Clinicopathological profile of gastrointestinal tuberculosis: a multinational ID-IRI study.

Data are relatively scarce on gastro-intestinal tuberculosis (GITB). Most studies are old and from single centers, or did not include immunosuppressed patients. Thus, we aimed to determine the clinical, radiological, and laboratory profiles of GITB. We included adults with proven GITB treated between 2000 and 2018. Patients were enrolled from 21 referral centers in 8 countries (Belgium, Egypt, France, Italy, Kazakhstan, Saudi Arabia, UK, and Turkey). One hundred four patients were included. Terminal ileum (n = 46, 44.2%), small intestines except terminal ileum (n = 36, 34.6%), colon (n = 29, 27.8%), stomach (n = 6, 5.7%), and perianal (one patient) were the sites of GITB. One-third of all patients were immunosuppressed. Sixteen patients had diabetes, 8 had chronic renal failure, 5 were HIV positive, 4 had liver cirrhosis, and 3 had malignancies. Intestinal biopsy samples were cultured in 75 cases (78.1%) and TB was isolated in 65 patients (86.6%). PCR were performed to 37 (35.6%) biopsy samples and of these, 35 (94.6%) were positive. Ascites samples were cultured in 19 patients and M. tuberculosis was isolated in 11 (57.9%). Upper gastrointestinal endoscopy was performed to 40 patients (38.5%) and colonoscopy in 74 (71.1%). Surgical interventions were frequently the source of diagnostic samples (25 laparoscopy/20 laparotomy, n = 45, 43.3%). Patients were treated with standard and second-line anti-TB medications. Ultimately, 4 (3.8%) patients died and 2 (1.9%) cases relapsed. There was a high incidence of underlying immunosuppression in GITB patients. A high degree of clinical suspicion is necessary to initiate appropriate and timely diagnostic procedures; many patients are first diagnosed at surgery.

Brucellosis in pregnancy: results of multicenter ID-IRI study.

Brucellosis in pregnant women is reported to be associated with obstetric complications (OCs), and adequate data for human brucellosis during pregnancy are largely lacking. We performed this multicenter retrospective cross-sectional study to evaluate the epidemiology, clinical course, treatment responses, and outcomes of brucellosis among pregnant women. The study period comprised a 14-year period from January 2002 to December 2015. All consecutive pregnant women diagnosed with brucellosis in 23 participating hospitals were included. Epidemiological, clinical, laboratory, therapeutic, and outcome data along with the assessment data of the neonate were collected using a standardized questionnaire. Data of 242 patients were analyzed. The OC rate was 14.0% (34/242) in the cohort. Of the 242 women, 219 (90.5%) delivered at term, 3 (1.2%) had preterm delivery, 15 (6.2%) aborted, and 5 (2.1%) had intrauterine fetal demise. Seventeen (7.0%) of the newborns were considered as low birth weight. Spontaneous abortion (6.1%) was the commonest complication. There were no maternal or neonatal deaths and pertinent sequelae or complications were not detected in the newborns. Splenomegaly (p = 0.019), nausea and/or vomiting (p < 0.001), vaginal bleeding (p < 0.001), anemia (blood hemoglobin < 11 g/dL; p < 0.001), high level of serum aspartate aminotransferase (> 41 IU/L; p = 0.025), oligohydramnios on ultrasonography (p = 0.0002), history of taking medication other than Brucella treatment during pregnancy (p = 0.027), and Brucella bacteremia (p = 0.029) were the significant factors associated with OCs. We recommend that pregnant women with OC or with fever should be investigated for brucellosis if they live in or have traveled to an endemic area.

Portraying infective endocarditis: results of multinational ID-IRI study.

Infective endocarditis is a growing problem with many shifts due to ever-increasing comorbid illnesses, invasive procedures, and increase in the elderly. We performed this multinational study to depict definite infective endocarditis. Adult patients with definite endocarditis hospitalized between January 1, 2015, and October 1, 2018, were included from 41 hospitals in 13 countries. We included microbiological features, types and severity of the disease, complications, but excluded therapeutic parameters. A total of 867 patients were included. A total of 631 (72.8%) patients had native valve endocarditis (NVE), 214 (24.7%) patients had prosthetic valve endocarditis (PVE), 21 (2.4%) patients had pacemaker lead endocarditis, and 1 patient had catheter port endocarditis. Eighteen percent of NVE patients were hospital-acquired. PVE patients were classified as early-onset in 24.9%. A total of 385 (44.4%) patients had major embolic events, most frequently to the brain (n = 227, 26.3%). Blood cultures yielded pathogens in 766 (88.4%). In 101 (11.6%) patients, blood cultures were negative. Molecular testing of vegetations disclosed pathogens in 65 cases. Overall, 795 (91.7%) endocarditis patients had any identified pathogen. Leading pathogens (Staphylococcus aureus (n = 267, 33.6%), Streptococcus viridans (n = 149, 18.7%), enterococci (n = 128, 16.1%), coagulase-negative staphylococci (n = 92, 11.6%)) displayed substantial resistance profiles. A total of 132 (15.2%) patients had cardiac abscesses; 693 (79.9%) patients had left-sided endocarditis. Aortic (n = 394, 45.4%) and mitral valves (n = 369, 42.5%) were most frequently involved. Mortality was more common in PVE than NVE (NVE (n = 101, 16%), PVE (n = 49, 22.9%), p = 0.042).

The virulence factors and antibiotic sensitivities of Escherichia coli isolated from recurrent urinary tract infections.

OBJECTIVE: We determined the antibiotic sensitivities of uropathogenic Escherichia coli (UPEC) strains isolated from the urine of patients who have recurrent urinary tract infections (UTIs). METHODS: Our study was carried out between November 2000 and January 2002 at the Infectious Diseases Clinic, Istanbul Haydarpasa Numune Hospital, Istanbul, Turkey. We compared the virulence factors (fimbrial adhesion, hemolysin production, motility property) of 50 strains of Escherichia coli (E. coli) isolated from urine with the same properties of 25 strains of E. coli isolated from stool specimens of healthy individuals. In addition, we detected the virulence factors of UPEC strains using a microbiological and biochemical methods and by using disk diffusion method, we were able to investigate the sensitivity of the strains to the antimicrobials. RESULTS: We found the level of mannose-resistant (MR) fimbriae bearing in the UPEC strains to be significantly higher than that in the controls (odds ratio=10.27, p<0.001). The difference in mannose-resistant hemoagglutination (MRHA) and mannose sensitive hemoagglutination (MSHA) bearing levels in UPEC strains were rather high. This difference was regarded as significant in terms of showing the virulence of fimbriae bearing strains (odds ratio=29.03, p<0.001). CONCLUSION: Our study demonstrates that strains with MR fimbriae have a rather high virulence (p<0.001), and that a combination of MR+MS fimbriae increased that virulence (p<0.001). As MR strains have a greater adhesive property, the determination of MR fimbriae bearing as high shows that fimbriae bearing plays an important role in widespread and resistant strains, especially in recurrent UTIs such as in our study. In addition, hemolysin capability was also a virulence factor in recurrent UTIs (p<0.01). In addition, the sensitivity of the strains to the antimicrobials appeared in the following order; imipenem 93%, norfloxacin 89%, ciprofloxacin 85%, netilmicin 80%, amikacin 78%, ceftriaxone 74%, gentamicin 72%, nitrofurantoin 71%, ampicillin-sulbactam 60%, amoxicillin-clavulanate 58%, Trimethoprim/sulfamethoxazole 45%, ampicillin 35%.

Hamsi scoring in the prediction of unfavorable outcomes from tuberculous meningitis: results of Haydarpasa-II study.

Predicting unfavorable outcome is of paramount importance in clinical decision making. Accordingly, we designed this multinational study, which provided the largest case series of tuberculous meningitis (TBM). 43 centers from 14 countries (Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria, Turkey) submitted data of microbiologically confirmed TBM patients hospitalized between 2000 and 2012. Unfavorable outcome was defined as survival with significant sequela or death. In developing our index, binary logistic regression models were constructed via 200 replicates of database by bootstrap resampling methodology. The final model was built according to the selection frequencies of variables. The severity scale included variables with arbitrary scores proportional to predictive powers of terms in the final model. The final model was internally validated by bootstrap resampling. A total of 507 patients' data were submitted among which 165 had unfavorable outcome. Eighty-six patients died while 119 had different neurological sequelae in 79 (16%) patients. The full model included 13 variables. Age, nausea, vomiting, altered consciousness, hydrocephalus, vasculitis, immunosuppression, diabetes mellitus and neurological deficit remained in the final model. Scores 1-3 were assigned to the variables in the severity scale, which included scores of 1-6. The distribution of mortality for the scores 1-6 was 3.4, 8.2, 20.6, 31, 30 and 40.1%, respectively. Altered consciousness, diabetes mellitus, immunosuppression, neurological deficits, hydrocephalus, and vasculitis predicted the unfavorable outcome in the scoring and the cumulative score provided a linear estimation of prognosis.

Comparison of brucellar and tuberculous spondylodiscitis patients: results of the multicenter "Backbone-1 Study".

BACKGROUND CONTEXT: No direct comparison between brucellar spondylodiscitis (BSD) and tuberculous spondylodiscitis (TSD) exists in the literature. PURPOSE: This study aimed to compare directly the clinical features, laboratory and radiological aspects, treatment, and outcome data of patients diagnosed as BSD and TSD. STUDY DESIGN: A retrospective, multinational, and multicenter study was used. PATIENT SAMPLE: A total of 641 (TSD, 314 and BSD, 327) spondylodiscitis patients from 35 different centers in four countries (Turkey, Egypt, Albania, and Greece) were included. OUTCOME MEASURES: The pre- and peri- or post-treatment spinal deformity and neurologic deficit parameters, and mortality were carried out. METHODS: Brucellar spondylodiscitis and TSD groups were compared for demographics, clinical, laboratory, radiological, surgical interventions, treatment, and outcome data. The Student t test and Mann-Whitney U test were used for group comparisons. Significance was analyzed as two sided and inferred at 0.05 levels. RESULTS: The median baseline laboratory parameters including white blood cell count, C-reactive protein, and erythrocyte sedimentation rate were higher in TSD than BSD (p<.0001). Prevertebral, paravertebral, epidural, and psoas abscess formations along with loss of vertebral corpus height and calcification were significantly more frequent in TSD compared with BSD (p<.01). Surgical interventions and percutaneous sampling or abscess drainage were applied more frequently in TSD (p<.0001). Spinal complications including gibbus deformity, kyphosis, and scoliosis, and the number of spinal neurologic deficits, including loss of sensation, motor weakness, and paralysis were significantly higher in the TSD group (p<.05). Mortality rate was 2.22% (7 patients) in TSD, and it was 0.61% (2 patients) in the BSD group (p=.1). CONCLUSIONS: The results of this study show that TSD is a more suppurative disease with abscess formation requiring surgical intervention and characterized with spinal complications. We propose that using a constellation of constitutional symptoms (fever, back pain, and weight loss), pulmonary involvement, high inflammatory markers, and radiological findings will help to differentiate between TSD and BSD at an early stage before microbiological results are available.

Analysis of antimicrobial consumption and cost in a teaching hospital.

BACKGROUND: The aim of this study is to compare the periods before and after the intervention applied using the ATC/DDD method in order to ascertain the rational use of antibiotics in a newly established hospital. METHOD: The appropriateness of the hospital's antibiotic use, consumption rates and the costs were calculated and compared with other hospitals. Based on these data, an intervention has been planned in order to raise the quality of antibiotic use. The periods before and after the intervention were compared. Between 16 May 2011 and 23 May 2012, data were collected from all hospital units by the infectious diseases specialists and a point prevalence survey was conducted. Anatomical therapeutic chemical classification and the defined daily dose (DDD) methodology were used to calculate the antibiotic consumption. RESULTS: On two specific days in 2011 and 2012, 194 out of 307 patients (63.2%) and 224 out of 412 patients (54.4%) received antibiotic treatment, respectively. In 2011 and 2012, the percentage of appropriate antibiotic use was 51% and 64.3%, respectively. Both in 2011 and 2012, inappropriate antibiotic use was found to be significantly higher in surgical clinics in comparison to the internal diseases clinics and the ICU. This was caused by the high rates of inappropriate perioperative antimicrobial prophylaxis observed in surgical clinics. During both years, approximately one-third of the antibiotics were prescribed for the purposes of perioperative prophylaxis, while 88.5% and 43.7% of these, respectively, were inappropriate and unnecessary. Cephalosporins, fluoroquinolones, combinations of penicillins (including ß-lactamase inhibitors) and carbapenems were the most frequently prescribed antibiotics during the study periods. The mean total antibiotic consumption was 93.6 DDD/100 bed-days and 63.1 DDD/100 bed-days, respectively. The cost of total antibacterial consumption was € 7901.33 for all the patients (€ 40.72 per infected patient) and € 6500.26 (€ 29.01 per infected patient), respectively. CONCLUSION: Each hospital should follow and assess their antibiotic use expressed in DDD in order to compare their antibiotic use with national and international hospitals (WHO, 2009 [14]).

Respiratory system involvement in brucellosis: the results of the Kardelen study.

BACKGROUND: Pulmonary involvement is a rare complication of brucellosis. We describe the largest series to date, to our knowledge, of patients with pulmonary brucellosis. METHODS: This 10-year, retrospective, descriptive study involved 27 centers in Turkey, including all patients with brucellosis with confirmed respiratory system involvement. RESULTS: Of 133 patients (67 men), 123 (92.5%) had acute infection (defined as < 2 months), with an overall mean ± SD duration of symptoms of 33.9 ± 8.5 days. The radiologic pattern of pulmonary disease was consolidation/lobar pneumonia in 91 patients (68.4%) and pleural effusion in 41 patients (30.8%), including 30 (22.5%) with both. Moreover, 23 patients (17.3%) had bronchitis (one with coexistent pneumonia), and 10 (7.5%) had nodular lung lesions (one with coexistent pneumonia and effusion). Blood culture results were positive in 56 of 119 patients, and all other cases were serologically confirmed. None of 60 sputum specimens and two of 19 pleural fluid samples (10.5%) yielded positive culture results for brucellosis. Other features of brucellosis, such as osteoarticular complications, were detected in 61 patients (45.9%); 59 (44.4%) had raised liver transaminase levels, and 59 (44.4%) had thrombocytopenia. Fifteen patients (11.3%) required management in an ICU for an average of 3.8 ± 2.2 days. All patients responded to standard combination antimicrobial therapy for brucellosis with no deaths, although treatment regimens required modification in seven patients. CONCLUSIONS: Brucellosis with pulmonary involvement is rare but has a good prognosis following treatment with appropriate antibiotics. Many clues in the exposure history, presenting clinical features, and baseline blood tests should alert the clinician to consider brucellosis.

Assessment of perioperative antimicrobial prophylaxis using ATC/DDD methodology.

OBJECTIVES: In the light of international experience and guidelines and in order to improve the quality of perioperative antimicrobial prophylaxis (PAP), various hospitals have set up their own multidisciplinary healthcare teams and have evaluated the density of PAP through close supervision and interventions. The aim of the present study was to compare the density, quality, and cost of PAP before and after an intervention implemented at our hospital in order to increase the quality of PAP. METHODS: PAP was monitored using a form prepared in line with the international guidelines, which was completed by the infection control nurse under the supervision of the infectious diseases specialist. In order to reduce the frequent errors in our PAP procedures, an intervention was implemented, and the period before this intervention (January-April 2011) was compared with the post-intervention period 1 year later (January-April 2012). The density of PAP was calculated according to the Anatomical Therapeutic Chemical classification/defined daily dose (ATC/DDD) methodology. RESULTS: A total of 2398 patients received PAP during this period. The most frequently used antibiotic before and after the intervention was cefazolin. Its use further increased after the intervention (p<0.001). After the intervention, the ratio of the correct timing of the first antibiotic dose increased from 91.7% to 99.0% (p<0.001), while the excessively long administration of PAP was reduced from 77.0% to 44.7% (p<0.001). The ratio of full compliance with the guidelines increased from 15.5% to 40.2% (p<0.001) and the rate of surgical site infections dropped from 18.5% to 12.0%. The density of antibiotic use dropped from 305.7 DDD/100 procedures=3.1 DDD/procedure to 162.1 DDD/100 procedures=1.6 DDD/procedure. CONCLUSION: The quality of PAP may be improved through better compliance with healthcare guidelines, close supervision, and training activities. Also, surgical site infections and the cost of PAP may be reduced through more appropriate antibiotic use, thus contributing to the national healthcare budget.

Efficacy and safety of tenofovir disoproxil fumarate in pregnancy for the prevention of vertical transmission of HBV infection.

AIM: To evaluate the effects of tenofovir disoproxil fumarate (TDF) use during late pregnancy to reduce hepatitis B virus (HBV) transmission in highly viremic mothers. METHODS: This retrospective study included 45 pregnant patients with hepatitis B e antigen (+) chronic hepatitis B and HBV DNA levels > 107 copies/mL who received TDF 300 mg/d from week 18 to 27 of gestation (n = 21). Untreated pregnant patients served as controls (n = 24). All infants received 200 IU of hepatitis B immune globulin (HBIG) within 24 h postpartum and 20 µg of recombinant HBV vaccine at 4, 8, and 24 wk. Perinatal transmission rate was determined by hepatitis B surface antigen and HBV DNA results in infants at week 28. RESULTS: At week 28, none of the infants of TDF-treated mothers had immunoprophylaxis failure, whereas 2 (8.3 %) of the infants of control mothers had immunoprophylaxis failure (P = 0.022). There were no differences between the groups in terms of adverse events in mothers or congenital deformities, gestational age, height, or weight in infants. At postpartum week 28, significantly more TDF-treated mothers had levels of HBV DNA < 250 copies/mL and normalized alanine aminotransferase compared with controls (62% vs none, P < 0.001; 82% vs 61%, P = 0.012, respectively). CONCLUSION: TDF therapy during the second or third trimester reduced perinatal transmission rates of HBV and no adverse events were observed in mothers or infants.

Treatment of chronic delta hepatitis: a nine-year retrospective analysis.

BACKGROUND: Chronic delta hepatitis is the most severe form of viral hepatitis, for which interferon administration is the only available treatment. However, the efficacy of interferon treatment is affected by the dose and duration of treatment, and relapse rates are high. OBJECTIVES: In this study, we sought to evaluate the efficacy of treatment with pegylated interferon and observe the relapse rates of delta hepatitis after treatment. PATIENTS AND METHODS: Forty-six patients with chronic delta hepatitis were retrospectively studied between January 2002 and December 2010. Patients were evaluated for biochemical, virological, and histological responses. They were then followed-up for at least 1 year after discontinuation of the treatment. RESULTS: All the 46 patients in the study received PEG-IFN therapy. Of the 46 patients,25 were treated with PEG-IFN for 1 year and 21 were treated for 2 years. Sixteen patients(34.7%) showed a biochemical response, 27 (58.6%) showed a virological response, and 39 (84.7%) showed a histological response. Sustained virological and biochemical responseswere achieved in 41% and 47.8% of the patients, respectively. Sixteen (84.2%) patients of the 19 with high levels of hepatitis delta virus RNA (HDV RNA) (HDV RNAlevel > 1 × 105) and 10 (71.4%) of the 14 patients with high titers of hepatitis B surface antigen(HbsAg) (HbsAg > 102 IU/mL) at the beginning of the treatment showed relapse after treatment. CONCLUSIONS: We found no significant differences between 1-year and 2-year treatments.However, the relapse rate was lower in the 2-year treatment group. Higher HDV RNA and HbsAg levels before treatment were associated with higher relapse rates. Younger age was a significant factor in predicting response.

Brucellosis in pregnancy.

This study was undertaken in order to evaluate the effect of brucellosis in pregnancy. The serum agglutination test, Coombs and/or blood culture systems were used in the diagnosis of brucellosis. From July 2003 to September 2010, the clinical and delivery patterns of 40 healthy pregnant women were compared with 39 pregnant women who had brucellosis. There were no birth defects, anomalies or mortalities. We observed that brucellosis in pregnancy increases the incidence of preterm delivery (P = 0.01) and low birth weight (P = 0.001) from that seen in general deliveries. A cephtriaxone/rifampicin combination was found to be the most effective treatment in pregnant women infected with brucellosis (P = 0.004). Brucellosis in pregnancy has no effect on the incidence of congenital malformations or stillbirths. Preterm delivery and low birth weight can be seen as pregnancy outcomes in brucellosis. Appropriate antimicrobial therapy of brucellosis in pregnancy will reduce morbidity and prevent complications.

Seroprevalence of Hepatitis B and C among Children in Endemic Areas of Turkey.

BACKGROUND AND AIMS: Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections are major worldwide public health problems. The objectives of this study were to evaluate the seroprevalence and epidemiological profile of hepatitis B and hepatitis C, to determine the impact of the national vaccination programme against hepatitis B on the prevalence of the hepatitis B surface antigen (HBsAg) carrier and the antibody to hepatitis B surface antigen (anti-HBs) occurrence rate among 0-14 year-old children in southeast Turkey. METHODS: The seroprevalence of hepatitis B and hepatitis C markers was evaluated retrospectively in a group of 10,391 children who were admitted to a tertiary hospital, the Diyarbakir Education and Research Hospital, from January 2005 to December 2008, in order to obtain a better understanding of the regional hepatitis seroprevalence. Children were divided into three different age groups: pre-education period (0-6 years), primary school period (7-12 years) and secondary school period (13-14 years). Samples were analyzed for HBsAg, hepatitis B e antigen (HBeAg), antibody to HBeAg (anti-HBe), anti-HBs positive/antibodies to hepatitis B core antigen (anti-HBc) positive, isolated anti-HBs and antibodies to Hepatitis C virus (anti-HCV) using a commercially available enzyme-linked immunosorbent assay (ELISA). RESULTS: The mean age of all participants was 8.5± 2 years (range, 0-14). The overall percentages for the prevalence of HBsAg, HBeAg, anti-HBe and anti-HCV were 8.1%, 2.1%, 5.9% and 0.5%, respectively. HBsAg seroprevalence differed significantly by age and gender (P < 0.001). HBeAg seroprevalence was high in the earliest years (P < 0.01). The overall prevalence of anti-HCV did not differ significantly by age (P > 0.5) but differed by gender (P < 0.001). The overall percentages for the prevalence of isolated anti-HBs and anti-HBs positive/anti-HBc positive were 34.2% and 56.9%,respectively. CONCLUSIONS: Our study sheds new light on hepatitis seroprevalence in southeastern Turkey. For example, 1) The seroprevalence of hepatitis B in southeast Turkey is still at its highest rate, according to the averages reported in other studies conducted in the same and different regions of Turkey; and it has not decreased, as reported previously. 2) HBeAg seroprevalence in the earliest years of childhood is high in our study; this is evidence for early acquisition of the infection.3) Isolated anti-HBs positive and anti-HBs positive/anti-HBc positive prevalence is high; given these features, it is obvious that despite the high incidence of vaccinated children, the prevalence of hepatitis B is increasing; and children acquire these viruses in their earliest years. 4) We found the overall prevalence of HCV infection unchanged. Our region has a low endemicity for HCV.

An investigation of Helicobacter pylori using culture, histopathological and serological examination methods and its antimicrobial sensitivities.

OBJECTIVES: In this study, the determination of Helicobacter pylori (H. pylori) by culture, histopathological and serological methods in cases of endoscopically diagnosed as duodenitis and duodenal ulcer (DU), a comparison of their relative advantages, and its antibiotic sensitivities were investigated. METHODS: Helicobacter pylori was investigated using 3 methods (culture, histopathological and serological examination) in 50 patients (25 diagnosed with duodenitis and 25 with DU) at the Department of Gastroenterohepatology, Istanbul Haydarpasa Numune Hospital, Turkey between December 2000 and February 2001. An investigation into its antibiotic sensitivities to amoxicillin, clarithromycin, metronidazole and azithromycin by disc diffusion methods and to amoxicillin and clarithromycin by E-test were investigated. RESULTS: Helicobacter pylori bacteria were observed in Gram stained preparates prepared from biopsy material in 34 out of 50 patients (68%), and were able to be produced in active culture in all these cases. Histopathological examination revealed the presence of H. pylori in 80% cases of DU and 60% cases of duodenitis; anti-CagA(IgG) was positively determined in 88% DU cases and in 60% duodenitis cases. There was a significant difference between the 2 groups in terms of diagnosis by histopathological and serological methods. The difference between the 2 groups produced in active culture in 84% cases of DU cases and 52% of duodenitis was statistically significant (p=0.0322). Using the E-test and disc diffusion methods, 8.8% of the strains that reproduced in culture were resistant to and 91.2% were sensitive to clarithromycin. All strains were determined to be sensitive to amoxicillin: 17.6% of the strains were determined to be resistant to metronidazole, 11.7% to azithromycin. CONCLUSION: It was observed that Gram staining is a rapid and reliable method of pre-diagnosis for H. pylori; that histopathological examination methods are of considerable importance in diagnosis; and that the investigation of the positivity of anti-CagA(IgG) will be a guide in the identification of virulent strains in particular. In addition, it was also concluded that since serological examination does not require invasive measures, this will pose an advantage. The culture method can be applied with the aim of diagnosis in cases identified as DU using endoscopy, and that in cases resistant to treatment it can be applied for the purpose of determining antimicrobial sensitivity. E-test and disc diffusion methods exhibited a rather good correlation, for which reason the disc diffusion method can be used in the determination of antimicrobial sensitivity in H. pylori strains.