Karakeçili, Faruk; Cilo, Burcu Dalyan; Akin, Hicran; Agca, Harun; Sinirtas, Melda; Özakin, Cüneyt; Yilmaz, Emel; Akalin, Halis

Introduction: Early identification of vancomycin-resistant enterococci (VRE) colonization by screening patients is necessary in terms of preventing spread and development of infection. The purpose of this study was to investigate the presence of VRE using and real time polymerase chain reaction (RT-PCR) and to compare the results and costs. Materials and methods: Patients in the risk group attending our hospital and planned for treatment with hospitalization were included. Two rectal swab specimens were taken. One swab specimen was inoculated into enterococci broth for CCSM. Resistant gene investigation was performed with the other specimen by using RT-PCR. The costs of the two methods were then compared. Results: VRE were detected in 75 (6.63%) of the 1130 patients screened using the two methods. Resistance gene was determined in 69 (6.1%) patients using RT-PCR and 32 (2.8%) with CCSM. RT-PCR results were negative in 6 patients with VRE growth determined using CCSM. VRE was detected with CCSM in all 26 patients in whom vanA genotype VRE were determined using RT-PCR, but no growth was determined with CCSM in any of the 43 patients in whom vanB genotype VRE were detected. Results obtained in 3 days using CCSM and within 4 hours using RT-PCR. Costs were 58 $ with CCSM and 46 $ with RT-PCR. Conclusion: VRE colonization being detected faster with RT-PCR than CCSM. When the costs in isolation of patients until VRE screening test results emerged were compared, VRE screening with RT-PCR was cost-effective. RT-PCR was markedly superior to CCSM in determining VanB type resistance. Due to the late results from CCSM and its failure to detect VanB type resistance, we think that RT-PCR can be an alternative to CCSM or that the two techniques can usefully be combined depending on the hospital conditions.

Karakecili, Faruk; Cilo, Burcu Dalyan; Karagoz, Alper; Jefferies, Meryem; Cikman, Aytekin; Akalin, Halis; Ozakin, Cuneyt

Introduction: Arbitrarily Primed-Polymerase Chain Reaction (AP-PCR) and Pulsed-Field Gel Electrophoresis (PFGE) are widely used genotyping methods for investigating outbreaks of infections. The aim of this research is to compare AP-PCR with PFGE, which is known as the gold standard method, and to determine if AP-PCR is suitable for use in outbreaks.Materials and methods: Between 2001 and 2009, 664 isolated vancomycin resistant enterococcus (VRE) strains were determined at the Bacteriology Laboratory, Department of Medical Microbiology. During nine years study 5 peak periods were identified. In each peak period of 3 months, 83 VRE strains were selected from the 664 for this research. For all isolates a comparison of AP-PCR and PFGE using 83 VRE strains was performed.Results: Enterococcus faecium was found to be the dominant species in all VRE isolated from hospitalized patients. 83 strains of E. faecium were included in the study, which were isolated from 5 different possible epidemic periods over 9 years. 15 different clonal strains were collected using the AP-PCR method and 11 using PFGE.Conclusion: PFGE was found to be repeatable and had a better separation power than AP-PCR. AP-PCR though is a simpler,cheaper and faster method and can be used for VRE epidemics as an alternative method. In future epidemiological outbreaks the comparative molecular methods are more reliable than a single method.

Karakeçili, Faruk; Akin, Hicran; Pekgöz, Murat; Mistik, Resit; Oral, Haluk Barboros; Akalin, Halis

Chronic granulomatous disease (CGD) is a rare, genetically heterogeneous disease characterized by severe infections that can be life threatening. The disease develops due to defects in nicotinamide adenine dinucleotide phosphate (NADPH) oxidase system. It is characterized by granuloma formation depending on recurrent infections and increased inflammatory response. Lung, skin, lymph nodes, and liver are the most involved organs. Nitroblue tetrazolium test (NBT) is the most frequently used test in screening. In this article, a chronic granulomatous disease case diagnosed in adulthood and having recurrent liver and lung abscesses is reported in light of the literature. A 22-year-old male patient was admitted to our polyclinic with high fever for two weeks. Patient's family history was received in terms of CGD and NBT was carried out. Patient's NBT result was negative (0%) twice. The patient was administered empiric ceftriaxone and metronidazole treatment. Abscess drainage was planned for the patient diagnosed as CGD as a result of the analyses. The patient who developed fever response and whose laboratory values improved was discharged proposing polyclinic control with trimethoprim/ sulfamethoxazole and itraconazole prophylaxis. This case indicates that, although rarely, CGD might be diagnosed in adulthood in our country where consanguineous marriage and hereditary diseases are common.