Abstract Background Pregnancy immunization is recommended to protect babies against pertussis, which has a high mortality and morbidity during infancy, but whooping cough vaccine is not given to pregnant women in Turkey. In this study, pertussis antibodies in maternal and cord blood were investigated. Methods The study group was one hundred and fifty-four mothers who gave birth at Hacettepe University Hospitals in Ankara, from July to October 2020. The information of the mothers was collected by questionnaire and sera were taken. In this descriptive epidemiological study, anti-PT and anti-FHA were investigated with ELISA (EUROIMMUN B. Pertussis toxin (PT) IgG, Filamentous Hemagglutinin (FHA) IgG) method in maternal and cord-paired sera, the limit value was accepted as 10 IU/ml. Anti-ACT was investigated in the sera of 79 mothers who were anti-PT or anti-FHA positive by Immunblot (EUROIMMUN Adenylate Cyclase Toxin (ACT) IgG) method. Correlation analysis of continuous numerical variables was performed. The difference between categorical variables was evaluated with the Chi-Square test. Results Mean (SD) maternal age, gestational age and birth weight were 30.1 (5.1) years, 38.5 (0.9) weeks, 3307 (441) g, respectively. Anti-PT and anti-FHA are at protective levels in 18.8% and 48.1% of the mothers, respectively. Anti-PT and anti-FHA are at the protective level in 38.3% and 55.8% of the cord, respectively. Anti-FHA positivity is 63.3% between the ages of 25 and under, 38.6% between the ages of 26-35, and 69.6% at the age of 36 and over (p = 0.005). 72.4% of mothers with anti-PT positive and 67.6% of mothers with anti-FHA positive were anti-ACT antibody positive. Anti-ACT positive mothers were immunized by having the disease, not by vaccine. Anti-PT and anti-FHA antibody levels in maternal and cord blood are highly correlated. Conclusions Protective level of pertussis antibodies in maternal and cord blood is low. Most mothers are immunized with pertussis infection, not vaccine. Key messages The amount of pertussis antibodies in maternal and cord blood is low in Turkey and maternal immunization is needed. The addition of pertussis-containing vaccines to pregnant immunization is important to protect babies from whooping cough disease, which remains a major public health problem.

Background: Haemophilus influenzae (H.influenzae) is an important bacterial pathogen which causing a wide variety of both invasive and respiratory infections. Antibiotic treatment may lead to development of resistance in H.influenzae strains, particularly in β-lactamase-negative ampicillin resistant (BLNAR) strains. The aim of the present study was to investigate the serotype distribution and antibiotic susceptibility of β-lactamase-negative ampicillin resistant (BLNAR) H.influenzae isolates from adult patients. Methods & Materials: One hundred and twenty-five BLNAR H. influenzae isolates were collected between the year of 2003 to 2012. The β-lactamase production of these isolates was examined by using DrySlide nitrocefin (BBL, Becton Dickinson, USA). All isolates were identified and characterized for capsular serotypes. Serotyping was performed by slide agglutination by using commercial antisera (BD Difco, H.influenzae antisera, USA). Antibiotic susceptibility to the following antimicrobial agents was determined with disc diffusion method according to CLSI: ampicillin (AMP), cefotaxime (CTX), cefuroxime (CXM), chloramphenicol (CHL) and trimethoprim-sulfamethoxazole (SXT). Results: Of the 125 H.influenzae isolates, 88 (70,40%), 13 (10,40%), 10 (8,00%), 7 (5,60%), 3 (2,40%), 2 (1,60%), 1 (0,80%) and 1 (0,80%) were from the sputum, bronchoalveolar lavage, tracheal aspirate, conjunctiva, nasofaringeal aspirate, blood, cerebrospinal fluid and pus, respectively. Serotype b 110 (88,00%) was most commonly observed among the BLNAR H.influenzae isolates. The rates of serotype e 6 (4,80%) and serotype d 3 (2,40%) were observed in follows. Five isolates were found as nontypeable (4,00%). Antimicrobial susceptibility results showed that 5 (4,00%) isolates were resistant to all studied antibiotics. All of these five isolates have serotype b, as well. Along with the AMP resistance, 53 (42.4%) isolates were susceptible to CTX, CXM, CHL and SXT in BLNAR. Conclusion: The rates of BLNAR H.influenzae infection is increasing worldwide which may cause severe important infection. This study may guide clinicians on appropriate use of antibiotics not only for reducing the morbidity and mortality in the patients but also to control the emergence and spread of antimicrobial resistance among BLNAR H.influenzae strains. This study emphasizes the continuous epidemiological monitoring of BLNAR H.influenzae isolates.

Background: Burkholderia spp. are problematic infectious agents for cystic fibrosis (CF) or chronic granulomatous disease patients. Due to the failure of identification with conventional techniques and high intrinsic resistance to most antibiotics, these infections very difficult to treat and can cause a marked reduction in life expectancy. The aim of this study was to identify Burkholderia spp. strains isolated from CF and non-CF patients with multilocus sequence analysis (MLSA). Also, the antibiotic resistance and synergies of antibiotics were evaluated. Methods & Materials: A total of 38 Burkholderia spp. (25 CF, 13 non-CF) isolates were analyzed. All the Burkholderia spp. were identified by MLSA. Antibiotic susceptibilities of ceftazidime, meropenem, trimethoprim/sulfamethoxazole (TMP-SXT) and levofloxacin were determined by broth microdilution method according to CLSI guidelines. Synergy tests are performed by checkerboard method. Results: Multilocus sequence analysis identified clinical isolates as B. cenocepacia (n = 16), B. contaminans (n = 11), B. gladioli (n = 4), B. dolosa (n = 4), B. multivorans (n = 2) and B. seminalis (n = 1). Among the 38 Burkholderia spp. isolates, overall rates of resistance to ceftazidime, meropenem, TMP-SXT, and levofloxacin was 34.2%, 65.8%, 50% and 39.5%, respectively. No significant difference in antibiotic resistance between cystic fibrosis and non-cystic fibrosis patients were detected. Synergy has shown between meropenem and TMP-SXT at two isolates. Antagonism has detected at 15 isolates (between meropenem and ceftazidime (n = 12); between ceftazidime and TMP-SXT (n = 3)) Conclusion: A variety of molecular approaches have been developed for the identification of closely related species and MLSA has successfully provided a reliable advanced discrimination method for Burkholderia isolates. Expression of several resistance mechanisms in species may lead to higher resistance, whereas antagonism between meropenem and ceftazidime might be attributed to the expression of the beta-lactamases.

Streptococcus pneumoniae infections are challenging since pneumococci have more than 90 serotypes and emergence of resistant strains has increased. Surveillance systems are essential for effective vaccine strategies and development of treatment protocols. This study aimed to evaluate the serotype distribution and antimicrobial susceptibility of S. pneumoniae causing invasive pneumococcal disease in adults (>18 years). S. pneumoniae strains were collected from 14 different centers between 2005 and 2015. Pneumococcal serogroup and serotype identification was performed using standard conventional methods. Antibiotic susceptibility testing was performed using E­test and interpreted according to the CLS I 2014 standards. S. pneumonia strains (n=346) were isolated from blood (60. 1%), bronchoalveolar lavage (19. 7%), cerebrospinal fluid (11. 0%), pleural fluid (6. 1%), and other body fluids (3. 1%). The most common S. pneumoniae serotypes were found as serotype 3 (13. 0%), 19F (12. 7%), 19A (6. 1%), 14 (4. 6%), and 6B (4. 0%). Vaccine coverage rate was 27. 4% for 7­valent pneumococcal conjugate vaccine (PCV­7), 53. 5% for PCV­13, and 62. 3% for 23­valent pneumococcal polysaccharide vaccine (P P V­23). For oral penicillin V, resistance rate was 21. 7% and intermediate resistance rate was 16. 8%. F or parenteral penicillin, 52. 6% was resistant in strains isolated from CS F (meningitis) and 0. 6% was resistant and 5. 8% was intermediate in strains isolated from other specimens. F or cefotaxime, 5. 3% was resistant and 18. 4% was intermediate in strains isolated from CS F , whereas 1. 6% was resistant and 6. 5% was intermediate in strains isolated from other specimens. Erythromycin resistance was 28. 6%. No resistance was detected to moxifloxacin but intermediate resistance was 0. 6%. Serotypes 19A and 19F exhibited higher rates of penicillin and erythromycin resistances. Since serotype distribution and antimicrobial susceptibility of clinical S. pneumoniae isolates may change in time naturally also with medical interventions like antibiotic use and vaccination, close monitoring is essential.

Aim Storage of human milk in refrigerator has been recommended for short term storage. It has been shown that some nutritional, immunological, bioactive properties and bactericidal activity of human milk can alter by refrigeration. Pyrex bottles and polyethylene bags are the two common containers in the setting of storage of human milk. The aim of this study is to compare the effect of the type of storage container on bactericidal activity of human milk at different duration of refrigeration. Methods Forty four samples of human milk were collected from 22 lactating mother. Two samples of human milk were obtained by manual expression from each mother. One was collected directly into sterile pyrex bottles and the other into polyethylene bags. Each sample was divided into three aliquots, one was processed immediately and remaining two were kept at 4°C for 24 and 48 hours. Bactericidal activity of each sample was studied. A strain of E.coli ATCC 25922 was used to determine the bacteridal effect of human milk. Results Bactericidal activity was significantly reduced in milk samples kept in polyethylene bags compared to the samples kept in pyrex bottles when milk samples stored at 4°C for 24 and 48 hours (p<0.05). Conclusion Short term storage of human milk in pyrex bottles is more appropriate than polyethylene bags for prevention of decrease in bactericidal activity.

Background and aims Sepsis is an important cause of morbidity and mortality among newborn infants. Blood culture is the gold standard. Early and definitive diagnosis of neonatal sepsis is difficult because its sings and symptoms are nonspecific. New leukocyte parameters such as neutrophil volume (MNV), conductivity (MNC), scattering (MNS) and volume distribution width (NDW) were introduced in the diagnosis of sepsis recently. We aimed to investigate these parameters in newborn sepsis and compare their efficacy with serum CRP, Procalcitonin (PCT), IL-6 levels. Methods This study was conducted in Hacettepe University Neonatology Unit, between July 2010 and February 2012. Total 227 newborns, 116 sepsis (40 proven, 76 clinical sepsis) and 111 control included in the study. Results Results are summarized in the Table 1. Abstract 44 Table 1 Cut-off levels Sensitivity (%) Specificity (%) PPV (%) NPV (%) AUC (%) CRP (mg/dl) >0.16 75.0 76.3 50.8 91.9 77.7 PCT (ng/dl) >0.44 75.0 86.0 60.4 89.3 86.9 IL-6 (pg/ml) >15.40 70.8 74.2 45.5 91.0 72.5 I/T ratio >0.19 62.5 92.5 79.4 88.9 81.5 MNV (au) >159.50 37.5 94.6 71.4 80.8 63.4 MNC (au) <144.50 78.4 46.8 35.2 86.7 62.6 MNS (au) <141.50 86.5 37.6 32.7 87.2 64.5 NDW (au) >29.25 66.7 75.3 43.9 84.0 68.2 Sensitivity, specificity, positive and ne Conclusions In conclusion new CBC parameters can be helpful in differential diagnosis of newborn sepsis in addition to other screening parameters. MNV seems the most useful parameter with the highest spesifity.

The main aim of this study was to assess brominated flame retardants (BFRs) in breast milk in the Northern parts of Tanzania. Ninety-five colostrum samples from healthy, primiparous mothers at Mount Meru Regional Referral Hospital (MMRRH), Arusha Tanzania, were analyzed for polybrominated diphenyl ethers (PBDEs), hexabromocyclododecane (HBCD), 1,2-bis(2,4,6-tribromophenoxy) ethane (BTBPE), hexabromobenzene (HBB), (2,3-dibromopropyl) (2,4,6-tribromophenyl) ether (DPTE), pentabromoethylbenzene (PBEB) and 2,3,4,5,6-pentabromotoluene (PBT). The Ʃ7PBDE (BDE 28, 47, 99, 100, 153, 154, 183) ranged from below level of detection (< LOD) to 785 ng/g lipid weight (lw). BDE 47, 99, 100 and 153 were the dominating congeners, suggesting recent and ongoing exposure to banned, commercial PentaBDE mixture. A multiple linear regression model revealed that mothers eating clay soil/Pemba during pregnancy had significantly higher levels of BDE 47, 99, 100 and 153 in their breast milk than mothers who did not eat clay soil/Pemba. Infant birth weight and birth length were significantly correlated with the levels of BDE 47, 99, 100 and 153. The estimated daily intake (ng/kg body weight/day) of BDE 47 and 99 exceeded the US EPA Reference doses (RfD) in four and eight mothers, respectively, suggesting a potential health risk to the nursing infants.

Staphylococcus aureus small-colony variants (SCVs) are being isolated more frequently in cystic fibrosis (CF) patients. We aimed to determine the prevalence of S. aureus SCVs and their phenotypic and genotypic properties in CF patients admitted to a university hospital. Specimens of 248 patients were examined during a period of 11 months. Colonies supposed to be SCVs were evaluated on Columbia blood agar, mannitol salt agar, and brain-heart infusion agar with 5% NaCl (BHIA 5% NaCl). Strains were confirmed by S. aureus nucA PCR. Antibiotic susceptibilities of SCVs and simultaneously isolated S. aureus strains were determined for oxacillin, gentamicin, trimethoprim-sulphamethoxazole, vancomycin, ciprofloxacin, linezolid, and tigecycline. Genetic relatedness between SCVs and normal S. aureus strains was determined with a pulsed-field gel electrophoresis (PFGE) method. S. aureus SCVs were detected in 20 of 248 patients (8.1%). The highest SCV isolation rate was obtained with MSA, followed by BHIA 5% NaCl. Auxotrophism for thymidine was demonstrated in six SCVs. The tigecycline susceptibilities of 48 SCV strains isolated in this study showed higher MIC values than those of 33 simultaneously isolated normal S. aureus strains. Whereas SCVs and normal S. aureus strains showed identical genotypes in 14 of the patients, five patients showed different genotypes. This first study from Turkey evaluating S. aureus SCVs in CF patients has indicated the importance of considering and reporting SCVs in chronic infections such as CF. The presence of SCVs will probably indicate persistent infection, and this might impact on antibiotic treatment decisions, as they are more resistant to antibiotics.

Cystatin, a proteinase inhibitor, is involved in the intracellular catabolism of proteins. We investigated the change in concentration of serum Cystatin C (CysC) in children with lymphomas and its diagnostic utility. Twenty-eight newly diagnosed patients with lymphoma were included in this study. The male/female ratio was 20/8, with a median age of 8.5 years (range 3-17 years). Thirteen patients had Hodgkin's lymphoma (HL) and 15 had non-Hodgkin's lymphoma (NHL). Cystatin C concentration was determined at the time of diagnosis and during remission. In the entire group, CysC concentrations at diagnosis and during remission were 0.87+/-0.29 mg/L and 0.86+/-0.21 mg/L, respectively (p=0.93). In the NHL group, CysC concentrations at diagnosis and remission were 0.89+/-0.32 mg/L and 0.85+/-0.23 mg/L, respectively (p=0.73). The CysC concentrations in the HL group at diagnosis and remission were 0.88+/-0.36 mg/L and 0.88+/-0.18 mg/L, respectively (p=0.73). No significant difference was observed between CysC concentrations in the HL (0.88+/-0.36 mg/L) and NHL (0.89+/-0.32 mg/L) groups. Cystatin C concentrations in all the patients with localized versus those with advanced disease were 0.91+/-0.41 mg/L and 0.88+/-0.3 mg/L, respectively (p=0.83). Cystatin C concentrations of the patients with localized and advanced HL were 0.95+/-0.45 mg/L and 0.77+/-0.14 mg/L, respectively, (p=0.41). Cystatin C level was higher in patients with localized disease, in those without B symptoms, and, at diagnosis, in those with an unfavorable response (Tab. 2, Ref. 20). Full Text in free PDF www.bmj.sk.

Sandfly fever viruses (SFVs) cause febrile diseases as well as aseptic meningitis/encephalitis and include serotypes sandfly fever Sicilian virus (SFSV), sandfly fever Naples virus (SFNV) and Toscana virus (TOSV). Infections are endemic in the Mediterranean basin and data on SFV activity in Turkey are limited. In this study, sera from 1533 blood donors from the Ankara, Konya, Eskisehir and Zonguldak provinces of Turkey were evaluated for SFV exposure by indirect immunofluorescence test (IIFT) and confirmed by virus neutralization test (VNT). One hundred and two patients with central nervous system (CNS) infections of unknown aetiology were also tested via IIFT and real-time reverse-transcription PCR for SFV/TOSV. Rate of overall IgG reactivity in IIFT was 32.9% (505/1533) among blood donors. TOSV exposure was confirmed by VNT in all study regions. Exposure to the recently-identified serotype sandfly fever Turkish virus, as evaluated by VNT, was revealed in Konya and Ankara. SFNV exposure was identified in Konya and SFSV was observed to be present in all regions except Zonguldak. TOSV RNA was detected in 15.7% (16/102) and was accompanied by TOSV IgM in 25% (4/16) of the patients. Partial L and S sequences suggested that TOSV circulating in Turkey can be grouped into TOSV genotype A strains. Exposure to TOSV and other SFV serotypes was revealed in blood donors and CNS infections by TOSV were identified for the first time in Turkey. Infections are observed to be endemic in central Anatolia and should be considered as aetiologic agents in cases/outbreaks of fever and meningoencephalitis.

SummaryTick‐borne encephalitis virus (TBEV) is the aetiological agent of tick‐borne encephalitis (TBE), a potentially fatal central nervous system infection of humans. TBE is endemic in many areas of Europe and Asia; however, very scarce data on TBEV activity are available from Turkey. We aimed to identify TBEV exposure in healthy blood donors and the impact of TBEV in central nervous system infections in Central/Northern Anatolia. Two‐thousand four hundred and fifty four sera, collected from blood donors at Ankara, Konya, Eskişehir and Zonguldak branches of the Turkish Red Crescent Middle Anatolia Regional Blood Center, were analysed for TBEV serosurveillance. Paired serum and cerebrospinal fluid samples from 108 patients with the diagnosis of aseptic meningitis/encephalitis of unknown aetiology were also evaluated to identify TBE and neuroborreliosis cases. Commercial enzyme‐linked immunosorbent assays and indirect immunofluorescence tests were employed for antibody detection. Forty‐seven donor samples (1.9%) were reactive for TBEV IgG. In 25 persons with IgG reactivity (53.1%), risk factors for tick‐borne infections were revealed. One sample from Zonguldak province (1/198; 0.5%) in the Black Sea region of Turkey was confirmed to possess neutralizing antibodies via plaque reduction neutralization test. TBEV IgM was detected in 9.2% (8/108) of the patients. IgM was accompanied by IgG reactivity in two persons where, in one, recent history of a tick bite was also identified. Intrathecal antibody production for TBEV could not be demonstrated. No evidence for Borrelia infections could be found. Confirmed exposure to TBEV and/or an antigenically similar tick‐borne flavivirus is documented for the first time in blood donors in Zonguldak in Northern Anatolia. Probable cases of TBE have also been identified from Central Anatolia. The epidemiology of TBEV activity in Turkey needs to be assessed and benefits of vaccination for general population, risk groups or travellers must be considered.

Purpose: Chronic otitis media with effusion (OME) is the leading cause of hearing loss during childhood. In bacterial etiology of OME, the most frequent pathogens responsible are Haemophilus influenzae followed by Streptococcus pneumoniae and Moraxella catarrhalis. This study aimed at evaluating the accuracy of nasopharyngeal (NP) specimens in the identification of pathogens in the middle ear fluid (MEF) in patients with OME. Materials and Methods: In this cross sectional, case-control study, 95 MEFs and 53 NP secretion specimens were obtained from 53 children. As a control group, 102 NP specimens were taken from children having an operation other than an otological disease. Conventional culture methods and multiplex-PCR method have been used to determine the etiology of OME; NP carriage between cases and control groups were compared using conventional culture methods. Pearson Chi-Square and Fisher’s Exact tests were used in statistical analysis. Results: Bacteria were isolated by culture in 37.9% of MEF specimens, 14.7% of which belonged to the group H. influenzae, S. pneumoniae and M. catarrhalis. PCR was positive in 30.5% specimens targeting the same pathogens. There was a two-fold increase in carriage rate of S. pneumoniae and H. influenzae in patients than controls for each pathogen. Conclusion: PCR is a more reliable method to detect middle ear pathogens in MEF in comparison with the conventional culture methods. The NP colonization wasn’t found to be an indicator of the pathogen in MEF although middle ear pathogens colonize more in nasopharynx of diseased children.

(2009). Predictors of Mortality in Patients with Bacteremia of Unknown Source Due to Extended Spectrum Beta-Lactamase Producing Escherichia coli. Journal of Chemotherapy: Vol. 21, No. 4, pp. 448-451.

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.

We aimed to document prevalence and clinical presentations of seropositivities for glutamate decarboxylase (GAD)-antibody, celiac's disease (CD) and autoimmune thyroiditis (AIT) in adult patients with type 1 diabetes mellitus (T1DM), and their first-degree relatives.Sixty-five patients with T1DM, 124 first-degree relatives and 65 healthy controls were screened for GAD-antibody, anti-thyroid peroxidase (ATPO), anti-thyroid stimulating hormone receptor (TSHR), anti-tissue transglutaminase and anti-gliadin antibodies in a matched case-control study.Prevalence of more than one seropositivity for CD-associated antibodies in T1DM-group is 6.0 times increased, compared with controls (p < 0.05). ATPO seropositivity is 5.3 times increased in T1DM group (p < 0.05), but TSHR antibody is comparable with controls (p > 0.05). Seropositivities for T1DM, AIT and CD are 4.3, 1.9 and 2.4 times more prevalent among first-degree relatives respectively, compared with controls (p < 0.05). Pathologically confirmed cases with CD among first-degree relatives were all identified at screening. In contrast, all of pathologically confirmed cases with CD in T1DM group, were either previously diagnosed or symptomatic at time of screening. In the group of patients with T1DM, 31% of seropositive cases for anti-ATPO were clinically latent for AIT, and 74% of ATPO (+) cases were identified at current screening study. Sixty-four per cent of ATPO (+) first-degree relatives were clinically latent for AIT, and 54% were identified at screening.Type 1 diabetes mellitus, CD and AIT represent a significant overlap in an adult population with already-diagnosed T1DM and their first-degree relatives. With regard to clinical presentations, CD was less likely to be clinically silent than AIT among patients with T1DM.

8610 Background: Osteopontin (OPN) and macrophage inflammatory protein-1 alpha (MIP) were suggested to have a role in pathogenesis of myeloma bone disease. In this study, we aimed to investigate the prognostic value of these markers along with biochemical markers of bone turnover including C-terminal telopeptide (Ctx), deoxypyridinoline (DPD), type-I collagen propeptide (T1-Pro), bone-specific alkaline phosphatase (BALP), in multiple myeloma (MM). Methods: Twenty-five patients with MM diagnosed between 2003 and 2005 were included. Pretreatment serum levels of OPN, MIP, Ctx, DPD, BALP, and T1-Pro were measured. The effects of these parameters on survival were assessed using Kaplan-Meier method and Cox regression analysis. Results: The patients comprised 8 women and 17 men. Median age was 65. 32% of the patients were stage I, 28% were stage II and 40% were stage III according to the International Staging System. Median follow-up was 28 months. Sixty-four percent of the patients received vincristine, doxorubicin, and dexamethasone regimen as induction. Five patients had undergone autologous bone marrow transplantation. Nine patients died on follow-up. Median survival time has not been reached yet. Two-year overall survival rate was 69%. The only parameter associated with survival was OPN level in Cox regression analysis (p=0.04). No significant relationship was found between survival and other parameters (p=0.15 for Ctx, p=0.2 for T1-Pro, p=0.47 for DPD, p=0.76 for BALP). The survival of the patients with high OPN levels was significantly shorter than those with normal OPN levels (29.7 months vs. not reached, p=0.049). Multivariate analysis was not performed because of the limited number of patients. Conclusions: Osteopontin has prognostic importance in newly-diagnosed patients with MM. Higher levels of OPN were found to be associated with shorter survival. This findings should be investigated in larger patient series. No significant financial relationships to disclose.