Two different synergy testing methods, the checkerboard and the E test methods, were used to compare the in vitro efficacies of various antimicrobial combinations against 16 Brucella melitensis strains isolated from blood cultures. The rate of agreement of the E test and checkerboard methods was found to be 55%. The most concordant results were found for the streptomycin-doxycycline combination in 12 (75%) tests, in which four strains showed synergistic activity by E test and antagonistic activity by the checkerboard method and in which one strain showed antagonistic activity by both methods. Even though each of these methods uses different conditions and endpoints, the results of both methods frequently agreed.Brucellosis is still an important health problem in developing countries and leads to serious economic losses (15,19). The disease causes abortion and sterility in animals and septicemia that progresses to chronic localized infections in various organs of humans (4,16,19). Although brucellosis has been eradicated from animals in some developed countries, 500,000 new cases are reported yearly throughout the world, and it is still a widespread zoologic disease in Turkey (8,11).Because brucellae are localized intracellularly, infections with these bacteria should be treated with antibiotics that can penetrate the cell at high concentrations. The World Health Organization recommends the use of two antibiotics in combination and, in some cases, four antibiotics in combination for the treatment of brucellosis. Because of the lack of effectiveness of present therapies, relapses, and difficulties related to the antibiotics used, such as adverse effects, absorbance disturbances, and the limited ability of certain age groups to use certain antibiotics, researchers have been forced to discover new treatment regimens (2, 19).Antimicrobial susceptibility tests are not yet standardized for brucellae, and routine susceptibility tests cannot be performed in microbiology laboratories. However, the antimicrobial susceptibilities and even the in vitro synergistic effects of antibiotics in combination against these microorganisms, which have scant growth in culture, can easily be performed by E test. The aim of this study was to evaluate the rate of agreement of two in vitro tests for synergy, E test and the checkerboard method, with various combinations of antibiotics that penetrate the cell wall against Brucella melitensis isolates recovered from blood. MATERIALS AND METHODSSixteen strains of B. melitensis isolated from blood cultures at the Microbiology Laboratory of Gaziantep University from January through December 2003 were included in this study. Blood samples were collected from in-and outpatient clinics of the Medical Faculty Hospital, and they were cultured in vials of the BACTEC 9120 system (Becton Dickinson, Rutherford, N.J.) at 37°C for at least 7 days. The isolates were identified on the basis of colony morphology, staining, and slide agglutination with antiserum. Small, round, and convex colonies that grew on ...

Dermatophyte infections and onychomycosis are not usually serious in term of mortality; however, they may have significant clinical consequences such as secondary bacterial infections, chronicity, therapeutic difficulties and esthetic disfigurement in addition to serving as a reservoir of infection. Our aim was to determine the prevalence of onychomycosis and dermatophytosis in a selected high risk group, consisting of male boarding school residents. A total of 410 males inhabiting two houses were evaluated by two dermatologists. In cases of clinical suspicion, appropriate samples were taken for direct microscopy and culture. The results showed that the prevalences of tinea pedis (athlete's foot) and pure pedal onychomycosis were 51.5% (n:211) and 4.4% (n:18), respectively. Thirty cases of those with tinea pedis were complicated by toenail onychomycosis. Tinea cruris was present only in five cases with tinea pedis. Interestingly 71.1% of those with tinea pedis and 45.8% of those with onychomycosis, associated with or without tinea pedis were unaware of their diseases. The most common fungal isolate was Trichophyton rubrum (76.6%) followed by Epidermophyton floccosum (11.6%), T. interdigitale (10.55%). Approximately one third of the cultures from nail specimens yielded pure growths of nondermatophyte moulds or Candida albicans. In conclusion, we found unexpectedly high prevalences of occult athlete's foot and toenail onychomycosis among the male residents of student houses. Our results indicate that health-care workers of such common boarding-houses should be more aware of clinical and subclinical dermatophyte infections and onychomycosis, and have more active approaches to educational measures and management strategies to prevent further infections. To our knowledge, this is the first epidemiologic study on the prevalences of dermatophytosis and onychomycosis in boarding-houses from Turkey.

Carbapenems are the choice of treatment in infections caused by multidrug resistant Enterobacteriaceae. In recent years carbapenem-resistant Enterobacteriaceae isolates due to carbapenemases have been increasingly reported worldwide. Multicenter studies on carbapenemases are scarce in Turkey. The aim of this study was to determine the distribution of carbapenemases from different parts of Turkey as a part of the European Survey of Carbapenemase Producing Enterobacteriaceae (EuSCAPE) project. Beginning in November 2013, carbapenem-resistant isolates resistant to at least one of the agents, namely imipenem, meropenem, and ertapenem were sent to the coordinating center. Minimum inhibitory concentrations for these carbapenems were determined by microdilution tests following EUCAST guidelines. Production of carbapenemase was confirmed by combination disk synergy tests. Types of carbapenemases were investigated using specific primers for VIM, IMP; NDM, KPC and OXA-48 genes by multiplex polymerase chain reaction. In a six month period, 155 suspected carbapenemase-positive isolates were sent to the coordinating center of which 21 (13.5%) were E.coli and 134 (86.5%) were K.pneumoniae. Nineteen (90.5%) strains among E.coli and 124 (92.5%) strains among K.pneumoniae were shown to harbour at least one carbapenemase gene by molecular tests, with a total of 92.3% (143/155). Carbapenemases were determined as a single enzyme in 136 strains (OXA-48: 84.6%; NDM: 6.3%; VIM: 2.8%; IMP: 1.4%) and as a combination in seven isolates (OXA-48 + NDM: 2.1%; OXA-48 + VIM: 2.1%; VIM + NDM: 0.7%). KPC was not detected in any of the isolates. According to the microdilution test results, resistance to imipenem, meropenem and ertapenem in OXA-48 isolates were 59.5%, 52.9% and 100%, respectively. The combination disk synergy test was 100% compatible with the molecular test results. As most of the OXA-48 producing isolates were susceptible to meropenem but all were resistant to ertapenem, ertapenem seems to be the most sensitive agent in screening carbapenemases in areas where OXA-48 is prevalent and phenotypic combination tests can be useful in centers where molecular tests are not available.

Colistin combined with tigecycline, cefoperazone/sulbactam or piperacillin/tazobactam revealed synergistic effects in some carbapenem-resistant A. baumannii strains. These results, together with the shortage of treatment options and the risk of developing resistance to colistin, suggest that clinicians should use colistin combined with other antibiotics or β-lactamase inhibitors when treating carbapenem-resistant A. baumannii infection.

Objective:This study aimed to evaluate the antimicrobial efficiency of PDT and the effect of different irradiation durations on the antimicrobial efficiency of PDT.Materials and Methods:Sixty freshly extracted human teeth with a single root were decoronated and distributed into five groups. The control group received no treatment. Group 1 was treated with a 5% sodium hypochlorite (NaOCl) solution. Groups 2, 3, and 4 were treated with methylene-blue photosensitizer and 660-nm diode laser irradiation for 1, 2, and 4 min, respectively. The root canals were instrumented and irrigated with NaOCl, ethylenediamine-tetraacetic acid, and a saline solution, followed by autoclaving. All the roots were inoculated with an Enterococcus faecalis suspension and brain heart infusion broth and stored for 21 days to allow biofilm formation. Microbiological data on microorganism load were collected before and after the disinfection procedures and analyzed with the Wilcoxon ranged test, the Kruskal-Wallis test, and the Dunn's test.Results:The microorganism load in the control group increased. The lowest reduction in the microorganism load was observed in the 1-min irradiation group (Group 2 = 99.8%), which was very close to the results of the other experimental groups (99.9%). There were no significant differences among the groups.Conclusions:PDT is as effective as conventional 5% NaOCl irrigation with regard to antimicrobial efficiency against Enterococcus faecalis.