever is a worldwide zoonosis caused by Coxiella burnetii. In Turkey, it has been reported from the late 1940s that Q fever is endemic in humans and animals. Our objective was to evaluate the seroprevalence in Samsun Tekkekoy (north Turkey), where an outbreak of Q fever occurred in 2002. In this cross-sectional study, subjects were selected by the random proportional sampling method. All subjects were healthy with no specific symptoms and tested by the microimmunofluorescent antibody test. In total, we tested 407 subjects; 33 (8.1%) of them were identified as past evidence of infection and 22 (5.4%) were considered as evolutive form of Q fever (17 acute and five chronic forms). The seroprevalence was significantly higher among people over 30 years of age, hunters, and slaughters than the others (p = 0.001, p = 0.034, and p = 0.006, respectively). We found 13.5% seropositivity among healthy subjects, confirming that Q fever is prevalent in our region and is often asymptomatic.

In order to assess the effect of the neonatal tetanus elimination program in Turkey, tetanus antibody prevalence among women of childbearing age from three selected provinces was evaluated in relation to vaccination doses of the single-type tetanus vaccine. A combined method of in-house enzyme-linked immunosorbent assay and particle agglutination test was used to determine tetanus antibody titers. Among 205 women aged 20-39 years, the tetanus antibody level was higher in women with 1-3 children than those without children. The geometric mean of the log antibody titer was increased proportionally with a slope of 0.405 +/- 0.174 per dose between 0 and 3 doses (P0.05). However, the proportion of 20-39-year-old women with the protective antibody in the provinces ranged from 54.8 to 86.6%. Diyarbakir had the lowest immunity with a larger number of children in the household, and a lower educational level. The results of our serological study demonstrated that the neonatal tetanus elimination program in Turkey is effectively promoting immunity against tetanus in pregnant women. However, the study also revealed that the tetanus immunity among women of childbearing age was still insufficient. Intensive implementation of the supplemental immunization activities and encouraging vaccinations through neonatal care services will improve the situation.

To evaluate immunity against measles and its relation with some variables among healthy subjects in 3 cities in Turkey.We carried out a cross-sectional study on measles antibody titers in the serum samples of 712 people from Antalya, 696 from Diyarbakir and 667 from Samsun, Turkey using particle agglutination test between February 2000 and October 2001. The study groups, informed and asked for their consent by midwives, consisted of randomly selected subjects of all ages older than 6 months. We implemented the study in 3 steps: physical examination, interview and blood collection.We considered titers ofor = 1:16 as positive and we observed lower seropositivity in Diyarbakir (90.8%) than Antalya (95.9%), and Samsun (94.9%) (p=0.040). We also observed that seropositivity was lower among preschool group than older groups (p=0.006). The number of doses of measles vaccine (p=0.001) and measles infection history (p=0.003) were found as a factor increasing the seropositivity ratio. There was no statistically significant between age groups (p=0.219), gender (p=0.148), residence (p=0.537), and number per household (p=0.983) among the provinces.Based on the findings, measles infection still has a high incidence in Turkey and the second dose of measles vaccine is extremely important in the prevention of measles transmission among school children and the community. Furthermore, we must improve our regional differences in routine vaccination services.

In order to determine a practically useful quantitative assay method for tetanus antibody in a large-scale seroepidemiological study, a method combining an in-house ELISA with a particle agglutination test (KPA) was evaluated in comparison with the in vivo mouse neutralization test. Serum samples with mouse neutralization antibody titers 0.01 IU/ml (the minimum protective level) or below showed considerable overestimation of antitoxin titers up to 1.0 IU/ml when studied by in-house ELISA alone. On the other hand, the KPA values were highly correlated with the mouse test, even in cases of titers equal to 0.01 IU/ml or below. The combination of these two procedures, in which in-house ELISA values of 1.0 IU/ml or below were replaced by KPA values, provided a high correlation in antibody titers with the mouse test (r = 0.968). We applied this combined method to a tetanus seroepidemiological survey in a province in Turkey. The survey included 347 subjects from the healthy population, and the quantitative analyses showed high antibody levels in children and young adults and significantly low levels among adults aged 40 or over. A characteristic distribution of antibody titers in each age group was also demonstrated.

The aim of this study was to assess immunity levels against tetanus in the areas of 26 health centers in Samsun, Antalya, and Diyarbakir in Turkey in 2000 - 2001. The study group consisted of 2,465 healthy subjects aged 6 months old or above, randomly selected from each age group in the area. Of these, a total of 2,094 (85.0%) serum samples were assayed for tetanus antibody; 716 were from Antalya, 706 were from Diyarbakir, and 672 were from Samsun. The surveys were implemented in three steps: physical examination, interview, and blood collection. ELISA-in-house was used as a screening procedure and a particle agglutination test was used to reassess antibody titers of 1.0 IU/ml or below. It was revealed that 73.5% subjects had the full protection level (/=0.1 IU/ml) of antibody in Antalya, 59.9% in Diyarbakir, and 75.0% in Samsun, indicating that protection against tetanus was significantly lower in Diyarbakir than in Antalya and Samsun. The results also showed that the percentage of protective levels decreased with increasing age in three provinces and was higher in rural areas than urban areas in Diyarbakir. The study indicates that the immunity levels against tetanus can be considered as satisfactory among children and adolescents but that it is necessary to increase immunity against tetanus among adults through effective vaccination of pregnant women and those in military service and also among people older than 40 years of age.

The aim of this study was to indicate the presence of tick-borne encephalitis (TBE) in an endemic area for Crimean-Congo haemorrhagic fever (CCHF) in Turkey. Of 39 CCHF suspected cases, one was found to be TBE virus Immunoglobulin M positive and seven were TBE virus immunoglobulin G positive. It is important to report this first appearance of the TBE virus in Turkey since 1967.

In 2010, 47 human cases of West Nile virus (WNV) infection, including 12 laboratory-confirmed and 35 probable cases, were identified in Turkey. These were the first cases detected during routine surveillance. The patients were from 15 provinces, mainly located in the western part of the country. Incidence was 0.19/100,000 with a maximum of 1.39 in Sakarya province. Forty of the total 47 cases showed neuroinvasive manifestation. Median age was 58 years with a range of four to 86. Ten of the patients died. Enhanced surveillance in humans and animals and mosquito control measures were implemented. The WNV infections were included in the national notifiable diseases list as of April 2011. In 2011, three probable and two confirmed cases of WNV infection were diagnosed in provinces where infections had been detected in the previous year, supporting a lower activity than 2010. However, detection of WNV infections in humans in 2010 and 2011 consecutively, may indicate that WNV has become endemic in the western part of Turkey. Field epidemiological studies were undertaken to understand more about the nature of infection in Turkey.