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Bacterial and fungal infections may emerge with or following COVID-19 infection. Corticosteroids, antibiotics, and other therapies utilized in severe cases of COVID-19 pneumonia may pose a risk for fungal infections. In this paper, we present the case of a 59-year-old female patient with underlying chronic renal failure and diabetes who received long-term corticosteroid therapy for COVID-19 pneumonia and subsequently developed fungemia and catheter infection due to Candida parapsilosis. We removed her subclavian catheter and administered amphotericin -B therapy for 37 days. Overall, we recommend keeping in mind that opportunistic fungal infections may emerge in patients receiving long-term immunosuppressive drug therapy due to COVID-19 with risk factors such as hemodialysis, central venous catheter use, and broad-spectrum antibiotic use.

Aims: Catheter-related bloodstream infections are important causes of mortality and morbidity. In this study, it was aimed to retrospectively determine the distribution of bacterial factors isolated from intra-catheter blood culture and antibiotic susceptibility rates of patients diagnosed with catheter infection in the intensive care unit of XXXXXXX Training and Research Hospital, Cardiovascular Surgery and Neurosurgery. Methods: In the intensive care unit of XXXXXXX Training and Research Hospital, Cardiovascular Surgery, and Neurosurgery, 79 bacteria isolated from intra-catheter blood cultures of patients diagnosed with catheter infection between January 1, 2021, and December 31, 2022, were included in the study.Antibiotic susceptibility of the factors reproducing in catheter blood culture was obtained from the hospital information system. Antibiotic susceptibilities of bacteria isolated from intra-catheter culture were determined by the disc diffusion method or VITEK-2 automated system. Results: The frequency of factors reproducing from intra-catheter blood culture of patients hospitalized in the intensive care unit of cardiovascular surgery and neurosurgery were Enterococcus spp., Klebsiella pneumoniae, Staphylococcus epidermidis, and Escherichia. coli retrospectively. Klebsiella pneumoniae isolates from intra-catheter blood cultures were resistant to ceftriaxone 75%, piperacillin-tazobactam 25%, amikacin 6.25%, but not to imipenem and meropenem. Antibiotic resistance rates of Staphylococcus aureus isolates isolated from intra-catheter blood cultures were as follows: 100% with penicillin, no resistance to vancomycin. In Escherichia coliisolate isolated from intra-catheter blood cultures, resistance to ceftriaxone was 6.3%, to piperacillin-tazobactam, 12.5%, to imipenem and meropenem, 16.6%, but not to amikacin. Acinetobacter baumanniiisolates isolated from intra-catheter blood culture showed 100% resistance to ceftriaxone, 100% to piperacillin-tazobactam, 85.7% to imipenem, 83.3% to meropenem, and no resistance to amikacin. In the Stenotrophomonas maltophilia isolatesisolated from intra-catheter blood culture, resistance to ceftriaxone, piperacillin-tazobactam, imipenem and meropenem was 100% and levofloxacin was 25%, while no resistance to trimethoprim/sulfamethoxazole was detected. Conclusion: Determining the antibiotic susceptibility of bacteria isolated from catheter culture will contribute to the determination of the appropriate treatment option in the empirical treatment of catheter infections in our hospital and contribute to decreasing in mortality and morbidity rates due to catheter infections.

Tuberculosis is an infectious disease whose diagnosis dates back to very early ages, which still maintains its importance in the world and in our country, can be treated and prevented with preventive (prophylactic) treatment. It is one of the leading causes of death in HIV/AIDS positive patients. Tuberculosis can be seen in two ways, mainly lung tuberculosis and extra-pulmonary tuberculosis. Tuberculosis forms other than lung and laryngeal tuberculosis are not contagious. Today, the HIV epidemic and international migration are the main causes of the increase in the number of tuberculosis cases. In this collected work, lung and non-pulmonary forms of tuberculosis, clinical diagnosis, and current developments in diagnosis are summarized.

Aim: The literature seems to miss the clinical course of COVID-19 infection among the pregnant and its effects on the fetus. The present study aimed to evaluate a total of 21 pregnant inpatients in Ankara Training and Research Hospital with the diagnosis of COVID-19 in terms of symptoms, physical examination findings, laboratory findings, treatment results, and complications. Material and Method: A total of 21 pregnant patients diagnosed with COVID-19 by reverse transcriptase polymerase chain reaction (RT-PCR) in Ankara Training and Research Hospital between 22.04.2020 and 27.09.2021 were included in the study. The clinical symptoms, physical examination findings, laboratory findings, and treatment outcomes of the patients, and the health status of the pregnant and newborn were retrospectively evaluated. Results: Of the 21 pregnant patients, 10 were Turkish citizens, and 11 were foreign nationals. The patients were aged 20-41 years with a mean age of 28.76 years. All patients were unvaccinated. Considering underlying diseases among the patients, it was found that one patient had hypertension, and one patient had thyroid disease. In order of frequency, the symptoms in the patients were cough (n =10), fatigue (n=8), sore throat (n=6), dyspnea (n=5), fever (n=3), myalgia (n=3), joint pain (n=1), and diarrhea (n=1). Physical examinations of the patients yielded a fever of 37.4 °C above in 3 patients and rales in one patient. Although one patient with COVID-19 pneumonia was followed up in the intensive care unit, all were discharged upon recovery. Chloroquine tablets were started in 6 patients, a combination of ritonavir (50 mg) and lopinavir (200 mg) in 4 patients, and favipiravir in one patient. Cesarean section was performed in 9 patients, while 12 patients gave normal delivery. Conclusion: Overall, the clinical course of COVID-19 infection in the pregnant followed up in this study was mild, and all newborns were healthy except for one. It is thought that close follow-ups for the pregnant are needed to minimize complications that may develop in them and their fetuses due to COVID-19 infection. Finally, the COVID-19 vaccine seems to be a must for the pregnant to prevent all possible COVID-related complications.

Objective: We evaluated PCR negativity in oropharyngeal and nasopharyngeal secretions of COVID-19 patients at the end of hydroxychloroquine and/or favipiravir treatments. Methods: Study inclusion criteria were being hospitalized, being older than 18 years, PCR positivity in oropharyngeal and nasopharyngeal secretions and being tested for SARS CoV-2-RNA PCR after treatment. Initially hydroxychloroquine treatment (group 1) was administered to the patients according to COVID-19 guide of Health Ministry. Favipiravir (group 2) alone or in combination with hydroxychloroquine (group 3) was administered to patients who were unresponsive to hydroxychloroquine or had severe pneumonia or were admitted to intensive care unit. Control respiratory specimens were taken no earlier than 24 hours, after the end of therapy. Repeated tests with 24–48-hour intervals were performed in patients with still positive PCR test results. The detection of SARS CoV-2-RNA was made by real-time PCR. Results: The study group included 492 patients who received treatment. Mean duration of symptoms was similar among three groups. PCR negativity rate was 52.8% in the specimens taken 24 hours after the end of treatment. PCR negativity rates was 27.9% (200/492) in 48 hours after the end of treatment, %13.8 (123/492) in 72nd hour and %3.8 (80/492) in 96th hour. The ratios of PCR negativity for all specimen days were similar in three groups. There was no statistically significant difference between the groups for time to PCR negativity from the date of positivity and after the end of treatment. We determined that early or late treatment did not make a difference in terms PCR negativity time. Conclusion: No difference was found in terms of the ratios of PCR negativity or time for negativity in oropharyngeal and/or nasopharyngeal specimens taken after the end of treatment in COVID-19 patients receiving hydroxychloroquine and/or favipiravir treatment.

Introduction: Corynebacterium striatum (C. striatum) is one of the most frequently reported nosocomial infection agents among patients hospitalized in intensive care units following the COVID-19 pandemic. It may cause various opportunistic infections, such as ventilator-associated pneumonia and catheter-associated bloodstream infections, in such patients. The present study attempted to investigate the antibiotic susceptibility of 14 nosocomial infection agent C. striatum strains, isolated from deep tracheal aspirate and blood culture samples of hospitalized patients, for seven different antibiotics (benzylpenicillin, ciprofloxacin, clindamycin, rifampicin, linezolid, tetracycline, and vancomycin). Material and Method: Antibiotic susceptibility of the strains for the mentioned antibiotics was determined utilizing a disk diffusion test in line with the recommendations of the European Antibiotic Susceptibility Committee (EUCAST).Results: While all the isolated C. striatum strains (100%) were resistant to benzylpenicillin, tetracycline, rifampicin, ciprofloxacin, and clindamycin, we found none of them to be resistant to vancomycin and linezolid.Conclusion: Overall, uncovering the antibiotic susceptibility of C. striatum strains isolated from clinical specimens would guide clinicians in deciding on the empirical treatment of hospital-acquired infections led by this agent.

Objectives: The probability of detecting viral and atypical agents in pneumonia patients has increased with the molecular methods used in recent years. We aimed to investigate pneumonia pathogens in endotracheal aspiration samples (ETA) of patients with severe community-acquired (CAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP) by multiplex polymerase chain reaction (m-PCR) and culture method. Methods: A prospective study was performed between December 2019 and October 2020. Patients 18 years and older with pneumonia followed in ICU on the mechanical ventilator were included. COVID-19 patients were excluded. Patients were grouped as CAP, HAP, and VAP. Two ETA samples were obtained from patients within 48 hours of the pneumonia diagnosis. Respiratory pathogens were investigated in samples by viral-bacterial m-PCR and bacterial culture methods. Results: 74 patients were included in the study. m-PCR of ETA samples achieved pathogen detection in 87.8% of patients compared with 58.1% with culture methods. The most common pathogen detected by m-PCR was Streptococcus pneumoniae in both CAP and HAP patients and Klebsiella spp. in VAP patients. The most common pathogen isolated by culture was Staphylococcus aureus in both CAP and HAP patients and Klebsiella spp. in VAP patients. Atypical pneumonia pathogens were positive for 14.9% of the patients. Atypical pathogens were recovered from 28.5% of CAP patients and 23.1% of HAP patients. Viruses constituted all of the atypical pathogens recovered from HAP patients. No atypical pathogen was found in VAP patients. Conclusion: In this study, S. pneumoniae was the most common pathogen detected with m-PCR, and S. aureus and Klebsiella spp. were the most common pathogens detected with culture. Determination of microbial etiology of lower respiratory tract samples by molecular methods for diagnosing severe CAP and HAP may be beneficial in terms of treatment. Keywords: pneumonia, multiplex PCR, endotracheal aspirate, conventional methods

Giriş: Tüm dünyaya yayılan COVİD-19 salgını, insanlık için hala bir tehdittir. Hastalığın epidemiyolojik, klinik, laboratuvar ve radyolojik özellikleri gün geçtikçe gün yüzüne çıkmaktadır. Tanı ve tedaviye yardımcı olmak için COVİD-19'lu çocuk ve yetişkinlerin özelliklerini değerlendirmeyi amaçladık. Gereç ve Yöntem: 23 Nisan-28 Mayıs 2020 tarihleri arasında COVİD-19 olduğu doğrulanan pediatrik ve yetişkin hastaların tıbbi kayıtlarının retrospektif olarak incelendi. Bulgular: Bu çalışmada toplam 93 çocuk ve 81 yetişkin değerlendirildi. Asemptomatik ve hafif vakalar çocuklarda %63.5, ebeveynlerde ise %50 idi. Çocukların %3.2'si orta derecede hastalığa sahipken, ebeveynlerin %9.8'inde vardı. Çocuklar ve ebeveynler arasında hastalık şiddeti açısından istatistiksel olarak fark vardı (P=0.01). Çocuklarda daha hafif klinik duruma rağmen bir çocuk öldü. Çocukların %8.6'sında ve ebeveynlerin %48.1'inde C-reaktif protein (CRP) düzeylerinde artış görüldü, çocuklar ve ebeveynler arasında CRP artışı açısından istatistiksel olarak anlamlı fark vardı (P=0.001). Sonuç: COViD-19'un klinik, laboratuvar ve radyolojik özellikleri çocuklarda ve yetişkinlerde farklılıklar göstermektedir. COVİD-19'un hastalık seyri çocuklarda yetişkinlere göre daha hafif gibi görünse de, COVİD-19'un çocuklarda ölümcül olabileceği akılda tutulmalıdır.

Infective endocarditis preoccupies a substantial place in infectious emergencies, and treatment delays are likely to cause increased mortality and morbidity. This paper attempts to explore and discuss the current knowledge on the diagnosis, treatment, and prophylaxis of infective endocarditis in light of the relevant literature. Infective endocarditis is an infectious condition that still keeps its significance and

Karbapenem dirençli Enterobacteriaceae (KRE)’nin neden olduğu enfeksiyonlar, küresel sağlık için ciddi bir sorundur. Karbapenemler, kapsamlı uygulamaları nedeniyle günümüzde direnç mekanizmaları gelişmiştir. Karbapenemaz sentezleyen izolatların saptanması, dağılımlarının takip edilmesi ve uygun tedavinin sağlanabilmesi açısından oldukça önemlidir. Günümüz ilaç direncinin saptanmasında Real-time-polimeraz zincir reaksiyonu (RT-PZR), başta olmak üzere çeşitli ticari moleküler tanı yöntemleri kullanılmaktadır. Ancak testlerin yapılabilmesi için pahalı ekipmanlara ihtiyaç duyulması nedeni ile, rutin bakteriyoloji laboratuvarlarında uygulanabilecek güvenilir, pratik ve düşük maliyetli testlere ihtiyaç duyulmaktadır.Bu çalışma, Etlik İhtisas Eğitim ve Araştırma Hastanesi’nde çeşitli servislerde yatan hastalardan izole edilen genişlemiş spektrumlu beta-laktamaz (GSBL) pozitif, karbapenemlere dirençli dirençli, kolistine duyarlı toplam 60 Gram-negatif bakteri (39 suş Acinetobacter baumannii (A. baumannii), 11 suş Klebsiella pneumoniae (K. pneumoniae ve 10 suş Pseudomonas aeruginosa (P. aeruginosa))’de izolatın mcr-1 ve blaOXA-48 gen bölgelerinin varlığını belirlemek amacıyla yapılmıştır. Klinik örnekler konvansiyonel yöntemler ile izole edildikten sonra kesin tanımlama ve antibiyotik duyarlılık testleri otomatize sistemle çalışılmıştır. GSBL ve kolistin direncinin doğrulanması disk difüzyon testi ve gradyen testleri ile yapıldı. PZR sonuçlarına göre A. baumannii suşunun 10 tanesinde, K. pneumoniae suşunun bir tanesinde ve P. aeruginosa suşunun bir tanesinde mcr-1 geni saptandı. A. baumannii suşunun 5 tanesinde, K. pneumoniae suşunun 2 tanesinde blaOXA-48 geni saptandı. A. baumannii suşunun bir tanesinde her iki genin varlığı tespit edilmiştir. Sonuç olarak, karbapenemaz enzimi üretimi ve gen bölgesinin belirlenmesinde hızlı, tekrarlanabilir ve yüksek doğrulukta yeni tanı yöntemlerine ihtiyaç duyulmaktadır., Infections caused by carbapenemresistant Enterobacteriaceae (CRE) are a serious problem for global health. Carbapenems have developed resistance mechanisms due to their extensive applications. Identification of isolates expressing carbapenemase is important for that terms of monitoring their distribution and providing appropriate treatment. For detection of drugresistance, it is used various commercial molecular diagnostic methods, especially Real Time-polymerase chain reaction (RT-PCR). However, nowadays due to the needed for expensive equipment to carry out the tests, it is needed reliable, practical and low-cost tests that can be applied in routine bacteriology laboratories.Our study was carried out to determine the presence of mcr-1 and blaOXA-48 gene regions of 60 ESBL positive, carbapenems resistant, colistin sensitive Gram negative bacteriae (39 strains of Acinetobacter baumannii (A. baumannii), 11 strains of Klebsiella pneumoniae (K. pneumoniae), and 10 strains of Pseudomonas aeruginosa (P. aeruginosa)) from patients hospitalized in various wards of Etlik İhtisas Training and Research Hospital. The clinical samples were isolated by conventional methods, after that precise identificationand antibiotic susceptibility tests were performed with an automated system. Confirmation of ESBL and colistin resistance was done by disc diffusion and gradient testing. According to PCR results, mcr-1 gene was detected in ten A. baumannii strains, one K. pneumoniae and one P. aeruginosa strain. The blaOXA-48 gene was detected in five A. baumannii strains and two K. pneumoniae strains. Both genes were detected in one of the A. baumannii strain. gene. As a result, it was needed new diagnostic methods that rapid, reproducible, highly accurate for determine carbapenemase enzyme production and gene presence.

Bu yazıda literatürde nadiren bildirilen bir durum olan varicella zoster ensefaliti ile tüberküloz menenjiti birlikteliği olan 58 yaşında erkek hasta sunuldu. Orbitofrontal bölgede zona tanısıyla valasiklovir tedavisi alırken hastada varicella zoster virüse bağlı olarak ensefalit kliniği gelişti. Tedavi sonrası ateşinin düşmemesi üzerine yapılan incelemelerde beyin omurilik sıvısında polimeraz zincir reaksiyonu testinde Mycobacterium tuberculosis kompleks’in pozitif saptandı. Hastaya tüberküloz menenjit tanısı konuldu. Tedavi sonrasında hastanın ateşi ve klinik yakınmaları tamamen düzeldi.

Aim: COVID-19 is an important public health problem in world and Turkey. The present study aimed to compare the clinical and laboratory findings and mortality rates among vaccinated and unvaccinated COVID-19 inpatients.Material and Method: We included patients receiving inpatient treatment in COVID-19 wards of our hospital between April 25 and October 22, 2021. The patients were divided into two groups: those with and without the COVID-19 vaccine. We extracted patient information from anamnesis files and the hospital information system. Then, we recorded the patients’ epidemiological and laboratory findings and vaccination status. Patients with at least two doses of the COVID-19 vaccine were considered “vaccinated.” We performed Fisher’s exact test and Chi-square test to analyze the data. All statistical analyses were performed in SPSS, and a p-value

Aim: In this study, it was aimed to determine the reproducing agents and the antibiotic susceptibility of the agents in a total of 89 urine samples cultured in Ankara Training and Research Hospital, Infectious Diseases and Clinical Microbiology laboratory during the 6-month period between 2021-2022. Material and Method: While growth was detected in urine culture in 68 (76%) of 89 urine samples taken in the study, no growth was found in 21 (24%) of them. Antibiotic susceptibility was studied on Mueller-Hinton agar by the disc diffusion method in isolates with growth in urine culture. Results: Reproducing factors are in order of frequency; 25 E. coli, 17 extended-spectrum beta-lactamase (ESBL) positive E. coli, 10 Klebsiella pneumoniae, 3 Pseudomonas aeruginosa, 3 Proteus mirabilis, 3 Enterococcus faecalis, 1 Enterobacter cloacae, 1 Candida krusei, 1 Staphylococcus aureus, 1 patient E. coli and Proteus species were determined. Resistance rates in E. coli strains isolated from urine culture; 20% (4/20) for ciprofloxacin, 5% (1/19) for nitrofurantoin, 9.5% (2/21) for trimethoprim/ sulfamethoxazole (TMP/SMZ). No resistance was found to fosfomycin 0% (0/19) and to carbapenems (imipenem, meropenem, and ertapenem) (0/21). The resistance rates in ESBL positive E. coli strains are; 100% (13/13) for ciprofloxacin, 7% (1/14) for nitrofurantoin, 12.5% (1/8) for fosfomycin, 26.6% (4/15) for TMP-SMZ. No resistance was found to carbapenems (imipenem, meropenem and ertapenem). Conclusion: In our study, it was determined that the most common infectious agent causing urinary tract infection was E. coli. In our study, it was determined that the resistance rates for ciprofloxacin and TMP-SMZ, which are used in empirical treatment, are high, and the resistance rates for fosfomycin and nitrofurantoin are low in E. coli strains that cause urinary system infection. Due to the low rates of resistance in the empirical treatment of urinary system infections, it would be a suitable approach to prefer oral treatment options such as fosfomycin and nitrofurantoin in outpatients.

Rino-orbito-serebral mukormikozis, Zygomycetes türü küf mantarlarının neden olduğu, mortalitesi ve morbidite oranı yüksek fırsatçı bir mantar enfeksiyonudur. Mukormikozis için en önemli risk faktörü kontrolsüz diyabet ve diyabetik ketoasidozdur. Bunun dışında; desferoksamin tedavisi, demir yüksekliği, immünosüpresif ilaçlar, kortikosteroid kullanımı diğer risk faktörleridir. Bu yazıda, geç tanı konulan rinoorbitoserebral mukormikozise bağlı olarak görme kaybı ve serebral apse gelişen 62 yaşında diyabetik bir erkek sunuldu. Hastaya cerrahi debridman ile birlikte lipozomal amfoterisin-B tedavisi uygulandı.

Bacterial and fungal infections can be seen with COVID-19.Besides, some infectious diseases may be confused with pneumonia due to COVID-19 infection. In this article, a 60-year-old male patient who was referred to our clinic with a preliminary diagnosis of COVID-19 pneumonia and finally diagnosed with Pneumocystis jirovecii pneumonia and pulmonary tuberculosis due to HIV infection is presented. The patient's complaints of fever, cough and sputum production at the time of admission completely resolved after Pneumocystis jirovecii and pulmonary tuberculosis treatments.

Legionella pneumophila, hafif seyirli pnömoniden, ağır seyirli pnömoni ve çoklu organ yetmezliğine kadar değişebilen klinik seyir gösteren, toplum ve hastane kaynaklı pnömonilere neden olabilen, sporadik veya salgınlar şeklinde ortaya çıkabilen bir bakteriyel pnömoni etkenidir. Legionella pneumophila, akla getirilmezse ve tanıya yönelik testler istenmezse gözden kaçabilir. Burada, Covid -19 pandemisi döneminde acil servise yüksek ateş, öksürük, nefes darlığı şikayetleri ile başvuran ve idrarda Legionella antijen pozitifliği ile Legionelloz tanısı konulan bir olgu sunuldu. Olguda Covid-19 infeksiyonu bilgisayarlı tomografide tipik tutulum saptanmaması ve Covid-19 polimeraz zincir reaksiyonu testinin negatif saptanması ile ile ekarte edildi. Olguya Legionella pneumophila yönelik levofloksasin tedavisi 21 gün süreyle uygulandı. Klinik ve laboratuvar bulguları düzelen hasta taburcu edildi. Sonuç olarak, Covid-19 pandemi döneminde Legionella pneumophila pnömonisinin Covid-19 pnömonisi ile karışabileceği ve anamnez ve klinik bulguları legionella ile uyumlu hastalarda akılda tutulması gerektiği görüşündeyiz.

Objective: Carbapenemase-producing strains of the Enterobacteriaceae family (CPE) are important agents of health-care associated infections in both our country and worldwide but their detection is difficult. The aim of this study was to compare RAPIDEC ® CARBA NP test and new chromogenic media, OXA-48 and CHROMID CARBA medium performances for detecting carbapenemase-resistant Enterobacteriaceae isolates. Material and method: This study was performed in intensive care units (ICU) of a tertiary care training and research hospital. Totally 67 Enterobacteriaceae strains (30 Escherichia coli, 37 Klebsiella pneumoniae) isolated from varies cultures including blood, urine and tracheal aspirate of ICU patients were included to the study. Identification and antibiotic susceptibility tests of the isolates were performed using VITEK 2 automated system as well disc diffusion test. All isolates were inoculated into chromogenic CHROMID CARBA medium and OXA-48 medium simultaneously. They are incubated at 37ºC for 24-72 hours. Color changes were evaluated at 24,48 and 72. hours. RAPIDEC ® CARBA NP test was also performed for all isolates according to the recommendations of the manufacturer and then its performance was compared with chromogenic media. When comparing the methods, carbapenem resistance values determined by disc diffusion and VITEK 2 automated system were accepted as reference.Results: Among 67 isolates, 28 (42%) were found carbapenem-sensitive and 39 (58%) carbapenem-resistant by using disc diffusion and VITEK-2 automated systems. When disc diffusion test and VITEK 2 automated systems were accepted as reference, compliance rate between Rapidec CARBA ® NP test and disc diffusion and VITEK-2 automated system was 93% (62/67) while it was 75% (50/67) between chromogenic media (CHROMID CARBA and OXA-48) and disc diffusion and VITEK-2. When chromogenic CHROMID CARBA and OXA-48 medium and RAPIDEC ® CARBA NP test were evaluated together, their compliance rate with disc diffusion and VITEK-2 automated system was 69% (46/67). Conclusions: In this study we found close to %70 compliance between CHROMID CARBA medium, OXA-48 medium and Rapıdec ® Carba NP test results. We believe that the studies involving more isolates should be performed on this subject. Moreover, we think that carbapenem resistance should be confirmed by genotypic tests which are the reference method., Amaç: Karbapenemaz üreten Enterobactericea (CPE) üyeleri ülkemizde ve dünyada önemli bir sağlık bakımıyla ilişkili infeksiyon etkenidir ve saptanmaları güçlük gösterirBu çalışmanın amacı; karbapeneme dirençli Enterobactericea üyelerini saptamada yeni bir kromojenik besiyeri olan CHROMagar CARBA ID ve OXA-48 besiyerleri ile RAPIDEC ® CARBA NP testin performansının karşılaştırılmasıdır Gereç ve Yöntem: Çalışmaya Ankara Eğitim ve Araştırma Hastanesi Yoğun Bakım ünitesinde yatan hastaların çeşitli klinik örneklerinden (Derin trakeal aspirat, kan, idrar vb.) izole edilen ve karbapenem direnci fenotipik olarak disk difüzyon ve otomatize sistemle (Vitek 2) ile saptanan 67 Enterobactericea suşu ( 30 E.coli, 37 Klebsiella pneumoniae) dahil edildi. İzole edilen 67 suşun disk difüzyon yöntemi ve VITEK-2 otomatize sistemi ile 28’inin (% 42) karbapeneme duyarlı , 39’unun (%58) ise karbapeneme dirençli olduğu saptandı. Şuslar eş zamanlı olarak CHROMagar CARBA ID ve OXA-48 besiyerlerine ekildi. Suşlar 37 ⁰C ‘de etüvde 24-72 saat süreyle inkübe edildi. Renk değişimleri 24,48 ve 72. saatlerde değerlendirildi. İzole edilen suşlarda RAPIDEC ® CARBA NP testi de çalışılarak kromojenik agar besiyerleri ile performansları karşılaştırıldı. RAPIDEC ® CARBA NP testi üretici firmanın önerileri doğrultusunda çalışıldı. Her iki yöntemin karşılaştırılmasında disk difüzyon ve otomatize sistemle (Vitek 2) ile saptanan karbapenem direnç sonuçları referans olarak kabul edildi.Bulgular: Toplam 67 izolatın , disk difüzyon ve VITEK 2 otomatize sistemle 28 (%42)’inin karbapeneme duyarlı, 39 (%58)’unun ise karbapeneme dirençli olduğu belirlendi. Disk difüzyon yöntemi ve VITEK 2 otomatize sistemi referans alındığında; Rapidec CARBA ® NP testin uyum oranı %93 (62/67) iken, kromojenik besiyerleri (CHROMID CARBA ve OXA-48) ile disk difüzyon yöntemi ve VITEK 2 yöntemi arasındaki uyum oranı %75 (50/67) idi. Disk difüzyon yöntemi ve VITEK 2 otomatize sistemi referans alındığında kromojenik CARBA ID ve OXA-48 besiyerleri ile RAPIDEC ® CARBA NP testi arasındaki uyum oranı %69 (46/67) olarak belirlendi. Sonuç: Karbapeneme dirençli Enterobactericea ailesi üyelerinin saptanmasında fenotipik yöntemlerin performansının değerlendirilmesi için bu testlerin referans yöntem olan genotipik testlerle karşılaştırıldığı daha fazla sayıda suş içeren in vitro çalışmalara ihtiyaç olduğu görüşündeyiz.

Hastanede yatan hastalarda COVID-19 pnömonisini ile birlikte veya takiben bakteriyel pnömoni gelişebilir. COVID-19 pnömonisi ile birlikte bakteriyel pnömoni gelişen hastalarda mortalite oranlarının yüksek olduğu bildirilmiştir. Bu yazıda, toraks bilgisayarlı tomografisi ile olası COVID-19 pnömonisi tanısı konulan ve sonrasında Klebsiella pneumoniae (K. pneumoniae) ’ya bağlı sekonder bakteriyel pnömoni 63 yaşında erkek hasta sunuldu. COVID-19 pnömonisi ve K. pneumoniae’ya bağlı uygun antimikrobiyal tedavi sonrasında klinik ve laboratuar bulguları düzelen hasta taburcu edildi. Sonuç olarak, COVID-19 pnömonisi tedavisine rağmen klinik ve laboratuar bulguları düzelmeyen hastalarda klinik tabloya sekonder bakteriyel pnömoni etkenlerinin eklenmiş olabileceği akılda tutulmalıdır., Bacterial pneumonia may develop with or following COVID-19 pneumonia in hospitalized patients. It has been reported that mortality rates are high in patients who develop bacterial pneumonia together with COVID-19 pneumonia. In this article, a 63-year-old male patient who was diagnosed with probable COVID-19 pneumonia by thorax computed tomography and then secondary bacterial pneumonia due to Klebsiella pneumoniae (K. pneumoniae) is presented. The patient, whose clinical and laboratory findings improved after COVID-19 pneumonia and appropriate antimicrobial therapy due to K. pneumoniae was discharged. In conclusion, it should be kept in mind that secondary bacterial pneumonia agents may be added to the clinical picture in patients whose clinical and laboratory findings do not improve despite the treatment of COVID-19 pneumonia.

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a type of autoimmune encephalitis characterized by seizures, psychiatric symptoms, and movement disorder, which may present with an acute or subacute course. It has been reported that the production of anti-NDMA receptor antibodies can be triggered in the course of herpes simplex encephalitis and anti-NMDA receptor encephalitis may occur clinically. It has been reported that 25% of patients with HSV encephalitis have anti-NDMA receptor antibodies and are associated with impaired improvement in cognitive performance. In this article, we present a case of anti-NMDA receptor encephalitis associated with HSV-type 1 encephalitis in a 30-year-old woman and review the literature. After the patient's treatment for HSV encephalitis ended, her psychiatric symptoms such as anxiety, agitation, hallucinations and euphoria persisted and he was diagnosed with anti NMDA receptor antibodies detected in CSF. The patient was transferred to the neurology clinic and intravenous immunoglobulin treatment was started.

International audience; BACKGROUND: Mucormycosis is an emerging aggressive mold infection. This study aimed to assess the outcome of hospitalized adults with rhino-orbito-cerebral mucormycosis (ROCM). The secondary objective was to identify prognostic factors in this setting. METHODS: This study was an international, retrospective, multicenter study. Patients’ data were collected from 29 referral centers in 6 countries. All qualified as "proven cases" according to the EORTC/MSGERC criteria. RESULTS: We included 74 consecutive adult patients hospitalized with ROCM. Rhino-orbito-cerebral type infection was the most common presentation (n = 43; 58.1%) followed by rhino-orbital type (n = 31; 41.9%). Twenty (27%) had acquired nosocomial bacterial infections. A total of 59 (79.7%) patients (16 in combination) received appropriate antifungal treatment with high-doses of liposomal amphotericin B. Fifty-six patients (75.7%) underwent curative surgery. Thirty-five (47.3%) required intensive care unit admission (27; 36.5% under mechanical ventilation). Hospital survival was 56.8%, being reduced to 7.4% in patients with invasive mechanical ventilation. A multivariate binary backward logistic regression model identified confusion at admission (OR 11.48), overlapping hospital-acquired infection (OR 10.27), use of antifungal treatment before diagnosis (OR 10.20), no surgical debridement (OR 5.92), and the absence of prior sinusitis (OR 6.32) were independently associated with increased risk for death. CONCLUSION: Today, ROCM still has high mortality rate. Improving source control, rational therpy, and preventing nosocomial infections may improve survival in this severe infection.

Aim: Staphylococcus aureus causes community-acquired and health care-related infections with high morbidity and mortality. The most common infections in which it is isolated are wound infections, urinary tract infections, pneumonia, septic arthritis, osteomyelitis and sepsis. Methicillin-resistant S. aureus was first identified in the 1960s and became an important factor in hospitals in the 1980s. Methicillin-resistant S. aureus, in healthcare-related infections, especially in hospitalized patients, is an important factor. In this study, the distribution of health care related S. aureus infections and MRSA isolates over a six-year period, by year, was examined. In the light of these data, it is aimed to evaluate compliance with infection control measures and rational antibiotic use.Material and Method: The data of S. aureus bacteria isolated from patients diagnosed with healthcare-associated infections and followed up in a tertiary hospital between January 2016 and December 2021 were obtained from the Infection Control Committee records. A total of 201 diagnosis of healthcare-associated infections caused by S. aureus bacteria was detected in a six-year period. S. aureus infections; Health care associated infection diagnoses were evaluated by considering the years, the diagnoses made by infectious diseases, and the clinics (Intensive Care Unit-Service) where the patients were followed. Results: According to the distribution of general healthcare-associated infectious agents in 2016, it was found that the rate, which was 1.29%, increased to 6.41% over the years. It was observed that there was a cumulative increase in the patients hospitalized and followed up in the wards until 2020, the rates were determined as 5%, 3.8%, 20.3%, 25.3%, 34.69% and 17.1%, respectively, over the years. The distribution in intensive care units (ICU) was determined as 3.9%, 10.3%, 11.9%, 19.4%, 20% and 23.5%, respectively. Health care-related S. aureus infections over the years were statistically significant compared to the increase observed in wards (p0.05).Conclusion: In the 6-year period, the rates of healthcare-associated infections caused by S. aureus increased approximately 5 times. However, it does not correlate with the increase in MRSA rates. We think that this increase can be prevented by providing hand hygiene trainings, increasing compliance with standard infection control measures and improving the rational use of antibiotics., Amaç: Staphylococcus aureus (S. aureus) morbidite ve mortalitesi yüksek toplum kaynaklı ve sağlık bakım ilişkili enfeksiyonlara neden olmaktadır. En sık izole edildiği enfeksiyonlar; yara yeri enfeksiyonları, üriner sistem enfeksiyonları, pnömoni, septik artrit, osteomyelit ve sepsistir. Metisiline dirençli S. aureus (MRSA) ilk olarak 1960’larda tanımlanmış olup ve 1980’lerde hastanelerde önemli bir etken haline gelmiştir. Özellikle hastanede yatan hastalarda, sağlık hizmeti kaynaklı enfeksiyonlarda metisiline dirençli S. aureus önemli bir etkendir. Bu çalışmada, sağlık bakım ilişkili S. aureus enfeksiyonlarının ve MRSA izolatlarının altı yıllık dönemde, yıllara göre dağılımı irdelenmiştir. Bu veriler ışığında enfeksiyon kontrol önlemlerine ve akılcı antibiyotik kullanımına uyumun değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Ocak 2016-Aralık 2021 tarihleri arasında bir üçüncü basamak hastanede yatırılarak izlenen, sağlık bakım ilişkili enfeksiyon tanısı konulan hastalardan izole edilen S. aureus suşlarına ilişkin verilere Enfeksiyon Kontrol Komitesi kayıtlarından ulaşıldı. Altı yıllık dönemde 201 adet S. aureus suşlarının neden olduğu sağlık bakımı ile ilişkili enfeksiyon tanısı konuldu. Sağlık bakımı ile ilişkili S. aureus enfeksiyonlarının tutulum yaptığı organ ve sistemlere göre dağılımları, görüldüğü kliniklere (yoğun bakım ünitesi–servis) ve yıllara göre dağılımları değerlendirildi.Bulgular: Sağlık bakımı ilişkili genel enfeksiyon etkenlerinin yıllara göre dağılımı incelendiğinde; 2016 yılında %1,29 olan oranının yıllar içinde artarak %6,41’e çıktığı saptandı. Servislerde yatırılarak izlenen hastalarda 2020 yılına kadar kümülatif bir artış olduğu izlendi, oranlar yıllara göre sırasıyla; %5, %3,8, %20,3, %25,3, %34,69 ve %17,1 şeklinde saptandı. Yoğun bakım ünitelerindeki (YBÜ) dağılım ise yıllara göre sırasıyla; %3,9, %10,3, %11,9, %19,4, %20 ve %23,5 olarak saptandı. YBÜ’de izlenen sağlık bakım ilişkili S. aureus enfeksiyonlarının yıllar içindeki artışı, servislerde izlenen artışa göre istatistiksel olarak anlamlı saptandı (p0,05). Sonuç: Toplam 6 yıllık dönemde S. aureus’un etken olduğu sağlık bakımı ilişkili enfeksiyon oranlarında yaklaşık beş kat artış saptanmıştır. Ancak, bu artışın MRSA oranlarındaki artış ile korelasyon göstermediği belirlendi. El hijyeni eğitimleri, standart enfeksiyon kontrol önlemlerine uyumun artırılması ve akılcı antibiyotik kullanımda iyileştirme sağlanarak bu artışın önüne geçilebileceğini düşünmekteyiz.

Introduction: This study was planned to determine the second line drug resistance and molecular epidemiological profiles of multidrug resistant Mycobacterium tuberculosis isolates isolated from different geographical regions of Turkey. Material and Method: In our study, 63 MDR M. tuberculosis isolates were evaluated for the drug susceptibility sent from different tuberculosis laboratories of Turkey. Secondary antituberculosis drugs resistance was evaluated by indirect proportion method. Epidemiological origins were evaluated by using IS6110-RFLP and spoligotyping methods. Results: Cycloserine, ethionamide, capreomycin, thiacetozone, ofloxacin, kanamsin and paraaminosalicylic acid resistance rates were 15.87%, 19.04%, 7.93%, 6.34%, 11.11%, 12.69% and 6.34.%, respectively. According to spoligotyping results, 11 different patterns were obtained, including 52 isolates consisting of 5 clusters and 11 patterns consisting of a single isolate. When we compared our results with the spoligotype database in the world; 42 of 52 isolates forming 5 clusters were identified as predefined spoligotypes (LAM7-TUR, LAM9, T clade). 10 isolates showed the characteristics of the U spoligotype family. Of the 11 isolates that produced 11 different patterns, 8 were Haarlem and T spoligotypes. It was found that 2 isolates had the characteristics of Orphan and 1 isolate had the characteristics of BOV family. Conclusion: In our study, LAM7-TUR, LAM9, T clade spoligotype families are common in our country and in the world were determined.

Aim: The aim of this study was to detect IgG responses against cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpes virus-6 (HHV-6) and parvovirus B19 in serum and synovial fluid in patients diagnosed with knee joint synovitis, and to investigate the role of specific local immune response against these viruses in detection of the etiology of synovitis.Material and Method: Adult patients with Grade 3 and 4 osteoarthritis and synovitis according to Kellgren-Lawrence classification who went into Bozok University Medical Faculty Hospital Orthopedics and Traumatology policlinic were included in the study as patient group. Patients in similar age group who had knee graphy because of knee pain or another reason but who didn’t have knee osteoarthritis according to Kellgren-Lawrence classification were chosen as control group. While 29 patients were included in patient group, 31 patients were included in control group. While synovial fluid and serum samples were taken from patients with synovitis, only serum samples were taken from control group. Anti-CMV,EBV, HHV-6 and parvovirus B19 IgG antibodies were analyzed with ELISA method in all serum samples. In order to determine synovial or local antibody production, albumin levels were detected in all samples belonging to patient group with spectrophotometric method as well as synovial antibody index (sABI) was calculated. Anti- CMV, EBV, HHV-6 and parvovirus B19 IgG positivity rate was investigated in samples of both patient and control groups. In patient group, IgG level in serum and synovial fluid and synovial antibody index (sABI) were compared.Results: For all viruses investigated in the study, IgG positivity rate in serum was detected as 91% for CMV, 85% for EBV, 36.6% for parvovirus B19 and 43% for HHV6. While the highest IgG positivity rates were found in CMV and EBV (100% and 86%, respectively) in patient group serums, IgG positivity rates for EBV and CMV were found 83% in control group serums. It was found that IgG positivity rates for parvovirus B19 and HHV-6 in serum and absorbance values were higher in patient group compared to control group. It was shown that in cases with synovitis, local antibody production was the highest for EBV IgG with 72.4%, and it was followed by CMV IgG (34.4%) and parvovirus IgG (27.5%). Conclusion: It was concluded that anti- EBV IgG, anti- CMV IgG, and anti-parvovirus B19 IgG positivity rates in serum were higher in patients with synovitis than control group. It should be kept in mind that viruses such as CMV, EBV, HHV-6 and parvovirüs-B19 can be considered as factors when the etiological agents cannot be detected in synovial culture samples in patients with synovitis, and it is believed that in addition to serum antibodies, determining the antibody index can be useful to investigate local antibody responses in synovial fluid in patients., Amaç: Bu çalışmada diz ekleminde sinovit tanısı alan hastalarda, serum ve sinoviyal sıvıda sitomegalovirüs (CMV), Epstein-Barr virüsü (EBV), human herpes virüs-6 (HHV-6) ve parvovirüs B19’a karşı oluşan IgG yanıtlarının saptanması ve bu virüslere karşı oluşan spesifik lokal immun yanıtın, sinovit etiyolojisinin belirlenmesindeki rolünün araştırılması amaçlandı.Gereç ve Yöntem: Çalışmaya Bozok Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Polikliniği’ne müracaat eden Kellgren Lawrence sınıflamasına göre evre 3 ve 4 osteoartrit ve sinoviti mevcut olan yetişkinler, hasta grubu olarak alındı. Benzer yaş grubunda, diz ağrısı nedeniyle veya başka bir nedenle diz grafisi çekilen ancak Kellgren Lawrence sınıflamasına göre diz osteoartriti olmayan hastalar kontrol grubu olarak seçildi. Hasta grubuna 29 sinovitli olan hasta alındı ve kontrol grubu olarak da 31 hasta çalışmamıza dahil edildi. Sinovitli hastalardan sinoviyal sıvı ve serum örnekleri alınırken kontrol grubundan sadece serum örnekleri alındı. Tüm örneklerde anti-CMV, EBV, HHV-6 ve parvovirus B19 IgG antikorları mikro ELISA yöntemiyle araştırıldı. Sinoviyal ya da lokal antikor üretimini belirlemek için hasta grubuna ait tüm örneklerde albumin düzeyi spektrofotometrik yöntemle saptandı ve sinoviyal antikor indeksi (sABI) hesaplandı. Hasta ve kontrol grubuna ait tüm örneklerde anti- CMV, EBV, HHV-6 ve parvovirüs B19 IgG pozitiflik oranı araştırıldı. Hasta grubunda serum ve sinoviyadaki IgG düzeyi ve sinoviyal antikor indeksi (sABI) karşılaştırıldı.Bulgular: Tüm çalışma grubunda araştırılan virüsler için serumda IgG pozitifliği sırasıyla; CMV için %91, EBV için %85, parvovirus B19 için %36,6, HHV-6 içinse %43 olarak saptandı. Hasta serumlarında IgG poziflik oranı CMV ve EBV için en yüksekti ve sırasıyla; %100 ve 86 olarak saptandı. Kontrol grubunda EBV ve CMV IgG pozitiflik oranı %83 olarak saptandı. Hasta grubunda serumda parvovirus B19 ve HHV-6 IgG pozitiflik oranı ve absorbans değerleri kontrol grubuna göre daha yüksek saptandı. Hasta grubu serum ve sinoviyal antikor pozitifliği açısından karşılaştırıldığında; sinovitli olgularda lokal antikor üretiminin EBV IgG için %72,4 ile en fazla olduğu bunu %34,4 ile CMV IgG; % 27,5 ile parvovirus IgG ‘nin takip ettiği belirlendi.Sonuç: Sinovitli hastalarda serumda anti- EBV IgG, anti- CMV IgG ve anti-parvovirüs B19 IgG pozitiflik oranları kontrol grubuna göre daha yüksek idi. Sinovitli hastalarda sinoviyal kültür örneklerinde etkenin saptanmadığı durumlarda; CMV, EBV, HHV-6 ve parvovirüs-B19 gibi virüslerin etken olabileceğinin akılda tutulmasının ve hastalarda serum antikorlarına ilaveten sinoviyal sıvıda lokal antikor yanıtlarının araştırılması için antikor indeksinin belirlenmesinin de yararlı olacağı görüşündeyiz.

Streptococcus intermedius is part of the normal oropharyngeal, genitourinary and gastrointestinal flora, and can cause purulent infections characterized by abscess formation involving the brain and the liver tissue In this report, multiple pyogenic liver abscesses due to S intermedius in a 46-year-old male admitted to the emergency department with complaints of fever, cough, and weakness, and hospitalized with a diagnosis of suspected COVID-19 with pneumonia, is presented The diagnosis was made by isolating the agent from the abscess After percutaneous abscess drainage and antimicrobial treatment, the patient fully healed

Metisiline dirençli Staphylococcus aureus (MRSA)’ya bağlı toplum kaynaklı deri ve yumuşak doku infeksiyonları oldukça nadirdir. Bu yazıda, son 6 ay içinde hastanede yatış öyküsü olmayan 74 yaşında diyabetik bir kadın hastada boyun bölgesinde toplum kaynaklı MRSA bağlı olarak gelişen karbonkül sunuldu. Teikoplanin tedavisi ve aralıklı karbonkül drenajı sonrasında hastanın şikayetleri ve laboratuvar bulguları düzeldi.

Kateter enfeksiyonlarının en sık etkeni cilt florasında yer alan stafilokoklar ve diğer Gram-pozitif bakterilerdir. Citrobacter freundii çoğunlukla nozokomiyal enfeksiyon etkeni olup, nadiren kateterle ilişkili kan dolaşımı enfeksiyonuna neden olur. Bu yazıda, hemodiyalize giren 39 yaşında bir erkek hastada Citrobacter freundii’ye bağlı olarak gelişen kateterle kan dolaşımı enfeksiyonu gelişen bir olgu sunuldu. Hastanın periferik kan ve kateter içinden alınan kan örneklerinde Citrobacter freundii üredi. Hastaya 10 gün süreyle seftriakson tedavisi uygulandı, tedavi sonrası klinik ve laboratuvar bulguları düzeldi. Sonuç olarak, özellikle hemodiyalize giren hastalarda nadirde olsa Gram-negatif bakterilerden Citrobacter freundii’nin de kateterle ilişkili kan dolaşımnı enfeksiyonu etkeni olabileceği akılda tutulmalıdır.

Hemodiyaliz hastalarinda santral venoz kateter infeksiyonlari en sik gorulen infeksiyonlar icerisinde yer alir. Kateter infeksiyonlarina en sik neden olan etkenler; Staphylococcus epidermidis , Staphylococcus aureus, Acinetobacter baumannii , E.coli ve Candida turleridir. Bacillus cereus ( B.cereus ) siklikla emetik veya diyareik tipte besin zehirlenmesi ve posttravmatik endoftalmik kinik tablolarina neden olmasina ragmen, hemodiyaliz hastalari ve immunsupresif hastalarda nadiren kateter infeksiyonu ve kataterle iliskili kan dolasimi infeksiyonuna neden olabilir . Bu yazida , 71 yasinda erkek hemodiyaliz hastasinda B.cereus’ a bagli olarak gelisen ve tedavi ile tamamen iyilesen kateterle iliskili kan dolasimi infeksiyonu olgusu bildirildi .

Amaç: Bu çalışmanın amacı HIV enfeksiyonu pozitif saptanan hastalarda HHV-6 DNA sıklığının, HHV-6 DNA’sı pozitif saptanan olgularda ise HHV-6 varyant türünün (varyant A veya varyant B) belirlenmesiydi.Gereç ve Yöntem: Çalışmaya 20 HIV pozitif hasta ile 57 HIV negatif sağlıklı birey dahil edildi. Hasta ve kontrol grubunda HHV-6 DNA’sı polimeraz zincir reaksiyonu (PZR) ile araştırıldı. HHV-6 DNA pozitif saptanan olgularda HHV-6 varyant türü restriksiyon parça uzunluğu polimorfizmi (restriction fragment lenght polymorphisim: RFLP) ile araştırıldı. İstatistiksel değerlendirme SPSS programında yapıldı, p≤0.05 istatistiksel olarak anlamlı kabul edildi. Bulgular: HIV pozitif hastalarda HHV-6 DNA pozitifliği %45 (9/20), HIV negatiflerde ise %33,3 (19/57) olarak belirlendi. Toplamda pozitiflik oranı %36,3 (28/77) idi. HIV pozitif hastalarda HHV-6 varyant B saptanırken, varyant A saptanmadı. Sonuç: HIV pozitif hastalarda HHV-6 seropozitifliği ve varyant tiplerinin öneminin belirlenmesi için daha fazla sayıda olgu içeren başka klinik çalışmalara gereksinim olduğu görüşündeyiz.

Amac: Influenza enfeksiyonu ozellikle sonbahar ve kis aylarinda yaygin olarak gorulen, mortalite ve morbiditeye neden olabilen damlacik yoluyla bulasan viral bir enfeksiyondur. Influenza enfeksiyonundan korunmada asilama onemli bir korunma yontemidir. Bu calismada, influenza enfeksiyonu acisindan risk grubunda yer alan doktor, hemsire ve yardimci saglik personelinden olusan saglik calisanlarinin grip asisi hakkindaki bilgi duzeylerinin ve asiya karsi yaklasimlarinin belirlenmesi amaclandi. Gerec ve Yontem: Calisma Mayis -Agustos 2015 tarihleri arasinda, Ankara ilindeki bes farkli hastanede gerceklestirildi. Bu tanimlayici anket calismasina toplam 363 saglik calisani dahil edildi. Katilimcilara grip ve asisi hakkinda 18 sorudan olusan bir anket uygulandi. Elde edilen sonuclar istatistiksel olarak degerlendirildi. Istatistiksel degerlendirmede Ki-kare, Fisher ve Mann-Whitney U testleri kullanildi. p degerinin ≤0.05 olmasi istatistiksel olarak anlamli kabul edildi. Bulgular: Calismaya katilan saglik calisanlarinin yas mediani 30 (19-60 yas), 280’i ( %77) kadin, 83’u (%23) erkekti. Katilimcilarin 49’u (%13,5) doktor, 227’si (%62,5) hemsire, 87’si (%24) yardimci saglik personeli idi. Calismaya katilanlarin bir onceki sene icin grip asisi yaptirma orani %25 (66/363) olarak belirlendi. Calismada grip asisi yaptirmama nedenleri siklik sirasina gore; bilimsel olarak yararli oldugundan inanmama (%43), diger nedenler (%24), ihmal etme (%18), is yogunlugu (%7), basindaki olumsuz haberler (%7) idi. Katilimcilardan sadece %49,6'si grip asisinin koruyucu olduguna inandigini ifade etti, erkeklerin grip asisinin koruyuculuguna guveni kadinlardan daha yuksek saptandi (p=0,000), bu oran doktorlar da anlamli oranda yuksekti. ‘‘Grip asisinin gerekliligine inaniyor musunuz?’’ sorusuna hemsireler anlamli olarak daha dusuk oranda evet cevabi verdi. ‘‘Hastalariniza grip asisi onerir misiniz?’’ sorusuna doktorlar anlamli olarak daha yuksek oranda evet cevabi verdi. Sonuc: Grip asisi ve koruyuculugu hususunda ozellikle hemsire ve yardimci saglik personelinin duzenli olarak bilgilendirilmesi, saglik personelinin her yil grip asisi yaptirmaya ozendirilmesi, saglik personelinin grip asisinin bilimsel olarak yararina inanmama onyargisini ortadan kaldirabilecegi gorusundeyiz.

Chronic hepatitis B (CHB) is an important public health problem in the world and Turkey. The aim of this study was to evaluate the histological, virological, serological and biochemical response rates in CHB patients receiving tenofovir or entecavir therapy. Control liver biopsies were performed on patients who received tenofovir or entecavir therapy for one year or longer. Histopathological grading was scored according to the modified Knodell system. Eighty-seven CHB patients were included in this study, 56 patients were receiving tenofovir and 31 patients were receiving entecavir therapy. Patients in two treatment groups were similar in terms of baseline parameters (p> 0.05). At the end of the treatment, there was a significant decrease in mean values of HBV DNA, alanine aminotransferase and necroinflammatory scores for both groups (p 0.05). Histological responses were obtained 66.1% from the tenofovir group and 54.8% from the entecavir group. Treatment with tenofovir and entecavir resulted with improvement in Ishak fibrosis scores in 12.5% and 12.9% of the patients, respectively. For 14.3% of the tenofovir-treated patients and for 22.6% of the entecavir-treated patients, the Ishak fibrosis scores worsened. Baseline intermediate/ advanced fibrosis stage (Ishak fibrosis score: 3-6) was found as independent determinant factor on histological response and improvement of fibrosis score (OR= 3.99, p= 0.01; OR= 31.67, p= 0.002; respectively) and treatment duration longer than five years is an independent determinant for improvement of necroinflammatory score (OR= 5.79, p= 0.02). There was no significant difference in the virological, serological, biochemical and, histological responses and improvement of necroinflammatory and fibrosis scores between tenofovir and entecavir groups (p> 0.05). Similar histological, virological, serological and biochemical responses were obtained in patients with CHB receving tenofovir and entecavir treatments. Further studies involving a large number of patients receiving long-term therapy should be done to understand the effects of antiviral treatments on healing of liver histology.

Neisseria meningitidis is a gram negativediplococcus and is one of the common causes of community-acquiredmeningitis inour country. In meningococcal meningitis, taking infection control measures andchemoprophyla is are important for the prevention of transmission. In thisarticle, a 20-year-old military personel who developed meningitis due to Neisseria meningitidis serogroup B waspresented and the infection control measures taken for the military unit andthose with close contact with the patient were reviewed., Neisseriameningitidis gram negatif diplokok olup ülkemizdetoplum kaynaklı menenjitin yaygın etkenlerinden biridir. Meningokok menenjitinde infeksiyonkontrol önlemlerinin alınması vekemoprofilaksi bulaşın önlenmesi açısından önemlidir. Bu yazıda, Neisseriameningitidis serogrup B’ye bağlı olarak menenjit gelişen, 20 yaşındaki birasker sunularak askeri birlik ve hastanın yakın temaslılarına yönelik alınan infeksiyonkontrol önlemleri gözden geçirilmiştir.

Proteus penneri (P.penneri) is a rare Gram negative bacilli that can cause invasive infectious diseases. P. penneri may cause clinical manifestations such as urinary tract infection, wound infection, sepsis.In this article, a 57-years-old female patient who developed wound infection and purulent discharge in the shoulder due to P. penneri after dog bite was presented and did not respond to amoxicillin-clavunate treatment. According to the antibiogram, piperacillin-tazobactam treatment was started intravenously (i.v.) at a dose of 3x4.5 g. The treatment was administered for 7 days. After treatment, the discharge in the lesion area completely resolved., Proteus penneri (P.penneri)invaziv infeksiyon hastalalıklarına neden olabilen, nadir görülen bir Gramnegatif basildir. P.penneri üriner sistem infeksiyonu, yara infeksiyonu,sepsis gibi klinik tablolara neden olabilir. Bu yazıda , köpek ısırığısonrasında P.penneri'ye bağlı sağkolunda yara infeksiyonu ve pürülan akıntı gelişen, amoksisilin-klavunattedavisine yanıt vermeyen 57 yaşında bir kadın olgu sunuldu. Hastayaantibiyogram sonucuna göre piperasilin-tazobaktam tedavisi 3x4.5 gr dozdaintravenöz (i.v.) yolla başlandı, tedavi 7 gün süreyle uygulandı. Tedavisonrası lezyon bölgesindeki akıntı ve yara yeri infeksiyonu tamamen düzeldi.

Pacemakers are foreign bodies which often used in the treatment of arrhythmias. Infection of pacemaker and the parts associated with pacemaker is extremely rare. The most important risk factors for development of infection; duration of the procedure, complications during operation and immunodeficiency of the patient. These infections are often seen when the pacemaker was inserted or removed as a result of the contamination. Although pacemaker infections are rare, the mortality rate is high. The most common causative agent is staphylococcus, gram negative bacteria and fungi may also be rarely causative agents. Ochrobactrum anthropi is a gram-negative, aerobic, oxidase positive, urease positive, motile and non-lactose-fermenting bacillus previously known as “ Achromobacter group”. It is an opportunistic pathogen that can cause infection in especially immunosupressive patients with permanent central venous catheter. The main infections reported due to this agent; bacteremia, central venous catheter-related sepsis, endocarditis, endophthalmitis, pancreatic abscess, urinary tract infections, meningitis, pelvic abscess and osteomyelitis. In the literature, just one case has been reported which developed pacemaker infection due to this agent. In this manuscript, fifty-four-year-old Afghan nationality patient was presented with the diagnosis of pacemaker and pacemaker lead infections.

Aim:Productionof extended-spectrum beta-lactamase (ESBL) enzymes are the mostcommon resistance mechanism against beta-lactam antibiotics on E.coliand Klebsiellaspp.Temocillin and fosfomycin have also been used in the treatment ofinfections caused by ESBL producing E.coliand Klebsiellaspp.The aim of this prospective study is to determine the susceptibilityof temocillin, fosfomycin, ertapenem, imipenem, meropenem, andpiperacillin-tazobactam to ESBL-producing E.coli isolateisolated from various clinical samples by the disk diffusion method.Materialand Methods: Thestudy included 80 E.colistrains isolated from various clinical samples in Ankara YıldırımBeyazıt University Yenimahalle Training and Research Hospital,Microbiology Laboratory and ESBL producing were determined by doubledisc synergy method. The susceptibilities of the strains totemocillin, fosfomycin, ertapenem, imipenem, meropenem, andpiperacillin-tazobactam were determined according to the CLSIrecommendations by disk diffusion method. Determined by double discsynergy method. The susceptibilities of the strains to temocillin,fosfomycin, ertapenem, imipenem, meropenem, andpiperacillin-tazobactam were determined according to the CLSIrecommendations by disk diffusion method.Results:The antibiotic susceptibility rates of ESBL-producing E.colistrains included in the study were as follows; ertapenem 100%(80/80), imipenem 100% (80/80), meropenem 100% (80/80), temocillin98.7% (79/80), piperacillin-tazobactam 96% (77/80) and fosfomycin 95%(76/80).Conclusion:Sensitivity of ESBL-producing E.colistrains against temocillin and fosfomycin were found to be high inour hospital. It has been determined that temocillin and fosfomycincan be used as alternative drugs to carbapenems in the treatment ofinfections due to these agents., Amaç:Genişlemiş spektrumlu beta-laktamaz (GSBL) enzimi üretimi ilebeta-laktam antibiyotiklere direnç gelişmesi E.coliveKlebsiella species(Klebsiellaspp.)suşlarında en sık görülen direnç mekanizmasıdır. GBSL üretenE.colive Klebsiellaspp.neden olduğu enfeksiyonların tedavisinde son yıllarda temosilin vefosfomisin de kullanılmaktadır. Bu çalışmanın amacı, çeşitliklinik örneklerden izole edilen ve GSBL üreten E.coli izolatlarının;temosilin, fosfomisin, ertapenem, imipenem, meropenem vepiperasilin-tazobaktam duyarlılıklarının olarak disk difüzyonyöntemiyle belirlenmesidirGereçve Yöntemler: Çalışmaya Ankara Yıldırım Beyazıt Üniversitesi YenimahalleEğitim ve Araştırma Hastanesi Mikrobiyoloji Laboratuvarı’ndaçeşitli klinik örneklerden izole edilen ve genişlemiş spektrumlubeta laktamaz (GSBL) ürettiği çift disk sinerji yöntemiylebelirlenen 80 E.colisuşu dahil edildi. Suşların; temosilin, fosfomisin, ertapenem,imipenem, meropenem ve piperasilin-tazobaktam duyarlılıkları diskdifüzyon yöntemiyle CLSI önerileri doğrultusunda belirlendi. Bulgular:Çalışmayadâhil edilen GSBL üreten E.colisuşlarında antibiyotik duyarlılık oranları sırasıyla;ertapenem %100 (80/80), imipenem %100 (80/80) , meropenem %100(80/80), temosilin %98,7 (79/80) , piperasilin-tazobaktam %96(77/80) ve fosfomisin %95 (76/80) olarak belirlendi. GSBLüreten E.colisuşlarında karbapenemlere (ertapenem, imipenem ve meropenem) dirençsaptanmadı.Sonuç:HastanemizdeGSBL üreten E.colisuşlarında temosilin ve fosfomisin duyarlılık oranlarınınyüksek olduğu, temosilin ve fosfomisinin bu etkenlere bağlıenfeksiyonların tedavisinde karbapenemlere alternatif ilaçlarolarak kullanılabileceği belirlendi.

İntrakraniyal tüberkülom,tüberküloza bağlı santral sinir sistemi infeksiyonunun önemli komplikasyonlarındanbirisidir. İntrakraniyal tüberkülomlar görüntüleme yöntemlerinde beyintümörleri ile karışabilir. Tanıda etkenin kültürden izolasyonu vehistopatolojik inceleme kullanılabilir. Tedavide cerrahi girişim veantitüberküloz tedavi uygulanır. Bu yazıda, Cibuti, Afrika’dan gelen ve intrakraniyalkitle nedeni ile opere edilen ancak biyopsi materyalinin histopatolojikincelemesi sonucunda tüberkülom olduğu saptanan 34 yaşında bir kadın hastasunuldu., Intracranial tuberculoma is one of the significant complicationsof central nervous system infection due to tuberculosis. Intracranialtuberculomas may be confused with brain tumors in imaging modalities. Diagnosisis made with the isolation of the causative agent from culture orhistopathological examination. Surgical intervention and antituberculosistreatment are used in the treatment. In this article, 34 years old femalepatient from Cibuti, Africa, who is operated with the diagnosis of intracranialmass is presented. The definite diagnosis of tuberculosis is made with thehistopathologic examination of biopsy specimens.

Objective: The purpose of this study is to compare the HHV-8 IgM and IgG positivity rates in patients with different malignancies, including non-Hodgkin lymphoma, Hodgkin’s lymphoma, acute lymphocytic leukemia, acute myelocytic leukemia, multiple myeloma, and chronic myelocytic leukemia. Material and Method: Totally 58 individuals, fifty patients with malignancies and eight healthy individuals were included in the study. Indirect fluorescent an tibody method was used to analyze HHV-8 IgM and HHV-8 IgG antibodies in patient and control groups. Statistical analysis was conducted with SPSS software. Fischer’s Exact Ki-kare test and the Mann-Whitney U-test were used in the statistical evaluation. P values ≤0.05 were considered statistically significant. Findings: In the patient group, 20% of the patients (10/50) were HHV-8 IgM positive. On the other hand, none of the individuals in the control group were HHV-8 IgM positive. In the patient group, 56% of the patients (28/50) were HHV-8 IgG positive, whereas 50% of the individuals (8/16) in the control group were HHV-8 IgG positive. HHV-8 IgM positivity was significantly higher in the patient group when compared to the control group. The highest level of HHV-8 IgM positivity was detected in AML patients, whereas MM patients had the highest level of HHV-8 IgG positivity. Conclusion: HHV-8 IgM and HHV-8 IgG positivity in patients with malignancies can be associated with reactivation or reinfection. Further clinical studies should be carried out on higher number of patients with different malignancies to identify the clinical significance of HHV-8 in these patients.

Intraabdominal abscesses occur rarely due to Candida species. The most important specific risk factors that cause this kind of abscesses are surgical operations, gastrointestinal perforations and gastrointestinal anastomotic leaks. Non-specific risk factors include; diabetes mellitus, immunosuppression, prolonged antibiotic use and admission to intensive care unit. In this article, a 63 year-old female patient’s, who had previously undergone extensive spectrum antibiotic treatment, intraabdominal abscess case occurred due to Candida glabrata is presented., İntraabdominal apseler nadir olarak Candida türlerine bağlı olarak gelişir. Bu tür apselere sebep olan en önemli spesifik risk faktörleri; cerrahi girişimler, gastrointestinal perforasyonlar ve gastrointestinal anastomoz kaçaklarıdır. Spesifik olmayan risk faktörleri arasında ise; diabetes mellitus, immunsüpresyon, uzun süreli antibiyotik kullanımı ve yoğun bakım ünitesinde yatış gibi etkenler yer almaktadır. Bu yazıda, geniş spektrumlu antibiyotik tedavisi almış 63 yaşında diyabetik bir kadın hastanın Candida glabrata’ya bağlı olarak gelişen intraabdominal apse vakası sunulmuştur.

Kirim Kongo kanamali atesi (KKKA) siklikla ilkbahar-yaz donemlerinde, nisan ile eylul aylari arasinda gorulen ve ulkemizde belirli cografyada endemik seyreden bir hastaliktir. Bu yazida KKKA tanisi ile kis mevsiminde, subat ayinda servisimizde izlenen ve mortal seyreden 61 yasinda bir erkek hasta sunuldu.

Objective: In this study, the sensitivity of minocycline, polymyxin B, cholestin and phosphomycin to carbapenem resistant multiresistant Acinetobacter baumannii (A. baumannii) strains (resistant to three or more antibiotic groups) isolated from patients in Ankara Training and Research Hospital It was aimed.Material and Method: Eighty nosocomial A. baumanii strains with a carbapenem resistant multidrug resistance phenotype were included in the study. Sensitivities of minocycline, polymyxin B and phosphomycin were determined by disc diffusion test and colistin susceptibility test by disk diffusion and E-test methods.Results: Eighty (100%) polymyxin B, 75 (93,75%) minocycline sensitive and 4 (5%) medium susceptible to 80 carbapenem resistant A.baumannii strains were evaluated by disc diffusion method. 75 (93.5%) were sensitive to colistin, 5 (6.25%) were moderately sensitive to colistin and 2 (2.5%) were sensitive to phosphomycin. By e-test, all 80 strains (100%) were detected as susceptible to colistin. The MIC range for colistin was 0.125-1.5 μg / ml, the MIC 50 value was 025 μg / ml (the MIC range was found to be 0.5 μg / ml). Conclusion: Polymyxin B and minocycline could be used in therapy because phosphomycin B and susceptibility rates were high in empirical treatment of carbamazepine resistant multispecific A.baumannii strains in our hospital. Phosphomycin could not be used in treatment because of high resistance rate.

Culture results that allow diagnosis and treatment of bacterial meningitis are at the earliest 24-48 hours. Therefore, cell count in CSF, biochemical properties of CSF and examination of CSF by Gram staining are of great importance for early diagnosis together with clinical findings. Since the meningitis is an emergency in terms of infection, especially in cases where the empirical treatment is started early without CSF and blood sample collection, or if patients have already received antibiotic treatment, the probability of detection of the agent in culture is reduced or disappeared. In such cases, diagnosis can be made by gram staining of CSF, investigation of bacterial antigens in CSF, and investigation of bacterial DNA by polymerase chain reaction. In this study, a 46-year-old female patient was presented and the literature was reviewed. In the case, ceftriaxone treatment was started without a CSF sample due to a preliminary diagnosis of meningitis. Therefore, no agent was detected in culture, but Streptococcus pneumoniae (S.pneumoniae) was found to be positive in CSF by multiplex PCR. Althoug apropriate antimicrobial treatment, the superior sagittal sinus and diffuse cerebral thrombus in bilateral transverses developed as a complication of pneumococcal meningitis, Bakteriyel menenjitlerin erken tanısı ve tedavisinde kültür sonuçları en erken 24-48 saatte çıktığından ötürü, klinik bulgularla birlikte BOS’da hücre sayımı, BOS’un biyokimyasal özellikleri ve BOS’un Gram boyama ile incelenmesi büyük önem taşımaktadır. Özellikle menenjitlerin infeksiyon acili olması nedeniyle kültür için BOS ve kan örneği alınmadan ampirik tedavinin erken başlandığı veya hastaların önceden antibiyotik tedavisi aldığı durumlarda kültürde etkenin saptanma olasılığı azalır veya ortadan kalkar. Bu gibi durumlarda BOS’un Gram boyaması, BOS’da bakteri antijenlerinin araştırılması yanı sıra son yıllarda polieraz zincir reaksiyonu ile de bakteri DNA’sı araştırılarak da tanıya gidilebilmektedir. Burada, menenjit ön tanısıyla BOS örneği alınmadan seftriakson tedavisi başlanan bu nedenle kültürde etkenin saptanmadığı, ancak; multipleks PZR yöntemiyle BOS’da Streptococcus pneumoniae (S.pneumoniae) pozitif saptanan 46 yaşında bir kadın hasta sunularak literatür gözden geçirildi. Olguda uygun antimikrobiyal tedaviye rağmen, pnömokok menenjiti komplikasyonu olarak superior sagittal sinüs ve bilateral transverslerde yaygın serebral trombüs gelişti.