Microorganisms isolated from the bile of the patients who have undergone cholecystectomy and their antibiotic resistance pattern: multicenter prospective study.

BACKGROUND: Gallbladder and biliary tract infections are diseases with high mortality rates if they are not treated properly. Microbiological evaluation of perioperatively collected samples both ensures proper treatment of patients and guides empirical treatment due to the determination of microorganism susceptibility. AIMS: This study aimed to isolate the microorganisms in bile cultures from patients who underwent cholecystectomy and to determine sensitivity results of these microorganisms. METHODS: This study was a multi-center and prospective design, included 360 patients, and was performed between 2019 and 2020. Culture results of bile taken during cholecystectomy were evaluated. RESULTS: Bacterial growth was found in the bile cultures of 84 out of 360 (23.3%) patients. Patients were divided into two groups according to whether they had risk factors for resistant microorganisms or not. While Escherichia coli (n = 11, 13%), Enterococcus spp. (n = 8, 9.5%), and Enterobacter spp. (n = 4, 4.7%) were detected most frequently in patients without risk. Staphylococcus spp. (n = 17, 20.2%), Enterococcus spp. (n = 16, 19%), and E. coli (n = 8, 9.5%) were the most frequently found microorganism at-risk patients. In multivariate analysis, bile culture positivity was found higher in patients who had history of biliary disease (p = 0.004), operation performed concurrently with a cholecystectomy (p = 0.035), and high rate of polymorphonuclear leukocytes (PNL) in total leukocyte count (p = 0.001). CONCLUSIONS: Our study shows that when starting empirical antibiotic treatment for bile ducts, whether patients are at risk for the development of resistant bacterial infection should be evaluated after which antibiotic selection should be made accordingly.

Incidence, etiology and risk factors associated with mortality of nosocomial candidemia in a tertiary care hospital in Istanbul, Turkey.

OBJECTIVE: The aim of this study was to determine the incidence, etiology and risk factors for mortality of patients with nosocomial candidemia. SUBJECTS AND METHODS: This observational study was performed at Haydarpasa Numune Training and Research Hospital, a tertiary care hospital with 750 beds, between the years 2004 and 2007. Fifty defined cases with a nosocomial bloodstream infection caused by Candida species were included in the study. All demographic, microbiological and clinical records for each patient were collected using a standardized form. Blood culture was performed by automated blood culture system, and those samples positive for yeast were subcultured on Sabouraud agar. RESULTS: The mean incidence density of nosocomial candidemia was 0.58/10,000 patient-days/year (range 0.17-1.4). Candidemia episodes increased from 0.17/10,000 to 1.4/10,000 patient-days/year (p < 0.0001). Candida albicans and non-albicans Candida accounted for 15 (30%) and 35 (70%) cases, respectively. The overall mortality was 56% and was significantly associated with stayingin the intensive care unit (odds ratio: 3.667, 95% confidence interval: 1.07-12.54, p = 0.034). CONCLUSION: This study showed that there was a significantly increased trend in the incidence of candidemia with high mortality during the study period.

The virulence factors and antibiotic sensitivities of Escherichia coli isolated from recurrent urinary tract infections.

OBJECTIVE: We determined the antibiotic sensitivities of uropathogenic Escherichia coli (UPEC) strains isolated from the urine of patients who have recurrent urinary tract infections (UTIs). METHODS: Our study was carried out between November 2000 and January 2002 at the Infectious Diseases Clinic, Istanbul Haydarpasa Numune Hospital, Istanbul, Turkey. We compared the virulence factors (fimbrial adhesion, hemolysin production, motility property) of 50 strains of Escherichia coli (E. coli) isolated from urine with the same properties of 25 strains of E. coli isolated from stool specimens of healthy individuals. In addition, we detected the virulence factors of UPEC strains using a microbiological and biochemical methods and by using disk diffusion method, we were able to investigate the sensitivity of the strains to the antimicrobials. RESULTS: We found the level of mannose-resistant (MR) fimbriae bearing in the UPEC strains to be significantly higher than that in the controls (odds ratio=10.27, p<0.001). The difference in mannose-resistant hemoagglutination (MRHA) and mannose sensitive hemoagglutination (MSHA) bearing levels in UPEC strains were rather high. This difference was regarded as significant in terms of showing the virulence of fimbriae bearing strains (odds ratio=29.03, p<0.001). CONCLUSION: Our study demonstrates that strains with MR fimbriae have a rather high virulence (p<0.001), and that a combination of MR+MS fimbriae increased that virulence (p<0.001). As MR strains have a greater adhesive property, the determination of MR fimbriae bearing as high shows that fimbriae bearing plays an important role in widespread and resistant strains, especially in recurrent UTIs such as in our study. In addition, hemolysin capability was also a virulence factor in recurrent UTIs (p<0.01). In addition, the sensitivity of the strains to the antimicrobials appeared in the following order; imipenem 93%, norfloxacin 89%, ciprofloxacin 85%, netilmicin 80%, amikacin 78%, ceftriaxone 74%, gentamicin 72%, nitrofurantoin 71%, ampicillin-sulbactam 60%, amoxicillin-clavulanate 58%, Trimethoprim/sulfamethoxazole 45%, ampicillin 35%.

The carriage of group B streptococci in Turkish pregnant women and its transmission rate in newborns and serotype distribution.

The prevalence of group B streptococci (GBS) colonization was studied in 500 pregnant women and their newborn infants by collecting vaginal and rectal swabs from mothers, and umbilical and throat swabs from their infants. Forty-six isolates of GBS were obtained from mothers' specimens and eight from neonates. Maternal and infant colonization rates were found to be 9.2% and 1.6%, respectively. Vertical transmission rate was 15.2%. Additionally, serotypes and antimicrobial susceptibility of 54 isolates of GBS were determined. Type Ia, II and III were common serotypes among GBS isolates from mothers and infants. When evaluating the factors that affect GBS carriage, age, socio-economic status and education level of pregnant women were important for carriage, while use of intrauterine device and parity were unrelated. No resistance to ampicillin, penicillin, ceftriaxone or vancomycin was found by disk diffusion method. A high level of resistance against tetracycline was noted (91%). Although invasive serotypes are predominant, the rarity of GBS disease in Turkish infants may be due to low rates of maternal carriage or to their possessing protective levels of GBS-specific IgG antibody in their sera.