This paper presents information about airborne mesophilic bacteria in the indoor and outdoor air of child day-care centers (CDCCs) in the city of Edirne, Turkey. Air samples were collected using the Petri plate gravitational settling method from the indoor and outdoor air of CDCCs. Counts of airborne bacteria were measured as colony forming units (CFU) collected by gravity onto Brain Heart Infusion Agar plates (with 5% sheep blood). Samples were taken monthly over a period of 12 months between January and December 2004. A total of 3,120 bacteria colonies were counted on 192 Petri plates. Four groups of culturable bacteria were identified: gram-positive cocci, gram-positive bacilli, endospore-forming gram-positive bacilli, and gram-negative bacteria. Airborne gram-positive bacteria were the most abundant at more than 95% of the measured population. While gram-positive cocci were more common in indoor environments, gram-positive bacilli were more dominant in outdoor air. Bacteria commonly isolated from CDCCs were identified at a genus level. Staphylococcus (39.16%), Bacillus (18.46%), Corynebacterium (16.25%), and Micrococcus (7.21%) were dominant among the genera identified in the present study. The dominant genera identified in the day-care centers were Staphylococcus, Micrococcus, and Corynebacterium for indoor air and Bacillus, Corynebacterium, and Staphylococcus for outdoor air. Staphylococcus, Streptococcus, Bacillus, and Corynebacterium genera were found in samples from every month. Bacterial colony counts were compared by sampling location (indoors and outdoors), seasons, and meteorological factors. We found negative correlations between the monthly total outdoor bacterial counts and the sampling day's average relative humidity and average rainfall, and the monthly average rainfall. Fluctuations in bacterial counts in different seasons were observed.

We studied the prevalence and molecular epidemiology of PER-1-type beta-lactamases among Acinetobacter, Klebsiella, and Pseudomonas aeruginosa strains isolated over a 3-month period in eight university hospitals from distinct regions of Turkey. A total of 72, 92, and 367 Acinetobacter, Klebsiella, and P. aeruginosa isolates were studied, respectively. The presence of blaPER was determined by the colony hybridization method and later confirmed by isoelectric focusing. We detected PER-1-type beta-lactamases in 46% (33/72) of Acinetobacter strains and in 11% (40/367) of P. aeruginosa strains but not in Klebsiella strains. PER-1-type enzyme producers were highly resistant to ceftazidime and gentamicin, intermediately resistant to amikacin, and susceptible or moderately susceptible to imipenem and meropenem. Among PER-1-type-beta-lactamase-positive isolates, five Acinetobacter isolates and six P. aeruginosa isolates from different hospitals were selected for ribosomal DNA fingerprinting with EcoRI and SalI. The EcoRI-digested DNAs were later hybridized with a digoxigenin-labelled PER-1 probe. The ribotypes and the lengths of blaPER-carrying fragments were identical in four Acinetobacter strains. A single isolate (Ac3) harbored a PER gene on a different fragment (approximately 4.2 kbp) than the others (approximately 3.4 kbp) and showed a clearly distinguishable ribotype. Ribotypes of P. aeruginosa strains obtained with EcoRI showed three patterns. Similarly, in Pseudomonas strains two different EcoRI fragments harbored blaPER (approximately 4.2 kbp in five isolates and 3.4 kbp in one isolate). PER-1-type beta-lactamases appear to be restricted to Turkey. However, their clonal diversity and high prevalence indicate a high spreading potential.

We monitored levels of bacteria and fungi in the indoor air at selected sites of several public primary schools in the city of Edirne, Turkey. Sampling was by the Petri plate method onto both a Rose-Bengal streptomycin agar medium and a 5% sheep-blood agar medium exposed to the air for 10-minute periods. Samples were collected monthly over a period of 6 months between August 2001 and January 2002. A total of 941 microfungi and 2066 bacterial colonies were counted on 90 Petri plates. During this 6-month period, 19 bacterial genera, 15 fungal genera and 48 species of fungi were isolated from the air in the schools. Some bacteria, such as coagulase-negative Staphylococcus, Corynebacterium and Bacillus, were predominant (42.7%, 20.4% and 6.9% of the total, respectively). Penicillium, Cladosporium and Alternaria were the most common fungal genera (42.8%, 19.3% and 10.1% of the total, respectively). Staphylococcus, Acinetobacter, Corynebacterium, Propionibacterium and Pseudomonas genera were found in every month. Statistical analysis of the data showed a positive correlation between the concentrations of bacteria and air humidity (p 0.002, R2 0.726) and between bacterial concentrations and age of the schools ( p 0.045, R2 0.787). Also, that there was seasonal variation since the concentrations of fungi and bacteria varied according to the months ( p 0.001).

The aim of this investigation was to monitor monthly the densities and distribution of indoor airborne fungi and bacteria in 6 different areas of Trakya University Hospital (Edirne, Turkey). Areas monitored were an operating theatre, birthing-room, emergency department, service area for infectious diseases, intensive care unit and the canteen. Our method was to expose Petri dishes which contained rose-bengal streptomycin agar and 5% sheepblood agar media to room air for 10-min periods. Samples were collected at 1-month intervals from September 2000 to February 2001. A total of 156 microfungal and 535 bacterial colonies were counted on 144 plates. During a 6-month period, 10 bacterial genera (Acinetobacter,

The aim of this study was to investigate the source and the size of a tularemia outbreak in a village located in a non-endemic area. Five patients from the same village were admitted to hospital with the same complaints all within one week of September 2001. Tularemia was suspected and a diagnosis was made after physical and anamnesis examinations. The village was visited the same week that the patients were admitted to the hospital, in the January and April 2002. The villagers were examined and screened serologically by microagglutination method and the water sources were investigated bacteriologically. A total of 14 people were found to be infected from the outbreak and the oropharyngeal form was the only clinical presentation. Antibody titers ranged between 1 : 80 and 1 : 640. The patients responded well to the aminoglycoside plus tetracycline therapy. Examination of the pipewater and three springs revealed that all the water sources were contaminated by coliforms, however, Francisella tularensis could not be isolated in glucose-cystine medium. Antibody levels stayed stable or decreased seven months after. Tularemia had not been reported in this area before, so the first patients were misdiagnosed. In conclusion tularemia should be considered in differential diagnosis of patients with fever, sore throat and cervical lymphadenopaties.

No abstract

The outcome of Helicobacter pylori infection has been related to specific virulence-associated bacterial genotypes. The best known genotypic virulence factors of H. pylori are cytotoxin-associated gene A (cagA) and vacuolating cytotoxin gene A (vacA). The objective of this study was to assess the relationship between H. pylori cagA and vacA status and histopathological findings. Esophagogastrodoedonoscopy was performed in 80 dyspeptic patients. Antrum and corpus biopsies were obtained for isolation of H. pylori and for histopathological assessment. The polymerase chain reaction was used to detect cagA and vacA genes of H. pylori using specific primers. Biopsy samples were stained with hematoxylin and eosin, and histopathological findings were graded using the "updated Sydney system". H. pylori from 57 of the 80 patients was incubated. Of the 57 patients, 44 were cagA positive. In the corpus biopsy specimens there was a significant relationship between the density of H. pylori colonization (P = 0.02) and chronic inflammation (P = 0.02) and cagA-positive genotypes. In the antrum specimens there was a significant relationship between cagA positivity and neutrophil activity (P = 0.003) and glandular atrophy (P = 0.002), but not with H. pylori density, chronic inflammation, and intestinal metaplasia. The odds ratio of cagA-positive vs. cagA-negative strains for the presence of glandular atrophy, irrespective of grading and of gastric localization, was 4.62 (95% CI, 1.18-18.08, P = 0.041). No significant relationships were observed between vacA s1 and s2 genotypes and histopathological parameters. Corpus neutrophil infiltration was found to be more severe in the m1 group than in the m2 group (P = 0.004). Other histopathological features showed no difference between m1 and m2 genotypes. In conclusion H. pylori strains showing cagA positivity are associated with more severe gastritis in some histological features but virulence factors of H. pylori do not appear to determine the overall pattern of gastritis.

PurposeCombination antibiotic treatment is preferred in nosocomial infections caused by Pseudomonas aeruginosa (P. aeruginosa). In vitro synergism tests were used to choose the combinations which might be used in clinic. The aim of this study was to investigate the synergistic efficacy of synergistic antibiotic combinations in multidrug resistant P. aeruginosa strains.Materials and MethodsSynergistic efficacies of ceftazidime-tobramycin, piperacillin/tazobactam-tobramycin, imipenem-tobramycin, imipenem-isepamycin, imipenem-ciprofloxacin and ciprofloxacin-tobramycin combinations were investigated by checkerboard technique in 12 multiple-resistant and 13 susceptible P. aeruginosa strains.ResultsThe ratios of synergy were observed in ceftazidime-tobramycin and piperacillin/tazobactam-tobramycin combinations as 67%, and 50%, respectively, in resistant strains, whereas synergy was not detected in other combinations. The ratios of synergy were observed in ceftazidime-tobramycin, piperacillin/tazobactam-tobramycin, imipenem-tobramycin, imipenem-ciprofloxacin and imipenem-isepamycin combinations as 31%, 46%, 15%, 8%, 8%, and respectively, in susceptible strains, whereas synergy was not detected in ciprofloxacin-tobramycin combination. Antagonism was not observed in any of the combinations.ConclusionAlthough the synergistic ratios were high in combinations with ceftazidime or piperacillin/tazobactam and tobramycin, the concentrations in these combinations could not usually reach clinically available levels. Thus, the solution of the problems caused by multiple resistant P. aeruginosa should be based on the prevention of the development of resistance and spread of the causative agent between patients.