Nosocomial meningitis in a university hospital between 1993 and 2002.

The aim of this study was to establish the relationship between nosocomial meningitis (NM) and surgical interventions, type of pathogens and other hospital infections (HIs). Fifty-one patients diagnosed with NM, according to the criteria of the Centers for Disease Control and Prevention, in the Neurosurgery Department of Ibn-i Sina Hospital of Ankara University between 1993 and 2002 were evaluated retrospectively. All individuals with NM were hospitalized in the intensive care unit. Third-generation cephalosporins were used for surgical prophylaxis and broad-spectrum antibiotics were used for treatment. NM occurred in 0.34% of all admissions and accounted for 0.53% of all HIs. Fourteen cases (28%) had at least one concurrent HI, mainly originating from surgical wounds and related secondary bacteraemia. Four cases had NM following surgical site infection with the same causative agent and three cases had bacteraemia. All the individuals had surgical interventions and 26 (51%) had operations concerning ventriculoperitoneal shunt. A positive microbiological cause was found in the cerebrospinal fluid of 49 patients, with 16 cases having a polymicrobial cause. Of all 67 micro-organisms isolated, 41 (61%) were Gram-negative bacilli, 23 (34%) were Gram-positive cocci and the remaining three (5%) were Candida spp. Staphylococci were the most common pathogens (30%), followed by non-fermentative Gram-negative bacilli (22%).

Candida colonization in mechanically ventilated patients.

The diagnosis of pulmonary candidosis is controversial. We undertook a prospective study on 50 mechanically ventilated (>48 h) patients who were hospitalized (>72 h) in the intensive care unit (ICU) with the aim of assessing the incidence of the isolation of Candida species from endotracheal aspirates (EA). Patients were categorized as individuals already colonized with Candida spp. on admission, individuals becoming colonized during hospitalization, or patients with no colonization. Patients in the ICU were hospitalized for a mean of 23 days. The percentage of patients already colonized with Candida was low (six of 50; 12%), the incidence of Candida isolation from EA in critically ill, mechanically ventilated patients in ICU was also low (six of 50; 12%). Age, duration of hospitalization, pre-treatment with antimicrobials or immunosuppressive agents and occurrence of underlying disease were not risk factors in our study. Both antifungal usage and neutropenia were more common in already colonized patients. No risk factors were determined for patients colonized during hospitalization. As all the isolates identified were C. albicans. It appears that at present, colonization and/or infection by more resistant Candida species is not a problem in our unit.

Mycobacterium tuberculosis drug resistance in Turkey, 1976-97.

Drug-resistant tuberculosis is increasing day by day and is a significant threat to tuberculosis control because there are few drugs effective against Mycobacterium tuberculosis. This study evaluates the resistance of the microorganism to primary anti-tuberculosis drugs over the 21-y period 1976-97. Records from the bacteriology laboratory of the Department of Chest Diseases and Tuberculosis, Ankara University Medical Faculty were evaluated retrospectively. Among 3,418 mycobacteria strains, 3,319 (97.1%,) M. tuberculosis were isolated and their susceptibility was examined by the proportion method in Loewenstein-Jensen medium. It was found that 60.8% of isolated strains were susceptible, whereas 39.2%, were resistant to at least one drug. Multi-drug resistant tuberculosis (MDR-TB) was found in 194 (5.8%) materials. Over the 21-y period studied, total resistance to isoniazid (INH), rifampicin (RF) and streptomycin (SM) were determined as 10.5, 6.9 and 7.0%, respectively. It was also observed that the resistance rates to INH or SM increased, whereas resistance to RF was not changed within this period. While resistance to the 2-drug combination RF+SM increased, resistance to INH+SM decreased significantly. There was no change in resistance to the 2-drug INH + RF or 3-drug INH + RF + SM combinations in the same period. In conclusion, combined therapy is still useful and available for the treatment of resistant tuberculosis, and INH should be included in the chemotherapeutic regimen even if high resistance rates are shown to exist.

Comparison of the effects of hospitalization and antibiotic usage on the aerobic intestinal flora.

Antimicrobial resistance among bacteria has arisen ever since antimicrobial agents were introduced in the clinic. Unfortunately, it seems that resistance is now emerging at a more rapid rate than ever before, as a consequence of the widespread use of antimicrobial agents. The spread of these multiresistant microorganisms is an increasing threat in many countries. The human intestinal flora is a huge potential reservoir of resistant microorganisms. Antimicrobial resistance in clinical isolates may cause serious infections and treatment failure, and lead to the use of higher doses or more toxic alternative drugs. This study was planned so as to compare the effects of hospitalization and antibiotic usage on the aerobic intestinal flora and included 43 hospitalized adult patients without any previous history of hospitalization and antibiotic usage during the last 30 d. Patients were divided according to their antimicrobial therapy, into treated and untreated groups. The individual use of antimicrobials was recorded. Antibiotic usage was found to be more effective on the aerobic intestinal flora compared with hospitalization without such medication.