Browsing by Author "Gazi, H"
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Item The Evaluation of the Diagnostic Performance of the BioFire FilmArray Meningitis/Encephalitis Panel in Children: A Retrospective Multicenter StudyBal, A; Saz, EU; Arslan, SY; Atik, S; Bayturan, S; Yurtseven, A; Gazi, H; Cicek, C; Kurugol, Z; Bal, ZSObjective Acute bacterial meningitis (ABM) declined after implementing conjugate Haemophilus influenzae type B and the pneumococcal vaccines worldwide. However, it still contributes to significant morbidity and mortality. The Biofire FilmArray Meningitis Encephalitis (FAME) panel can rapidly diagnose common bacterial and viral pathogens. Several studies suggested that the use of FAME may accelerate diagnosis and decrease the time to pathogen-specific therapy. However, the clinical utility is still controversial due to scarce data and relatively high costs. Therefore, we aimed to evaluate the diagnostic performance of FAME in children. Methods A retrospective multicenter cross-sectional study was conducted to evaluate FAME in diagnosing ABM in children with a suspected central nervous system infection between January 2017 and May 2021. Results This study consisted of 179 children diagnosed with central nervous system infection who had parallel testing done using FAME and traditional microbiological diagnostic methods. Twenty-two FAME results were positive; 8 (36.3%) were bacterial pathogens and 14 (53.7%) were viral pathogens . The most common viral pathogen was human herpesvirus 6 (n =6; 27.2%), followed by herpes simplex virus 1 (n =4; 18.1%), Enterovirus spp. (n = 2; 9%), Parechovirus (n = 2; 9%), and Cytomegalovirus (n = 1; 4.5%). Bacterial pathogens included S. pneumoniae (n = 3; 13.6%), H. influenzae (n = 3; 13.6%), Neisseria meningitidis (n = 1; 4.5%), and Streptococcus agalactiae (n = 1; 4.5%). Bacterial culture confirmed S. pneumoniae infection in only 1 of 8 (12.5%) patients, while 7 of 8 bacterial meningitis were only detected by FAME. Conclusion FAME may also help with diagnosis and pathogen identification in patients who have already had antibiotics before cerebrospinal fluid collection. The use of FAME to detect infections quickly may minimize the improper use of medications, treatment duration, and the cost of hospitalization.Item Prevalence of Chlamydia trachomatis/Neisseria gonorrhoeae and Human Papilloma Virus among Women-at Risk in the Aegian Region of Turkey, and their knowledge about IIIV/AIDSGazi, H; Surucuoglu, S; Yolasigmaz, G; Sen, M; Akcali, S; Dinc, G; Teker, A; Sanlidag, T; Koroglu, GBackground. The aim of this study was to determine the prevalence of selected sexually transmitted diseases (STDs) and the level of knowledge and attitudes regarding HIV/AIDS among Turkish brothel based sex-workers (SWs). Subjects and Methods: A pre-designed questionnaire was administered to 199 SWs to obtain their sexual behaviours and their level of knowledge of HIV/AIDS. The specimens collected for C trachomatis/N gonorrhoeae and human papillomavirus (HPV) were tested using Gen-Probe PACE 2 and HPV-screening assays, respectively. Result. Aproximatelly sixty-seven per cent of the SWs knew that condoms afforded protection against HIV/AIDS and 62% reported continued use of condoms. Although most of the SWs had heard about HIV/AIDS, thorough knowledge of transmission and prevention was lacking. The overall estimated rates for C trachomatis/N gonorrhoeae and HPV were 18.6% and 9.7%, respectively. CONCLUSION: There is a need for further studies to generate more data on the prevalence of STDs and the knowledge of STDs in this population.Item Seroprevalence of West Nile virus, Crimean-Congo hemorrhagic fever virus, Francisella tularensis and Borrelia burgdorferi in rural population of Manisa, western TurkeyGazi, H; Özkütük, N; Ecemis, T; Atasoylu, G; Köroglu, G; Kurutepe, S; Horasan, GDBackground & objectives: Zoonotic diseases are well recognised threat to public health globally. The information of regional prevalence and associated risk factors allow the national programmes to determine and frame better strategies for their control, as they also provide the actual status of zoonosis in the region. The aim of this study was to determine the seroprevalence of West Nile virus (WNV), Crimean-Congo hemorrhagic fever virus (CCHFV), Francisella tularensis and Borrelia burgdorferi among the rural residents of Manisa region, Turkey and to identify the associated risk factors. Methods: Cross sectional study was conducted in rural parts of Manisa, Aegean region of western Turkey in 2012. Blood samples from 324 randomly selected subjects were screened for the presence of IgG antibodies to WNV, CCHFV, F. tularensis and B. burgdorferi with commercially available kits. The demographic structure of the rural residents and risk factors related to lifestyle such as outdoor agriculture activities, animal husbandry, hunting and history of tick bite were questioned and their relationships with positive results were analyzed statistically. Results: It was observed that 49 subjects (15%) had IgG antibodies to at least one of the zoonotic agents studied. The seroprevalence of F. tularensis was highest with a percentage of 7.1% (n = 23). Distribution of the positive results for WNV, CCHFV and B. burgdorferi were 4.3% (n = 14), 3.7% (n = 12) and 0.9% (n = 3), respectively. Older age and uncompleted secondary education were the statistically significant risk factors for seropositivity to at least one zoonotic agent investigated. Logistic regression analyses confirmed that older age (over 50) increased the risk of WNV and CCHFV seropositivity. Interpretation & conclusion: Seropositivity rates were not found to be higher than the expected rates. Further, studies are needed to evaluate the threat of vector borne zoonoses and associated risk factors in the study area.Item Drug-resistant pulmonary tuberculosis in western Turkey: prevalence, clinical characteristics and treatment outcomeSurucuoglu, S; Ozkutuk, N; Celik, P; Gazi, H; Dinc, G; Kurutepe, S; Koroglu, G; Havlucu, Y; Tuncay, GBACKGROUND: Although high antituberculosis (anti-TB) drug resistance rates have been reported in Turkey, the clinical characteristics and implications for the outcome of anti-TB treatment have not been fully investigated. We determined the prevalence of anti-TB drug resistance and examined demographic data, clinical characteristics and treatment outcome in relation to patterns of resistance. METHODS: From the TB case registry of a university hospital and the two largest dispensaries in Manisa city, we identified all pulmonary TB cases with a culture-proven definitive diagnosis and antimicrobial susceptibility results for a 7-year period. We collected and analyzed demographic and clinical data and information on treatment outcome for those cases in relationship to anti-TB drug resistance. RESULTS: Of 355 M. tuberculosis strains, 71.5% were susceptible to streptomycin, isoniazid, rifampicin and ethambutol. Any drug resistance and multi-drug resistance (MDR) rates were 21.1% and 7.3% and were higher in males (53% and 9%, respectively) than in females (22% and 1%, respectively). Drug resistance was significantly higher in old cases (acquired drug resistance) vs new cases (primary drug resistance), and was associated with treatment failure (P<0.001). The prevalence of MDR was significantly higher in the old cases (22.4%) than in the new cases (4.4%) (P<0.001). Symptoms, radiographic findings, associated diseases, and sputum smear positivity were unrelated to the development of resistance. The prevalence of any drug resistance and MDR was significantly higher in those with treatment failure than in patients with treatment success. CONCLUSION: High resistance rates, particularly for acquired MDR, indicate a need for improvement in the TB control programme in our region.Item Antimicrobial Resistance Patterns of Mycobacterium abscessus Complex Clinical IsolatesSürücüoglu, S; Özkütük, N; Gazi, H; Çavusoglu, CObjective:This study aimed to identify subspecies of Mycobacterium abscessus complex (MABC) isolates from clinical samples by a molecular technique and to determine mutations responsible for macrolide and aminoglycoside resistance. We also aimed to investigate the correlation of phenotypic and molecular test results by examining the resistance to antimicrobial agents according to CLSI standard using the liquid microdilution test. Methods: 27 MABC isolates from clinical samples were examined. Molecular subspecies identification and mutations responsible for aminoglycoside (rrs mutation) and macrolide resistance (rrl mutation) were determined using the GenoType NTM-DR test. The resistance phenotypes of the strains to various antimicrobial agents were investigated by the Sensititre (TM) RAPMYCOI AST microdilution test. Results: Of the 27 isolates tested, 21 were M. abscessus subsp. abscessus, three were M. abscessus subsp. bolletii, and three were M. abscessus subsp. massiliense; rrs and rrl mutations were not observed in any strains. Except for one isolate, all M. abscessus subsp. abscessus strains showed the erm(41) T28 genotype, which indicates inducible macrolide resistance. The correlation between the GenoType NTM-DR and phenotypic susceptibility test results was 81% (k=0.5, p=0.02) for inducible macrolide resistance and 89% for acquired macrolide resistance. The most effective antimicrobial agents were amikacin, cefoxitin, imipenem, linezolid, and tigecycline. Conclusion: Although the GenoType NTM-DR test is reliable in identifying and detecting molecular macrolide and aminoglycoside resistance, there were discrepancies in the results. We recommend confirming the results with the phenotypic susceptibility method after growth on culture. Although the M. abscessus complex is resistant to many antimicrobial agents, it has shown high sensitivity to amikacin, cefoxitin, imipenem, linezolid, and tigecycline. High levels of inducible macrolide resistance in isolates indicate the importance of subtyping and sensitivity testing of iso-lates in patients where culture conversion has not been achieved.Item Evaluation of Real-Time PCR Method for Rapid Diagnosis of Brucellosis with Different Clinical ManifestationsSurucuoglu, S; El, S; Ural, S; Gazi, H; Kurutepe, S; Taskiran, P; Yurtsever, SGIn this study, we tested the advantages of TaqMan real time PCR technique and compare it to conventional methods using serum samples from patients with different clinical forms of brucellosis. A total of 50 patients were included in the study. Blood culture using BACTEC 9240 system, Standard Wright's tube agglutination, and real time PCR methods were used. Control blood samples from 30 people with no history of brucellosis or exposure to Brucella spp. were examined too. Serological assay was positive for 49 patients (98%). Forty-four (88%) of the 50 patients had a positive PCR result, whereas Brucella spp were isolated from blood cultures of 18 patients (36%). STA test was all positive for focal brucellosis. Real time PCR test was positive in 9 patients with focal disease (90%), whereas blood culture was positive only in 4 patients (40%). The sensitivity, specificity, positive and negative predictive values of the real time PCR method were calculated as 88%, 100%, 100%, and 83%, respectively. Our results suggest that the high sensitivity and specificity of real time PCR method make it a useful tool for diagnosis of brucellosis with different clinical manifestations.Item Characterization of rpoB mutations by line probe assay in rifampicin-resistant Mycobacterium tuberculosis clinical isolates from the Aegean region in TurkeyOzkutuk, N; Gazi, H; Surucuoglu, S; Gunduz, A; Ozbakkaloglu, BThe nature and frequency of mutations in the rpoB gene of rifampicin (RIF)-resistant Mycobacterium tuberculosis clinical isolates vary considerably according to the geographical location, and very little information is available regarding specific mutational patterns in our country. The main objective of this study was to determine the frequency of mutations in the hypervariable region of the rpoB gene in RIF-resistant M. tuberculosis isolates recovered from tuberculosis patients in our region by using the INNO-LiPA Rif. TB kit and to evaluate the performance of the kit for the detection of RIF-resistance. Mutations associated with RIF resistance were studied by line probe assay (LiPA) in 65 RIF-resistant and 56 RIF-susceptible M. tuberculosis strains isolated from different patients in the Aegean region of Turkey. The LiPA identified all susceptible strains (100%) as RIF-sensitive and 63 of 65 (96.9%) phenotypically documented RIF-resistant M. tuberculosis isolates as RIF-resistant, with specific detection of mutation in 44 (67.7%) isolates, whilst 2 strains were identified as RIF-susceptible. The R5-pattern (Ser-531-Leu mutation) was the most frequently observed (35 of 65, 53.8%), followed by the Delta S2-pattern (7.7%) and Delta S4-pattern (7.7%).Item Aspergillus Endogenous Endophthalmitis as a Clue to Identifying a Delayed Lumbosacral OsteomyelitisAltinisik, M; Akgun, YD; Erdogan, M; Mutawakkil, AF; Gazi, HPurposeTo present a case of aspergillus-induced endogenous endophthalmitis evolving into delayed lumbosacral osteomyelitis, initially misdiagnosed as ankylosing spondylitis (AS) in an immunocompetent patient.MethodCase Report.ResultsA 38-year-old woman, initially treated for pneumonia, experienced sudden loss of vision in her left eye, prompting a thorough examination that revealed a distinct chorioretinal infiltrate. Microbiological analysis of the patient's vitreous samples detected Aspergillus fumigatus, leading to the diagnosis of endogenous endophthalmitis. Treatment involved vitrectomy, intravitreal injections, and intravenous amphotericin B. Two months later, she was referred for lower back pain, misdiagnosed as AS. Lumbosacral biopsy confirmed Aspergillus involvement once more, necessitating antifungal therapy.ConclusionThis case highlights the atypical progression of Aspergillus-induced endogenous endophthalmitis to delayed lumbosacral osteomyelitis in an immunocompetent individual. It highlights the crucial role of a meticulous medical history examination and interdisciplinary collaboration in diagnosing and managing diseases, especially in cases with atypical presentations.Item Significance of Fluorescent In-Situ Hybridization Method in Rapid Diagnosis of BrucellosisGazi, H; Yurtsever, SG; Sürücüoglu, S; El, S; Ertural, PObjective: Brucellosis is a zoonosis commonly seen worldwide it causes severe disease and great economic loss. Rapid and sensitive tests are increasingly required for detection of the disease since currently used conventional diagnostic methods give results late and there are some factors affecting its sensitivity. Recently, a number of diagnostic tests have been determined that use different clinical samples in order to diagnose brucellosis in a short time. However a sufficiently sensitive and specific, optimized, routinely applicable molecular method is still lacking for detection of brucellosis which is defined as a difficult infection in terms of diagnosis and treatment. Fluorescent in situ hybridization (FISH) is a novel molecular diagnostic method that can detect Brucella spp. from hemoculture tubes signaling positively by shortening identification time. In this study, we aimed to compare FISH technique with conventional culture method in diagnosis of brucellosis and to investigate its use routinely. Material and Methods: A total of 100 hemoculture samples of patients who applied with the suspicion of brucellosis were studied with FISH and culture methods concurrently, after gram staining. Standard Wright's tube agglutination (STA) test was also used for interpretation of the FISH results. Results: Of the tested samples, 43 studied with cultures, 52 with STA and 44 with FISH were found positive. The FISH detected Brucella spp. in 34 positive cultures and in 29 STA positive sample. Sensitivity, specifity, positive and negative predictive values of FISH method were found as 79.0%, 82.4%, 77.2% and 83.9% respectively when evaluated together with culture which is the gold standard method. Conclusion: FISH is a rapid and easily applicable method not requiring much equipment. However, it was concluded that it could not be used as a cost-effective diagnostic tool as it was not as sensitive enough as desired, and in case of it is used, it would be useful to confirm FISH negative samples with culture and/or serum tube agglutination test.Item In-vitro effects of various antimicrobial combinations against multidrug-resistant Acinetobacter baumannii strainsGüçkan, R; Kurutepe, S; Gazi, H; Kilinç, ÇIn recent years, Acinetobacter strains have emerged as one of the most important nosocomial pathogens, especially in patients admitted to an intensive care unit (ICU). The progressively increasing antibiotic resistance against A. baumannii is now a major problem in our country as it is throughout the world. This resistance against A. baumannii has increased and led clinicians to find alternative antibiotics or antibiotic combinations. In the present study, it is aimed to evaluate the interaction between colistin-rifampicin, colistin-imipenem, tigecycline-rifampicin and tigecycline-imipenem antibiotic combinations using microdilution checkerboard and E-test methods against ten multidrug resistant A. baumannii strains. Since A. baumannii strains have become frequently observed as an infection factor and since antimicrobial resistance rates have increased, there should be newly developed drugs for better treatments. In this study, 50 A. baumannii strains were isolated from various clinical specimens between June 2005 and September 2009 in Celal Bayar University, Faculty of Medicine, Department of Microbiology and Clinical Microbiology, and in Bacteriology Laboratory. Isolation and identification procedures were performed by using conventional biochemical tests as well as by BBL Crystal GN; N/F ID (Becton Dickinson, USA) or Phoenix 100 BD systems (Becton Dickinson, USA). The antibiotic susceptibilities of strains were investigated by using the disk diffusion method according to the recommendations of the Clinical and Laboratory Standards Institute. According to our in vitro study results, the checkerboard method, which was used to examine the synergy between colistin-rifampicin and colistin-imipenem, showed 80% synergistic activity. Tigecycline-imipenem combination had lowest synergetic (10%) efficiency and highest antagonistic effect (30%). The consistency between checkerboard and E-test methods was 52,5% (range 10-70%). Further comparison studies of the E-test synergy technique with the checkerboard and time-kill methods are warranted.Item Molecular Diversity of Drug Resistant Mycobacterium Tuberculosis Strains in Western TurkeySürücüoglu, S; Günal, S; Özkütük, N; Biçmen, C; Özsöz, A; Gazi, H; Durmaz, RObjective: The aim of this study was to investigate the molecular diversity and clonal relationship of drug resistant Mycobacterium tuberculosis strains isolated in Western Turkey. Materials and Methods: A total of 87 strains isolated between 2006 and 2009, eight of which were rifampicin monoresistant and 79 were multidrug resistant, were analyzed with IS6110 RFLP and spoligotyping methods. Results: The results of spoligotyping showed that 7% of the strains were orphans, and 8% were undefined for family in the SpolDB4 database. Major families of the strains were LAM (38%), T (35%), Haarlem (7%), Beijing (2%), S (2%) and U (1%) families. The clustering rate by spoligotyping was calculated as 75%. The most predominant SIT cluster was SIT41 (29%). According to the results of IS6110 RFLP, 71 different patterns of IS6110 were observed. Low copy number was found in 26% of the strains. When the results of two methods were combined, the final clustering rate was calculated as 26%. Conclusions: The genotypical distribution of drug resistant tuberculosis isolates in our region indicates genetic diversity and the clustering rate was found low in our region. However, more comprehensive and long-term molecular epidemiological studies are needed to control the drug resistant strains.Item Second-line drug susceptibilities of multidirug-resistant Mycobacterium tuberculosis isolates in Aegean region - TurkeyÖzkütük, N; Sürücüoglu, S; Gazi, H; Coskun, M; Özkütük, A; Özbakkaloglu, BAim: The emergence of multidrug-resistant tuberculosis (MDR-TB) is increasing, and the standard short-course regimen used for the treatment of TB is likely to be ineffective against MDR-TB, leading to the need for second-line drugs. In such situations, drug susceptibility testing is necessary to select an appropriate treatment regimen. Unfortunately, there are few studies showing the pattern of the second-line drug resistance in Turkey. We aimed to analyze the resistance to second-line anti-tuberculosis drugs of MDR strains of Mycobacterium tuberculosis isolated from the Aegean region of Turkey. Materials and Methods: In this study, drug susceptibility testing of 40 MDR-TB strains isolated from the Aegean region of Turkey was performed using the BACTEC 460 TB radiometric system. Capreomycin, ethionamide, kanamycin, amikacin, clofazimine and ofloxacin were tested in 1.25 mu g/ml, 1.25 mu g/ml, 5.0 mu g/ml, 1.0 mu g/ml, 0.5 mu g/ml, and 2.0 mu g/ml concentrations, respectively. Results: The results showed that 37.5% of the strains were resistant to ethionamide, 25% to capreomycin, 5% to kanamycin, amikacin and ofloxacin, and 2.5% to clofazimine. One (2.5%) of the 40 MDR-TB cases was defined as extensively drug-resistant tuberculosis (XDR-TB). Conclusions: The results of the study indicate that the high rates of resistance to ethionamide and capreomycin may be a problem in the treatment of patients with MDR-TB; XDR-TB is not yet a serious problem in our region.Item Comparison of interferon-gamma whole blood assay with tuberculin skin test for the diagnosis of tuberculosis infection in tuberculosis contactsÖztürk, N; Sürücüoglu, S; Özkütük, N; Gazi, H; Akçali, S; Köroglu, G; Çiçek, CTuberculin skin test which is used for the detection of latent tuberculosis (TB), has many disadvantages such as false positivities due to cross reactions between environmental mycobacteria and BCG strain, false negativities due to immunosuppression and malpractice, and also difficulties in application and evaluation. Recently a new diagnostic test which measures the production of interferon (IFN)gamma in whole blood upon stimulation with specific ESAT-6 and CFP-10 antigens of Mycobacterium tuberculosis has been introduced. Since most of the mycobacteria other than tuberculosis and BCG strain do not contain these antigens, the detection of IFN-gamma levels indicates the specific T-cell response against M.tuberculosis. The aim of the study was to compare the tuberculin skin test and whole blood IFN-gamma assay (QuantiFERON (R)-TB Gold, Cellestis Ltd, Carnegie, Victoria, Australia) for the identification of latent TB infection in the contacts with active TB patients. The tests results were evaluated by using Kappa (K) analysis, and K coefficients of < 0.4, 0.4-0.75 and > 0.75 were accepted as poor, moderate and excellent agreements, respectively. A total of 233 subjects from three risk groups were included to the study. Group 1 included the household members (n=133) who had contact with smear positive index cases, Group 2 included the subjects from community (n=46) who had contact with smear positive index cases, and Group 3 included health care workers (n=74) who had contact with TB patients or their specimens. The positivity rates of tuberculin skin test and IFN-gamma assay in the cases were found as 37% and 42%, respectively. There were no significant differences among the three patient groups with regard to the results of the tuberculin skin test (p > 0.05). However, the positive result of the IFN-gamma assay in Group 1 was found statistically higher than the other groups (51.3%, p=0.013). A poor agreement between the two tests was detected in the results taken from 233 subjects (65.7%, K=0.28), while agreement was moderate in unvaccinated group (72.7%, K=0.44). Evaluation of agreement rates of the tests according to the risk groups yielded 64.6% (K=0.3) for Group 1, 71.7% (K=0.32) for Group 2, and 63.5% (K=0.21) for Group 3, which all coefficients showed poor agreement. Although IFN-gamma blood assay has many advantages such as objective and quantitative results, no interference with vaccination due to the use of specific antigens and being practical, the high cost and the need for well-equipped laboratory are its disadvantages. As a result it was concluded that, IFN-gamma blood assay has limited value for the detection of latent TB infection in our country, since the prevalence of TB infection and BCG vaccination rates are high in Turkey.Item In vitro Activity of Rifabutin and Clofazimine to Macrolide- Resistant Mycobacterium abscessus Complex Clinical IsolatesSürücüoglu, S; Özkütük, N; Gazi, H; Çavusoglu, CMycobacterium abscessus complex (MABSC) is one of the most resistant bacteria against antimicrobial agents. The number of agents that can be used by oral route, such as macrolides, is limited in antimicro- bial therapy. In recent years, rifabutin and clofazimine have gained importance as they can be admin- istered by oral route and have shown synergistic effects with macrolides and aminoglycosides. The aim of this study was to determine the in vitro activity of rifabutin and clofazimine against clinical isolates of MABSC resistant to macrolides. A total of 48 MABSC isolates obtained from respiratory tract and other clinical samples in the Tuberculosis Laboratories of the Faculty of Medicine of Manisa Celal Bayar and Ege Universities were included in the study. Subspecies differentiation and aminoglycoside and macrolide resistance of the isolates were determined by GenoType NTM-DR test. Rifabutin and clofazimine sus- ceptibilities were determined by standard broth microdilution method. Of the MABSC isolates 42 were identified as M.abscessus subsp. abscessus, three as M.abscessus subsp. bolletii and three as M.abscessus subsp. massiliense. None of the isolates exhibited rrs and rrl mutations indicating acquired macrolide resistance and aminoglycoside resistance. However, the erm(41) T28 genotype which is associated with inducible macrolide resistance was detected in 41 (85%) of the strains. All M.abscessus subsp. massiliense isolates were found to be genotypically susceptible to macrolides. The minimum inhibitory concentration (MIC) range values for rifabutin were 0.0625 to 32 mu g/mL, while for clofazimine, the range was 0.0625 to 1 mu g/mL. Rifabutin MIC values were significantly higher (mean 5.98 mu g/mL vs 0.5 mu g/mL, p= 0.026) in the isolates with macrolide resistance. There was no correlation between macrolide resistance and clofazimine MIC values (mean 0.25 mu g/mL vs. 0.214 mu g/mL, p= 0.758). The MIC50 and MIC90 values for rifabutin were 1 and 8 mu g/mL, respectively, while for clofazimine they were 0.25 and 0.5 mu g/mL. Macrolide resistance was found to be higher in isolates with rifabutin MIC values above the MIC50 value (p= 0.045). In conclusion, the determination of higher rifabutin MIC values in isolates resistant to macrolides suggested that susceptibility testing should be performed before adding rifabutin to the treatment regimen. The low MIC values of clofazimine in all strains indicated that it may be used as a first choice in the combination therapy. However, further studies using a larger number of clinical isolates and applying genotypic and phenotypic susceptibility tests are needed to determine threshold MIC values to assist clinicians in treatment decisions.Item Prevalence and evaluation of a choromogenic medium for isolation of Escherichia coli O157 from children with acute gastroenteritisDegerli, K; Kurutepe, S; Gazi, H; Demirel, M; Gülkan, E; Sürücüoglu, SObjective: Comparative performance status of CHROMagar O157 (CHROM) sorbitol-MacConkey (SMAC) media for the detection of Escherichia coli (E. coli) O157 in stool specimens isolated from 339 children under 5 years of age who presented with acute gastroenteritis between September 2008 and September 2010 was determined. Methods: Stool specimens were inoculated onto Sorbitol-MacConkey agar (SMAC), CHROMagar O157, Selenit F, Salmonella-Shigella (SS) and MacConkey agars. All plates were incubated aerobically for 24 to 48 h at 35 degrees C. Colorless colonies on the SMAC plate and mauve colonies on the CHROM plate were selected for further identification by conventional biochemical tests as well as by semi-automated system. Colonies confirmed to be E. coli were screened for O157 antigen by Dry spot E. coli O157 latex particle agglutination test. Results: In 339 stool samples examined, Salmonella spp was isolated in 14 (4.1%), and Shigella spp. in 11 (3.2%), while Escherichia coli O157 was detected in only 1 (0.3%) sample. Suspect E. coli O157 stains grew on 8 CHROMagar (2.1%; 8/339) and 14 SMAC (14/339; 3.8%) plates. Rate of false positivity for colony picks from SMAC (n= 13; 65%) media was almost 2-fold higher than that for CHROM (n= 7; 35%). Conclusion: Routine use of chromogenic media for the investigation of E. coli O157' nin in the selected cases with bloody diarrhea is deemed appropriate.Item Seroprevalance of Measles, Rubella, Mumps, Varicella, Diphtheria, Tetanus and Hepatitis B in Healthcare WorkersCiliz, N; Gazi, H; Ecemis, T; Senol, S; Akcali, S; Kurutepe, SObjective: We aimed to determine the antibody levels of healthcare workers of Celal Bayar University Hospital against vaccinepreventable diseases such as measles, rubella, mumps, diphtheria, tetanus, varicella and hepatitis B, and encourage compliance to recommended vaccinations for non-immune staff. Methods: The antibody levels were tested by enzyme-linked immunosorbent assay (ELISA). Demographic characteristics were collected by a questionnaire, and the history of the diseases, immunization and the sharps-related injuries were queried. Results: 44% percent of 309 healthcare personnel were exposed to occupational injury at least once, and 78.3% of the injuries were needle-stick injuries. Injuries were found to be more common among doctors and nurses, and pediatric and surgical departments, respectively. Frequency of anti-HBs positivity among healthcare workers was 84.1%, while 71.5% of healthcare workers were immunized with HBV vaccine before starting to work, and the immunization status directly correlated with the level of education. In general, high seropositivity was noted for measles (99.7%), rubella (97.0%), mumps (99.7%) and varicella (99.7%), while diphtheria (60.8%) and tetanus (93.5%) antibody levels significantly decreased with age. Histories of the disease and vaccination were not reliable while verifying the immunity status. Conclusions: It is necessary to increase adherence to universal protective measures in healthcare workers and to take corrective and protective measures for sharps-related injuries. It is also essential to increase hepatitis B vaccination rates and to confirm the immune status of medical staff working in high risk departments and diphtheria and tetanus vaccinations should be repeated once every ten years.Item Seasonal Trends and Interactions of Viral Pathogens in Children Presenting with Acute Respiratory Tract Infections in the Advancing Periods of SARS-Cov-2 PandemicTürkmen Recen, Ö; Gazi, H; Bayturan Sen, S; Bal, A; Akçali, SAlthough various bacteria and viruses have been identified in the etiology of acute respiratory tract infections (ARI), 90% of acute ARIs that develop in children are of viral origin. The aim of this study was to investigate the seasonal trends and interactions between infectious agents and to determine the risk factors associated with ARI in children aged 1-15 years admitted to the Pediatric Emergency Department of Manisa Celal Bayar University Hospital in the advancing periods of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic. To determine the bacterial and viral agents, samples were taken from 314 patients attending to the hospital with symptoms suggestive for ARI, between 06/01/2021 and 05/31/2022. Viral and bacterial agents were identified by multiplex polymerase chain reaction (PCR) and automated identification system, respectively. Demographic data of the participants and possible risk fac- tors for ARI were recorded in the questionnaires. In the study, viral agents were detected in 77.3% of the children, and the most common infectious agent was rhinovirus/enterovirus (RV/EV) (36.3%), followed by influenza viruses (11.2%), and SARS-CoV-2 (10.5%). While RV/EV positivity was found to be higher in children with moderate and below average (p< 0.001) hand hygiene, influenza positivity was found higher in those attending school/preschool institution (p< 0.001) and whose mothers working full-time (p< 0.001). Respiratory syncytial virus positivity was associated with maternal smoking (p= 0.013) and home overcrowding (p= 0.014). Bacterial colonization was detected in 33 (11.6%) of 284 children whose swabs were taken for both bacterial and viral agents and the most frequently detected agents were Staphylococcus aureus (60.6%) and Pseudomonas aeruginosa (15.2%). Having siblings (p= 0.008) and maternal smoking (p= 0.012) were found to be associated with the detection of bacterial agents. In this study, in the advanced period of the pandemic, the most detected agents and seasonal characteristics were found to be similar to the pre-pandemic period. It is thought that knowing the regional etiology and risk factors will contribute to taking the necessary local control and protective measures.Item Increasing antimicrobial resistance in Escherichia coli isolates from community-acquired urinary tract infections during 1998-2003 in Manisa, TurkeyKurutepe, S; Surucuoglu, S; Sezgin, C; Gazi, H; Gulay, M; Ozbakkaloglu, BUrinary tract infections are among the most common infections with an increasing resistance to antimicrobials. The aim of this study was to determine the change in antimicrobial susceptibility of Escherichia coli isolates from patients with community-acquired urinary tract infection (UTI) for the years 1998 through 2003 and to suggest that the current empirical antibiotic therapy used for these patients is inappropriate. During the study period, 7,335 community urine samples of which 1,203 (16.4%) grew bacterial isolates were analyzed. Among the total of 1,203 isolates, 880 (73.2%) were E. coli. The range of resistance of E. coli to ampicillin was 47.8 to 64.6% and that to trimethoprim-sulfamethoxazole was 37.1 to 44.6% during the study period. The susceptibility pattern of E. coli to nitrofurantoin and cefuroxime did not vary significantly over the 6-year period. There was a significant increase in the susceptibility of E. coli to ciprofloxacin (11.3 - 26.7%), amoxicillin-clavulanate (18.4 - 29.2%) and gentamicin (7.0 - 25.6%) (P < 0.05). Empirical initial treatment with ampicillin and trimethoprim-sulfamethoxazole was thus inadequate in approximately half of UTI cases in our region.Item Comparison of antimicrobial effects of dexmedetomidine and etomidate-lipuro with those of propofol and midazolamKeles, GT; Kurutepe, S; Tok, D; Gazi, H; Dinç, GBackground and objectives: The aim of our study was to investigate the antimicrobial effects of dexmedetomidine and etomidate-lipuro, and to compare these effects with those of midazolam and propofol on Staphylococcus aureus, Escherichia coli, Pseudomonas aeroginosa, Acinetobacter baumannii and extended-spectrum beta-lactamase Escherichia coli (E. coli ESBL). Methods: All hypnotic dilutions were exposed to micro-organisms for 0, 30, 60, 120 and 240 min at room temperature in vitro. The inoculums taken from diluted suspensions were re-inoculated on blood agar and incubated for 18-24 h at 35 degrees C after which a count of the colonies was compared. Results: Midazolam reduced the viable cells of S. aureus at 30, 60, 120 and 240 min, and also completely inhibited the growth of E. coli, R aeroginosa, A. baumannii and E. coli ESBL. Dexmedetomidine, etomidate-lipuro and propofol, however, did not inhibit any of the micro-organisms tested. Conclusion: In vitro, midazolam had an antimicrobial effect on E. coli, P aeroginosa, A. baumannii and E. coli ESBL. Like propofol and dexmedetomidine, etomidate-lipuro had no antimicrobial effect on any of the micro-organisms tested.Item Antimicrobial susceptibility of bacterial pathogens in the oropharynx of healthy school children in TurkeyGazi, H; Kurutepe, S; Sürücüoglu, S; Teker, A; Özbakkaloglu, BBackground & objectives: Information on oropharyngeal carriage rates of Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus Pyogenes and Moraxella catarrhalis and their resistance pattern in healthy school children in Turkey is lacking. The present study was undertaken to determine the carriage rates and antimicrobial resistance of these bacterial pathogens in such children aged 6-14 yr in Manisa, Turkey. Methods: A total of 1022 children were included from nine schools selected randomly from 32 schools. Throat swabs were cultured for bacteria which were identified using standard microbiological methods. Antimicrobial susceptibility was determined as per National Committee for Clinical Laboratory Standards guidelines. Results: Of the 1022 children 240 (23.4%) harboured S. pneumoniae, , 162 (15.8%) H. influenzae. 30 (2.9%) S. pyogenes and 82 (8%) M.. catarrhalis in their oropharynx. For S. peumoniae overall 17.9 per cent of the isolates were intermediately and 7 per cent were resistant to penicillin and resistance to erythromycin trimethoprim-sulphamethoxasole (TMP/SMX), and chloramphenicol was 13.7, 9.1 and 1.6 per cent, respectively. Ampicillin resistance observed in 20.9 per cent of H. influenzae isolates was associated with the presence of D-lactamase. except two isolates interpreted as -lactamase-negative ampicillin resistant strains. Resistance of H. influenzae to TMP/SMX, chloramphenicol, azithromycin, cefaclor and amoxicillin/clavulanic acid was 14.2. 2.4, 1.8, 1.2 and 1.2 per cent, respectively. M. catarrhalis isolates produced beta-lactamase in 80.5 per cent of the cases and all were susceptible to macrolides and clavulanic acid/amoxicillin combination; the highest rate of resistance of 17 per cent was for TMP/SMX. One (3.3%) isolate of S. pyogenes was resistant to macrolides tested. Interpretation & conclusion: Our data shows that upper respiratory tract of about 50 per cent children was colonized with respiratory pathogens. There is a need for surveillance of nasopharyngeal carriage of resistant strains in healthy school children.