ABSTRACT
The aim of this study was to determine the incidence, etiology and risk factors for mortality of patients with nosocomial candidemia. 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. 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]. This study showed that there was a significantly increased trend in the incidence of candidemia with high mortality during the study period
ABSTRACT
We determined the antibiotic sensitivities of uropathogenic Escherichia coli [UPEC] strains isolated from the urine of patients who have recurrent urinary tract infections [UTIs]. 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. 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]. 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%