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Introduction: The increased use of antibiotics and antifungals for prophylactic and therapeutic purposes in hospitals cause an increase in fungal infections. In recent years, the increase and resistance development in infections caused by non-albicans Candida (NAC) have increased the importance of identification of fungi at the species level. The aim of this study was to identify Candida species isolated from various clinical specimens. Materials and Methods: Candida species isolated from sterile clinical samples in our laboratories between 2014-2017 were evaluated retrospectively. Blood samples were incubated in BACTEC FX (BD, USA) automated system for five days and other samples were incubated at 37°C for 18-24 hours after cultured in 5% sheep blood, chocolate, Eozin Methylene Blue and Saboraud dekstroz agars. The species differentiation of the strains that was identified as yeast with Gram staining was done by both conventional methods and automated system (PhoenixTM 100-yeast ID, BD, USA). Results: In this study, a total of 996 Candida growth was detected; including 43.2% Candida albicans and 56.8% NAC. The most frequently isolated NAC species were; C. parapsilosis (27.6%), C. tropicalis (17.9%), C. glabrata (4.3%) and C. kefyr (2.5%). Candida species were isolated mostly from urine (50.7%), blood (44.3%), catheter (2.6%) and peritoneal fluid (0.8%). The most frequently isolated species in blood were C. parapsilosis (52.8%), C. albicans (29.5%), C. tropicalis (11.1%) and C. glabrata (3.4%). In samples from intensive care units (ICU), the most common species were C. albicans (40.5%) and C. parapsilosis (35.9%). It was found that the rate of C. albicans decreased in the last two years while the rates of C. parapsilosis increased significantly in 2017 among the samples that came from the ICU. In addition, when all the clinics were evaluated, C. parapsilosis rate increased significantly in 2017 when compared to other years. Conclusion: Non-albicans Candida types are the most commonly isolated Candida species in our hospital. In our study, the most common isolated NAC was C. parapsilosis in the blood samples while its rate was significantly high in the samples from the ICU. We think that due to intrinsic resistance, hospitals should determine their epidemiologic data periodically for prevention, development of treatment strategies, planning of clinical treament policies, monitoring of the infection course and evaluation of the infection control measures.

Amac: Kultur pozitif pnomonili yatan hastalarda, non-fermentatif gram negatif bakterilerin (NFB) dagilimi, antimikrobiyal direnc oranlari ile bunlarin yillar icerisinde ki degisimi analiz edilerek, ampirik tedavide kullanilabilecek antimikrobiyallerin belirlenmesi amaclanmistir. Gerec ve Yontem: 2014–2019 tarihleri arasinda cesitli servislerde yatarak tedavi goren hastalarin solunum yolu orneklerinden izole edilen NFB uremeleri retrospektif olarak degerlendirilmistir. Bakterilerin identifikasyonu ve antimikrobiyal duyarlilik testi otomatize sistem (Phoenix,BD,USA) kullanilarak yapilmistir. Bulgular: Calismaya 2865 ornek dahil edilmistir. Orneklerin %72,3’u yogun bakim unitelerinde (YBU) yatan hastalardan alinmistir. Acinetobacter baumannii %56(n:1604), Pseudomonas aeruginosa %39,4(n:1128) ve Stenotrophomonas maltophilia %4,6(n:133) oraninda izole edilmistir. Pseudomonas aeruginosa izolatlarinda amikasin (n(%5,5) vs. n(%11,2), p:0.001), aztreonam (n(%73,6) vs. n(%93,4), p:0.000) ve kolistin (n(%2) vs. n(%14,5), p:0.000) direnclerinin, A. baumannii izolatlarinda ise gentamisin (n(%63,9) vs. n(%89,1), p:0.000), amikasin (n(%73,7) vs. n(%83,4), p:0.000) ve kolistin (n(%1,2) vs. n(%11,2), p:0.000) direnclerinin gec peryotta anlamli olarak arttigi saptanmistir. Yogun bakim unitelerinde ise P. aeruginosa izolatlarinda amikasin (n(%7,2) vs. n(%12,5), p:0.024), aztreonam (n(%79,9) vs. n(%93,8), p:0.000) ve kolistin (n(%1,7) vs. n(%14,3), p:0.000) direnclerinin, A. baumannii izolatlarinda ise amikasin (n(%78,3) vs. n(%87,1), p:0.000) ve kolistin (n(%0,8) vs. n(%11,2), p:0.000) direnclerinin gec peryotta anlamli olarak arttigi belirlenmistir. Stenotrophomonas maltophilia izolatlarinda trimetoprim-sulfametaksazol direnci saptanmamistir. Sonuc: Antibiyotiklerin yogun ve kontrolsuz kullanimi direncli suslarin sayisini ve dagilimini arttirmaktadir. Bu nedenle YBU basta olmak uzere hastanelerde NFB’lerin dagilim ozellikleri ve ilac direnc oranlari hakkindaki bilgileri kavramak, antibiyotiklerin dogru ve etkin kullaniminin yani sira ilac direnc oranlarinin da azaltilabilmesi icin oldukca onemlidir.

Appendicitis is the most common surgical disease evaluated by pediatric surgeons in the emergency department. Despite the history, physical examination, laboratory tests and imaging methods, the misdiagnosis may be observed often in children. Pentraxin-3 (PTX-3) is an acute phase protein which is produced directly in the inflammatory tissue. Our aim was to investigate the diagnostic value of PTX-3 levels in appendicitis in pediatric patients and compare it with the other serum parameters.Eighty-eight patients (aged18 years) were included in this study [Group 1 (n = 28) healthy volunteers, Group 2 (n = 28) patients with non-specific abdominal pain, Group 3 (n = 34) patients underwent appendectomy]. Serum white blood cell (WBC), absolute neutrophil count (ANC), neutrophil/lymphocyte ratio (NLR), C-reactive protein (CRP) and PTX-3 values were measured.Median serum levels of WBC were higher in Group 2 and 3 than Group 1. ANS, NLR, CRP and PTX-3 were higher in Group 2 than Group 1 and were higher in Group 3 than the other groups. The highest sensitivity was found in NLR3.5 [94.1 (95% CI = 80.3-99.3)] and PTX-3 5.6 ng/mL [91.8 (95% CI = 76.3-98.1)]. PTX-3 has the highest specificity among all of the parameters [90.7 (95% CI = 79.7-96.9)]. The area under the ROC curve showed that the diagnostic value of PTX-3 was greater than any other parameter [0.979 (95% CI = 0.92-0.99)].In this study, we have shown that PTX-3 is very useful with high sensitivity and specificity in the diagnosis of appendicitis compared to WBC, ANS, NLR and CRP as a first in the literature.

Aim: Chronic suppurative otitis media (CSOM) continues to be a major health issue in developing countries. The goal of this study was to establish the microorganisms causing CSOM and their susceptibility to antimicrobials. Materials and Methods: External ear tract swab that came to our laboratory between 2014-2019 were evaluated retrospectively. The data were obtained from the hospital medical records. Data was collected using an electronic database. Results: The analysis included 185 ear swab samples. These patients 55.1% male and 44.9% female, and average age was 44.29 ± 1.6 (2-86) years. Forty (21.6%) of the patients included in the study were diagnosed with cholesteatoma as having chronic suppurative otitis media. The first three bacteria species isolated from the samples included in the study; Pseudomonas aeruginosa (31.9%), Staphylococcus aureus (11.9%) and Escherichia coli (9.7%). In addition, in 10.8% of the samples Candida spp. and in 5.4% of the samples Aspergillus spp. were isolated. The first three species isolated from the patients with cholesteatoma; P. aeruginosa (6.5%),S. aureus (4.3%) and Candida spp. (3.2%), the first three species isolated in patients without cholesteatoma; P. aeruginosa (25.4%), E. coli (8.1%), S. aureus and Candida spp. (7.6%) was detected. Ciprofloxacin (68.8%) and gentamicin (46.7%) in P. aureginosa isolates, amoxicillin-clavulonic acid (66.7%) and trimethoprim-sulfamethoxazole (42.9%) in E. coli isolates were found to be the most resistant antimicrobials. Conclusion: In conclusion, antimicrobial therapy should not be initiated in CSOM patients without waiting for the culture result. However, in cases where empirical antimicrobial therapy is mandatory, the first choice has been determined as amikacin. Good awareness of microorganisms’ antimicrobial sensitivity can lead to appropriate antibiotic usage and treatment success for CSOM. We think that multicenter prospective studies are needed to organize effective treatments of these infections.

The most effective method for monitoring country-level drug resistance frequency and to implement the necessary control measures is the establishment of a laboratory-based surveillance system. The aim of this study was to summarize the follow up trend of the drug-resistant tuberculosis (TB) cases, determine the load of resistance and evaluate the capacities of laboratories depending on laboratory quality assurance system for the installation work of National Tuberculosis Laboratory Surveillance Network (TuLSA) which has started in Ankara in 2011. TuLSA studies was carried out under the coordination of National Tuberculosis Reference Laboratory (NRL) with the participation of TB laboratories and dispensaries. Specimens of TB patients, reported from health institutions, were followed in TB laboratories, and the epidemiological information was collected from the dispensaries. One isolate per patient with the drug susceptibility test (DST) results were sent to NRL from TB laboratories and in NRL the isolates were rechecked with the genotypical (MTBDRplus, Hain Lifescience, Germany) and phenotypical (MGIT 960, BD, USA) DST methods. Molecular epidemiological analysis were also performed by spoligotyping and MIRU/VNTR. Second-line DST was applied to the isolates resistant to rifampin. A total of 1276 patients were reported between January 1st to December 31th 2011, and 335 cases were defined as "pulmonary TB from Ankara province". The mean age of those patients was 43.4 ± 20 years, and 67.5% were male. Three hundred seventeen (94.6%) patients were identified as new cases. The average sample number obtained from pulmonary TB cases was 3.26 ± 2.88, and 229 (68.3%) of them was culture positive. DST was applied to all culture positive isolates; 90.4% (207/229) of cases were susceptible to the five drugs tested (ethambutol, isoniazid, pyrazinamide, rifampicin, streptomycin). Eight (3.5%) of the isolates were multidrug-resistant (MDR-TB), while no extensively drug-resistant strains were detected. MDR-TB is likely to occur in 63.3 times more among previously treated cases, and 73.3 times more in legal aliens. The achievement of therapy among pulmonary TB cases was 91.9%. Spoligotyping performed for 221 M.tuberculosis complex isolates, showed that all strains were clustered in nine groups. SIT 41 (105/221; 47.5%) was the most frequent spoligotype detected, and clustering rate based on MIRU-VNTR results were found as 16.3%. All of the clustered strains were sensitive while all of MDR-TB isolates showed specific MIRU-VNTR profiles. In conclusion, TuLSA studies started in Ankara in 2011 and the system is still expanding in the country. Our data obtained with TuLSA have been published as a regional surveillance data in the WHO Global Tuberculosis Report 2011, and as a national surveillance data in Global Tuberculosis Report 2012.

Human polyomaviruses, namely BK (BKV) and JC (JCV) viruses are small DNA viruses that cause latent infections worldwide. Primary infections are usually acquired in the early periods of life and are generally asymptomatic. However BKV/JCV infections may cause severe clinical conditions in immunosuppressive patients such as bone marrow and solid organ transplantation or cancer patients. The aim of this retrospective study was to investigate the presence of BKV and JCV nucleic acids by real-time polymerase chain reaction (RT-PCR) in the clinical samples of patients with high risk. A total of 268 (62 blood, 206 urine) samples obtained from 115 immunocompromised patients hospitalized in Gazi University Hospital between July 2007 to January 2009, were included to the study. Viral nucleic acids were extracted from the samples with High Pure PCR Template Preparation Kit (Roche, Germany). By using amplification mix (TIB Molbiol GmbH, Germany) that included primers targeting 174 (JCV) and 219 (BKV) base pair fragments of the small t antigen, and hybridization probes (Roche, Germany), nucleic acids were amplified with LightCycler (Roche Applied Science, Germany) system. As a result, total polyomavirus DNA positivity rate was found as 33.2% (89/268). When BKV and JCV DNA positivities were evaluated according to the samples, 25.2% (53/206) of urine samples yielded positive results for BKV, 14.5% (30/206) for JCV and 2.4% (5/206) for both BKV and JCV. Only one of the blood samples (1/62; 1.6%) were found positive by means of BKV DNA, while none of the blood samples were positive for JCV DNA. The distribution of BKV and JCV DNA positivity rates according to the inpatient clinics were as follows, respectively; 24.3% and 9.5% for pediatric nephrology, 9.6% and 8.2% for renal transplantation unit, 13.5% and 18.9% for adult nephrology, 30.8% and 15.4% for bone marrow transplantation unit, 22.9% and 8.6% for pediatric clinics. In samples from pediatric hematology patients, BKV positivity was 36.4% (4/11), while there were no JCV positivity. However, in hematology patients, while JCV was positive in one of the three samples, no BKV positivity was detected.BKV was seen in three of six samples obtained from patients in the intensive care unit. JCV was positive in both of the two samples obtained from patients in pediatric endocrinology. The only patient that had BKV DNA in blood sample was a renal transplant patient. BKV + JCV DNAs were positive together in only five (1.9%) of the urine samples. In 24% (22/89) of the samples, BKV DNA was found ≥ 10⁷ copies/ml, in 2.2% (2/89) JCV DNA was ≥ 10⁷ copies/ml, whereas in 2.2% (2/89) of samples both BKV and JCV DNA was ≥ 10⁷ copies/ml. All of those samples with high DNA levels were urine. The data of this study led to the establishment of a collaborative algorithm between the laboratory and clinics in our hospital for the diagnosis and follow-up of the patients in terms of BKV/JCV infections. In conclusion, since BKV/JCV reactivations and infections are crutial in immunosuppressive patients, especially medical centers specialized in bone marrow and renal transplantation, diagnostic and monitoring procedures related to those infections should be programmed.