Causes of nosocomial pneumonia and evaluation of risk factors in a University Hospital in Turkey

To determine the incidence, risk factors, mortality rate, and organisms causing nosocomial pneumonia [NP]. We carried out this study in the Intensive Care Units [ICUs], General Medical and Surgical wards of Baskent University, Training and Research Hospital in Adana, Turkey, between November 2000 and August 2002. Patients were observed from the time of admission until 48 hours after discharge from the hospital. In this study, 618 [2.1%] nosocomial infections [NIs] were detected in 29778 patients. One hundred and fifteen of these infections were NP and investigated with surveillance prospectively. The most frequently isolated microorganisms in NP were methicillin-resistant Staphylococcus aureus [MRSA] 32.8%, Pseudomonas species 21.5%, methicillin-sensitive Staphylococcus aureus [MSSA] 10.2%, Klebsiella species [9.1%] and Acinetobacter species 5.9%, E. coli; 5.4% [10/186], Streptococcus species; 4.8% [9/186], Candida species; 4.8% [9/186], Enterobacter species; 2.7% [5/186] and the other bacteria; 2.7%. The predominant pathogens isolated in this study were MRSA [33.8%], Pseudomonas species [16.9%] and MSSA [16.9%] in early-onset pneumonias and MRSA [32.2%], Pseudomonas species [24.0%], and Klebsiella species [10.7%] in late-onset pneumonias. This study demonstrated that the possibility of developing NP, significantly increases with such risk factors as decreased level of consciousness, respiratory failure, mechanical ventilation and tracheostomy. Each center should know its patients' profile, the factors that increase the infection, the antibiotic resistance patterns of microorganisms, and the distribution of hospital infections in every department. Strategies to prevent both development of antibiotic resistance and spread of resistant organisms are necessary

Anti-Toxoplasma gondii antibodies in hemodialysis patients receiving long-term hemodialysis therapy in Turkey

Toxoplasma is a globally distributed pathogen for humans and animals. In situations of immunodeficiency, Toxoplasma gondii [T. gondii] emerges as a life-threatening infection. Toxoplasma gondii is transmitted parenterally, flourish in state immunosuppression and, most toxoplasma infections are asymptomatic. In the present study, we aimed to investigate the prevalence of anti-T. gondii antibodies in hemodialysis patients with chronic renal failure. We undertook a prospective study of our maintenance hemodialysis patients to determine whether these sources posed a risk for transmission of T. gondii. This study was carried out on patients undergoing regular hemodialysis in the dialysis units [Hemodialysis Center of Antakya State Hospital, Emir Hemodialysis Center and Antakya Hemodialysis Center, Hatay, Turkey] between January 2004 and June 2004. Two hundred and fifty-five hemodialysis patients and 50 healthy controls were studied for the prevalence of anti-T. gondii antibodies by enzyme-linked immunosorbent assay. Anti-immunoglobulin G [IgG] and immunoglobulin M [IgM] T. gondii antibodies positivity were found to be 195 [76.5%] of the 255 hemodialysis patients and 24 [48%] of the 50 control subjects. The difference between them was statistically significant [p<0.05]. In addition, an increase of the seropositivity rate was detected with increasing length of time on hemodialysis treatment, indicating a statistically significant difference between these 2 parameters [p<0.05]. These findings confirm a high prevalence of toxoplasma infection in hemodialysis patients. These patients are a risk group for toxoplasma infection. Moreover, it is recommended that hemodialysis patients who are susceptible to toxoplasma infections should be identified by T. gondii IgG and IgM specific serological tests. Therefore, patients undergoing hemodialysis should be screened for toxoplasma before dialysis to prevent the dissemination of this infection through the hemodialysis procedure