Actions of N-acetylcysteine, daptomycin, vancomycin, and linezolid on methicillin-resistant Staphylococcus aureus biofilms in the ventriculoperitoneal shunt infections: an experimental study.

BACKGROUND: Shunt systems are used to provide cerebrospinal fluid drainage in the treatment of hydrocephalus. Recently, antibiotic-impregnated shunt systems are used to prevent colonization in the ventriculoperitoneal catheters. Methicillin-resistant Staphylococcus aureus (MRSA) is the most common causative microorganism of shunt infections. The aim of the study is to investigate effects of several substances on MRSA biofilms in the ventriculoperitoneal catheters. METHODS: The present study consists of mainly eight groups (each has two subgroups as antibiotic-impregnated and nonantibiotic-impregnated catheters). In addition, each group contains six molds using MRSA strains. In this study, daptomycin (DAPT) (2 mg/ml), vancomycin (VAN) (10 mg/ml), linezolid (LIN) (2 mg/ml), N-acetylcysteine (NAC) (6 mg/ml), and various combinations of these substances were used to evaluate the treatment against MRSA using scanning electron microscope (SEM) images and microbiological enumeration. RESULTS: The colony count in the antibiotic-impregnated samples significantly decreased compared to nonantibiotic-impregnated samples in the MRSA, MRSA + DAPT, and MRSA + LIN groups (p < 0.01), respectively. Conversely, the colony count in antibiotic-impregnated samples significantly increased compared to nonantibiotic-impregnated samples in NAC + DAPT and NAC + VAN groups (p < 0.01), respectively. CONCLUSIONS: The results showed that the use of antibiotic-impregnated catheters has a significant impact on the prevention of infection whereas the combination of NAC and DAPT showed better antibiofilm and antibacterial effects than other combinations on the prevention and treatment of nonantibiotic-impregnated catheter infections.

The effect of favipiravir versus hydroxychloroquine on clinical and laboratory findings in COVID-19 in healthcare workers.

OBJECTIVES: Comparative data on hydroxychloroquine and favipiravir, commonly used agents in the treatment of Coronavirus Disease-2019 (COVID-19), are still limited. In this study, it was aimed to compare treatment outcomes in healthcare workers with COVID-19 who were prospectively followed by the occupational health and safety unit. METHODS: A total of 237 healthcare-workers, diagnosed as mild or moderate COVID-19 between March 11, 2020 and January 1, 2021, were given hydroxychloroquine (n = 114) or favipiravir (n = 123). Clinical and laboratory findings were evaluated. RESULTS: The mean age of the patients was 33.4±11.5 years. The mean time to negative PCR was found to be significantly shorter in patients receiving favipiravir compared to the hydroxychloroquine group (10.9 vs. 13.9 days; p < 0.001). The rate of hospitalization in the hydroxychloroquine group was significantly higher than favipiravir group (15.8% vs. 3.3%). In terms of side effects; the frequency of diarrhea in patients receiving hydroxychloroquine was significantly higher than that in the favipiravir group (31.6% vs. 6.5%; p < 0.001). CONCLUSIONS: Favipiravir and hydroxychloroquine were similar in terms of improvement of clinical symptoms of healthcare workers with mild or moderate COVID-19 infection, but favipiravir was significantly more effective in reducing viral load and hospitalization rates. Furthermore, favipiravir caused significantly less side-effects than hydroxychloroquine.

Spontaneous Cervical Epidural Abscess Caused by Serratia Marcescens.

Serratia marcescens infections are very rare and usually occur in the form of nosocomial and opportunistic infections. The subjects usually have severe medical comorbidities such as immunosuppression, diabetes mellitus, and renal failure. Spontaneous Serratia marcescens infection is very rare. In this case, we demonstrate that it can be seen in the spontaneous cervical epidural abscess. A 54-year female patient presented with a complaint of weakness in the left arm. Cervical magnetic resonance imaging revealed a spinal epidural abscess at the C5-6 level. Surgery was planned for this lesion. The abscess that created a cervical mass effect was totally removed and treatment with oral antibiotics was continued due to S. marcescens growth in the culture. This is the first case where S. marcescens has caused the development of a cervical epidural abscess in a patient without any medical comorbidity. Key Words: Serratia marcescens, Spinal epidural abscess, Vertebral osteomyelitis, Cervical discitis.

In Vitro Activity of Linezolid, Daptomycin and N-acetylcysteine Agents on Staphylococcus Aureus Biofilms in the Ventriculoperitoneal Shunt Model.

AIM: To examine the effects of N-acetylcysteine (NAC) alone and in combination with linezolid (LIN) and daptomycin (DAPT) on methicillin-sensitive Staphylococcus aureus (MSSA) biofilm formation. MATERIAL AND METHODS: Twelve groups (each containing six molds) of standard ventriculoperitoneal shunts were infected with MSSA. By using microbiological and electron microscopic evaluation methods, NAC was evaluated, alone and in combination with DAPT and LIN, in terms of preventing and eliminating biofilm capacity. The effect of NAC alone and in combination with DAPT and LIN were shown by microbial counts and electron microscopic observation. RESULTS: There was no significant difference in biofilm formation in shunts after different antibiotic treatments. However, the combination of NAC and DAPT had the highest bactericidal effects of all the groups. CONCLUSION: The resistance of bacteria and the dose-dependent effects of antibiotics can be considered.

Flexor Tenosynovitis Due to Tuberculosis in Hand and Wrist: Is Tenosynovectomy Imperative?

The treatment of flexor tenosynovitis in the hand and wrist due to tuberculosis is controversial. Although some authors recommend the antituberculous chemotherapy, the others recommend the surgical treatment. In this article, 12 patients with synovial tuberculosis of the flexor aspect of the hand and the wrist were evaluated with respect to diagnosis and treatment modalities. None of the patients had a history of tuberculosis, concomitant disease, immunosuppressive drug use, drug abuse, and human immunodefficiency virus positivity. A chest x-ray and family screening were performed in all of the cases, none had evidence of tuberculosis in the lung. The biopsy, histopathological examination, acid-fast bacillus staining, and BACTEC tuberculosis culture were performed. Antituberculous chemotherapy was initiated in patients diagnosed with tuberculosis by either histological or microbiological examinations. The patients did not undergo any further surgery after biopsy procedures. The lesions regressed totally in all patients after 3 months of treatment. Carpal tunnel syndrome symptoms and signs recruited at five months of treatment. In patients with flexor tuberculosis tenosynovitis, it is possible to achieve good results by applying only medical therapy after a biopsy, and without the need for further surgery.