Prevalence and antimicrobial susceptibility of Escherichia coli in outpatient urinary isolates in Izmir, Turkey.

BACKGROUND: Knowledge of antimicrobial resistance pattern in Escherichia coli, the predominant pathogen associated with urinary tract infection (UTI), is important as a guide in selecting empirical antimicrobial therapy. The aim of this study was to determine the antibiotic susceptibility patterns of E. coli strains isolated from adult outpatients with UTI, in Izmir, Turkey. MATERIAL/METHODS: This study was performed with isolates from outpatients with UTI, collected from 5 university and tertiary-care hospitals in Izmir, Turkey. Isolates were analyzed by standard methods and antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion method. RESULTS: A total of 4,534 E. coli strains (3,449 females and 1,085 males) were examined. Antibiotic resistance rates of the isolates for female and male, respectively: Ampicillin (61.8%, 78.7%), amoxicillin-clavulanic acid (36.6%, 59.1%), cefuroxime (22.5%, 41.3%), cefotaxime (18.2%, 35.8%), piperacillin-tazobactam (11.6%, 31.2%), amikacin (8.3%, 13.9%), gentamicin (24.9%, 40%), trimethoprim-sulfamethoxazole (42.1%, 57.3%), and ciprofloxacin/norfloxacin (42.1%, 63.3%). Extended spectrum beta-lactamase rate was found to be 18.3% and 26.1% for females and males, respectively. The isolates were significantly more resistant to all antibiotics in men than in females in this study (p<0.001). CONCLUSIONS: The most important finding of our study is that a considerable proportion of the studied E. coli isolates were resistant to most antibiotics except amikacin. These data provide useful information for clinicians in determining the appropriate empirical antimicrobial regimen, and help authorities to formulate antibiotic prescription policies.

Rate of chronicity and time of disappearance of HBsAg following acute hepatitis B.

BACKGROUND/AIMS: Chronic hepatitis B is associated with significantly increased risk of developing cirrhosis, and hepatocellular carcinoma. It's, therefore, important to understand the incidence and risk factors associated with chronicity following acute hepatitis B. METHODOLOGY: Among 863 acute hepatitis patients admitted consecutively to the hospital, 320 with serum immunoglobulin M antibody to hepatitis B core antigen were classified as acute hepatitis B. Of these patients, serum samples were collected 3 and 6 months after clinical onset. RESULTS: Complete follow-up was achieved in 240 patients and 11 (4.6%) became chronic carriers. Only alcohol addiction other than epidemiological, clinical or biochemical parameters was found to be significantly associated with chronic evaluation. In serum samples collected from 205 of 240 patients 3 months after the onset of infection, hepatitis B surface antigen clearance was observed in 181 (88.3%). Number of patients increased to 194 (94.6%) at the end of 6 month and both of these rates were found to be highly significant. CONCLUSIONS: There is still no certain way of predicting the outcome of acute hepatitis B whether a newly infected patient will resolve the illness or not. Alcohol addiction seems to have an impact on the chronicity but additional research is needed.

Bacterial colonization of double J stents and bacteriuria frequency.

AIM: Stents and catheters are widely used in urology. In our study the frequency of double J stent (DJS) colonization and stent associated bacteriuria is investigated. MATERIALS AND METHODS: Between June 2000-April 2001, 61 patients (17-72 years old) to whom DJ stenting was done (5 of them bilateral) were included in this study. Stone extraction/lithotripsy, extracorporeal shockwave lithotripsy (ESWL), open urolithiazis surgery and hydronephrosis were the indications. Sterile urine samples were obtained prior to stenting. Patients were clinically followed and after the treatment DJ stents were removed after having urinary cultures via the cystoscope. DJS cultures were also made. RESULTS: DJS indwelling times were between 15-90 days (52.5 +/- 8.6). In 3 female, 8 male totally 11 patients bacterial colonizations were observed. In 10 of them both stent and urinary cultures were positive, and showed identical microorganisms; 80% E. Coli, 10% E. Coli+ Candida, 10% Klebsiella. CONCLUSIONS: Our infection rate of DJS and urine is 18% which is not very high. Routine DJS cultures are not needed as the same microorganisms grow in urine cultures. No age or sex relation to the infections is found. Antibiotic prophylaxis is effective in preventing clinically ouvert infectious diseases.