Causative Agents of Intravenous Catheter-Related Infections and Their Antibiotic Susceptibilities

Aktas, Elif | Sari, Emre Nur | Keskin, Aysegul Seremet | Piskin, Nihal | Kulah, Canan | Comert, Fusun

Article | 2011 | MIKROBIYOLOJI BULTENI45 ( 1 ) , pp.86 - 92

Intravenous catheterization can lead to colonization as well as a broad spectrum of infections ranging from catheter site infections to catheter-related blood stream infections (CRBSIs). The aim of this study was to evaluate the distribution of causative agents and their antibiotic susceptibility patterns in CRBSIs and catheter site infections along with the colonization rates and colonizing microorganisms in Zonguldak Karaelmas University Hospital, Turkey. The results of cultures from catheter tips and/or intracatheter blood cultures and simultaneously taken peripheral blood cultures were sent to medical microbiology laboratory and . . . were retrospectively investigated for 201 patients hospitalized between September 2007 and September 2009. The catheter tips were cultured by semi-quantitative and quantitative culture methods. Blood cultures from the catheters and peripheral veins were performed in BACTEC 9120 (Becton Dickinson, USA) blood culture systems. The antibiotic susceptibility tests were done by Kirby-Bauer disk diffusion method according to the guidelines of the Clinical and Laboratory Standards Institute (CLSI). Out of 201 patients included, 28 (13.9%) had CRBSIs and 13 (6.4%) had catheter site infections while colonization was defined for 55 (27.3%) patients. Of 28 patients with CRBSIs, Acinetobacter spp. were isolated from 11 including five carbapenem-resistant strains, methicillin-resistant coagulase-negative staphylococci (MRCNS) from eight, methicillin-susceptible coagulase-negative staphylococci (MSCNS) from two, Klebsiella pneumoniae from two patients and one of each patient's cultures yielded methicillin-resistant Staphylococcus aureus (M RSA), carbapenem-resistant Pseudomonas aeruginosa, Enterococcus spp., Escherichia coli and MRCNS + Enterococcus faecium. Of 13 patients with catheter site infections, five MSCNS, two methicillin-susceptible S.aureus (MSSA), two E.coli, and one of each K.pneumoniae, MRCNS, Enterococcus spp., K.pneumoniae + P.aeruginosa were isolated. No resistance to vancomycin and teicoplanin were detected among the staphylococci isolated from CRBSIs and catheter site infections. The distribution of the 55 colonizing microorganisms were as follows; 18 MSCNS, 18 MRCNS, four Acinetobacter spp., five K.pneumoniae, three E.coli, two MSSA, and one of each MRSA, P.mirabilis, P.aeruginosa, Corynebacterium spp., Candida albicans. In this study, the predominant microorganism isolated from CRBSIs was Acinetobacter spp., followed by coagulase-negative staphylococci. This unexpected distribution of the agents was related to the Acinetobacter spp. that have gained endemic potential following an Acinetobacter outbreak in our hospital in 2006. We emphasize that it is critical for any individual hospital to assess periodically the distribution and susceptibility profiles of isolates obtained from catheter-related infections to set out rational empirical treatment strategies Daha fazlası Daha az


Aktas, Elif | Ogedey, Esra Deniz | Kulah, Canan | Comert, Fusun Begendik

Article | 2010 | MIKROBIYOLOJI BULTENI44 ( 4 ) , pp.647 - 650

Hepatitis C virus (HCV) is one of the significant causes of hepatitis, cirrhosis and hepatocellular carcinoma all throughout the world. There are six genotypes and more than 50 subtypes of HCV. HCV genotyping is of crucial importance in the determination of the treatment protocols and the follow-up of the clinical course since treatment success is low and the duration of treatment is longer in HCV genotype 1 infected cases. The aim of the present study was to evaluate the HCV genotype profiles of the patients with chronic hepatitis C in Zonguldak, providing the first data about HCV genotypes from western Black-Sea region, Turkey. Th . . .e HCV genotypes of 44 patients (26 female, 18 male; age range: 29-89 years, mean age: 60.05 +/- 10.81 years) with positive anti-HCV antibody and HCV-RNA results, admitted to the hospital between May 2007 and July 2009, were retrospectively evaluated and included in the study. Alanine aminotransferase (ALT) levels of the patients were between 8-160 IU/L (mean 63.99 +/- 37.15 IU/L) and the aspartate aminotransferase (AST) levels were between 17-160 IU/L (mean 62.77 +/- 36.75 IU/L). HCV antibody was determined by ELISA method (Abbott Laboratories, USA), and HCV-RNA was determined by two commercial real-time polymerase chain reaction systems [Cobas Taqman (Roche Diagnostic, USA) and Rotor-Gene 6000 (Corbett Research, USA)]. The genotyping was performed by a reverse hybridization based method, Versant (R) HCV Genotype Assay (LiPA) 2.0 (Bayer Health Care, Belgium). HCV genotypes could not be determined for 5 (11.4%) patients since HCV-RNA levels were low. Genotyping could be performed for 39 (88.6%) patients and 38 (97.4%) had genotype 1b and one (2.6%) patient had genotype la. In conclusion, in concordance with the other studies conducted in our country, genotype 1b was found to be the most prevalent genotype in patients from our region Daha fazlası Daha az

Nosocomial meningitis with dual agents and treatment with intraventricular gentamicin

Oeztoprak, Nefise | Celebi, Gueven | Baruoenue, Fatma | Kalayci, Murat

Article | 2008 | MIKROBIYOLOJI BULTENI42 ( 3 ) , pp.497 - 501

Nosocomial central nervous system infections constitute 0.4% of all nosocomial infections. The responsible pathogens of nosocomial meningitis are quite different from community-acquired meningitis with high rates of morbidity and mortality. The most important prognostic factor is the appropriate choice of pathogen-specific antibacterial therapy. In this report, a 64 years old woman with nosocomial meningitis caused by Klebsiella pneumonioe and Acinetobacter spp. after lumbar disc hernia operation, has been presented. The risk factors were detected as recent history of neurosurgical operation for three times and long term (29 days) u . . .se of external ventricular drainaige (EVD) catheter. Empirical meropenem (3 x 2 g, IV) and vancomycin (2 x 1 g, IV) therapy was initiated upon the diagnosis of nosocomial meningitis based on the clinical and laboratory findings on the postoperative fifth day. Extended-spectrum beta-lactamase (ESBL) producing K. pneumonice (susceptible to amikacin, imipenem, meropenem, cefoxitine, ciprofloxacin, piperasillin-tazobactam and trimethoprim/sulfamethoxazole) was recovered from cerebrospinal fluid (CSF) and blood samples obtained on the same day. There was no change in the status of the patient on the eighth day of meropenem therapy, with high leukocyte number (1300/mm(3)) and presence of gram-negative bacilli in CSF, and ESBL positive K. pneumonioe (antibiotic susceptibility pattern same with the previous isolate) growth in CSF culture. Thereupon intravenous ciprofloxacin (3 x 400 mg) was added to the therapy and her EVD has been changed. However, ESBL positive K. pneumonioe (antibiotic susceptibility pattern same with the previous isolate) together with Acinetobacter spp. (susceptible to gentamycin, tobramycin, netilmicin, ciprofloxacin, levofloxacin and cefepime) were isolated from CSF and blood cultures obtained on the 13(th) day of meropenem and fifth day of ciprofloxacin therapy. Therefore intraventricular and intravenous gentamicin (15 mg/days and 3 x 120 mg, respectively) were added to the therapy. The patient recovered at the end of three weeks treatment without any additional sequela other than her primary illness. This case was the first case of nosocomial meningitis due to ESBL positive K. pneumonioe together with Acinetobacter spp. in the available literature Daha fazlası Daha az


Aktas, Elif | Mengeloglu, Firat Zafer | Kulah, Canan | Comert, Fusun Begendik

Letter | 2010 | MIKROBIYOLOJI BULTENI44 ( 2 ) , pp.339 - 341

In this study, a total of 390 methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from clinical specimens between April 2004 and June 2008, in a university hospital in Zonguldak (located at Black Sea region), Turkey, were evaluated retrospectively for reduced susceptibility to vancomycin Brain heart infusion (BHI) plates containing 4 and 6 mu g/ml of vancomycin were used to screen for vancomycin intermediate S aureus (VISA) strains Additionally, vancomycin minimal inhibitory concentrations (MIC) of the isolates were determined by agar dilution method No growth was observed on the screen plates after 24 and 48 hours o . . .f incubation None of the isolates revealed MIC values equal to or higher than 2 mu g/ml, MIC(90) and MIC(50) values were 1 mu g/ml Although VISA isolates were not detected in this study, no data was obtained for heterogeneous VISA isolates since macro-E test or population analysis were not performed It was concluded that systematic surveillance of MRSA isolates is of particular importance to investigate the presence of VISA/hVISA isolates which may lead to treatment failures and hospital epidemic Daha fazlası Daha az

Investigation of IL-1 Beta, IL-1 Receptor Antagonist and IL-8 Gene Polymorphisms in Patients with Chronic Hepatitis B and C

Borekci, Gulay | Karakas Celik, Sevim | Kandemir, Ozlem | Aras, Nurcan | Yalin, Serap

Article | 2014 | MIKROBIYOLOJI BULTENI48 ( 2 ) , pp.271 - 282

The host immune response is closely related to the prognosis of disease and viral persistence in hepatitis B (HBV) and hepatitis C virus (HCV) infections. Althought it is well known that cytokines and genetic factors play important roles in the pathogenesis of chronic HBV and HCV infections, the underlying mechanisms are not fully understood. This study was conducted to determine the role of interleukin (IL)-1 beta, IL-1 receptor antagonist (1L-1RA) and IL-8 gene polymorphisms in chronic hepatitis B and C infections. A total of 361 subjects, 171 with chronic hepatitis B (62 female, 109 male; age range: 18-74 yrs) and 104 with chroni . . .c hepatitis C (63 female, 41 male; age range: 25-79 yrs), and a control group of 86 healthy subjects (41 female, 45 male; age range: 18-72 yrs) were included in the study. Following the DNA extractions from peripheral blood leukocytes of the study groups, single nucleotide polymorphisms of 1L-1 beta -31, -511, +3954; IL-1RA and IL-8 -251, -353, -738, -845 gene regions were investigated by using specific primers with real-time PCR method. It was found that the genotype frequency of IL-8 -251 AT (OR: 7.895, p= 0.003) and IL-8 -738 TA (OR: 6.317, p= 0.007) in patients with chronic hepatitis B and the genotype frequency of IL-1 beta -31 CT (OR: 6.757, p= 0.001), IL-1 beta -511 CT (OR: 4.060, p= 0.004), IL-8 -251 AT, (OR: 13.622, p= 0.001), IL-8 -738 TA (OR: 14.058, p= 0.001), and IL-8 -845 TC (OR: 2.539, p= 0.004) in patients with chronic hepatitis C was significantly higher than the control group. When the allelic frequency was compared between chronic hepatitis B patients and the control group, it was determined that IL-1 beta +3954 T allel increased the disease risk 1.5 times (p< 0.05), however, no statistically significant difference was detected for the other allels. It was also determined that IL-8 -845 C allel increased the disease risk 0.6 times in chronic hepatitis C (p< 0.05) and no statistically significant difference was detected for the other allels (p> 0.05). In conclusion, IL-1 beta -31, -511 and IL-8 -251, -738, -845 gene polymorphisms may play a role in the chronicity of hepatitis B and C infection. In order to determine the importance of this cytokine polymorphisms in hepatitis B and hepatitis C virus infections, large-scale studies with different patient groups such as carriers, chronic hepatitis, cirrhosis, and hepatocellular carcinoma should be conducted to elucidate the molecular mechanisms underlying the disease process Daha fazlası Daha az

Differential diagnosis of bacterial and viral meningitis in childhood acute meningitis: A statistical model

Celik, Nesat | Tanir, Gonul | Aydemir, Cumhur | Tuygun, Nilden | Zorlu, Pelin

Article | 2007 | MIKROBIYOLOJI BULTENI41 ( 1 ) , pp.63 - 69

Acute bacterial meningitis (BM) which is a pediatric emergency with high mortality and morbidity, must be diagnosed and treated promptly. There is no unique method to prove or rule out the diagnosis of BM in a patient with cerebrospinal fluid (CSF) findings consistent with BM but negative Gram stain and culture results. For this purpose the combination of CSF parameters are used for diagnosis. The aims of this study were to compare retrospectively the mean leukocyte count, serum C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), CSF leukocyte and neutrophil, CSF protein and glucose values in 40 bacterial and 29 viral me . . .ningitis (VM) patients, ages between 1 month and 14 years, and to develop a statistical model for the differentiation of BM and VM cases. Logistic regression analysis was used to investigate the relationship between BM and age, CRP, ESR, leukocyte count, CSF leukocyte, neutrophil, protein and glucose values. Based on CSF protein and neutrophil ratio which were found as independent variables, the regression model could predict the patients having BM with 95% and viral meningitis with 93.2% accuracy Daha fazlası Daha az

Increase in Size of Lymph Nodes or Occurrence of New Lymphadenopathy During Antituberculosis Chemotherapy: Paradoxical Response

Yalcinsoy, Murat | Baran, Ates | Bilgin, Sevinc | Afsar, Bilgen Begum | Celenk, Olga | Esen Akkaya, Mevhibe

Letter | 2013 | MIKROBIYOLOJI BULTENI47 ( 2 ) , pp.385 - 387

Investigation of the Association Between Chronic Hepatitis B and C Infections and TNF-alpha(-308) Gene Polymorphism

Borekci, Gulay | Aras, Nurcan | Kandemir, Ozlem | Yalin, Serap | Celik, Sevim Karakas | Berkoz, Mehmet

Article | 2016 | MIKROBIYOLOJI BULTENI50 ( 2 ) , pp.236 - 244

Cytokines and genetic factors play important roles in the pathogenesis of chronic hepatitis B (CHB) and chronic hepatitis C (CHC) infections. Variations in cytokine genes may effect the gene expression and may lead to changes in the clinical manifestations of diseases. One of the single nucleotide polymorphisms in the promoter region of tumor necrosis factor-alpha (TNF-alpha) gene is the polymorphism at -308. position which was investigated in many studies by means of its relationship between CHB and CHC infections, however their results are incompatible. Furthermore, there is no sufficient data on this subject in our country. This . . .study was aimed to determine the relationship between TNF-a(-308) gene polymorphism with CHB and CHC infections. A total of 271 patients with chronic hepatitis and 181 healthy subjects were included in the study. Of them 167 were CHB cases (67 female, 100 male; age range 18-74 years, mean age: 40.23 +/- 13.09) and 95 controls for CHB group (46 female, 49 male; mean age: 36.41 +/- 15.0 years), while 104 were CHC cases (63 female, 41 male; age range: 25-79 years, mean age: 52.8 +/- 12.6) and 86 controls for CHC group (41 female, 45 male; mean age: 36.4 +/- 14.9 years). After the isolation of genomic DNA from blood samples of the patient and control groups, TNF-alpha(-308)G/A (rs 1800629) polymorphism was investigated by using the real-time polymerase chain reaction from the obtained DNAs. Among CHB group, TNF-alpha(-308) GG, GA, AA genotypes were detected in 126 (75.4%), 38 (22.8%) and 3 (1.8%) of the patients, respectively, while these numbers were 84 (88.4%), 11 (11.6%) and 0 (0%) in control group, respectively. Among CHC group, TNF-a(-308) GG, GA, AA genotypes were detected in 37 (35.6%), 28 (26.9%) and 39 (37.5%) of the patients, respectively, while these numbers were 38 (44.2%), 8 (9.3%) and 40 (46.5%) in control group, respectively. The frequency of GA genotype was significantly higher in both patient groups compared to the control groups (p=0.024 for CHB and p= 0.006 for CHC). When the distribution of allele frequencies of TNF-alpha(-308)G/A polymorphism was evaluated in the patients and control groups, it was noted that G allele was found to be high in CHB patients comparing with controls (94.2% vs 86.8%), however A allele was identified to be lower than controls (5.8% vs 13.2%) (p= 0.008). In contrast, there was no significant difference in terms of allele frequency compared with CHC patients and the control group (p= 0.969). In conclusion, our data in accordance with the results of many studies in literature, determined that TNF-alpha(-308) polymorphisms can influence the chronicity of hepatitis B and C infections. Further studies on this subject would contribute to the elucidation of the molecular mechanisms of chronic hepatitis B and C diseases Daha fazlası Daha az


Oztoprak, Nefise | Celebi, Gueven | Aydemir, Hande | Piskin, Nihal | Bektas, Sibel | Koca, Rafet | Kuloglu, Figen

Article | 2008 | MIKROBIYOLOJI BULTENI42 ( 4 ) , pp.701 - 706

Infective endocarditis due to high level aminoglycoside resistant Enterococcus faecalis and methicillin resistant coagulase-negative staphylococci presenting with rheumatic manifestations

Piskin, Nihal | Akduman, Deniz | Aydemir, Hande | Celebi, Gueven | Oeztoprak, Nefise | Aktas, Elif

Article | 2008 | MIKROBIYOLOJI BULTENI42 ( 3 ) , pp.509 - 514

Infective endocarditis has variable clinical presentations and may present with rheumatologic manifestations. Infective endocarditis due to high level aminoglycoside resistant enterococci represents a severe therapeutic challenge as none of the currently recommended treatment regimens are bactericidal against these isolates. In this report, a case of infective endocarditis with double aetiology, high level aminoglycoside resistant Enterococcus faecalis together with methicillin-resistant coagulase-negative staphylococci (MR-CNS), presenting with leukocytoclastic vasculitis and rapidly progressive glomerulonephritis, has been present . . .ed. A 48-years-old woman was admitted to our hospital with malaise and non-pruritic purpural rush on her lower extremities. On admission she had no fever or leukocytosis. Skin biopsy showed leukocytoclastic vasculitis and steroid therapy was started. On 12(th) day of admission rapidly progressive glomerulonephritis was diagnosed and she received plasmapheresis and haemodialysis support. Transthoracic echocardiography (TTE) demonstrated 1 x 1.5 cm vegetation on the mitral valve. An initial diagnosis of infective endocarditis was made and empirical treatment with vancomycin and gentamicin was started. All blood cultures yielded high level aminoglycoside resistant E. faecalis and additionally two of them yielded MR-CNS. Vancomycin was administered in combination with high dose ampicillin and repeated blood cultures taken after administration of ampicillin, revealed no growth. The patient remained afebrile, renal functions improved and a repeat TTE done on 20(th) day of ampicillin therapy showed waning of the vegetation. On 42(nd) day of treatment repeat TTE showed new vegetation on the mitral valve and severe valve insufficiency, so the patient was scheduled for mitral valve replacement. She was treated for 12 weeks with vancomycin and ampicillin and recovered successfully. In conclusion; infective endocarditis should be considered in the differential diagnosis of leukocytoclastic vasculitis and rapidly progressive glomerulonephritis. Physicians should document their treatment outcomes and experience with high level aminoglycoside resistant enterococcal infective endocarditis, which is a therapeutic challenge, so that the best therapeutic options can be identified Daha fazlası Daha az


Celebi, Gueven | Buyukates, Mustafa | Dogan, Sait Mesut | Piskin, Nihal | Aydemir, Hande | Oztoprak, Nefise | Aktas, Elif

Article | 2009 | MIKROBIYOLOJI BULTENI43 ( 2 ) , pp.319 - 323

Staphylococcus lugdunensis is an infrequent cause of infective endocarditis (IE) and usually involves native valves of the heart. It causes life-threatening events such as rupture of cardiac valve or cerebral or pulmonary embolism due to necrosis on the endocardial tissue involved by the bacteria. Antibiotic therapy without cardiac surgery or delayed cardiac surgery usually follows a fatal course in S.lugdunensis endocarditis. In this report the first case of S.lugdunensis endocarditis from Turkey was presented. A 37 years-old man was admitted to the emergency department with a 2-weeks history of fever chills and accompanying interm . . .ittent pain on the left side of the thorax. Other than recurrent folliculitis continuing for 20 years, his history was unremarkable. Echocardiography revealed vegetation on the mitral valve of the patient and vancomycin plus gentamicin were initiated with the diagnosis of IE. All blood cultures (5 sets) taken on admission and within the initial 48 hours of the antibiotic therapy yielded S.lugdunensis. According to the susceptibility test results, the antibiotic therapy was switched to ampicillin-sulbactam plus rifampin. Blood cultures became negative after the third day of therapy, however, cardiac failure was emerged due to rupture of mitral valve and chorda tendiniea on the 12(th) day of the therapy. Cardiac surgery revealed that mitral valve and surrounding tissue of the valve were evidently necrotic and fragile, anterior leaflet of the mitral valve was covered with vegetation, posterior leaflet and chorda tendiniea were ruptured. Vegetation was removed and the destructed mitral valve was replaced with a mechanical valve. Vegetation culture remained sterile, however, antibiotics were switched to vancomycin plus rifampin due to persistent fever on the 21(st) day of the therapy (9(th) day of operation). Fever resolved four days after the antibiotic switch. Antibiotics were stopped on the 9(th) weeks of admission and the patient was discharged. He had no problem in follow-up controls for one year. In conclusion, proper antibiotic therapy combined with early cardiac surgery seems to be the optimal therapeutic approach in IE caused by S.lugdunensis Daha fazlası Daha az


Hanci, Sevgi Yilmaz | Cevahir, Nural | Kaleli, Ilknur | Hanci, Volkan

Article | 2008 | MIKROBIYOLOJI BULTENI42 ( 4 ) , pp.617 - 625

This study focuses on the prevalence of hepatitis G virus (GBV-C/HGV) in hemodialysis patients and blood donors in Denizli (located at Aegean region of Turkey). A total of 100 patients (mean age: 56.8 +/- 13.3 years; 46 female) receiving hemodialysis and 100 blood donors (mean age: 31.3 +/- 8.1 years; 8 female) were included in the study. The presence of GBV-C/HGV RNA was determined in all patients by reverse transcriptase-PCR and the presence of GBV-C/HGV anti-E2 antibodies was determined by a commercial enzyme immunoassay (Diagnostic Automation, INC (R)). Viral RNA positivity was determined in 14 (14%) of the hemodialysis patients . . . and 2 (2%) of the blood donors, the difference being statistically significant (p < 0.05). GBV-C/HGV anti-E2 antibodies were detected in 1 (1%) of the hemodialysis patients and 3 (3%) of the blood donors. Anti-E2 positive patient also revealed positive result for viral RNA. There was no statistically significant difference between the two groups in terms of anti-E2 positivity. The prevalence of GBV-C/HGV was 14% in hemodialysis patients and 5% in blood donors (p < 0.05). There was no significant difference in terms of duration of hemodialysis, serum ALT levels, age or gender between GBV-C/HGV positive and negative hemodialysis patients. In conclusion, since hemodialysis patients are at an increased risk of parenteral transmission, they have significantly higher GBV-C/HGV viremia rates and prevalence when compared to blood donors. However, the prevalence of GBV-C/HGV and coexistence between GBV-C/HGV and hepatitis C virus have been decreasing in our region owing to increased hygienic precautions in hemodialysis units, avoidance of unnecessary blood transfusions and more widespread use of erythropoietin Daha fazlası Daha az

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