Effects of monensin sodium and live attenuated oocyst vaccine as coccidiosis management programs on productive performance, bone quality and mineral utilisation in broiler chickens.

1. The following study was conducted to evaluate the influence of coccidiosis vaccine-induced metabolic stress on the utilisation of minerals in broilers. The starter, grower and finisher phase diets, including macro- and micro minerals at the recommended levels for the breed standards, were fed to chickens between 1 and 39 d of age.2. A total of 486, one-d-old male broilers were randomly distributed into three coccidiosis management programs (CMP) with six replications each. The CMP comprised: monensin sodium (MON), coccidiosis vaccine (VAC), not treated with MON or VAC (CNT).3. No significant differences between CMP were observed for body weight and weight gain among treatments. When compared to the CNT, the VAC program increased feed intake (P < 0.05) between d 1 to 13 and 14 to 26, while FCR worsened in the latter (P < 0.05) and the former (P = 0.05) periods.4. For birds in the MON and VAC programs, tibia bone length at d 13 and bone diameter at d 39 were both enhanced (P < 0.05). Meat yield characteristics were comparable among the CMP.5. Faeces of VAC birds had a lower (P < 0.05) dry matter and ash content than those in CNT program. CMP had no effect on serum or bone mineral concentrations at any point in time. For minerals, Mg, Na, and K faecal excretion was reduced (P < 0.01) as a result of the VAC program at d 13 with a trend at d 26.6. Compared to the CNT, the VAC program decreased the percentage ratio of drip loss (P = 0.08), water holding capacity (P < 0.01) and cooking loss (P < 0.01) in breast meat.7. Overall, the results showed that current broiler industry practices are capable of meeting the mineral needs of broilers vaccinated against coccidiosis.

First Report of Campylocarpon fasciculare Causing Black Foot Disease of Grapevine in Turkey.

Soil-borne fungal diseases have become an important problem in grapevine nurseries of the Aegean region (western Turkey) in recent years. Reduced vigor, black vascular streaking in basal ends, blackish-sunken necrotic root lesions, and young vine death were observed in 15 grapevine nurseries of Manisa city in May 2011 and 2012. To determine the causal agents, symptomatic young grapevine (Vitis vinifera cv. Sultana 7) plants (grafted on 1103 Paulsen) were collected from nurseries (8 to 10 plants from each). Symptomatic basal end tissues were surface disinfested with 95% ethanol and flame sterilized. The internal tissues were plated onto potato dextrose agar amended with tetracycline (0.01%). Campylocarpon-like fungi were isolated (with 37.9% isolation frequency) from only one nursery (corresponding to 6.7% of all surveyed nurseries). Fungal colonies were incubated for 21 days in the dark to induce sporulation. Fungal colonies produced cottony aerial mycelium and turned chocolate-brown to dark brown on PDA. Abundant macroconidia were observed at branched conidiophores on long and cylindrical phialides. Microconidia were not observed. Macroconidia were generally 2 to 4 septate, cylindrical and slightly curved, with the following dimensions: 2 septate: 33.5 to 40.7 × 6.1 to 7.6 µm (mean: 35.9 × 6.8 µm), 3 septate: 36.2 to 43.4 × 6.6 to 8.3 µm (mean: 37.3 × 7.6 µm), and 4 septate: 48.9 to 53.5 × 7.6 to 8.3 µm (mean: 50.7 × 8.0 µm). Fifty macroconidia were measured. Morphologically, the isolates resembled the published description of Campylocarpon fasciculare Schroers, Halleen & Crous (2,4). For molecular identification, fungal DNA was extracted from mycelium and ribosomal DNA fragments (ITS1, 5.8S ITS2 rDNA), ß-tubulin, and histone H3 genes, amplified with ITS 4-5, Bt 2a-2b, and H3 1a-1b primers (3,5), and sequenced. Sequences were compared with those deposited in GenBank. The isolate (MBAi45CL) showed 99% similarity with Campylocarpon fasciculare isolates AY677303 (ITS), AY377225 (ß-tubulin), and JF735502 (histone H3). The DNA sequences were deposited into GenBank under accessions KJ573392, KJ573393, and KJ573394 for ITS, ß-tubulin, and Histone H3 genes, respectively. To fulfill Koch's postulates, pathogenicity tests were conducted under greenhouse conditions on own-rooted grapevines (Vitis vinifera) cv. Sultana 7. Plants were removed from the rooting bench and the roots were slightly trimmed and submerged in a 107 ml-1 conidial suspension of the isolate for 60 min (5). After inoculation, the rooted cuttings were planted in 1-liter bags containing a mixture of soil, peat, and sand (2:1:1, v/v/v), and maintained in the greenhouse (24°C. 16/8-h day/night, 75% RH). Ten plants were inoculated with the isolate and five plants were submerged in sterile distilled water (control). After 4 months, young vines were examined for vascular discoloration, reduced root biomass, blackish lesions, and recovery of fungal isolates. The experiment was repeated twice. Blackish-brown discoloration of xylem vessels and necrosis in the basal ends was visible in the inoculated plants but not in the control plants. The pathogen was successfully re-isolated from 69.1% of the inoculated plants. This report is important for the new studies aiming at black foot disease control in Turkey viticulture. References: (1) A. Cabral et al. Phytopathol. Mediterr. 51:340, 2012. (2) P. Chaverri et al. Stud. Mycol. 68:67, 2011. (3) N. L. Glass and G. C. Donaldson. Appl. Environ. Microbiol. 61:1323, 1995. (4) F. Halleen et al. Stud. Mycol. 50:431, 2004. (5) T. J. White et al. PCR Protocols: A Guide to Methods and Applications. Academic Press, San Diego, CA, 1990.

First Report of Wood Canker Caused by Botryosphaeria dothidea, Diplodia seriata, Neofusicoccum parvum, and Lasiodiplodia theobromae on Grapevine in Turkey.

The Aegean region (western Turkey) is the center of table, raisin, and wine grape cultivation. During the 2012 growing season, wood canker symptoms were observed in vineyards in Manisa city. Symptoms adjacent to pruning wounds, including shoot dieback and wedge-shaped wood discolorations observed in cross section, were among the most prevalent symptoms of the vines. To identify the causal agents, symptomatic woody tissues were surface disinfested with 95% ethanol and flame-sterilized and the discolored outer bark was cut away. The internal tissues (0.5 cm2) were excised from cankers of vines and plated onto potato dextrose agar amended with tetracycline (0.01%) (PDA-tet). The most frequently isolated fungi, based on general growth pattern, speed of growth, and colony color, resembled species in the Botryosphaeriaceae family. According to morphological characteristics, four different groups have been identified based on visual discrimination. After DNA extraction, ribosomal DNA fragments (ITS1-5.8S-ITS2) (2) amplified with ITS4 and ITS5 primers were sequenced and sequences were compared with those deposited in NCBI GenBank database. Four different Botryosphaeriaceae isolates were identified, including Botryosphaeria dothidea (MBAi25AG), Diplodia seriata (MBAi23AG), Lasiodiplodia theobromae (MBAi28AG), and Neofusicoccum parvum (MBAi27AG) (Accession Nos. KF182329, KF182328, KF182331, and KF182330, respectively) with species nomenclature based on Crous et al. (1). Pathogenicity tests were conducted under greenhouse conditions (24°C, 16/8-h day/night, 70% RH) on 1-year-old own rooted grapevine (Vitis vinifera) cv. Sultana Seedless seedlings using one isolate from each of the Botryosphaeriaceae species specified above. Stems of grapevine seedlings were wounded by removing bark with 4-mm cork borer and fresh mycelial plugs were inoculated into the holes and covered with Parafilm. Sterile PDA plugs were placed into the wounds of control seedlings. Five vines were inoculated per isolate. The experiment was repeated twice. After 4 months of incubation, grapevine seedlings were examined for the extent of vascular discoloration and recovery of fungal isolates. Mean lesion lengths on wood tissues were 85.3, 17.2, 13.9, and 13.1 mm for N. parvum, B. dothidea, L. theobromae, and D. seriata, and 6.3 mm for control. Each fungal isolate was successfully re-isolated from inoculated seedlings to fulfill Koch's postulates. To our knowledge, this is the first report of multiple species in the Botryosphaeriaceae causing wood canker and dieback on grapevine in Turkey. These results are significant because Botryosphaeriaceae species are known causal agents of grapevine trunk disease worldwide (3). References: (1) P. W. Crous et al. Stud. Mycol. 55:235, 2006. (2) B. Slippers et al. Mycologia 96:83, 2004. (3) J. R. Urbez-Torres. Phytopathol. Mediterr. 50:S5, 2011.

Is atopy and autoimmunity more prevalent in patients with alopecia areata? A comparative study.

OBJECTIVE: We aimed to determine whether there was a difference between adult and paediatric alopecia areata patients with respect to the severity and pattern of the disease, nail changes and personal and family history of autoimmune diseases and also in comparison with controls. METHODS: Two groups were included: patients with onset of alopecia before the age of ≤18 years and >18 years. The total number of the patients were 124. The control group was comprised of 114 age- and gender-matched patients. RESULTS: There were 81 adults and 43 children. No statistically significant difference was present between disease severity and gender, age, personal and family history of autoimmune disease in the adult and paediatric group (P > 0.5). Thirteen adults with scalp involvement had nail changes. 61.5% had mild and 38.46% had severe disease (P > 0.5). Of the 43 paediatric patients, 10 patients had nail changes. Severe alopecia was present in 40% of patients with nail changes; however, 9.1% had severe alopecia in patients without nail changes (P = 0.04). There was no statistical significance in patients with and without familial autoimmune diseases when compared with pattern and severity of the diseases between the two groups. CONCLUSION: The frequencies of autoimmune and atopic diseases were not different between adult and paediatric patients and the control group. We did not find a statistically significance between disease severity and personal and family history of autoimmune disease in the two groups. Disease severity was not related to nail changes in the adult group. However, severe alopecia areata was more prevalent in children with nail changes. Furthermore, ophiasis pattern was more prevalent in the paediatric group with nail changes compared with the adult group.

Macrophage migration inhibitory factor in patients with vitiligo and relationship between duration and clinical type of disease.

BACKGROUND: Vitiligo is a disorder of pigmentation characterized by the presence of depigmented skin macules. Cellular immunity is known to have a role in the pathogenesis of vitiligo. Macrophage migration inhibitory factor (MIF) is a potent activator of macrophages and is considered to play an important role in cell-mediated immunity. AIMS: To determine serum level of MIF in patients with vitiligo and compare with healthy controls. We also aimed to determine whether there is a relationship between MIF levels and the disease duration, clinical vitiligo and involved body surface area (BSA) in patients with vitiligo. METHODS: The study group comprised 30 patients with vitiligo (14 men, 16 women) and 30 healthy controls, matched for age and gender. Blood samples were taken for MIF analysis. RESULTS: The mean serum level of MIF in patients with vitiligo (40.83 +/- 31.66 pg/mL) was significantly higher than that of the control group (21.00 +/- 6.48 pg/mL) (P = 0.002). There was a positive correlation between disease duration and MIF levels (r = 0.601, P < 0.001). Mean MIF level of patients with acral and acrofacial vitiligo (n = 6) was 48.25 +/- 32.02 pg/mL, and of patients generalized vitiligo (n = 18) was 44.46 +/- 35.25 pg/mL. There was no significant difference between these two groups (P > 0.05). However there was a significant difference in MIF levels between patients with localized (20.41 +/- 5.23, n = 5) and acral-acrofacial (P = 0.02) vitiligo and those with generalized (P = 0.006) vitiligo. There was no relationship between BSA and MIF levels. CONCLUSIONS: Mean serum MIF level of patients with vitiligo was higher than that of controls, indicating that MIF has a role in the pathogenesis of vitiligo.

Hearing loss in patients with Behçet's disease: an audiological and transient evoked otoacoustic emission study.

OBJECTIVE: To investigate hearing loss in patients with Behçet's disease. MATERIALS AND METHODS: Twenty-four consecutive cases of Behçet's disease and 24 sex- and age-matched controls were included in this study. Pure tone and high frequency audiometric tests were performed and pure tone average hearing thresholds calculated for both groups. Transient evoked otoacoustic emission testing was also performed. RESULTS: Pure tone audiometry showed a sensorineural hearing loss in 15 of the Behçet's disease ears. Hearing thresholds were significantly higher in the study group than in the control group, on both pure tone frequency (except 0.5 kHz) and high frequency audiometry. Significant reductions in transient evoked otoacoustic emission amplitude were found at 1.4 and 2 kHz in the Behçet's disease patients. There were no significant differences in reproducibility, stimulus intensity or stability, comparing the Behçet's disease patients and controls. CONCLUSION: Significantly lower mid-frequency amplitudes were found in Behçet's patients on transient evoked otoacoustic emission testing.

Effect of graft type on postoperative liver function recovery in living liver donors.

BACKGROUND: Donor safety is the primary focus in living-donor liver transplantation. Although, the procedure carries a significant risk of morbidity and even death, the use of marginal living donors is a current issue of discussion. PATIENTS AND METHODS: Between September 2001 and October 2008, we performed 203 liver transplantation procedures using organs from living donors. Of 203 donors, 115 were men and 88 were women, with a mean (SD; range) age of 34.5 (9; 19-66) years. One hundred fifty donors were first-degree relatives of the recipients, 36 were second-degree relatives, and 17 were spouses. We did not accept grafts with remnant volume less than 40% or from donors with impaired liver function. We performed 96 right-lobe 38 left-lobe, and 69 left-lateral segmentectomies. For the right-lobe grafts, the median hepatic vein was always left in the remnant liver. The mean ratios of remnant to total donor liver volume were 42.0%, 66.8%, and 74.6% for the right-, left-, and left lateral segmentectomies, respectively. Mean hospitalization time was 7.0, 6.2, and 9.7 days, respectively. Mean operative time was 330, 324, and 324 minutes, respectively. Only 15 donors (7.8%) received autologous blood transfusions during surgery. Liver function tests including alanine aminotransferase, aspartate aminotransferase and bilirubin concentrations and prothrombin time were assessed postoperative days 1, 3, and 5 at outpatient follow-up, usually at week 3. RESULTS: There were no deaths; however, 26 complications occurred in 20 of 203 donors (5.2%), most of which were treated with radiologic interventions. CONCLUSION: Larger grafts produce impaired function in the early postoperative period; however, they do not have a negative effect in the long term. The remnant volume should be measured fastidiously, and surgeons must avoid taking large volumes of liver, especially in right-lobe donors.

Liver transplantation in management of alveolar echinococcosis: two case reports.

Hepatic alveolar echinococcosis is an infectious disease caused by the larval stage of Echinococcus multilocularis, which grows primarily in the liver of an infected person and develops as a tumorlike lesion. In advanced cases, the organisms infiltrate every organ neighboring the liver and spread hematogenously to distant organs such as lungs and brain. Surgical resection and liver transplantation are accepted treatment options for early and advanced disease, respectively. Herein, we present case reports of 2 patients with advanced alveolar echinococcal disease that invaded both lobes of the liver and neighboring vital structures including the inferior vena cava. Despite the technical difficulty of the surgery, both patients were successfully treated with living donor liver transplantation. Liver transplantation should be accepted as a life-saving treatment of choice in patients with alveolar echinococcosis for whom there is no other medical or surgical treatment options.

Is androgenetic alopecia a risk for atherosclerosis?

BACKGROUND: Several studies have demonstrated the presence of an association between androgenetic alopecia (AGA) and cardiovascular disease. The aim of this study was to evaluate subclinical atherosclerosis in patients with AGA and healthy controls by the incorporation of carotid intima-media thickness (IMT) and high-sensitive C-reactive protein (hs-CRP) along with echocardiography (ECHO) and exercise electrocardiography (ExECG). METHODS: We performed a case-control study in 50 male patients with AGA and 31 age-matched healthy male controls with normal hair status. Both the AGA patients and controls with a history of diabetes mellitus, cigarette smoking, hypertension, cardiovascular or cerebrovascular disease, and renal failure were excluded. AGA was classified according to the Hamilton-Norwood scale. Serum lipids, serum hs-CRP, total testosterone, and dehydroepiandrosterone sulphate were examined in all study subjects. Carotid ultrasonography was used to measure the IMT of the common carotid arteries (CCA). ECHO and ExECG were performed in all subjects. RESULTS: IMT of the CCA was found to be significantly higher in patients with severe vertex pattern AGA when compared to patients with other patterns of AGA and healthy controls (P < 0.05). Hs-CRP in patients with any group of AGA was not significantly different from those healthy controls (P > 0.05). ECHO showed that cardiac structural and functional measures were in normal ranges. ExECG was also normal in all subjects. CONCLUSION: Severe vertex pattern AGA should be considered to have an increased risk of subclinical atherosclerosis. For this reason, CCA IMT measurement can be recommended as a non-invasive and early diagnostic method.

Liver transplantation in patients with hepatocellular carcinoma: one center's experience.

Hepatocellular carcinoma (HCC), which worldwide is the fifth most common malignancy in men and the ninth most common malignancy in women, accounts for 6% of all malignant lesions. We evaluated our results of liver transplantation for patients with HCC. Between January 2004 and April 2007, 31 patients (5 females, 26 males; age range, 1.1-65 years) with preoperatively or incidentally diagnosed HCC underwent orthotopic liver transplantation (OLT) at our center. Eleven grafts were from deceased donors, and 20 from living-related donors. Inclusion criteria were no invasion of a major vascular structure and no evidence of extrahepatic disease. In 17 patients, tumors exceeded the Milan criteria. According to the tumor-node-metastasis staging system, 6 patients had stage 1, 8 had stage II, 2 had stage III, and 15 had stage 4A carcinoma. Three complications occurred in 31 patients: hepatic arterial thrombosis in 1 patient and biliary leakage in 2. At a mean follow-up of 24.3 +/- 12.5 months, 29 patients are well with excellent graft function. Two patients died at 23 and 17 months after OLT respectively. The longest graft survival is 43 months. There have been 4 tumor recurrences, namely, at 4, 26, 24, and 29 months after OLT, respectively. Patient and disease-free survival rates are 93.5% and 90%, respectively. In conclusion, OLT provided long-term disease-free survival for patients with HCC, even those with locally advanced tumors who had no effective alternative treatment than transplantation.

Postsurgical complications in living-related liver donors.

From September 2001 until March 2007, we performed 127 living-donor liver transplantations in our transplantation center. Of 127 donors, 74 were men and 53 women, of overall mean donor age of 35.2 +/- 9.3 years (range, 20-56 years). Ninety-six (75.6%) were first-degree relatives, 18 (14.1%) were second-degree relatives, and 13 (10.3%) were spouses. We performed 34 (26.7%) left hepatic lobectomies, 33 (25.3%) left lateral segmentectomies, and 60 (48%) right hepatic lobectomies. The mean percentages of remnant to donor total liver volume for the right, left, and left-lateral lobectomies were 41.7%, 67.8%, and 75.1%, respectively. The mean length of patient postoperative hospital stay was 7.4 +/- 3.1 days (range, 3-33 days). There was no postoperative mortality. Ten complications occurred in 7 of the 127 donors (5.5%). Most complications were treated with radiologic interventions. In conclusion, donor safety should be the primary focus in living-donor liver transplantation. More experience, improved surgical techniques, and meticulous donor evaluation will help to minimize morbidity and mortality for living liver donors.

Clinical course of hepatitis C virus infection in renal transplant recipients.

UNLABELLED: Patients with end-stage renal disease are at high risk for exposure to hepatitis C virus (HCV) infection. Although both viral replication and liver disease progression are accelerated after renal transplantation, the long-term impact of chronic HCV infection is unclear. Our aim was to analyze the course of HCV infection in renal transplant recipients and the effects of HCV reactivation on patient and graft survival. METHODS: We retrospectively examined the 21-year (1985-2006) data of 1274 renal transplant recipients, 43 of whom were anti-HCV positive at the time of transplantation. RESULTS: The mean posttransplant follow-up of 43 patients was 62.0 +/- 7.3 months. At the time of transplantation, HCV RNA was positive in 11 (25.6%) patients and negative in 32 (74.4%) patients. HCV reactivation was seen in 19 (45.2%) patients at a mean time of 20.8 +/- 5.7 months. In 31 (72%) patients, acute rejection occurred, whereas graft loss occurred in 10 (23%) patients. Three (7%) patients died. Among 43 patients, 22 (51.2%) were treated with interferon before transplantation. There was a statistically significant association between pretransplant interferon therapy and pretransplant HCVRNA level (P=.024), but no significant association of HCV reactivation and graft rejection, mortality, or kidney survival. CONCLUSION: HCV reactivation occurred in nearly half of the renal transplant recipients, mostly in the second year. Patient survival and graft survival were not affected by HCV reactivation. Anti-HCV positivity should not preclude chronic renal failure patients from renal transplantation.

Right lobe adult living-donor liver transplantation.

Living-donor liver transplantation is another treatment option to cadaveric liver transplantation in adult recipients. We report the outcomes of 49 right lobe adult living-donor liver transplantations performed at our institution between April 2003 and June 2006. The mean age of the recipients was 41.7 +/- 12.5 years. The median graft-to-recipient weight ratio was 1.2% +/- 0.4%. In recipients, the mean operative time was 10.6 +/- 2.7 hours. The mean number of blood transfusions administered was 4.1 +/- 5.1 units. The mean time spent in the intensive care unit was 2.3 +/- 1.5 days. In recipients, five vascular and five biliary complications occurred during the early postoperative period, and four vascular and two biliary complications developed in the late postoperative period. Thirteen of the 49 recipients died within 4 months of surgery. The mean age of the donors was 36.6 +/- 9 years. In the donors, the mean operative time was 6.4 +/- 1.6 hours, mean residual liver volume was 43.3% +/- 6.1%, and the mean hospital stay was 9.5 +/- 4.5 days. Two donors required an intraoperative blood transfusion. None of our donors died, but six complications occurred in four donors. The mean postoperative follow-up was 13.4 +/- 9.6 months. In conclusion, in Turkey, as in other countries, organ demand exceeds organ availability. Graft size presents a problem for adult recipients, but right lobe living donor transplant may be a life-saving option for these recipients when performed by experienced surgical teams.

Living-donor liver transplantation: results of a single center.

In the absence of cadaveric donor liver transplantation, living-donor liver transplantation (LDLT) is an alternative option for patients with end-stage liver disease. The objective of this study was to evaluate the outcome of LDLT at a single medical center in Turkey. We retrospectively analyzed the results of 101 LDLTs in 99 recipients with end-stage liver disease. We transplanted 49 right liver lobes, 16 left lobes, and 36 hepatic segments II and III. Most donors (46%) were parents of the recipients. Seventeen recipients had concomitant hepatocellular carcinoma and cirrhosis. Retransplantation was performed in two recipients. Ten hepatic arterial thromboses, 1 hepatic arterial bleeding, and 12 biliary leaks occurred in the early postoperative period. Most complications were treated with interventional techniques. Three hepatic vein stenoses, three portal vein stenoses, one hepatic arterial stenosis, and six biliary stenoses developed during the late postoperative period. Recipients with those complications were treated with interventional techniques. Mean follow-up was 14.2 +/- 10.9 months. During that time, no tumor recurrence was detected in any recipient with hepatocellular carcinoma. Twenty-two recipients died during the follow-up. At this time, the remaining 77 recipients (77%) are alive, exhibiting good graft function. In general, complication rates are slightly higher after LDLT than after cadaveric liver transplantation. However, most complications can be treated with interventional techniques. LDLT continues to be a life-saving option in countries without satisfactory cadaveric donation rates.

Liver transplantation for small babies.

Orthotopic liver transplantation remains a major medical and surgical challenge in small pediatric patients. From April 2003 to June 2006, 21 small babies (each of whom weighed less than 10 kg or was younger than 1 year of age) underwent orthotopic liver transplantation. Five were girls and 16 were boys with a mean age of 15.7 +/- 9.3 months (range, 2-24 months); their mean weight at the time of transplantation was 9.8 +/- 3.6 kg (range, 6-16 kg). All transplants were obtained from a living-related donor. Left lateral segment was used for all transplantations. The median graft-to-recipient weight ratio was 3.5% +/- 1.2% (range, 1.5%-6.1%). During the early postoperative period, hepatic arterial thrombosis was identified in 4 patients, and a biliary leak was detected in 2 patients. In 2 patients, portal vein stenosis was identified during the late postoperative period. At the time of this writing, the 17 alive patients (81%) exhibited good graft function at median follow-up of 14.8 +/- 10.9 months (range, 1-39 months). Four patients died during the follow-up. Histological examination revealed hepatocellular carcinoma in 2 patients, and Burkitt's lymphoma in 1 patient. In conclusion, our data confirmed that living-related donors, especially in this age group, provide a reliable source for the organ pool. Satisfactory results can be achieved despite the anatomic handicaps of this age group.

Nosocomial urinary tract infections: micro-organisms, antibiotic sensitivities and risk factors.

OBJECTIVE: Although urinary tract infections (UTIs) are the most common hospital-acquired infections, the epidemiology of these UTIs is not well defined in Turkey. The aim of this surveillance study was to determine micro-organisms responsible for UTI, their antibiotic sensitivities and to describe the incidence and risk factors of nosocomial urinary tract infections (NUTI). SUBJECTS AND METHODS: This was a prospective surveillance study including cases of NUTI in intensive care units and various inpatient clinics. This study was carried out between November 2000 and January 2002. The following information was recorded: patients' age, gender, type of infection (hospital-acquired), presence of urinary catheter, intensive care unit admission, duration of hospital stay, type of organisms isolated and their antimicrobial susceptibility. The diagnosis of NUTI was based on criteria established by the Centers for Disease Control, Atlanta. Mini Api and conventional culture methods were used to determine the causative agents. The agents were isolated on eosin methylene blue agar and 5% sheep blood agar Statistical analyses of data were by chi-square test and logistic regression. RESULTS: In this study, 618 (2.1%) nosocomial infections (NIs) were determined in 29,778 patients, and 178 of these infections were NUTI (28.8%, 178/618). The mean age of NUTI patients was 61.0 +/- 19.4 years (0-91 years) and 82 NUTI patients (46.1%) were male and 96 (53.9%) were female. The most frequently isolated micro-organism was Escherichia coli (31.4%) followed by Candida spp (21.3%), Klebsiella spp (10.6%) and Enterococcus spp (6.9%). Compared to the rate of other NIs, the rate of NUTI increased by 1.011 times per year of age, by 2.052 times in females and by 3.83 times in patients with urinary catheters (p < 0.05). The most effective antibiotics against Gram-negative bacteria were found to be imipenem and meropenem. CONCLUSIONS: Important factors to prevent NUTI are to avoid unnecessary urethral catheterization, to choose narrow spectrum antibiotics according to antibiotic sensitivities, to investigate regularly the causative micro-organisms and their resistance patterns and to update the treatment protocols.

Nosocomial urinary tract infections: micro-organisms, antibiotic sensitivities and risk factors / Infecciones nosocomiales del tracto urinario: microorganismos, sensibilidades antibióticas y factores de riesgo

OBJECTIVE: Although urinary tract infections (UTIs) are the most common hospital-acquired infections, the epidemiology of these UTIs is not well defined in Turkey. The aim of this surveillance study was to determine micro-organisms responsible for UTI, their antibiotic sensitivities and to describe the incidence and risk factors of nosocomial urinary tract infections (NUTI). SUBJECTS AND METHODS: This was a prospective surveillance study including cases of NUTI in intensive care units and various inpatient clinics. This study was carried out between November 2000 and January 2002. The following information was recorded: patients' age, gender, type of infection (hospital-acquired), presence of urinary catheter, intensive care unit admission, duration of hospital stay, type of organisms isolated and their antimicrobial susceptibility. The diagnosis of NUTI was based on criteria established by the Centers for Disease Control, Atlanta. Mini Api and conventional culture methods were used to determine the causative agents. The agents were isolated on eosin methylene blue agar and 5sheep blood agar Statistical analyses of data were by chi-square test and logistic regression. RESULTS: In this study, 618 (2.1) nosocomial infections (NIs) were determined in 29,778 patients, and 178 of these infections were NUTI (28.8, 178/618). The mean age of NUTI patients was 61.0 +/- 19.4 years (0-91 years) and 82 NUTI patients (46.1) were male and 96 (53.9) were female. The most frequently isolated micro-organism was Escherichia coli (31.4) followed by Candida spp (21.3), Klebsiella spp (10.6) and Enterococcus spp (6.9). Compared to the rate of other NIs, the rate of NUTI increased by 1.011 times per year of age, by 2.052 times in females and by 3.83 times in patients with urinary catheters (p < 0.05). The most effective antibiotics against Gram-negative bacteria were found to be imipenem and meropenem. CONCLUSIONS: Important factors to prevent NUTI are to avoid unneces...

OBJETIVO: Aunque las infecciones del tracto urinario (ITU) son las que con mayor frecuencia se adquieren en los hospitales, su epidemiología no se halla bien definida en Turquía. El objetivo de este estudio de vigilancia fue determinar los microorganismos responsables de la ITU, sus sensibilidades antibióticas, y describir la incidencia y los factores de riesgo de las infecciones del tracto urinario nosocomiales (ITUN). SUJEITOS Y MÉTODOS: Este fue un estudio prospectivo de vigilancia que incluyó casos de ITUN en unidades de cuidados intensivos y en varias clínicas de ingreso. El estudio se llevó a cabo entre noviembre de 2000 y enero de 2002. Se registró la siguiente información: edad del paciente, sexo, tipo de infección (adquirida en el hospital), presencia de catéter urinario, ingreso a la unidad de cuidados intensivos, duración de la estadía hospitalaria, y el tipo de organismo aislado así como su susceptibilidad antimicrobiana. El diagnóstico de ITUN se basó en criterios establecidos por los Centros de Control de Enfermedades, Atlanta. El sistema Mini Api y métodos de cultivo convencionales fueron usados con el propósito de determinar los agentes causantes. Los agentes causantes fueron aislados sobre agar-eosina-azul de metileno y agar sangre de oveja a 5%. El análisis estadístico de los datos se realizó usando la prueba de chi-cuadrado y regresión logística. RESULTS: En este estudio, se determinaron 618 (2.1%) infecciones nosocomiales (IN) en 29 778 pacien-tes, y 178 de estas infecciones resultaron ser INTU (28.8%, 178/618). La edad media de los pacientes de INTU fue 61.0 B1 19.4 años (0–91 años) y 82 pacientes de INTU (46.1%) fueron varones y 96 (53.9%) fueron hembras. El micro-organismo más frecuentemente aislado fue Escherichia coli (31.4%), seguido por Candida spp (21.3%), Klebsiella spp (10.6%) y Enterococcus spp (6.9%). En comparación con la tasa de otras IN, la tasa de INTU aumentó 1.011 veces por año de edad, 2.052 veces en las...