[Investigation of the Antibacterial Synergistic Activity of Fosfomycin-Teicoplanin Combination in Methicillin-Resistant Staphylococcus aureus Strains Isolated from Various Clinical Sample]. / Çesitli Klinik Örneklerden Elde Edilen Metisiline Dirençli Staphylococcus aureus Izolatlarinda Fosfomisin-Teikoplanin Kombinasyonunun Antibakteriyel Sinerjistik Etkinliginin Arastirilmasi.

The aim of this study was to investigate the detection of teicoplanin and fosfomycin antibiotic susceptibility of methicillin-resistant Staphylococcus aureus (MRSA) strains by different methods and to evaluate the antibacterial synergistic effect of teicoplanin-fosfomycin combination by using checkerboard assay and time kill curve assay. Forty-five MRSA strains isolated from clinical samples in routine medical microbiology laboratory of Göztepe Prof. Dr. Süleyman Yalçin City Hospital were included in the study. In the first stage of the combination study, minimum inhibitory concentrations (MIC) were investigated by broth microdilution for teicoplanin and by both broth microdilution and agar dilution methods for fosfomycin. The combination of teicoplanin and fosfomycin was tested by the checkerboard method in 45 MRSA strains and combination effect was determined according to fractional inhibitory concentration index (ΣFIC) calculation. The synergistic effect and bactericidal activity of antibiotic combination were studied against a randomly selected strain from the strains used in the study by using time-kill method for 24 hours. As a result of teicoplanin and fosfomycin antibiotic susceptibility studies, all isolates were found to be susceptible to both antibiotics according to the susceptibility breakpoints determined by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). A synergistic effect was found in 22 (49%), additive effect in 22 (49%) and indifferent effect in one (2%) of the 45 strains studied with the checkerboard method. The mean ΣFIC of 45 isolates was found to be 0.5. In the combination study of the antibiotics of the isolate that was studied with time-kill method, synergism was detected for 1/8 MIC concentrations at 12th hour and 24th hour and synergism at 1/4 MIC concentration at sixth hour, 12th hour and 24th hour. In the combination study of 1/4 MIC concentrations of antibiotics, bactericidal effect was detected at sixth hour and this effect was observed to disappear at 12th and 24th hours. High rate of synergistic antibacterial effect of teicoplanin-fosfomycin combination on MRSA isolates was demonstrated as a result of in vitro tests. Such studies conducted on antibiotic-resistant bacterial infections will provide clinicians different treatment options and will contribute to increasing survival. As a result of this study, provided that it is supported by future clinical studies, it can be stated that the teicoplanin-fosfomycin combination may be an effective treatment option in community and hospital-acquired infections caused by MRSA.

HBsAg, anti-HCV and anti-HIV seroprevalence among blood donors in Southeastern Anatolia, Turkey, 2011-2015.

Transmission of infections through blood and blood product transfusion is a serious healthcare problem. There are insufficient up-to-date data about seroprevalence of HBsAg, anti-HCV and anti-HIV ½ among healthy blood donors in Turkey. We aimed to investigate the seroprevalence of HBsAg, anti-HCV and anti-HIV ½ in Southeastern Anatolia, Turkey. HBsAg, anti-HCV, and anti-HIV ½ analysis results among blood donors who applied to Dicle University Faculty of Medicine, Diyarbakir District Blood Centre, between January 1, 2011 and December 31, 2015 were retrospectively evaluated. HBsAg, anti-HCV, and anti-HIV 1/2 screenings were performed using a fully automated device with the microparticle enzyme immunoassay method (MEIA). The chi-square (χ2) test was applied to variables. Among the donors, 1607 (1.73%) were HBsAg-positive, 255 (0.27%) were anti-HCV-positive and two (0.0021%) were positive for anti-HIV 1/2. HBsAg positivity rates by years were 2.50% in 2011, 1.92% in 2012, 1.74% in 2013, 1.53% in 2014 and 1.27% in 2015 (p<0.001). HBsAg-positivity was 0.78% for the donors between 18-24 years of age, 1.90% for those between 25-49 years of age and 3.92% for donors over the age of 49 (p<0.001). Anti-HCV positivity rates were as follows: 0.35% in 2011, 0.34% in 2012, 0.29% in 2013, 0.23% in 2014 and 0.16% in 2015 (p<0.001). Verified anti-HIV 1/2 positivity was observed for only two donors (0.0021%) within five years. HBsAg and anti-HCV positivity were observed to decrease significantly over the years and were significantly lower among younger donors.

Absence of the mecC gene in methicillin-resistant Staphylococcus aureus isolated from various clinical samples: The first multi-centered study in Turkey.

BACKGROUND: mecA is a predefined gene causing methicillin resistance in Staphylococcus aureus (S. aureus) isolates; however, it has been shown that some methicillin-resistant S. aureus (MRSA) strains do not carry this gene. Recently, in isolates found to be MRSA-positive but mecA-negative, a new resistance gene called mecC, which is a homolog of mecA, has been reported. This study aimed to investigate the mecC and mecA genes in MRSA strains isolated from different geographic regions in Turkey. METHODS: The sample of the study consisted of 494 MRSA strains isolated from seven geographical regions in Turkey between 2013 and 2016. The strains were obtained from 17 centers, comprising 13 university hospitals, three education and research hospitals, and one state hospital. Methicillin resistance in S. aureus strains was determined using the agar disk diffusion method with a cefoxitin disk and the agar dilution method with oxacillin. The mecC and mecA genes in MRSA strains was investigated by Polymerase Chain Reaction (PCR). RESULTS: Of the MRSA strains investigated, 47.9% were isolated from intensive care units. Concerning sample type, 36.7% were detected in the respiratory tract (tracheal aspirate, sputum, etc.), 24.8% in blood, 18.7% in skin and soft tissues, 9.3% in nasal swabs, 5.4% in urine, 4.1% in ears, and 1% in sterile body fluid. Using PCR, mecC was not identified in any of the S. aureus strains isolated from different clinical microbiology laboratories. mecA gene positivity was found in 315 of the MRSA strains (63.8%). Staphylococcal Cassette Chromosome mec (SCCmec) type was identified in 232 strains (46.9%), of which 136 (58.7%) were type II, 75 (32.4%) were type IV, 12 (5.1%) were type IIIb, six (2.5%) were type I, and three (1.3%) were type III. CONCLUSION: This is the first multi-centered study to investigate MRSA strains isolated from different regions in Turkey. The mecC gene was not detected in any of the MRSA strains. We believe that this study will constitute an important basis for monitoring possible future changes.

Seropositivity of Hepatitis A in Children Aged 7-14 Years in Diyarbakir Province Center.

BACKGROUND Hepatitis A virus (HAV) is a common morbidity in society, and mortality is more common in older ages. It is important to identify the prevalence in the population, the development of primary protection methods, and vaccination policies. This study aimed to identify anti-HAV seropositivity in children in 3 different schools in Diyarbakir, Turkey, to evaluate the risk factors influencing prevalence, and thus to develop strategies to prevent infection. MATERIAL AND METHODS The study was a prospective investigation of 600 children with a mean age of 10.5 years (range, 7-14), including 291 males and 309 females. RESULTS The seropositivity was 45.7% (41.2% in males and 49.8% females) with a statistically significant difference by sex (p=0.042). It was also significantly correlated with age. Factors significantly associated with seropositivity were educational level and income of parents, number of rooms in the house, type of toilet, number of siblings, and source of drinking water. Hence, older age, more siblings, crowded household, and low socioeconomic level are risk factors for seropositivity. CONCLUSIONS Protection strategies for the disease include improving socioeconomic level, increasing the level of education, disseminating appropriate drinking water, improving infrastructure and sewage disposal, and public health education on hygiene and the importance of vaccination. We also believe that active immunization against HAV in Turkey in general and in our province in particular can prevent infection in children and related complications in older people.

[Investigation of antibiotic resistance patterns and reduced vancomycin susceptibilities of methicillin-resistant Staphylococcus aureus isolates: a multi-center study]. / Metisiline dirençli Staphylococcus aureus izolatlarinin antibiyotik direnci ve azalmis vankomisin duyarliliginin arastirilmasi: Çok merkezli bir çalisma.

The aims of this study were to determine the minimum inhibitory concentration (MIC) values of vancomycin, teicoplanin, daptomycin, quinupristin/dalfopristin, linezolid, tigecycline, chloramphenicol, rifampicin, ofloxacin and tetracycline and to investigate the reduced vancomycin susceptibility among methicillin-resistant Staphylococcus aureus (MRSA) strains isolated in hospitals located in different geographical regions of Turkey. A total of 100 MRSA strains isolated from patients (of which 50% were from intensive care units) hospitalized in seven centers in Turkey [Istanbul (n= 15), Ankara (n= 15), Izmir (n= 15), Adana (n= 15), Diyarbakir (n=15), Erzincan (n= 15), Van (n= 10)], between August 2013 - August 2014, were included in the study. Fourty-three strains were isolated from blood, whereas 21 were from lower respiratory tract, 17 from wounds, eight from catheters, six from urine, four from nasal swab and one from cerebrospinal fluid samples. Methicillin resistance of the isolates was determined by using cefoxitin (30 µg) disk with standard disk diffusion method, while the MIC values of other antibiotics were determined with E-test in accordance with the recommendations of Clinical and Laboratory Standards Institute (CLSI). MIC results obtained for quinupristin-dalfopristin (Q/D) were evaluated according to the CLSI criteria used for methicillin-susceptible S.aureus and for tigecycline according to the criteria recommended by the Food and Drug Administration for MRSA. Primarily, agar screening method (ASM) was used for determination of vancomycin-intermediate S.aureus (VISA) and heterogeneous VISA (hVISA) strains. Brain heart infusion agar containing 6 µg/ml vancomycin was used in ASM, and the strains with suspicion of VISA/hVISA were screened by standard E-test and macro E-test methods. All MRSA strains were susceptible to vancomycin, teicoplanin, daptomycin, Q/D and linezolid by E-test method; and their rates of susceptibility for tigecycline, chloramphenicol, rifampicin, ofloxacin and tetracycline were detected as 89%, 97%, 40%, 39% and 32%, respectively. MIC50/MIC90 values were 1.5/2 µg/ml for vancomycin, 2/4 µg/ml for teicoplanin, 0.19/0.38 µg/ml for daptomycin, 0.19/0.38 µg/ml for Q/D, 0.75/1 µg/ml for linezolid, 0.19/0.75 µg/ml for tigecycline, 3/6 µg/ml for chloramphenicol, 32/32 µg/ml for rifampicin, 32/32 µg/ml for ofloxacin and 32/64 µg/ml for tetracycline, respectively. For the evaluation of reduced vancomycin susceptibility, 2% (2/100) of MRSA strains were defined as VISA and 5% (5/100) as hVISA with ASM. One of those seven isolates identified as VISA/hVISA with ASM was evaluated as suspected hVISA by using both standard E-test and macro E-test methods. In conclusion, no MRSA resistant strain to vancomycin, teicoplanin, daptomycin, Q/D and linezolid was determined in our study. However tigecycline resistance (11%) was found higher than expected. As the glycopeptide resistance is increasing in the world and because of the intense use of these drugs in Turkey, the rates of vancomycin resistance among MRSA strains should be investigated periodically.

Panton-Valentine leukocidin in community and hospital-acquired Staphylococcus aureus strains.

Staphylococcus aureus causes serious hospital-acquired (HA) and community-acquired (CA) infections. Skin and soft-tissue infections especially are sometimes caused by strains harbouring Panton-Valentine leukocidin (PVL). PVL belongs to a family of bi-component leukocidal toxins produced by staphylococci. It is a pore-forming toxin encoded by lukF-PV and lukS-PV. A total of 70 S. aureus strains: 38 (54%) methicillin-resistant (MRSA) and 32 (46%) methicillin-susceptible (MSSA), were isolated from patients admitted to Dicle University Hospital (Turkey). Identification of S. aureus and antibiotics-susceptibility testing were performed with PHOENIX 100. PVL genes and mecA genes were detected by polymerase chain reaction. Of the 70 studied strains, 36 ones (51%) were community acquired and 34 ones (49%) were hospital acquired . A total of 38 (54%) strains were positive for mecA (mecA+), of which 32 ones (84%) were HA. Of the mecA- strains, 30 (94%) were CA. Of the 70 studied strains, 12 (17%) strains were PVL+: 8 (22%) of the 36 CA strains and 4 (12%) of the 34 HA strains. Of the 12 PVL+ strains, 4 strains were mecA+. The PVL positivity rate was 25% in MSSA, whereas 10.5% in MRSA. Of the overall PVL+ strains, seven strains were obtained from wounds; four ones from skin abscess; and one from blood culture. Taken together, the obtained results showed a substantial level of PVL genes in the studied region. Although PVL is known as a common virulence factor of CA MRSA, HA MRSA isolates in our study showed a considerable rate of PVL positivity.

Effect of routine Hepatitis B vaccination program in Southeast of Turkey? Comparing of the results of HBV DNA in terms of age groups for the years 2002 and 2012.

Diyarbakir is the largest residential area in the Southeastern Anatolia of Turkey. Routine HBV vaccination has begun to be implemented by the Ministry of Health in Turkey in 1998. The purposes of this study were to detect the levels of HBV DNA in patients with HBV in 2012, and to compare the results of the year 2002 according to age groups. HBV DNA results of patients were divided in to seven age groups (0-14, 15-20, 21-30, 31-40, 41-50, 51-60, and > 61 years) and for comparison of HBV DNA levels of 2002 and 2012, HBV DNA values in pg/ml of year 2002 were translated into IU/ml and HBV DNA levels were grouped as < 5 pg/ml < 2.43 × 10(5) IU/ml, 5-100 pg/ml 2.43 × 10(5)-4.86 × 106 IU/ ml, 101-2000 pg/ml 4.87 × 10(6)-9.72 × 10(7) IU/ml, > 2000 pg/ml > 9.72 × 10(7) IU/ml 2-3. A statistically significant decrease was seen in the number of individuals in 0-14 age group in 2012 compared with 2002. In 2002 the rate of individuals in 0-14 age group was 18.8% whereas 4.8% in 2012. Our study was suggested that that routine HBV vaccination program, contributed to the reduced risk of HBV infection in our region.

[Evaluation of rapid genotype assay for the identification of gram-positive cocci from blood cultures and detection of mecA and van genes]. / Kan Kültürlerinde Üreyen Gram-Pozitif Koklarin Tanimlanmasi ve mecA ve van Genlerinin Saptanmasinda Hizli Genotip Testinin Degerlendirilmesi.

Rapid and accurate identification of bacterial pathogens grown in blood cultures of patients with sepsis is crucial for prompt initiation of appropriate therapy in order to decrease related morbidity and mortality rates. Although current automated blood culture systems led to a significant improvement in bacterial detection time, more rapid identification systems are still needed to optimise the establishment of treatment. Novel genotype technology which is developed for the rapid diagnosis of sepsis, is a molecular genetic assay based on DNA multiplex amplification with biotinylated primers followed by hybridization to membrane bound probes. The aim of this study was to evaluate the performance of "Genotype® BC gram-positive” test for the identification of gram-positive cocci grown in blood cultures and rapid detection of mecA and van genes. This test uses DNA.STRIP® technology which includes a panel of probes for identification of 17 gram-positive bacterial species and is able to determinate the methicillin and vancomycin resistance mediating genes (mecA and vanA, vanB, vanC1, vanC2/C3) simultaneously, in a single test run. A total of 55 positive blood cultures from BACTECTM Plus/F (Becton Dickinson, USA) aerobic and pediatric blood culture vials were included in the study. The isolates which exhibit gram-positive coccus morphology by Gram staining were identified by Genotype ® BC gram-positive test (Hain Life Science, Germany). All of the samples were also identified with the use of Phoenix PMIC/ID Panel (Becton Dickinson, USA) and antibiotic susceptibilities were determined. Of the 55 blood culture isolates, 17 were identified as Staphylococcus epidermidis [all were methicillin-resistant (MR)], 9 were S.aureus (one was MR), 18 were S.hominis (10 were MR), 4 were E.faecalis, 3 were E. faecium (one was vanconycin-resistant), 2 were S.saprophyticus (one was MR), 1 was S.warneri and 1 was S.haemolyticus, by Phoenix automated system. Genotype® BC gram-positive test results revealed consistency with Phoenix system regarding bacterial identification in 46 (83.6%) of the samples. The two bacteria identified as S.saprophyticus by the Phoenix system could not be identified by the Genotype® BC test since this species were not included in the identification panel of the system, however, mecA gene were detected in these two samples by Genotype® BC test. Genotype® BC test detected mecA gene in five samples which were not detected as methicillin resistant by the Phoenix system. Besides polymicrobial growth was determined in five samples by Genotype ® BC test, but not by the automated system. One E.faecium isolate with vanA gene was correctly identified by Genotype® BC test. In conclusion, Genotype® BC gram-positive test is a fast and reliable test for the identification of the most important gram-positive pathogens and mecA and van genes directly from positive blood culture bottles. This test was also found superior than the automated Phoenix system regarding the detection of polymicrobial growth. These data indicated that, routine use of DNA strip technology-based assay would be useful for clinical diagnosis in patients with sepsis.

[Two diarrhea cases caused by Cyclospora cayetanensis]. / Cyclospora cayetanensis'in neden oldugu iki diyare olgusu.

Cyclospora cayetanensis is an intestinal protozoon that has emerged as an important cause of endemic or epidemic diarrheal disease in children and adults worldwide. Cases of cyclosporiasis have been frequently missed, since it is difficult to detect the parasite in fecal sample, despite an increasing amount of data regarding this parasite. In this case report two patients admitted to hospital with complaints of diarrhea and abdominal pain, were presented. Blood and urine biochemistry of both of the patients were within the normal limits and no pathogenic bacteria were grown in their stool samples. Occult blood in stool were negative in both cases. Both of the cases had normal serum immunoglobulin levels and had negative viral hepatitis, HIV and autoimmune markers. Direct microscopic examination and modified acid-fast staining of the stool samples revealed C.cayetanensis oocysts. Clinical response and eradication of the parasite were achieved with two weeks trimethoprim/sulphamethoxazole (2 x 160/240 mg) therapy. Since both cases applied in July 2009, an epidemiological investigation was initiated, however, no relation was determined. Although Cyclospora infections are assumed to be endemic in our country, the sporadic case reports might be attributed to the lack of relevant information about the parasite by the clinicians, lack of appropriate laboratory diagnosis and specialized personel for parasitic examination. Thus, screening studies performed with appropriate diagnostic methods for Cyclospora, might provide more informative epidemiological data related to this infection in Turkey.

Adapted T cell interferon-gamma release assay for the diagnosis of pleural tuberculosis.

BACKGROUND: Better and more rapid tests are needed for the diagnosis of tuberculous pleural effusion (TPE), given the known limitations of conventional diagnostic tests. OBJECTIVES: To estimate diagnostic accuracy of the QuantiFERON-TB Gold In-Tube (QFT-GIT) test (and its components) using data-derived cutoffs in pleural fluid. METHODS: The QFT-GIT test was performed on whole blood and pleural fluid from 43 patients with TPE and 29 control subjects (non-TPE). To achieve the objective, QFT-GIT test, estimating likelihood ratios and receiver operating curve analysis were performed. RESULTS: The sensitivity and specificity using the QFT-GIT for the diagnosis of TPE were 48.8% and 79.3%, respectively, in pleural fluid. The best cutoff points for tuberculosis (TB) antigen, nil and TB antigen minus nil results were estimated at 0.70, 0.90 and 0.30 IU/ml, respectively. Area under the curve of TB antigen IFN-γ response was 0.86 (CI: 0.76-0.93), nil tube was 0.80 (CI: 0.69-0.89) and TB antigen minus nil tube was 0.82 (CI: 0.72-0.90). When the best cutoff scores of the nil tubes were set at this value, the results of a likelihood ratio of a positive and a negative test were 9.44 (7.4-12.0) and 0.37 (0.09-1.5), respectively. The percentages of indeterminate results in pleural fluid among the TPE cases were 42% (most of them caused by high nil IFN-γ values) using the QFT-GIT test. CONCLUSION: QFT-GIT test or its components have poor accuracy in the diagnosis of TPE, largely because of a high number of indeterminate results due to high background IFN-γ production in the TPE.

Evaluation of the skin flora after chlorhexidine and povidone-iodine preparation in neurosurgical practice.

BACKGROUND: Currently, there are various antiseptics used for cleaning the skin before surgery, but there is no standard procedure in practice. Chlorhexidine and povidone-iodine are the most preferred compounds among antiseptics. Both are proved to be safe and effective for skin disinfection. In this study, our aim was to investigate the combined effects of chlorhexidine and povidone-iodine on the skin's flora before neurosurgical intervention, consecutively. METHODS: Randomly, 50 cranial and 50 spine neurosurgery cases were assigned to the study. The first culture was obtained after hair removal and before cleaning the skin with any antiseptic. The second culture was obtained after the skin had been cleaned with chlorhexidine for 3 minutes. Then, the skin was cleaned twice with povidone-iodine for 30 seconds, and the third and fourth cultures were taken from the skin incision area. Bacteria were identified by means of standard laboratory identification methods. Positive culture results were compared statistically among order of cultures obtained. RESULTS: In the first culture evaluation, 39 (33 cnS, 6 Stapylococcus aureus) of 50 cranial samples and 37 (33 cnS, 4 S aureus) of 50 spine samples showed reproduction. In the second culture, 9 cranial and 5 spine samples showed reproduction of cnS. In the third and fourth cultures, no growth was observed (P < .001). CONCLUSION: Three minutes' cleaning of the incision area with chlorhexidine, followed by 30-second cleaning with povidone-iodine, could be a sufficient disinfection procedure for preoperative preparation of the skin in patients undergoing a neurosurgical procedure.

[Investigation of anticardiolipin antibodies in chronic hepatitis B infection together with total anti-delta positivity]. / Kronik hepatit B enfeksiyonu ile birlikte total anti-delta pozitifliginde antikardiyolipin antikorlarinin arastirilmasi.

Anticardiolipin antibodies (ACAs) are formed against phospholipids in various clinical conditions such as autoimmune diseases, malignancy, infectious diseases, alcohol-related and hepatic cirrhosis. The aims of this study were to investigate the presence of ACAs in patients with chronic hepatitis B together with positive total anti-delta antibodies, and to investigate the relationship between age, gender, and some laboratory parameters (ALT, AST, albumin, globulin, platelet number) of patients with chronic hepatitis delta virus (HDV) infection, who were positive or negative for ACAs. A total of 60 patients (43 male, 17 female) with chronic hepatitis D infection [HBsAg positive, HBeAg negative, anti-HBe positive, anti-HBc IgG positive, anti-HBc IgM negative, total anti-delta positive, anti-HCV negative] and 30 patients (21 male, 9 female) without hepatitis D infection [HBsAg positive, HBeAg negative, anti-HBe positive, anti-HBc IgG positive, anti-HBc IgM negative, total anti-delta negative, anti-HCV negative] as control group were included to the study. ACA IgG and IgM were searched by a commercial microELISA kit (Euroimmun, Germany). The statistical evaluation was performed with Pearson's chi-square test, Student's t-test, and Fisher's exact test. Total ACAs positivity rate of 60 patients with chronic HDV infection, was found as 13.3%, in which four of the patients were positive for only ACA IgM, while four was positive for only IgG. Positivity for both ACA IgG and ACA IgM could not be detected in these patients. No patients in the control group had positivity for ACAs (IgG and/or IgM). A statistically significant difference was observed in terms of ACA positivity between patients with and without HDV infection (p< 0.05). After all, there was no statistically significant correlation between ACAs positivity and the age, sex, and laboratory parameters of the patients with chronic HDV infection, except lower serum albumin levels (p= 0.004). Although the data of this study revealed a statistically significant positive correlation between chronic HDV infection and anticardiolipin antibodies, it is clear that there is a need for further studies on this subject.

The prevalence of primary and secondary Helicobacter pylori resistance to clarithromycin and probable contributing cofactors: data from southeastern Anatolia.

BACKGROUND/AIMS: Antibiotic resistance of Helicobacter pylori is the most important reason for failure in its eradication. We aimed to determine the prevalence of primary and secondary H. pylori resistance to clarithromycin in isolated H. pylori from dyspeptic patients in southeastern Anatolia and to evaluate the cofactors affecting this clinical problem. METHODOLOGY: The study involved adult patients who had already been diagnosed with symptomatic H. pylori infection based on rapid urease test, gastric histopathological examination and culture. H. pylori strains were isolated from antral biopsies taken during upper endoscopy in 142 dyspeptic patients with no previous therapy against the microorganism. MICs of clarithromycin were determined by E-test. Patients were treated for 14 days with standard triple-agent protocol. H. pylori eradication rate was assessed after 8 weeks. Each patient was re-interviewed to determine secondary resistance. Primary clarithromycin resistance was defined as pre-treatment resistance, while secondary as after treatment resistance. Strains were considered resistant to clarithromycin if the MIC > 1 microg/mL. RESULTS: In total 213-105 women and 108 men-patients was enrolled to the study. The mean age was 35.5+/-14.1 years. In 142 (66.7%) patients out of the total patients enrolled in the study, H. pylori was detected. H. pylori could be cultured from only 61 (43%) of them. In 16.4% of the cases, primary clarithromycin resistance was noted. After 8 weeks, seventy-seven (54.2%) of the 142 patients were reevaluated. Helicobacter pylori eradication could be achieved in 68.8% of them. The proportion of H. pylori eradication in clarithromycin-sensitive patients was 75.8% and the respective proportion was 10% for resistant cases. In the group where H. pylori was still positive the secondary resistance percentage was found to be 27.2%. CONCLUSIONS: The prevalence of primary clarithromycin resistance is relatively high in our geographical area. Secondary resistance rate was 27.2%. None of the criteria of age, gender, presence of endoscopic lesions, detected H. pylori concentration and gastritis activity showed any effect on the primary resistance.

Risk factors for drug resistant tuberculosis in southeast Turkey.

We undertook a cross-sectional survey of 116 patients at Dicle Hospital, Turkey, who had with bacteriologically confirmed tuberculosis (TB). Demographic and clinical features, including age, gender, pulmonary TB history, associated diabetes mellitus, previous TB treatment, residential area and education, were collected from charts. Eighty-four of the strains were found to be susceptible to all drugs. The resistance to one or more drug(s) was found in 32 strains. Multi-drug resistant (MDR) TB was found in 13 strains (11.3% of the total and 40.7% of the drug resistant strains). The resistance to isoniazid was the most frequently seen (25 strains, 21.5%). In the multivariable analysis, only previous TB treatment (P = 0.000) remained a significant predictor for drug resistance; in MDR, previous TB treatments (P = 0.002) remained significant in the final model. The patient's educational status was found to be negatively correlated with the risk of MRD-TB (P = 0.035). Previous TB treatment and low educational status were found to important risk factors for the development of MDR-TB.

Lamivudine for the prevention of hepatitis B virus reactivation in hepatitis-B surface antigen (HBSAG) seropositive cancer patients undergoing cytotoxic chemotherapy.

Hepatitis B virus (HBV) is one of the major causes of chronic liver disease worldwide. Cancer patients who are chronic carriers of HBV have a higher hepatic complication rate while receiving cytotoxic chemotherapy (CT) and this has mainly been attributed to HBV reactivation. In this study, cancer patients who have solid and hematological malignancies with chronic HBV infection received the antiviral agent lamivudine prior and during CT compared with historical control group who did not receive lamivudine. The objectives were to assess the efficacy of lamivudine in reducing the incidence of HBV reactivation, and diminishing morbidity and mortality during CT. Two groups were compared in this study. The prophylactic lamivudin group consisted of 37 patients who received prophylactic lamivudine treatment. The historical controls consisted of 50 consecutive patients who underwent CT without prophylactic lamivudine. They were followed up during and for 8 weeks after CT. The outcomes were compared for both groups. Of our control group (n= 50), 21 patients (42%) were established hepatitis. Twelve (24%) of them were evaluated as severe hepatitis. In the prophylactic lamivudine group severe hepatitis were observed only in 1 patient (2.7%) of 37 patients (p < 0.006). Comparison of the mean ALT values revealed significantly higher mean alanine aminotransferase (ALT) values in the control group than the prophylactic lamivudine group; 154:64 (p < 0.32). Our study suggests that prophylactic lamivudine significantly decreases the incidence of HBV reactivation and overall morbidity in cancer patients during and after immunosuppressive therapy. Further studies are needed to determine the most appropriate nucleoside or nucleotide analogue for antiviral prophylaxis during CT and the optimal duration of administration after completion of CT.

An experimental Staphylococcus aureus meningitis model for investigating induced leptomeningeal and subpial inflammation in rats: a transmission electron microscopy study.

OBJECTIVE: To evaluate leptomeningeal and subpial inflammatory responses of experimental Staphylococcus aureus bacteriemia following intraperitoneal and intravenous applications and to compare the inflammatory reactions in different regions of central nervous system. MATERIAL AND METHODS: Forty anesthetized rats were divided into four groups equal in number. The rats in group-I were given 1 ml suspension of Staphylococcus aureus intraperitoneally. Group-II was the control group of group I; it was administrated 1 ml 0.9% NaCl in water intraperitoneally. The rats in group-III were given the same amount of bacteria intravenously. Group IV was the control group of the group-III; it was administrated 1 ml 0.9% NaCl solution intravenously. The rats were sacrificed on the 21st day. Inflammatory changes of different regions of the central nervous system were examined under transmission electron microscopy. Statistical analysis was done by using variance analysis, Bonferroni, Tamhane post hoc, Student's t and univariate tests. RESULTS: Thoracic and occipital regions were the most vulnerable zones. Increasing of collagen tissue was the most detected inflammatory change. CONCLUSION: This experimental model can be used for inducing subpial and leptomeningeal inflammations and it may be developed for investigations of pathogenesis of leptomeningitis during systemic infections.

Microbiologic and histologic assessment of intentional bacterial contamination of bone grafts.

PURPOSE: The purpose of this study was to investigate methods of removing pathogenic micro-organisms from bone grafts that have been contaminated during surgery. MATERIALS AND METHODS: Femora were removed from Sprague-Dawley rats and were divided into sections and contaminated in solutions of the bacteria Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli. Contaminated bone specimens in each group were immersed in various solutions for specified periods so their antibacterial effects could be evaluated. After these procedures were performed, bone specimens were cultured in nutrient media. Bone structure was evaluated, and the appropriate decontamination method was selected. RESULTS: Solutions such as povidone-iodine, neomycin, cephazolin sodium, and rifamycin were found to be effective decontaminants. These solutions did not damage the bone structure. Among these solutions, only rifamycin was effective against all bacteria used in this study to contaminate bone grafts. CONCLUSIONS: Rifamycin seems to be the most suitable agent for the elimination of contamination introduced into bone grafts during surgery.

[Investigation of autoantibody, anti-HCV and anti-HIV seropositivities in "anti-HBc alone" positive samples]. / SALT Anti-HBc Pozitif orneklerde otoantikor, anti-HCV ve anti-HIV seropozitifliginin arastirilmasi.

"Anti-HBc alone" which is an unusual serologic pattern of hepatitis B virus (HBV) infections, may be detected in the seropositive samples for hepatitis C virus (HCV), human immunodeficiency virus (HIV) infections and in the presence of autoantibodies due to cross reactions. In this study, 20 serum samples with isolated antibody to hepatitis B core antigen, which were detected in May 2005, have been investigated by means of the presence of some autoantibodies (anti-nuclear antibody; ANA and rheumatoid factor; RF), anti-HCV and anti-HIV, in the Central Laboratory of Dicle University Medical School. All of the "anti-HBc alone" samples were negative for HBV-DNA by real-time polymerase chain reaction (PCR), and liver enzyme (ALT and AST) levels were normal except for three patients. As a result, a total of six (30%) samples were found positive. Four of them were positive for ANA and two were positive for anti-HCV, while one serum yielded positivity for both ANA and anti-HCV. Anti-HCV positive samples were searched for the presence of HCV-RNA by real-time PCR, and none were found positive. Of three patients with increased AST and ALT levels, one was anti-HCV positive, one was ANA positive, while the other was negative for all parameters. In conclusion, possible presence of autoantibodies and anti-HCV should be taken into consideration during the evaluation of isolated anti-HBc IgG positive test results.

The use of enzyme linked immunosorbent assay (ELISA) and direct fluorescent antibody (DFA) methods for diagnosis of Giardia intestinalis.

The aim of this study was to evaluate the value of the direct fluorescent antibody (DFA) techniques reported to have high sensitivity and specificity and the enzyme linked immunosorbent assay (ELISA) test used to determine antigens in stool samples in the routine diagnosis of Giardia intestinalis. When 44 stool samples in which G. intestinalis cysts and/or trophozoites had been seen during native Lugol examination were investigated, positivity detected with the trichrome staining method, monoclonal ELISA method and monoclonal DFA method was found to be 37 (84.0%), 39 (88.6%) and 35 (79.5%) respectively. DFA detected Crytosporidium parvum cysts in addition to G. intestinalis in one sample. Twenty-seven (61.4%) of the samples were positive with all three methods. When compared with the DFA method, the ELISA method had a sensitivity of 88.6%, a specificity of 88.8%, a positive predictive value of 79.5% and a negative predictive value of 20.0% while the trichrome staining method had a sensitivity of 85.7%, a specificity of 77.8%, a positive predictive value of 81.1% and a negative predictive value of 22.2%. There was no statistically significant difference between the DFA and ELISA tests and between the DFA test and the trichrome staining method for diagnosing G. intestinalis (p > 0.05).