Analysis of antimicrobial consumption and cost in a teaching hospital

The aim of this study is to compare the periods before and after the intervention applied using the ATC/DDD method in order to ascertain the rational use of antibiotics in a newly established hospital. The appropriateness of the hospital's antibiotic use, consumption rates and the costs were calculated and compared with other hospitals. Based on these data, an intervention has been planned in order to raise the quality of antibiotic use. The periods before and after the intervention were compared. Between 16 May 2011 and 23 May 2012, data were collected from all hospital units by the infectious diseases specialists and a point prevalence survey was conducted. Anatomical therapeutic chemical classification and the defined daily dose [DDD] methodology were used to calculate the antibiotic consumption. On two specific days in 2011 and 2012, 194 out of 307 patients [63.2%] and 224 out of 412 patients [54.4%] received antibiotic treatment, respectively. In 2011 and 2012, the percentage of appropriate antibiotic use was 51% and 64.3%, respectively. Both in 2011 and 2012, inappropriate antibiotic use was found to be significantly higher in surgical clinics in comparison to the internal diseases clinics and the ICU. This was caused by the high rates of inappropriate perioperative antimicrobial prophylaxis observed in surgical clinics. During both years, approximately one-third of the antibiotics were prescribed for the purposes of perioperative prophylaxis, while 88.5% and 43.7% of these, respectively, were inappropriate and unnecessary. Cephalosporins, fluoroquinolones, combinations of penicillins [including beta-lactamase inhibitors] and carbapenems were the most frequently prescribed antibiotics during the study periods. The mean total antibiotic consumption was 93.6 DDD/100 bed-days and 63.1 DDD/100 bed-days, respectively. The cost of total antibacterial consumption was euro 7901.33 for all the patients [euro 40.72 per infected patient] and euro 6500.26 [euro 29.01 per infected patient], respectively. Each hospital should follow and assess their antibiotic use expressed in DDD in order to compare their antibiotic use with national and international hospitals [WHO, 2009 [14]].

Pregnancy associated with brucellosis and acute viral hepatitis: course and outcome [co-infections in pregnancy]

To assess the outcome and course of pregnancies complicated by Brucellosis [BCS] and acute viral hepatitis [AVH] infections. Prospective study. Diyarbakir State Hospital, Turkey. Eighty-eight pregnant women admitted to Diyarbakir State Hospital, Turkey. Serum agglutination test [SAT], Coombs anti-Brucella test and / or blood culture system were used in the diagnosis of BCS. Enzyme-linked immunosorbent assays [ELISA] and polymerase chain reaction [PCR] was used in the diagnosis of viral hepatitis. The clinical course and delivery pattern of 32 healthy pregnant women was compared with that of 32 pregnant women who had BCS and 24 pregnant women who were concurrently infected with BCS and AVH. There was no maternal mortality. Preterm delivery occurred in 18.75% of the 32 pregnant women with BCS and 37.5% of 24 pregnant women with BCS and AVH [P = 0.004]. The incidence of low birth weight was also significant between the two groups [p < 0.0001]. Antepartum hemorrhage might be warning sign of the occurrence of complications in pregnant women with BCS and AVH [p < 0.001]. An important observation from the present study is that maternal BCS and AVH [even concurrent] had no effect on the incidence of congenital malformations or stillbirths; it did increase the incidence of prematurity and low birth weight over that seen in the general delivery population. In spite of the high complication rates, BCS and AVH in pregnancy are well-tolerated diseases even when they occur together

role of trace elements in helicobacter pylori infected patients

To evaluate the effect of trace elements in patients with Helicobacter pylori associated chronic gastritis. Prospective study. Clinical services of the clinical microbiology and infectious diseases and gastroenterology clinics at Dicle University, Turkey A total of 92 patients with variable severity of chronic gastritis [45 Helicobacter pylori positive and 47 Helicobacter pylori negative gastritis] and 90 age and sex matched healthy subjects were included in the study conducted between October 2006 and November 2008. Histopathologic examination, culture of Helicobacter pylori and urease tests were performed for each patient. The atomic absorption spectrophotometer was used in the measurement of trace elements in the serum. Serum copper and zinc levels were significantly elevated in patients with Helicobacter pylori associated gastritis compared to Helicobacter pylori negative gastritis and healthy controls [p < 0.0001]. Serum copper, zinc and Cu / Zn levels in patients with Helicobacter pylori negative chronic gastritis was not significantly different from the serum levels in healthy controls [p > 0.05]. Our results suggest a relationship between Helicobacter pylori associated chronic gastritis and the elevation of trace element levels in serum. This study confirms that the elevation of trace element levels in serum [Cu and Zn levels] will be helpful in the diagnosis of Helicobacter pylori associated chronic gastritis in the abscence of invasive procedures, and is useful in predicting the severity of infection in patients with chronic gastritis

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

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%