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Introduction: Campylobacter infections are among the most common causes of bacterial enteritis. This study aims to determine the sensitivity, specificity and positive predictive values (PPV) of culture and culture-independent tests for the diagnosis of Campylobacter enteritis. Methodology: A total of 400 stool samples were included in the study. BD MAX enteric bacterial panel (BD Diagnostics, Franklin Lakes, NJ, USA) and EntericBio Gastro Panel II (Serosep, Limerick, Ireland) were used as commercial molecular tests. RIDA®QUICK Campylobacter (R-Biopharm, Darmstadt,, Germany) and CerTest (Biotec, Zaragoza, Spain) were used to detect Campylobacter antigens. Samples were cultured in CCDA media and subjected to bacterial identification by mass spectrometry. Results: Among the 400 specimens, 41 (10.2%) were evaluated as Campylobacter positive; 21 were culture-positive and 20 were detected as positive by both PCR methods. Of the 21 isolates grown in culture, 16 (76.2%) were identified as C. jejuni and 5 (23.8%) as C. coli. While all 21 culture-positive specimens were detected as positive by both molecular tests, 18 of the specimens were found positive by RidaQuick, and 16 by Certest ICA. Of the 20 culture-negative Campylobacter cases, 18 were positive by RidaQuick and 12 by Certest ICA. Sensitivities of culture, ICA-RidaQuick and ICA-CerTest were 51.2%, 87.8 and 68.3, respectively. The specificities of all tests were in the range of 90-100 %. PPV of molecular tests, ICA-RidaQuick and ICA-CerTest were > 95%, 72 % and 48.3 %, respectively. Conclusions: Molecular tests were superior to culture and ICA in terms of sensitivity, specificity, and positive predictive value.

Aim: The Covid-19 pandemic has affected healthcare system deeply. The healthcare workers served at high risk. In this period, medical students continued their education remotely. This study was aimed to evaluate the concerns of the medical students about their own health as well as their profession and thoughts about their decision to start medical school. Methods: This study was conducted in Ankara Yildirim Beyazit University, Faculty of Medicine between 10-17 May 2020. The online questionnaire including demographic information, occupational anxiety, health anxiety, health cognition level were sent to 2281 students. The data were obtained using a convenience sampling. The distribution of the data is presented using median (minimum-maximum). Double-series correlation coefficient, chi-square test and polychoric correlation coefficient were used to evaluate the relationship between responses to the questionnaire. Results: A total of 885 students completed the questionnaire. The mean age was 21.47 (±2.62); 545 (61.9%) of them were female. A number of 809 (91.8%) students stated that they chose medical school willingly while 72 (8.2%) students unwillingly. Those who unwillingly chose medicine had a high desire to change their profession. The distance education was sufficient for 168 (19.2%) students; partially sufficient for 435 students. As the semester increased, their professional anxiety, awareness of the advantages and disadvantages of their professions, trust to the health system, ability of reviewing different professional resources increased. Female students were more concerned about their professional and general health than male students. Conclusions: Although the pandemic had effects on medical students' profession choice and anxiety levels, in general, these effects was not higher. The professional anxiety, awareness of the profession, trust to the health system, ability of reviewing different professional resources were related to semester year. Distance education systems should be improved. Psychological support can be provided for the students. Moreover the results should be evaluated regarding the time of study and expectations the end of pandemic in a short time that may be the reason more optimistic answers.

Background: Candida infections are a significant cause of morbidity and mortality in hospitalized patients. Acquired resistance to antifungal agents and strains with intrinsic resistance makes it hard to manage the infection. Objectives: We aimed to examine the risk factors of candidemia associated with patient mortality, the species causing candidemia, and their antifungal susceptibility. Methods: Patient data were collected from medical records retrospectively. MALDI-TOF MS was used to identify Candida species. Antifungal susceptibility testing was conducted by the colorimetric broth microdilution method. Results: A total of 155 patients were included in the study. The incidences of candidemia were 0.92, 0.72, 0.99, 0.97, and 2.28 per 1,000 cases in 2016, 2017, 2018, 2019, and 2020, respectively. Candida albicans accounted for 45% of all cases, followed by C. parapsilosis complex (28%), C. tropicalis (10%), and C. glabrata (8%). The 30-day crude mortality was 45%. There was no significant difference in mortality between C. albicans and non-albicans yeast species. The susceptibility rates for anidulafungin, micafungin, caspofungin, voriconazole, and fluconazole were as follows: 97%, 97%, 97%, 97%, and 90% in C. albicans, 95%, 95%, 98%, 72%, and 67% in C. parapsilosis complex, and 100%, 100%, 100%, 38%, and 63% in C. tropicalis. The susceptibility rates for anidulafungin, micafungin, and caspofungin in C. glabrata were 100%, 100%, and 92%, respectively. All 12 C. glabrata strains were susceptible-dose-dependent against fluconazole and uninterpretable for voriconazole. Conclusions: Incidences of candidemia and susceptibility patterns of strains may vary over time and amongst the regions. Candida albicans was the predominant strain, and echinocandins demonstrated the highest susceptibility rates against the most common species isolated in this study. Antifungal susceptibility tests are crucial in guiding patient treatment.

Introduction: In Turkey, the number of infected people with HIV-1 increased five-fold between the years 2011-2018. In 2019, 20202 HIV-infected individuals and 1786 AIDS patients were reported. It is necessary to update the physicians’ knowledge on medical, ethical, legal and social issues about HIV infected patients, and to increase the number of physicians following these patients. In this study, it was aimed to determine the problems experienced by infectious diseases and clinical microbiology (IDCM) physicians on diagnosis, treatment and follow-up and to increase their awareness. Materials and Methods: In the study, a questionnaire with 39 questions was sent to 400 IDCM physicians via e-mail. The results of 131 physicians in total were analyzed. In statistical comparison, chi-square test was used for categorical data, and p value below 0.05 was accepted as statistically significant in 95% confidence interval. SPSS v 21.0 program was used for statistical analysis. Results: Of the 131 physicians who participated in the study, 89 (67.9%) were females, 75.6% of these physicians stated that they follow HIV-infected patients. Average working durations of the physicians who followed and did not follow the patients were 16.0 ± 10.4 (1-44) and 11.9 ± 5.6 (2-26) years, respectively. Of the 32 physicians who did not follow the patients, 22 (68.8%) stated that they wanted to follow patients on provided conditions. The most common reasons for physicians not following HIV-infected patients are lack of access to laboratory tests (56.3% n= 18) and inadequate hospital/outpatient conditions (50.0% n= 16). Of the 99 physicians who follow HIV-infected patients, 87 (87.8%) can access all diagnostic tests, and 98 physicians (98.9%) can access at least one. The most commonly found difficulties in patient follow-up are the lack of social insurance of the patient (43.4%) and informing relatives about the disease (37.4%). Seventy-two point seven percent of the physicians have difficulties in the management of the patient group (mental disorder, drug addiction and prisoners) who has social problems. Physician-patient compliance (96%), drug posology (79.8%) and insurance problems (79.8%) were found to be the leading factors affecting treatment compliance. Conclusion: The most challenging issues of physicians following HIV-infected patients are the follow-up of patients without social insurance and the management of socially problematic patients. The most common reasons for physicians not following these patients are inaccessibility to laboratory tests and insufficient hospital conditions. Our study outputs will contribute to the education plans of infectious diseases physicians in our country. Increasing physician patient compliance is important in combating this disease.

Rapid emergence of antibiotic-resistant bacteria has made it harder for us to combat infectious diseases and to develop new antibiotics. The clustered regularly inter-spaced short palindromic repeats – CRISPR-associated (CRISPR-Cas) system, as a bacterial adaptive immune system, is recognized as one of the new strategies for controlling antibiotic-resistant strains. The programmable Cas nuclease of this system used against bacterial genomic sequences could be lethal or could help reduce resistance of bacteria to antibiotics. Therefore, this study aims to review using the CRISPR-Cas system to promote sensitizing bacteria to antibiotics. We envision that CRISPR-Cas approaches may open novel ways for the development of smart antibiotics, which could eliminate multidrug-resistant (MDR) pathogens and differentiate between beneficial and pathogenic microorganisms. These systems can be exploited to quantitatively and selectively eliminate individual bacterial strains based on a sequence-specific manner, creating opportunities in the treatment of MDR infections, the study of microbial consortia, and the control of industrial fermentation. © 2020 Gholizadeh et al.

Due to limitations in commercial diagnostic methods, this study aimed to develop a reliable real-time polymerase chain reaction (Rt-PCR) assay for early diagnosis of brucellosis. Optimization of the Rt-PCR method was performed on serum samples spiked by Brucella melitensis with different densities ranging from 101 to 108 colony-forming units (cfu)/mL; each density was prepared in ten samples. The limit of detection was investigated by using Thermo DNA extraction kit with Maxima SYBR Green Rt-PCR and two TaqMan probe–based Rt-PCR protocols performed by QuantiTect and TEMPase multiplex PCR master mixes in two thermal cyclers, which were Rotor-Gene and Bio-Rad. The validation of the optimized protocol was carried on 20 brucellosis-negative samples and 20 samples spiked with B. melitensis by using a combination of Thermo DNA extraction kit with TEMPase PCR master mix. SYBR Green Rt-PCR yielded positive results on all samples having ≥ 104 cfu/mL of B. melitensis in both thermal cyclers. Its limit of detection was 112 DNA copies per reaction. The positivity of both probe-based Rt-PCR protocols was 100% and 80% on the samples having 103 cfu/mL and 102 cfu/mL of B. melitensis, respectively. The limit of detection of probe-based protocols was defined as 4 DNA copies per reaction. The optimized Rt-PCR protocol showed high-level accuracy, precision, specificity, and sensitivity, each having a rate of 100%. The current study indicated that the TaqMan probe–based Rt-PCR protocol optimized and validated with serum samples can be reliably used for early diagnosis of brucellosis.

Objective: Brucellosis is a zoonotic disease with various clinical presentations and early diagnosis is crucial to avoid severe complications. Due to limitations of conventional diagnostic methods, polymerase chain reaction (PCR) based approaches have gained importance in diagnosis.We aimed to evaluate diagnostic value of multiplex real time-PCR (mRT-PCR) in serum samples collected from brucellosis suspected patients by comparision sensitivity of mRT-PCR with those of conventional diagnostic methods. Material and Methods: A total of 249 serum samples collected from the suspected brucellosis patients admitted to the hospitals in three different provinces were analyzed by serological tests, culture and mRT-PCR. In laboratories of the participating hospital, serum samples were tested for the Brucella specific antibody by commercial serological kits including standart tube agglutination test (STAT), Coombs’ test, and immunocapture test (ICT). Blood culture was performed for 153 of the patients in the participating hospital. All serum samples were analyzed for the presence of Brucella DNA by mRT-PCR. Results: According to laboratory test results, 215 of the 249 suspected cases having comparible clinical data were identified as brucellosis cases. Of the 215 brucellosis cases, 36 were diagnosed as definitive cases, the remaning 179 patients were presumptive cases. Sensitivity of mRT-PCR in the samples that were positive by ICT, STAT, Coombs’ test, and blood culture was 70.2%, 77.3%, 83%, and 97.2%, respectively. By using mRT-PCR, additional 17 suspected patients were diagnosed as presumptive cases. Among the mRT-PCR positive serum samples, Brucella abortus was detected in 3 samples (1.9%), the remaining 156 samples (98.1%) had B. melitensis DNA. Conclusion: Our results indicate that mRT-PCR can be considered a useful diagnostic tool in patients who have negative serologic test results, and in detection of Brucella species. Keywords: Brucellosis, Multiplex real-time PCR, Serological diagnosis, Culture

Objective: Nasocomial infections are major health problems due to their high morbidity and mortality, prolonged hospital duration and higher treatment costs. Methicillin-resistant staphylococcus species became one of the leading bacteria causing nasocomial infections especially in intensive care units, recently. The minimum inhibitory concentration value of an antibiotic gives the concentration of antibiotic needed to inhibit the bacteria in the infection area. Careful monitoring of minimal inhibitory concentration (MIC) values is necessary especially during long-term treatments of meticillin-resistant Staphylococcus aureus (MRSA) and meticillin-resistant coagulase-negative staphylococci (MRCoNS) infections1,2. Increasing antibiotic resistance in methicillin-resistant staphylococci, has led to the need for different antibiotics. Methods: A total of 60 meticillin-resistant staphylococci strains isolated in Microbiology Laboratory of Dicle University Hospital, from clinical specimens of patients in adult İntensive Care Units (ICUs) between April 2013 and March 2014 were included in this study. After identification with conventional and automated system, the antibiotic susceptibility rates of vancomycin, teicoplanin, daptomycin, linezolid, quinupristin/dalfopristin, tigecycline, ceftaroline were determined by E-test method. Results: The majority of the samples (26.7%) were sent from Pulmonary Diseases and Tuberculosis intensive care unit and the blood samples were the most common materials (80%) . All staphylococcal strains in our study were determined as susceptible to vancomycin, daptomycin, linezolid, teicoplanin and tigecycline. One (1.6%) MRCoNS isolate was resistant to quinupristin/dalfopristin while 11 (36.6%) of the MRSA isolates were resistant to ceftaroline. In comparison with the MIC values of MRSA and MRCoNS, only tigecycline was significantly different. Thirty MRSA strains were evaluated in terms of vancomycin-intermediate Staphylococcus aureus/heteroresistant vancomycinintermediate Staphylococcus aureus (VISA/hVISA) with macro E-test method; any VISA/hVISA isolate was not detected. Antibiotic concentrations below the MIC level, not only leads to treatment failure but also causes mutant bacteria to appear. In order to control the resistance to antibiotics in the treatment of infections due to MRSA and MRCoNS agents, the clinician should be notified of the MIC values of the drugs and the treatment should be planned accordingly. VISA/hVISA isolates should be considered in treatment failures of infections due to MRSA which are in vitro susceptible to vancomycin. Further testing is needed to detect these isolates. Despite the fact that ceftaroline is not a drug used in our country, the high resistance rate in our study is remarkable. This situation may be due to the intensive use of other beta-lactam antibiotics. Therefore, antibiotic susceptibility results should be taken into consideration during planning the treatment of infections. The high average MIC values of tigecycline in MRCoNS infections should also be monitored carefully Giriş: Hastane enfeksiyonları morbidite ve mortalitesinin yüksek olması, hastanede kalış süresini uzatması ve yüksek tedavi maliyeti nedeniyle önemli bir sağlık sorunudur. Son yıllarda özellikle Yoğun Bakım Ünite (YBÜ)’leri başta olmak üzere hastane enfeksiyonlarında en sık izole edilen etkenlerin başında metisiline dirençli stafilokok (MRS) türleri gelmektedir. Antibiyotiğin minimum inhibisyon konsantrasyon (MİK) değeri, enfeksiyon bölgesinde bakteriyi inhibe etmek için gereksinim duyulan antibiyotik konsantrasyonudur. Metisilin dirençli Staphylococcus aureus (MRSA) ve Metisilin dirençli Koagulaz Negatif Stafilokok (MRKNS) enfeksiyonlarında, özellikle uzun süreli tedaviler esnasında MİK değerlerinin dikkatle izlenmesi gereklidir1,2. Metisiline dirençli stafilokoklarda gittikçe artan antibiyotik direnci, farklı antibiyotiklere ihtiyaç duyulmasına neden olmuştur. Yöntemler: Çalışmada Dicle Üniversitesi Hastanesi Mikrobiyoloji Laboratuvarı’na Nisan 2013-Mart 2014 tarihleri arasında erişkin yoğun bakım ünitelerinden gelen metisiline dirençli 60 stafilokok suşu kullanılmıştır. Konvansiyonel ve otomatize sistem ile tür tayini yapıldıktan sonra E-test yöntemi ile vankomisin, teikoplanin, daptomisin, linezolid, kinupristin/dalfopristin, tigesiklin, seftarolin antibiyotiklerine duyarlılıkları araştırılmıştır. Bulgular: Göğüs Hastalıkları ve Tüberküloz yoğun bakım ünitesi, en fazla örneğin (%26,7) gönderildiği klinik, kan örnekleri mikroorganizmaların en sık izole edildiği materyal (%80) olmuştur. Çalışmamızdaki tüm stafilokok suşları vankomisin, daptomisin, linezolid, teikoplanin ve tigesikline karşı duyarlı bulunmuştur. Bir (%1,6) MRKNS, kinupristin/dalfopristin’e, 11 (%36,6) MRSA izolatının seftaroline dirençli olduğu bulunmuştur. MRSA ve MRKNS suşlarının MİK değerleri karşılaştırıldığında sadece tigesiklinde anlamlı fark bulunmuştur. Makro E-test yöntemi ile incelenen 30 MRSA suşu içerisinde vankomisine orta duyarlı S. aureus/ heterojen vankomisine orta duyarlı S. aureus (VISA/hVISA) suşlar tespit edilmemiştir. MRSA ve MRKNS suşlarının MİK değerleri karşılaştırıldığında sadece tigesiklinde anlamlı fark bulunmuştur. 30 MRSA suşu, makro E-test yöntemi ile Vankomisine orta duyarlı S. aureus/heterojen vankomisine orta duyarlı S. aureus (VISA/hVISA) açısından değerlendirilmiş, VISA/hVISA suşu tespit edilmemiştir. Antibiyotik MİK değerinin altındaki tedavi dozları, mutant bakterilerin oluşumunda önemli bir faktör olmakla birlikte tedavi başarısızlığına yol açmaktadır. MRSA ve MRKNS etkenlerine bağlı enfeksiyonların tedavisinde antibiyotiklere karşı gelişen direncin kontrol altında tutulabilmesi için ilaçların MİK değerlerinin klinisyene bildirilmesi ve buna göre tedavinin planlanması gerekmektedir. İnvitro olarak vankomisine duyarlı olan ancak tedavi başarısızlığı gösteren MRSA enfeksiyonlarında VISA/hVISA akla gelmeli ve bu yönde ileri tetkikler yapılmalıdır. Seftarolin, ülkemizde kullanılan bir ilaç olmamasına rağmen çalışmamızda yüksek direnç oranı dikkat çekicidir. Bu durum, diğer beta laktam antibiyotiklerin yoğun kullanımına bağlı olabilir. Dolayısıyla enfeksiyon hastalıklarının tedavisi planlanırken antibiyogram sonuçları mutlaka göz önünde bulundurulmalıdır. MRKNS enfeksiyonlarında tigesiklindeki ortalama MİK değerinin yüksekliği, izlenmesi gereken bir durumdur.

There are currently no licensed vaccines or therapeutics for COVID‐19. Anti‐SARS CoV‐2 antibody‐containing plasmas, obtained from the recovered individuals who had confirmed COVID‐19, have been started to be collected using apheresis devices and stored in blood banks in some countries in order to administer to the patients with COVID‐19 for reducing the need of intensive care and the mortality rates. Therefore, in this review, we aim to point out some important issues related to convalescent plasma (CP) and its use in COVID‐19. CP may be an adjunctive treatment option to the anti‐viral therapy. The protective effect of CP may continue for weeks and months. After the assessment of the donor, 200‐600 mL plasma can be collected with apheresis devices. The donation interval may vary between countries. Even though limited published studies are not prospective or randomized, until the development of vaccines or therapeutics, CP seems to be a safe and probably effective treatment for critically ill patients with COVID‐19. It could also be used for prophylactic purposes but the safety and effectiveness of this approach should be tested in randomized prospective clinical trials.

Background: In chronic hepatitis B patients with or exposed to the risk of osteoporosis or renal dysfunction, switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide fumarate (TAF) or entecavir (ETV) may be the right choice. Objectives: This study aimed to present real-life data in terms of the efficacy and safety of a TAF/ETV treatment change while receiving TDF. Methods: This retrospective study was conducted on 344 adult patients from 10 centers. The data of patients who had changed to ETV (n = 107) and TAF (n = 237) while receiving TDF were analyzed. The data collected at 0 and 6 months of treatment were analyzed. The virological response was assessed based on undetected hepatitis B virus (HBV) DNA. Serum alanine aminotransferase (ALT) values were used to evaluate the biochemical response. For renal function, serum creatinine and phosphorus, as well as estimated glomerular filtration rate (eGFR), were recorded. Moreover, lumbar spine and hip T-scores along with the serum lipid profile were evaluated. Results: The mean age of patients was 41.14 ± 13.46 years, and 224 (65.1%) of the participants were male. The treatment arms were not significantly different in terms of demographic characteristics, comorbid diseases, infection duration, family history of HBV infection, blood platelet count, serum biomarkers, such as ALT, phosphorus, creatinine, total bilirubin, albumin, lipid profile, and HBV DNA levels at the beginning. No statistically significant difference was found between the proportion of undetectable HBV DNA of the two treatment groups after 6 months (P = 0.221). The ALT normalization in the ETV and TAF groups at the sixth month compared to the baseline levels was not significantly different (P = 0.853, P = 0.330, respectively). There was no statistically significant difference between the two treatment arms regarding changes in eGFR, creatinine, phosphorus, hip, and spine T-scores from baseline to 6 months (P = 0.296, P = 0.78, P = 0.141, P = 0.832, P = 0.947, respectively). In those who switched to TAF or ETV, low-density lipoproteins cholesterol were observed to be significantly higher after 6 months compared to baseline values (P = 0.002, P = 0.049, respectively). The TC increased significantly in the TAF group (P = 0.035). Conclusions: Our study showed that switching to ETV and TAF sustained the viral suppression and biochemical response achieved by TDF therapy. The treatment switch to TAF of ETV can control renal dysfunction and reduce bone mineral density caused by TDF.

WOS:000639966700013 Giriş: Türkiye’de, HIV-1 ile infekte kişi sayısı 2011-2018 yılları arasında beş kat artış göstermiş; 2019’da 20202 HIV ile infekte birey ve 1786 AIDS hastası bildirilmiştir. Hekimlerin HIV ile infekte hastalarla ilgili tıbbi, etik, hukuki ve sosyal konulardaki bilgilerinin güncellenmesi ve bu hastaları takip eden hekim sayısının artırılması gerekmektedir. Bu çalışmada infeksiyon hastalıkları ve klinik mikrobiyoloji (EHKM) hekimlerinin tanı, tedavi ve takipte yaşadıkları sorunların belirlenmesi ve farkındalıklarının artırılması amaçlanmıştır. Materyal ve Metod: Çalışmada 400 EHKM hekimine 39 soruluk anket formu elektronik posta ile gönderilmiştir. Toplamda 131 hekimin sonuçları analiz edilmiştir. İstatistiksel analizde kategorik veriler için ki kare testi kullanılmış ve %95 güven aralığında 0.05’in altındaki p değeri istatistiksel olarak anlamlı kabul edilmiştir. İstatistiksel analizler için SPSS v 21.0 programı kullanılmıştır. Bulgular: Çalışmaya katılan 131 hekimin 89’u (%67.9) kadındır, %75.6’sı (n= 99) HIV ile infekte hastaları takip ettiğini belirtmiştir. Hasta takip eden ve etmeyen hekimlerin meslekte ortalama çalışma süreleri sırasıyla 16.0 ± 10.4 (1-44) ve 11.9 ± 5.6 (2-26) yıldır. Hasta takip etmeyen 32 hekimin 22’si (%68.8) uygun koşulları olduğunda takip etmek istediğini belirtmiştir. Hekimlerin HIV ile infekte hasta takip etmemesinin en sık nedenleri takipte kullanılacak laboratuvar testlerine erişilememesi (%56.3 n= 18) ve hastane/poliklinik şartlarının yetersiz olmasıdır (%50.0 n= 16). HIV ile infekte hasta takip eden 99 hekimden 87’si (%87.8) tanı testlerinin tümüne erişebilmekte, 98 hekim (%98.9) en az birine erişebilmektedir. Hasta takibinde en çok zorlanılan konular hastanın sosyal güvencesinin olmaması (%43.4) ve hastalık konusunda yakınlarının bilgilendirilmesidir (%37.4). Hekimlerin %72.7’si sosyal özellikleri sorunlu olan hasta grubunun (mental bozukluk, ilaç bağımlılığı ve mahkûmlar) yönetiminde zorlanmaktadır. Hekim-hasta uyumu (%96), ilaç pozolojisi (%79.8) ve sigorta sorunları (%79.8) tedavi uyumunu etkileyen faktörlerin başında gelmektedir. Sonuç: HIV ile infekte hasta takip eden hekimlerin en zorlandığı konular sosyal güvencesi olmayan hastaların takibi, hasta yakınlarının bilgilendirilmesi ve sosyal olarak sorunlu hastaların yönetimidir. Hekimlerin hasta takip etmemesinin en sık nedenleri laboratuvar testlerine erişilememesi ve hastane şartlarının yetersiz olmasıdır. Çalışmamız çıktıları ülkemizdeki infeksiyon hastalıkları hekimlerinin eğitim planlarına katkı sağlayacaktır. Hekim hasta uyumunun artırılması bu hastalıkla mücadelede önemlidir Introduction: In Turkey, the number of infected people with HIV-1 increased five-fold between the years 2011-2018. In 2019, 20202 HIV-infected individuals and 1786 AIDS patients were reported. It is necessary to update the physicians’ knowledge on medical, ethical, legal and social issues about HIV infected patients, and to increase the number of physicians following these patients. In this study, it was aimed to determine the problems experienced by infectious diseases and clinical microbiology (IDCM) physicians on diagnosis, treatment and follow-up and to increase their awareness. Materials and Methods: In the study, a questionnaire with 39 questions was sent to 400 IDCM physicians via e-mail. The results of 131 physicians in total were analyzed. In statistical comparison, chi-square test was used for categorical data, and p value below 0.05 was accepted as statistically significant in 95% confidence interval. SPSS v 21.0 program was used for statistical analysis. Results: Of the 131 physicians who participated in the study, 89 (67.9%) were females, 75.6% of these physicians stated that they follow HIV-infected patients. Average working durations of the physicians who followed and did not follow the patients were 16.0 ± 10.4 (1-44) and 11.9 ± 5.6 (2-26) years, respectively. Of the 32 physicians who did not follow the patients, 22 (68.8%) stated that they wanted to follow patients on provided conditions. The most common reasons for physicians not following HIV-infected patients are lack of access to laboratory tests (56.3% n= 18) and inadequate hospital/outpatient conditions (50.0% n= 16). Of the 99 physicians who follow HIV-infected patients, 87 (87.8%) can access all diagnostic tests, and 98 physicians (98.9%) can access at least one. The most commonly found difficulties in patient follow-up are the lack of social insurance of the patient (43.4%) and informing relatives about the disease (37.4%). Seventy-two point seven percent of the physicians have difficulties in the management of the patient group (mental disorder, drug addiction and prisoners) who has social problems. Physician-patient compliance (96%), drug posology (79.8%) and insurance problems (79.8%) were found to be the leading factors affecting treatment compliance. Conclusion: The most challenging issues of physicians following HIV-infected patients are the follow-up of patients without social insurance and the management of socially problematic patients. The most common reasons for physicians not following these patients are inaccessibility to laboratory tests and insufficient hospital conditions. Our study outputs will contribute to the education plans of infectious diseases physicians in our country. Increasing physician patient compliance is important in combating this disease.

WOS:000654928300001 PMID: 33977603 Objective Occult hepatitis B infection (OHBI) appears to have a higher prevalence in populations at high risk for hepatitis B virus (HBV) infection with concomitant liver disease. The aim was to assess the prevalence of OHBI in a sample of human immunodeficiency virus -1 positive and HBV surface antigen-negative (HIV-1+/HBsAg-) Turkish patients. Methods Ten centres in Turkey were included in the study. Patients were selected on the basis of a power calculation with a known population size of HIV-positive patients and a reported prevalence of OHBI. Gender, age, occupation, place of residence, treatment and clinical status, and laboratory results, including immunodeficiency panel, antibody tests, hemogram, biochemistry, and coagulation studies were evaluated retrospectively. Results The number of HIV-infected patients followed in these centres was 3172 and the sample population numbered 278. All 278 were HBsAg negative. The mean age of the sample was 37.2 +/- 13.1 years and 235 (84.5%) were male. All but one patient (99.6%) had been treated with antiretroviral therapy. Of the 278 patients, 169 (60.6%) were positive for Anti-HBs and 125 (44.8%) were positive for Anti-HBc IgG. HIV RNA was detected in 203/278 (73%) of the patients. Four HBV DNA (1.4%) were diagnosed with OHBI. There was no significant difference in hemogram, hemoglobin or bilirubin concentrations in those with OHBI compared with the other patients. Conclusion In a representative sample of HIV+ patients from 10 Turkish centres, the prevalence of OHBI was found to be 1.4%. In HIV positive patients, it is important to identify those with OHBI for optimal clinical management and prognosis.

Amaç: Aşı tereddüdü hem Türkiye hem de dünya için toplumsal tehdit oluşturan bir tutumdur. Bu konuda Türkçeye validasyonu yapılmış bir ölçek bulunmamaktadır. Bu çalışmanın amacı Opel ve ark. tarafından 2011 yılında geliştirilip 2013 yılında revize edilen ve ‘Parent Attitudes About Childhood Vaccines Survey ‘isimli ölçeğin Türkçeye dil validasyonunun yapılmasıdır. Gereç ve Yöntem : Çalışma bir dil validasyonu çalışması olarak gerçekleştirilmiştir. Opel DJ ve arkadaşları tarafından geliştirilen ölçek için ‘Seri yöntem’ kullanılarak dil validasyonu çalışması yapılmıştır. Ölçeğin çeviri, gözden geçirme, geri çeviri, açıklığın ve aynılığın değerlendirmesi ile çevirisi sağlanmış ve Modifiye Lawshe yöntemiyle kapsam geçerlilik analizi yapılarak son hali verilmiştir. Uzmanların ölçek maddelerine yönelik içerik uygunluğu yönünden belirtmiş oldukları görüşlere göre her madde için kapsam geçerlilik oranı ve kapsam geçerlilik indeksi hesaplanmıştır. Bulgular. Tüm ölçek soruları için kapsam geçerlilik oranı kritik değer olan 0,455’in üzerinde saptanmıştır. Ölçeğin kapsam geçerlilik indeksi değeri ise 0,630 olup ölçek sorularının kapsam geçerliliğinin istatistiksel olarak anlamlı olduğu tespit edilmiştir. Çıkarımlar: Çocukluk çağı aşılarına yönelik ebeveyn tutumları ölçeğinin dil validasyonunun tamamlanması ve kapsam geçerlilik testlerinden istatistik olarak anlamlı sonuçlar alınmış olması bu ölçeğin Türkçe anlaşılırlığının sağlandığını göstermektedir. Sonrasında yapılacak geçerlilik ve güvenilirlik çalışmaları ile ölçeğin Türkiye’de aşı tereddüdü konusunda ebeveyn tutumlarını ölçebilir hale gelmesi hedeflenmektedir. Böylece daha geniş kitlelerde çalışılarak aşı tereddüdü ve mücadelesi konusunda yapılacak çalışmalara katkı sağlayacağı düşünülmektedir.

Myroides spp. are low-grade opportunistic pathogens. Outbreaks due to Myroides spp. have rarely been described in the literature to date. We report a healthcare-associated outbreak of urinary tract infections (UTIs), caused by Myroides odoratimimus, in a Turkish hospital. As of March 2019 until May 2019, 6 strains of M. odoratimimus were isolated from the urine samples of patients, all of whom were hospitalized in intensive care units. After identification and antibiotic susceptibility testing using the VITEK 2 system, MALDI-TOF-MS and 16S rRNA-based sequencing methods were performed for confirmation and species-level identification. Pulsed-field gel electrophoresis (PFGE) was performed in order to investigate the clonal relatedness of the isolates. All the patients were immunocompromised and underwent urinary catheterization. None of the patients had urinary neoplasm, surgery, or calculi. VITEK 2 and MALDI-TOF-MS systems revealed that the isolates belonged to the Myroides genus; however, the aforementioned systems neglected to identify the isolates at the species level. The isolates were all successfully identified as M. odoratimimus through 16S rRNA-based sequencing. The isolates were resistant to every antibiotic tested. All isolates had an indistinguishable PFGE pattern, thus indicating cross-transmission between cases. Although M. odoratimimus is rarely isolated from human specimens, clinicians should be aware of its ability to cause UTIs and infectious outbreaks.

The novel coronavirus SARS-CoV-2 (Covid-19), spreading from Wuhan, China, is one of the causes of respiratory infections that can spread to other people through respiratory particles, and can cause symptoms such as fever, dry cough, shortness of breath, anorexia, fatigue and sore throat in infected patients. This review summarizes current strategies on the diagnosis. Additionally, treatments, infection prevention and control of the SARS-CoV-2 are addressed. In addition to the respiratory system, this virus can infect the digestive system, the urinary system and the haematological system, which causes to observe the virus in the stool, urine and blood samples in addition to throat sample. The SARS-CoV-2 causes changes in blood cells and factors and makes lung abnormalities in patients, which can be detected by serological, molecular, and radiological techniques by detecting these changes and injuries. Radiological and serological methods are the most preferred among the other methods and the radiological method is the most preferred one which can diagnose the infection quickly and accurately with fewer false-negatives, that can be effective in protecting the patient's life by initiating treatment and preventing the transmission of infection to other people.

Amaç: Ülkemizde 2017 verileriyle 17.000 kişinin HIV (insan immün yetmezlik virüsü) ile enfekte olduğu bilinmektedir. Hastalığın tedavisinde ilaç uyumu en önemli noktalardandır. HIV/AIDS tedavisinde hasta eğitimi çok önemlidir. Bu çalışmanın amacı eğitim müdahalesi yapılan hasta grubunda ilaç uyumunun değerlendirilmesidir.Yöntemler: Çalışma retrospektif verilerin analiz edildiği bir müdahale çalışması olarak gerçekleştirilmiştir. MayısTemmuz 2017 tarihleri arasında Dicle Üniversitesi Tıp Fakültesi Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji bölümünde izlenmekte olan 107 HIV/AIDS hastası çalışmaya dahil edilmiştir. Hastalığa özgü detaylı eğitim almayı kabul eden hastalar 1. Grup olarak değerlendirilmiştir. Eğitim almak istememiş olan 25 hasta ise (2. Grup/Kontrol grubu) standart poliklinik bilgilendirmesi almıştır. Her iki grubun eğitimleri aynı hekim tarafından verilmiştir. Hastaların tedavinin 3. ve 6. aylarındaki ilaç uyumları tablet sayma yöntemiyle değerlendirilmiştir. Bulgular: Tedavi almakta olan 107 hastanın yaş ortalaması 28.6 yıldır. Hastaların 86’sı (%80,4) erkektir. Hastaların eğitim durumları incelendiğinde %8,4’ü (n=9) sadece okuryazar, %67,3’ü (n=72) ilk ve orta öğretim mezunu olarak tespit edilmiştir. Hastaların öğrenim durumları ile 3. ve 6. aydaki ilaç uyumları arasında istatistiksel olarak anlamlı bir fark tespit edilmemiştir (sırasıyla p=0,159 ve p=0,274). Günlük tablet sayısından bağımsız olarak, ilaç uyumu, eğitim verilenlerde istatistiksel olarak anlamlı düzeyde yüksek saptanmıştır ( p

Purpose. This study aimed to investigate the effect of smoking on the buccal microbiome and to analyse the descriptive ability of each of the seven hypervariable regions in their 16S rRNA genes. Methodology. Microbiome compositions of 40 buccal swab samples collected from smokers (n =20) and non-smokers (n =20) were determined using 16S rRNA sequencing. Seven different 16S rRNA hypervariable regions (V2, V3, V4, V6-7, V8 and V9) in each sample were amplified using the Ion Torrent 16S Metagenomics kit and were sequenced on the Ion S5 instrument. Results. Seven hypervariable regions in the 16S rRNA gene were successfully sequenced for all samples tested. The data obtained with the V2 region was found to be informative but the consensus data generated according to a number of operational taxonomic unit reads gathered from all seven hypervariable regions gave the most accurate result. At the phylum level, no statistically significant difference was found between smokers and non-smokers whereas relative abundances of Veillonella atypica , Streptococcus australis , Prevotella melaninogenica , Prevotella salivae and Rothia mucilaginosa showed significant increases in the smoker group (P-adj=0.05). Alpha diversity results did not show a significant difference between the two groups; however, beta diversity analysis indicated that samples of smoker and non-smoker groups had a tendency to be clustered within themselves. Conclusion. The results of the current study indicate that smoking is a factor influencing buccal microbiome composition. In addition, sequencing of all seven hypervariable regions yielded more accurate results than those with any of the single variable regions.

The diversity and distribution of TEM, SHV and CTX-M type of extended-spectrum beta-lactamases (ESBLs) are important for the treatment and control of infections. Determination of ESBL genes in clinical isolates by polymerase chain reaction (PCR) and DNA sequencing can obtain useful data for their molecular epidemiology and risk. The aim of this study was to investigate the frequency of beta-lactamase genes in Acinetobacter baumannii strains isolated from different regions of Turkey. A total of 519 A.baumannii strains collected from hospitals located at 12 different provinces of Turkey (Bolu (n= 67), Tokat (n= 47), Trabzon (n= 25), Ordu (n= 27), Diyarbakir (n= 47), Nigde (n=31), Kayseri (n= 36), Ankara (n= 41), Kirikkale (n= 26), Kahramanmaras (n= 25), Mersin (n= 40), Istanbul (n= 107)] between 2011-2012 period were included in the study. Identification of the isolates were performed by both conventional methods and automated systems, VITEK2 Compact (BioMerieux, France) and API 32GN (BioMerieux, France). Disc diffusion method was used for the detection of antibiotic susceptibilities of the isolates and the results were evaluated according to CLSI (Clinical and Laboratory Standards Institute) criteria. Tigecycline and colistin sensitivities of the isolates were evaluated according to BSAC (British Society for Antimicrobial Chemotherapy) criteria. The presence of beta-lactamase genes, namely blaoxa-51, blaTEM, blaSHV, blaCTX-M1, blaCTX-M2, blaGES and blaVIM were detected by PCR. In our study, the resistance rates against colistin, tigecycline, ampicillin-sulbactam, amoxicillin-clavulanic acid, cefoperazone/sulbactam, tobramycin, ceftriaxone, piperacillin-tazobactam, gentamicin, ampicillin, tetracycline, cefepime, piperacillin, amikacin, trimethoprim-sulfamethoxazole, meropenem, levofloxacin, ciprofloxacin, imipenem and ceftazidime were detected as; 0.6%, 2.7%, 11.9%, 15.2%, 21%, 22.9%, 23.9%, 48.6%, 59.5%, 61.8%, 66.3%, 67.8%, 69.2%, 71.1%, 77.5%, 78.6%, 81.1%, 82.9%, 87.5% and 89.4%, respectively. All of the isolates (100%) were OXA-51 positive, while 443 (85.4%) out of 519 strains harbored other beta-lactamase genes searched in the study. When the distribution of the genes were evaluated, blaTEM-1 was found as the predominant one with a frequency rate of 55.7% (n=289/519), followed by blaCTX-M2 (63/519, 12.1%), blaCTX-M1 (42/519, 8.1%), blaSHV (40/519, 7.7%), blaGES (8/519, 1.5%) and blaVIM (1/519, 0.2%). Cooccurence of ESBL genes was detected in 16.3% (72/443) of the strains, being mostly TEM+CTX-M2 (20/72, 27.8%), TEM+SHV (11/72, 15.3%) and TEM+CTX-M1 (10/72, 13.9%). In addition, it was noted that the distribution of ESBL genes between isolates showed differences according to the provinces. Accordingly, none of the strains isolated from four provinces (Bolu, Nigde, Mersin, Kahramanmaras) and from three provinces (Bolu, Kahramanmaras, Diyarbakir) harbored blaCTX-M1/M2 and blaSHV genes, respectively. The blaTEM gene was detected in isolates collected from all of the provinces, with a highest frequency in Nigde (28/31, 90.3%) and lowest in Trabzon (1/25, 4%). The presence of GES-11 type ESBLs was found only in the isolates sent from Nigde province (8/31; 25.8%). Screening of metallo-beta-lactamase VIM gene also yielded a single positive result amongst only Nigde isolates (1/31; 3.2%), and this gene was identified as VIM-5 type by DNA sequencing. This study which is the first comprehensive national research to characterize ESBLs in A.baumannii isolates by molecular methods, showed that the most prevalent ESBL type is TEM (289/519, 55.7%) amongst A.baumannii strains isolated from different regions of our country. The data of our study is parallel to the results of previous studies carried out from Turkey.

Introduction: Carbapenem-resistant Klebsiella pneumoniae are a major problem. We aimed to investigate carbapenemase-encoding genes and transferable mcr-1 genes among 57 carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates from hospitalized patients. Methodology: Antibiotic susceptibility tests were performed by Phoenix (BD). Results for ertapenem and colistin were confirmed by gradient diffusion and microdilution methods. Carbapenemase and mcr-1 genes were investigated by Polymerase Chain Reaction (PCR). Results: Thirty-two (56.14%) isolates were from intensive care units (ICU). Antibiotic resistance rates by Phoenix: 52.63% for amikacin; 73.69% trimethoprim sulfamethoxazole; 91.23% cefepime; 82.46% tigecycline; 59.65% colistin. Carbapenemases positivity: 82.45% (47) for blaOXA-48, 40.35% (23) blaOXA-55, 3.50% (2) blaOXA-51, 1.75% (1) blaOXA-23, 1.75% (1) blaOXA-24, 1.75% (1) blaIMP. blaOXA-58, blaKPC, blaNDM-1, and blaVIM were not detected. Twenty (35.08%) isolates had both blaOXA-48 and blaOXA-55. Three isolates were mcr-1 (+) and blaOXA-48 (+). One mcr-1 (+) isolates was blaOXA-51 (+). One colistin sensitive isolate determined by Phoenix, was found colistin resistant by microdilution. Conclusion: OXA-48 and OXA-55 co-harboring isolates and mcr-1 gene (+) isolates were spreading. Automated colistin susceptibility results should be confirmed by microdilution method. Resistance mechanisms in Enterobacteriaceae should be determined and the isolates should be monitored by molecular epidemiological methods. Effective infection control measures will contribute to reduce risk of antibiotic resistant bacterial infections and dissemination of antibiotic resistance.

The diagnosis of human brucellosis requires culture or serological tests for the conformation of the clinical findings. Isolation of the bacteria is used as a gold standard, however it is time consuming and processing of positive cultures has a potential risk for laboratory acquired human brucellosis. Polymerase chain reaction (PCR) based methods have offered new approaches for early diagnosis of brucellosis and reduce the risk of laboratory acquired human brucellosis. A major limitation of the PCR method is the difficulty to remove the inhibitors in specimens. The aim of this study was to determine the performance of two DNA extraction kits by using two separate PCR master mixes and to determine appropriate "extraction kit - PCR master mix" combination for the diagnosis of Brucella from whole blood samples and blood culture bottles. Two commercial DNA extraction kits, NORGEN Blood DNA isolation kit (Norgen) and Thermo Scientific GeneJet Whole blood genomic DNA purification kit (Thermo Fisher Scientific, USA) and two PCR master mixes, QuantiTect multiplex PCR (QuentiTect, Qiager, Almanya) and Ampliqon Multiplex TEMPase (Amliqon, Denmark) were assessed on 30 simulated blood samples with known concentrations (102-104 cfu/ml) of Brucella melitensis ATCC 23456 strain and 10 blood culture bottles that gave positive signal. By using different combinations of extraction kits and PCR master mixes, a total of 160 different multiplex real-time PCR (Rt-PCR) trials were performed with probes and primers specific to Brucella spp., B.melitensis, and the internal control glyceraldehyde-3-phosphate dehydrogenase (GAPDH). All the 120 Rt-PCR trials performed on the DNA samples extracted from blood samples gave positive results with GAPDH probe/primers. The rate of positive PCR results for Brucella spp. was 96.7% for the combination of Norgen-QuantiTect, 93.3% for Thermo-Ampliqon, 93.3% for Thermo-QuantiTect, and 86.7% for Norgen-Ampliqon. The frequency of positive B.melitensis results for these combinations were 96.7%, 93.3%, 56.7% and 90%, respectively. In the samples with the bacterial density of 102 cfu/ml, Brucella spp. detection rates were 80% for Thermo-Ampliqon and Norgen-Ampliqon, and 90% for Thermo-QuantiTect and Norgen-QuantiTect; and for B.melitensis positivite rates were 90%, 70%, 20%, and 90%, respectively. Rt-PCR assays with the DNA samples extracted from blood culture bottles using Norgen isolation kit yielded 80% positivite result. However, the frequency of PCR positivite results was only 20% in the DNA samples extracted by Thermo DNA extraction kit. PCR result for GAPDH gene was also negative in 80% of the samples extracted by Thermo kit. Our results revealed that for the removal of inhibitors and detection of even low number of Brucella spp./B.melitensis in blood samples and blood culture bottles, NORGEN Blood DNA isolation kit can be used with a combination of QuantiTect multiplex PCR or Ampliqon Multiplex TEMPase.

ResumoIntroduçãoas taxas de desenvolvimento de infecção ou colonização por bactérias multirresistentes [BMR (+)] em unidades de terapia intensiva são muito elevadas. O objetivo deste estudo foi determinar a possível associação entre o risco de desenvolvimento de infecções hospitalares e o aumento da carga de trabalho diária da equipe de enfermagem por causa da insuficiência de pessoal em unidade de terapia intensiva.Métodosforam incluídos 168 pacientes. O volume da carga de trabalho e os procedimentos feitos em pacientes foram avaliados com o uso de instrumentos de medidas como o Projeto de Pesquisa em Enfermagem (Project de Recherché en Nursing) e o Omega, respectivamente. Os critérios usados para definir infecções foram os estabelecidos pelos Centros de Controle de Doenças.Resultadosdos 168 pacientes, 91 (54,2%) eram do sexo feminino e 77 (45,8%) do masculino. As médias das idades de mulheres e homens foram 64,9±6,2 e 63,1±11,9 anos, respectivamente. A média do tempo de internação em unidade de terapia intensiva foi de 18,4±6,1 dias. As bactérias multirresistentes foram isoladas a partir de culturas de 39 (23,2%) pacientes. O desenvolvimento de infecção por BMR (+) foi correlacionado com tempo de internação, Omega 1, Omega 2, Omega 3, Omega total, PPE diário e PPE total (p0,05).Conclusãoo risco de desenvolvimento de infecção hospitalar em unidade de terapia intensiva está diretamente relacionado com o aumento da carga de trabalho de enfermagem, as intervenções praticadas e o tempo de internação. A falta de pessoal em unidade de terapia intensiva é um problema de saúde importante que afeta principalmente os pacientes que requerem cuidados. A infecção hospitalar colocou um fardo pesado sobre a economia de muitos países. Para controlar o desenvolvimento de infecção hospitalar em UTI, a carga de trabalho de enfermagem, a composição do pessoal e as condições de trabalho devem ser organizadas.AbstractIntroductionthe rates of multiresistant bacteria colonization or infection (MRB+) development in intensive care units are very high. The aim of this study was to determine the possible association between the risk of development of nosocomial infections and increased daily nurse workload due to understaffing in intensive care unit.Methodswe included 168 patients. Intensity of workload and applied procedures to patients were scored with the Project de Recherché en Nursing and the Omega scores, respectively. The criteria used for infections were those defined by the Centers for Disease Control.Resultsof the 168 patients, 91 (54.2%) were female and 77 (45.8%) were male patients. The mean age of female and male was 64.9±6.2 years and 63.1±11.9 years, respectively. The mean duration of hospitalization in intensive care unit was 18.4±6.1 days. Multiresistant bacteria were isolated from cultures of 39 (23.2%) patients. The development of MRB+ infection was correlated with length of stay, Omega 1, Omega 2, Omega 3, Total Omega, daily PRN, and Total PRN (p0.05).Conclusionthe risk of nosocomial infection development in an intensive care unit is directly correlated with increased nurse workload, applied intervention, and length of stay. Understaffing in the intensive care unit is an important health problem that especially affects care‐needing patients. Nosocomial infection development has laid a heavy burden on the economy of many countries. To control nosocomial infection development in the intensive care unit, nurse workload, staffing level, and working conditions must be arranged.

Hepatitis B virus (HBV) is an enveloped virus with a genome composed by partially double-stranded DNA. The diagnosis of HBV infection is generally based on serological and molecular assays. Enzyme immunoassays are the most important serological assays identifying virus-encoded antigens and their corresponding antibodies. The molecular tests focus on the detection of quantitative viral load, drug resistance mutations, genotyping, and core promotion/precore mutation assays. The fully automated real-time polymerase chain reaction (PCR) methods are considered as standard methods to detect and quantify HBV DNA because of their high capacity to detect a wide dynamic range of viral load and due to lack of carry-over contamination. Biosensors and biochips seem to be useful technologies for serological diagnosis of HBV. Ultra-deep sequencing technologies will be useful for the analysis of HBV mutants in order to study the dynamics of viral variants.

Background: Brucellosis is a zoonotic disease caused by Brucella species. Although brucellosis is considered as an occupational disease in adults, recently it has become an infectious disease affecting all age groups, including children. Molecular epidemiological studies are crucial for control and treatment of disease in children. Objectives: This study aimed at identifying Brucella species, to detect antibiotic susceptibilities and define transmission dynamics between the Brucella isolates in children. Methods: A total of 77 Brucella isolates were identified by conventional and polymerase chain reaction methods. Anti - biotic susceptibilities were investigated by E - test strips. The isolates were genotyped by using multiple locus variable number tandem repeat analysis (MLVA) (MLVA - 16 Orsay), including 8 mini - satellite (panel 1) and 8 microsatellite (panel 2A and 2B) markers. Results: The mean age was 9.14 ± 3.4 years. All patients had been consuming unpasteurized milk. All isolates were Brucella melitensis biovar 3. Only 2 isolates were resistant to ceftriaxone, while the other isolates were susceptible to other antimicrobial agents. The MLVA - 16 typing revealed 42 MLVA profiles. Eighteen profiles included 2 or more isolates, indicating a clustering rate of 66.7%. Twenty - four isolates showed a unique profile. Single locus, double locus, and 3 locus variants were detected in 32, 26, and 15 isolates, respectively. Bruce 30, Bruce 16, Bruce 9, Bruce 7, and Bruce 4 were highly discriminatory loci, respectively. All strains were defined as genotype 122, according to MLVA - 11, and genotype 43 according to MLVA - 8, and were in the Eastern Mediterranean genotype. Conclusions: High clustering rate revealed that brucellosis among the children mainly resulted from common sources. Controlling animal movements and avoiding contaminated milk products have an importance to interrupt spread of brucellosis in children.

Objective: Enterococci are the second most common cause of nosocomial urinary tract and wound infections, also third most common cause of nosocomial bacteremia. Currently, especially vancomycin-resistant enterococci (VRE) are one of the significant pathogens that cause nosocomial infections and increase mortality, morbidity, and healthcare costs. Therefore prevention and control of the nosocomial VRE outbreaks and epidemiological analysis of the infection are important. Pulsed-Field Gel Electrophoresis (PFGE) is accepted as a “gold standard” method in the molecular epidemiological analysis of enterococcal infections. The aims of this study are to determine the clonal relationship among the nosocomial enterococcal isolates and the rate of cross-contamination between them. Method: Thirty-six Enterococcus strains isolated from hospitalized patients with nosocomial infection in different clinics of Dicle University Hospital between November 2010 and June 2012 were included in this study. A total of 36 isolates were obtained from various clinical samples including urine (n=18), blood (n=6), bronchoalveolar lavage (BAL) fluid (n=5), wound biopsy sample (n=5), vaginal smear (n=1) and catheter tip (n=1). Nine of the thirty-six isolates were VRE. Isolation and identification of the isolates were conducted in the OZET Amac: Enterokoklar hastaneden kaynaklanan uriner

Immune thrombocytopenia (ITP) is an immune haematologic disorder causing platelet destruction mediated by anti-platelet antibodies. In this study we aimed to evaluate the clinical and laboratory variables of ITP patients in southeast of Turkey.In this retrospective study 167 ITP patients between 2005 and 2015 were evaluated. All patients were screened for immunological parameters including ANA (antinuclear antibodies), anti dsDNA (anti-double-stranded-DNA), ACA(anti-cardiolipin) IgM and IgG, LA (lupus anticoagulants). All patients were screened for Helicobacter pylori, HBsAg (Hepatitis B surface antigen), anti-HCV (hepatitis C virus antibody), and anti-HIV ½ (HIV antibody) and brucellosis..Among the patients, 50 (29.9%) patients were male, 117 (70.1%) were female. The age range of patients was 18-86 (mean 38.16±14). In 56 patients (33.5%) splenectomy was performed. 36 patients (21.6%) were positive for ANA, 5 (3%) were positive for anti dsDNA, 14 (8.4%) for ACA Ig G, and 14 (8.4%) patients for ACA IgM. LA was tested in 165 patients and 30 (18%) patients were positive for LA. Microbiologic evaluation was as follows: 16 patients (9.6%) were positive for HbsAg, 109 (65.3%) positive for Anti-HBs, 5 positive for anti-HCV (3%), 56 (33.5%) patients were positive for Helicobacter pylori antigen, 5 (2.9%) for Brucella and one patient was positive for anti-HIV ½.Immune thrombocytopenia patients have to be evaluated according to their demographic characteristics and laboratory results. Secondary causes of ITP were HIV, HCV, Helicobacter pylori, brucellosis, tuberculosis, and autoimmune diseases in our region. Management of ITP patients can change in different regions.

Introduction: In recent years, the prevalence of multidrug-resistant P. aeruginosa has remarkably increased. Thus, we wanted to investigate the carbapenem resistance mechanisms and clonal relationship among 80 carbapenem-resistant P. aeruginosa strains. Methodology: Carbapenemase production was detected using the Modified Hodge Test (MHT), EDTA combined disc method (ECD), and PCR. Expression levels of efflux and porin genes were mesured by real-time reverse transcription PCR. Clonal relationship of the isolates was investigated by pulsed-field gel electrophoresis (PFGE). Results: Carbapenemase production was detected in 7.5% of the isolates with MHT/ECD tests and in 11.3% of the isolates with PCR. Although the specificity of MHT/ECD was high, the sensitivitivity was low. oprD downregulation and mexB, mexY, and mexD overexpression were demonstrated in 55%, 16.3%, 2.5%, and 2.5% of the isolates, respectively. Multiple carbapenem resistance mechanisms were found in nearly a quarter of the isolates. PFGE typing of the 80 P. aeruginosa isolates yielded 61 different patterns. A total of 29 isolates (36.3%) were classified in 10 clusters, containing 2 to 7 strains. We could not find a strict relationship between PFGE profile and carbapenem resistance mechanisms. Conclusions: Although oprD downregulation and MexAB-OprM overexpression were the most common mechanisms, carbapenem resistance was associated with multiple mechanisms in the study. MHT/ECD tests should not be used alone for investigation of carbapenemase production in P. aeruginosa. Rapid tests with high sensitivity and specificity should be developed for the detection of carbapenemase production in P. aeruginosa.

Enterococcus faecalis is one of the important causes of nosocomial infections. Nowadays, increasing prevalence of antibiotic-resistant bacteria and slow progress in recognizing new antimicrobial agents has limited the efficiency of conventional antibiotics, which cause to find novel strategies to overcome bacteria. Therefore, in this study, we aimed to assess the role of efaA gene in the biofilm formation and the role of ftsZ gene in the controlling of bacterial growth by the anti-sense PNAs(Peptide Nucleic Acid).E. faecalis ATCC® 29212™was used for the study of PNAs designed to targeting the start codon section of the ftsZ andefaA genes. PNA attachment to RNA was confirmed by blotting. Electroporation technique was used for the intracellular transfer of anti-ftsZ PNAs. The spot-plating method was used to the assessment of alteration in bacterial growth. Biofilm formation assay and real-time PCR were used for detection of biofilm inhibitory effect of cell penetrating peptide (CPP) conjugated to anti-efaA PNAs.ByftsZ PNAs treatment, no growth was seen from the strain in agar by a spot plating method and the inhibition zone of anti-ftsZ PNAs was not seen. PNAs against the efaA gene decreased by 95% the expression of the efaA gene and biofilm formation. In addition, the(3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide) MTT assay showed no toxicity on MCF7 cells for both of anti-ftsZand anti-efaA PNAs.This study used new genetic and molecular tools to inhibit pathogenicity and infection by E. faecalis. In this study, we suggested that efaA gene plays a critical role in the biofilm formation and anti-efaA PNAs could decrease the formation of biofilm, as well as, anti-ftsZ PNAs could eliminate bacterial growth.

Staphylococcus species are one of the major causes of bacterial bloodstream infections. Multi-resistant staphylococci infections are major therapeutic problems. This study was aimed to detect methicillin, linezolid and vancomycin susceptibilities of Staphylococcus isolates. A total of 870 Staphylococcus strains isolated from blood cultures of hospitalized patients with BSI. Antimicrobial susceptibilities of methicillin, linezolid and vancomycin were detected according to the Clinical and Laboratory Standards Institute (CLSI). A total of 771 (88.6%) isolates were coagulase-negative staphylococci (CoNS). 700 (80.5%) isolates were methicillin-resistant (MR) and 170 (19.5%) were methicillin-susceptible (MS). All the MS isolates were also susceptible to linezolid. However 15 (1.7%) of MR strains were resistant to linezolid. The minimum inhibitory concentration range for the linezolid-resistant isolates by Etest was 6-32 µg/mL. The difference between linezolid susceptibilities for MS and MR staphylococci was not quite statistically significant (p = 0.052). There was no statistically significant difference between S. aureus and CoNS isolates for linezolid susceptibility. All of the isolates were susceptible to vancomycin. In conclusion, linezolid is currently an efficient option for the treatment of methicillin-resistant staphylococci infections.

Objectives: Urinalysis and urine culture are most common tests for diagnosis of urinary tract infections. The aim of our study is to examine the diagnostic performance of urine analysis and the role of urine analysis to determine the requirements for urine culture. Methods: Urine culture and urine analysis results of 362 patients were retrospectively analyzed. Culture results were taken as a reference for chemical and microscopic examination of urine and diagnostic accuracy of the test parameters, that may be a marker for urinary tract infection, and the performance of urine analysis were calculated for predicting the urine culture requirements. Results: A total of 362 urine culture results of patients were evaluated and 67% of them were negative. The results of leukocyte esterase and nitrite in chemical analysis and leukocytes and bacteria in microscopic analysis were normal in 50.4% of culture negative urines. In diagnostic accuracy calculations, leukocyte esterase (86.1%) and microscopy leukocytes (88.0%) were found with high sensitivity, nitrite (95.4%) and bacteria (86.6%) were found with high specificity. The area under the curve was calculated as 0.852 in ROC analysis for microscopic examination for leukocytes. Conclusion: Full-automatic urine devices can provide sufficient diagnostic accuracy for urine analysis. The evaluation of urine analysis results in an effective way can predict the necessity for urine culture requests and especially may contribute to a reduction in the work load and cost. J Clin Exp Invest 2014; 5 (2): 286-289, Amaç: Tam idrar analizi ve idrar kültürü idrar yolu enfeksiyonlarının tanısı için sıklıkla yapılan incelemelerdendir. Çalışmamızın amacı tam idrar analizinin tanısal performansını ve idrar kültürü gerekliliğini belirlemedeki rolünü incelemektir. Yöntemler: İdrar kültürü ve tam idrar analizi sonucu olan 362 hasta sonucu retrospektif olarak incelendi. Kültür sonuçları referans kabul edilerek, idrarın kimyasal ve mikroskopik incelemesinde, idrar yolu enfeksiyonu göstergesi olabilecek testlerin tanısal doğruluk parametreleri hesaplandı ve kültür istemini öngörmedeki performansı değerlendirildi. Bulgular: Toplam 362 hastaya ait idrar kültürü sonuçlarının %67 si negatifti ve bu kültür sonucu negatif olan örneklerin %50,4 ünde kimyasal analizde lökosit esteraz, nitrit ve mikroskopik analizde lökosit ve bakteri sonuçları normal olarak bulundu. Tanısal doğruluk hesaplamalarında, lökosit esteraz (%86,1) ve mikroskopide lökosit (%88,0) testlerinin sensitiviteleri yüksek bulunurken, nitrit (%95,4) ve bakteri (%86,6) incelemelerinin spesifiteleri yüksek bulundu. Mikroskopide lökosit incelemesi için yapılan ROC analizinde eğri altındaki alan 0,852 olarak hesaplandı. Sonuç: Tam otomatik idrar cihazları, tam idrar analizi için yeterli tanısal doğruluğu sağlayabilmektedir. Tam idrar analizi sonuçlarının etkin bir şeklide değerlendirilmesi kültür istemleri için gerekliliği öngörebilir ve laboratuvarlarda özellikle iş yükü ve maliyetin azalmasına katkı sağlayabilir.

Background The aim of this study was to determine the rate of health care-associated infection (HC-AI) and device-associated health care-associated infections (DA-HAIs), and distribution of causative microorganisms and etiologic factors responsible for these infections in a neonatal intensive care unit (NICU) of a state hospital in southeastern Turkey. Methods A laboratory-based, active, prospective nosocomial infection surveillance study was performed in NICUs from January 2008 to December 2011. The rates of HC-AIs were determined on a daily basis. The findings were evaluated by applying the definitions of the Centers for Disease Control and Prevention National Healthcare Safety Network. Results In a 4-year period, 580 HC-AIs, 81 of which were DA-HAIs, were detected among 6932 patients. The rate of hospital acquired infection was 8.3% and 7.69/1000 patient days. Ventilator-associated pneumonia (VAP) was the second most frequent (13.1%) HC-AI and the most frequent was DA-HAI. The VAP rate was 6.4 per 1000 ventilator days. Mechanical ventilation was the most frequently used invasive device. Median time to diagnosis of VAP was 32.11 ± 29.3 days from the time of admission. Acinetobacter baumannii (48%) and Pseudomonas aeruginosa (32%) were the most frequent microorganisms. Colistin was the most effective antibiotic by in vitro test. The antibiotic resistance ratios of A. baumannii were ≥54% for carbapenems, aminoglycosides, and cefoperazone–sulbactam; ≥88% for quinolones; and ≥92% for ceftazidime, ceftriaxone, and piperacillin–tazobactam. Conclusions Device-associated nosocomial infections was a particularly important problem in NICU. Close monitoring will decrease the rates of device-related nosocomial infections.

Introduction: This study investigated the seroprevalence of hepatitis B virus surface antigen (HBsAg), antibody against hepatitis C virus (anti-HCV), antibody against human immunodeficiency virus type 1/2 (anti-HIV 1/2), and antibody against Treponema pallidum (anti-Treponemal or syphilis antibody) in healthy volunteer blood donors, and assessed their distribution according to the years and genders. Methodology: HBsAg, anti-HCV, anti-HIV ½, and syphilis screening results of a total of 266,035 healthy volunteer blood donors who had been admitted for blood donation to the Regional Blood Center of Dicle University Hospital between January 2000 and December 2010 were evaluated, retrospectively. HBsAg, anti-HCV, and anti-HIV 1/2 screening were performed using a fully automated device with the microparticle enzyme immunoassay method (MEIA). Syphilis screening was performed by Rapid Plasma Reagin (RPR) carbon test between January 2000 and December 2009, and by using a fully automated device with the MEIA method between January 2010 and December 2010. Results: Of 266,035 healthy volunteer blood donors, 259,384 (97.5%) were male and 6,651 (2.5%) were female. Statistically, there was not any significant difference between male and female genders for HBsAg, anti-HCV and syphilis seropositivities (P = 0.729, P = 0.748, and P = 0.861, respectively). HBsAg was found to be positive in 8,422 (3.17%), anti-HCV in 1,703 (0.64%), anti-HIV 1/2 in one (0.0004%) of 266,035 healthy volunteer blood donors, and syphilis antibody with RPR in 166 (0.07%) of 246,341 healthy volunteer blood donors. Conclusion: Blood donor forms should be carefully tailored to improve the identification of possible risks of transfusion-transmitted infections.

Objective: To investigate the antibiotic resistance genes inserted into class 1 and class 2 integrons in Acinetobacter baumannii (A. baumannii) isolates obtained from nine different cities in Turkey. Methods: A collection of 281 A. baumannii clinical isolates were collected from nine diferent state hospitals in Turkey and were confirmed as A. baumannii by conventional biochemical, API testing and bla-OXA-51 specific PCR. The isolates were examined by PCR for existence of class 1 and 2 integron gene cassettes. Results: They were characterized by antimicrobial susceptibility testing and the highest resistance rates were determined for piperacillin (90.03%), ciprofloxacin (87.54%), cefepime and trimethoprim/sulfamethoxazole (81.13%). The lowest resistance rates was for cefotaxime (3.55%). class I integrons were detected in 6.4% (18/281) of A. baumannii strains and no class 2 integron was detected. The gene cassettes of class 1 integrons AacC1-AAC(3) I-aadA1, AacC1-aadA1, AAC(3)-I, AAC(3)-I -AAC(3)-I -aadA1, TEM-1, AAC(3)-I-aadA1 - AAC(3)-I -AAC(3)-I, AAC(3)-I -AAC(3)-I -AAC(3)-I -aadA1, AAC(3)-I - aadA1, AAC(3)-I-AAC(3)-I, AAC(3)-I-aadA1-AAC(3)-I-aadA1, AAC(3)-I-AAC(3)-I-aadA1-AAC(3)-I-aadA1 were detected in eighteen strains. The aac genes family were most frequently found integrated into the class 1 integrons and it was followed by aadA genes and TEM-1 genes. Conclusions: This is an extensive study on the distribution of class 1 integron among A. baumannii in Turkey. In addition to these, two new alleles were observed. Their percentage rates of similarity to other cassettes are 95% aadA1 (TKA18) and 89% aadA1 (ANKA3). © 2013 Asian Pacific Tropical Biomedical Magazine. 2-s2.0-84883257201 PubMed: 23998017

Anthrax is a rare disease caused by Bacillus anthracis. Antrax is zoonotic disease and is often encountered in persons engaged in animal husbandry. Cutaneous anthrax is approximately 95% of anthrax in humans. Palbebral involvement is rare.In this study, we aimed to evaluate the clinical presentation, diagnosis and treatment of cases with cutaneous palpebral anthrax.In this study, the patients diagnosed of cutaneous palpebral anthrax between January 2000 and December 2012, were investigated and evaluated, retrospectively. Cutaneous palpebral anthrax was diagnosed by the presence of typical anthrax lesion and/or observation of gram-positive encapsulated bacilli in gram prepations and/or culture positive of samples taken from lesions. In the cases who were culture-negative and without bacilli in gram-staining, the diagnosis was based on the presence of characteristic clinical presentation with a history of severe scarring formation, swelling, black eschar and positive response to the treatment.A total of 21 patients with cutaneous palpebral anthrax admitted to the two hospitals between January 2000 and December 2012. Eight patients were male (38.1%) and 13 patients were female (61.9%), and the mean age was 31 ± 21.2 (range 1-82 years). The most common symptoms on admission to the hospital were swelling and redness on the skin. Periorbital lesions were in the right eye in 14 cases and the most common eyelid involvement was seen in upper eyelid with 15 cases. The diagnosis was based on isolation of bacteria in five (23.8%) cases, detection of gram-positive bacilli in direct examination of characteristic lesion material in six (28.5%) cases. Ten (47.7%) cases were diagnosed by the characteristic appearance of the lesion. Malignant pustule was seen in all of our patients and seven cases (33.4%) had malignant edema. In the treatment, penicilin was used for 10 (47.7%) cases, ampicillin-sulbactam for five (23.8%) cases and, ciprofloxacin for three (14.3%) cases. Cicatricial ectropion was observed in 10 (47.7%) patients, lagophthalmos developed in four (19%) patients, and corneal scar in two (9.5%) patients. The distribution of the cases did not differ by the year but showed a density in the months from July to September (62.7%).Early diagnosis and high dose antibiotic treatment can facilitate the treatment and prevent development of eyelid complications including cicatricial ectropion, corneal scars and palpebral symphysis. Prolonged follow-up is necessary in patients who develop complications and surgical intervention.

The diversity and distribution of TEM, SHV and CTX-M type of extended-spectrum beta-lactamases (ESBLs) are important for the treatment and control of infections. Determination of ESBL genes in clinical isolates by polymerase chain reaction (PCR) and DNA sequencing can obtain useful data for their molecular epidemiology and risk. The aim of this study was to investigate the frequency of beta-lactamase genes in Acinetobacter baumannii strains isolated from different regions of Turkey. A total of 519 A.baumannii strains collected from hospitals located at 12 different provinces of Turkey (Bolu (n= 67), Tokat (n= 47), Trabzon (n= 25), Ordu (n= 27), Diyarbakır (n= 47), Niğde (n=31), Kayseri (n= 36), Ankara (n= 41), Kirikkale (n= 26), Kahramanmaraş (n= 25), Mersin (n= 40), Istanbul (n= 107)] between 2011-2012 period were included in the study. Identification of the isolates were performed by both conventional methods and automated systems, VITEK2 Compact (BioMerieux, France) and API 32GN (BioMerieux, France). Disc diffusion method was used for the detection of antibiotic susceptibilities of the isolates and the results were evaluated according to CLSI (Clinical and Laboratory Standards Institute) criteria. Tigecycline and colistin sensitivities of the isolates were evaluated according to BSAC (British Society for Antimicrobial Chemotherapy) criteria. The presence of beta-lactamase genes, namely blaoxa-51, blaTEM, blaSHV, blaCTX-M1, blaCTX-M2, blaGES and blaVIM were detected by PCR. In our study, the resistance rates against colistin, tigecycline, ampicillin-sulbactam, amoxicillin-clavulanic acid, cefoperazone/sulbactam, tobramycin, ceftriaxone, piperacillin-tazobactam, gentamicin, ampicillin, tetracycline, cefepime, piperacillin, amikacin, trimethoprim-sulfamethoxazole, meropenem, levofloxacin, ciprofloxacin, imipenem and ceftazidime were detected as; 0.6%, 2.7%, 11.9%, 15.2%, 21%, 22.9%, 23.9%, 48.6%, 59.5%, 61.8%, 66.3%, 67.8%, 69.2%, 71.1%, 77.5%, 78.6%, 81.1%, 82.9%, 87.5% and 89.4%, respectively. All of the isolates (100%) were OXA-51 positive, while 443 (85.4%) out of 519 strains harbored other beta-lactamase genes searched in the study. When the distribution of the genes were evaluated, blaTEM-1 was found as the predominant one with a frequency rate of 55.7% (n=289/519), followed by blaCTX-M2 (63/519, 12.1%), blaCTX-M1 (42/519, 8.1%), blaSHV (40/519, 7.7%), blaGES (8/519, 1.5%) and blaVIM (1/519, 0.2%). Cooccurence of ESBL genes was detected in 16.3% (72/443) of the strains, being mostly TEM+CTX-M2 (20/72, 27.8%), TEM+SHV (11/72, 15.3%) and TEM+CTX-M1 (10/72, 13.9%). In addition, it was noted that the distribution of ESBL genes between isolates showed differences according to the provinces. Accordingly, none of the strains isolated from four provinces (Bolu, Niğde, Mersin, Kahramanmaraş) and from three provinces (Bolu, Kahramanmaraş, Diyarbakir) harbored blaCTX-M1/M2 and blaSHV genes, respectively. The blaTEM gene was detected in isolates collected from all of the provinces, with a highest frequency in Niğde (28/31, 90.3%) and lowest in Trabzon (1/25, 4%). The presence of GES-11 type ESBLs was found only in the isolates sent from Niğde province (8/31; 25.8%). Screening of metallo-beta-lactamase VIM gene also yielded a single positive result amongst only Niğde isolates (1/31; 3.2%), and this gene was identified as VIM-5 type by DNA sequencing. This study which is the first comprehensive national research to characterize ESBLs in A.baumannii isolates by molecular methods, showed that the most prevalent ESBL type is TEM (289/519, 55.7%) amongst A.baumannii strains isolated from different regions of our country. The data of our study is parallel to the results of previous studies carried out from Turkey.

Pseudomonas aeruginosa is one of the leading nosocomial pathogens worldwide, and their infections are difficult to treat due to acquired resistance to many antibiotics. This study aimed to detect class 1 and 2 integrons and antibiotic susceptibility of clinical isolates of P. aeruginosa. Two hundred and five P. aeruginosa strains were collected from the seven general state hospitals in Turkey. They were characterized by antimicrobial susceptibility testing, screened for class 1 and class 2 integrons, and evaluated for the association between antibiotic resistance phenotypes and the presence of integrons. intI gene was amplified in 10 isolates (4.87%) by PCR and in seven isolates of them (70%) were found different gene cassettes. The aadA gene integrated into the class 1 integrons was most frequently found and it was followed by aac genes and blaOXA family genes. Sequence analysis of variable regions of the class 1 integrons showed five gene cassette arrays; aadA1(99%), aac(3)-Id(82%)-orf-aac(3”)-Ia(99%), aac(3)-Ie(83%)-blaoxa10(100%)- aadA1 (100%), aadA6(99%, 100%), aac(6’)-I(97%)-orf-aadA2(99%). No class 2 integron was detected. This study is the first multicenter study for class 1 integrons and it indicates the low rate of presence of class 1 gene cassette in P. aeruginosa.

To investigate antibacterial and antifungal effectiveness of orthophenylphenol (Fumispore, LCB, La Salle, France) with a new administration method in healthcare environments. Materials and methods: This study was performed in 3 units of the Dicle University Hospital. Surface swab and ambient air samples were collected just before the application of Fumispore and 6 h later. All samples were inoculated onto plate count agar and Sabouraud dextrose agar. The total aerobic colony count (ACC) was determined by using the standard method based on quantitative bacterial measurement. Results: In total, 30 surface swabs and 6 ambient air samples were collected. The mean values of the total ACC were determined on surface swabs: 12.1 colony CFU/cm2 for total microorganisms and 2.9 CFU/cm2 for fungi before application, and 1.6 CFU/cm2 for total microorganisms and 0.4 CFU/cm2 for fungi after application. The mean values of the total ACC were detected in ambient air samples: 258 CFU/m3 for total microorganisms and 208 CFU/m3 for fungi before application, and 20 CFU/m3 for total microorganisms and 15 CFU/m3 for fungi after application. Conclusion: The total ACC values obtained before and after applications have shown that orthophenylphenol (Fumispore) is suitable for adequate disinfection in healthcare environments.

Ecthyma gangrenosum is a skin lesion associated with Pseudomonas aeruginosa. A previously healthy one-year-old boy who had been diagnosed with varicella 10 days ago was admitted to our hospital with complaints of diarrhea, green ear discharge and new lesions in the diaper area. Intravenous meropenem and amikacin had been previously initiated. Physical examination revealed greenish, well bordered necrotic ulcers on both gluteal areas and the perianal area. Pseudomonas aeruginosa grew in wound culture. A colostomy was opened due to recalcitrant diarrhea and ulcers. The patient remitted in one month and was discharged. T lymphocyte subgroups and immunoglobulins were found to be normal on immunologic evaluation. We presented this case to draw attention to the fact that ecthyma gangrenosum due to Pseudomonas aeruginosa may occur in the diaper area and that sepsis due to Pseudomonas should be investigated.