Introduction. The aims of this study are to determine the seroprevalence for measles, mumps, rubella, and varicella zoster virus (VZV) in a cohort of nursing students, to evaluate vaccination response rates of nonimmune students, and to calculate the cost of vaccinating students based on seroprevalence screening. Material and methods. A cross-sectional study was conducted August 2015-November 2016 among 326 healthy nursing students aged 14.1-18.1 years. Serum IgG antibodies were measured by ELISA. Results were analyzed by the Chi-square test; a p-value of < 0.05 was considered statistically significant. Results. The number of seropositive participants (%) was 308 (94.5%) for rubella, 295 (90.5%) for VZV, 244 (74.9%) for measles, and 219 (67.2%) for mumps. A significant correlation was found between measles IgG and age. A relationship was also observed between VZV IgG and kindergarten attendance. Response rates to measles, rubella, VZV, and mumps vaccination were 96%, 92.3%, 87.5%, 78.8%, respectively. The total cost of vaccination after IgG screening was less than vaccination without screening. Conclusions. In this study, participants' immunity to measles and VZV was low. Prevaccination serological screening was cost-effectiveness method for preventing measles, mumps, rubella, and varicella infections. We believe that administering booster measles, mumps, and rubella (MMR) vaccine doses or developing a special MMR vaccination strategy for at-risk groups may prevent MMR outbreaks.

Introduction: Acinetobacter baumanii causes difficulties in the treatment of nosocomial infections due to increasing resistance worldwide. With an increase in resistant infections, the use of colistin has come to the fore. We aimed to investigate the antimicrobial resistance profile of A. baumanii strains isolated from clinical specimens as hospital-acquired colonizations and infection agents and to evaluate the clinical and microbiologic responses and adverse effects of antibiotic regimens used in patients who were isolated because of having infectious agents. Materials and Methods: A retrospective descriptive study of 326 adult patients with nosocomial A. baumannii colonizations and infections was conducted between January 2012 and December 2017 in Niğde Education and Research Hospital. In addition, a total of 212 adult patients who received at least 72 hours of antimicrobial therapy were evaluated. Standard and automated methods were used to identify isolated strains and antibiotic susceptibility. The antimicrobial susceptibility profile change over the 6-year period was evaluated. Adverse effects, and clinical and microbiologic response were evaluated in patients receiving antimicrobial therapy. Analysis of the variables was performed using SPSS 22.0 (IBM Corporation, Armonk, New York, United States). Results: When antimicrobial resistance rates were examined, it was seen that imipenem (99.7%), ampicillin sulbactam (81.6%), cefoperazone sulbactam (60.3%), netilmicin (89.4%), tobramycin (88.4%), gentamicin (83.1%), amikacin (91.6%) and tigecycline (33.7%) had resistance rates; colistin resistance was not detected in the isolates. Resistance rate to other antibiotic groups was 100%. The resistance rates of ampicillin sulbactam, cefoperazone sulbactam, gentamicin, amikacin, and tigecycline were found to be statistically significant (p< 0.05). There were no significant differences in terms of nephrotoxicity, and clinical and microbiologic response among patients in whom colistin was used in combination with carbapenem, ampicillin/sulbactam, cefoperazone/sulbactam, and tigecycline (p> 0.05). Conclusion: In accordance with the global data, antimicrobial resistance rate in A. baumanii isolates was found to be high in our study. Treatment regimens in which colistin is used with other antimicrobial agents have no superiority in terms of efficacy and adverse effects. There is a clear need for new and effective antimicrobial agents in the treatment of resistant A. baumanii infections.

Coronavirus 2019 (COVID-19) infection causes excessive cytokine response and a decrease in cellular immune response and this increases susceptibility to fungal co-infections. Mucormycosis is a rare, lifethreatening invasive fungal infection. In this report, two cases who developed rhino-orbito-cerebral mucormycosis shortly after having COVID-19 infection were presented. The first case was a 68-year old woman who admitted to our clinic with orbital cellulitis in her left eye and had a known diagnosis of asthma and rheumatoid arthritis. She was diagnosed with COVID-19 pneumonia 40 days ago, stayed in the intensive care unit for a long time, and received pulse steroid (1000 mg methylprednisolone), interleukin-1 (IL-1) inhibitor (anakinra) and broad-spectrum antibiotic treatments together with antiviral therapy during this period. The second case was a 63-year-old male patient with known diabetes mellitus, hypertension and retinitis pigmentosa, with a history of hospitalization in the intensive care unit due to COVID-19 pneumonia 20 days ago and received pulse steroid therapy during this period. He admitted to our clinic with the complaints of droopy right eyelid, swelling, nausea and vomiting. In both cases, paranasal sinus tomography findings were consistent with invasive sinusitis. Functional endoscopic sinus surgery was performed immediately in less than 16 hours from the first admission in both cases. Histopathological examination of the both cases revealed results consistent with mucormycosis. Mucorales spp. was isolated in sinus tissue culture of the second case taken during the operation. Both of the patients received liposomal amphotericin B. First case died on the 19th day of the treatment. Second case was discharged with full recovery after nine weeks of treatment. The suppression of cellular immunity during the COVID-19 infection, and the use of steroids and interleukin inhibitors in the treatment of severe cases may increase secondary invasive fungal infections. Therefore, clinicians should more frequently consider possible fungal infections in patients with COVID-19.