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Introduction: The transmission rate of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by blood transfusion is thought to be low; however, it has not yet been proven whether the virus is transmitted by blood transfusion. Published studies have reported that SARS-CoV-2 RNA has been detected in the blood, plasma, or serum of infected individuals. This study aimed to investigate the presence of SARS-CoV-2 RNA in the serum of blood donors and evaluate the risk of transmission of SARS-CoV-2 by transfusion. Materials and Methods: In this study, 200 blood samples were taken from volunteer blood donors. In all serum samples, SARS-CoV-2 RNA was detected by reverse-transcription quantitative polymerase chain reaction assay. Medical records of the donors and recipients were retrospectively reviewed. Results: SARS-CoV-2 RNA was detected in seven (3.5%) of the donor serum samples. None of the positive donors had symptoms of coronavirus disease 2019 (COVID-19), and none had been admitted to the hospital after donation. Seven SARS-CoV-2 RNA-positive donor blood components were given to 12 recipients. No medical records indicated that COVID-19 occurred after the transfusion of blood components for recipients. Conclusion: This study demonstrated the presence of SARS-CoV-2 RNA in the serum of asymptomatic donors. Although our data suggest that the transfusion of blood products from asymptomatic donors to recipients with SARS-CoV-2 RNA in their serum may not result in COVID-19, further studies are needed to prove that SARS-CoV-2 is not transmitted by blood transfusion.

Introduction: Interest in fosfomycin, an old antibiotic, has been reignited because of the use of its intravenous formulation (fosfomycin sodium) in resistant infections. The aim of this study was to screen for carbapenem resistance in Enterobacterales isolates from the bloodstream, and determine the frequency of carbapenamases types and fosfomycin resistance genes in carbapenem-resistant Enterobacterales (CRE) strains. Materials and Methods: Enterobacterales isolates from the bloodstream of liver transplant patients aged 18 years and older were screened for carbapenem resistance between 2017 and 2019. In isolates that were resistant to at least one carbapenem antibiotic were further screened for fosfomycin susceptibility. Carbapenem susceptibility was tested for by the E-test, fosfomycin susceptibility was tested for by the agar dilution methods, and evaluated in accordance with European Committee on Antimicrobial Susceptibility Testing criteria. The frequency of OXA-48, NDM, KPC, VIM, and IMP type carbapenemases and fosA, fosA3, and fosC2 fosfomycin resistance genes were screened for using the polymerase chain reaction method. Results: A total of 115 Enterobacterales isolates from bloodstream infections were obtained. Carbapenem resistance was detected in 34 (29.3%) isolates, 41.2% of them were Escherichia coli and 58.8% of them were Klebsiella pneumoniae. Out of the 34 isolates, 61.8% produced carbapenemases, and OXA-48 was the most common type of carbapenemase. The fosfomycin resistance rate was 73.5%. Among the 34 carbapenem-resistant isolates, the frequency of the fosA gene was 5.9%. The genes fosA3 and fosC2 were not detected in any isolates. FosA + OXA-48 and fosA + NDM genes were detected in CRE isolates. Conclusion: This is the first study reporting on the screening for fosfomycin resistance genes in blood isolates of liver transplant patients in Turkey. Despite high fosfomycin resistance, detection of only two resistance genes reveals that there may be fosfomycin resistance due to other resistance mechanisms.

Introduction: The biofilm formation ability plays an important role in the pathogenesis of Staphylococcus aureus infections. This study aimed to investigate the biofilm production ability of methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) isolates and evaluate the relationship between their antimicrobial resistance profile and biofilm formation ability. Materials and Methods: A total of 50 MRSA and 50 MSSA isolates were examined. The antimicrobial susceptibility testing of isolates was performed using the disk diffusion method. The broth microdilution method was used to determine the minimum inhibitor concentrations (MICs) of vancomycin and teicoplanin. The biofilm formation ability of isolates was tested on Congo Red Agar. The presence of icaA, icaD, IS256, and eno genes was investigated by polymerase chain reaction. Results: Both MRSA and MSSA isolates were found susceptible to vancomycin, teicoplanin, chloramphenicol, and linezolid. Two MRSA and 2 MSSA isolates were determined as heterogeneous vancomycin-intermediate S. aureus. No significant difference was observed between the biofilm formation ability of MRSA and MSSA isolates. The eno and icaD genes were detected in 100% of both MSSA and MRSA isolates. The icaA gen was detected in all MRSA and 49 MSSA isolates. The IS256 was detected in 35 of the 50 MRSA isolates. None of the MSSA isolates were positive for the IS256. The amikacin, gentamicin, ciprofloxacin, levofloxacin, rifampin, clindamycin, and tetracycline resistance rates in IS256- positive MRSA isolates were significantly higher than those IS256-negative MRSA isolates. The mean MIC values of vancomycin and teicoplanin in IS256-positive MRSA isolates were significantly higher than those in IS256-negative MRSA isolates. Conclusion: This study revealed that the presence of the IS256 sequence was correlated with antimicrobial resistance, especially MRSA isolates.

Background: Colistin and carbapenem-resistant Acinetobacter calcoaceticus- Acinetobacter baumannii complex (CCR-Acb complex) was isolated from two consecutive patients in the neurological intensive care unit (NICU). An urgent reaction to this desperate situation was required. Patients and methods: Screening cultures were taken from the other patients sharing the NICU with index patients and repeated periodically. NICU was closed for new admissions. Infection control precautions (ICP) such as hand hygiene, cohorting patients colonized with CCR-Acb complex, cohorting the staff caring for these patients, daily bathing with chlorhexidine gluconate impregnated clothes, using gowns when contacting with patients and patient care area, and sodium hypochlorite tablets for environmental cleaning were enforced. Results: Screening cultures revealed carbapenem-resistant Acb complex in 12 out of 32 patients and 8 of them were colonized with CCR-Acb complex. NICU was opened for new admissions one month later. No further new cases with CCR-Acb complex were detected by screening cultures after 6 weeks with enforcement of ICP. Moreover, the rate of nosocomial infections caused by other multi-drug resistant Gram-negative bacilli (MDR-GNB) decreased significantly when rates before and after closing the NICU were compared. Conclusion: ICP were effective not only to limit the spread of CCR-Acb complex but also decreased the incidence of other MDR-GNB infections when applied adequately. Keywords: Acinetobacter baumannii, Carbapenem resistance, Colistin resistance, Intensive care unit, ICU

Introduction: Tuberculosis (TB) is caused by Mycobacterium tuberculosis and can involve any organ, especially the lungs. In recent years, especially in developed countries, the incidence of TB has increased due to the growing number of people with acquired immunodeficiency. This has led to an increase in the incidence of extrapulmonary TB (EPTB). This study examined patients with EPTB confirmed by positive M. tuberculosis culture in İnönü University Faculty of Medicine, Department of Microbiology and Clinical Microbiology, Molecular Microbiology Laboratory. Materials and Methods: Patients with positive M. tuberculosis culture in the molecular microbiology laboratory of our hospital between January 1, 2004 and December 31, 2014 were retrospectively evaluated according to culture-confirmed site of involvement, acid-fast bacillus (AFB), polymerase chain reaction (PCR) positivity, drug resistance, and mortality. Results: The study included 132 patients; 41 (31.1%) were male and 91 (68.9%) were female. The mean age was 46.4±18.5 (17-86) years. Extrapulmonary TB types were TB lymphadenitis in 48 patients (36.4%), musculoskeletal TB in 23 (17.4%), disseminated TB in 17 (12.9%), urinary TB in 11 (8.3%), abdominal TB in 11 (8.3%), TB meningitis in eight (6.1%), pleural TB in six (4.5%), genital TB in five (3.8%), and cutaneous TB in three patients (2.3%). Acid-fast bacillus positivity rates were 21.7% in musculoskeletal samples, 16.6% in pleural samples, 12.5% in cerebrospinal fluid, 9% in urinary tract samples, and 6.2% in lymph nodes. Polymerase chain reaction positivity was not detected in cerebrospinal fluid or skin samples. The rate of resistance to at least one anti-tuberculous drug was 20%. Mortality was 16.1% (n=9) in the 56 patients (42.4%) with available data. Conclusion: Lymphatic TB was the most common form in our patients. According to national data, pleural TB is among the common forms of EPTB in Turkey. However, the rate of pleural TB was low in our study due to the lack of pleural biopsy in our hospital during the study period. In TB-endemic regions such as Turkey, it is important to consider EPTB in the differential diagnosis of patients with relevant clinical findings and to confirm the diagnosis with TB culture primarily, as well as methods such as AFB staining and PCR.

Helicobacter pylori is a worldwide common bacteria that infects humans. This Gram-negative microorganism is microaerophilic, spiral or curved shaped, and urease, catalase and oxidase-positive. It has the ability to live in the acidic environment of the gastric mucosa. It has been shown that H. pylori plays a role in the development of gastric ulcers and malignant lesions. Furthermore, it was reported that H. pylori may be a cause of several systemic illnesses such as cardiovascular, dermatologic, immunologic, neurologic, hematologic, ophthalmologic, gynecologic, endocrine, and hepatobiliary diseases. In addition, positive or negative correlations between H. pylori infection and rhinitis, sinusitis, adenoiditis or adenoid hyperplasia, otitis media, tonsillitis, or tonsil hypertrophy have been demonstrated in various studies in the literature. However, H. pylori’s role in the pathogenesis or association with these diseases remains controversial. Some studies reported that systemic immune and inflammatory responses against H. pylori might cause some systemic diseases as well as different types of malignancies. Although there are studies about the role of H. pylori in benign and malignant diseases of the upper and lower respiratory tract, further studies are needed to reveal the pathophysiological relationship between H. pylori infection and respiratory diseases. The aim of this review was to summarize the studies that reported either a positive or negative relationship between H. pylori and benign and malignant diseases of the respiratory tract.

Introduction: Nosocomial infections continue to be an important health problem since they seriously increase the rate of mortality and morbidity as well as hospitalization period and treatment costs. Acinetobacter spp. have an important place among the factors that cause hospital infections. Fast and accurate detection of Acinetobacter baumannii outbreaks is important in the treatment and control of epidemic infections. In our study, it was aimed to investigate the molecular similarities of carbapenem resistant A. baumannii isolates isolated as hospital infectious agents with Pulsed-Field Gel Electrophoresis (PFGE) method. Materials and Methods: This study was conducted in a medical center to examine the genetic relationship of a specific agent group detected in the non-pandemic period and is a cross-sectional study. In our study, the molecular similarities of 93 carbapenem resistant A. baumannii isolates isolated as hospital infectious agents from various clinical materials sent to Fırat University Hospital Central Laboratory and Infectious Diseases Department Laboratory between December 1, 2013 and June 30, 2014 were investigated with PFGE method. Results: A. baumannii strains showed 30 different PFGE profiles. Clonally related strains were included in seven different clusters. Eighty of 93 A. baumannii strains in total were included in any cluster. The clustering rate of the strains was found to be 86%. When the isolate dates of 55 strains in 1 cluster with the highest number of isolates were examined in our study, it was seen that this clone survived in our hospital for about five months. Conclusion: This study showed that A. baumannii strains isolated as nosocomial infection agents can survive for a long time. It was thought that carbapenem resistance spread horizontally among Acinetobacter spp. It was concluded that the necessity of training activities for infection control measures and compliance should be examined, and antibiotic use policies should be revised in terms of carbapenem resistance.

Background: Klebsiella pneumoniae is an important nosocomial pathogen that can lead to high morbidity and mortality. ESBL and carbapenamase producing strains may cause epidemic situations. The aim of our study was to investigate the molecular epidemiology and clonal relationship between carbapenem resistant K. pneumoniae strains isolated from our hospital during a three month period. Methods: Fourteen carbapenem resistant K. pneumoniae strains isolated during April 1st–June 30th 2013 were included. The identification and the antibiotic susceptibility of the strains were studied by Vitek 2 Compact (Biomerieux, France) system. The carbapenemase production of the isolates were investigated by Modified Hodge assay. The blaOXA of the strains was investigated by in house PCR. The clonal relationship between the isolates were studied by pulsed-field gel electrophoresis (PFGE) and automatized repetitive extragenic palindromic PCR (Rep-PCR, DiversiLab sistemi, Biomerieux, France) methods. Results: All the K. pneumoniae isolates were carbapenem resistant; they were all susceptible to gentamycin and colistin. All of them had blaOXA-48. The genotyping analysis revealed that eight isolates were in the same cluster both by Rep-PCR (similarity border ≥95%) and PFGE (Tennover criteriae) analysis. The other isolates did not belong to any other clusters. The strains that are in the same cluster are isolated from the Anesthesiology Intensive Care Unit during a three month period. The cluster ration by both methods was 57%. Conclusions: All K. pneumoniae strains possessed blaOXA-48. The clonal spreading was particularly detected in Anesthesiology Intensive Care Unit. Molecular epidemiological monitorization of nosocomial pathogens may prevent the spread of these multidrug resistant pathogens. Keywords: Carbapenem resistant K. pneumoniae, Molecular epidemiology, blaOXA-48

Introduction: Brucella spp. are intracellular bacteria that may cause acute, subacute and chronic infections. Despite optimum antibiotic treatment, relapse of brucellosis occurs in some patients. There is less amount of knowledge about immune response in relapse of brucellosis. Materials and Methods: Twenty patients with acute brucellosis, 16 patients with relapsed brucellosis and as a control group 20 healthy volunteers were enrolled in this study to explore the immune response variation during relapse of brucellosis. The distribution of peripheral blood mononuclear cells was investigated by flow cytometry and level of various cytokines involved in inflammatory and anti-inflammatory response were measured by enzyme-linked immunosorbent assay in serum samples. Results: The most prominent data in phenotyping examination was the significant reduction (1.45 times) in the percentage of activated T cell (CD3+human leukocyte antigen-DR+) population in the relapse group in comparison to the acute brucellosis group. However, percentage of activated T cell population in the relapse group was 2.59 times higher than in healthy controls (p