External auditory canal microbiology and hearing aid use.

OBJECTIVE: The aim of this study was to determine the presence and nature of bacterial flora on hearing aids and the ears of this population. We wonder if the microbiology of the ears with hearing aid wearing differs from the other ear. SETTING: Tertiary referral center. DESIGN: A prospective, clinical study. SUBJECTS AND METHODS: Three samples were taken, one from the surface of the hearing aid's ear mold; one from the hearing aid-wearing ear canal and the last one from the ear without hearing aid. Samples were cultured to determine qualitatively and quantitatively the pathogenic microorganisms present. RESULTS: A total of 123 samples, obtained from 41 hearing aid users, were analyzed. Methicillin-resistant coagulase-negative staphylococci, methicillin-susceptible Staphylococcus aureus, methicillin-resistant S. aureus, Pseudomonas aeruginosa, Escherichia coli, Acinetobacter species, Staphylococcus auricularis, and Stenotrophomonas maltophilia were identified organisms. CONCLUSIONS: We identified unexpected microorganisms both on hearing aids and hearing aid using ears. This study demonstrates that using hearing aid alters the ear canal flora. To avoid otitis externa, it is important to use an appropriate hygiene routine to clean and disinfect hearing aids and ear molds.

In vitro susceptibility of enterococci strains isolated from urine samples to fosfomycin and other antibiotics.

Enterococci are mostly isolated from urinary tract infections (UTIs). Increasing antibiotic resistance affects the success rate in empirical treatment, thus makes antibiotic susceptibility tests important. The aim of this study was to determine the species distribution and resistance patterns of Enterococcus strains isolated from urine samples to antibacterial agents including fosfomycin in a teaching hospital, Istanbul. The identification of 100 Enterococcus strains were determined by using conventional methods and API 20 Strep (bioMerieux France). The susceptibility testing was performed by disk diffusion and Etest. The majority of isolates were E. faecalis (67%), followed by E. faecium (33%). The ratio of E. faecalis to E. faecium was 2.03/1. E. faecalis and E. faecium strains were resistant to penicillin (38.8, 93.9%), ampicillin (4.8, 84.8%), vancomycin (1.5, 18.2%), teicoplanin (1.5, 18.2%), gentamicin (13.4, 58%), ciprofloxacin (34.3, 84.8%), levofloxacin (34.3, 87.9%), norfloxacin (38.8, 84.8%), tetracycline (89.6, 48.5%), nitrofurantoin (1.5, 39.4%), and fosfomycin (2.3, 0%) (p < 0.0001), respectively. Resistance to fosfomycin was observed in neither E. faecium strains, nor vancomycine-resistant enterococci strains. It was concluded that, enterococci are important pathogens for UTI; species identification and periodic evaluation of antibiotic susceptibility pattern would be guide for early empirical treatment and in uncomplicated UTI, fosfomycin could be an alternative option for therapy.

Evaluation of microbiological spectrum and risk factors of cellulitis in hospitalized patients.

BACKGROUND AND DESIGN: Cellulitis is a common soft tissue infection and the severity of disease vary from mild to life threatening. The aim of the present retrospective study was to evaluate age, sex, site of infection, microbiological spectrum and the risk factors of cellulitis in hospitalized patients. MATERIALS AND METHODS: The data were retrospectively obtained by the review of 185 hospitalized patients who were diagnosed as cellulitis between 2003 and 2009 in the departments of dermatology, infectious diseases, internal medicine and surgery clinics of Haydarpasa Numune Training and Research Hospital (Istanbul, Turkey). The diagnosis was done by infectious diseases and dermatology specialists in all patients who were included to this study. Demographic findings, wound-blood cultures and risk factors of the patients with cellulitis were evaluated. RESULTS: Eighty-six were female, 99 were male of total 185 patients, and the mean age of them was 48 ± 27 (14-85). The leg was the involved site in 69% of the patients. The most frequent isolated bacteria from wound cultures were methicillin-sensitive Staphylococcus aureus 31.5%, Pseudomonas aeruginosa 12.6%, and Escherichia coli 12.3%. However, methicillin-sensitive S. aureus 32.5%, methicillin-resistant S. aureus 22.5%, coagulase-negative staphylococci 17.5% were detected from blood cultures. There was not any underlying risk factor in 104 (55.3%) patients. The risk factors observed in the other 81 patients were previous surgery or open wound 29 (35.8%), diabetes mellitus 19 (26.6%), cardiovascular diseases 16 (19.7%), immunosuppression 11 (13.5%), lymphoedema 6 (7.4%). CONCLUSION: In the patients hospitalized for cellulitis, the most frequently isolated microorganism from the wound and blood cultures was S. aureus and the most frequently detected risk factors were to have an open wound and previous surgery. Especially when the patients had risk factors, it was observed that the bacterial spectrum was broader and the clinical presentation was severe. The wound and blood cultures should be performed simultaneously for the microbiological diagnosis and the appropriate management of cellulitis.

Clinical features, laboratory data, management and the risk factors that affect the mortality in patients with postoperative meningitis.

BACKGROUND: Nosocomial meningitis is a rare complication following neurosurgical procedures and is associated with high morbidity and mortality. AIM: The aim of this study was to describe the clinical characteristics and the risk factors associated with mortality in patients who developed nosocomial meningitis following neurosurgical operations. SETTING AND DESIGN: Tertiary care hospital and an observational study. MATERIALS AND METHODS: The study subjects included 2265 patients who underwent various neurosurgical operations during 2003-05. The diagnosis of nosocomial meningitis was based on the Center for Disease Control criteria. STATISTICAL ANALYSIS: It was performed by using Statistical Package for Social Sciences for Windows 10.0 program. RESULTS: The incidence of postoperative nosocomial meningitis was 2.7% (62 episodes in 49 patients among 2265 patients operated). Staphylococcus aureus and Acinetobacter spp. were the most frequently isolated pathogens. Of the 49 with meningitis 20 (40.8%) patients died. In the logistic regression analysis model, Glascow coma scale score less than 10 (Odds Ratio (OR): 19.419, 95% Confidence Interval (CI); 1.637-230.41, P = 0.001), and low cerebrospinal fluid glucose level (< or = 30 mg/ dL) (OR: 10.272, 95% CI; 1.273-82.854, P = 0.002), and presence of concurrent nosocomial infection (OR: 28.744, 95% CI;1.647-501.73, P =0.001) were the independent risk factors associated with mortality. CONCLUSION: The mortality in patients who developed meningitis was high. The high percentage of concurrent nosocomial infections was associated with a high mortality rate which was a serious problem.

Alterations in bacterial spectrum and increasing resistance rates in isolated microorganisms from device-associated infections in an intensive care unit of a teaching hospital in Istanbul (2004-2010).

The aim of the present study was to determine the rate of device-associated infection (DAI) and the change in profiles and antimicrobial resistance patterns of the causative microorganisms in a medical-surgical intensive care unit (ICU), as well as to evaluate the effect of a new nationwide hospital infection control program (NHICP), which has been implemented in Turkey. In this study, 5,772 patients that were hospitalized for a total of 43,658 days acquired 1,321 DAIs, with an overall rate of 30.2% per 1,000 ICU days. Between 2004 (before the NHICP) and 2010, the incidence densities of catheter-associated urinary tract infection (CAUTI) decreased from 10.2 to 5.7 per 1,000 device-days (P < 0.0001), and central venous catheter-associated bloodstream infection (CVC-BSI) decreased from 5.3 to 2.1 per 1,000 device-days (P < 0.0001). However, ventilator-associated pneumonia increased from 27.0 to 31.5 per 1,000 device-days. Multidrug-resistant species rates increased from 5.8% to 76.6% (P < 0.0001) for Acinetobacter spp. and from 6.8% to 53.1% (P < 0.0001) for Pseudomonas aeruginosa. The extended-spectrum ß-lactamase-producing Enterobacteriaceae rate increased from 23.1% to 54.2% (P = 0.01); the vancomycin-resistance rate among Enterococcus spp. increased from 0% in 2004 to 12.5% in 2010 (P = 0.0003). In conclusion, while a significant decrease was achieved in the incidences of CAUTI and CVC-BSI, the NHICP was not completely effective in our ICU. The high incidence of DAI and the increasing prevalence of multidrug-resistant microorganisms indicate that further interventions are urgently needed.