Prognostic Risk Factors in Ventilator-Associated Pneumonia.

BACKGROUND Ventilator-associated pneumonia (VAP) is a nosocomial infection commonly seen in patients in intensive care units (ICU). This study aimed to analyze factors affecting prognosis of patients diagnosed with VAP. MATERIAL AND METHODS Critically ill patients with VAP were retrospectively evaluated between June 2002 and June 2011 in the ICU. VAP diagnosis was made according to 2005 ATS/IDSA (Infectious Diseases Society of America/American Thoracic Society) criteria. First pneumonia attacks of patients were analyzed. RESULTS When early- and late-onset pneumonia causes were compared according to ICU and hospital admittance, resistant bacteria were found to be more common in pneumonias classified as early-onset according to ICU admittance. APACHE II score of >21 (p=0.016), SOFA score of >6 (p<0.001) on admission to ICU and SOFA score of >6 (p<0.001) on day of diagnosis are risk factors affecting mortality. Additionally, low PaO2/FIO2 ratio at onset of VAP had a negative effect on prognosis (p<0.001). SOFA score of >6 on the day of VAP diagnosis was an independent risk factor for mortality [(p<0.001; OR (95%CI): 1.4 (1.2-1.6)]. CONCLUSIONS Resistant bacteria might be present in early-onset VAP. Especially, taking LOS into consideration may better estimate the presence of resistant bacteria. Acinetobacter baumannii, Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus (MRSA) were the most frequent causative microorganisms for VAP. SOFA score might be more valuable than APACHE II score. Frequently surveilling SOFA scores may improve predictive performance over time.

Mortality predictors of Staphylococcus aureus bacteremia: a prospective multicenter study.

BACKGROUND: Staphylococcus aureus is one of the causes of both community and healthcare-associated bacteremia. The attributable mortality of S. aureus bacteremia (SAB) is still higher and predictors for mortality and clinical outcomes of this condition are need to be clarified. In this prospective observational study, we aimed to examine the predictive factors for mortality in patients with SAB in eight Turkish tertiary care hospitals. METHODS: Adult patients with signs and symptoms of bacteremia with positive blood cultures for S. aureus were included. All data for episodes of SAB including demographics, clinical and laboratory findings, antibiotics, and outcome were recorded for a 3-year (2010-2012) period. Cox proportional hazard model with forward selection was used to assess the independent effect of risk factors on mortality. A 28-day mortality was the dependent variable in the Cox regression analysis. RESULTS: A total of 255 episodes of SAB were enrolled. The median age of the patients was 59 years. Fifty-five percent of the episodes were considered as primary SAB and vascular catheter was the source of 42.1 %. Healthcare associated SAB was defined in 55.7 %. Blood cultures yielded methicillin-resistant S. aureus (MRSA) as a cause of SAB in 39.2 %. Initial empirical therapy was inappropriate in 28.2 %. Although overall mortality was observed in 52 (20.4 %), 28-day mortality rate was 15.3 %. Both the numbers of initial inappropriate empirical antibiotic treatment and the median hours to start an appropriate antibiotic between the cases of fatal outcome and survivors after fever onset were found to be similar (12/39 vs 60/216 and 6 vs 12 h, respectively; p > 0.05). High Charlson comorbidity index (CCI) score (p = 0.002), MRSA (p = 0.017), intensive care unit (ICU) admission (p < 0.001) and prior exposure to antibiotics (p = 0.002) all were significantly associated with mortality. The Cox analysis defined age [Hazard Ratio (HR) 1.03; p = 0.023], ICU admission (HR 6.9; p = 0.002), and high CCI score (HR 1.32; p = 0.002) as the independent predictive factors mortality. CONCLUSIONS: The results of this prospective study showed that age, ICU stay and high CCI score of a patient were the independent predictors of mortality and MRSA was also significantly associated with mortality in SAB.

Brucellosis: a retrospective evaluation of 164 cases.

INTRODUCTION: Brucellosis is a public health problem that is prevalent in several developing countries. METHODS: The clinical and laboratory characteristics of 164 cases of brucellosis in Bursa, Turkey, were retrospectively evaluated. RESULTS: The ages of the 164 patients ranged from 15-85 years. All of the patients underwent the Rose Bengal test and 163 (99.4%) patients tested positive. 122 (74.4%) patients were diagnosed with acute brucellosis, 31 (18.9%) with subacute brucellosis and 11 (6.7%) with chronic brucellosis. Focal involvement was found in 101 (61.6%) patients. Although patients with focal involvement had a higher white blood cell count (p = 0.002), those without focal involvement had higher aspartate transaminase and alanine transaminase values, and lower platelet values (p = 0.005, 0.007 and 0.039, respectively). Spondylodiscitis was observed on imaging in 58 (66.7%) of the 87 patients who presented with back pain. Among the 118 patients who were examined within the first month of treatment, 79 (66.9%) responded to treatment. The relapse rate was 11.6% among all 164 patients. CONCLUSION: Brucellosis should be considered as a differential diagnosis among patients who present with fever, and joint or back pain. Focal involvement should be investigated in the presence of leucocytosis, and subacute or chronic forms of brucellosis. To identify cases of spondylodiscitis, radiography should be performed in patients who present with back pain.

Nosocomial Acinetobacter pneumonia: Treatment and prognostic factors in 356 cases.

BACKGROUND AND OBJECTIVE: Acinetobacter baumannii and A. baumannii/calcoaceticus complex are commonly encountered pathogens in nosocomial infections. This study aimed to evaluate the treatment and prognostic risk factors in nosocomial pneumonia caused by these microorganisms. METHODS: The study was conducted retrospectively in Uludag University Hospital and included 356 adult non-neutropenic patients with nosocomial pneumonia. RESULTS: Of the subjects, 94.9% (n = 338) had ventilator-associated pneumonia. The clinical response rate was 57.2%, the 14-day mortality 39.6% and the 30-day mortality 53.1%. The significant independent risk factors for the 30-day mortality were severe sepsis (OR, 2.60; 95% CI: 1.49-4.56; P = 0.001), septic shock (OR, 6.12; 95% CI: 2.75-13.64; P < 0.001), APACHE II score ≥ 20 (OR, 2.12; 95% CI: 1.28-3.50; P = 0.003) and empiric monotherapy (OR, 1.63; 95% CI: 1.00-2.64; P = 0.048). Multi-trauma (OR, 2.50; 95% CI: 1.11-5.68; P = 0.028) was found to be a protective factor. In patients with a clinical pulmonary infection score (CPIS) > 6 on the third day of treatment, both the 14- and 30-day mortality rates were high (P < 0.001, P < 0.001). Also, the 14- and 30-day mortality rates were significantly higher in the patients treated with empiric monotherapy compared with combination therapy (48/93 (51.6%)-46/123 (37.4%), P = 0.037 and 62/93 (66.7%)-65/123 (52.8%), P = 0.041, respectively) in pneumonia caused by imipenem-resistant strains. CONCLUSION: Mortality rates were high in pneumonia caused by imipenem-resistant A. baumannii or A. baumannii/calcoaceticus complex. In the units with a high level of carbapenem resistance, antibiotic combinations should be considered for empiric therapy.

Comparison of blood culture and multiplex real-time PCR for the diagnosis of nosocomial sepsis.

BACKGROUND: In many cases of suspected sepsis, causative microorganisms cannot be isolated. Multiplex real-time PCR generates results more rapidly than conventional blood culture systems. METHODS: In this study, we evaluated the diagnostic performance of multiplex real-time PCR (LightCycler® SeptiFast, Roche, Mannheim, Germany), and compared with blood cultures and cultures from focus of infection in nosocomial sepsis. RESULTS: Seventy-eight nosocomial sepsis episodes in 67 adult patients were included in this study. The rates of microorganism detection by blood culture and PCR were 34.2% and 47.9%, respectively. Sixty-five microorganisms were detected by both methods from 78 sepsis episodes. Nineteen of these microorganisms were detected by both blood culture and PCR analysis from the same sepsis episode. There was statistically moderate concordance between the two methods (κ=0.445, P<0.001). There was no significant agreement between the blood culture and PCR analysis in terms of microorganism detected (κ=0.160, P=0.07). Comparison of the results of PCR and cultures from focus of infection revealed no significant agreement (κ=0.110, P=0.176). However, comparison of the results of PCR and blood cultures plus cultures from focus of infection (positive blood culture and/or positive culture from focus of infection) showed poor agreement (κ=0.17, P=0.026). When the blood culture was used as the gold standard, the sensitivity, specificity, positive and negative predictive value of PCR in patients with bacteremia was 80%, 69%, 57% and 87%, respectively. CONCLUSIONS: SeptiFast may be useful when added to blood culture in the diagnosis and management of sepsis.

Investigation of methicillin resistant Staphylococcus aureus in neonatal intensive care unit.

Methicillin resistant Staphylococcus aureus (MRSA) strains lead to severe infections in immunosupressive patients, geriatric population and premature infants. 27 MRSA strains isolated in the Neonatal Intensive Care Unit was considered as an outbreak and it was aimed to investigate the genetic and epidemiologic relation of the MRSA outbreak. MecA gene was investigated in the S. aureus strains and pulsed field gel electrophoresis (PFGE) was used to investigate the genetic relation between outbreak strains. MecA gene was showed in all isolates. PFGE revealed that there were two different strains and most of the isolates (25/27) were owing to same clone. One of the samples were found closely related with the common strain and the other sample was found genetically unrelated. To terminate the outbreak; liquid baby food was gained to the baby food kitchen, no more new patient was imported to the neonatal unit and none of the patients were exported from neonatal unit to other clinics during outbreak, education about infection control precautions was given to all the staff and nursing bottle dishwasher was obtained. To manage and terminate the outbreak, besides the infection control precautions, tests to determine the genetic relation between outbreak strains which are done in the microbiology laboratory are needed. Molecular analysis of outbreak strains will contribute to prove the epidemiologic and evolution of outbreaks.

Investigation of vancomycin resistant Enterococcus faecium outbreak in neonatal intensive care unit.

Enterococci are one of the major agents of community-acquired and nosocomial infections. In this study we aimed to analyze the clonal relation of the vancomycin-resistant Enterococci outbreak seen at the Neonate Intensive Care Unit (NICU) of Uludag University Hospital. Vancomycin resistance gene was investigated in the Enterococcus faecium strains and pulsed field gel electrophoresis (PFGE) was used to investigate the genetic relation between outbreak strains. Enterococci grown in all patient samples were identified as Enterococcus faecium by BD Phoenix 100 (Becton Dickinson, USA). We found vanA resistance gene in all of the swab samples by Xpert VanA/B test on Cepheid (Cepheid, USA). PFGE band patterns revealed two different strains, of which the majority of them (22/24) had the same clonal origin. The common clonal origin was also isolated from rectal probes. Perianal swab culture positivity was evaluated as colonization but culture growth in two blood cultures, two urine cultures and one wound culture was evaluated as infection and treated with linezolid. All of the patients survived the outbreak. Besides the infection control precautions determining the genetic relation between outbreak strains which can be done in the microbiology laboratory is necessary to control an outbreak. PFGE is a reliable method in the microbiologic analysis of outbreaks. Molecular microbiologic analysis of outbreak strains will contribute to prove the epidemiologic and evolution of outbreaks.

Diagnosis of acute tonsillopharyngitis in primary care: a new approach for low-resource settings.

BACKGROUND: Diagnosing GABHS (Group A-beta Hemolytic Streptococcus) tonsillopharyngitis by clinical scoring is a recommended approach in developed countries, but there is still much controversy for low resource settings. AIM: We aimed to assess the impact of Centor criteria with the support of practical laboratory tests. METHODS: We prospectively included patients complaining sore throat (N = 282). We evaluated them in terms of Centor scoring and performed white blood cell count (WBC), C-reactive protein (CRP), rapid antigen detecting test, and throat culture. RESULTS: In GABHS cases (N = 32, 11·3%), two of the criteria were observed to be positive in more than half of the cases (N = 19, 59·3%), while 13 (40·7%) cases met three/four criteria. The specificity of having two criteria was found to be 65·5% and increased to 91·5% after including CRP and WBC. CONCLUSION: Centor criteria could be safely used to reduce unnecessary antibiotic usage for tonsillopharyngitis in developing countries.

[Evaluation of PCR results in the diagnosis of Epstein-Barr virus infections]. / Epstein-Barr Virus Enfeksiyonlarinin Tanisinda PCR Sonuçlarinin Degerlendirilmesi.

Epstein-Barr virus (EBV), a herpesvirus leading to latent infections, is principally responsible for infectious mononucleosis, and also plays role in the etiology of various lymphomas and post-transplantation lymphoproliferative disease (PTLD). Laboratory diagnosis of EBV infections depends on the detection of atypical lymphocytes, heterophile antibodies, specific antibodies against viral capsid (VCA), nuclear (EBNA) and early (EA) antigens, and of the viral DNA. Since the seropositivity rate in adult population is very high (80-95%) in our country, routine serologic tests may be insufficient to characterize EBV reactivation in immunosuppressive subjects, such as transplant recipients or oncology patients. In those cases VCA IgG avidity test and molecular methods are more useful. This study was conducted to determine the role of viral DNA levels detected by real-time polymerase chain reaction (Rt-PCR) and serological tests for the diagnosis and follow up of EBV infections in renal transplant recipients and pediatric oncology patients. A total of 62 adult renal transplant recipients, 37 children with oncological diseases, and 50 EBVseropositive immunocompetent healthy subjects (28 children, 22 adults) as controls, were included in the study. Four blood samples, once before transplantation and three times thereafter (at first week, first and third months) were collected from transplant recipients; in pediatric oncology patients blood samples were collected four times, once before immunosuppressive treatment and three times thereafter (at first, third and sixth months), while the control group had a single blood sample collected. Serological profiles for EBV were searched by Paul-Bunnel and immunoblotting tests; VCA IgG avidity by ELISA and viral load by Rt-PCR. EBV-DNA was found positive in 3 (4.8%) of the renal transplant patients. While in these patients the CD4/CD8 ratio was significantly lowered in the first week and third month posttransplant, no PTLD or organ rejection developed. EBV-DNA was positive in 3 (8.1%) of the pediatric oncology patients. This positivity was attributed to Hodgkin's disease in two of these cases and to reactivation in the third case. EBV-DNA positivity was present in 10 (20%) of the control subjects. In the adult controls whose immunoblot results were compatible with the serologic pattern of an acute infection, the correlation among positive EBV-DNA, positive Paul-Bunnel and low IgG avidity results was statistically significant. As for children in the control group, this serologic profile was significantly correlated with low IgG avidity only. The data obtained from this study indicated that no risk of EBV-related PTLD or acute rejection was found in the first three months in the adult renal transplant patients. In children with EBV-related malignancy the search for EBV-DNA by RtPCR before therapy may be useful in the diagnosis, follow-up and prognostic evaluation. Serologic results should be supported by IgG avidity and PCR in order to ascertain the presence of EBV reactivation in immunosuppressive patients.

[Comparative evaluation of in vitro activities of carbapenems against gram-negative pathogens: Turkish data of COMPACT study]. / Karbapenemlerin Gram-Negatif Patojenlere Karsi In Vitro Aktivitelerinin Karsilastirmali Degerlendirmesi: COMPACT Çalismasi Türkiye Verisi.

The aim of this study was to determine the in vitro activities of doripenem, imipenem, and meropenem against clinical gram-negative isolates. A total of 596 clinical isolates were obtained from intensive care unit (ICU) and non-ICU patients in 10 centers over Turkey between September-December 2008. The origin of the isolates was patients with nosocomial pneumonia (42.4%), bloodstream infections (%40.4), and complicated intraabdominal infections (17.1%). Of the isolates, 51.8% were obtained from ICU patients. The study isolates consisted of Pseudomonas spp. in 49.8%, Enterobacteriaceae in 40.3%, and other gram-negative agents in 9.9%. The minimum inhibitory concentrations (MIC) for doripenem, imipenem and meropenem were determined for all isolates in each center using Etest® strips (AB Biodisk, Solna, Sweden). Of the isolates, 188 (31.5%) were resistant to at least one of the carbapenems. MIC50 of doripenem against Pseudomonas spp. Was 1 mg/L which was similar to that of meropenem and two-fold lower than imipenem. Susceptibility to carbapenems in P.aeruginosa was 64% for doripenem at an MIC level of 2 mg/L, 53.9% and 63% for imipenem and meropenem at an MIC level of 4 mg/L, respectively. Doripenem and meropenem showed similar activity with the MIC90 of 0.12 mg/L whereas imipenem was four-fold less active at 0.5 mg/L. Against other gramnegative pathogens, mostly Acinetobacter spp., MIC50 was 8 mg/L for doripenem and 32 mg/L for other two carbapenems. P.aeruginosa isolates were inhibited 84.2% with doripenem and 72.1% with meropenem at the MIC level of 8 mg/L. Doripenem generally showed similar or slightly better activity than meropenem and better activity than imipenem against pathogens collected in this study. Against Pseudomonas spp., doripenem was the most active of the three carbapenems. Doripenem and meropenem were equally active against Enterobacteriaceae and at least four-fold more active than imipenem. It was concluded that doripenem seemed to be a promising agent in the treatment of nosocomial pneumonia, blood stream infections and intraabdominal infections particularly in patients who were under risk of developing antimicrobial resistance.

[Evaluation of the fully automated BACTEC MGIT 960 system for testing susceptibility of Mycobacterium tuberculosis to front line antituberculosis drugs and comparison with the radiometric BACTEC 460 TB method]. / Mikobakterilerin majör antitüberküloz ilaçlara duyarliliginin otomatize BACTE MGIT 960 sistemi ile arastirilmasi ve radyometrik BACTEC 460 TB sistemi ile karsilastirilmasi.

The performance of the fully automated BACTEC MGIT 960 (Becton Dickinson, Cockeysville, Md.) system for susceptibility testing of Mycobacterium tuberculosis to critical concentrations of 4 major antituberculosis drugs [streptomycin (STR), isoniazid (INH), rifampin (RIF) and ethambutol (EMB)] was evaluated with 100 clinical isolates and compared to that of the radiometric BACTEC 460 TB (Becton Dickinson, Sparks, Md.) system. The results of BACTEC 960 MGIT, which are not compatible with BACTEC 460 TB, were re-evaluated according to the results obtained. The discordance was 2.25% at the critical concentrations of both systems. After the reproducibility testing, the discordance between 2 systems reduced to 1.25% and the concordance increased to 98.75%. In our study, no very major error was observed; major error was detected as 2.25% (STR 2, INH 4, RIF 2 and EMB 1) in the 1st trial, and 1.25% (INH 3, RIF 2) in the 2nd trial. When BACTEC 460 TB has been compared with BACTEC 960 MGIT, the overall specificity was 100% in all tests, the sensitivity was 95.6-98.9% in the initial testing, however, the sensitivity changed to 96.7-100% after the reproducibility testing. It was concluded that there was no statistically significant disconcordance between the two test systems. Thus BACTEC MGIT 960 might be an alternative to BACTEC 460 TB for susceptibility testing of antituberculosis agents.

Investigation of colistin sensitivity via three different methods in Acinetobacter baumannii isolates with multiple antibiotic resistance.

BACKGROUND: In recent years there has been an increase in life-threatening infections caused by Acinetobacter baumannii with multiple antibiotic resistance, which has lead to the use of polymyxins, especially colistin, being reconsidered. The aim of this study was to investigate the colistin sensitivity of A. baumannii isolates with multiple antibiotic resistance via different methods, and to evaluate the disk diffusion method for colistin against multi-resistant Acinetobacter isolates, in comparison to the E-test and Phoenix system. METHODS: The study was carried out on 100 strains of A. baumannii (colonization or infection) isolated from the microbiological samples of different patients followed in the clinics and intensive care units of Uludag University Medical School between the years 2004 and 2005. Strains were identified and characterized for their antibiotic sensitivity by Phoenix system (Becton Dickinson, Sparks, MD, USA). RESULTS: In all studied A. baumannii strains, susceptibility to colistin was determined to be 100% with the disk diffusion, E-test, and broth microdilution methods. Results of the E-test and broth microdilution method, which are accepted as reference methods, were found to be 100% consistent with the results of the disk diffusion tests; no very major or major error was identified upon comparison of the tests. The sensitivity and the positive predictive value of the disk diffusion method were found to be 100%. CONCLUSIONS: Colistin resistance in A. baumannii was not detected in our region, and disk diffusion method results are in accordance with those of E-test and broth microdilution methods.

[In vitro susceptibility to linezolid in methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus strains]. / Metisiline dirençli Staphylococcus aureus ve vankomisine dirençli enterokok suslarinin in vitro linezolid duyarliligi.

There has been a dramatic increase in the number of infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) worldwide. Linezolid which is one of the first oxazolidinones in clinical use, has bacteriostatic activity on gram-positive bacteria including MRSA and VRE. The aim of this study was to investigate the in vitro susceptibilities of MRSA and VRE clinical isolates to linezolid. A total of 100 MRSA strains isolated from clinical specimens as infectious agents (96 blood, 2 pleural fluid, 1 peritoneal fluid, 1 joint fluid isolates), and 101 VRE (Enterococcus faecium) strains isolated from clinical specimens as colonizing or infectious agents (79 rectal swabs, 11 blood, 3 catheter, 3 peritoneal fluid, 3 urine, 2 wound isolates) in Microbiology Laboratory of Uludag University Medical Faculty Hospital, Turkey, were included to the study. In vitro linezolid activity has been searched by E-test method and all of the isolates were found susceptible to linezolid. Linezolid minimal inhibitory concentration (MIC) ranged for MRSA and VRE between 0.25-3 microg/mL and 0.25-2 microg/mL, respectively. Linezolid MIC50 and MIC90 values for MRSA were 1.5 microg/mL and 2 microg/mL, respectively, while for VRE these values were 0.75 microg/mL and 1.5 microg/mL, respectively. Our results were in parallel with the data of other national and international studies, emphasizing that linezolid is a new and effective choice in treatment of infections caused by resistant gram-positive bacteria.

[Cystic echinococcosis in Turkey from 2001-2005]. / Türkiye'de 2001-2005 Yillari Arasinda Kistik Ekinokokkozis.

Cystic echinococcosis (CE) caused by the metacestode form of Echinococcus granulosus is a major public health problem especially in animal-raising regions of the world. In the present study, CE cases were determined during 2001-2005 by investigating different hospital and health directorship documents and Health Ministry documents, retrospectively. Our results show that there were 2534 (13.13%) cases in the Marmara region; 2114 (16.94%), in the Aegean region; 2578 (16.09%), Mediterranean region; 5404 (38.57%), in the Middle Anatolian region; 428 (5.70%), in the Black Sea region; 844 (6.80%), in the eastern Anatolian region; and 887 (2.75%), in the southeastern Anatolian region making a total of 14,789 CE cases. Finally, it has been determined that the patients were hospitalized for a total of 149,464 days.

Evaluation of leukocyte esterase and nitrite strip tests to detect spontaneous bacterial peritonitis in cirrhotic patients.

AIM: To investigate the diagnostic efficacy of leukocyte esterase and nitrite reagent strips for bedside diagnosis of spontaneous bacterial peritonitis (SBP). METHODS: A total of 63 consecutive patients with cirrhotic ascites (38 male, 25 female) tested between April 2005 and July 2006 were included in the study. Bedside reagent strip testing was performed on ascitic fluid and the results compared to manual cell counting and ascitic fluid culture. SBP was defined as having a polymorphonuclear ascites count of >or= 250/mm(3). RESULTS: Fifteen samples showed SBP. The sensitivity, specificity, positive and negative predictive values of the leukocyte esterase reagent strips were; 93%, 100%, 100%, and 98%, respectively. The sensitivity, specificity, positive and negative predictive value of the nitrite reagent strips were 13%, 93%, 40%, and 77%, respectively. The combination of leukocyte esterase and nitrite reagents strips did not yield statistically significant effects on diagnostic accuracy. CONCLUSION: Leukocyte esterase reagent strips may provide a rapid, bedside diagnostic test for SBP.

[Meningitis caused by Oerskovia xanthineolytica]. / Oerskovia xanthineolytica menenjiti.

Oerskovia species are Nocardia-like bacteria that have been only and rarely associated with human infections. In this report, a meningitis case caused by Oerskovia xanthineolytica was presented. A 44 years old male patient who had experienced ventriculo-peritoneal shunt (V-P shunt) due to hydrocephaly, developed meningitis. O. xanthineolytica was isolated from three of the cerebrospinal fluid (CSF) samples and V-P shunt cultures. Identification of the isolate was performed by Phoenix SystemTM (NMIC/ID-5 panel, Becton Dickson, Sparks, MD, USA). Empirical vancomycin (2x1 g/day iv) plus rifampin (1x600 mg/day po) therapy has failured. Since CSF cultures were still positive in the 22nd day of therapy, the shunt was removed and continuation of the same antimicrobial treatment for 42 days resulted in complete cure.

Comparison of the E-test method with an automated bacterial identification and antimicrobial susceptibility detection system for screening extended-spectrum beta-lactamase producers.

Some automated systems used in clinical microbiology laboratories are able to detect products responsible for antimicrobial resistance. In this study, 626 isolates (436 Escherichia coli, 134 Klebsiella pneumoniae and 56 Klebsiella oxytoca strains) were examined for the presumptive detection of extended-spectrum beta-lactamase (ESBL) production by 2 methods: the Sceptor system (BD, Sparks, MD, USA) and the E-test. ESBL production was detected in 26 E. coli strains (5.96%), 60 K. pneumoniae strains (44.77%) and 15 K. oxytoca strains (26.78%) by ceftazidime/ceftazidime-clavulanate E-test. Using the E-test, ESBL production was detected in 25 of 201 E. coli strains (12.43%), 55 of 75 K. pneumoniae (73.33%) and 14 of 27 K. oxytoca strains (51.85%) that were alerted as ESBL-producing strains by the Sceptor system. ESBL positivity was detected in 1 E. coli, 5 K. pneumoniae and 1 K. oxytoca strains, that were not warned as being ESBL producers by the Sceptor system. These data suggest that clinical microbiology laboratories should not only rely on these rapid automated systems but also use another method for screening ESBL producers, such as the E-test. The rates of these ESBL-producing isolates in this study were lower than those in other studies reported from other parts of Turkey, but higher than those reported from the USA and Europe.

Increased risk of chronic hepatitis in children with cancer.

BACKGROUND: There is a risk of viral hepatitis for children with cancer. Both hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in countries with high prevalence cause major problems in the management of cancer patients. In this study, we evaluated the incidence and chronicity of HBV and HCV infections in children with malignant diseases receiving chemotherapy. PROCEDURE: One hundred ninety-eight children with cancer (mean age = 7.5 +/- 2.5 years) and 100 healthy children as a control group were screened for HBV and HCV. Liver function tests, the number of transfusions, HBV and HCV serology were regularly monitored. In seropositive children, HBV-DNA and HCV-RNA were measured. Chronic hepatitis was defined as having an alanine aminotransferase (ALT) level three times of upper normal limit, positive HBV and HCV antigenemia for longer than 6 months. Liver biopsies were performed in all children with chronic hepatitis. The relationship between the chronic hepatitis and study parameters was statistically analyzed. RESULTS: HBsAg positivity, anti-HCV, and mixed (HBV and HCV) infection were found in 11.6, 5.5, 2% of children, respectively. Most HBV infected children developed chronic hepatitis (48%) while 26 and 21.7% became carriers and immune, respectively. One died of acute fulminant HBV hepatitis. Of HCV infected children, 63.6% also had positive HCV-RNA. Four children with mixed infection (100%) all progressed to chronic hepatitis. In this setting, chronic hepatitis was observed in 22 of 38 infected children (57.8%). The majority had leukemia and lymphoma. Children with HBsAg antigenemia developed chronic hepatitis in shorter time than HCV positive children (median 13 months vs. 51 months, P < 0.001). CONCLUSION: We observed an increased incidence of chronic hepatitis and even mortality due to HBV infection. This suggests that HBV and HCV infections are serious causes of morbidity and mortality in children with cancer.