No data on whether brucellar meningitis or meningoencephalitis can be treated with oral antibiotics or whether an intravenous extended-spectrum cephalosporin, namely, ceftriaxone, which does not accumulate in phagocytes, should be added to the regimen exist in the literature. The aim of a study conducted in Istanbul, Turkey, was to compare the efficacy and tolerability of ceftriaxone-based antibiotic treatment regimens with those of an oral treatment protocol in patients with these conditions. This retrospective study enrolled 215 adult patients in 28 health care institutions from four different countries. The first protocol (P1) comprised ceftriaxone, rifampin, and doxycycline. The second protocol (P2) consisted of trimethoprim-sulfamethoxazole, rifampin, and doxycycline. In the third protocol (P3), the patients started with P1 and transferred to P2 when ceftriaxone was stopped. The treatment period was shorter with the regimens which included ceftriaxone (4.40 ؎ 2.47 months in P1, 6.52 ؎ 4.15 months in P2, and 5.18 ؎ 2.27 months in P3) (P ‫؍‬ 0.002). In seven patients, therapy was modified due to antibiotic side effects. When these cases were excluded, therapeutic failure did not differ significantly between ceftriaxone-based regimens (n ‫؍‬ 5/166, 3.0%) and the oral therapy (n ‫؍‬ 4/42, 9.5%) (P ‫؍‬ 0.084). The efficacy of the ceftriaxone-based regimens was found to be better (n ‫؍‬ 6/166 [3.6%] versus n ‫؍‬ 6/42 [14.3%]; P ‫؍‬ 0.017) when a composite negative outcome (CNO; relapse plus therapeutic failure) was considered. Accordingly, CNO was greatest in P2 (14.3%, n ‫؍‬ 6/42) compared to P1 (2.6%, n ‫؍‬ 3/117) and P3 (6.1%, n ‫؍‬ 3/49) (P ‫؍‬ 0.020). Seemingly, ceftriaxone-based regimens are more successful and require shorter therapy than the oral treatment protocol.

Cases of orf virus infection in human in Turkey have been reported for many years. Scab material from a man was found positive by PCR using pan-parapox-specific primers for parapoxvirus infection. The amplicon was purified and sequenced. The present study provides for the first time a phylogenetic analysis of parapoxviruses from Turkey. The partial B2L gene sequence of a Turkish orf virus from a human presented here may be useful for characterization of parapoxvirus infections in Turkey based on the phylogenetic analysis studies.

Methicillin-resistant Staphylococcus aureus (MRSA) colonize most frequently in the anterior nares of the nose and cause serious infections all over the world. The aim of this study was to determine the nasal carriage rate of S. aureus and MRSA strains in Turkish elementary school children. We also analyzed molecular characterizations of MRSA strains by using pulse field gel electrophoresis (PFGE), multi locus sequence typing (MLST), staphylococcal chromosomal cassette mec (SCCmec) typing, and detection of the Panton-valentine leucocidin (PVL) gene. The nasal swabs were obtained from 4,050 children during a 4 month period in Ankara. In vitro antimicrobial susceptibility testing to 1 mug oxacillin and 30 mug cefoxitin was determined by a disk diffusion method. We found that the 1,001 of 4,050 (24.7%) children were colonized with S. aureus. Three S. aureus strains were resistant to oxacillin and cefoxitin. The rate of MRSA among all children was 0.07%. The MRSA strains revealed three different PFGE pattern. All MRSA isolates by harbored the SCCmec type IV element, but not the PVL gene. The two MRSA isolate belonged to sequence type (ST) 30, whereas the other one was a unique type. The results of this study demonstrated that S. aureus nasal carriage rate was consistent with previous studies. However, MRSA carriage rate was low. This study also indicated that the ST30-type IV without PVL gene MRSA clone may be expected to spread in Turkish community.

For a panel of 153 Staphylococcus aureus clinical isolates (including 13 vancomycin-intermediate or heterogeneous vancomycin-intermediate and 4 vancomycin-resistant strains), MIC 50 s and MIC 90 s of three novel dihydrophthalazine antifolates, BAL0030543, BAL0030544, and BAL0030545, were 0.03 and 0.25 g/ml, respectively, for methicillin-susceptible strains and 0.03 and <0.25 g/ml, respectively, for methicillin-resistant strains. For a panel of 160 coagulase-negative staphylococci (including 5 vancomycin-intermediate and heterogeneous vancomycin-intermediate strains and 7 linezolid-nonsusceptible strains), MIC 50 s and MIC 90 s were <0.03 and <0.06 g/ml, respectively, for methicillin-susceptible strains and 0.06 and 0.5 g/ml, respectively, for methicillin-resistant strains. Vancomycin was active against 93.0% of 313 staphylococci examined; linezolid was active against all S. aureus strains and 95.6% of coagulase-negative staphylococcus strains, whereas elevated MICs of clindamycin, minocycline, trimethoprim, and rifampin for some strains were observed. At 4؋ MIC, the dihydrophthalazines were bactericidal against 11 of 12 staphylococcal strains surveyed. The prolonged serial passage of some staphylococcal strains in the presence of subinhibitory concentrations of BAL0030543, BAL0030544, and BAL0030545 produced clones for which dihydrophthalazines showed high MICs (>128 g/ml), although rates of endogenous resistance development were much lower for the dihydrophthalazines than for trimethoprim. Single-step platings of naïve staphylococci onto media containing dihydrophthalazine antifolates indicated considerable variability among strains with respect to preexistent subpopulations nonsusceptible to dihydrophthalazine antifolates.The prevalence of multidrug-resistant staphylococci (2,18) and the emergence of methicillin-resistant Staphylococcus aureus (MRSA) as a prominent cause of community-acquired skin and skin structure infections (28) are of concern to the medical community. Infections caused by coagulase-negative staphylococci (CoNS), once considered rare, are becoming increasingly frequent, particularly in patients with indwelling medical devices and those who are immunocompromised, and such infections are associated with significant morbidity and mortality (40). The adhesion of Staphylococcus epidermidis to endothelial cells is enhanced at temperatures encountered during a moderate fever (27), and the internalization of CoNS by host cells (1,7,27) probably contributes to antibiotic failure and infection persistence in some patients. Glycopeptides, especially vancomycin, are the current standard of care for the empirical treatment of suspected methicillin-resistant staphylococcal infections, but staphylococci with reduced susceptibility, tolerance, or resistance to vancomycin have appeared in clinical settings (2,15,19,33), and their frequency is almost certainly underreported due to problems with identification and confusion over breakpoints (2,39).The spread of multidrug-resistant staphylococci mandates the ...