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AIM/BACKGROUND: ''''Achromobacter species'''' are aerobic, motile, non-fermentative Gram-negative bacilli that most often causes healthcare-associated infections. This study aimed to evaluate the characteristics of patients with ''''Achromobacter spp.'''' infections, over ten years in a tertiary hospital. METHODS: Demographic data, co-morbidities, laboratory findings, and treatments of the patients were evaluated retrospectively. Antimicrobial susceptibility results of the isolates were determined by disk diffusion and gradient strip test. RESULTS: A total of 154 patients and their clinical isolates were included in the study. The median age was 54, and 68% were male. Among the patients, 107 had at least a chronic condition, and 61 (or 39%) had any form of immunosuppression. The majority of Achromobacter species (46%), which were isolated from surgical clinic samples, came from abscess and wound samples (43%). A polymicrobial infection was seen in 50 individuals, and 18 patients (12%) died within 28 days (Table). The rate of trauma was higher (26 vs. 8%; p = 0.002) and the rate of chronic disease was lower (58% vs. 75%; p = 0.032) in patients with polymicrobial infection. Patients with polymicrobial infections had a greater rate of abscess samples (68% vs. 36%; p more...

Bee bread is fermented and naturally preserved pollen that is enriched with digestive enzymes and organic acids from both honey and the salivary gland secretions of honeybees. As yet, there is insufficient information concerning which bacteria and yeasts are involved in the fermentation. This study seeks to determine the contents of microorganisms in fresh and dry bee bread samples and to ascertain the antimicrobial resistance of these isolated microorganisms. Fresh and dry bee bread samples were obtained from 8 different colonies that were cultivated in suitable medium to reproduction the aerobic microorganisms, anaerobic microorganisms, and fungi. The isolated strains in bee bread samples were identified by conventional and MALDI-TOF MS methods. The minimal inhibitory concentrations (MIC) of the antimicrobial agents for strains were determined according to the Clinical and Laboratory Standards Institute (CLSI). The 34 strains were isolated from fresh bee bread samples. There were no microrganisms reproduced in the dried bee bread samples. The 34 isolated strains were; Aspergillus spp. (12), Rhizopus oryzae (6), Mucor circinelloides (1), Bipolaris (2), Trichoderma (3), Paecilomyces variotii (1), Penicillium chrysogenum (1), Kodamaea ohmeri (1), Bacillus altitudinis/pumilus (3), Bacillus licheniformis (1), B. megaterium (1), Micrococcus luteus (1) and Serratia marcescens (1). The MIC values of itraconazole (IT), voriconazole, anidulafungin (AND), and caspofungin (CS) for Mucor and Rhizopus strains were higher (≥32 μg/mL), with the exception of amphamphotericin B posaconazole. All antifungal agents had lower MIC values compared to the Aspergillus, Bipolaris, P. variotii, and K. ohmeri strains. The trichoderma strains had low MIC values (≤0.50 μg/mL), with the exception of IT. The P. chrysogenum strains were found to have low MIC value (≤0.25 μg/mL) compared to posaconazole, AND, and CS. In this study, there were no microorganisms reproduce in the dried bee bread samples stored under suitable conditions. In addition, it was concluded that yeast, mold, and bacteria isolated in fresh bee bread samples may be resistant to antibiotics and antifungal drugs. more...

Healthcare-associated infections (HAIs) are a global public health issue with clinical and socioeconomic consequences. These infections are important indices for the quality of healthcare services which are serious complications that should be addressed in pediatric intensive care units (PICUs). This study aimed to retrospectively examine the bacterial HAIs, the frequency of isolated pathogen microorganisms, the areas of infection, and the antibiotic susceptibility recorded in the surveillance system in our Pediatric Intensive Care Unit for five years between 01.01.2015 and 31.12.2019. Two thousand five hundred forty-five patients were admitted to the pediatric intensive care unit during the study period and treated. One-hundred ninety HAIs were detected in 99 patients. In the study, gram-negative microorganisms were most commonly seen (160/190). Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella spp. were the most common bacteria. Enterococcus spp. and coagulase-negative staphylococci were the most common gram-positive microorganisms. The mortality rate of a bacterial HAI was 40.4%. There was no resistance against vancomycin in Gram-positive microorganisms. The resistance rate against methicillin was 100% in coagulase-negative staphylococci and 50% in S. aureus strains. The cumulative rate of carbapenem resistance was found as 76.1% in Pseudomonas aeruginosa, 45.2% in Klebsiella spp. and 0% in Escherichia coli. In 2019, the resistance rate against colistin in Klebsiella spp. and Pseudomonas aeruginosa were 46.2% (6/13) and 20% (1/5), respectively. The resistance rate against carbapenem and colistin was 81.1% and 0% in Acinetobacter baumannii. It was observed that the use of carbapenem before an infection episode increased significantly, and the rate of carbapenem resistance reached 100% over the years in Pseudomonas aeruginosa and Klebsiella spp. A significant proportion of the isolates were multidrug-resistant strains, significantly threatening survival. Implementation of effective preventive strategies to combat the emergence of antibiotic resistance is urgently needed. more...

Various clinical outcomes, reinfections, vaccination programs, and antibody responses resulted from the COVID-19 pandemic. This study investigated the time-dependent changes in SARS-CoV-2 antibody responses in infected and/or vaccinated and unvaccinated individuals and to provide insights into spike and nucleocapsid antibodies, which fluctuate during infectious and non-infectious states. This cohort study was carried out at the Ege University Faculty of Medicine hospital in İzmir (western Turkey) and the Erciyes University Faculty of Medicine hospital in Kayseri (central Turkey) between December 2021 and January 2023, which coincided with the second half of COVID-19 pandemic. The study included 100 COVID-19 PCR-positive patients and 190 healthcare workers (HCWs). Antibody levels were followed up via quantitative anti-SARS-CoV-2 spike and qualitative anti-nucleocapsid immunoassays (Elecsys™). Antibody levels declined after infection but persisted for at least 6–8 months. Individuals who had received only CoronaVac had higher anti-nucleocapsid antibody levels in the early months than those who received mixed vaccination. However, anti-spike antibodies persisted longer and at higher levels in individuals who had received mixed vaccinations. This suggests that combining two different vaccine platforms may provide a synergistic effect, resulting in more durable and broad-spectrum immunity against SARS-CoV-2. The study provides information about the vaccination and antibody status of healthcare workers in the second half of the pandemic and provides valuable insights into the dynamics of antibody responses to COVID-19 infection and vaccination. more...

INTRODUCTION: Urinalysis by automated urine analyzer, including microscopy and dipstick test, is easy, rapid, and inexpensive. Among these parameters, leukocyte count (WBC) or leukocyte esterase (LE) has relatively sufficient sensitivity in urinary tract infection (UTI) detection. Urine culture is accepted as the gold standard for the diagnosis of UTI. Unnecessary culture requests constitute the majority of the microbiology laboratory workload. This study aimed to evaluate the performance of a multi-criteria algorithm by using urinalysis in predicting negative urine cultures. METHODS: During a 2-week period, randomly selected 600 urine samples that reached the microbiology laboratory for urine culture were subjected to chemical and microscopic urinalysis without waiting. Urinalysis was performed using Iris iQ200 (Iris Diagnostics, Chatsworth, USA). LE >25 μL-1, nitrite positive, and WBC >5 per HPF were accepted as abnormal/positive. The sensitivity and specificity were also calculated by Receiver operating characteristic analysis at alternative threshold values for all small particles. A multi-criteria algorithm based on these urine parameters was developed, and its performance was evaluated by determining specificity, sensitivity, negative predictive value (NPV), and positive predictive value. RESULTS: Multi-criteria algorithm based on urinalysis gave false-negative results for only 3 (0.5%) samples. This algorithm had 98.9% NPV and eliminated 47.4% of urine samples from the culture workflow. DISCUSSION AND CONCLUSION: This algorithm may reduce unnecessary culture requests and more effective use of time and resources. more...

Sepsis is a major healthcare problem worldwide. Its mortality and morbidity is still high. Early diagnosis of sepsis and appropriate management in the initial hours improve outcomes. The Surviving Sepsis Campaign published new definitions for sepsis in 2016. In Sepsis-3 definitions, sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Organ dysfunction can be identified as an acute change in total SOFA score of at least two points consequent to the infection. However, this definition is endorsed by two international societies and there is much discussion regarding new definitions. Prospective validation of this definition on different levels is needed. The infectious source in sepsis depends on patients" underlying diseases and origin of the infection (community-acquired or healthcare-associated). In the literature, urinary tract and skin-soft tissue infection are the common sites in community-acquired sepsis, whereas respiratory system and intraabdominal infections are more common in nosocomial sepsis. Another challenge in sepsis management is the increasing incidence of sepsis due to multidrugresistant bacteria and limited treatment options. New antibiotics may be treatment options in the future. In this review, current definitions of sepsis, physiopathology of sepsis, foci of sepsis and causative microorganisms, microbiological diagnosis and rapid diagnosis methods, biomarkers used in the diagnosis of sepsis, antimicrobial treatment and resistance, new antibiotics and non-antibiotic therapy are discussed. more...