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BACKGROUND The human microbiota modulates the immune system and forms the surface flora. Antibiotic administration causes dysbiosis in the intestinal flora. It is not clear if antibiotic administration in the community effects the upper airway flora in the mid-term or long-term. This study aims to define long-term influence of antibiotics on upper airway flora. MATERIAL AND METHODS In this prospective study, aerobic microbiological analysis of nasal and nasopharyngeal surfaces was performed. Antibiotic administration history of the last 6 months was retrieved using the social insurance database. Culture results of antibiotic-treated and antibiotic-naïve subjects were compared by Pearson's chi-square test or Fisher's exact test. RESULTS A total of 210 subjects were included in the study. Normal flora were documented in 86 nasal swabs and 99 nasopharyngeal swabs. Most of the remaining cases demonstrated gram-positive bacterial overgrowth. There were 113 subjects who did not receive any antibiotic, and 93% of the remaining 97 patients received broad-spectrum antibiotics. Statistical analysis showed that nasal and nasopharyngeal flora did not change upon antibiotic administration, but antibiotic administration during the last month caused increased methicillin resistance development of coagulase-negative Staphylococcus and Staphylococcus aureus microorganisms. CONCLUSIONS Antibiotic exposure did not lead to perturbations in general composition of upper airway flora within 6 months, although the incidence of methicillin resistance in coagulase-positive and -negative Staphylococci demonstrated significant increases when patients received antibiotic during the last month. This should be considered in case of broad-spectrum antibiotic administration, since methicillin resistance increases the morbidity and mortality of nosocomial Staphylococcus infections.

Amaç: Bu çalışmada hastanemize başvuran idrar yolları enfeksiyonu (İYE) tanısı almış çocuklarda idrar kültürlerindeüreyen mikroorganizmaların sıklık ve duyarlılıklarının saptanması amaçlanmıştır. Bulgularımızagöre bölgemizdeki ampirik antibiyotik seçenekleri belirlenebilecektir.Gereç ve Yöntemler: İki yıllık sürede idrar kültürlerinde anlamlı üreme olan 1167 çocuk hasta örneği çalışmayadahil edilmiştir. Hastalardan uygun şartlarda alınan orta akım idrar örnekleri, %5 koyun kanlı agarve eosin metilen blue (EMB) agar besiyerlerinin yüzeyine inoküle edilmiştir. İzolatların tanımlanması veduyarlılık testleri Clinical and Laboratory Standards Institute (CLSI) kriterlerine göre VITEK 2 Compact (bio-Merieux-Fransa) sistemi ile yapılmıştır.Bulgular: Üreyen mikroorganizmalar içinde en sık Escherichia coli (%73,1) görülmüş olup bunu sırasıylaKlebsiella spp. (%9,6) ve koagülaz negatif stafilokoklar (KNS) (%5) takip etmiştir. Enterobacteriaceae grububakterilerde direnç en çok ampisilin (%69) ve trimetoprim-sülfametoksazole (SXT) (%34,4) karşı gözlenirken,en az meropenem (%0,8) ve amikasine (%5) karşı tespit edilmiştir. KNS ve Staphylococcus aureus izolatlarındaen dirençli antibiyotik penisilin olurken (%90 ve %88) her iki grupta da linezolid, vankomisin ve teikoplaninekarşı direnç saptanmamıştır. Enterococcus spp. izolatlarında ise en fazla direnç ampisiline (%76)karşı gözlenmiştir.Sonuç: Saptanan sonuçlar bölgemizde çocukluk dönemindeki İYE sağaltımında antibiyogram yapılmasınınönemini ve gerekliliğini göstermekte; ampirik tedavi başlanması gereken durumlarda ise ampisilin, amoksisilin-klavulanik asit, sefuroksim ve SXT tercih edilmesinin uygun olmayacağını düşündürmektedir. Düşükdirenç nedeniyle aminoglikozidler ampirik tedavide önerilebilecek antibiyotiklerdir.Anahtar Kelimeler: Ampirik tedavi; Antibiyotik direnci; Çocuklar; İdrar analiziABSTRACTObjective: We aimed to detect common microorganisms in children with urinary tract infections (UTIs)in our hospital and to determine empirical antibiotic options according to their antibiotic sensitivity andresistance patterns.Materials and Methods: The samples of 1167 pediatric patients with significant growth in urine cultures fora period of two years were included in the study. Midstream urine samples were taken from patients underappropriate conditions and inoculated to blood agar and eosin methylene blue (EMB) agar. Identification ofisolated strains and susceptibility testing was performed by VITEK 2 Compact (bioMerieux-France) systemaccording to Clinical and Laboratory Standards Institute (CLSI) criteria.Results: Escherichia coli was the most frequently isolated bacteria with the rate of 73.1% and this wasfollowed by Klebsiella spp. (9.6%) and coagulase-negative staphylococci (CNS) (5%). While Enterobacteriaceaefamily were found to be more resistant to ampicillin (69%) and sulfamethoxazole/trimethoprim(SXT) (34.4%), the resistance patterns to meropenem (0.8%) and amikacine (5%) were the lowest. CNS andStaphylococcus aureus were found more resistant to penicillin (90% and 88%) and there were no resistanceto linezolid, vancomycin and teicoplanin. The antibiotic which had the highest resistance rate was ampicillin(76%) for Enterococcus spp. isolates.Conclusion: The present study proved the importance and requirement of culture and antibiogram. Thesefindings show ampicillin, amoxicillin-clavulanic acid, cefuroxime and SXT are not suitable drugs for empirictherapy for UTIs treatment. Aminoglycosides may be recommended antibiotics because of the low resistancerates.Key words: Empiric therapy; Antibiotic resistance; Children; Urinanalysis

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 bla(oxa-51), bla(TEM), bla(SHV), bla(CTX-M1), bla(CTX-M2), bla(GES) and bla(VIM) 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, bla(TEM-1) was found as the predominant one with a frequency rate of 55.7% (n=289/519), followed by bla(CTX-M2) (63/519, 12.1%), bla(CTX-M1) (42/519, 8.1%), bla(SHV) (40/519, 7.7%), bla(GES) (8/519, 1.5%) and bla(VIM) (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 bla(CTX-M1/M2) and bla(SHV) genes, respectively. The bla(TEM) 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.

Objective We explored the impact of clinical response to treatment for Attention Deficit/Hyperactivity Disorder (ADHD) in children and adolescents on the subsequent changes in their self-image profile, the quality of life of their parents, and its effect on socio-demographic variables. Method Conners Rating Scales for Parents (CPRS-R) and for Teachers (CTRS-R) completed at the time of entry to the service were repeated to measure clinical response to treatment; the Self-image Profiles for Children (SIP-C) and Adolescents (SIP-A), the World Health Organization Quality of Life (WHOQoL) questionnaire and postcode data were used to evaluate other domains. Results Data was collected for 53 boys (84%) and 10 girls (16%) with current mean age 11.5 years. Four-fifths (51/63) received pharmacological treatment and all parents were offered group parent training program. The only subscale in CPRS-R to show significance was the ADHD Index. The CTRS-R demonstrated statistically significant improvement ( p Conclusion Clinical improvement in ADHD symptoms was positively correlated with some improvement in the Self-image Profile of children and adolescents, but its impact on the QoL in parents was limited.

15 gün önce Nijerya’dan geldiği öğrenilen 34 yaşında erkek hasta, yüksek ateş, titreme, eklem ağrısı ve terleme şikayetleriyle polikliniğimize başvurmuştur. Yapılan periferik yaymasında eritrositlerin içerisinde taşlı yüzük manzarasında trofozoitlerin görülmesi üzerine Plasmodium falciparum tanısı konularak tedavisi başlanmıştır. Olgu yurtdışı kaynaklı sıtma hastalığına dikkati çekmek ve gerekli korunma yöntemlerinin alınmasını vurgulamak amacıyla sunulmuştur., 34 years old male patient was admitted to our outpatient clinic with complaints of high fever, chills, joint pain and sweatting. The patient's history was learned that he was come from Nigeria 15 days ago. The peripheral smear test was showed that signed ring shaped trophozoids present in the erithrocytes so that Plasmodium falciparum malaria was diagnosed. This case was reported to attract attention to imported malaria and taking the precautions for the prevention of the disease