Search

Objectives: Urinary tract infections (UTIs) remain one of the most common infections for antibiotic prescription. Increased resistance to antibiotics currently used to treat these infections may lead to significant problems. Extended spectrum beta-lactamase (ESBL) production in organisms causing UTIs are often responsible for the increase in resistance. The aim of this study was to investigate the in vitro antimicrobial susceptibility of ESBL producing community acquired urinary E. coli isolates to Ceftazidime/Avibactam (CAZ/AVI) and other antimicrobial agents using disk diffusion method. Methods: Between 2016 and 2017, a total of 100 ESBL producing E. coli urine isolates were collected from outpatients who had no history of hospitalization in the last three months in Akdeniz University Hospital. All isolates were tested for in vitro susceptibility to the CAZ/AVI and other antimicrobial agents using disk diffusion method. Results: No CAZ/AVI and carbapenem resistance were observed. Resistance rates to other antimicrobial agents were as follows: ampicillin 100%, amoxicillin/clavulanate 85%, cefotaxime 98%, ceftazidime 89%, cefepime 82%, gentamicin 41%, ciprofloxacin 65%, levofloxacin 39%, fosfomycin 3%, nitrofurantoin 2%, trimethoprim/sulfamethoxazole 72% and Piperacillin/Tazobactam 41%. Conclusions: Our results showed that ceftazidime / avibactam, carbapenems, nitrofurantoin and fosfomycin may be among the first line treatment options in the empirical therapy. In selected patients, CAZ/AVI could be an option for the treatment of UTI caused by ESBL producing E.coli which may reduce the use of carbapenems. J Microbiol Infect Dis 2019; 9(2):112-115.

BACKGROUND Soluble CD200 (sCD200) is a novel immuno-effective molecule, which acts to regulate inflammatory and acquired immune responses. Recently, our study group showed that sCD200 was present in serum and blister fluid in a patient with bullous pemphigoid and a patient with toxic epidermal necrolysis. We therefore planned this study to evaluate the sCD200 levels of autoimmune and inflammatory skin disorder patients and to compare them with that of healthy controls. MATERIAL/METHODS Our study included 30 consecutive patients with psoriasis vulgaris, 15 with pemphigus vulgaris, and 15 healthy controls. Clinical examination and laboratory tests were performed on the same day. Psoriasis patients were also assessed with the Psoriasis Area and Severity Index (PASI) and pemphigus patients were assessed using the Pemphigus Disease Area Index (PDAI). Levels of sCD200 in the serum samples were quantified using ELISA kits. RESULTS The serum sCD200 level was observed to be statistically significantly higher in patients with psoriasis vulgaris (96.7±15.8) compared to patients with pemphigus vulgaris (76.2±14.6), (p

Purpose: Differentiation of Staphylococcus aureus (S. aureus) from coagulase-negative staphylococci is very important in blood stream infections. Identification of S. aureus and coagulase-negative staphylococci (CoNS) from blood cultures takes generally 18-24 h after positive signaling on continuously monitored automated blood culture system. In this study, we evaluated the performance of tube coagulase test (TCT), slide agglutination test (Dry Spot Staphytect Plus), conventional polymerase chain reaction (PCR) and LightCycler Staphylococcus MGrade kit directly from blood culture bottles to achieve rapid identification of S. aureus by using the BACTEC 9240 blood culture system. Materials and Methods: A total of 129 BACTEC 9240 bottles growing gram-positive cocci suggesting Staphylococci were tested directly from blood culture broths (BCBs) with TCT, Dry Spot Staphytect Plus, conventional PCR and LightCycler Staphylococcus MGrade kit for rapid identification of S. aureus. Results: The sensitivities of the tests were 99, 68, 99 and 100%, respectively. Conclusion: Our results suggested that 2 h TCT was found to be simple and inexpensive method for the rapid identification of S. aureus directly from positive blood cultures.

Aim: Salmonella infections are the leading cause of food-borne infections and can cause gastroenteritis outbreaks worldwide. Salmonella species is defined as inability to lactose fermentation, using citrate as a carbon source, using lysine as nitrate source and forming Hydrogen sulfide (H2S) in TSI agar. However, confirmation of false positive results is time consuming and lead to increased costs. The aim of this study is to evaluate the performance of CHROMagar Salmonella (CHROMagar Microbiology, France) which is developed for isolation and detection of Salmonella species. Material and Method: For this purpose, among a total of 148 isolates which were isolated from various clinical specimens and stocked at the Central Laboratory of Akdeniz University Hospital, 65 were Salmonella spp., 10 were Pseudomonas aeruginosa, 10 were E. coli, 10 were Acinetobacter baumannii, 10 were Klebsiella pneumoniae, 18 were Morganella morganii, 11 were Citrobacter spp., 5 were Providencia spp., 4 were Aeromonas spp., 5 were Proteus spp. were included in this study. All of the 65 Salmonella spp. isolates apperared with mauve colonies at the CHROMagar Salmonella. Results: E. coli and Klebsiella pnemoniae species were seen as blue, Providencia species were seen as pale-blue; Morganella morganii species were seen as pale-pink, mauve; and Pseudomonas aeruginosa species were seen as pale. Acinebacter baumannii and Aeromonas spp. species were also seen as mauve colonies. Dicussion: CHROMagar Salmonella medium can detect Salmonella species with %100 sensitivity, however there is a need to biochemical or serological confirmation.

Blood-stream infections due to Candida species are important causes of morbidity and mortality in hospitalized patients. We conducted a prospective study of patients with candidemia at Akdeniz University Hospital, between 01 March 2002 and 01 March 2003 and predictors of mortality were investigated. Thirty-five consecutive patients with candidemia identified by at least one positive blood culture. Risk factors for candidemia that previously described in literature as central venous catheters (86%), multiple broad-spectrum antibiotics (82%), urinary catheters (71%), parenteral nutrition (60%) found in our patients. C. albicans was the most frequently isolated species (60%). Overall mortality was 57%. In univariate analysis, mortality was significantly associated with the presence of central venous catheters (p= 0.009), stay in intensive care unit (p= 0.016) and prolonged use mechanical ventilator (p= 0.036). In multivariate logistic regression; mortality was not statistically significant associated with any risk factors in patient with candidemia. It may be related to small sample size.

Forty-one years old male patient who was operated on with the diagnosis of acute necrotizing pancreatitis admitted with probable intraabdominal infection. We determined psoas abscess which fistulized to the skin of abdominal wall by radiological examinations. As Aeromonas hydrophila was isolated from the pus, the patient was evaluated for the risk factors. Intraabdominal infection was treated by imipenem during three weeks without any surgical intervention. The patient remained symptomless during three months follow up. The case was presented because of the unusual psoas abscess which was caused by A. hydrophila.

Legionnaires’ disease is a community-acquired or nosocomial pneumonia caused by Legionella species, and the immunocompromised patient is at particular risk. In this study we report a case of Legionnaires’ disease repeating three times in an HIV positive renal transplant patient. The laboratory diagnosis was obtained by detection of Legionella pneumophila using direct fluorescent antibody (DFA) staining. An environmental investigation failed to reveal L. pneumophila in any water specimens taken from the patients private accomodation. We conclude that Legionnaires’ disease should be always considered in the diagnosis among immunocompromised patients who have pneumonia without an etiologic diagnosis or in cases of treatment failure. We also remark that patients who have AIDS should be considered at risk for recurrent Legionella infections.

We report a case of bacteremia caused by Chryseobacterium indologenes in a patient who was treated due to the non-Hodgkin lymphoma and developed neutropenia and fever. According to the antimicrobial susceptibility test result, ciprofloxacin was added to the treatment. On the 10th day of the treatment a good response was achieved and the patient discharged after complete recovery.

Twenty-four years old male who had chronic myelocytic leukemia (CML) for eight months, was admitted to emergency unit because of fatigue, palpitation, dyspnea and fever. He was hospitalized because of blastic transformation from CML to acute myelocytic leukemia (AML) and also febrile neutropenia. Respiratory distress and hypotension occurred and respiratory syncytial virus (RSV) pneumonia was laboratorally diagnosed. He responded to the oral ribavirin therapy but he died because of a new febrile neutropenic episode and bleeding. This case is the first reported RSV pneumonia in a febrile neutropenic patient and its treatment choices are limited in our country.

Background Many studies associated nosocomial infections with increased hospital costs due to extra days in hospital, staff time, extra investigations and drug treatment. The cost of antibiotic treatment for these infections represents a significant part of hospital expenditure. This prospective observational study was designed to determine the daily antibiotic cost of nosocomial infections per infected adult patient in Akdeniz University Hospital. Methods All adult patients admitted to the ICUs between January 1, 2000, and June 30, 2003 who had only one nosocomial infection during their stay were included in the study. Infection sites and pathogens, antimicrobial treatment of patient and it's cost were recorded. Daily antibiotic costs were calculated per infected patient. Results Among the 8460 study patients, 817 (16.6%) developed 1407 episodes of nosocomial infection. Two hundred thirty three (2.7%) presented with only one nosocomial infection. Mean daily antibiotic cost was $89.64. Daily antibiotic cost was $99.02 for pneumonia, $94.32 for bloodstream infection, $94.31 for surgical site infection, $52.37 for urinary tract infection, and $162.35 for the other infections per patient. The treatment of Pseudomonas aeruginosa infections was the most expensive infection treated. Piperacillin-tazobactam and amikacin were the most prescribed antibiotics, and meropenem was the most expensive drug for treatment of the nosocomial infections in the ICU. Conclusions Daily antibiotic cost of nosocomial infections is an important part of extra costs that should be reduced providing rational antibiotic usage in hospitals.