Bartonella henselae is the causative agent of cat scratch disease (CSD). In this study, we aimed to investigate the clinical data of patients with suspicion of CSD and delineate current epidemiological features.A total of 785 patients with suspected CSD were included in the study. B. henselae IgM antibody was determined by indirect fluorescent antibody (IFA) test using a commercial kit (Euroimmun, Germany). Sex, age, clinical pre-diagnosis and animal contact information of the patients were obtained from hospital electronic database records.Seventy-eight (9.9%) of 785 samples were seropositive. Out of 78 patients, 46 with animal contact data were further analyzed. Of these patients, 56% were male, and 41% were under 18 years of age. Seropositivity was more commonly observed in fall and winter. The most common finding was lymphadenitis (63%). Thirty-five patients (76%) had a previous history of animal contact (cat/dog). Of the 46 seropositive patients, 78.3, 15.2, 4.4, and 2.1% had titers of 1:80, 1:160, 1:320, and 1:640, respectively.Our study confirms that CSD is not rare in Turkey. Thus, it should always be considered in the differential diagnosis of patients presenting with lymphadenopathy in all age groups, particularly children. Questioning of cat exposure should never be neglected, especially in areas with intense population of stray cats, such as Istanbul.

The rate of extensively drug-resistant and pan-resistant gram-negative rods isolated as infectious agents is increasing around the world and in Turkiye. One of the important options in the treatment of these infections is the combined use of antibiotics. Therefore, the aim of this study was to investigate the in vitro effect of meropenem/colistin and meropenem/fosfomycin combinations on carbapenem-resistant gram-negative bacilli isolated as infectious agents. Escherichia coli (n= 6), Klebsiella pneumoniae (n= 10), Pseudomonas aeruginosa (n= 5), and Acinetobacter baumannii (n= 6) isolates were recovered from blood and tracheal aspirate samples of patients hospitalized in our hospital's intensive care unit were included in the study. In the first stage of the combination study, minimal inhibitory concentrations (MIC) were investigated by broth microdilution for meropenem and colistin, and agar dilution methods for fosfomycin. In the second stage of the study, synergy, partial synergy, indifference, and antagonistic effects were investigated with the checkerboard method for the meropenem/colistin combination and the agar dilution method for the meropenem/fosfomycin combination. The checkerboard results were interpreted as follows: fractional inhibitory concentration index (FICI) values <= 0.5 synergy, < 0.5-<= 1 partial synergy, > 1-<= 4 indifference and FIC values of > 4 antagonism. MIC values obtained in the study were interpreted according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. Of the 27 isolates studied with the broth microdilution method, 63% were found to be colistin-resistant and 37% susceptible. The MIC values of fosfomycin against Enterobacterales group bacteria were found to be in the range of 2-2048 mg/L. Two of the six E.coli isolates and nine of the 10 K.pneumoniae isolates were found to be resistant to fosfomycin (IV). The MIC values of >= 128 mg/L were found in all 11 non-fermentative gram-negative rods with intrinsic resistance to fosfomycin. In the combination of meropenem/colistin, synergy and partial synergy were observed in 11 (40.7%) of 27 isolates, an indifference effect was observed in 13 (48.2%), and antagonistic effects were observed in three (11.1%) of the isolates. The synergy and partial synergy effects of this combination were 37.5% for Enterobacterales group bacteria, 50% for E.coli, and 30% for K.pneumoniae. Regarding the 11 non-fermentative gram-negative rods included in the study, 83.3% synergy and partial synergy was found in A.baumannii for the meropenem/colistin combination, while no synergy and partial synergistic effect was found in P.aeruginosa. Meropenem/fosfomycin synergy and partial synergy effects were 83.3% (5/6) for E.coli, 100% (8/8) for K.pneumoniae, 100% (6/6) for A.baumannii, and 25% (1/4) for P.aeruginosa. In all of the isolates studied, meropenem/fosfomycin combination was found to be more effective than the meropenem/colistin combination. It would be meaningful to support these data obtained in vitro with clinical efficacy results to be obtained as a result of the application of antibiotics in vivo, taking into account the pharmacokinetic and pharmacodynamic properties of the antibiotics used in this study.

Ventilatör ilişkili pnömoni (VİP), yoğun bakım ünitesi (YBÜ) kaynaklı en ciddi enfeksiyonlardan biridir. Bu çalışmanın amacı, hastanemizde VİP etkeni olarak izole edilmiş karbapenem dirençli Klebsiella pneumoniae ve Pseudomonas aeruginosa izolatlarına karşı seftazidim-avibaktamın in vitro etkinliğini saptamaktır. Endotrakeal aspirat (ETA) tarama örneklerinde etken mikroorganizma ile kolonizasyon sıklığı, VİP ile ilişkili risk faktörleri ve hasta sağ kalım sonuçlarının belirlenmesi de amaçlanmıştır. Bu retrospektif çalışmaya, Eylül 2021- Aralık 2022 tarihleri arasında Haydarpaşa Numune Hastanesi YBÜ’nde yatan ve 48 saatten daha fazla mekanik ventilasyon desteği görmüş ve VİP tanısı almış hastalar ve ETA örnekleri dahil edildi. Suşların identifikasyonunda MALDI-TOF (VITEK-MS, bioMérieux, Fransa), antibiyotik duyarlılığının belirlenmesinde VITEK 2 otomatize sistemi (bioMérieux, Fransa) kullanıldı. Seftazidim-avibaktam duyarlılığı disk difüzyon yöntemi ile belirlenerek, dirençli bulunan suşlar ayrıca gradiyent difüzyon yöntemi (MIC strip, Liofilchem, İtalya) ile çalışıldı. Suşların antibiyotik duyarlılığı, European Committee on Antimicrobial Susceptibility Testing (EUCAST) kriterlerine göre değerlendirildi. Hastalara ait mikrobiyolojik veriler laboratuvar iletişim sistemi üzerinden, klinik bilgiler ise hastane iletişim sisteminde yer alan elektronik tıbbi kayıtlardan elde edildi. Çalışmaya VIP gelişen ve örneklerinden karbapenem dirençli K. pneumoniae (n=18) ve P. aeruginosa (n=22) izole edilen 40 hasta dahil edildi. K. pneumoniae izolatlarının %22.2’si, P. aeruginosa izolatlarının ise %86.4’ü seftazidim-avibaktama dirençli bulundu. K. pneumoniae üremesi olan hastaların %16.6’sında, P. aeruginosa üremesi olanların %31.8’inde sürveyans ETA örneklerinde aynı etkenlerle kolonizasyon varlığı saptandı. VİP öncesi, en sık kullanılan antibiyotiklerin meropenem ve piperasilin-tazobaktam olduğu görüldü. K. pneumoniae üremesi olan hastalarda mortalite %83.4 iken, P. aeruginosa üremesi olanlarda %95.5 idi. Çalışmamızda karbapenem dirençli P.aeruginosa izolatlarında belirlenen yüksek direnç oranının da işaret ettiği gibi, son seçenek antibiyotiklerden biri olan seftazidim- avibaktamın, ciddi enfeksiyonlarda zamanında ve etkin kullanımı için, düzenli direnç takibininin yapılması gereklidir. Ayrıca kolonizasyonu saptamada sürveyans ETA kültürlerinin alınması, olası VİP etkeni mikroorganizmaların önceden bilinmesi için önemlidir.

Kronik Hepatit C enfeksiyonunun tedavisi ve prognozunun belirlenmesinde Hepatit C virüs (HCV) genotip tayini kilit rol oynamaktadır. HCV genotip dağılımı, bölgesel farklılıklar gösterdiği için güncel verilerin takibi önemlidir. Bu çalışmada İstanbul ilinde altı yıllık süre içinde HCV genotip dağılımının ve dağılımdaki değişikliklerin incelenmesi amaçlanmıştır. Çalışmaya, hastanemize Ocak 2016-Aralık 2021 tarihleri arasında başvuran ve HCV genotiplendirmesi yapılan erişkin hastalar dahil edilmiştir. Hastalara ait demografik veriler hastane elektronik bilgi sistemi üzerinden retrospektif olarak incelenmiştir. Çalışmaya alınan 386 hastanın %52.1’i kadın, ortalama yaş 56.1±15.5 idi. Hastaların %59.3’ünde Genotip1b, %15.3’ünde Genotip 3, %10.6’sında Genotip 1a, %2.6’sında Genotip 2, %2.6’sında miks genotip ve %2.1’inde Genotip 4 saptanmıştır. Genotip 1b’de 2018 yılında bir artış saptanırken, Genotip 3 2021 yılında, 2019 ve öncesine göre daha yüksek oranda bulunmuştur. Genotip 4, 2016' ya göre 2019 ve 2020 yıllarında anlamlı düzeyde daha yüksek bulunmuştur. Miks genotip’in son üç yılda 2017'ye göre anlamlı düzeyde yüksek olduğu saptanmıştır. Yaş, cinsiyet ve viral yük açısından genotip dağılımında istatistiksel olarak anlamlı bir fark bulunmamıştır. Sonuç olarak, hastalarımızda en sık saptanan Genotip1b, genotipler arasında ilk sıradaki yerini hala korumaktadır. Genotip 3 ve 4 oranları ise yıllar içinde anlamlı düzeyde değişikliğe uğramış ve her iki genotipin büyük çoğunluğunu yerli hastaların oluşturması dikkat çekici bulunmuştur. İstanbul hem turistik faaliyetler hem de göç sebebiyle farklı coğrafyalardan insan hareketliliğinin yoğun olduğu bir şehir olması sebebiyle, HCV genotip değişimlerinden farklı düzeyde etkilenmektedir. Bu değişimlerin düzenli takibi; tedavi seçimine yön vermesi ve prognozun belirlenmesinin yanısıra, yerel kontrol programlarının geliştirilmesi noktasında epidemiyolojik veriye katkı sağlaması açısından da önemlidir.

Mycobacterium abscessus (M.abscessus), which is from the group of non-tuberculosis mycobacteria and is widely found in the natural environment, has been reported with increasing frequency as the causative agent of various infections; especially in the lower respiratory tract and in immuncompromised people. In this report, a case of M.abscessus, which developed tubular adenoma, pancytopenia and sepsis on the basis of chronic renal failure (CRF) was diagnosed by suspecting the causative agent in the Gram stain examination prepared from blood culture, was presented. A 49-year-old patient with CRF, who had complaints of weight loss, weakness, and loss of appetite for the last six months, admitted to the emergency department with a 7-8-day history of severe diarrhea and fever. Besides other tests, as the white blood cell count was 1.6 x 103/mu l, neutrophil count was 80.6%, hemoglobin was 9.3 g/ dl and the platelet value was 36 x 103/mu l in the blood samples, the patient was first taken into internal medicine service and then to the intensive care unit with a preliminary diagnosis of hypotension and sepsis. Meropenem and teicoplanin were started with the preliminary diagnosis of peritonitis in the internal medicine service. In addition to other tests, on the fifth day of antibiotic treatment, two consecutive sets of blood cultures were taken and sent to the microbiology laboratory. A positive signal was obtained from two aerobic blood culture samples at 42 and 45 hours of incubation in the BacT/Alert device. No bacteria were observed in the Gram staining of these samples and Erhlich Ziehl Neelsen (EZN) staining was performed because the structures considered as dye residues were noted as a result of the examination. Acid-fast bacteria were observed in the EZN-stained slide examination, and a panic report was given to the clinician. The patient died shortly after the notification was made in the evening hours. On culture plates inoculated after a positive signal, at the end of two days of aerobic incubation at 37 degrees C, small smooth S colonies grew on chocolate and sheep blood agar. Growing bacteria were detected as positive by EZN staining and identified as M.abscessus with 99.9% confidence by MALDI-TOF MS. After the bacterium was named as M.abscessus, the isolates were sent to the tuberculosis central laboratory of Sureyyapaa Chest Diseases and Thoracic Surgery Hospital for molecular typing. After DNA extraction from the growing colonies and polymerase chain reaction (PCR), they were typed using the GenoType NTM-DR (Hain Lifescience GmbH, Germany) kit and identified as M.abscessus, consistent with the MALDITOF MS result. After the species level identification, the erm, rrl (clarithromycin, azithromycin), and rrs (kanamycin, amikacin, and gentamicin) genes were investigated in the isolate, and it was determined that the bacteria were resistant to macrolides and sensitive to aminoglycosides. In the clinic, it should be noted that, non-tuberculous mycobacteria may play a role as an agent in immunocompromised people. On the other hand, it should be considered that non-tuberculosis bacteria may be the causative agent, with gram-positive bacilli appearing as stain residues or pale staining in Gram stains made from samples of such patients. As in this case, if the agent is seen as dye residue in blood culture Gram staining samples, it may be life-saving to suspect the agent and to report the result to the clinician accurately and quickly after EZN staining.