ÖZETElizabethkingia meningosepticum, özellikle yenidoğanlar ve immün süpresif hastalarda hayatı tehdit eden hastane kaynaklı enfeksiyonlara yol açabilen gram-negatif bir fırsatçı patojendir. Değişik bir antibiyotik duyarlılık paternine sahip olan E.meningosepticum, gram-negatif bakterilerin duyarlı olduğu birçok antibiyotiğe dirençli olup, vankomisin ve kotrimoksazol (SXT) gibi gram-pozitif bakterilere etkili olan antibiyotiklere duyarlılık gösterir. Bu nedenle E.meningosepticum enfeksiyonlarında tedavinin başarısı, etkenin doğru tanımlanmasına bağlıdır. Bu raporda, birçok organı etkileyen genetik bir bozukluk olan Bardet-Biedl sendromuna bağlı kronik böbrek yetmezliği gelişen ve diyaliz kateteri bulunan bir hastada görülen kateter ile ilişkili E.meningosepticum bakteriyemisi sunulmaktadır. Bardet-Biedl sendromlu femoral kateteri olan 25 yaşında erkek hasta acil servise bir gündür var olan yüksek ateş ve titreme şikayetleriyle başvurmuştur. Başvuru sırasında alınan kan kültürlerinin her ikisi, iki gün sonra pozitif sinyal vermiş; kanlı agar besiyerine yapılan pasajda 37°C'de 16 saatlik inkübasyon sonunda gram-negatif bakteri kolonilerine benzeyen düzgün kenarlı, iri, gri koloniler ürerken, MacConkey agara yapılan pasajda beş gün sonunda üreme olmamıştır. Bakteri kolonileri KOH, oksidaz, katalaz, üreaz, eskülin, MOI (Motility Indole Ornithine) testleriyle pozitif; sitratla negatif sonuç vermiş; Gram boyamada zayıf boyanan, gram-negatif, ince basiller izlenmiştir. İzolat, Vitek ® 2 sistemi (bioMérieux, ABD) ile E.meningosepticum olarak tanımlanmış ve tanı PCR ile 16S RNA gen bölgesinin amplifikasyonu ve dizi analizi yapılarak doğrulanmıştır. İzolatın antibiyotik duyarlılığı Vitek 2 sistemiyle belirlenmiş, vankomisin duyarlılığı ise Kirby-Bauer disk difüzyon testiyle değerlendirilmiştir. İzolatın, ampisilin/sulbaktam piperasilin/tazobaktam, seftazidim, sefepim, meropenem, imipenem, amikasin, gentamisin, netilmisin, levofloksasin, tetrasiklin, kolistin ve rifampisine dirençli; tigesiklin ve tetrasikline orta duyarlı; sefoperazon/sulbaktam, siprofloksasin, levofloksasin, SXT Geliş Tarihi

Background Cardiovascular disease (CVD) is a major cause of mortality in HIV infected patients. Agreement between commonly used risk prediction equations for classification of high-risk individuals is varied in different populations. We aimed to compare the degree of agreement of four CVD risk calculators in a multicenter cohort.Methods A cross-sectional study was conducted among adult HIV patients who are followed in five tertiary centers between July 2016 and February 2017. Inclusion criteria were: age 40–74 years, without known CVD and not receiving statins. All necessary information to calculate risk scores were collected during follow-up visits with a standardized form. Web-based tools for each score were used for calculations. Persons were considered at higher risk if 10-year CVD risks ≥20% with FRS-CVD, >10% with SCORE for high-risk countries, >7.5% for ASCVD, and 5 year risk ≥5% with DAD or if they had additional risk factors defined for each score for automatic high-risk stratification. Based on the interpretation of CVD risk, the patients were placed in two categories: low/medium and high/very high. Agreement between scores was assessed by Cohen’s kappa (κ) statistics.ResultsOf 667 patients who were active during the study period, CVD scores of 527 HIV-infected patients (82% male) were assessed. Median (interquartile range) age was 48 (43–54) years. Prevalence of CVD risk factors were: 11% family history of early-onset CVD, 50% current smokers, 57% overweight or obese, 22% hypertension, and 8% diabetes mellitus. The prevalence of high CVD scores or risk equivalents was high ranging from 20.3% to 36.3%. The DAD-full, DAD-reduced, ASCVD and SCORE had 83.9%, 85%, 83.5% and 93.2% agreement compared with the FRS-CVD (κ = 0.55, 0.59, 0.61 and 0.80), respectively. European AIDS Clinical Society, European Society of Cardiology, Adult Treatment Panel-III and 2013 American College of Cardiology/American Heart Association guidelines would recommend statin therapy for 35.1%, 21.8%, 31.9% and 36.4% of patients, respectively.Conclusion We found moderate/substantial agreement among risk prediction tools evaluated in this study. Agreement was high for lower scores and at higher ages. Whether those scores accurately estimate risk at population level needs further evaluation.Disclosures All authors: No reported disclosures.

Aim:To examine the effects, after septoplasty, of local antibiotic pomades as an alternative to prophylactic antibiotic use, which is a controversial matter among the otolaryngologists, on nasal flora and bacterial growth.Material and Method:Nasal packings placed after septoplasty surgery to provide septal stabilization and bleeding control pose a risk in terms of infection. In this study, 106 patients, who were examined by comparing mupirocin- and fusidic acid–soaked packings and antibiotic-free packings, were divided into three groups. Nasal cultures were obtained from each patient twice, before the surgery and on the second day immediately after the packings were removed, and the culture results were statistically compared.Results:In the mupirocin group (group 2), postoperative normal flora growth rate was significantly higher than in the fusidic acid group (group 3) and the antibiotic-free group (group 1) (p < 0.024). In the mupirocin group (group 2), the gram-positive growth rate in the postoperative period showed a significant decrease when compared when the preoperative period (p < 0.05) (5.7%). In the fusidic acid group (group 3), the postoperative gram-positive rate showed a significant decrease compared with the preoperative period (p < 0.05). In group 2, the postoperative methicillin-resistant Staphylococcus aureus rate showed a significant decrease than in the preoperative period (2.9%) (p < 0.05). Similarly, in group 3, the postoperative methicillin-resistant S. aureus rate showed a significant decrease compared with that of the preoperative period (11.1%) (p < 0.05).Conclusion:Use of mupirocin- and fusidic acid–soaked nasal packings after septoplasty significantly decreased, especially, postoperative gram-positive bacterial growth in nasal cultures. Although systemic antibiotherapy was not administered, the lack of local and systemic infection findings was an important result that we obtained in terms of clinical use. Usage advantages of mupirocin and fusidic acid soaked packings are an easily applicable, cost-effective, and safe method.

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The objective of this study was to assess the bacterial etiology and effectivity of endotracheal aspirate (ETA) and miniY nonbronchoscopic, protected bronchoalveolar lavage (mini-BAL) cultures in early-and late-onset ventilator-associated pneumonia (EO-VAP and LO-VAP, respectively) in our intensive care unit. This prospective study was performed in all patients who were hospitalized in the intensive care unit beyond 48 hours and had possessed the VAP clinical criteria according to the Centers for Disease Control and Prevention. The bacterial etiology of VAP was investigated using ETA and mini-BAL samples collected within 24 hours after diagnosis of VAP. Ventilatorassociated pneumonia cases that occurred within the first 5 days of intubation were described as EO-VAP; and the cases the occurred exceeding 5 days were described as LO-VAP. A total of 43 clinically diagnosed VAP episodes composed of 10 EO-VAP and 33 LO-VAP cases were studied in 31 patients. Endotracheal aspirate cultures yielded 11 isolates, and mini-BAL cultures yielded 9 isolates collected from samples of 10 attacks with suspected EO-VAP. Staphylococcus spp was the leading agent in EO-VAP cases as detected by both ETA (27.3%) and mini-BAL (33.3%) cultures. On the other hand, ETA cultures identified 22 isolates, and mini-BAL cultures identified 24 isolates in 33 attacks suspected with LO-VAP. Gram-negative bacteria were prominent in LO-VAP cases; Pseudomonas aeruginosa was the leading bacterium in both culture methods; ETA (42.4%) and mini-BAL (45.5%). Overall, ETA and mini-BAL cultures yielded similar results in patients suspected of having VAP. Morphologies of all 33 isolates (100%) obtained with ETA cultures and 30 (90.9%) of 33 isolates obtained with mini-BAL cultures were observed in Gram stain of relevant samples. According to our results, Gram stains of both ETA and mini-BAL samples can help the clinician to initiate the appropriate antimicrobial therapy and save time before obtaining the culture results.(Infect Dis Clin Pract 2010;18: 177Y182)