ABSTRACT Before use of the pneumococcal conjugate vaccine PCV7 became widespread in Turkey, 202 invasive pneumococcus isolates were analyzed. The most common serotypes were 19F and 6B. In children ≤2 years of age, the potential coverage rate of PCV7 was 69.5%. The most frequent non-PCV7 serotypes were 19A, 3, 1, 6A, and 8.

Aim: Methicillin-resistant Staphylococcus aureus (MRSA) is still the commonest pathogen in hospital-acquired infections with high morbidity and mortality. MRSA colonization usually precedes infection and dissemination of the microorganism. The aim of this study was to determine risk factors for the colonization and infection with MRSA in a medical intensive care unit (MICU) and to show the genetic relation of strains.Materials and methods: This study was conducted prospectively between I December 2004 and 31 January 2006 in MICU. Patients (>16 years) admitted to the MICU were screened for MRSA on admission (in the First 48 hours), at the end of the first week, and at the ICU discharge using anterior nares, axilla, and groin swabs. Risk factors for colonization and infection of MRSA were evaluated. Strains isolated from colonized patients were evaluated for genetic relation.Results: During the study period, 259 patients were evaluated for the risk factors of MRSA acquisition. The colonization rate was 18.5%, and 64.6% of the patients were colonized in the first week. In multiple logistic regression analysis, only the length of stay in MICU and mechanical ventilation were significant risk factors for colonization. MRSA infection occurred in 15 (31%) of 48 colonized patients during MICU stay. MRSA colonization and tracheostomy were significant risk factors for MRSA infection. A genetic relation was found in 48 isolates from colonized patients in MICU and 23 isolates from colonized patients on admission. Overall, 4 clones (clone A, B, C, and D) were determined from colonized patients on admission; clone A (37%), clone B (32%), clone C (21%), and clone D (10%). Moreover, patients colonized during MICU stay had similar clones (clone A-30% clone B-57%, and clone C-13%) with these patients.Conclusion: This study shows a high colonization rate and dissemination of MRSA in a developing country with inadequate infrastructure (lack of nurse, lack of isolation rooms, and heavy workload).

Aim: Acinetobacter baumannii is one of the most common causes of ventilator-associated pneumonia in intensive care units. The aim of this study was to determine the risk factors for colonization in the respiratory tract and infection with A. baumannii in a medical intensive care unit (MICU), and to examine the genetic link between strains and the spread of isolates.Materials and methods:This study was conducted prospectively between 1 December 2004 and 31 January 2006 in the MICU. Patients (> 16 years old) admitted to the MICU that were mechanically ventilated and/or intubated were enrolled in the study.Results: Ninety-eight patients were evaluated for A. baumannii colonization during or at the end of their intubation; 44 (45%) of these patients were colonized by A. baumannii. The length of intubation (OR: 1.032, P = 0.014) and diabetes mellitus (OR: 4.140, P = 0.008) were the major risk factors for colonization of the respiratory tract by A. baumannii. During the study period A. baumannii infection developed in 35 (80%) of the 44 colonized patients. The important risk factors for A. baumannii infection were colonization (OR: 3.962, P = 0.006) and tracheostomy (OR: 4.857, P = 0.001). Genotyping analysis was performed for 59 isolates. Overall, 3 clones (clone A, B, and C) were identified in patients; 88% were clone A (52 isolates), 7% were clone B (4 isolates), and 5% were clone C (3 isolates).Conclusion: Length of intubation and diabetes mellitus were significant risk factors for A. baumannii colonization in intubated patients. Moreover, colonization and tracheostomy predisposed patients to infection. Additionally, this study documented the spread of multi-drug resistant A. baumannii in intubated patients in an MICU with limited resources.

Resistance rates to amikacin, ciprofloxacin, ceftazidime, cefepime, imipenem, cefoperazone/sulbactam and piperacillin/tazobactam in Escherichia coli (n = 438), Klebsiella pneumoniae (n = 444), Pseudomonas aeruginosa (n = 210) and Acinetobacter baumanni (n =200) were determined with E-test in a multicenter surveillance study (HITIT-2) in 2007. ESBL production in Escherichia coli and K. pneumoniae was investigated following the CLSI guidelines. Overall 42.0% of E.coli and 41.4% of K. pneumoniae were ESBL producers. In E. coli, resistance to imipenem was not observed, resistance to ciprofloxacin and amikacin was 58.0% and 5.5% respectively. In K. pneumoniae resistance to imipenem, ciprofloxacin and amikacin was 3.1%, 17.8% 12.4% respectively. In P. aeruginosa the lowest rate of resistance was observed with piperacillin/tazobactam (18.1%). A. baumanni isolates were highly resistant to all the antimicrobial agents, the lowest level of resistance was observed against cefoperazone/sulbactam (52.0%) followed by imipenem (55.5%). This study showed that resistance rates to antimicrobials are high in nosocomial isolates and show variations among the centers.

AIM:To investigate the effects of exogenous melatonin on bacterial translocation and apoptosis in a rat ulcerative colitis model.METHODS:Rats were randomly assigned to three groups: group I: control, group II: experimental colitis, group III: colitis plus melatonin treatment. On d 11 after colitis, plasma tumor necrosis factor-alpha, portal blood endotoxin levels, colon tissue myeloperoxidase and caspase-3 activity were measured. Bacterial translocation was quantified by blood, lymph node, liver and spleen culture.RESULTS:We observed a significantly reduced incidence of bacterial translocation to the liver, spleen, mesenteric lymph nodes, portal and systemic blood in animals treated with melatonin. Treatment with melatonin significantly decreased the caspase-3 activity in colonic tissues compared to that in trinitrobenzene sulphonic acid- treated rats (16.11 +/- 2.46 vs 32.97 +/- 3.91, P < 0.01).CONCLUSION:Melatonin has a protective effect on bacterial translocation and apoptosis.

Purpose: Methicillin resistant Staphylococcus aureus (MRSA) infections are frequent in intensive care units (ICUs). This prospective study was implemented to investigate the frequency of MRSA colonization on admission to ICU.Materials and methods: This study was conducted at Erciyes University Faculty of Medicine Gevher Nesibe Hospital Internal Medicine ICU from December 2004 to January 2006. All patients admitted to ICU were included in the study. Nose, axilla and groin swab cultures were carried out within 48 hours of ICU admission then cultivated on mannitol salt agar including 6mg/L oxacillin.Results: A total of 408 patients were followed up during the study. MRSA colonization on admission was detected in 23 (5.64%) patients. MRSA infection was detected in 5 (21.7%) of those colonized patients. Staying in hospital before ICU admission, length of stay in hospital before ICU, previous antibiotic use, duration of previous antibiotic use, decubit ulcers and central venous catheter were statistically significant (p<0.05). Comorbidities, age, sex, APACHE II and SOFA scores were not determined as risk factors.Conclusion: The patients colonized with MRSA before admission to ICU are important sources of MRSA out breaks. Detection of risk factors may decrease the rate of MRSA infections in ICUs.

Purpose: This study focused on the effect of immuno-compromising conditions on the clinical presentation of severe listerial infection. Patients and Methods: Nine human listeriosis cases seen from 1991-2002 were reviewed. All adult patients, from whose blood, peritoneal fluid or cerebrospinal fluid (CSF) the L. monocytogenes was isolated, were included in this retrospective study. Results: Listeriosis presented as primary sepsis with positive blood cultures in 5 cases and meningitis with positive CSF cultures in 4 cases. All of these patients had at least one underlying disease, most commonly, hematologic malignancy, diabetes mellitus, amyloidosis and hepatic cirrhosis; 55.6% had received immunosuppressive or corticosteroid therapy within a week before the onset of listeriosis. The patients were adults with a mean age of 60 years. Fever, night sweats, chills and lethargy were the most common symptoms; high temperature (> 38 degrees C), tachycardia, meningeal signs and poor conditions in general were the most common findings on admission. The mortality rate was 33.3% and was strictly associated with the severity of the underlying disease. Mortality differences were significant between sepsis (20%) and meningitis (50%) patients. Conclusion: Listeriosis as an uncommon infection in our region and that immunesuppressive therapy is an important pre-disposing factor of listeriosis. Sepsis and meningitis were more common in this group of patients and had the highest case-fatality rate for food-bome illnesses.

The objective of this study was to isolate, identify, and genotype Campylobacter jejuni from various sources in the province of Kayseri, Turkey. A total of 6667 samples consisting of 5167 human fecal swabs, 600 dog rectal swabs, 600 cattle gallbladders, and 300 chicken carcasses were examined. The samples were plated onto mCCDA (cefoperazone charcoal desoxycholate agar) agar. In order to identify C. jejuni, phenotypic tests and PCR (polymerase chain reaction) were performed. C. jejuni was isolated in 1.43%, 43.50%, 31.16%, and 56% of the human, dog, cattle, and chicken samples, respectively. Among the 690 C. jejuni strains that were isolated during the study period, 200 C. jejuni strains (50 strains from each species) were randomly selected. The selected strains were typed by using PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism) fla-typing. DdeI and HinfI restriction enzymes were used for molecular typing. Following the DdeI enzyme application, the strains produced various numbers of bands between 4 and 7, with a total of 20 different band profiles. No similar band profiles were seen among the strains isolated from different sources. It was found that HinfI was not a more discriminative enzyme for fla-typing of C. jejuni isolates.

The aims of this study were to detect BRO beta-lactamase types and to evaluate any correlation with the susceptibility patterns of 90 clinical isolates of Moraxella catarrhalis. The overall prevalences of the bro-1 and bro-2 genes were 78% and 12%, respectively. Penicillin G MICs for BRO-1+ isolates were significantly higher than those for BRO-2+ isolates. All the isolates were susceptible to amoxycillin-clavulanate, levofloxacin and cefixime. Resistance to clarithromycin, tetracycline and trimethoprim-sulphamethoxazole was 1.1%, 2.2% and 1.1%, respectively. One-step, length-based PCR was an efficient method to screen for BRO beta-lactamase genes.

Treatment of life threatening pneumococcal infections such as meningitis has recently become problematic due to the emergence of antibiotic resistant strains. Antimicrobial susceptibility data usually derived from the studies that included all clinical pneumococcal isolates. However, resistance patterns of this microorganism isolated from meningitis cases in our country are not exactly known. The aim of this study was to determine the antimicrobial susceptibility and serotypes of Streptococcus pneumoniae strains isolated from meningitis cases. This retrospective study was designed in three university hospitals in Turkey and 72 pneumococci isolated from patients with meningitis were evaluated. In this study disk diffusion test and E-test methods were used to determine the susceptibility of pneumococci to some antibiotics. All S.pneumoniae isolates were serotyped using Quellung reaction. Although resistance for oxacillin was found by disc diffusion method in 11 isolates, only six of them were found to be resistant by E-test. By the latter procedure, no resistance was recorded against ceftriaxone and meropenem, while chloramphenicol resistance was found as 1.4%. In our study, erythromycin, ciprofloxacin and levofloxacin resistance were 2.8%, TMP-SMX resistance was 26.4%, while no vancomycin resistance was detected by disk diffusion. In evaluation of 72 pneumococci, we found 16 different serotypes and four isolates could not be serotyped. The serogroup 23 (n: 19) was the most common one followed by serotype 19 (n: 9) and serotype 14 (n: 7). Of six resistant isolates, three pneumococci were serogroup 23 and the remaining were from three different serotype/serogroups 11, 14 and 19. As a result penicillin resistance in pneumococci isolated from meningitis was low and there was no resistance to ceftriaxone. It seems that ceftriaxone is an appropriate choice for empirical treatment of meningitis in our patients. These findings also revealed that pneumococcal polysaccharide capsule vaccines in use cover most of the invasive pneumococcal serotypes.

Acinetobacter baumannii is a significant pathogen of bloodstream infections in hospital patients that frequently causes single clone outbreaks. We aimed to evaluate the genetic relatedness and antimicrobial susceptibility of Acinetobacter spp. bloodstream isolates, in order to obtain insight into their cross-transmission. This prospective study was conducted at the Erciyes University Hospital. During a 1-y period, all patients with nosocomial BSI caused by Acinetobacter spp. were included in the study. All data with regard to the patients, underlying diseases and risk factors for BSI and the severity of disease were collected. Blood culture isolates of Acinetobacter spp. were identified according to their morphology and biochemical reactions. The antimicrobial susceptibility was determined using the Kirby-Bauer disk diffusion test according to the NCCLS; the genetic relatedness of isolates was determined by RAPD-PCR analysis and pulsed-field gel electrophoresis (PFGE). 41 patients acquired a nosocomial bloodstream infection caused by A. baumanii during this period. 88% of these infections (36 of 41) occurred while the patients were treated in the intensive care unit. Nearly 80% of the isolates belonged to 3 genotypes, suggesting cross-transmission in ICU settings where infection control practices are poor. All Acinetobacter isolates were multidrug-resistant and the crude mortality of patients infected with A. baumanii was 80.5%. We concluded that the genetic relatedness of Acinetobacter spp. causing BSI was very high, indicating cross-transmission within the ICU setting. Essential components of an infection control programme to prevent nosocomial transmission of A. baumannii are early detection of colonized patients, followed by strict attention to standard precautions and contact isolation.

Brucellosis is a zoonotic infection, transmitted to humans primarily by consumption of unpasteurized milk and milk products. Transmission by blood transfusion is possible but very unusual. Herewith we present two newborns with positive blood cultures for Brucella melitensis after exchange transfusions. However, the standard tube agglutination titers against Brucella were not elevated and the newborns did not develop brucellosis. It is suggested that, in areas endemic for brucellosis, blood donors should be questioned about symptoms of brucellosis, and if suspected, serological tests for brucellosis should be indicated before blood transfusion. At the same time, the prevalence of the disease among animals should be reduced with effective animal disease control programs.

PURPOSE:To investigate the efficacy of intravitreal piperacillin/tazobactam (250 microg/0.1 ml) in the treatment of experimental Pseudomonas aeruginosa endophthalmitis in rabbits. MATERIALS AND METHODS:Twenty New Zealand White albino rabbits were used in this study. The rabbits were divided into two groups (10 rabbits in each), and the right eyes were treated with 0.1 ml intravitreal injections of P. aeruginosa suspension (ATCC 27853, 2 x 10(4) CFU); the left eyes served as uninfected control and were injected with 0.1 ml of saline solution. The right eyes of rabbits in group 1 (n = 10) received intravitreal injection of 250 microg piperacillin/tazobactam 24 h after intravitreal inoculation of P. aeruginosa. Group 2 eyes (n = 10) received no treatment and served as infected controls. Clinical examination of the eyes in each group was performed on the first, third, and sixth day after the inoculation of P. aeruginosa. After the last ophthalmic examination, 0.1 ml vitreous aspirates were obtained for microbiological analysis, and then the eyes were enucleated for histopathological evaluation. RESULTS:The mean clinical scores of group 1 and group 2 at the first day after P. aeruginosa inoculation were similar (p > 0.05). At the sixth day, the mean clinical score of group 1 was significantly lower when compared with group 2 eyes (p < 0.001). Microbiological analysis revealed that group 2 had a significantly more cfu/ml than group 1 (p < 0.001), and the mean histopathological score of group 2 was significantly higher than group 2 (p = 0.009). CONCLUSIONS:Intravitreal application of 250 microg/0.1 ml piperacillin/tazobactam seems to be effective in the treatment of P. aeruginosa endophthalmitis in rabbits. Intravitreal piperacillin/tazobactam combination may be a new therapy for P. aeruginosa endophthalmitis.

Background: To investigate the efficacy of intravitreal piperacillin/tazobactam in rabbit eyes with experimental S. epidermidis endophthalmitis and to compare the outcomes with intravitreal vancomycin application. Material and Methods: Twenty-four New Zealand white albino rabbits were divided into three equal groups (n = 8 in each), and the right eyes received 0.1-ml intravitreal injections of S. epidermidis suspension. The left eyes served as uninfected controls and were injected with 0.1 ml of saline solution. The right eyes of rabbits in group 1 were treated with intravitreal injection of 250 µg/0.1 ml piperacillin/tazobactam 24 h after intravitreal inoculation of S. epidermidis whereas group 2 eyes received intravitreal 1 mg/0.1 ml vancomycin. Group 3 eyes received no treatment and served as infected controls. Clinical examination of the eyes in each group was performed on the 1st, 3rd and 6th day after the inoculation of S. epidermidis. On the 6th day, 0.1-ml vitreous aspirates were obtained for microbiological analysis, and then the eyes were enucleated for histopathological evaluation. Results: There were no statistically significant differences in mean clinical scores between the groups on the first day after S. epidermidis inoculation (p > 0.05). On the 6th day, the mean clinical score of group 3 was significantly higher (p < 0.001), but the mean clinical scores of groups 1 and 2 were similar (p = 0.812). The mean logarithmic value of colony-forming units per milliliter of groups 1, 2 and 3 were 0.6 ± 1.3, 0.5 ± 1.5 and 5.3 ± 0.7, respectively. Mean histopathological scores of the groups were 8.3 ± 0.9, 7.5 ± 1.3 and 15.6 ± 1.2, respectively. Group 3 eyes had significantly more colony-forming units per milliliter and a higher histopathological score (for each, p < 0.001), and there were no statistically significant differences in microbiological and histopathological scores between groups 1 and 2 (for each, p > 0.05). Conclusion: Intravitreal application of 250 µg/0.1 ml piperacillin/tazobactam seems to be approximately equally effective with intravitreal 1 mg/0.1 vancomycin application in the treatment of experimental S. epidermidis endophthalmitis. Therefore, intravitreal piperacillin/tazobactam may be an alternative therapeutic option in the treatment of S. epidermidis endophthalmitis.

Salmonella species may cause wide spectrum of infections changing from enterocolitis to sepsis. However, Salmonella meningitis in adults is a rare but important clinical condition with a high mortality rate. In this report, a 71 years old male patient with Salmonella enteritidis meningitis who was followed-up with the diagnosis of immune thrombocytopenic purpura and had been administered azothioprin and prednisolone, has been presented and similar cases in the literature have been reviewed. The cerebrospinal fluid culture yielded S. enteritidis, and the isolate was intermediate susceptible to ampicillin, susceptible to cefotaxime, trimethoprim-sulphametoxasole, ciprofloxacin and chloramphenicol. Our patient was successfully treated with ceftriaxone (2 x 2 gr i.v.) and discharged with total cure.

In the present study, we aimed at comparing the efficacies of intravitreal piperacillin/tazobactam and ceftazidime applications in the treatment of experimental Pseudomonasaeruginosa endophthalmitis in rabbit eyes. Twenty-four New Zealand white albino rabbits were divided into three groups (n=8 in each), and the right eyes received 0.1 ml intravitreal injections of P. aeruginosa suspension. The left eyes served as uninfected control and were injected with 0.1 ml of saline solution. The right eyes of rabbits in group 1 were treated with intravitreal injection of 250 microg/0.1 ml piperacillin/tazobactam 24 hr after intravitreal inoculation of P. aeruginosa, whereas group 2 eyes received intravitreal 1 mg/0.1 ml ceftazidime. Group 3 eyes received no treatment and served as infected controls. Clinical, microbiological and histopathological evaluations of the eyes in each group were performed on the 1st, 3rd, and 6th day after the inoculation of P. aeruginosa. The mean clinical scores of each group were similar at the first day after P. aeruginosa inoculation (P>0.05). At the 6th day, there was no statistically significant difference in mean clinical scores between group 1 and 2, but mean clinical score of group 3 was significantly higher (P<0.001). Microbiological analysis and histopathological scoring demonstrated no statistically significant difference between group 1 and 2 (for each, P>0.05). Group 3 eyes had a significantly more CFU/ml and higher histopathological score (for each, P<0.001). In conclusion, intravitreal application of 250 microg/0.1 ml piperacillin/tazobactam seems to be effective in the treatment of P. aeruginosa endophthalmitis in rabbits, but is not superior to intravitreal ceftazidime application. Therefore, intravitreal piperacillin/tazobactam may be a useful alternative to ceftazidime for pseudomonal endophthalmitis.

Forty clinical isolates of Bacillus anthracis were studied. The MIC(90) values of penicillin G, doxycycline, ciprofloxacin, gatifloxacin, and levofloxacin were 0.016, 0.03, 0.06, 0.06 and 0.12 mg/l, respectively. Susceptibilities suggest that the quinolones may also be considered as an alternative therapy for anthrax.

We describe a rare case of peritonitis caused by an unusual fungus, Trichoderma sp., in a patient on continuous ambulatory peritoneal dialysis. Management of the patient consisted of Tenckhoff catheter removal and antifungal chemotherapy, but the patient died.