Bacteriology of surgical wound infections in a tertiary care hospital in Turkey.

OBJECTIVE: To determine the spectrum of the pathogens cultured from surgical wound infections and assess their antimicrobial drug resistances. DESIGN: Laboratory-based retrospective study for the five year period. SETTING: A four hundred bed, tertiary-care university hospital in Turkey. RESULTS: Overall 621 pathogens were identified from January 1999 to January 2004. Of these isolates, 431 (69%) were gram-positive, 178 (29%) were gram-negative bacteria and also 12 (2%) were identified as Candida albicans. The most common organism was Staphylococcus aureus (50%), followed by Escherichia coli (8%), Streptococcus pyogenes (7%), Pseudomonas aeruginosa (7%), coagulase-negative staphylococci (6%), Enterococcus faecalis (4%), Enterobacter spp. (4%), Klebsiella pneumoniae (3%), Acinetobacter spp. (3%), Proteus spp. (3%), group B. B-haemolytic streptococci (2%), Candida albicans (2%), and Citrobacter spp. (1%). The rate of resistance to methicillin in staphylococci and multidrug resistance in S. aureus were 31% and 12%, respectively. There was no increase in resistance to methicillin by years. Piperacillin/tazobactam, sefoperazone/sulbactam, carbapenems, ofloxacin and amikacin were the most active agents against gram-negative isolates. The rates of extended spectrum beta-lactamase production in K. pneumoniae and E. coli strains were determined as 14%, and 6%, respectively. CONCLUSION: Methicillin resistant Staphylococcus aureus (MRSA) is emerging as a major pathogen in surgical wound infections. We concluded that antimicrobial treatment of surgical wound infections should include empiric coverage for MRSA. The surveillance of resistance in pathogens causing surgical wound infections is necessary to promote the appropriate therapeutic choices for these infections.

Relationship between pinworm and urinary tract infections in young girls.

Urinary tract infection is particularly common in young girls and Enterobius vermicularis (pinworm) is one of the most prevalent worms found in children worldwide. Young girls, with or without urinary tract infection, were examined for pinworms in order to explore a possible relationship between these two problems. Of the 55 young girls with urinary tract infection, 20 (36.4%) had pinworm eggs in the perianal and/or perineal region monitored using the cellophane tape method, while 9 (16.4%) of 55 young girls who had never previously had a urinary tract infection were found to have Enterobius eggs in at least one of the cellophane tape tests, and the difference was found to be significant (p<0.05). These results suggested that urinary tract infections may be related to pinworms. When a urinary tract infection is diagnosed in young girls, cellulose tape should be applied to both the perianal and the perineal regions on at least three consecutive occasions.

Evaluation of rational antibiotic use.

The emergence of antibiotic resistant bacteria is a major problem throughout the world and a rational use of antibiotics is therefore very important. This study was performed to estimate the appropriateness of antimicrobial drug use in Celal Bayar University Hospital in Manisa. The data of all inpatients (n=937) between October and December 1998 were collected according to the Kunin and Jones criteria. Of the patients, 16.6% (n=156) were receiving antibiotics, and in 63.5, 23.0 and 13.5% of these, a single, two and three agents were used, respectively. The purpose of antibiotic use was for prophylaxis in 23.9%, as an empiric decision in 71.4% and for therapeutic culture-based reasons in 4.7%. The rate of rational antibiotic use was 45.7% and it was statistically higher in those patients from whom specimens had been taken for culture than in patients receiving prophylactic or empiric antibiotics. On medical wards, rational antibiotic usage was 55.1%, while it was 26.3% in surgical wards (P<0.0001). The low rate of appropriate antibiotic use in our university hospital reflects the urgent need of rationalization.

The effect of CagA status on response to Helicobacter pylori eradication therapy in Western Turkey.

If cytotoxin-associated gene A (CagA) status affects the response rates of therapy, then it may be possible to predict Helicobacter pylori eradication rates. We aimed to evaluate the response to eradication treatment of H. pylori infection in CagA-positive and CagA-negative patients. A total of 184 patients (93 males, 91 females, mean age 42.6 +/- 12.8 years) with H. pylori-positive chronic gastritis were studied. Subjects underwent a gastroscopy and biopsy specimens were taken from the gastric antrum, body, and fundus. Before the eradication therapy was given all patients were tested for CagA, TNF-alpha and gastrin levels. They were then prescribed lansoprazole (30 mg bid), clarithromycin (500 mg bid), and amoxicillin (1.0 mg bid) for one week. On the 8th week a second endoscopy was performed and further biopsy specimens were obtained from the same sites as in the initial endoscopy. One hundred and twenty-seven patients (69.1%) were found to be CagA positive and 57 patients (30.9%) were CagA negative. The total eradication rate was 82.6%. In the CagA-positive group this rate was 87.4%, and in the CagA-negative group it was 71.9% (P = 0.019). TNF-alpha levels were higher in the CagA-positive than in the CagA-negative group (P = 0.001). However, gastrin levels were not different between groups (P = 0.421). Our findings revealed that CagA-negative status might be a risk factor for failure of H. pylori triple therapies. The CagA pathogenicity island gives a growth advantage to H. pylori strains and has been associated with an increase in the inflammatory response at the gastric mucosal level. These properties could make CagA-positive H. pylori strains more susceptible to antibiotics.

Oropharyngeal carriage and penicillin resistance of Neisseria meningitidis in primary school children in Manisa, Turkey.

INTRODUCTION: To determine the oropharyngeal carriage rates and serogroups of Neisseria meningitidis in primary school children in Manisa, Turkey as well as the prevalence and penicillin resistance of N. meningitidis. MATERIALS AND METHODS: Throat swabs obtained from 1128 children were cultured and recovered organisms were tested by disk diffusion method and the E-test for antimicrobial susceptibilities. RESULTS: The carriage rate of N. meningitidis in our region was 6.2% (71 strains) and the serogroups identified were serogroups A (28.1%), B (22.5%), C (35.2%), D (2.8%) and W-135 (11.2%). Penicillin resistance was found in 16 strains (22.5%), while beta-lactamase activity was found in none. CONCLUSIONS: The carriage rate of N. meningitidis and serogroups are similar to the rates reported in other countries. Continued surveillance of meningococci for antimicrobial resistance will allow early detection of changes in susceptibility patterns that might affect recommendations for chemoprophylaxis as well as for treatment.

Granulomatous hepatitis following intravesical bacillus Calmette-Guerin therapy.

Although intravesical bacillus Calmette-Guerin (BCG) administration is an effective method in the treatment of superficial urinary bladder carcinoma, some complications may arise such as a granulomatous reaction either in the urinary tract or, in rare cases, outside the urinary tract. We report in this paper a case of granulomatous hepatitis following intravesical BCG administration.

Effects of different disinfectants on decontamination of laryngoscopes.

Guidelines for controlling possible contamination of laryngoscopes should be formulated with the benefit of relevant experimental data. In this study, the effects of five different disinfectants commonly used for the disinfection of laryngoscopes are evaluated. We formed 14 groups, with 10 blades in each. The first 7 groups were contaminated with hospital related meticillin resistant Staphylococcus aureus (MRSA), and the remaining 7 groups with hospital related multiple resistant Pseudomonas aeruginosa (PA). For the first group of blades, no disinfection procedure was carried out and, were assumed as a control group. Blades in remaining groups were rested for 10 minutes in containers containing 70% alcohol (II), 1/100 dilution of cetrimide (III), 1/100 dilution of chlorhexidine (IV), 1/10 dilution of chlorhexidine (V), 1/10 dilution of povidone iodine (VI), and 1/100 dilution of ammonium chloride (VII). Disinfectant used in a group was considered effective when growth was seen in 5 or less than 5 plates representing that group. All disenfectants tested were found effective on decontamination of laryngoscopes. Five different moderate level disinfectants, which are commonly used for the disinfection of laryngoscopes, have been found effective even on resistant hospital microorganisms like MRSA and P. aeruginosa. They may be the choices of the disinfectants, especially 1/10 dilution of chlorhexidine gluconate and 1/100 dilution of ammonium chloride.

The resistance of Pseudomonas aeruginosa strains to fluoroquinolone group of antibiotics.

Fluoroquinolones are antibiotics that are very effective against many gram negative microorganisms, including P. aeruginosa. However, resistance to these antibiotics has been reported in recent years as well. In this study, the sensitivity of 136 P. aeruginosa strains, isolated from various clinical materials, to fluoroquinolones has been investigated. The lowest resistance rate was in ciprofloxacin with 12.5%. The resistance rates of the others were as follows: norfloxacin 14.7%, levofloxacin 16.9%, ofloxacin 19.9% and pefloxacin 28.7%. The 88.2% of the resistant strains to all fluoroquinolones were originated from intensive care unit.

Prevalence of Chlamydia pneumoniae specific antibodies in different clinical situations and healthy subjects in Izmir, Turkey.

Serological markers for Chlamydia pneumoniae were investigated by using the microimmunofluorescence (MIF) test in various age and patient groups in a specific area in Turkey. IgG seropositivity to C. pneumoniae was 64.3% and 18.7% in healthy adults and children, respectively. The highest positivity rate (77%) was in the 15-19 age group. Among the groups investigated, serological findings revealed a possible etiological association between C. pneumoniae and the clinical condition in the groups with acute myocardial infarction, atypical pneumoniae and chronic obstructive pulmonary disease.

The effect of CagA status on response to Helicobacter pylori eradication therapy in Western Turkey

If cytotoxin-associated gene A (CagA) status affects the response rates of therapy, then it may be possible to predict Helicobacter pylori eradication rates. We aimed to evaluate the response to eradication treatment of H. pylori infection in CagA-positive and CagA-negative patients. A total of 184 patients (93 males, 91 females, mean age 42.6 ± 12.8 years) with H. pylori-positive chronic gastritis were studied. Subjects underwent a gastroscopy and biopsy specimens were taken from the gastric antrum, body, and fundus. Before the eradication therapy was given all patients were tested for CagA, TNF-alpha and gastrin levels. They were then prescribed lansoprazole (30 mg bid), clarithromycin (500 mg bid), and amoxicillin (1.0 mg bid) for one week. On the 8th week a second endoscopy was performed and further biopsy specimens were obtained from the same sites as in the initial endoscopy. One hundred and twenty-seven patients (69.1 percent) were found to be CagA positive and 57 patients (30.9 percent) were CagA negative. The total eradication rate was 82.6 percent. In the CagA-positive group this rate was 87.4 percent, and in the CagA-negative group it was 71.9 percent (P = 0.019). TNF-alpha levels were higher in the CagA-positive than in the CagA-negative group (P = 0.001). However, gastrin levels were not different between groups (P = 0.421). Our findings revealed that CagA-negative status might be a risk factor for failure of H. pylori triple therapies. The CagA pathogenicity island gives a growth advantage to H. pylori strains and has been associated with an increase in the inflammatory response at the gastric mucosal level. These properties could make CagA-positive H. pylori strains more susceptible to antibiotics