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Genotype distribution of hepatitis C virus (HCV) can vary over the years between different patient groups and regions. The prevalence of intravenous drug users (IVDU) is known to increase in our country, yet there are a limited number of studies investigating the distribution of HCV genotypes in this group. These data are essential for monitorization of the changes in HCV epidemiology. The present study aimed to evaluate the five-year results of HCV genotyping among patients infected with HCV related to IVDU and unrelated to drug use. Plasma samples of 720 patients (HCV antibody, HCV RNA positive), which were sent to our laboratory for HCV genotyping between January 2014-March 2019 were analyzed. HCV RNA extraction from plasma samples was performed in the automated-extraction system of EZ1 advanced (Qiagen, Germany) using the EZ1 virus mini kit v2.0 (Qiagen, Germany). Amplicons were obtained by amplifying the 5'NCR and core gene region in the Rotorgene 6000 real-time PCR (Qiagen, Germany) device with the HCV RNA real-time quantitative 2.0 (NLM, Italy) kit. For the genotyping, a commercial line probe assay (LIPA) based on in vitro reverse hybridization GEN-C2.0 kit (NLM, Italy) which can distinguish 1, 2, 3, 4, 6 genotypes and 1a, 1b, 2a/c, 2b, 3a, 3b, 3c, 3k, 4a, 4b, 4c/d, 4e, 4f, 4h, 5a, 6a/b, 6g, 6f/q, 6m, 7a subtypes of HCV, based on variations in the 5'-NCR and core regions was used. HCV genotype distribution of 266 IVDU (93.2%: male; median age: 25 +/- 6.82) and 454 non-drug users (51.3%: male; median age: 56.5 +/- 16.06) were examined. In order of frequency in the group with IVDU; genotype 1a, 3a, 1b, 4c/d, 2b, 4, 3 were observed and genotype 1, 2a/c and mixed genotype (1+3a) were detected in one patient. In the group without IVDU, in order of frequency; genotype 1b, 1a, 3a, 1, 2a/c, 4 were observed and genotype 2b, 4c/d, 5a, 6a/b, 6 and mixed genotype (3+4) were detected in one patient. Genotypes la and 3a were significantly higher in the IVDU group (p< 0.00001, p< 0.00001), while 1b was significantly higher in patients without IVDU (p< 0.00001). Genotypes 1a and 3a were more common in young men (p< 0.00001, p= 0.000163), while 1b was higher in middle-aged women (p< 0.00001). The incidence of genotypes 1b (p= 0.021) and 3a (p= 0.012) was higher in foreign nationals than the Turkish patients. When the HCV genotype distribution was examined by years, it was observed that the percentages of genotype 1b and la were decreasing, while the percentage of genotype 3a was increasing. As a result, in this study, HCV genotype distribution among IVDU was observed to be different from the general population without IVDU. It was found that genotypes la and 3a were more common in the IVDU group. As in the other regions of our country, genotype 1b was found most frequently in the general population. Genotype 3a increases significantly compared to years. In our study, the determination of genotypes existing in different parts of the world may be due to the foreign nationals living in our city and our region is a tourism center. It is also necessary to investigate whether there is an increase in IVDU over the years.

Ülkemizde, moleküler mikrobiyoloji tanı laboratuvarlarında yapılan HBV DNA ve HCV RNA viral yük saptama testlerinin ulusal bir dış kalite kontrol programında değerlendirilmesi amacıyla MOTAKK (Moleküler Tanıda Kalite Kontrol) Ulusal Programı başlatılmıştır. ISO 17043:2010 (Uygunluk değerlendirmesi- Yeterlilik deneyi için genel şartlar) standartlarına uyularak hazırlanan bu program, ülkemizde yapılan moleküler tanı testlerinin, daha standart ve doğru yapılmasına katkıda bulunarak, yurt dışından sağlanan dış kalite kontrol (DKK) programlarının yerini almayı amaçlamaktadır. Bu çalışmada, MOTAKK DKK Programı kapsamındaki HBV DNA ve HCV RNA viral yük 2015 ve 2016 sonuçlarının değerlendirilmesi amaçlanmıştır. Yapılan çağrılar MOTAKK web sayfası (www.motakk.org) üzerinden ilan edilmiştir. Web sayfası üzerinden kayıt olan katılımcı laboratuvarlara, 2015 ve 2016 yıllarında birer kalite kontrol paneli gönderilmiştir. Çevrimlerde kullanılan paneller, HBV, HCV, HIV, HAV, Parvovirüs B19 ve CMV serolojik belirteçleri negatif olan plazma ile dilüsyon yapılan değişik viral yüklere sahip örnekler ile hazırlanmış, negatif örneklerle beraber soğuk zincirde katılımcı laboratuvarlara ulaştırılmıştır. Laboratuvarlar ilgili testleri 2-3 hafta içerisinde sonuçlandırarak, MOTAKK web sayfasına sonuçlarını girmiştir. MOTAKK tarafından geliştirilen bir yazılım ile katılımcı laboratuvarların sonuçları ISO 13528’e uygun olarak analiz edilerek sonuç raporları oluşturulmuş ve web sayfasına yüklenerek katılımcılara iletilmiştir. Katılımcılar, çalışma sonucunu diğer laboratuvar sonuçları ile karşılaştırmalı olarak değerlendirme imkanına sahip olmuş ve referans değerlere ve ortalama sonuçla ilgili farklılıkları görerek kullandıkları testleri tekrar değerlendirmiştir. HBV DNA ve HCV RNA DKK programına, 2015-2016 yıllarında 70-73 laboratuvar katılmıştır. Katılımcılar, program araçlarına yüksek uyum göstererek kayıt, sonuç girme ve sonuç raporlarının alınmasını aksaksız olarak gerçekleştirmişlerdir. HBV panelinde; 2015 yılında katılımcı laboratuvarların %72.6-89.1’inin, 2016 yılında ise %84.7-90.3’ünün 1 standart sapma (SS) aralığında yer aldığı görülmüştür. HCV panelinde ise; katılımcıların %70.8-89.1’i 1 SS’de, ikinci çağrının yapıldığı 2016 yılında ise, %84.7-90.3’ünün 1 SS’nin içerisinde yer aldığı görülmüştür. Bu proje ile Türkiye’de HBV DNA ve HCV RNA ile ilgili ilk kez ulusal bir DKK programı hazırlanmış ve başarıyla uygulanmıştır. MOTAKK, DKK programı sonuç raporlarında sağlanan bilgiler, yurt dışından sağlanan kalite kontrol programı sonuç raporlarının sağladığı tüm bilgileri karşılamakta; ek olarak kullanılan teknolojilerin ve ticari ürünlerin sağlıklı karşılaştırmalarına olanak sağlamaktadır. MOTAKK, as a national external quality control program has been launched to evaluate the molecular detection of viral infections including HBV DNA and HCV RNA in molecular microbiology diagnostic laboratories in Turkey. This program is prepared in compliance with ISO 17043:2010 (Conformity assessment general requirements for proficiency testing) standards, and aims to take the place of external quality control programs from abroad, contributing to standardization and accuracy of molecular diagnostic tests in our country. The aim of this study was to evaluate 2015 and 2016 results of the MOTAKK External Quality Control Program for HBV DNA and HCV RNA viral load . The calls were announced on the web page of MOTAKK (www.motakk.org). The quality control samples were sent to participating laboratories in 2015 and 2016. Main stocks were prepared from patients with chronic hepatitis B and C who had viral load detection with reference methods according to WHO reference materials for viral load studies to improve quality control sera. From these main stocks, samples with different viral loads were prepared from dilutions of plasma with HBV, HCV, HAV, HIV, Parvovirus B19 and CMV negative serologic markers. Quality control samples were sent to the participating laboratories along with the negative samples in the cold chain. The laboratories accomplished the related tests within 2-3 weeks and entered their results on the MOTAKK web page. These results were analysed according to ISO 13528 (Statistical methods for use in proficiency testing by interlaboratory comparison) and scoring reports were created by a software developed by MOTAKK and sent to participating labs. Each laboratory evaluated their own results in comparison with the other laboratory results, reassessed the tests via observing the distance from the mean result and the reference values. The number of laboratories participating in the HBV DNA and HCV RNA external quality control program was 70-73 in 2015-2016. Participants were able to comply with the program tools, registering, entering results and receiving the results reports without problem. In HBV panel, 72.6-89.1% and 84.7-90.3% of the participant laboratories were in 1 standard deviation (SD) in 2015-2016, respectively. In HCV panel, 70.8-89.1% and 84.7-90.3% of the participant laboratories were in 1 SD in 2015-2016, respectively. A national external quality control program for HBV DNA and HCV RNA in Turkey has been prepared for the first time with this project and implemented successfully. All the data provided in the MOTAKK external quality control program final report, compensate all the data provided by the quality control program final reports from abroad; additionally, the report allows comparison of used technologies and commercial products.

Tüm dünyada yaygın olarak bulunan sitomegalovirus (cytomegalovirus; CMV), immün sistemi normal konaklarda sıklıkla belirtisiz enfeksiyonlara yol açarken, immün yetmezliği olanlarda ve fetusta çok ciddi komplikasyonlara neden olabilmektedir. CMV'nin zarf yapısında yer alan glikoprotein B (gB), bu proteini kodlayan UL55 genindeki polimorfi zmlere göre dört genotipe ayrılmaktadır. CMV gB geninde saptanan nükleotid polimorfi zmlerinin; virusun hücre tropizmini, konağın immün yanıtını ve sonuçta CMV'nin patogenezini etkileyebileceği düşünülmektedir. Bu araştırmanın amacı, Türkiye'nin farklı bölgelerinden ve farklı hasta gruplarından elde edilen CMV izolatlarının gB genotiplerinin belirlenmesidir. Çalışmaya, Cytomegalovirus (CMV), a common virus found all around the world, usually causes asymptomatic infections in immunocompetent hosts, however it may lead to serious complications in immunodefi cient patients and in the fetus. CMV is divided into four genotypes according to the polymorphisms in UL55 gene that encodes for envelope glycoprotein B. Nucleotide polymorphisms of CMV gB gene can affect the cell tropism of the virus and host immune response and believed to have important changes in the pathogenesis of CMV. the aim of this study was to determine the gB genotypes of CMV isolates from different patient groups selected from different regions of Turkey. A total of 136 clinical specimens from patients (66 female, 70 male; age range: 0-65 years, mean age: 24.03 ± 17.17) who were diagnosed to have CMV infection by polymerase chain reaction (PCR) and/or antigenemia tests, between 2001-2014, in the medical school hospitals of Akdeniz, Ege, Istanbul Cerrahpasa and Erciyes Universities (located at Mediterranean, Aegean, northwest and central Anatolia regions, respectively), were included in the study. the patient group consisted of 80 renal transplant (RT) recipients, 35 stem cell transplant (SCT) recipients, 13 newborns, seven heart transplant (HT) recipients and one pregnant woman. CMV gB genotypes were determined by PCR-RFLP (restriction fragment length polymorphism) method, and DNA sequencing and phylogenetic analysis were performed for the randomly selected 15 isolates with different genotypes. Among 136 (135 plasma, 1 amnion fl uid) samples, the most frequent genotype was gB1 (n= 44, 32.4%), followed by gB2 (n= 39, 28.6%), gB3 (n= 36, 26.5%) and gB4 (n= 8, 5.9%); however nine (6.6%) samples could not be genotyped. When analysis were interpreted according to the patient groups, it was determined that the genotypes in RT recipients were gB1 32.3%, gB2 28.7%, gB3 26.5% and gB4 5.9%; in SCT recipients gB1 34.3%, gB2 28.6%, gB3 22.9% and gB4 5.7%; in HT recipients gB3 57.1%, gB1 14.3% and gB2 14.3%; in newborns gB1 38.4%, gB3 30.8%, gB2 15.4% and gB4 7.7%, and gB2 genotype in the pregnant woman. As our study was a descriptive study to determine the genotypes of CMV gB, the relationship between the genotypes and the variants such as viral load, symptomatic disease and prognosis were not analyzed. As a result, the isolation of different gB genotypes in various case groups from four distinctive provinces, underlines the diversity of CMV gB genotypes in Turkey

A Klebsiella pneumoniae clinical isolate resistant to imipenem was recovered from blood culture of a 4 years old child with the diagnosis of acute precursor B cell lymphoblastic leukemia. PCR assays of Klebsiella pneumoniae isolate were positive with blaCTX-M and blaVIM genes. Sequence analysis of the 160 bp amplicon matched with blaVIM 1. Patient was discharged on the 15th day of ciprofloxacin theraphy with remission. We report here the first VIM-1 positive Klebsiella pneumoniae isolate case from Akdeniz University Hospital. Urgent and rapid precautions must be preferred including antibiotic policy and infection control practices when the first case with different resistance patern is detected. Key words: K. Pneumoniae; Metallo-Β-Lactamases; VIM 1., Akut Prekürsör B Hücreli Lenfoblastik Lösemi tanısıyla izlenen 4 yaşındaki bir çocuğun kan kültürü örneğinden imipenem dirençli Klebsiella pneumoniae izole edildi. İzolatın PCR analizi sonuçları VIM ve CTX- M enzimleri açısından pozitif olarak saptandı. Yapılan DNA sekans analizi sonucunda 160bp'lik bölge blaVIM-1 ile uyumlu olarak bulundu. Hasta siprofloksasin tedavisinin 15. gününde remisyonla taburcu edildi. Bu olguda Akdeniz Üniversitesi Hastanesi'nde ilk kez saptanan VIM 1 pozitif Klebsiella pneumoniae izolatı sunulmuştur. Farklı direnç paternine sahip bir vaka görüldüğünde, hızlı bir şekilde antibiyotik politikalarını da içeren infeksiyon kontrol önlemleri alınmalıdır. Anahtar kelimeler: K. Pneumoniae; Metallo-Β-Laktamaz; VIM 1.

Acinetobacter türleri son yıllarda hastanemiz yoğun bakım hastalarında en sık rastlanan etkenlerdendir. Acinetobacter türlerinin neden olduğu infeksiyonların kısıtlı tedavi seçenekleri arasında karbapenemler ön sırada yer almaktadır. Bu çalışmada Acinetobacter baumannii suşlarına karşı doripenem, imipenem ve meropenemin in vitro aktivitesinin değerlendirilmesi amaçlanmıştır. Akdeniz Üniversitesi Merkez Laboratuvarı'na 01 Ocak-31 Aralık 2009 tarihleri arasında yoğun bakımlardan gelen çeşitli klinik örneklerden izole edilen toplam 94 Acinetobacter baumannii suşu çalışmaya alınmıştır. İzolatlar konvansiyonel yöntemler ve otomatize sistem (Phoenix, Becton Dickinson, ABD) ile tanımlanmış, imipenem, meropenem ve doripenem duyarlılıkları E-test yöntemi ile çalışılmış, Acinetobacter baumannii suşlarında imipenem, meropenem ve doripenem duyarlılık oranları sırasıyla %22.3, %17.0, %12.8 bulunmuştur. Çalışmamızın sonuçlarına göre Acinetobacter baumannii suşlarının doripenem MİK50/MİK90 değerlerinin imipenem ve meropeneme benzer olduğu saptanmıştır., In the last few years Acinetobacter spp. are among the most common bacterial pathogens in the patients of our hospital intensive care unit. Carbapenems take an important role among the limited treatment options of infections caused by Acinetobacter species. The aim of this study was to determine the in vitro activities of doripenem, imipenem, and meropenem against clinical Acinetobacter baumannii isolates. Between 01 January-31 December 2009, a total of 94 Acinetobacter spp. strains from Intensive Care Units to Akdeniz University Microbiology laboratory isolated from different clinical specimens were included in the study. Species are identified by conventional assays and BD Phoenix automated system (Becton Dickinson, USA) and susceptibility to imipenem, meropenem, doripenem was studied by E-test. Imipenem, meropenem, doripenem susceptibility of Acinetobacter baumannii isolates were found to be 22.3%, 17.0%, 12.8%, respectively. As a result of our study, doripenem MİK50/MİK90 values of Acinetobacter baumannii isolates are similar with of imipenem and meropenem.