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Objective: Most patients with coronavirus disease (COVID-19) have abnormalities of lymphocyte subsets. This study aimed to determine the distribution of lymphocytes in patients with various severity levels of COVID-19 and to describe the relationship between the CD4+ T helper and prognosis. Materials and Methods: Adult (>18 years old) patients with COVID-19 who followed up in a tertiary hospital were included in the study prospectively. Demographic and clinical characteristics of the patients were obtained from the hospital records. Peripheral flow cytometry was studied in patients with different severity of COVID-19 and different prognoses. Next, we analyzed the characteristics and predictive values of lymphocyte subsets in COVID-19 patients. Results: Totally 86 patients were included in the study, of which 21 (24.4%) had asymptomatic, 23 (26.7%) had mild/moderate, and 42 (48.8%) had severe/critical COVID-19. Severe/critical patients had lower lymphocyte levels and older age than asymptomatic patients (p

© 2021 by Associação Paulista de Medicina.BACKGROUND: Coronavirus disease 2019 (COVID-19) is an ongoing global health threat. However, currently, no standard therapy has been approved for the disease. OBJECTIVES: To evaluate the clinical effectiveness of convalescent plasma (CP) in patients with acute respiratory distress syndrome (ARDS) due to COVID-19. DESIGN AND SETTING: Retrospective study conducted at Kayseri City Education and Research Hospital, Kayseri, Turkey. METHODS: The case group consisted of adult patients (> 18 years) with ARDS due to COVID-19 who received CP in combination with antiviral and supportive treatment. These patients were compared with others who only received antiviral and supportive treatment. RESULTS: During the study period, a total of 30 patients with ARDS due to COVID-19 were included. Eleven patients (36%) received CP in combination with antiviral and supportive treatment, whereas nine-teen patients (64%) in the control group only received antiviral and supportive treatment. On admission, the median age, demographic and clinical data and initial laboratory test results were similar between the groups (P > 0.05). On the 14th day of treatment, the laboratory values remained similar between the groups (P > 0.05). The mortality rates were not significantly different between the groups. CONCLUSION: CP treatment did not affect mortality or lead to clinical improvement for COVID-19 patients with ARDS.

Human coronaviruses (HCoV) were first described in the mid-1960s. HCoV is an enveloped RNA virus with a single chain and positive polarity. The name “corona” comes from the crown-like spikes on the surface of the virus. Four major subgroups are known as follows: alpha, beta, gamma and delta. Subtypes of coronaviruses circulating in humans (HCoV-229E, HCoV-OC43, HCoV-NL63 and HKU1-CoV) are mostly viruses that cause colds. Coronaviruses are zoonotic viruses that infect many mammals and birds [1]. There are many coronaviruses that have not been transmitted to humans yet but are detected in animals. Before the virus (most likely a bat virus) gained the ability to infect humans, it jumps an intermediate host as occurred in previous outbreaks. It has been revealed that for emerge of SARS-CoV (Severe acute respiratory syndrome), civet cats played an imported role for transmission of disease to humans, whereas one-humped camels played an intermediate host for MERS-CoV (Middle East Respiratory Syndrome) [2]. SARS-CoV was first defined in February 2003 in Asia (Guandong, China) and has spread to more than two dozen countries in North and South America, Europe and Asia. In about eight months, 8098 people are infected, and 774 people died. Since 2004, to our knowledge, there have been no new cases reported in the world. MERS- CoV also causes a severe respiratory disease with symptoms of fever, cough and shortness of breath. The disease was seen for the first time in September 2012 in Saudi Arabia, and all the patients with MERS- CoV had a history of travel or residence in the Arabian Peninsula and nearby countries. Outside the Arabian Peninsula, the disease was seen in the Republic of Korea in 2015. Again, the outbreak was associated with a traveler returning from the Arabian Peninsula. To date, 2494 people have been infected, and there 858 related deaths were reported related to MERS [2, 3].

Copyright © 2022 by The Korean Society of Infectious Diseases, Korean Society for Antimicrobial Therapy, and The Korean Society for AIDS.Background: Bacteremia is a common complication in hematopoietic stem cell transplant (HSCT) recipients. Prophylactic fluoroquinolone is recommended and used in these individuals. Breakthrough infections can occur with fluoroquinolone-resistant strains. We aimed to identify the incidence, resistance, and risk factors for bacteremia in HSCT recipients receiving fluoroquinolone prophylaxis. Materials and Methods: This retrospective study was performed on patients who received fluoroquinolone prophylaxis and underwent autologous and allogeneic HSCT between 2015 and 2019. The incidence of bacteremia, comorbidity, treatment, and invasive procedures was compared in these patients with and without bacteremia. Results: There were 553 patients included in the study, 68 (12.3%) had bacteremia. The incidence of bacteremia is 8.2% of autologous HSCT recipients and 18.4% of allogeneic HSCT recipients. The significant risk factors associated with bacteremia were steroid-using (odds ratio [OR]:13.83, 95% confidence interval [CI]: 2.88 - 66.40), higher Charlson Comorbidity Index (CCI)-mean (OR: 1.57, 95% CI: 1.15 - 2.16), diabetes mellitus (OR: 4.29, 95% CI: 1.11 - 16.48) in autologous HSCT, steroid-using (OR: 6.84, 95% CI: 1.44 - 32.33), longer duration of neutropenia (OR: 1.05, 95% CI: 1.01 - 1.09) using central venous catheter (OR: 7.81, 95% CI: 1.00 - 61.23) in allogeneic HSCT. Seventy-three pathogens were isolated from a total of 68 bacteremia episodes. The most commonly occurring agents were Escherichia coli, Klebsiella pneumoniae and Enterococcus spp. Resistance to fluoroquinolones was 87.2%, 70.0% and 60.0% among these strains, respectively. Conclusion: High CCI, diabetes mellitus, use of steroids and long-term neutropenia and use of central venous catheters were significantly associated with the breakthrough bacteremia in HSCT recipients receiving fluoroquinolone prophylaxis. Fluoroquinolone prophylaxis may reduce the incidence of bacteremia but may select strains resistant to fluoroquinolone.

Aim: To investigate whether C-reactive protein/albumin ratio (CAR) has an association with new onset atrial fibrillation (NOAF) in SARS-CoV-2. Materials & methods: This study included 782 patients with SARS-CoV-2 infection, who were hospitalized in Turkey. The end point of the study was an occurrence of NOAF. Results: NOAF was identified in 41 patients (5.2%). Subjects who developed NOAF had a higher CAR compared with those who did not develop NOAF (p

ÖzetAmaç:Karbapeneme dirençliKlebsiella pneumoniae(KDKp), dünya çapında hastane kaynaklı infeksiyonların önde gelen etkenlerinden biridir. Yüksek mortaliteyle seyreden kan dolaşımı infeksiyonları (KDİ)’na neden olmaktadır. Artan çoklu ilaç direncine bağlı olarak, tedavi seçenekleri çok sınırlıdır ve prognoz kötüdür. Bu çalışmanın amacı KDKp’nin etken olduğu KDİ’lerde mortalite için risk faktörlerini değerlendirmektir.Yöntemler:Eylül 2013 ile Ekim 2017 tarihleri arasında üçüncü basamak bir hastanede KDKp’ye bağlı kan dolaşımı infeksiyonu geçiren erişkin (>16 yaş) hastalar retrospektif olarak değerlendirildi. Hastaların demografik verileri, Charlson komorbidite indeksi (CKİ), yatış tarihinde ve infeksiyon günüde “acute physiology and chronic health evaluation” (APACHE II) skoru üreyenK. pneumoniae suşlarının minimum inhibitör konsantrasyonu (MİK) değerleri, antibiyotik tedavisi ve sonuçları (30 günlük mortalite) elektronik veri tabanlarından kaydedildi.Bulgular:Çalışma süresi boyunca toplam 82 hasta takip edildi. Medyan yaş 54.5’ti ve 48 (%58.5)’i erkekti. İnfeksiyon günü medyan APACHE II skoru 14 (IQR 6-28) ve CKİ 4.0 (IQR 0-12) idi. Kırk altı (%56.1) hastada YBÜ kaynaklı KDİ, 36 (% 43.9)’sında santral kateterle ilişkili KDİ ve 25 (% 30.5)’inde primer KDİ vardı. Elli (%61.0) hastada kombinasyon tedavisi uygulanırken en sık kullanılan antibiyotik kombinasyonu kolistin/tigesiklin (% 28) idi. Hastane ve yoğun bakım mortalite oranları sırasıyla %56.1 (46/82) ve %65.2 (30/46) idi. Tek değişkenli analizde, KDKp-KDİ ilişkili mortalite için risk faktörleri; yüksek CKİ, tedavinin beşinci gününde klinik yanıtsızlık, hastaneye yatış ve infeksiyon tarihinde yüksek APACHE II skoru olarak bulundu (p<0.05). Çok değişkenli analizde; mortalite için en önemli risk faktörü infeksiyon gününde APACHE II skoru idi (OR: 1.190; %95 CI: 1.088-1.301). Kombinasyon tedavisi veya monoterapinin sağkalım üzerine anlamlı bir etkisi yoktu. Ayrıca, KDKp suşlarının MİK değerleri mortaliteyle ilişkili bulunmadı.Sonuçlar:KDKp-KDİ’nın hastane mortalitesi %56.1 idi. İnfeksiyon gününde APACHE II skoru mortalite için en önemli prognostik faktördü. Mortalite oranı, kombinasyon (%54.3) ve monoterapi (%45.7) alan hastalar arasında benzerdi.

© 2020 Elsevier Inc.Background: There is limited data concerning the prevalence of arrhythmias, particularly atrial fibrillation (AF), which may develop as a consequence of direct myocardial injury and the inflammatory state existing in COVID-19. Methods: This single-center study included data concerning 658 COVID-19 patients, who were hospitalized in our institute, between April 20th, 2020 and July 30th, 2020. Demographic data, findings of the imaging studies, and laboratory test results were retrieved from the institutional digital database. Results: New onset AF (NOAF) was identified in 33 patients (5%). Patients who developed AF were older (72.42 ± 6.10 vs 53.78 ± 13.80, p < 0.001) and had higher frequencies of hypertension and heart failure compared to patients without NOAF (p < 0.001, for both). The CHA2DS2-VASc score was higher in patients, who developed NOAF, compared to those who did not during hospitalization for COVID-19 (p < 0.001). Subjects, who developed NOAF during hospitalization, had a higher leukocyte count, neutrophil / lymphocyte ratio (NLR), C-reactive protein, erythrocyte sedimentation rate, and procalcitonin levels compared to those without NOAF (p < 0.001 for all comparisons). Diffuse lung infiltration was also more frequent in COVID-19 patients, who developed NOAF, during hospitalization (p = 0.015). Multivariate logistic regression analysis demonstrated that age, CHA2DS2-VASc score, CRP, erythrocyte sedimentation rate, and presence of diffuse lung infiltration on thorax CT were predictive for NOAF. Conclusion: The prevalence of NOAF in hospitalized COVID-19 patients is higher than the general population. Age, CHA2DS2-VASc score, C-reactive protein, erythrocyte sedimentation rate, and presence of diffuse lung infiltration on thorax CT may be used to identify patients at high risk for development of NOAF. Especially among these parameters, the presence of diffuse lung infiltration on thorax CT it was the most powerful independent predictor of NOAF development.

BK polyomavirus (BKPyV) infections are an important cause of morbidity and mortality after hematopoietic stem cell transplantation (HSCT). Hemorrhagic cystitis (HC) may occur in patients undergoing HSCT due to the BKPyV reactivation. This study aimed to assess risk factors, clinical characteristics and treatment options of BKPyV infections after HSCT. A total of 54 patients with HSCT were retrospectively evaluated and BKPyV disease was found in 24 (44%). HC was seen in 20 (83%) of patients with BKPyV disease. The median age of patients was 42 and 50% of them were male. The most common underlying disease was Acute Myeloid Leukemia (62%). Five patients had autologous and 15 patients had allogeneic HSCT. The median time to engraftment was 15 days. GVHD was seen only in 7 patients. The median time elapsed to BKPyV disease after HSCT was found as 60 days. Nineteen patients with BKPyV disease had grade 3 and one patient had grade 2 HC. While BKPyV viremia was positive in five patients, viruria was detected in all patients. Eighteen (75%) of the patients with BKPyV disease were treated with cidofovir (5mg/kg IV) and 11 with ciprofloxacin (800 mg/day). Four of the patients who received intravesical cidofovir (dose). The complete response was obtained 53% of patients with BKPyV disease. In conclusion, BKPyV disease is an emerging clinical problem after HSCT causing morbidity and mortality. It can develop especially in the early period after allogeneic stem cell transplantation. This situation has been associated with the use of immunosuppressive treatments after transplantation. Close monitoring of BK virus in high-risk patients can be an important method to improve the complication in the early period.

Objective: Bloodstream infection (BSI) is one of the major causes of morbidity and mortality associated with sepsis in the world. The aim of this retrospective study is to investigate positive blood cultures in adult patients with fatal outcome, and to evaluate the results of their blood cultures, the etiology of bacteremia and whether they received appropriate antimicrobial therapy or not.

Background Fungal pneumonia is a common infectious complication of hematological cancer (HC) patients. In this retrospective study, the objective was set to identify the risk factors and outcome of fungal pneumonia in adult HC patients. Materials and Methods This retrospective study was conducted with adult (>16 years) HC patients from January 2017 and December 2018. Results During the study period, of 181 patients included 76 were diagnosed with fungal pneumonia. The most common HC was identified as acute myeloid leukaemia (40%). Of the participating patients, 52 (29%) were hematopoietic stem cell transplant (HSCT) recipients. The median age of patients with fungal pneumonia was significantly greater: 57 vs. 48 (odds ratio [OR]: 1.08) and they had longer hospitalization durations (OR: 1.14). Overall, 37 patients (20%) died, and 28-day mortality was significantly greater among patients with fungal pneumonia than without fungal pneumonia (33% vs. 11%). The most significant risk factors for mortality in fungal pneumonia were identified as need of intensive care unit (ICU) (OR: 191.2, P

BackgroundTuberculous meningitis (TBM) represents a diagnostic and management challenge to clinicians. The“Thwaites’ system” and “Lancet consensus scoring system” are utilized to differentiate TBM from bacterial meningitis but their utility in subacute and chronic meningitis where TBM is an important consideration is unknown.MethodsA multicenter retrospective study of adults with subacute and chronic meningitis, defined by symptoms greater than 5 days and less than 30 days for subacute meningitis (SAM) and greater than 30 days for chronic meningitis (CM). The “Thwaites’ system” and “Lancet consensus scoring system” scores and the diagnostic accuracy by sensitivity, specificity, and area under the curve of receiver operating curve (AUC-ROC) were calculated. The “Thwaites’ system” and “Lancet consensus scoring system” suggest a high probability of TBM with scores ≤4, and with scores of ≥12, respectively.ResultsA total of 395 patients were identified; 313 (79.2%) had subacute and 82 (20.8%) with chronic meningitis. Patients with chronic meningitis were more likely caused by tuberculosis and had higher rates of HIV infection (P P P ConclusionBoth criteria can be helpful in distinguishing TBM from bacterial meningitis, but only the Lancet consensus scoring system can help differentiate TBM from meningitis caused by fungal, viral and unknown etiologies even though significant overlap occurs and the overall diagnostic accuracy of both criteria were either poor or fair.

The antibiotic colistin, which had been previously abandoned, is being brought back as a last line of defense against bacterial infection. However, colistin resistance was reported shortly after its reintroduction. This study evaluated the risk factors for colonization/infections due to colistin-resistant Acinetobacter baumannii (ColR-Ab) and Klebsiella pneumoniae (ColR-Kp) strains and characterized the molecular epidemiology of these two strains.Age, previous hospitalization duration, and previous use of carbapenem and colistin were risk factors for ColR-Kp, whereas previous use of carbapenem and colistin was a risk factor for ColR-Ab. According to pulsed-field gel electrophoresis analysis, most ColR-Kp strains could be grouped into two major pulsotypes. This appears to be an indicator of cross contamination of ColR-Kp strain, since different isolates appeared to be belonging to the same clones. The existence of colistin-susceptible (ColS) and colistin-resistant (ColR) strains in the same pulsotypes might also be an indicator of the recent emergence of resistance mechanisms.The results highlight the emergence of ColR pathogens in Turkey, which is considered to be developing country, and that carbapenem use coupled with insufficient infection control measures might increase the risk of ColR outbreaks.

Background: The aim of this study is to assess the clinical and microbiological features of infections in patients with morbidly adherent placenta (MAP) treated by leaving placenta in situ (LPIS). Materials and methods: Retrospective analysis of MAP cases who were treated by LPIS between 2 May 2010 and 15 March 2017. The inclusion criteria were gestational age at or above 24 weeks, prenatal diagnosis, elective operation, and complete data. Results: Nineteen MAP cases were treated by LPIS during the study period. The mean +/- SD duration for total placental resorbtion was 145 +/- 47 days. Three patients were readmitted to the hospital because of fever (3/19). A total of 65 culture samples were taken from the patients during their follow- up periods. In four cases (4/12) cervical cultures showed positive growth [Escherichia coli (2), Klebsiella pneumoniae (1), mixed culture with Enterococcus spp. and E. coli (1)]. Fifteen (15/26) urine samples were sterile, three were polymicrobial. In eight cases, urine culture revealed E. coli growth (one E. coli and Enterococcus spp.). Three out of 16 (3/16) surgical incision samples revealed growth of E. coli. No bacterial growth was detected in blood cultures. Susceptibility results of Gram-negatives indicate that the resistance rates of beta-lactam antibiotics are high (14/20, 70%). No secondary surgical intervention occurred during the study period due to infection. Conclusions: Majority of postpartum cervical discharge, fever, and increased CRP levels do not represent morbid infections and/or sepsis. With early detection, and implementation of antibiotherapy (combination of an aminoglycoside and clindamycin), they can be easily controlled and secondary surgical interventions can be prevented.

Objective: In this study, serovar distributions and antimicrobial resistance profiles of Salmonella strains isolated from clinical samples of patients admitted to our hospital between 2013 and 2016 were evaluated.

OBJECTIVE: Patients in surgical intensive care units are thought to be at the highest risk for developing candidemia, especially patients undergoing abdominal surgery. The present study aims to investigate risk factors for candidemia in patients with abdominal surgery. METHODS: A retrospective study was undertaken that involved patients admitted to the surgical ICU between January 2016 and January 2017. All postoperative adult patients (>18 years old) who underwent abdominal surgery were included in this study. RESULTS: During the one-year study period, 49 patients developed candidemia. Thirty-five of candida isolates were non-albicans strains. Of them, 25 (51%) isolates were Candida parapsilosis, eight (16.3%) isolates were C. glabrata, one (2%) isolate was C. tropicalis and one (2%) isolate was C. kefyr. The median age of all patients enrolled in this study was 60.5+-15.6 years. In univariate analysis, the duration of the hospital stays, intensive care unit stay, type of surgery, respiratory failure, total parenteral nutrition, transfusion and use of central venous catheter were significantly higher in patients with candidemia. In multivariate analysis, duration of hospital and intensive care unit stay and use of central venous catheter was associated with an increased risk of candidemia. The mortality rate of case patients was 36.7%. CONCLUSION: Patients undergoing abdominal surgery are at increased risk of candidemia, especially the patients with prolonged intensive care unit/hospital stay and the patients with a central venous catheters. Antifungal prophylaxis may be considered for patients with increased risk.

Objective: Timely diagnosis is crucial for successful treatment of infections. Contemporarydiagnostics of clinically significant infections relies on a variety of laboratory-based tests.However, the routine microbiological methods, per se are not always confirmatory for theaccurate diagnosis in some cases with a significant time delay. Rapid detection of causativeagents using nanopore-based metagenomic sequencing is reported in a case of suspectedtuberculosis not confirmed using conventional microbiology diagnostics, and in a case ofsuspected brucellosis with delayed confirmation by conventional microbiology.Materials and Methods: This report includes two cases. Patient-1 was clinically diagnosedwith peritoneal tuberculosis while Patient-2 had relapsing brucellosis. Cultures and PCRwere negative for the peritoneal fluid of Patient-1. Serological determinants for brucellosiswere under the thresholds for Patient-2. The blood culture was positive for Brucella spp;however, the results were available only after seven days. Peritoneal fluid and blood samplewere obtained from Patient-1 and Patient-2, respectively. Total DNA was extracted usingcommercial kits. Shotgun metagenomic sequencing was performed using Oxford NanoporeTechnologies. Read-event data were base-called by the software Metrichor using workflowv2.39.3.Results: For Patient-1, the first Mycobacterium tuberculosis reads were confidently detected in20 minutes, for Patient-2 the first Brucella melitensis read was detected at 30-minutes-timepoint. Overall, the pathogens were detected within 6 hours. We demonstrated a real-timenanopore sequencing technology for the rapid detection of infectious agents in two crucialcases where traditional microbiological methods failed to reveal the pathogens.Conclusion: In this report, we present that real-time sequencing can not only detectconventionally unrevealed pathogens, but it can achieve this in a tight time-frame.Therefore, it could be said that the nanopore sequencing has the promise to enhance ourability to diagnose infectious diseases.

Brucellosis is a common zoonotic disease with high morbidity. In the majority of human cases, the causative agent is B. melitensis. Infection is transmitted to humans by direct/indirect contact with the contaminated animal products (e.g., consumption of unpasteurized milk), infectious aerosols and aborted fetus. Brucellosis often affects middle-aged adults and young people. Patients with brucellosis tend to have non-specific symptoms, including fever, chills, night sweats, joint pain and myalgia. Brucellosis affects various organs and tissues. The osteoarticular system is one of the most commonly described affected systems in humans. In several clinical studies, the prevalence of Osteoarticular Brucellosis (OB) is reported as 2-77%. Most important osteoarticular clinical forms osteomyelitis, spondylitis, sacroiliitis, arthritis and bursitis. Spondylitis and spondylodiscitis are the most frequent complications. Spondylodiscitis often affects the lumbar (especially at the L4- L5 levels) and low thoracic vertebrae than the cervical spine. Back pain and sciatica radiculopathy are the most common complaints about patients. Sacroiliitis is associated with severe pain, especially back pain in affected individuals. Spinal destructive brucellar lesions are also reported in adults in previous studies. Brucellosis is diagnosed with clinical inflammatory signs (eg. tenderness, pain) of the affected joints together with positive serological tests and positive blood/synovial fluids cultures. Serological test measures the total amount of IgM/IgG antibodies. Standard agglutination test (SAT) titer ≥1: 160 is in favor of brucellosis diagnosis. Enzyme-Linked Immunosorbent Assay (ELISA) and Polymerase chain reaction (PCR) are other types of diagnostic tests. Radiological assessments, such as joint sonography, computed tomography, magnetic resonance imaging, are the most helpful radiological methods to diagnose spinal brucellosis. The agents commonly used in the treatment of brucella spondylitis are doxycycline, streptomycin, gentamicin, ciprofloxacin, trimethoprim/sulfamethoxazole and rifampicin. The recommended regimens for treatment of brucella involve two or three antibiotics combinations. No standard treatment, physicians prescribe drugs based on conditions of the disease. Patients need a long-term (usually at three months) antibiotic therapy for mainly aiming to prevent relapses. Surgery may be required for patients with spinal abscess. This review focused on physicians' awareness for osteoarticular involvement, clinical presentation, diagnosis and current treatment of OB.

Mucormycosis is a rare, life-threatening opportunistic infection caused by Mucorales. The most common organisms that cause mucormycosis in humans are Rhizopus, Mucor, Rhizomucor, Lichtheimia (Absidia), and Cunninghamella. Risk factors for the disease include diabetes mellitus, metabolic acidosis, hematologic malignancies, prolonged severe neutropenia, use of corticosteroids, and human immunodeficiency virus infection. Diagnosis and treatment of infection are difficult.

Brucellosis is an ancient disease caused by brucellae, which are small, facultative, intracellular, gram-negative coccobacilli. Ten species of Brucella have been identified as the causative agents of brucellosis in mammalian hosts. Natural infections with Brucellae occur globally among humans and animals, resulting in significant economic losses. Research in recent years has focused on appropriate methods for environmental sampling, early detection techniques, decontamination procedures, and the development of new therapeutics and vaccines. Despite this research focus, there is still no human vaccine available. This is of particular concern as Brucellae are highly infectious via the aerosol route; therefore, they have the potential to be misused as agents of biological warfare. The global biological terrorist risk is increasing yearly due to a number of factors including increased migration, escalating numbers of displaced people, the speed and scale of global travel, and technological advances which have enhanced our ability to manipulate pathogens. Presented are a review of the recent developments in brucellosis research and an evaluation of the risks associated with the use of brucellae in deliberate biological attacks.

We aimed to develop a scoring system for predicting in-hospital mortality of community-acquired (CA) sepsis patients. This was a prospective, observational multicenter study performed to analyze CA sepsis among adult patients through ID-IRI (Infectious Diseases International Research Initiative) at 32 centers in 10 countries between December 1, 2015, and May 15, 2016. After baseline evaluation, we used univariate analysis at the second and logistic regression analysis at the third phase. In this prospective observational study, data of 373 cases with CA sepsis or septic shock were submitted from 32 referral centers in 10 countries. The median age was 68 (51-77) years, and 174 (46,6%) of the patients were females. The median hospitalization time of the patients was 15 (10-21) days. Overall mortality rate due to CA sepsis was 17.7% (n = 66). The possible predictors which have strong correlation and the variables that cause collinearity are acute oliguria, altered consciousness, persistent hypotension, fever, serum creatinine, age, and serum total protein. CAS (%) is a new scoring system and works in accordance with the parameters in third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). The system has yielded successful results in terms of predicting mortality in CA sepsis patients.

Multidrug resistance observed in microorganisms, especially in hospital-based pathogens, poses a serious public health threat. While scientists have not been able to develop a radical solution for the increasing antibiotic resistance problem, the search for treatment alternatives in appropriate clinical settings continues consistently. Although bacteriophage (phage) therapy was quite popular between 1920 and 1950, it has been abandoned in many parts of the world due to various reasons, nowadays it is again at the agenda and is at the forefront of alternative therapies. In this rediscovery process in area of infectious diseases and clinical microbiology, it is important to consider the interesting history of phage therapy, the reasons for abandonment, the advantages/disadvantages over antibiotics, and the concerns about deployment in clinical use.

Microbiology laboratories play an important role in epidemiology and infection control programs. Within microbiology laboratories, molecular microbiology techniques have revolutionized the identification and surveillance of infectious diseases. The combination of excellent sensitivity, specificity, low contamination levels and speed has made molecular techniques appealing methods for the diagnosis of many infectious diseases. In a well-equipped microbiology laboratory, the facility designated for molecular techniques remains indiscrete. However, in most developing countries, poor infrastructure and laboratory mismanagement have precipitated hazardous consequences. The establishment of a molecular microbiology facility within a microbiology laboratory remains fragmented. A high-quality laboratory should include both conventional microbiology methods and molecular microbiology techniques for exceptional performance. Furthermore, it should include appropriate laboratory administration, a well-designed facility, laboratory procedure standardization, a waste management system, a code of practice, equipment installation and laboratory personnel training. This manuscript lays out fundamental issues that need to be addressed when establishing a molecular microbiology facility in developing countries. (C) 2015 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Limited. All rights reserved.

Saprochaete capitata is a very rare pathogen that causes invasive disease particularly in patients with haematological malignancies. We recognised a clustering of S. capitata fungaemia in recent years. So, we report our 6-year surveillance study of fungaemia among patients with haematological malignancies and haematopoietic stem cell transplant. We performed a retrospective and observational study. Hospitalised patients aged >18 years with haematological malignancies were included in the study. A total of 51 fungaemia episodes of 47 patients were analysed. The characteristics of fungaemia in patients with S. capitata compared to patients with candidemia. Median duration of neutropenia was 21.5 days in patients with S. capitata fungaemia, whereas this duration was significantly shorter in patients with candidemia (8 days). Interval between first and last positive culture was significantly longer in patients with S. capitata fungaemia (P < 0.05). Previous use of caspofungin was significantly more common in patients with S. capitata fungaemia. Thirty-day mortality was found 40% for patients with candidemia, whereas it was 39% for patients with S. capitata. In conclusion, despite its limitations this study showed that a novel and more resistant yeast-like pathogen become prevalent due to use of caspofungin in patients with long-lasting neutropenia which was the most noteworthy finding of this 6-year surveillance study.

Crimean-Congo hemorrhagic fever (CCHF) is a fatal systemic viral infection which is an important health problem in Turkey. Many systemic symptoms have been reported including fever, hemorrhage, headache, fatigue, muscle ache, abdominal pain, nausea and vomiting. A 45-year-old male farmer with CCHF presented with massive peritoneal effusion and hyperbilirubinemia. To our knowledge, this is the first case of peritoneal effusion and hyperbilirubinemia in an adult patient with CCHF. His clinical symptoms successfully improved with supportive therapy. In patients who live in endemic areas with atypical presentation for the diagnosis of CCHF should be kept in mind.

Background Extensively resistant Acinetobacter baumannii has emerged and spread worldwide as a significant cause of health care-associated infections and outbreaks. It also causes life-threatening infections among neonates, including bacteremia. The aim of this study was to investigate an outbreak of A baumannii bacteremia (ABB) among neonates. Materials and methods A retrospective, case-control study was conducted from July 2014 to July 2015 in a neonatal intensive care unit (NICU). Risk factors associated with ABB in univariate and multivariate analysis with logistic regression was performed. Molecular typing by pulsed field gel electrophoresis was used to confirm relatedness of bacteremic A baumannii strains. Results During the 5-year period (2011-2016), 68 patients in our NICU were diagnosed with BSI due to A baumannii. The case-control study included 41 case patients within the outbreak caused by a major epidemic clone and 108 control patients. Risk factors (by univariate analysis) associated with ABB were intubation, 14-day mortality, and use of peritoneal dialysis and an umbilical catheter. Multivariate analysis identified 14-day mortality (odds ratio, 5.75; 95% confidence interval, 2.58-12.79) and umbilical catheter use (odds ratio, 2.44; 95% confidence interval, 1.1-5.4) as independent risk factors for ABB. Conclusions This outbreak of bacteremia due to resistant A baumannii affected 41 infants and was associated with 58% mortality. Control of the outbreak was achieved by implementing long-term sustained infection control measures within the unit.

Surveillance of candidemia is essential to monitor trends in species distribution and change in the incidence and antifungal resistance. In this study, we aimed to investigate prevalence, resistance rates, antifungal utilization and costs. A 6-year retrospective analysis of the data belonging to patients with candidemia hospitalized between 2010 and 2016 was performed. The annual usage of fluconazole and caspofungin and the usage of these antifungals in different units were described in defined daily doses (DDD) per 1000 patient days. In total, 351 patients of candidemia were included. Median age of the patients was 45 (0-88) and 55.1% of them were male. Overall, 48.1% of the candidemia episodes (169/351) were due to C. albicans, followed by C. parapsilosis (25.1%), C. glabrata (11.7%). Length of hospital stay was longer with a median of 20 days among patients with non-albicans candidemia. Presence of a central venous catheter was found to be an associated risk for candidemia caused by non-albicans strains. Annual incidence of candidemia increased from 0.10 to 0.30 cases/1000 patient days. Antifungal use was increased over years correlated with the cost paid for it. The policy against candidemia should be specified by each institution with respect to candidemia prevalence, resistance rates, antifungal use and costs.

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Brucellosis is a worldwide zoonosis caused by Brucella species. The disease remains a significant economic and public health problem particularly in the Mediterranean countries. Clinical manifestations of brucellosis are variable and often nonspecific, simulating infectious and noninfectious diseases. Osteoarticular involvement is the most common focal complication of brucellosis and morbidity. Mortality rate due to brucellosis is low, mostly secondary to endocarditis and central nerve involvement of disease. The diagnosis of brucellosis depends on the clinical presentations and laboratory tests. Detection of Brucella species by culture method is sometimes unsuccessful; therefore, serological tests are preferred. These tests are easy to perform, and results can be obtained within a short span of time. Several serologic tests have been developed for the diagnosis of human brucellosis, including the standard agglutination tube (SAT) test, anti-human globulin (Coombs) test, indirect fluorescence antibody (IFA) test, and enzyme-linked immunosorbent assay (ELISA). SAT is the primary test used in many clinical laboratories. IFA and ELISA are simple and reliable for the detection of immunoglobulin classes especially in complicated cases. Polymerase chain reaction (PCR) technique is highly sensitive and specific for the determination of Brucella spp. from peripheral blood and other tissues. Recent patents are especially based on molecular assays in the diagnosis of brucellosis. However, PCR is still expensive and may not be appropriate for daily practice.

Tularemia is a bacterial zoonotic disease. The etiologic agent is Francisella tularensis which is a gram negative coccobacillus and has an exceedingly low infectious dose. Natural infections with F. tularensis have been reported in a range of vertebrates including mammals, birds, amphibians and fish. Tularemia occurs in humans only in the northern hemisphere and most frequently in Scandinavian countries, northern America, Japan and Russia. It is also an epidemic disease in some part of Turkey. The infection is transmitted to humans by arthropod bites (ticks, flies, mosquitoes), by direct contact with infected animals, by contact with infected tissues or fluids of infectious animals, by ingestion of contaminated water or food or by inhalation of infective aerosols. Clinical forms are ulceroglandular or glandular, oculoglandular, oropharyngeal, respiratory and typhoidal forms. The diagnosis is based on the isolation of F.tularensis and/or positive serology. In the therapy, the first choice is an aminoglycosides (streptomycin or gentamicin) and alternative choice is ciprofloxacin or doxycycline. Duration of therapy is suggested as 10-14 days. A live attenuated vaccine is only in use some parts of the former Soviet Union but no licensed vaccine available.

Hantaviruses as a member of the family Bunyaviridae are RNA viruses with enveloped, negative-sense, singlestranded segmental genome. Today, more than 20 different hantavirus species are recognized. Eleven of them cause clinical symptoms in humans. While Hantaan (HTNV), Puumala (PUUV), Dobrava (DOBV), Seoul viruses causes different forms of hemorrhagic fever with renal syndrome (HFRS), Sin Nombre virus and Sin Nombre-like viruses found especially in the United States causes hantaviruses pulmonary syndrome (HPS) with high mortality. In our country, infections have been reported with subtypes of the hantaviruses firstly PUUV in the Western Black Sea region, then DOBV from Giresun and Kastamonu. A case of hantavirus infection similarly in the form of RSHF from the rural area of Kazan district in Ankara has been reported in this article. Sixty seven year old male patient was admitted to the emergency room with complaints of dizziness, fever and fatigue in June of 2011. Leukopenia, thrombocytopenia elevated liver enzymes and creatinine was detected in laboratory investigations at the emergency room. The patient was hospitalized and followed with initial diagnosis of Crimean-Congo hemorrhagic fever (CCHF). Further investigation of the serum samples at the Refik Saydam Hygiene Center and Research Laboratory of Virology with indirect immunofluorescent antibody (IFA) (Hantaviruses Mosaic-1, Euroimmun, Germany) resulted OZET Bunyaviridae ailesinin bir uyesi olan hantavirusler zarfli, negatif polariteli tek iplikli segmenter RNA genomuna sahiptirler. Gunumuzde 20’den fazla hantavirus turu tanimlanmistir. Bunlardan 11 tanesi insanda klinik bulgulara yol acmaktadir. Hantaan (HTNV), Puumala (PUUV), Dobrava (DOBV), Seoul virusleri farkli formlarda renal sendromlu kanamali atesi (RSKA) neden olurken, Sin Nombre virus ve Sin Nombre benzeri virusler ozellikle Amerika’da yuksek mortalite ile giden hantavirus pulmoner sendromundan (HPS) sorumludurlar. Ulkemizde, ilk olarak Bati Karadeniz bolgesinde PUUV alt tipine ait hantavirus olgulari, daha sonra Giresun ve Kastamonu’dan DOBV alt tipinde RSKA olgulari bildirilmistir. Bu makalede benzer sekilde RSKA formunda Ankara’nin Kazan ilcesinde gorulen hantavirus enfeksiyonu olgusu sunulmustur. 67 yasinda erkek hasta; bas donmesi, yuksek ates ve halsizlik sikâyetleri ile 2011 yili haziran ayinda acil servise basvurmustur. Acilde yapilan tetkiklerinde; lokopeni, trombositopeni, karaciger enzimleri ve kreatininde yukseklik saptanmistir. Hasta Kirim Kongo kanamali atesi (KKKA) on tanisiyla yatirilmis ve takip edilmistir. Ileri laboratuvar incelemeler icin Refik Saydam Hifzisihha Merkezi Baskanligi, Viroloji Referans ve Arastirma Laboratuvari’na gonderilen serumda indirekt immunflorasan testi (IFA) (Hantavirus Mosaic–1, Euroimmun, Germany) ile hantavirus IgM zayif pozitif, IgG zayif pozitif olarak sonuclanmistir. Immunoblot testi (Euroimmun, Turk Hijyen ve Deneysel Biyoloji Dergisi 1 Erciyes Univeristesi, Tip Fakultesi, Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji, KAYSERI 2 Refik Saydam Hifzissihha Merkezi Baskanligi, Viroloji Referans ve Arastirma Laboratuvari, ANKARA 3 Diskapi Yildirim Beyazit Egitim ve Arastirma Hastanesi, Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji, ANKARA Gelis Tarihi / Received : Kabul Tarihi / Accepted : Iletisim / Corresponding Author : Aysegul ULU-KILIC Erciyes Univeristesi, Tip Fakultesi, Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji, KAYSERI Tel : +90 505 445 11 32 E-posta / E-mail : draysegululu@yahoo.com 06.02.2012 03.05.2013 DOI ID : 10.5505/TurkHijyen.2013.50103 Ulu-Kilic A, Caglayik-Yagci D, Dede G, Tutuncu E, Uyar Y, Sencan I. Ankara Ili Kazan Ilcesi kirsal bolgesinden hantavirus enfeksiyonu olgusu. Turk Hij Den Biyol Derg, 2013; 70(1): 27-32. Cilt 70  Sayi 1  2013 Turk Hij Den Biyol Derg 28 Hantavirusler dogada kendine ozgu farkli rodent veya bocek yiyicilerle tasinan zarfli RNA virusleridir. Avrupa’da PUUV, DOBV ve Saarema (SAAV) olarak uc hantavirusun RSKA’ye neden oldugu bilinmektedir. PUUV, hafif seyirli RSKA ile iliskilidir. SAAV; Danimarka, Estonya, Finlanda Almanya, Rusya’da tespit edilmis fakat SAAV’nun neden oldugu RSKA olgusu rapor edilmemistir. DOBV, Apodemus flavicollis turu rodent ile tasinir ve Arnavutluk, Bosna Hersek, Cek Cumhuriyeti, Yunanistan’da bulunmustur. DOBV siddetli formda RSKA ile iliskilidir. RSKA’nin kulucka suresi ortalama 1–4 gun olup, tipik olarak atesli, hipotansif, oligurik, diuretik ve konvelasan donemlerden olusur. Bu donemlerin ayirimi her zaman klinik olarak belirgin degildir. Enfeksiyonun seyri subklinikten, olumle seyreden forma kadar cesitlilik gosterebilir, cesitli organlari etkileyerek yaygin hale gelebilir (1–3). Ulkemizde ise ilk olarak Zonguldak ve Bartin’da PUUV alt tipine ait hantavirus olgulari, daha sonra Giresun ve Kastamonu’dan DOBV alt tipinde olgular bildirilmistir (4–6). Bu makalede benzer sekilde RSKA formunda Ankara’nin Kazan ilcesinde gorulen hantavirus enfeksiyonu olgusu sunulmustur. Olgumuz, Ankara’dan bildirilen ilk RSKA olgusu olmasi nedeniyle onem tasimaktadir. OLGU Altmis yedi yasinda erkek hasta, hastaneye yatisindan 4–5 gun once baslayan bas donmesi ve yeni eklenen yuksek ates ve halsizlik sikâyetleri ile 2011 yili Haziran ayinda acil servise basvurmustur. Acilde yapilan tetkiklerinde; lokopeni, trombositopeni, karaciger enzimleri ve kreatininde yukseklik saptanmistir. Hasta KKKA on tanisiyla yatirilmis ve takip edilmistir. Ankara’nin Kazan ilcesi Dutozu Koyunde yasayan hasta ciftcilik ve hayvancilikla ugrasmaktadir. Hastanin klinigimize yatisinda yapilan ilk fiziksel muayenesinde genel durumu orta-iyi olup, vucut isisi; 38°C, KB 110/80 mmHg, nabiz 90/dak ve solunum sayisi 20/dak olarak izlenmistir. Hastanin laboratuvar bulgularinda beyaz kure sayisi 3.360/ mm3, hemoglobin 14,1g/dl, trombosit sayisi 118.000/ mm3 olup, periferik yaymasinda %87 polimorfonukleer lokosit (PNL), %4 lenfosit, %3 monosit, %3,5 eozinofil belirlenmistir. Hastanin basvurusunda ve takibinde izlenen laboratuvar bulgulari Tablo 1’de gosterilmistir. 24 saatlik idrarda proteinuri 1650 mg (normal 50–80 mg/gun) ve kreatinin 2.280 (800–2.000 mg/gun) tespit edilmistir. Abdominal ultrasonografi degerlendirmesinde ise karaciger ve dalak normal boyut ve eko yapisinda saptanmis, bilateral bobrek parankim ekolari grade 1 artmis, parankim kalinliklari GIRIS HANTAVIRUS OLGUSU Germany) ile ise negatif saptanmistir. Fakat hastanin 11 gun sonra gonderilen ikinci serumunda IFA testinin yani sira DOBV pozitifligi immunblot testi ile de serolojik olarak gosterilmistir. Hastanin ilk serum orneginden yapilan realtime (RT) polimeraz zincir reaksiyonu (PZR) testi negatif olarak bulunmustur. Olgumuz, Ankara’dan bildirilen ilk RSKA enfeksiyonu olmasi nedeniyle onem tasimaktadir. Anahtar Kelimeler: Hantavirus, renal sendromlu kanamali ates in weakly positivity of anti-hantavirus IgM and IgG. The first serum samples revealed negative by immunoblot test (Euroimmun, Germany). After 11 days the second sample of the patient revealed DOBV positivite with both IFA and immunoblot serologically. In-house RT Polymerase chain reaction (PCR) test was found to be negative in the first serum sample of the patient. This case is important of being the first HFRS infection reported from Ankara.

A 66-year-old female patient with multiple myeloma (MM) was admitted to the emergency service on 29.09.2014 with an inability to walk, and urinary and faecal incontinence. She had previously undergone autologous bone marrow transplantation (ABMT) twice. The patient was hospitalized at the Department of Haematology. Further investigations showed findings suggestive of a spinal mass at the T5-T6-T7 level, and a mass lesion in the iliac fossa. The mass lesion was resected and needle biopsy was performed during a colonoscopy. Examination of the specimens revealed plasmacytoma. The patient also had chronic obstructive pulmonary disease (COPD) and was suffering from respiratory distress. After consultation with an infectious diseases specialist the patient was placed on an intravenous antibiotherapy with piperacillin/tazobactam (4.5g x 3) on 17.10.2014. During piperacillin/tazobactam treatment, the patient suffered from drowsiness, her general condition deteriorated, and she had rales on auscultation of the lungs. The patient underwent thoracic computerized tomography (CT) which showed areas of focal consolidation in the lower lobes of the two lungs (more prominent on the left), and increased medullary density. The radiology report suggested that fungal infection could not be ruled out based on the CT images. The sputum sample was sent to the mycology laboratory and direct microscopic examination performed with Gram and Giemsa staining showed the presence of septate hyphae; therefore voriconazole was added to the treatment. Slow growing (at day 10), grey-greenish colonies and red pigment formation were observed in all culture media except cycloheximide-containing Sabouraud dextrose agar (SDA) medium. The isolate was initially considered to be Talaromyces marneffei. However, it was subsequently identified by DNA sequencing analysis as Talaromyces purpurogenus. The patient was discharged at her own wish, as she was willing to continue treatment in her hometown. Unfortunately, the patient died on December 8, 2014. In conclusion, apart from T. marneffei, less common strains such as T. purpurogenus should be considered when clinical samples obtained from patients with haematologic/oncologic disorders show fungal colonies that form red pigments on the culture media and when microscopic examination suggests a morphological appearance similar to Penicillium species.

Background The screening of critically ill patients at high risk of vancomycin resistant enterococci (VRE) colonization, to detect and isolate colonized patients, is recommended to prevent and control the transmission of VRE. Screening asymptomatic carriers brings financial burden for institutions. In this study, we performed risk analysis for VRE colonization and determined the financial burden of screening in a middle-income country, Turkey. Methods We retrospectively analyzed the VRE surveillance data from a pediatric hospital between 2010 and 2014. A case-control study was conducted to identify the risk factors of colonization. Total cost of VRE screening and additional costs for a VRE colonized patient (including active surveillance cultures and contact isolation) were calculated. Results During the 4-year period, 6,372 patients were screened for perirectal VRE colonization. The rate of culture-positive specimens among all patients screened was 239 (3.75%). The rate of VRE infection was 0.04% (n = 3) among all patients screened. Length of hospital stay, malignancy, and being transferred from another institution were independently associated risk factors for colonization. Annual estimated costs for the laboratory were projected as $19,074 (76,295/4) for all patients screened. Cost of contact isolation for each patient colonized in a ward and an intensive care unit was $270 and $718, respectively. Conclusions In developing countries, institutions should identify their own high-risk patients; screening priorities should be based on prevalence of infection and hospital financial resources.

Objective: We aimed to describe the risk factors for fatality among the patients with Acinetobacter baumannii bacteremia. Methods: Patients with a positive blood culture for A. baumannii by BacT/Alert (bioMerieux, Durham, NC) system were selected. Surviving and nonsurviving patients were compared in terms of demographic characteristics, underlying diseases, invasive procedures, and antibiotic resistance of the microorganisms. Therapies were evaluated according to the results of antibiotic susceptibility tests, and impact of inappropriate therapies for A. baumannii bacteremia was evaluated statistically. Results: Of the 40 patients enrolled, 21 (52.5%) died due to A. baumannii bacteremia. Univariate analysis of risk factors for fatality revealed the following parameters to be significant: >50 years of age, an APACHE II score >16, and transfer from one unit to another more than once (p 16. Overall imipenem resistance in A. baumannii was 67.5%, and carbapenem resistance among fatal cases was 76%. When the antibiotic sensitivity results were assessed, it was noted that 70% of the patients had been receiving inappropriate therapy. However, the antibiotic therapy received or initiated empirically was not shown to be a significant risk factor for mortality (p>0.05). Conclusions: Knowing the risk factors that indicate mortality in such patients and ensuring early diagnosis are of critical importance with respect to prognosis. Starting appropriate therapy by making the right decisions regarding the severity of acute and un

Skin infections caused by Paecilomyces species have been rarely described in patients with solid organ transplantation. Cutaneous manifestations are highly variable and include erythematous macules, nodules, pustules, and vesicular and necrotic lesions. The diagnosis of these infections is generally made by examination of a skin biopsy. Management of these fungal infections is difficult due to the immunocompromised state of the patients. Moreover, antifungal therapy and immunosuppressive drug interactions should be considered during treatment management. Herein, we reported a case of cellulitis caused by Paecilomyces variotii in a 56-year-old man who had undergone a kidney transplantation. Erythematous macular and nodular lesions on the left hand and left foot appeared first; within 2 months the skin lesions became ulcerated, hemorrhagic, and progressively painful and the patient was admitted to our hospital. The diagnosis was made by skin biopsy and tissue culture. The skin lesions resolved by the sixth week of the treatment with voriconazole.

WOS: 000384527500014, PubMed ID: 27625226, Aims: There is no report on the factors affecting the resolution of symptoms related to meningitis during treatment of tuberculous meningitis (TBM). Thus, we examined the factors associated with early therapeutic responses. Materials and Methods: This multicenter study included 507 patients with microbiologically confirmed TBM. However, 94 patients eligible for the analysis were included in this study from 24 centers. Six out of 94 patients died and the statistical analysis was performed with 88 survivors. Early and late responder groups were compared in the statistical analysis. P < 0.05 were considered to show a significant difference. Results: In the multivariate analysis, the presence of vasculitis (P = 0.029, OR = 10.491 [95% CI, 1.27u86.83]) was found to be significantly associated with a delayed fever response whereas hydrocephalus was associated with altered mental status for 9 days duration (P = 0.005, OR = 5.740 [95% CI, 1.68u19.57]). According to linear regression analysis, fever was significantly persisting (7 days) in the presence of vasculitis (17.5 vs. 7, P< 0.001) and hydrocephalus (11 vs. 7, P = 0.029). Hydrocephalus was significantly associated with persisting headache (21 vs. 12, P = 0.025), delayed recovery of consciousness (19.5 vs. 7, P = 0.001), and a delay in complete recovery (21 vs. 14, P = 0.007) in the linear regression analysis. Following institution of treatment, the complaints seemed to disappear in up to 2 weeks among TBM survivors. Conclusions: In the absence of hydrocephalus or vasculitis, one week of anti-tuberculosis treatment seems to be adequate for the resolution of TBM symptoms. Hydrocephalus and vasculitis delay the resolution of TBM symptoms in response to antimycobacterial treatment.

Melchers, Willem/0000-0002-5446-2230; Yalcin, Ata Nevzat/0000-0002-7243-7354; Aktas, Zerrin/0000-0002-5998-0440; Ersoy, Yasemin/0000-0001-5730-6682; Hosoglu, Salih/0000-0002-4034-9202 WOS: 000385857700013 PubMed: 27259712 Epidemic clones of Acinetobacter baumannii, described as European clones I, II, and III, are associated with hospital epidemics throughout the world. We aimed to determine the molecular characteristics and genetic diversity between European clones I, II, and III from Turkey and Azerbaijan. In this study, a total of 112 bloodstream isolates of carbapenem-resistant Acinetobacter spp. were collected from 11 hospitals across Turkey and Azerbaijan. The identification of Acinetobacter spp. using conventional and sensitivity tests was performed by standard criteria. Multiplex polymerase chain reaction (PCR) was used to detect OXA carbapenemase-encoding genes (bla(OXA-23-like), bla(OXA-24-like), bla(OXA-51-like), and bla(OXA-58-like)). Pulsed-field gel electrophoresis (PFGE) typing was used to investigate genetic diversity. The bla(OXA-51-like) gene was present in all 112 isolates, 75 (67 %) carried bla(OXA-23-like), 7 (6.2 %) carried bla(OXA-58-like) genes, and 5 (4.5 %) carried bla(OXA-24-like) genes. With a 90 % similarity cut-off value, 15 clones and eight unique isolates were identified. The largest clone was cluster D, with six subtypes. Isolates from clusters D and I were widely spread in seven different geographical regions throughout Turkey. However, F cluster was found in the northern and eastern regions of Turkey. EU clone I was grouped within J cluster with three isolates found in Antalya, Istanbul, and Erzurum. EU clone II was grouped in the U cluster with 15 isolates and found in Kayseri and Diyarbakir. The bla(OXA-24-like) gene in carbapenemases was identified rarely in Turkey and has been reported for the first time from Azerbaijan. Furthermore, this is the first multicenter study in Turkey and Azerbaijan to identify several major clusters belonging to European clones I and II of A. baumannii. Erciyes University Scientific Research ProjectsErciyes University [BAP kodu 4059] This study was supported by Erciyes University Scientific Research Projects (BAP kodu 4059).