Mikrobiyol Bul
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The increase in the prevalence of epidemic strains of methicillin resistant Staphylococcus aureus (MRSA) in hospitals and community requires special attention of infection control. The aim of this study was to determine the pathogenic phenotype (i.e. infectivity and resistotype) and genotypic characteristics (i.e. PFGE-pulsotyping, SLST-spa typing, MLST-sequence typing, eBURST-clonal complex detection algorithm) of clinical MRSA isolates in the Central Blacksea region of Turkey, in order to understand their short- and long-term epidemiological and evolutionary dynamics, and to investigate any probable presence of a significant clustering. ⋯ The dominant MRSA clone was ST239 which was one of the five major pandemic MRSA clones. Nosocomial MSSA isolates displayed long-term clonal diversity. This study produced regional evolutionary-epidemiological data that may support further regional, national and international long-term surveillance studies of S.aureus strains.
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Methicillin-resistant Staphylococcus aureus (MRSA) which exhibits a worldwide spread, has become a serious public health problem. There are several studies indicating that there may be a relationship between the high rate of MRSA infections and long-term use of fluoroquinolones. The aim of this study was to investigate the effect of fluoroquinolone (FQ) use in the respiratory intensive care unit (ICU) on the development of the hospital-acquired MRSA infection and mortality. ⋯ In the multivariate analysis, four independent risk factors related to the mortality in patients under FQ treatment were determined, namely malignancy (OR: 2.280, p= 0.002), re-intubation practices (OR: 4.071, p= 0.005), VAP (OR: 5.097, p= 0.009) and the use of FQ > 7 days (OR: 3.63, p= 0.003). In conclusion, our data indicated that the use of FQs in the ICU did not increase the development of hospital-acquired MRSA infection significantly, and FQ use for more than seven days was an independent risk factor for mortality. Additionally, it was thought that high leukocyte counts might be a predictive marker for the development of MRSA infection.
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Neisseria meningitidis is an unusual pathogen among the causes of acute bacterial conjunctivitis. Meningococcal conjunctivitis may present as primary or secondary infection, while primary meningococcal conjunctivitis may emerge as invasive or non-invasive forms. N.meningitidis W135 strain is not common in Turkey, and is rarely reported as the cause of meningitis. ⋯ Both strains isolated from these cases were found similar according to their phenotypical characteristics, however genotyping could not be performed. Since no other sources of exposure could be found, it was concluded that the infant with conjunctivitis acquired the bacteria from the other patient during their shared hospital visit. This patient is the first N.meningitidis W135 conjunctivitis case reported from Turkey.
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Pneumocystis jirovecii causes pneumonia in premature, newborn or malnourished children, as well as in immunocompromised subjects such as chemotherapy receiving, transplant and AIDS patients. Since the mortality and morbidity rates of Pneumocystis pneumonia (PCP) in these patients were high, rapid and accurate diagnosis is important. The aim of this study was to evaluate the diagnostic value of Giemsa staining (GS), direct fluorescent antibody (DFA) assay, (1→3)-β-D-Glucan (BDG) test and real-time polymerase chain reaction (PCR) for the detection of P.jirovecii in clinical specimens. ⋯ In the ROC analysis performed for BDG test, with DFA and BAL-PCR taken as the gold standards, the sensitivity, specificity and cut-off values of BDG were estimated as 100%, 93.9% and 494 pg/ml, and 100%, 72.8% and 62 pg/ml, respectively. Our data indicated that, overall specificity was high (100%) when using GS and DFA tests together, while the sensitivity has been elevated to 93% with the additional use of PCR and BDG tests, in the diagnosis of PCP-suspected patients. In conclusion, combination of all these tests should be performed for the laboratory diagnosis of P.jirovecii.
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Case Reports
[HBV vaccine escape mutations in a chronic hepatitis B patient treated with nucleos(t)ide analogues].
The hepatitis B virus (HBV) polymerase (pol) gene completely overlaps with the envelope (S) gene. Nucleos(t)ide analogue (NA) resistance mutations in the pol gene of HBV, either from selection of primary or secondary resistance mutations, typically result in changes in the overlapping hepatitis B surface antigen (HBsAg). Recent studies have conferred a new acronym to these HBV pol/S gene overlap mutants; ADAPVEMs, for antiviral drug-associated potential vaccine-escape mutants. ⋯ However, multiple HBV vaccine-escape mutations (sS143T + sD144E + sG145R + sE164D + sI195M) have been determined on the HBV overlapping pol/S gene region. Lamivudine and telbivudine which are the frequently preferred drugs for the treatment of CHB in Turkey, have the potential to lead to ADAPVEMs. Thus ADAPVEMs should be monitored in infected and NA treated CHB patients and their public health risks should be assessed.