Candida auris is a fungal pathogen that was first identified in 2009. Since its definition, it has spread globally and has caused life-threatening nosocomial infections. Increases in the number of immunocompromised individuals, empirical use of broad-spectrum antimicrobials and widespread use of catheterizations are the predisposing factors in the development of infection. There are problems for the identification of C.auris with the routine methods. In this case report, infections with C.auris, isolated for the first time from three patients in our hospital's intensive care units (ICU) between November 2020-January 2021, were presented. The first case was a 46-year-old male patient with laryngeal carcinoma who developed cardiopulmonary arrest during anesthesia induction in the tumor operation, and was followed up in the ICU. C.auris growth was detected in the blood and intravenous (IV) catheter tip cultures on the 66th day of admittance. Cure achieved on the 24th day under caspofungin treatment as no growth was determined. Second case was a 71-year-old female patient admitted to the emergency department with shortness of breath and general condition disorder that developed after COVID-19 infection and hospitalized in ICU with the diagnosis of pneumonia and acute renal failure. In the 16th day of admittance C.auris growth was detected in blood and from catheter tip cultures and the patient died in the 18th day. The third case was a 49-year-old male patient, followed up in ICU with the diagnosis of subarachnoid hemorrhage after he admitted to the emergency department with confusion. In the 35th day of admittance, 100000 CFU/ mL C auris growth was detected in urine culture. The patient was accepted as asymptomatic fungiuria and followed up in the ICU. It was determined that the three patients were intubated, had urinary and femoral venous catheters and were being followed under wide spectrum antibiotherapy when the growth of C.auris was detected. Isolates identified as C.auris by MALDI-TOF Microflex LT/SH Smart MS in the Medical Microbiology Laboratory were then confirmed by conventional methods and DNA sequencing in the National Mycology Reference Laboratory. Antifungal susceptibility tests were performed by broth microdilution method. Fluconazole MIC values were >256 mg/ml for all cases. Long-term survival in hospital environments, colonization on skin, resistance to disinfectants of C.auris, facilitate the spread of the fungi and resistance to antifungals lead to treatment failures. In this case report, it was aimed to draw attention to the infections with C.auris, its diagnosis and risk factors.

Background/Objectives: Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections present a significant clinical challenge due to limited therapeutic options and high transmission potential. This study aimed to identify the resistance genes associated with carbapenemase production in CRKP isolates and evaluate the in vitro activity of ceftazidime/avibactam (CZA) and meropenem/vaborbactam (MEV), among other β-lactam/β-lactamase inhibitor combinations. Methods: Between October 2021 and June 2022, a total of 504 CRKP isolates were grown from patient samples in intensive care units. When duplicate patient samples were removed, the remaining 89 isolates were included in the study. Bacterial identification and antimicrobial susceptibility testing were per-formed using MALDI-TOF, Phoenix M50, and disk diffusion methods, following EUCAST guidelines. PCR analyses identified carbapenemase genes such as OXA-48, NDM, and KPC. Results: The most prevalent carbapenemase gene was OXA-48 (79.8%), followed by NDM (21.4%) and KPC (17.9%). The susceptibility rate to CZA was 82.0%, significantly higher than MEV (10.1%). All isolates were resistant to piperacillin/tazobactam and ceftolozane/tazobactam. Among MEV-resistant isolates, most carried the OXA-48 gene, while NDM was common in CZA-resistant isolates. Conclusions: CZA demonstrates high efficacy against OXA-48-producing CRKP, making it a viable treatment option in settings where OXA-48 predominates. The limited activity of MEV in this study underscores the need for molecular surveillance of resistance mechanisms to guide empirical therapy.

Objective: Invasive candidiasis is defined as an important infection that increases the duration of patients’ hospital stay, costs, mortality and morbidity. In this study, we aimed to investigate the frequency of candidiasis in blood cultures of pediatric hematology patients, Candida species, antifungal susceptibilities, and their effects on mortality. Materials and Methods: Patients with Candida growth in their blood cultures at follow-up in the pediatric hematology clinic of our hospital between 2020 and 2024 were included in the study. Age, gender, primary diseases and risk levels, subtypes and antifungal susceptibilities of Candida grown in blood cultures, the presence of neutropenia in patients, the antifungals used for prophylaxis and treatment, the duration of infection, other bacteria grown additionally during the fungal infection period, the local infection source and the patients’ discharge status were obtained from medical records. These constituted the study data. Results: Blood cultures were requested for 594 patients from the Pediatric hematology Clinic, and Candida was grown in only 37 (6.7%) of them. A total of 43.2% of them were the Candida parapsilosis complex, 29.7% were Candida albicans and 8.1% were the Candida haemulonii complex. Antifungal susceptibilities were over 90% for anidulafungin, micafungin, caspofungin, posaconazole, itraconazole and amphotericin B, followed by 86.7% for fluconazole and 84.4% for voriconazole. The mean age of the patient group was 6.8 years, 50.5% of whom were female and 40.5% of whom were male. The Candida infections developed on the 12.1th day of the neutropenia process on average. The mean invasive Candida infection period was 7 days. A total of 18.9% had a second bacterial infection and 13.5% had a local infection. A total of 51.4% had a single antifungal, 18.9% had two antifungals and 2.1% had more than two antifungals. A total of 35.1% of the patients with invasive candidiasis died. The primary diagnosis of the disease, Patient risk level, and the female gender were important factors affetting mortality. Conclusions: In a pediatric hematology clinic, the non-albicans group in invasive candidiasis infections was notable, with the C. parapsilosis complex occurring most frequently. There was still a high sensitivity to echinocandin antifungals and a decreased sensitivity to triazoles. It was found that the factor of the clinical diagnosis, being in the high-risk group and being female had significant effects on the survival rate of patients with candidiasis infections.

Lower respiratory tract (LRT) infections require rapid and accurate diagnosis. While bacterial culture remains the gold standard, multiplex PCR (mPCR) enables faster and more sensitive detection of multiple pathogens. This study evaluates the Bio-Speedy mPCR panel for 18 bacteria in comparison to conventional culture. A total of 100 LRT samples were analyzed. Complete concordance between the methods was observed in 85% of samples, with mPCR detecting pathogens slightly more frequently (62% vs. 53%). Discrepancies were primarily due to prior antibiotic therapy, low bacterial loads, colonization, or pathogens not included in the PCR panel. The sensitivity and specificity of mPCR were 79.3% and 96.8%, respectively, with negative agreement at 98.9% and positive agreement at 57.0%. Considering culture-negative but clinically relevant PCR-positive results, the sensitivity improved to 98.1% and the positive agreement to 86.7%. mPCR offers early pathogen detection, enabling timely therapy and potentially improving outcomes, particularly in intensive care settings. While culture remains indispensable for viable pathogen identification, combining mPCR with conventional methods provides complementary information, particularly when prior antibiotic use or the presence of fastidious pathogens may compromise culture results. Careful consideration of cost, patient population, and clinical context is recommended for optimal implementation of mPCR panels.

Members of the Erwiniaceae family, which can be found saprophytic in humans, have been identified several times as an infectious agent after their first identification in 1920. Erwinia persicina was first identified as a plant pathogen by being isolated from cucumber, tomato and banana in 1990, and it was shown to cause disease in many plant species in the following years. E.persicina was diagnosed as a urinary tract infection agent in an 88-year-old female patient in 1998. Our case, a 30-year-old male patient, was hospitalized for perihilar cholangiocarcinoma while being examined with the complaint of abdominal pain. In preparation for the operation, external drainage from the left lobe biliary tract was performed. The same bacterial growth was detected in the three bile fluid cultures of the patient taken on different dates. The bacterium was identified as E.persicina by MALDI-TOF Microflex LT/SH Smart MS (Bruker Daltonics, Germany) and Erwinia rhapontici with VITEK MS (Biomerieux, France), Rahnella aquatilis with VITEK 2 automated system, Pantoea agglomerans with BD Phoenix™ M50 (BD Diagnostics, USA) automated system. E.persicina identification was also obtained by Sanger sequencing. Antibiotic susceptibility results were evaluated according to the non-species related breakpoints criteria of the European Committee on Antimicrobial Susceptibility Testing (EUCAST). While resistance was found to cefuroxime and cefazolin, the isolate was found to be sensitive to many other beta-lactam antibiotics, quinolones and aminoglycosides. E.persicina is a bacterium that is rarely isolated as an infectious agent in humans. The reason for this may be that it is a plant pathogen on the one hand, and mistakes made in its diagnosis on the other. Many identification systems do not have this bacterium in their library. In this case report, our aim was to emphasize that mistakes made in the diagnosis of E.persicina may play a role in the rare occurence of the agent.

Toxoplasmosis is a common disease all over the world and is caused by Toxoplasma gondii. Although toxoplasmosis is usually mild, it can be clinically more serious in immunocompromised and pregnant women. Toxoplasmosis may cause miscarriage, premature birth and stillbirth in pregnancy. In this study, we aimed to report the regional prevalence of T. gondii seropositivity and acute toxoplasmosis cases. In the study, Toxoplasma IgM, IgG and Toxoplasma IgG avidity test results of pregnant women who applied to our hospital between 01/11/2018 and 14/05/2020 were reviewed for toxoplasmosis retrospectively. The duplicate samples were excluded and the results of the remaining 6567 pregnant women’s test results were evaluated. Toxoplasma IgM and IgG tests were performed together in 6435 pregnant women. Toxoplasma IgG positivity was detected in 1902 (28.9%) of them. Toxoplasma IgG avidity test was performed in 53 of 146 pregnant women, whose Toxoplasma IgM values were positive or within the limits of range. Three of these pregnant women had low Toxoplasma IgG avidity and were considered to be risky for intrauterine infection and treatment was initiated. As a result; we retrospectively evaluated the Toxoplasma IgM, Toxoplasma IgG and Toxoplasma IgG avidity test results requested from pregnant women who applied to our hospital in our study,. Similar to other studies conducted in our country, we observed that Toxoplasma IgG positivity increased significantly with age (p<0.001). Because the animal husbandry is widespread in our province, it is thought that the risk of encountering the agent increases with age, which may explain this situation. Toksoplazmoz tüm dünyada yaygın olarak görülen ve etkeni Toxoplasma gondii olan bir hastalıktır. Genellikle hafif olmakla birlikte, immün yetmezliği olanlarda ve gebelerde klinik olarak daha ciddi seyredebilmektedir. Gebelikte geçirilen toksoplazmoz sonucu düşük, erken ve ölü doğum görülebilmektedir. Bu çalışmada T. gondii seropozitifliğinin ve akut toksoplazmoz olgularının bölgesel prevalansının incelenmesi amaçlanmıştır. Çalışmada 01/11/2018 ile 14/05/2020 tarihleri arasında hastanemize başvuran gebelerin Toksoplazma IgM, IgG ve Toksoplazma IgG avidite test sonuçları retrospektif olarak incelenmiştir. Mükerrer örnekler çıkarıldığında geriye kalan 6567 gebeye ait test sonuçları değerlendirmeye alınmıştır. Gebelerin 6435’inde Toksoplazma IgM ve IgG testleri birlikteliği gözlenmiştir. Bunların 1902’sinde (%28.9) Toksoplazma IgG pozitifliği saptanmıştır. Toksoplazma IgM değeri pozitif veya sınır değer aralığındaki 146 gebenin 53’ünde Toksoplazma IgG avidite testi istemi yapılmıştır. Bu gebelerden üçünde Toksoplazma IgG aviditesi düşük bulunmuş ve intrauterin enfeksiyon açısından riskli olarak kabul edilerek tedavi başlanmıştır. Sonuç olarak; çalışmada hastanemize başvuran gebelerden istenen Toksoplazma IgM, Toksoplazma IgG ve Toksoplazma IgG avidite test sonuçları retrospektif olarak değerlendirilmiştir. Ülkemizde yapılan diğer çalışmalarla benzer şekilde Toksoplazma IgG pozitifliğinin yaşla birlikte anlamlı olarak arttığı gözlenmiştir (p<0.001). İlimizde hayvancılığın yaygın olması nedeniyle etkenle karşılaşma riskinin yaş ilerledikçe artmasının bu durumu açıklayabileceği düşünülmüştür.