Empirical cefepime+vancomycin versus ceftazidime+vancomycin versus meropenem+vancomycin in the treatment of healthcare-associated meningitis: results of the multicenter ephesus study.

BACKGROUND: Herein, we analyzed the efficacy of main antibiotic therapy regimens in the treatment of healthcare-associated meningitis (HCAM). MATERIALS/METHODS: This retrospective cohort study was conducted in 18 tertiary-care academic hospitals Turkey, India, Egypt and Romania. We extracted data and outcomes of all patients with post-neurosurgical meningitis cases fulfilling the study inclusion criteria and treated with empirical therapy between December 2006-September 2018. RESULTS: Twenty patients in the cefepime + vancomycin-(CV) group, 31 patients in the ceftazidime + vancomycin-(CFV) group, and 119 patients in the meropenem + vancomycin-(MV) group met the inclusion criteria. The MV subgroup had a significantly higher mean Glasgow Coma Score, a higher rate of admission to the intensive care unit within the previous month, and a higher rate of antibiot herapy within the previous month before the meningitis episode (p < 0.05). Microbiological success on Day 3-5, end of treatment (EOT) clinical success (80% vs. 54.8%% vs 57.9%), and overall success (EOT success followed by one-month survival without relapse or reinfection 65% vs. 51.6% vs. 45.3%), EOT all cause mortality (ACM) and day 30 ACM (15% vs. 22.6% vs. 26%) did not differ significantly (p > 0.05) among the three cohorts. No regimen was effective against carbapenem-resistant bacteria, and vancomycin resulted in an EOT clinical success rate of 60.6% in the methicillin-resistant staphylococci or ampicillin-resistant enterococci subgroup (n = 34). CONCLUSIONS: Our study showed no significant difference in terms of clinical success and mortality among the three treatment options. All regimens were ineffective against carbapenem-resistant bacteria. Vancomycin was unsuccessful in approximately 40% of cases involving methicillin-resistant staphylococci or ampicillin-resistant enterococci.

[Evaluation of Histological Response in Chronic Hepatitis B Patients with Tenofovir or Entecavir Therapy]. / Tenofovir veya Entekavir Tedavisi Alan Kronik Hepatit B Hastalarinda Histolojik Yanitlarin Degerlendirilmesi.

Chronic hepatitis B (CHB) is an important public health problem in the world and Turkey. The aim of this study was to evaluate the histological, virological, serological and biochemical response rates in CHB patients receiving tenofovir or entecavir therapy. Control liver biopsies were performed on patients who received tenofovir or entecavir therapy for one year or longer. Histopathological grading was scored according to the modified Knodell system. Eighty-seven CHB patients were included in this study, 56 patients were receiving tenofovir and 31 patients were receiving entecavir therapy. Patients in two treatment groups were similar in terms of baseline parameters (p> 0.05). At the end of the treatment, there was a significant decrease in mean values of HBV DNA, alanine aminotransferase and necroinflammatory scores for both groups (p<0.001); however, no statistically significant change was observed in fibrosis scores (p> 0.05). Histological responses were obtained 66.1% from the tenofovir group and 54.8% from the entecavir group. Treatment with tenofovir and entecavir resulted with improvement in Ishak fibrosis scores in 12.5% and 12.9% of the patients, respectively. For 14.3% of the tenofovir-treated patients and for 22.6% of the entecavir-treated patients, the Ishak fibrosis scores worsened. Baseline intermediate/ advanced fibrosis stage (Ishak fibrosis score: 3-6) was found as independent determinant factor on histological response and improvement of fibrosis score (OR= 3.99, p= 0.01; OR= 31.67, p= 0.002; respectively) and treatment duration longer than five years is an independent determinant for improvement of necroinflammatory score (OR= 5.79, p= 0.02). There was no significant difference in the virological, serological, biochemical and, histological responses and improvement of necroinflammatory and fibrosis scores between tenofovir and entecavir groups (p> 0.05). Similar histological, virological, serological and biochemical responses were obtained in patients with CHB receving tenofovir and entecavir treatments. Further studies involving a large number of patients receiving long-term therapy should be done to understand the effects of antiviral treatments on healing of liver histology.

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.

Chemical composition and antimicrobial activity of the commercial Origanum onites L. oil against nosocomial carbapenem resistant extended spectrum beta lactamase producer Escherichia coli isolates.

In recent years rapidly growing antibiotic resistance has increased interest toward natural products, especially essential oils because of their various effects. The aim of this study was to identify the chemical composition of the commercial Origanum onites essential oil (EO) and to investigate the antimicrobial activity by disc diffusion and dilution methods, against ten different ATCC strains, including eight bacteria, two yeasts and seventy-nine clinical nosocomial Escherichia coli isolates that produce extended spectrum beta lactamase (ESBL). The chemical composition of EO was analyzed by GC and GC-MS. The major compounds of the EO were determined as carvacrol (51.4%) followed by linalool (11.2%), p-cymene (8.9%) and γ-terpinene (6.7%). O. onites EO had antimicrobial activity against all standard strains and inhibited microbial growth of ESBL positive E. coli isolates. According to our results, O. onites EO may be an alternative to synthetic drug, used in combination with other antibiotics for treatment of infection caused by multidrug resistant bacteria after testing toxic effects and irritation at preferred doses on human.

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.

Comparison of colistin monotherapy and non-colistin combinations in the treatment of multi-drug resistant Acinetobacter spp. bloodstream infections: a multicenter retrospective analysis.

OBJECTIVES: To compare the efficacy of colistin (COL) monotherapy versus non-COL based combinations in the treatment of bloodstream infections (BSIs) due to multidrug resistant Acinetobacter spp.(MDR-A). MATERIALS AND METHODS: Retrospective data of 107 MDR-A BSI cases from 27 tertiary centers in Turkey were included. PRIMARY END-POINT: 14-day mortality. SECONDARY END-POINTS: Microbial eradication and clinical improvement. RESULTS: Thirty-six patients in the COL monotherapy (CM) group and 71 in the non-COL based combinations (NCC) group were included in the study. Mean age was 59.98 ± 20 years (range: 18-89) and 50.5% were male. Median duration of follow-up was 40 days (range: 9-297). The 14-day survival rates were 52.8% in CM and 47.23% in NCC group (P = 0.36). Microbiological eradication was achieved in 69% of CM and 83% of NCC group (P = 0.13). Treatment failure was detected in 22.9% of cases in both CM and NCC groups. Univariate analysis revealed that mean age (P = 0.001), Charlson comorbidity index (P = 0.03), duration of hospital stay before MDR-A BSI (P = 0.04), Pitt bacteremia score (P = 0.043) and Acute Physiology and Chronic Health Evaluation II score (P = 0.05) were significant in terms of 14-day mortality. Advanced age (P = 0.01) and duration of hospital stay before MDR-A BSI (P = 0.04) were independently associated with 14-day mortality in multivariate analysis. CONCLUSION: No significant difference was detected between CM and non-COL based combinations in the treatment of MDR-A BSIs in terms of efficacy and 14-day mortality.

[Evaluation of second-line antituberculosis drug susceptibilities of multidrug-resistant Mycobacterium tuberculosis complex isolates by E-test method]. / Çok ilaca dirençli Mycobacterium tuberculosis kompleks izolatlarinda ikinci basamak antitüberküloz ilaç duyarliliklarinin E-test yöntemi ile degerlendirilmesi.

Multidrug-resistant (MDR) tuberculosis (TB) constitutes a restricting factor for the effective treatment of TB worldwide. Early diagnosis and appropriate treatment of patients are the most effective strategy in the control of MDR-TB. Therefore, knowledge of drug resistance patterns of the MDR-TB clinical isolates are necessary in planning of an appropriate treatment regimen for the patient. The aims of this study were to detect the susceptibilities of MDR-TB isolates to second-line anti-TB drugs by E-test method, and to compare their results with Löwenstein-Jensen (LJ) proportion method. A total of 122 MDR (resistant to isoniazid and rifampicin) Mycobacterium tuberculosis complex (MTC) strains isolated from samples of patients with pulmonary TB were included in the study. The isolates were identified by conventional methods and first-line anti-TB drug susceptibility testing was performed by the proportion method using LJ medium. The susceptibilities of the isolates to second-line anti-TB drugs [kanamycin (KN), ofloxacin (OFL), ethionamid (ETN), linezolid (LIN)] were tested by proportion method on LJ medium and E-test method on Middlebrook 7H11 medium. For this purpose, E-test strips (bioMerieux, Fransa) of KN (0.016-256 mg/ml), OFL (0.02-32 mg/ml), ETN (0.016-256 mg/ml), and LIN (0.016-256 mg/ml) were used. The susceptibility tests were evaluated in 5., 7., and 10. days after application of the E-test strips, and proportion method on LJ medium was evaluated 28 days later. Second line-anti-TB drug susceptibility results were obtained in 5 to 10 days by E-test. Of the MDR MTC strains 98% (119/122) were susceptible to KN, OFL and LIN, while 2% (3/122) of the strains were resistant to KN and ETN. The correlation between E-test and LJ proportion method was estimated as 96% for KN and ETN, 98% for OFL, and 100% for LIN. When compared with LJ proportion method, the specificity of E-test in the detection of susceptibility to KN, OFL, ETN and LIN were 60%, 38%, 60%, and 100%, respectively, while the sensitivity was 100% for all drugs. Our results indicated that E-test method exhibited high sensitivity and specificity (100%) for LIN, so it may be used alone in susceptibility testing for this drug, however since the specificity is low (38%) for OFL it should be used together with the proportion method. In conclusion, E-test method might contribute for initiation of an early and effective anti-TB drug treatment and control of infection by rapid diagnosis in MDR-TB cases.

Clinical importance of serum neopterin level in patients with pulmonary tuberculosis.

OBJECTIVE: Neopterin is a sensitive marker for cell-mediated immune response. Because of this, the neopterin levels of body fluids show cell-mediated immune response in different infectious diseases which involve T cells and macrophages. The aim of this study was to determine the clinical importance of neopterin levels in patients with tuberculosis and compare with those levels of healthy subjects. METHODS: Seventy patients with tuberculosis (46 newly diagnosed cases, 15 relapse cases, and 9 multidrug-resistant tuberculosis cases) and 18 healthy adult individuals were included in the study. Neopterin concentrations were measured by the ELISA method according to the protocol of the manufacturer. Chi-square test was used in statistical analysis; p⩽0.05 was considered statistically significant. RESULTS: Serum mean neopterin levels were 23.74±21.8nmol/L (median: 18.3) in newly diagnosed patients with pulmonary tuberculosis; 28.69±21.2nmol/L (median: 21.2) in relapse patients and 31.28±14nmol/L (median: 25.4) in multidrug-resistant tuberculosis cases, respectively. Serum mean neopterin levels were 4.03±5.12nmol/L (median: 5.1) in healthy subjects. The serum neopterin levels were found to be significantly higher in patients with tuberculosis than the control group. There was a statistically significant correlation between neopterin positivity (neopterin level ⩾10nmol/L was accepted to be positive) and clinical symptoms of hemoptysis and weight loss. Besides statistically significant correlations between neopterin positivity and hemoglobin level, sedimentation rate, mean leukocyte count and radiological involvement (localized or diffuse) were determined. CONCLUSION: Serum neopterin levels can be used as a helper laboratory finding for the diagnosis of patients with tuberculosis. For this aim, further controlled studies are needed.

The comparison of pandemic HIN1 IgG levels between HIN1 influenza-vaccinated healthcare workers and unvaccinated healthcare workers.

BACKGROUND/AIM: To compare pandemic H1N1 (pH1N1) IgG antibody levels between healthcare workers who were vaccinated with the pH1N1 influenza vaccine and the unvaccinated healthcare workers who were selected as the control group. MATERIALS AND METHODS: A total of 68 healthcare workers were included in this study. Of those, 53 were adults vaccinated with the H1N1 influenza vaccine and 15 were unvaccinated. Serum samples were parsed and stored at -40 °C until they were examined. RESULTS: Of the total 53 vaccinated healthcare workers, 16 (30.1%) were positive for IgG antibodies (titer > 11), 17 (32.0%) were negative for IgG antibodies (titer < 9), and 20 (37.7%) were borderline (titer: 9-11). Of the 15 unvaccinated healthcare workers, 1 (6.6%) was positive for IgG antibodies, 11 (73.3%) were negative for IgG antibodies, and the remaining 3 (20.0%) had borderline values (P = 0.014, P < 0.05). In both groups, there was no statistically significant difference between IgG-negative, IgG-positive, and borderline subjects in terms of age or sex. CONCLUSION: The IgG antibody level was higher in the vaccinated healthcare workers than among the unvaccinated healthcare workers.

[Evaluation of antibiotic susceptibilities and VISA-VRSA rates among MRSA strains isolated from hospitalized patients in intensive care units of hospitals in seven provinces of Turkey]. / Türkiye'de Yedi Ildeki Hastanelerin Yogun Bakim Ünitelerinden Izole Edilen MRSA Suslarinda VISA-VRSA Arastirilmasi ve Antibiyotik Duyarlilik Durumlarinin Saptanmasi

The aim of this study was to determine whether vancomycin resistant Staphylococcus aureus (VRSA) and vancomycin intermediate susceptible S.aureus (VISA) strains were present among methicillin-resistant S.aureus (MRSA) strains isolated from patients hospitalised at intensive care units (ICU) of hospitals located at different regions of Turkey and to determine the minimum inhibitory concentration (MIC) values of teicoplanin, linezolid, tigecycline, quinupristin-dalfopristin and daptomycin, which are alternative drugs for the treatment of MRSA infections. A total of 260 MRSA clinical strains (isolated from 113 lower respiratory tract, 90 blood, 24 wound, 17 catheter, 13 nasal swabs, two urine and one CSF sample) were collected from nine health-care centers in eight provinces [Ankara (n= 52), Konya (n= 49), Antalya (n= 40), Istanbul (n= 7), Izmir (37), Diyarbakir (n= 15), Van (n= 12), Trabzon (n= 48)] selected as representatives of the seven different geographical regions of Turkey. Methicillin resistance was determined by cefoxitin disk diffusion in the hospitals where the strains were isolated and confirmed by oxacillin salt agar screening at the Refik Saydam National Public Health Agency. Screening for VISA and VRSA was conducted using the agar screening test and E-test. Susceptibility of the MRSA strains to other antibiotics was also determined by E-test method. None of the 260 MRSA strains were determined to be VRSA or VISA. All were susceptible to teicoplanin and linezolid, and susceptibility rates to daptomycin, tigecycline and quinupristin-dalfopristin were 99.6%, 96.9%, and 95%, respectively. Absence of VISA and VRSA among the MRSA strains surveyed currently seemed hopeful, however, continuous surveillance is necessary. In order to prevent the development of VISA and VRSA strains the use of linezolid, tigecycline, quinupristin-dalfopristin and daptomycin should be encouraged as alternative agents of treatment of MRSA infections.

[Can mannose-binding lectin and plasma level of soluble urokinase receptor be used in diagnosis and treatment monitorization of brucellosis patients?]. / Brusellozlu Hastalarda Mannoz-Baglayan Lektin ve Plazma Çözünür Ürokinaz Reseptör Düzeyi Tani ve Tedavi Izleminde Kullanilabilir mi?

The aim of this study was to evaluate the diagnostic value of serum mannose-binding lectin (MBL) and plasma soluble urokinase plasminogen activator receptor (SuPAR) levels in monitoring the treatment in patients with brucellosis, by comparing their levels before and after treatment with the values obtained from healthy control group. Thirty brucellosis patients (mean age: 25.8 ± 12.2 years; 15 were male) and 28 healthy controls (mean age: 29.3 ± 12.3 years; 15 were male) were included in the study. Patients were diagnosed with brucellosis according to the characteristic clinical findings and by brucella standard tube agglutination test (SAT) titer ≥ 1/160 and/or blood culture positivity. Serum MBL (Antibodyshop, Denmark) and plasma SuPAR (Virogates, Denmark) levels were investigated with commercial ELISA kits. In our study, no statistical significance was observed between the pre-treatment (13.8 ± 13.4 ng/ml) and post-treatment (12.4 ± 13.1 ng/ml) MBL levels of the patient group and MBL levels of the control group (16.5 ± 14.8 ng/ml) (p> 0.05). Moreover, the mean SuPAR levels measured in pre-treatment and post-treatment plasma samples of the brucellosis patients was 5.1 ± 1.9 ng/ml and 2.9 ± 1.3 ng/ml, respectively, while the mean SuPAR level was 1.8 ± 0.5 ng/ml in the control group. The difference between mean SuPAR levels of patients in pre- and post-treatment samples was found statistically significant (p< 0.001). In addition SuPAR levels were significantly higher in patients before and after treatment than the control group (p> 0.001). In conclusion, plasma SuPAR level would be a useful marker for the diagnosis and treatment follow up of the patients with brucellosis.

[The effectiveness of hand hygiene products on MRSA colonization of health care workers by using CHROMagar MRSA]. / El Hijyen Ürünlerinin Saglik Çalisanlarinda MRSA Kolonizasyonuna Etkilerinin CHROMagar MRSA ile Arastirilmasi

The aims of this study were; to investigate the hand hygiene compliance of the health care workers (HCWs) during their routine patient care, to determine the methicillin-resistant Staphylococcus aureus (MRSA) hand colonization of the HCWs, to investigate the effect of different hand hygiene products on MRSA colonization and to evaluate the effectiveness of chromogenic agar for detecting MRSA. HCWs were investigated during their routine patient care and hand cultures were taken before and after hand wash/hygiene. Two different techniques were used to obtain the hand cultures: fingertip method (CHROMagar MRSA containing HygiSlide); and direct swab method and then inoculation to CHROMagar MRSA media. MRSA strains grown on those cultures were confirmed with conventional methods. A total of 100 HCWs (of them 61 were female; mean age: 32.7 ± 5.2 years; age range: 25-51 years) involving physicians (n= 33), nurses (n= 38) and health care assistants (n= 29), were included in the study. MRSA was detected in 39% and 11% before hand hygiene and in 13% and 6% after hand hygiene, with HygiSlide CHROMagar media and with CHROMagar in plate media, respectively. No difference were found regarding clinics, occupations, or the type of patient handling in those HCWs who were positive (n= 13) for MRSA colonization following hand hygiene, and those who were negative (n= 26). However, the type of the hand hygiene product used exhibited a statistical difference. None of the seven HCWs who used alcohol based hand rub revealed growth in the second culture while 10 of 19 (53%) HCWs who used soap and three of 13 (23%) HCWs who used chlorhexidine were still colonized with MRSA. In terms of reduction in the MRSA counts, the most effective one was the alcohol based hand rub while the soap was the least, since seven of 19 (37%) HCWs who used soap showed no reduction at all in the MRSA counts. A high ratio of hand colonization with MRSA was detected in our hospital staff (39%). It was shown that the colonization could be reduced significantly (with a rate of 66%) with hand hygiene. Alcohol based hand rub was found to be the most effective method in hand hygiene. The fingertip technique was found to be superior to inoculation to plate media for obtaining hand cultures and CHROMagar MRSA media was found to be rapid, effective and practical for detecting the MRSA hand colonization.

[A case of ventilator-associated pneumonia due to Pantoea agglomerans]. / Pantoea agglomerans'a Bagli Ventilatörle Iliskili Pnömoni Gelisen Bir Olgu.

Pantoea species, which are the members of Enterobacteriaceae family are gram-negative bacilli that are frequently found on many plants and in soil. They may lead to localized infections in healthy subjects and systemic infections in immunosuppressed patients. In this case report a ventilator-associated pneumoniae due to Pantoea agglomerans was presented. A 55 year-old male patient with chronic renal failure was hospitalized in intensive care unit following cardiopulmonary arrest. The patient developed fever (38.8°C), had pulmonary infiltrations in chest X-ray and leucocytosis. Treatment with piperacillintazobactam was initiated upon diagnosis of nosocomial pneumoniae. Bacterial growth from the deep tracheal aspirate of the patient was identified as P.agglomerans by VITEK2 automated system (bioMérieux, France) and the identification was confirmed by conventional microbiological methods. Since the strain was susceptible to the cephoperazon-sulbactam, tobramycin, tetracycline, gentamicin and levofloxacine, the treatment was changed to levofloxacine and cephoperazon-sulbactam and the patient improved. This case was presented to withdraw attention to rare opportunistic pathogens that may lead to nosocomial infections particularly in patients with underlying diseases.

Evaluation of serum TWEAK concentration in patients with acute pancreatitis.

BACKGROUND AND AIM: Tumor necrosis factor-like weak inducer of apoptosis (TWEAK) is a member of the tumor necrosis factor super family of structurally-related cytokines. The aim of this study was to determine the diagnostic and prognostic role of serum TWEAK concentration in patients with acute pancreatitis. METHODS: Twenty four patients with acute pancreatitis and 24 consecutive healthy age- and sex-matched control subjects were included in the study. The serum concentrations of TWEAK were measured at admission and then at remission. The average time between admission and remission was 7-10 days. RESULTS: At admission, TWEAK concentration was significantly lower in patients with acute pancreatitis compared to control subjects (p < 0.001). Serum TWEAK concentrations were elevated after the remission period, however the differences were not statistically significant. In addition, serum TWEAK concentration showed a significant, inverse correlation with amylase, lipase, CRP, AST, fibrinogen, LDH and a positive correlation with calcium, albumin and platelet count. CONCLUSIONS: Patients with acute pancreatitis have lower serum TWEAK concentration than healthy subjects. These results suggest that serum TWEAK concentration could be a potential biomarker of acute pancreatitis.

[Evaluation of vancomycin, teicoplanin, linezolide and tigecycline susceptibilities of nosocomial methicillin-resistant Staphylococcus strains by E-test]. / Hastane Kaynakli Metisiline Dirençli Stafilokok Suslarinda Vankomisin, Teikoplanin, Linezolid ve Tigesiklin Duyarliliginin E-Test Yöntemiyle Degerlendirilmesi.

The aim of this study was to determine the minimal inhibitory concentration (MIC) values of vancomycin, teicoplanin, tigecycline and linezolid in 100 methicillin-resistant staphylococci [21 methicillin-resistant Staphylococcus aureus (MRSA) and 79 methicillin-resistant coagulase negative staphylococcus (MR-CNS)] isolated as agents of nosocomial infection from patients at Ankara Training and Research Hospital between June 2005-March 2007. The MIC values for vancomycin, teicoplanin, linezolid and tigecycline were tested by E-test method (AB Biodisk, Sweden). For 21 MRSA strains MIC50 and MIC90 values were as follows: vancomycin 0.125 µg/ml and 1 µg/ml; teicoplanin 0.5 µg/ml and 3 µg/ml, linezolid 0.047 µg/ml and 0.19 µg/ml; tigecycline 0.094 µg/ml and 0.5 µg/ml, respectively. For 79 MR-CNS strains MIC50 and MIC90 values were as follows: vancomycin 0.5 µg/ml and 2 µg/ml; teicoplanin 2 µg/ml and 4 µg/ml; linezolid 0.125 µg/ml and 0.25 µg/ml; tigecycline 0.38 µg/ml and 0.5 µg/ml, respectively. No resistance to vancomycin, teicoplanin, tigecycline and linezolid were determined in methicillin-resistant staphylococcus strains isolated from the inpatients in our hospital. Among glycopeptides, MIC50 and MIC90 values of vancomycin were found to be lower than that of teicoplanin.

Human herpesvirus 6 infection in hemodialysis and peritoneal dialysis patients.

BACKGROUND: Human herpesvirus 6 (HHV-6) infection occurs worldwide and can be reactivated from latency during periods of immunosuppression, especially after organ transplantation. No previous study has evaluated the influence of dialysis type on HHV-6 infection. The aim of the present study was to determine the prevalence of HHV-6 antibodies in hemodialysis (HD) and peritoneal dialysis (PD) patients. METHODS: We studied 36 PD patients, 35 HD patients, and 20 healthy subjects, all with no history of organ transplantation. After systematic inquiries and a physical examination, blood was drawn for determination of biochemical parameters, cytomegalovirus immunoglobulin M (IgM) and immunoglobulin G (IgG), hepatitis B surface antigen, and the hepatitis C and human immunodeficiency virus antibodies. Titers of HHV-6 IgM and IgG antibodies were determined by ELISA. RESULTS: Titers for HHV-6 IgM antibody were positive in 9 HD patients (25.7%), 8 PD patients (22.2%), and 2 control subjects (10.0%, p > 0.05). More HD patients (20.0%) than PD patients (5.6%, p = 0.07) or control subjects (0.0%, p = 0.03) were positive for HHV-6 IgG antibody. In HD patients, HHV-6 IgG seropositivity and duration of dialysis were positively correlated (R = 0.33, p = 0.05). CONCLUSIONS: Infection with HHV-6 is not rare in PD and HD patients. In addition, HHV-6 IgG seropositivity was significantly higher in HD patients than in control subjects and approached significance when compared with seropositivity in PD patients. Moreover, in HD patients, HHV-6 IgG seropositivity correlated with duration on HD. These preliminary findings provide insight into the pre-transplantation period for patients and may aid our understanding of how to best protect patients against HHV-6 after transplantation.

[Evaluation of Quantiferon-TB Gold and tuberculin skin test in patients with tuberculosis, close contact of patients, health care workers and tuberculosis laboratory personnel]. / Tüberkülozlu hastalar, yakin temaslilari, saglik çalisanlari ve tüberküloz laboratuvari personelinde Quantiferon-TB Gold ve tüberkülin cilt testinin degerlendirilmesi.

Tuberculin skin test (TST) has been used effectively for a long time, despite inherent sensitivity and specificity limitations. Patients with a positive TST without active tuberculosis are identified as having latent tuberculosis infection. Identifying patients with latent tuberculosis infection with this test is an important part of control of the disease. A whole-blood inferferon gamma (IFN-γ) assay, the Quantiferon TB Gold test (QTG; Cellestis, Australia) which is a promising in vitro diagnostic test for the identification of latent tuberculosis infection (LTBI), has potential advantages over the TST. This test includes Myobacterium tuberculosis specific ESAT- 6 and CFP-10 antigens. The aim of this study was to compare the results obtained by QTG and TST in active tuberculosis (TB) patients, close contacts of patients, health care workers and tuberculosis laboratory personel. Twenty-six patients with active pulmonary TB, 6 close contacts of those patients, 11 health care workers with contact to TB patients and 8 TB reference laboratory personnel were included in the study. Prior to administration of the TST, blood samples were drawn from each participant for QTG test. All subjects were asked for BCG vaccination history and examined for a BCG scar. All individuals had a BCG scar. The QTG assay was performed in whole blood samples according to manufacturer's instructions. The agreement between TST and QTG was measured with kappa statistical analysis. In active TB patients (true-infected cases) TST (PPD) positivity was found 34.6% (9/26) while QTG positivity was 65.3% (17/26). Although the positivity rate was higher in QTG test, this difference was not found statistically significant (p > 0.001). TST and QTG positivity rates for health care workers, close house contact of TB patients and TB laboratory staff were as follows, respectively; 36% (4/11) and 27% (3/11); 16.6% (1/6) and 83% (5/6); 37.5% (3/8) and 75% (6/8). The mean PPD diameter was 11 mm in QTG negative group and 14 mm in QTG positive group with a statistically significant difference (p < 0.001). However, there was no statistical significance between QTG positive and negative groups by means of age (p ≥ 0.05) and gender (p < 0.001). In conclusion, QTG assay was superior to TST in its ability to detect LTBI and active TB infection, not to be affected with BCG vaccination, to discriminate responses due to non-tuberculous mycobacteria, and to avoid variability and subjectivity associated with application and reading the TST. Besides, QTG assay needs only one visit to the test unit. However, its being expensive than TST and requirement for special equipments and skilled laboratory personnel, are among the disadvantages of QTG assay.

[Methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus carriage rates in a neonatal intensive care unit]. / Yenidogan yogun bakim ünitesinde metisiline dirençli Staphylococcus aureus ve vankomisine dirençli enterokok tasiyicilik oranlarinin belirlenmesi.

This study was aimed to determine the rates of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) carriage in a neonatal intensive care unit in a Training and Research Hospital in Ankara, Turkey. A total of 135 newborns were included in the study. Following 5 days stay in intensive care unit, samples were taken from nose and umbilicus for the detection of MRSA and cultivated in mannitol-salt agar and oxacillin-resistance screening agar (ORSAB), respectively. The samples taken from rectum to screen VRE, were placed onto Enterococcosel agar which contained vancomycin and ceftazidime. The confirmation of methicillin resistance in MRSA suspected isolates was performed by oxacillin and cefoxitin disk diffusion tests according to Clinical Laboratory Standards Institute (CLSI) guidelines. Twenty eight (20.7%) of 135 newborns had nasal MRSA carriage, 30 (22.2%) of 135 had umbilical and 10 (7.4%) had both nasal and umbilical MRSA carriage. No rectal VRE carriage was found among the newborns. As a result, we suggest that periodical MRSA and VRE carriage investigation in the patients hospitalized in neonatal intensive care units is of outmost help to control and prevent nosocomial infections.

[Evaluation of oxacillin resistance screening agar and chromogenic MRSA agar media for the detection of methicillin resistance in Staphylococcus aureus clinical isolates]. / Staphylococcus aureus klinik izolatlarinda metisilin direncinin saptanmasinda oksasilin direnci tarama agar ve kromojenik MRSA agar besiyerlerinin degerlendirilmesi.

Methicillin-resistant Staphylococcus aureus (MRSA) strains which are the most frequent causes of hospital acquired infections, are also currently encountered with increasing frequency in community acquired infections. Therefore rapid and accurate identification of MRSA strains is essential in both implementation of infection control measures and prevention of the nosocomial spread of this microorganism. The aim of this study was to determine the specifisity, sensitivity, positive and negative predictive values of two commercial media, one was Oxacillin Resistance Screening Agar Base (ORSAB; Oxoid, England) and the other was chromogenic MRSA agar (BBL CHROMagar MRSA; BD, Paris, France), for the identification of MRSA strains. A total of 175 clinical S. aureus isolates, of which 45 were MRSA, and 130 were methicillin-susceptible S. aureus (MSSA), whose susceptibility to methicillin were determined by disk diffusion method using oxacillin and cefoxitin disks in Mueller-Hinton agar medium, were included in the study. When oxacillin disk diffusion test was accepted as the reference method, the specificity, sensitivity, positive and negative predictive values of ORSAB were found as 97.7%, 40%, 36.5% and 98.1%, respectively; while these values were detected as 95.5%, 37.6%, 35.7% and 96.1% for CHROMagar MRSA, respectively. These results indicated that both media may be used in laboratories where work load is high and the number of personnel is inadequate especially in screening studies together or in addition to another medium (mannitol-salt agar). However, since these methods exhibit low specifity (high false positive results), positive results should be confirmed using other methods such as disk diffusion, E-test or microdilution susceptibility testing.

Comparison of tuberculin skin testing and T-SPOT.TB for diagnosis of latent and active tuberculosis.

The T-SPOT.TB test does not cross-react with Bacille Calmette-Guérin or most non-tuberculosis mycobacterium species, and is based on IFN-gamma responses to Mycobacterium tuberculosis-specific antigens. The objective of this study was to compare tuberculin skin test (TST) with T-SPOT.TB results used in the diagnosis of active tuberculosis (TB) as well as latent tuberculosis infection (LTBI). A total of 136 subjects participated in three different groups (47 patients with active pulmonary TB, 47 healthy persons without M. tuberculosis exposure, and 42 hospital members with a history of close contact with active TB patients). The T-SPOT.TB sensitivity (83.0%) and the negative predictive value (NPV) (82.6%) in the diagnosis of active TB were significantly higher than those of TST. The sensitivity and NPV of the TST were 38.3 and 60.8%, respectively. The T-SPOT.TB specificity (80.9%) and positive predictive value (81.3%) were lower than those of TST (95.7 and 90.0%, respectively). The performance of T-SPOT.TB and TST for diagnosing LTBI was the same (54.8%). T-SPOT.TB was superior in terms of sensitivity (83.0%); TST detected only 18, whereas T-SPOT.TB test detected 39 out of 47 patients with active TB. T-SPOT.TB is thought to have better performance than TST due to false-negative results in diagnosing active TB. However, it is considered that large prospective longitudinal studies are needed for diagnosing LTBI.