The frequency and variety of infections caused by fungi are increasing. However, changes and intercenter and regional differences are observed in the distribution of fungal species over the years. It is important to update the epidemiological data in order to enable early and appropriate treatment. In this retrospective study, the number of fungi isolated from clinical samples, their distribution at the genus/ species level and the variations over the years in Hacettepe University hospital which is a regional center for patients at risk of fungal infection were investigated. For this purpose, laboratory records from 2008- 2019 were examined and 21813 fungal strains isolated from 19636 clinical samples were detected. When the first (2008-2013) and second (2014-2019) six-year periods were compared, a 2.5 fold increase was observed in the number of specimens yielding fungal growth (first period; n= 5620, second period; n= 14016). Fungi were most frequently isolated from urine (45.0%), lower respiratory tract (30.7%) and blood (6.8%) samples. Mould isolation rate in all samples increased significantly in the second six-year period (from 8.3% to 10.6%, p≤ 0.001). As expected, the most frequent yeast was Candida albicans (57.0%) and mould was Aspergillus fumigatus complex (50.4%). In the second six-year period, isolation of C.albicans (59.3% to 56.0%, p≤ 0.001) among yeasts and A.fumigatus complex (58.1% to 48.0%, p≤ 0.001) among moulds decreased significantly. In urine specimens, most common fungi were C.albicans (49.8%), Candida glabrata complex (15.6%), Candida tropicalis (8.9%) and Candida kefyr (7.5%). In lower respiratory tract specimens, the most common mould was A.fumigatus complex (51.2%), which has decreased from 63.7% in the first six years to 47.1% in the second period (p≤ 0.001). Over the same period, other Aspergillus species (from 25.5% to 34.1%, p= 0.002) and non-Aspergillus moulds (from 36.3% to 52.9%, p≤ 0.001) were increased. In blood samples, C.albicans (44.4%), Candida parapsilosis complex (21.5%) and C.glabrata complex (13.0%) were the most frequent species. In the second six-year period, the frequency of C.albicans decreased from 47.3% to 42.2% (p= 0.059) and the frequency of C.glabrata complex increased from 9.5% to 15.5% (p≤ 0.001) when compared to the first period. For the sterile specimens other than blood, the most common species were C.albicans (37.8%), C.glabrata complex (9.1%) and C.parapsilosis complex (4.7%). However, the number of fungal isolates and the distribution of the species showed great variation over the years. In our center, a substantial increase in the number of fungal strains isolated from the clinical specimens were observed over a 12-years period. In addition and similar to previously published reports, the increase of strains belonging to species with decreased antifungal susceptibility and/or species with unknown susceptibility were detected. The use of local data is required in order to implement early and appropriate antifungal treatment because of inter-center and regional differences observed in epidemiological trends regarding the distributions of fungal genera and species. Surveillance studies to be conducted with the participation of large and sufficient numbers of centers in our country, as we have done for our center, will also contribute to approaches regarding the management of fungal infections by revealing the epidemiological data in a comprehensive manner.

Candida türleri, insanlarda en sık enfeksiyona neden olan fungal patojenler olup, son yıllarda tanı ve tedavi yaklaşımlarındaki gelişmelere paralel olarak gittikçe önemleri artmaktadır. Bu çalışmada, retrospektif olarak kan kültürlerinden izole edilen Candida türlerinin dağılımı ve antifungal duyarlılıklarının belirlenmesi amaçlanmıştır.

Clostridium difficile antibiyotik ile ilişkili ishal ve kolitlerin en önemli nedenidir. Dünyada önemli bir sağlık sorunu olan antibiyotik ile ilişkili ishal olgularının %15-30'undan sorumlu tutulmaktadır. Clostridium difficile enfeksiyonu hafif ishalden toksik megakolon oluşumuna kadar varan, değişken bir klinik tablo sergilemektedir İleri yaş, hastanede yatma ve özgün antibiyotiklere maruz kalma Clostridium difficile enfeksiyonu için en yaygın risk faktörleridir. Bu çalışmada uzun süre hastanede yatan hastalarda Clostridium difficile toksin A/B varlığı araştırılmıştır; bu tür bir araştırma bölgemizde daha önce hiç yapılmamıştır.

Aim: Tetanus is an acute and lethal disease caused by exotoxins named tetanospasmin produced by Clostridium tetani. Despite being vaccine-preventable, tetanus is still a toxicinfectious disease with high mortality. In this cross-sectional study, it is aimed to determine levels of tetanus anti-toxin IgG and factors affecting it in adults in the region. Material and Methods: This cross-sectional study was conducted with patients applied to the blood sampling laboratory unit of Düzce University Hospital. Tetanus anti-toxin IgG Enzyme-Linked Immuno Sorbent Assay kits (Catalog number: EI 2060-9601 G, Euroimmun, Germany) were used for detection of tetanus antibodies. Those with tetanus anti-toxin IgG >0.1 IU/ml were considered immunized. Socio-demographic information of participants were collected using a questionnaire during blood collection. Results: Sufficient tetanus antibody was detected in 140 (39.3%) of 356 patients. Protective antibody ratios were found as 49 (70.0%) in 30-40 age group, 39 (54.9%) in 41-50 age group, 22 (31.0%) in 51-60 age group, 16 (22.2%) in 61-70 age group and 14 (19.4%) in >71 age group. Tetanus immunity ratios were significantly reduced with aging (p<0.001). Protective antibodies were found to be higher in the groups who had more education and who were vaccinated in adult ages for any reason than in the other groups (both p<0.001). Conclusion: It was thought that the childhood immunity should be reinforced with the booster doses during adulthood by routine tetanus immunization program. In addition, the high level of tetanus immunity in those with high educational level has shown the importance of education.

Hastane enfeksiyonları tıp dünyasının çözüm bulmaya çalıştığı öncelikli sorunlar arasında yer almaya devam etmektedir. Yatan hastalarda nozokomiyal pnömoniye sebep olabilecek kaynaklardan biri de oksijen tedavisi sırasında kullanılan nemlendirme cihazlarıdır. Bu çalışmada Düzce Üniversitesi Araştırma ve Uygulama Hastanesi'nin çeşitli servislerinde bulunan oksijen tedavisi nemlendiricilerini mikrobiyolojik açıdan incelemek amaçlanmıştır. Gereç ve Yöntemler: 16.9.2016-20.3.2017 döneminde toplam 102 adet oksijen tedavisi nemlendiricisinden steril kaplara su örnekleri alınarak %5 koyun kanlı agar, eosin methylene blue agar, Sabouraud dextrose agar ve Löwenstein-Jensen besiyerine ekim yapıldı. Üreyen koloniler konvansiyonel ve otomatize yöntemler kullanılarak tanımlandı. Bulgular: Yüz iki örneğin 69'unda (%68) toplam 98 adet mikroorganizma üremiştir. Bu organizmaların 75'i (%77) bakteri, 23'ü (%23) mantar idi. Bakterilerin 56'sı (%75) nonfermentatif Gram-negatif bakteri (Chryseobacterium indologenes, Pseudomonas aeruginosa, Acinetobacter lwoffii, Acinetobacter baumannii, Acinetobacter ursingii, Acinetobacter haemolyticus, Sphingomonas paucimobilis, Stenotrophomonas maltophilia, Delftia acidovorans, Brevundimonas diminuta); 13'ü (%18) Corynebacterium spp.; 2'si (%3) Rhizobium radiobacter; 1'i (%1) Bacillus spp.; 1'i (%1) Neisseria spp.; 1'i (%1) Staphylococcus epidermidis; 1'i ise (%1) Mycobacterium gordonae idi. Mantarların ise 21'i (%91) küf mantarı (Fusarium spp., Aspergillus spp., Penicillium spp., Exophiala spp., Cladosporium spp., Acremonium spp., Cladophialophora spp., Alternaria spp.); 2'si (%9) maya mantarı (Candida krusei, Candida albicans) idi. Tartışma ve Sonuç: Servislerde bulunan oksijen tedavisi nemlendiricilerinin kullanımı ve dezenfeksiyonu ile ilgili kurallara yeterince uyulmadığı görülmüştür. Sağlık çalışanlarının bu kurallara riayet konusunda eğitilmesi ve denetlenmesi gerektiği düşünülmüştür.