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Amaç: Staphylococcus aureus, hastane kaynaklı ve toplum kökenli enfeksiyonların önemli bir nedenidir. S. aureus'un tıbbi implantlara ve konak dokuya tutunması ve olgun bir biyofilmin oluşması, kronik enfeksiyonların kalıcılığında önemli bir rol oynamaktadır. Çalışmamızın amacı, metisiline duyarlı S. aureus (MSSA) ve metisiline dirençli S. aureus (MRSA) izolatlarının biyofilm oluşturma potansiyelini belirlemek ve aralarındaki farkı gözlemlemektir. Gereç ve Yöntemler: Çalışmamıza Mikrobiyoloji laboratuvarına gönderilen çeşitli klinik örneklerden elde edilen toplam 200 S. aureus suşu (100 MRSA ve 100 MSSA) dahil edilmiştir. İzolatların tanımlanması Vitek MS (BioMerieux, Fransa) cihazı ile antibiyotik duyarlılıkları Vitek2 Compakt (BioMerieux, Fransa) otomatize sistemi ile belirlendi. Biyofilm üretimi, Mikrotitrasyon plak yöntemi kullanılarak çalışıldı. MSSA ve MRSA suşlarının biyofilm oluşturma yeteneği istatistiksel olarak incelendi. İstatistiksel anlamlılık düzeyi p

Objective: To evaluate the serotype distribution and antibiotic resistance in pneumococcal infections in adults and to provide a perspective regarding serotype coverage of both current and future pneumococcal vaccines. Patients and methods: This passive surveillance study was conducted with the Streptococcus pneumoniae strains isolated from the specimens of patients with pneumonia (materials isolated from bronchoalveolar lavage), bacteraemia, meningitis, pleuritis and peritonitis between 2015 and 2018. Serogrouping and serotyping were performed by latex particle agglutination and by conventional Quellung reaction using commercial type-specific antisera, respectively. The strains were analysed for penicillin, cefotaxime, erythromycin and moxifloxacin susceptibilities by E-test. Results: In the whole study group (410 samples from adults aged ≥18 years), the most frequent serotypes were 3 (14.1%), 19 F (12%) and 1 (9.3%). The vaccine coverage for PCV13, PCV15, PCV20 and PPV23 was 63.9%, 66.6%, 74.1% and 75.9%, respectively, in all isolates. Penicillin non-susceptibility in invasive pneumococcal disease (IPD) was 70.8% and 57.1% in the patients aged

Amaç: Enfeksiyöz gastroenteritler, özellikle çocuklarda morbidite ve mortalitenin en önemli nedenlerinden biridir. Rotavirüs ve enterik adenovirüsler, enfeksiyöz gastroenteritlerin önemli viral etkenlerindendir. Çalışmamızda, akut gastroenterit ön tanısı ile laboratuvara gönderilen gaita örneklerinde; rotavirüs ve adenovirüs pozitifliği ile etkenlerin cinsiyet, yaş ve mevsimsel dağılımının belirlenmesini amaçladık.Gereç ve Yöntemler: Temmuz 2015-Haziran 2019 tarihleri arasında çeşitli kliniklerden akut gastoenterit ön tanısı ile mikrobiyoloji laboratuvarına gönderilen gaita örnekleri rotavirüs ve adenovirüs varlığı açısından incelendi. Gaita örneklerini incelemede kalitatif immunokromotografik yöntem ile çalışan Simple/StickRota Adeno (Operon, İspanya) kiti kullanılmıştır. Çalışma verilerini retrospektif olarak inceledik. İstatistiksel değerlendirmeler, “Ki-Kare (Chi square) testine” göre yapıldı.Bulgular: Çalışmaya dahil edilen 5294 örneğin, 472’sinde (%8.91) rotavirüs pozitifliği; 237’sinde (%4.4) ise adenovirüs pozitifliği saptanmıştır. Rotavirüs pozitifliği 13-24 ay arasında 104 (%22) ve 2-5 yaş arasında 116 (%24.5); adenovirüs pozitifliği 2-5 yaş arasında 38 (%16) ve 18 yaş üstünde 85 (%35.8) olarak saptanmıştır. Mevsimsel olarak rotavirüs enfeksiyonlarının 179’u (%37.9) ilkbahar, 153’ü (%32.5) kış; adenovirüs enfeksiyonlarının 65’i (%27.4) kış, 61’i (%25.8) yaz aylarında saptanmıştır.Sonuç: Viral gastroenterit etkenlerinden rotavirüs ve adenovirüs, dışkıda bakılan antijen testleriyle kolaylıkla tespit edilebilir. Rotavirüs ve adenovirüs pozitiflik oranlarının, yaş, cinsiyet ve mevsimsel dağılımlarının bilinmesi bölgesel ve ülke çapında verilere katkı sağlayacaktır.

Elizabethkingia anophelis was firstly isolated from the midgut of the Anopheles gambiae mosquito in 2011. After this year, it was isolated in some intensive care cases in Africa and Asia. This study, it was aimed to confirm the identification of E. anophelis in the blood of a pediatric patient.After the suspicious bacteria were grown on blood agar, MALDI-TOF MS and 16s rRNA gene sequencing methods were used to identify and an antibiotic susceptibility test was carried out by Vitek 2 Compact system according to the EUCAST. Finally, a phylogenetic tree was created based on the 16s rRNA gene region.The isolate was identified as E. anophelis by both methods. It was found to be resistant to all beta-lactam antibiotics and also susceptible to ciprofloxacin and levofloxacin. According to the 16S rRNA-based phylogenetic tree, our isolate clustered within a branch containing other E. anophelis.These findings will guide clinicians in choosing which antibiotic to choose if they encounter this agent. Also, the clinicians should be vigilant against this agent, as it is a newly emerging infectious agent in Turkey.

Fluoroquinolones, are effective agents both against gram-positive and gram-negative bacteria. Quinolones show bactericidal effect as a result of inhibition of DNA gyrase and topoisomerase IV enzymes. Main quinolo resistance mechanisms are chromosomal mutations in these enzymes and decreased intracellular accumulation due to efflux pumps or decreased membrane uptake. Recently a new quinolone resistance mechanism mediated by plasmids has been defined. These plasmids carry genes called as qnr. Qnr genes do not cause quinolone resistance but they cause decreased quinolone susceptibility and lead to higher minimum inhibitory concentrations. Currently there are qnrA, qnrB, qnrC, qnrD and qnrS genes. This study was aimed to investigate the presence of plasmid-mediated quinolone resistance determinants in carbapenem resistant Enterobacterales isolates. A total 154 carbapenem resistant Enterobacterales isolates were included in the study. Presence of qnrA, qnrB, qnrC, qnrD and qnrS genes were investigated by multiplex polymerase chain reaction (PCR) method. The results of the PCR amplification revealed that qnrA was detected in two isolates (E6, E85) (1.29%), qnrB was detected in 12 isolates (8.4%) (E32, E43, E46, E61, E62, E84, E94, E149, E 166, E167, E177, E179) and qnrS was detected in six isolates (E15, E25, E57, E63, E70, E80) (4.54%). And one isolate (E9) was both positive for qnrB and qnrS. QnrC and qnrD were not detected in any isolates. Transferable quinolone resistance due to the dissemination of qnr genes may have important impacts in terms of infection control and treatment problems. Survey of plasmid mediated quinolone resistance will help to determine the size of the issue and guide the measures that should be taken to avoid escalation of resistance and dissemination problem.

Background: Infections caused by carbapenem-resistant gram-negative bacteria are treated with colonistin as a last resort. However, the increased resistance in recent years is significant for treating multiple drug-resistant infections. Objectives: This study aimed to determine the resistance genes mobile colistin resistance (mcr)-1 and mcr-2 in the colistin-resistant isolates, understand the resistance mechanism, and help with treatment. Methods: Isolates were identified in the Vitek MS automated system. The antibiotic susceptibility was tested with the Vitek 2 Compact automated system. Enteric gram-negative bacilli isolates were stored at -20°C until the molecular study. DNA extraction of colistin-resistant isolates was performed by boiling method. Then, polymerase chain reaction (PCR) optimization was performed using the specific primers, and mcr-1 and mcr-2 genes were investigated by the multiplex PCR method. Results: About 170 enteric gram-negative bacilli isolate were mainly sent from internal medicine (44.7%) and neurology (13.5%) services. According to the species identification, 37.6% of the isolates were Klebsiella pneumonia, and 31.7% were Serratia marcescens. Based on PCR results, mcr-1 and mcr-2 genes were not detected in the isolates. Conclusions: Increased colistin resistance and the worrying discovery of mcr genes require urgent precautions, even though the study did not detect mcr-1 and mcr-2. New studies investigating mcr genes in new isolates are needed to understand the mechanism of resistance and identify resistant isolates.

To evaluate the serotype distribution and antibiotic resistance in pneumococcal infections in adults and to provide a perspective regarding serotype coverage of both current and future pneumococcal vaccines.This passive surveillance study was conducted with theIn the whole study group (410 samples from adults aged ≥18 years), the most frequent serotypes were 3 (14.1%), 19 F (12%) and 1 (9.3%). The vaccine coverage for PCV13, PCV15, PCV20 and PPV23 was 63.9%, 66.6%, 74.1% and 75.9%, respectively, in all isolates. Penicillin non-susceptibility in invasive pneumococcal disease (IPD) was 70.8% and 57.1% in the patients aged65 and ≥65 years, respectively. About 21.1% and 4.3% of the patients with and without IPD had cefotaxime resistance. Non-susceptibility to erythromycin and moxifloxacin was 38.2% and 1.2%, respectively.The results revealed that novel PCV vaccines may provide improved coverage as compared with the currently available vaccine, PCV13. The significant antibiotic resistance rates imply the need to extend the serotype coverage of the vaccines. Continuing the surveillance in pneumococcal diseases is critical to explore the serotype distribution and incidence changes of IPD cases in the population and to inform policy makers to make necessary improvements in the national immunization programmes.Key messagesThis multicentre study demonstrated the most recent serotype distribution and antibiotic resistance in adult population in Turkey.Shifting from PCV13 to novel conjugated vaccines will significantly increase the coverage.Continuing the surveillance in pneumococcal diseases is critical to explore the serotype distribution changes and the incidence of cases with invasive pneumococcal disease in the population.

Amaç: Bruselloz; dünyada yaygın bakteriyel zoonoz olup ülkemizde de sık olarak görülebilmektedir. İnsanlarda gelişen bruselloz hastalığının tanısında başlıca kültür ve serolojik yöntemler kullanılmaktadır. Biz hastanemizde bruselloz serosürveyansını görmeyi amaçladık. Yöntem: Temmuz 2014-Temmuz 2019 tarihleri arasında hastanemiz mikrobiyoloji laboratuvarına gönderilen bruselloz açısından şüpheli örnekler Rose Bengal ve testi ile değerlendirilmiş olup Rose Bengal testinde aglütinasyon gözlenen örnekler pozitif sayılmıştır. Brucella Coombs jel testinde ise önce hasta örneklerinin seumları, hastalar için ayrılan kuyular içinde yapılmış olup (1/40-1/5120) 1/160 ve üzerindeki titreler pozitif olarak kabul edilmiştir. Bulgular: Çalışmaya dahil edilen 13796 bruselloz şüpheli hasta örneğinden Rose Bengal testi pozitif 1040 (%7,5) hasta bulunmuştur. Brucella Coombs jel testi pozitif olan hasta sayısı ise 468 (%3,4) dir. Rose Bengal testi pozitif olup Brucella Coombs jel testi negatif olan 615 (%4,5), Rose Bengal testi negatif olup Brucella Coombs jel testi pozitif olan 43 hasta (%0,3) bulunmuştur. Sonuç: Rose Bengal ve Brucella Coombs jel testi kullanılarak hastanemizde son 5 yıldaki brusella serosürveyansını araştırdık. Son yıllarda kullanımı yaygınlaşan Brucella Coombs jel testi ile elde ettiğimiz sonuçların birçok laboratuvarda kullanılan Standart tüp aglütinasyon testi ile uyumlu olduğunu özellikle blokan antikorlar varlığında sonuçların daha güvenilir olabileceğini ve ilerde birçok merkezde kullanılabileceğini gösterdik.

Introduction Zonulin is a protein that plays a role in the reversible regulation of epithelial permeability. As zonulin is released in large amounts into the intestinal lumen, it disrupts the integrity of the tight junctions and causes continuous migration of antigens to the submucosa. Consequently, it can trigger inflammatory processes and severe immune reactions. In severe cases, SARS-CoV-2 may have a major impact on the clinical manifestations of the disease by directly or indirectly affecting intestinal cells and triggering systemic inflammation. Therefore, our study aimed to investigate the role of one of the possible mediators, zonulin, in the severity of the COVID-19 infection. Methods Thirty COVID-19 patients and 35 healthy controls were included in the study. Blood samples were taken from the patients on the 1st, 4th, and 8th days of hospitalization. Serum zonulin levels were determined by enzyme-linked immunosorbent assay (ELISA). Complete blood count (white blood cell [WBC], neutrophil, lymphocyte, and platelet), biochemical parameters (serum lactic acid dehydrogenase [LDH], erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], D-dimer, ferritin, fibrinogen levels) were determined and chronic systemic disease states of the patients were assessed. Results Serum zonulin levels were notably higher in the healthy control group compared to the patient group (p=0.003). Although there was an increase in the zonulin values by time in hospitalization, this rising was not significant. Conversely, ESR and CRP levels were significantly higher in the patient group (p0.001). There was no significant difference between the two groups regarding gender, age, and WBC counts. Conclusion The serum zonulin levels of COVID-19 patients with the mild clinical course were lower than the healthy control group. Moreover, serum zonulin levels were not correlated with ESR, CRP, and other inflammation markers. Our results suggest that low serum zonulin levels in COVID-19 patients might represent a mild disease course.

Objectives Aspergillus fumigatus causes several diseases in humans and azole resistance in A. fumigatus strains is an important issue. The aim of this multicentre epidemiological study was to investigate the prevalence of azole resistance in clinical and environmental A. fumigatus isolates in Turkey. Methods Twenty-one centres participated in this study from 1 May 2018 to 1 October 2019. One participant from each centre was asked to collect environmental and clinical A. fumigatus isolates. Azole resistance was screened for using EUCAST agar screening methodology (EUCAST E.DEF 10.1) and was confirmed by the EUCAST E.DEF 9.3 reference microdilution method. Isolates with a phenotypic resistance pattern were sequenced for the cyp51A gene and microsatellite genotyping was used to determine the genetic relationships between the resistant strains. Results In total, resistance was found in 1.3% of the strains that were isolated from environmental samples and 3.3% of the strains that were isolated from clinical samples. Mutations in the cyp51A gene were detected in 9 (47.4%) of the 19 azole-resistant isolates, all of which were found to be TR34/L98H mutations. Microsatellite genotyping clearly differentiated the strains with the TR34/L98H mutation in the cyp51A gene from the strains with no mutation in this gene. Conclusions The rate of observed azole resistance of A. fumigatus isolates was low in this study, but the fact that more than half of the examined strains had the wild-type cyp51A gene supports the idea that other mechanisms of resistance are gradually increasing., Bursa Uludag University Scientific Research Projects Commission [QUAP[T]-2015-5]; Ener Private Health Service Company, This work was partly supported by Bursa Uludag University Scientific Research Projects Commission (QUAP[T]-2015-5) and Ener Private Health Service Company.

Background: Pseudomonas aeruginosa is an important opportunistic pathogen, and carbapenem resistance is an emerging problem. The determination of resistance genes is vital for epidemiological purposes, and the early determination of carbapenemase production methods is also recommended. Objectives: The present study aimed to investigate the presence of VIM, NDM, IMP, GES, SPM, GIM, and SIM genes in P. aeruginosa isolates. Methods: In this study, 200 carbapenem-resistant P. aeruginosa isolates were included. The DNA extraction of the carbapenem-resistant isolates was performed using the boiling method. Following the DNA extraction, optimization was conducted using the original primers. After optimization, the VIM, NDM, IMP, GES, SPM, GIM, and SIM genes were examined using the polymerase chain reaction (PCR) method. Results: The isolates were mainly identified from the tracheal aspirate cultures (34.5%). The PCR method revealed the presence of VIM in one of the P. aeruginosa isolates, and the NDM gene in one isolate using. None of the isolates was positive in terms of the IMP, GES, SPM, GIM, and SIM genes. Conclusions: In our study, two carbapenemase genes (VIM and NDM) were detected in the P. aeruginosa isolates.

Introduction: Carbapenem resistance is an emerging problem in Enterobactarales. We aimed to investigate the presence of carbapenemase genes blaNDM, blaKPC, blaVIM and blaOXA-48 and evaluate the phenotypic blue-carba method and carbapenem inactivation method (CIM) in Enterobacterales isolates. Methodology: Total of 153 Enterobacterales isolates were tested in the study. Presence of blaNDM, blaKPC, blaVIM and blaOXA-48 genes was investigated by polymerase chain reaction (PCR) method. Carbapenemase production of the isolates was also tested by blue-carba method and CIM. Results: The presence of blaOXA-48 gene was detected in 110 (71.4%) and blaNDM gene was detected in 2 (1.3%) of the Enterobacterales isolates by PCR method. None of the isolates were positive for blaKPC and blaVIM genes. The 121 (78.54%) of the isolates were found to be positive by blue-carba method and CIM. And 105 (68.18%) of the isolates were determined as positive by both PCR, blue-carba and CIM. Conclusions: In our study, 112 (72.7%) of the Enterobacterales isolates were found to be positive for carbapenemase genes (blaoxa-48 and blaNDM), and 121 (78.57%) of different isolates were found to be positive for blue-carba and CIM. However, 105 (68.18%) of the carbapenem resistance isolates found to be positive for all three methods.

Objective: Aim of this study is to identify nonfermentative Gram-negative bacteria isolated from blood cultures of patients undergoing treatment in various clinics in our hospital,to examine antimicrobial resistance profilesMethods: June 2016 – June 2019 blood cultures sent to the Microbiology Laboratory were retrospectively evaluated. Blood cultures were tested in BacT/Alert (BioMerieux, France) automated system of. Identification of growth microorganisms were tested in Vitek MS (BioMérieux, France) automated system and antibiotic sensitivity determined on Mueller - Hinton (BioMérieux, France) agar by disk diffusion method and Vitek2 Compakt (BioMerieux, France) automated system. Antibiotic susceptibility rates were evaluated according to EUCAST (European Committee on Antimicrobial Susceptibility Testing) criteria.Results: Over a period of 3 years, 668 nonfermentative bacteria were isolated from blood cultures. The 299 (45%) of the microorganisms isolated are Acinetobacter spp. and 270 of them were identified as Acinetobacter baumannii. And 189 (28%) of them were Pseudomonas spp. and 164 of them were identified as Pseudomonas aeruginosa. Stenotrophomonas maltophilia was isolated from 42 (6%) specimen. Acinetobacter spp. has the highest resistance rates against levofloxacin and ciprofloxacin as 76%. Pseudomonas spp. has the highest resistance rates against piperacillin as 32%. All Stenotrophomonas maltophilia isolates were found to be sensitive to trimethoprim/ sulfomethoxazole.Conclusion: Antibiogram results of nonfermentative Gram negative bacteria in blood cultures obtained in our hospital, is important to shed light on the antimicrobial resistance patterns that will occur in the coming years. Blood-stream infection factors and sensitivity tests should be followed continuously and effective treatment protocols should be applied, Amaç:Bu çalışmadaki amacımız, hastanemizde çeşitli kliniklerde tedavi görmekte olan hastaların kan kültürlerinden izole edilen nonfermentatif gram negatif bakterileri tanımlamak, antimikrobiyal direnç profillerini incelemektir.Yöntem:Tıbbi Mikrobiyoloji laboratuvarına Haziran 2016 – Haziran 2019 tarihleri arasında gönderilen kan kültürleri retrospektif olarak değerlendirildi. Kan kültürleri otomatize sistem ile BacT/Alert (BioMerieux, Fransa) çalışıldı. Üreyen mikroorganizmaların tanımlanması Vitek MS (BioMérieux, Fransa) ile antibiyotik duyarlılıkları Mueller- Hinton (BioMérieux, Fransa) agarda disk difüzyon yöntemi ve VITEK 2 (BioMerieux, Fransa) otomatize sistemle belirlenmiştir.Antibiyotik duyarlılık oranları EUCAST (European Committee on Antimicrobial Susceptibility Testing) kriterlerine göre değerlendirilmiştir.Bulgular: Laboratuvarımızda3 yıllık sürede kan kültürlerinden 668 nonfermentatif bakteri izole edildi.İzole edilen mikroorganizmaların 299’u (%45) Acinetobacter spp. ve bunların 270 tanesi Acinetobacter baumanniiolarak tespit edildi. 189’ u (%28) Pseudomonas spp. ve bunların 164 tanesi Pseudomonas aeruginosa olarak tespit edildi.42’ sini (%6)Stenotrophomonas maltophilia, geriye kalan 138’ ini (%21) diğer nonfermentatif bakteriler oluşturmaktadır. Acinetobacter spp. en yüksekdirenç oranlarılevofloksasin ve siprofloksasin için %76 olarak saptanmıştır. Pseudomonas spp. en yüksek direnç oranları piperasilin için %32 olarak saptanmıştır. Stenotrophomonas maltophilia’ ların hepsi trimetoprim/ sülfometoksazol’ e duyarlı saptanmıştır.Sonuç:Hastanemizde elde ettiğimiz kan kültürlerindeki nonfermentatif bakterilerin antibiyotik direnç sonuçları, gelecek yıllarda oluşacak antimikrobiyal direnç paternlerine ışık tutması bakımından önem taşımaktadır.Kan dolaşımı enfeksiyonu etkenlerinin ve duyarlılık testlerinin devamlı olarak takip edilerek etkin tedavi protokollerinin uygulanması gerekmektedir.

Invasive fungal infections (IFI) continue to be an important cause of morbidity and mortality in patients with hematological malignancies. Candida and Aspergillus species constitute most of the IFI in these patients.. It has been reported that most of the invasive aspergillosis epidemics are related to the construction works in the hospital. In this study, we aimed to investigate the frequency of IFI in the old and the new hospital building after relocation in patients with hematological malignancies. Of 8042 patients who were hospitalized in the Department of Hematology, Ondokuz Mayıs University Faculty of Medicine between January 2015 and September 2019, 412 patients who were initiated antifungal therapy were included in the study. The patients in the hematology clinic, which were moved to the new oncology hospital building in January 2018, were grouped as prior and after relocation, and their demographical data, hematological diagnosis, chemotherapy regimens, mortality, IFI, focus of infection, presence of central venous catheter, antifungal prophylaxis and treatment, galactomannan level, fungal culture and computed tomography (CT) findings were evaluated retrospectively. It was determined that 55% of the patients were male and the median age was 58 (range:18-93). The rate of IFI development was 5.12% (n= 412) and the rate of invasive mold infection was 1.2% (n= 145). The most common hematological disease for which antifungal treatment initiated was acute myeloid leukemia (AML) with a rate of 50% (n= 206/412). Of patients, 73% received induction chemotherapy (42%, first induction, 31% reinduction), 13.4% received consolidation therapy. Invasive mold infection was diagnosed as 40% possible, 59% probable, 1% proven. While patients had similar characteristics such as age, gender, hematological disease, chemotherapy regimens and antifungal prophylaxis prior and after transportation, the rate of development of invasive mold infection was 2.1%, 2.06 / 1000 patient days, before transportation, 1.37% (p= 0.009), 1.15/1000 patient days (p0.001) after transportation, and it was statistically significantly lower after transportation. The median value of galactomannan antigen was detected as 0.17 (0.02-5.9). Blood cultures revealed 10.3% fungal growth and the most common growth was Candida albicans with 54.8% and Mucor spp. as mold with 3.2%. Large-scale construction works such as renovation, extension and demolition works in old hospital buildings are a permanent condition in different units. Clinicians should be aware of that infections due to opportunistic fungi can be seen in immunosuppressive patients close to such construction sites, and even cause epidemics. It should be kept in mind that these infections, which can progress with serious morbidity and mortality are difficult to treat but can be prevented by infection control measures.

Background: Invasive Trichosporon infections are rarely seen opportunistic fungal infections in children and mainly affect immunocompromised patients. This multicenter retrospective study has rewieved the characteristics, risk factors, treatment modalities and outcomes of bloodstream infections caused by Trichosporon species in children diagnosed over the past ten years in Turkey. Methods: The study was performed with the participation of 12 of 55 hospitals invited from Turkey. In each center, the patients with bloodstream infections caused by Trichosporon spp. between January 2010 and December 2020 were retrospectively ascertained and the results were reported to the study coordinator by means of a simple case report. Data were collected on patient demographics, underlying condition(s), treatment of.infections caused by Trichosporon spp, and 7 and 30- day mortality rates. Results: A total of 28 cases with fungemia caused by Trichosporon spp. were included in the study. The most common underlying disease was paediatric cancers (39.3%). T. asahii infections were detected in 78.5 % (n=22) of patients. A various spectrum of antifungal treatment regimens were used including intravenous amphotericin B monotherapy in 35.7%, intravenous amphotericin B and voriconazole combination in 32.1% and intravenous voriconazole monotherapy in 28.6% of the patients. The overall mortality rate was 28.5 %. The mortality rates were 12.5% in the voricanozole, 30% in the amphotericin B and 33.3% in combined voriconazole -amphotericin B arms Conclusions: Invasive Trichosporon infections with an important impact of patients quality of life are almost related to underlying diseases with an overall mortality rate of 28.5%. Voriconazole was found to be associated with lower mortality rates when compared with other treatment regimens. (c) 2021 SFMM. Published by Elsevier Masson SAS. All rights reserved.

Introduction: In recent years, increasing infections due to fungi have drawn attention. Especially, Candida albicans is the most frequent infectious agent with its virulence factors. Furthermore, because C. albicans is a nosocomial infection agent, it can lead an increase in mortality and morbidity. In this study, it was aimed to genotype C. albicans strains that caused candidemia by molecular methods and to investigate one of the most important virulence factors, Secreted Aspartyl Proteinase 4 (SAP4). Materials and Methods: Our study included 50 C. albicans strains isolated from blood cultures. The isolates were identified both phenotypically and genotypically. Arbitrarily-Primed Polymerase Chain Reaction (AP-PCR) and Pulsed Field Gel ElectrophoresisElectrophoretic Karyotype Analysis (PFGE-EK) methods were used for molecular genotyping of the strains. Furthermore, the presence of SAP4 a virulence factor for C. albicans was investigated by polymerase chain reaction (PCR). Results: The 50 C. albicans isolates included in our study were separated to 26 genotypes by AP-PCR, 41 genotypes by PFGE-EK, and SAP4 was detected in 49 of the 50 isolates. Conclusion: In conclusion, dominant genotypes among the C. albicans isolates were not detected. Results of both molecular typing methods revealed that C. albicans isolates were generally endogenous. Furthermore, SAP4 gene was detected in 98% of the isolates. A considerable presence of this gene in blood sample isolates suggests that it contributes to systemic infections. More elaborative studies on the function of SAP4 gene in endogenous infections of C. albicans may contribute to the prevention of these infections in the future.

Amaç: Helicobacter pylori, insan gastrik mukozasına yerleşerek kronik gastrit ve peptik ülser hastalığına neden olan, MALT lenfoma ve mide adenokanserinde risk faktörü olduğu tespit edilmiş bir bakteridir. Çalışmamızda dispepsi şikayeti ile gelen hastaların gaitalarında H. pylori antijen sıklığı ile cinsiyet ve kliniklere göre dağılımlarının retrospektif olarak incelenmesi amaçlanmıştır. Gereç ve Yöntemler: 2016-2019 yılları arasında Ondokuz Mayıs Üniversitesi Tıp Fakültesi Hastanesi poliklinik ve servislerinden gönderilen gaita örneklerinde H. pylori antijeni varlığı retrospektif olarak değerlendirildi. Antijen saptanmasında immünokromotografi esaslı, monoklonal antikorlar içeren üretici firma tarafından duyarlılığı %98,2 özgüllüğü %98,4 olarak belirtilen CerTest (Biotec,İspanya) kiti kullanıldı. Verilerin istatistiksel analizinde Ki-kare testi kullanıldı. Anlamlılık düzeyi p

Introduction: Stenotrophomonas maltophilia, a non-fermentative bacterium, predominantly causes opportunistic infections in immunocompromised individuals and those receiving long-term, large-dose, broad spectrum antimicrobial agents. It is inherently resistant to most of the available antimicrobial agents. Trimethoprim-sulfamethoxazole (TMP/SMX), ceftazidime (CAZ), and levofloxacin (LVX) are the drugs of choice used for the infection treatment. The study aims to investigate the presence of plasmid-mediated quinolone resistance determinants of QnrA, QnrB, QnrC, QnrD, QnrS, and OqxAB genes in S. maltophilia isolates. Materials and Methods: A total of 122 S. maltophilia isolates from various clinical specimens were tested in the study. The susceptibility of TMP/SMX and LVX was determined by disk diffusion method. The minimum inhibitory concentration value of CAZ was determined by the gradient diffusion test. Qnr (A, B, C, S, D) determinants and OqxAB were investigated using multiplex polymerase chain reaction. OqxA was investigated in the isolates and the presence of OqxB in OqxA-positive isolates. Results: Five (4%) of the S. maltophilia isolates were resistant to TMP/SMX. Levofloxacin and CAZ resistances were determined as 6.5% and 56.5%, respectively. QnrS was detected in two of the isolates, and OqxA gene was found in three isolates. However, these isolates were not OqxB positive. One of these three positive isolates has been previously found to be QnrS-positive. Conclusion: In our study, QnrS was detected in two and OqxA gene in three of the S. maltophilia isolates.

Q fever is a zoonotic disease that is known to be widespread throughout the world by many researches since its discovery in 1935 and it is important in terms of animal and public health. Coxiella burnetii, which is the etiological agent of the disease, is an obligate intracellular pathogen. While the disease generally manifests itself with abortion in animals, disease manifests as atypical pneumonia or granulomatous hepatitis in the acute form and as endocarditis in the chronic form in humans. Its presence in Turkey has been shown with a large number of studies. The aim of this study was to show the genotypic relationship with MLVA analysis of C. burnetii samples found in cattle, sheep and goat samples in Erzurum and Samsun Veterinary Control Institutes and blood samples collected from humans with atypical pneumonia findings. In the study, MLVA analyses of 100 positive samples from 50 cows, 41 sheep and 9 goats from Northeast Anatolia and Black Sea regions and C. burnetii positive samples found in 6 individuals with atypical pneumonia were performed. As a result of the study, it was found that 106 C. burnetii samples had belong to 16 genotype groups. It was found that genotype XVI was the most prevalent among these groups and it was seen in both regions. In addition to this, genotype IX profile was the second largest group with 83.3% (5/6) of human samples. In this study, the genotypes common in the regions were determined and a data source was created for possible outbreaks.

Amaç: Bu çalışmada hastanemizin ayaktan ve yatarak takip edilen hastaların alt solunum yolu örneklerinden izole edilen ve solunum yolu enfeksiyonlarının en önemli enfeksiyon etkenleri olan Haemophilus influenzae, Moraxella catarrhalis ve Streptococcus pneumoniae suşlarının antibiyotik duyarlılık oranlarının belirlenmesi ve ampirik antibiyotik tedavisine yol göstermesi amaçlanmıştır. Gereç ve Yöntemler: Ondokuz Mayıs Üniversitesi Tıp Fakültesi Hastanesi Tıbbi Mikrobiyooji Laboratuvarı’na 2015-2017 yıllarında çeşitli kliniklerden gönderilen alt solunum yolu örnekleri retrospektif olarak incelenmiştir. İzolatların tanımlanması Vitek MS (Biomerieux, Fransa) cihazı; antibiyotik duyarlılıkları Vitek 2 Compact (Biomerieux, Fransa) cihazı ve Mueller-Hinton Fastidious (Biomerieux, Fransa) agarda disk difüzyon yöntemi ile belirlenmiştir. Elde edilen duyarlılık oranları EUCAST (European Committee on Antimicrobial Susceptibility Testing) kriterlerine göre değerlendirilmiştir Bulgular: Alt solunum yolları örneklerinden izole edilen 2427 adet suş retrospektif olarak incelendi. Streptococcus pneumoniae izolatlarına karşı %67 penisilin, %58 eritromisin direnci; Moraxella catarrhalis’e %9 eritromisin, %9 sefotaksim, %3 seftriakson direnci; Haemophilus influenzae’e %92 eritromisin %33 sefotaksim direnci saptanmıştır. Sonuç: Alt solunum yolunun en sık izole edilen bu üç bakteriyel patojene karşı rutinde kullanılan antibiyotiklere karşı her geçen gün direnç artmaktadır. Etken belirlendikten sonra antibiyotik duyarlılık testlerinin yapılması tedavinin yönlendirilmesi açısından önemlidir.

Amaç: Campylobacter türleri insanda sistemik infeksiyon ve ishallerin önemli sebeplerindendir. Bu çalışmadaki amacımız Campylobacter üretimini sağlamak için uygun besiyerini araştırmak ve üretilecek bakterilere antimikrobiyal duyarlılık testleri çalışarak direnç profillerini tespit etmektir. Yöntem: Çalışmamıza 01 Mayıs - 01 Ekim 2016 tarihleri arasında ishal yakınması ile başvuran hastalardan, mikrobiyoloji laboratuvarına kültür için gönderilen 405 gaita örneği çalışılmıştır. Campylobacter üretimi için Modifiye Charcoal Cephoperazone Deoxycholate Agar (mCCDA) ve Skirrow besiyeri olmak üzere iki farklı besiyeri kullanılmıştır. Üreme görülen kültürlerdeki bakterilere konvansiyonel testler yapılmıştır ve Campylobacter şüpheli olanların Vitek MS ile tanımlaması yapılmıştır.Bulgular: İncelenen 405 dışkı örneğinin dokuzunda Campylobacter (%2,2) türü bakteri üremiştir. Bunların altısı Campylobacter jejuni, diğer üç tanesi ise Campylobacter coli olarak tanımlanmıştır. Elde edilen dokuz izolatın yedisi (%77,8) kan bazlı Skirrow besiyerinde üremiştir. Bu yedi izolattan ikisi aynı zamanda kömür bazlı mCCDA besiyerinde de üremiştir. İki izolat (%22,2) ise sadece mCCDA besiyerinde üremiştir. İzole edilen dokuz Campylobacter türü izolata EUCAST kılavuzunun önerileri doğrultusunda disk difüzyon yöntemiyle antibiyotik duyarlılığı çalışılmıştır. Test edilen antibiyotikler içinde eritromisin en duyarlı (%77,7), siprofloksasin ise en dirençli (%77,7) olarak bulunmuştur.Sonuç: Besiyeri olarak kan bazlı besiyerinin kömür bazlı besiyerine göre daha iyi üreme sağladığı görülmüştür. Antibiyotiklerden en duyarlı olarak bulunan eritromisin’in ilk tercih olarak kullanılması ve yüksek bulunan kinolon direncinin dikkate alınması gerektiği düşünülmektedir.

Amaç: Menenjit, beyni saran meningeal zarların ve spinal kordun enflamasyonudur. Bakteri, virüs ve mantarlar gibi pek çok etken menenjite yol açabilir. Menenjit; antimikrobiyal ve destek tedavi yöntemlerinde elde edilen gelişmelere rağmen hala ciddi mortalite ve morbidite nedeni olmaya devam etmektedir. Bu sebeple menenjitte acil tedavi mortalite ve morbiditenin düşürülmesi için çok önemlidir. Bu çalışmada hastanemiz mikrobiyoloji laboratuvarına gönderilen beyin omurilik sıvısı örneklerinde (BOS) Real-Time polimeraz zincir reaksiyonu (PZR) yöntemi ile tespit edilen etkenlerin değerlendirilmesi amaçlanmıştır.Yöntem: Bu çalışmada 01/08/2019-30/09/2020 tarihleri arasında Ondokuz Mayıs Üniversitesi Tıp Fakültesi Moleküler Mikrobiyoloji Tanı Laboratuvarına gönderilen 169 hastanın BOS örneği çalışmaya dahil edilmiştir. Çalışmada Real-Time PZR yöntemi ile çalışan SmartCycler by Cepheid cihazıyla BOS örnekleri çalışılmıştır. Bu sistemde Streptococcus pneumoniae, Neisseria menengitidis, Haemophilus influenza, Herpes simplex-1 (HSV-1), Herpes simplex-2 (HSV-2), Human herpes virüs type-6 (HHV-6), Epstein barr virüs (EBV), Varicella zoster virüs (VZV) ve Cytomegalo virüs (CMV) etkenleri tespit edilebilmektedir.Bulgular: Çalışmaya 169 hastanın BOS örneği dahil edilmiştir. Çalışmamıza dahil edilen hastaların %50.88’i erkek, %49.12’si kadın hastalardan oluşmaktadır. Hastalarımızın %63.90’ı 18 yaş grubu hastalardan oluşmaktadır. PZR sonucuna göre pozitiflik saptanan hasta sayısı 20 olup pozitiflik oranı %11.83’tür. Pozitiflik saptanan örneklerin %40’ını S. pneumoniae, %20’sini HSV-1, %15’ini N. menengitidis, %5’ini EBV , %5’ini H. influenzae, %5’ini HHV-6, %5’ini, HSV-2 ve %5’ini VZV oluşturmaktadır. Sonuç: Menenjit hastalarında uygun ve yeterli antimikrobiyal tedavi için öncelikle etkenin belirlenmesi gerekmektedir. PZR gibi moleküler yöntemlerle etkenlerin erken saptanması mümkündür ve bu alanda PZR’nın sağladığı erken tanı avantajından yararlanılmalıdır., Objectıve: Meningitis is an inflammation of the meningeal membranes and spinal cord that surround the brain. Meningitis; despite advances in antimicrobial and supportive treatment methods, it is still a serious cause of mortality and morbidity. For this reason, emergency treatment in meningitis is very important in reducing mortality and morbidity. In this study, it was aimed to evaluate the factors detected by Real-Time PCR method in cerebrospinal fluid(CSF) samples that are sent to our hospital's microbiology laboratory.Methods: In this study, CSF samples of 169 patients who were sent to Ondokuz Mayıs University Microbiology Laboratory between 01/08/2019-30/09/2020 were included. In the study, CSF samples were studied with the SmartCycler by Cepheid working with Real-Time PCR method. In this system, Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenza, Herpes simplex-1 (HSV-1), Herpes simplex-2(HSV-2), Human herpes virus type-6(HHV-6), Epstein barr virus(EBV), Varicella zoster virus(VZV) and Cytomegalo virus(CMV) factors can be detected.Results: CSF samples of 169 patients were included in the study. 63.90% of our patients are patients in the 18 age group. The number of PCR positive patients results were 20 and the positivity rate was 11.83%. Positive samples consist of 40% S. pneumoniae, 20% HSV-1, and 15% N. meningitidis.Conclusion: In meningitis patients, the agent must first be determined for appropriate and adequate antimicrobial treatment. It is possible to detect the factors early with molecular methods such as PCR, and the early diagnosis advantage provided by PCR should be used in this field.

Candida tropicalis is the fourth leading cause of candidemia in Turkey. Although C. tropicalis isolates from 1997 to 2017 were characterized as fully susceptible to antifungals, the increasing global prevalence of azole-non-susceptible (ANS) C. tropicalis and the association between high fluconazole tolerance (HFT) and fluconazole therapeutic failure (FTF) prompted us to re-evaluate azole susceptibility of C. tropicalis in Turkey. in this study, 161 C. tropicalis blood isolates from seven clinical centers were identified by ITS rDNA sequencing, genotyped by multilocus microsatellite typing, and tested for susceptibility to five azoles, two echinocandins, and amphotericin B (AMB); antifungal resistance mechanisms were assessed by sequencing of ERG11 and FKS1 genes. the results indicated that C. tropicalis isolates, which belonged to 125 genotypes grouped into 11 clusters, were fully susceptible to echinocandins and AMB; however, 18.6% of them had the ANS phenotype but only two carried the ANS-conferring mutation (Y132F). HFT was recorded in 52 isolates, 10 of which were also ANS. Large proportions of patients infected with ANS and HFT isolates (89 and 40.7%, respectively) showed FTF. Patients infected with azole-susceptible or ANS isolates did not differ in mortality, which, however, was significantly lower for those infected with HFT isolates (P = 0.007). There were significant differences in mortality (P = 0.02), ANS (P = 0.012), and HFT (P = 0.007) among genotype clusters. the alarming increase in the prevalence of C. tropicalis blood isolates with ANS and HFT in Turkey and the notable FTF rate should be a matter of public health concern., Major National R&D Projects of the National Health Department [2018ZX10101003]; National Natural Science Foundation of ChinaNational Natural Science Foundation of China (NSFC) [31770161]; Shanghai Science and Technology CommitteeShanghai Science & Technology Committee [17DZ2272900, 14495800500]; Shanghai Municipal Commission of Health and Family Planning [2017ZZ01024-001]; Shanghai Sailing Program [19YF1448000]; Chinese Academy of Engineering [2019-XY-33], This work was supported by the Major National R&D Projects of the National Health Department (2018ZX10101003), National Natural Science Foundation of China (31770161), Shanghai Science and Technology Committee (17DZ2272900 and 14495800500), Shanghai Municipal Commission of Health and Family Planning (2017ZZ01024-001), Shanghai Sailing Program (19YF1448000), and the Chinese Academy of Engineering (2019-XY-33).

Objectives: To determine the serotype distribution of pneumococcus causing invasive pneumococcal disease (meningitidis, bacteremia and empyema) in children in Turkey, and to observe potential changes in this distribution in time to guide effective vaccine strategies. Methods: We surveyed S. pneumoniae with conventional bacteriological techniques and with real-time polymerase chain reaction (RT-PCR) in samples of cerebrospinal fluid (CSF), blood and pleural fluid. S. pneumoniae strains were isolated from 33 different hospitals in Turkey, which are giving health services to approximately 60% of the Turkish population. Results: A total of 167 cases were diagnosed with invasive pneumococcal disease between 2015 and 2018. We diagnosed 52 (31.1%) patients with meningitis, 104 (62.2%) patients with bacteremia, and 11 (6.6%) patients with empyema. Thirty-three percent of them were less than 2 years old and 56% less than 5 years old. Overall PCV13 serotypes accounted for 56.2% (94/167). The most common serotypes were 19 F (11.9%), 1 (10.7%) and 3 (10.1%). Conclusions: Besides the increasing frequency of non-vaccine serotypes, vaccine serotypes continue to be a problem for Turkey despite routine and high-rate vaccination with PCV13 and significant reduction reported for the incidence of IPD in young children. Since new candidate pneumococcal conjugate vaccines with more serotype antigens are being developed, continuing IPD surveillance is a significant source of information for decision-making processes on pneumococcal vaccination. © 2020 The Author(s). Published with license by Taylor & Francis Group, LLC., Pfizer, The study was supported by Pfizer.