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Öğe Analysis of three outbreaks due to Klebsiella species in a neonatal intensive care unit(Slack Inc, 2003) Ayan, M; Kuzucu, C; Durmaz, R; Aktas, E; Cizmeci, ZOBJECTIVE: To investigate the clinical, microbiological, and epidemiologic features of three outbreaks caused by Klebsiella during 3 years. SETTING: Neonatal intensive care unit of a university hospital. PATIENTS: Thirty affected neonates. METHODS: Data were collected through chart reviews and conversations with physicians. Screening samples were obtained from the staff, the neonates, and the environment. Antibiogram typing and arbitrarily primed polymerase chain reaction-based fingerprinting were used to type the strains. RESULTS: The first outbreak had 13 K pneumoniae strains isolated. The second outbreak had 10 K. oxytoca strains isolated. The third outbreak had 20 K. pneumoniae strains isolated. More than half of the patients had low birth weights, were premature, and underwent mechanical ventilation and intravenous catheterization. Approximately three-fourths of the patients died. The isolates tested were completely susceptible to meropenem, cefoxitin, and ciprofloxacin and were resistant to cephalothin. More than half of these strains were resistant to many beta-lactam antibiotics, amikacin, and trimethoprim/sulfamethoxazole. Typing procedures yielded 3 antibiotypes and 3 genotypes among the isolates of the first outbreak, 3 antibiotypes with 1 subtype and 2 genotypes with 1 subtype in the second outbreak, and 2 antibiotypes and 2 genotypes in the third outbreak. CONCLUSIONS: Klebsiella outbreaks mainly affected premature neonates with intravenous catheters, mechanical ventilation, or both. The high mortality rate (76.7%) was notable. Resistance to multiple antibiotics, but mainly to broad-spectrum beta-lactam antibiotics, was observed, particularly in K pneumoniae isolates. Molecular typing indicated that the three outbreaks were not related to one other.Öğe Comparison of the semisolid agar antifungal susceptibility test with the NCCLS M38-P broth microdilution test for screening of filamentous fungi(Amer Soc Microbiology, 2004) Kuzucu, C; Rapino, B; McDermott, L; Hadley, SAntifungal susceptibility testing of pathogenic molds is being developed. A simple screening semisolid agar antifungal susceptibility (SAAS) test accurately measures susceptibilities of yeasts. The performance of the SAAS screening test for filamentous fungi was assessed by comparing MICs of four antifungals (amphotericin B [AMB], AMB lipid complex [ABEL], itraconazole [ITZ], and posaconazole [POS]) for 54 clinical mold isolates with the results of the National Committee for Clinical Laboratory Standards (NCCLS) proposed broth microdilution method (M38-P). The SAAS test utilized inocula stabbed into tubes of 0.5% semisolid heart infusion agar. In both tests MICs were read after incubation at 35degreesC for 48 h. The isolates tested were Aspergillus fumigatus, Aspergillus niger, Aspergillus flavus, other Aspergillus spp., Fusarium spp., Penicillium sp., Mucor sp., Scedosporium prolificans, Trichophyton sp., and an unidentified dematiaceous mold. Concordance of test results was determined as the percent agreement of MICs I dilution. The overall agreement between the tests for each drug was as follows: AMB, 94%; ABEL, 83%; ITZ, 94%; POS, 94%. For the Aspergillus spp., all but one were susceptible to ITZ by SAAS test; all were susceptible to POS (MIC range, 0.25 to 4 mug/ml). Three of six non-Aspergillus molds that were resistant to AMB and ABEL by SAAS (MIC greater than or equal to 2 mug/ml) were also resistant by the NCCLS test. The SAAS test compared favorably to the NCCLS broth microdilution test for molds, and most of the clinical isolates tested were susceptible to all four drugs.Öğe Nosocomial Stenotrophomonas maltophilia cross-infection(Mosby-Elsevier, 2004) Gulcan, H; Kuzucu, C; Durmaz, RBackground: Increased nosocomial Stenotrophomonas maltophilia infection rates in newborns, especially in recent years, are a significant cause for concern. These cases are the second case group in the literature to have been identified as nosocomial cross-infection with S maltophilia in neonates. Objective: To investigate the clinical, microbiological, and epidemiologic features of the outbreak caused by S maltophilia in the neonatal intensive care unit within a period of 7 days. Methods: Three cases with nosocomial S maltophilia infection considered to be the result of cross-transmission were prospectively analyzed. Arbitrarily primed polymerase chain reaction (AP-PCR) performed with M13 primer and pulsed-field gel electrophoresis (PFGE) of genomic DNA after digestion with XbaI were used to determine clonal relationship among the isolates. Results: S maltophilia was isolated from the blood cultures of all 3 patients. Molecular typing confirmed that the 3 cases were epidemiologically linked. Conclusions: Opportunistic pathogens such as S maltophila can lead to major problems in neonates. Molecular typing is helpful to improve effective control programs for preventing the spread of the infection.Öğe The prevalence of fecal colonization of enterococci, the resistance of the isolates to ampicillin, vancomycin, and high-level aminoglycosides, and the clonal relationship among isolates(Mary Ann Liebert, Inc, 2005) Kuzucu, C; Cizmeci, Z; Durmaz, R; Durmaz, E; Ozerol, IHThe gastrointestinal tract carriage of enterococci was searched in 150 hospitalized patients and 100 outpatients, and clonal relatedness of the isolates and their resistance to ampicillin, vancomycin, and high-level streptomycin and gentamicin were investigated. A stool sample or rectal swab collected from each patient was inoculated into appropriate media within an hour. Enterococcus species were identified by using conventional biochemical tests, API-20 Strep assay, and BBL crystal kit. Antibiotic susceptibility tests were performed using Kirby-Bauer disk diffusion method. A polymerase chain reaction (PCR) was used to detect vanA and vanB genes. Pulsed-field gel electrophoresis (PFGE) and arbitrarily primed-polymerase chain reaction (AP-PCR) methods were used for molecular typing of the strains. Enterococci were isolated from 90 (60%) of the specimens collected from 150 inpatients. Of these 90 isolates, 37 (41%) had high-level gentamicin resistance, 36 (40%) had high-level streptomycin resistance, and 50 (55.6%) had ampicillin resistance. Fecal colonization was found in 30% of the outpatients. Resistances to ampicillin, high-level streptomycin, and gentamicin were 13%, 10%, and 3%, in these patients' isolates, respectively. No vancomycin-resistant enterococci were detected by both agar diffusion and PCR assays in our study. Both typing procedures were applied on 78 Enterococcus strains isolated from inpatients. AP-PCR typing showed that 30 (50.8%) of the 59 E. faecium and 5 (50%) of the 10 E. faecalis strains were clonally related. These values were found to be 12 (20.3%) and two (20%) by PFGE, respectively. The typing procedures did not find any clustered strains in the six E. durans and three E. avium isolates. Neither PFGE nor AP-PCR result was significantly different among the sensitive and resistant strains. Our results indicate that the high prevalence of colonization with ampicillin and high-level aminoglycoside-resistant enterococci is an important problem in our medical center. The high clonal diversity among the isolates indicates limited spread of antibiotic-resistant strains between patients.Öğe Rhino-orbito-cerebral mucormycosis in transfusion-associated graft-versus-host disease: Case report(Karger, 2005) Bayindir, Y; Aydogdu, I; Bayindir, T; Kaya, E; Kuzucu, C; Alkan, A; Ersoy, YTransfusion-associated graft-versus-host disease (TA-GvHD) is in most cases refractory to immunosuppressive therapy and fatal because of severe bone marrow aplasia. Mucormycosis is a rare invasive fungal infection, but it has clinical importance because of its often delayed diagnosis and high mortality. Invasive mucomycosis is frequently associated with diabetes mellitus, neutropenia, severe immunodeficiencies following steroid therapy, organ transplantation, cytotoxic chemotherapy, and AIDS. We present a case of lethal rhino-orbito-cerebral mucormycosis after TA-GvHD in an initially healthy patient.Öğe An unusual case of pericarditis caused by Cardiobacterium hominis(W B Saunders Co Ltd, 2005) Kuzucu, C; Yetkin, G; Kocak, G; Nisanoglu, V[Abstract Not Available]
