EFFECTS OF STANDARD AND/OR GLUTAMINE DIPEPTIDE AND/OR OMEGA-3 FATTY ASCID-SUPPLEMENTED PARENTERAL NUTRITION ON NEUTROPHIL FUNCTIONS, INTERLEUKIN-8 LEVEL AND LENGTH OF STAY--A DOUBLE BLIND,CONTROLLED, RANDOMISED STUDY.

BACKGROUND AND AIMS: Protein calorie malnutrition for cancer patients is related with altered cellular and humoral immunity. Standard TPN and glutamine and lipid emulsion with omega 3 fatty acids were given to colorectal cancer patients and the effects of these to neutrophil functions and IL-8 levels are compared. METHODS: Consecutive 36 patients with colorectal cancer diagnosed with endoscopic biopsy and with malnutrition determined by subjective global assessment were enrolled to study. The patients are randomly divided into four groups. Standard TPN to control group, TPN with glutamine solution to S-D group, TPN with omega 3 fatty acid solution to S-O group and TPN with omega 3 fatty acids solution and glutamine to S-D-O group were given for seven days after the operation. At the preoperative, postoperative first day and 7th day, neutrophil phagocytosis index, neutrophil adhesivity index and IL-8 levels were determined. RESULTS: In all groups compared to control group neutrophil phagocytosis index were increased significantly (p<0.05). The most increasing was in group 3. There wasn't significant difference between groups about postoperative first day neutrophil adhesiveness index (p>0.05). At the 7th day the neutrophil adhesivity index for study groups were increased compared with control group, but there was no significant differences between groups. There was no significant difference between groups for IL-8 levels. CONCLUSIONS: As a result of the study, altered cellular immunity in colorectal cancer patients with malnutrition can be corrected with omega 3 fatty acid emulsions and glutamine added to TPN so the ratio of morbidity and mortality can be decreased.

Extended-spectrum beta-lactamases in ceftazidime-resistant Escherichia coli and Klebsiella pneumoniae isolates in Turkish hospitals.

PURPOSE: To study the prevalence of TEM-, SHV- and GES-type beta -lactamases among Escherichia coli and Klebsiella pneumoniae strains having ceftazidime MICs higher than 2 mg/L. METHODS: A total of 63 E. coli and 41 K. pneumoniae isolated from five different university hospitals were studied for the existence of TEM-, SHV- and GES-type beta -lactamases. Susceptibility tests were carried out according to the criteria of National Committee for Clinical Laboratory Standards. MICs were obtained by agar dilution method. Existence of extended-spectrum beta -lactamases (ESBLs) were assessed by double-disc synergy test (DDST). Existence of the above-mentioned beta -lactamase genes were studied both by PCR with specific oligonucleotide primers and isoelectric focusing methods. RESULTS: None of the isolates were carbapenem-resistant. DDSTs were positive in 50 (79.3%) and 33 (80.5%) of E. coli and K. pneumoniae , respectively. TEM gene was detected in 41 (65.1%) and 19 (46.3%), whereas SHV gene in 18 (28.6%) and 20 (48.8%) of E. coli and K. pneumoniae strains, respectively. GES genes were not detected. CONCLUSIONS: TEM and SHV genes are highly prevalent among ESBL-producing E. coli and K. pneumoniae , whereas GES-type ESBLs are absent and found not to be responsible of ceftazidime resistance in Turkish hospitals.

Resistance emergence among P. aenrginosa in a rat thigh-abscess model. Comparison of imipenem and meropenem treatment.

Resistance emergence to carbapenem antibiotics was studied in a rat-thigh abscess model. Abscesses were developed in three groups with a total of 15 P. aeruginosa strains (three rats per strain). Groups were assigned to imipenem or meropenem treatment while one was left antibiotic-free. Test strains were fully susceptible to these antibiotics and the "Mutant Preventing Concentrations" of imipenem and meropenem over these strains were comparable. Antibiotic serum levels, assessed by serum bioassay test, were similar among therats. After four days, rats (n=45) were sacrificed and carbapenem resistant mutants were selected on imipenem (4 mg/L) and meropenem (4 mg/L) supplemented agar plates. Resistant variants of three strains, from four abscesses, were detected; one in the meropenem group, two in the imipenem and one in the untreated group. The MICs of imipenem and meropenem for the mutants were increased fourfold times or even higher of their counterparts. Resistance emergence under antibiotic pressure in P. aeruginosa has been shown in various conditions. To our knowledge, however, resistance emergence in abscess and also the comparison of imipenem and meropenem in this regard has not been studied before.

Piperacillin with and without tazobactam against extended-spectrum beta-lactamase-producing Pseudomonas aeruginosa in a rat thigh abscess model.

BACKGROUND: We compared the antibacterial effect of piperacillin, piperacillin-tazobactam and imipenem in a paired rat thigh abscess model. METHODS: Two abscesses were provoked in the thighs of rats, one on the right with an extended-spectrum beta-lactamase (OXA-14)-producing Pseudomonas aeruginosa (Ps-162) and the other on the left thigh with a control strain. RESULTS: The colony counts from the abscesses in log 10 colony-forming units per gram (mean +/- SD) in the imipenem group were 2.78 +/- 1.71 and 3.19 +/- 1.66, in the piperacillin-tazobactam group 4.36 +/- 0.23 and 2.44 +/- 1.97, and in the piperacillin group 4.44 +/- 0.21 and 3.71 +/- 0.99 for Ps-162 and the control strain, respectively. The mean colony counts were significantly different (p < 0.05) between Ps-162 and the control strain in the piperacillin and piperacillin-tazobactam groups. CONCLUSION: These data showed that piperacillin and piperacillin-tazobactam were significantly less effective against extended-spectrum beta-lactamase-producing P. aeruginosa, while imipenem was equally effective against both Ps-162 and the control strain in this abscess model.

Transient increase in diarrheal diseases after the devastating earthquake in Kocaeli, Turkey: results of an infectious disease surveillance study.

Immediately after the devastating earthquake in Turkey in August 1999, an infectious disease surveillance system was established in Kocaeli Province (the biggest area affected). This surveillance study was mainly focused on diarrheal diseases. During a 33-day period, 1,468 stool cultures were processed. Diarrheal diseases increased step-by-step and later decreased to the initial level by the end of this period. Cases were scattered throughout the entire region, and the identified causes were various, indicating a multifocal increase. Of the identified causes, Shigella species were the most common. Nevertheless, Shigella isolates also belonged to distinct serotypes and clones. This study indicated a multifocal, multiclonal increase in diarrheal diseases after this massive disaster, thus indicating the necessity to set up infectious disease surveillance systems after such events.