Clinical aspects and risk factors of nosocomial Stenotrophomonas maltophilia bacteremia episodes in a Turkish intensive care unit.

Stenotrophomonas maltophilia is an important nosocomial pathogen with increasing frequency in recent years, especially in immunocompromised and clinically debilitated patients. The aim of this study is to describe the characteristics of 35 episodes of S. maltophilia bacteremia at Celal Bayar University hospital in Turkey over a 3-year period from January 2003 to December 2005. Cases were identified with microbiology laboratory records and clinical data were collected from the medical record of each patient. The source of bacteremia was central venous catheter (CVC) in 65.7% (23) and respiratory tract infection in 2.9% (1) of episodes while the source of bacteremia was unknown in 11 (31.4%) episodes of bacteremia. Factors significantly associated with mortality were age of > or =65 years, APACHE score of > or =16, the presence of the total parenteral nutrition, anemia, low creatinine clearance level and shock. The most sensitive antibiotic was found as trimethoprim-sulfamethoxazole (91.4%) in antibiotic susceptibility testing of the isolates. Susceptibilities of piperacillin-tazobactam and netilmicin which frequently used antibiotics as an empirical therapy were 62.8% and 68.6%, respectively.

Maternal carriage and antimicrobial resistance profile of group B Streptococcus.

BACKGROUND: The aim of this study was to determine the prevalence of group B Streptococcus (GBS) colonization and to evaluate the antimicrobial resistance profile in women in the third trimester of pregnancy. MATERIALS AND METHODS: A total of 310 pregnant women, referred in weeks 35 to 37 of gestation, were screened for GBS colonization during a 10-month period. Samples were collected from the vagina and the rectum. RESULTS: The colonization rate was 10.6% and 22 women (66.7%) had both positive vaginal and rectal cultures. Rates of GBS colonization were significantly lower in patients aged 24 years or older and in those with a third or later pregnancy. None of the isolates were resistant to penicillin and ampicillin, whereas 21.2% and 9.1% showed resistance to erythromycin and clindamycin, respectively. CONCLUSION: Screening and antimicrobial susceptibility testing of GBS during pregnancy are important to guide appropriate therapy.

Investigation of synergism of meropenem and ciprofloxacin against Pseudomonas aeruginosa and Acinetobacter strains isolated from intensive care unit infections.

The aim of this study was to determine synergistic effects of meropenem and ciprofloxacin against Pseudomonas aeruginosa and Acinetobacter strains isolated from intensive care unit (ICU) infections. A total of 18 P. aeruginosa and 17 Acinetobacter strains were tested. MICs were determined using the broth microdilution method. The synergy of meropenem and ciprofloxacin was investigated in glass tubes using time-kill methodology. The synergistic effect of meropenem and ciprofloxacin in combination was found to be 22% at 0.5 x the MIC and 61% at 1 x the MIC in P. aeruginosa strains. Two strains (11%) showed synergy at both 0.5 and 1 x the MIC. Of the 18 P. aeruginosa strains, 1 strain (6%) did not show a synergistic effect at either 0.5 or 1 x the MIC. In Acinetobacter strains, the synergistic effect of meropenem and ciprofloxacin in combination was found to be 29% at 0.5 x the MIC and 18% at 1 x the MIC. One strain (6%) showed synergy at both 0.5 and 1 x the MIC. Of the 17 Acinetobacter strains, 8 strains (47%) did not show a synergistic effect at either 0.5 or 1 x the MIC. According to the results of this study, the combination of meropenem and ciprofloxacin is more effective than either antibiotic alone in ICU infections due to P. aeruginosa strains.

Evaluation of rational antibiotic use.

The emergence of antibiotic resistant bacteria is a major problem throughout the world and a rational use of antibiotics is therefore very important. This study was performed to estimate the appropriateness of antimicrobial drug use in Celal Bayar University Hospital in Manisa. The data of all inpatients (n=937) between October and December 1998 were collected according to the Kunin and Jones criteria. Of the patients, 16.6% (n=156) were receiving antibiotics, and in 63.5, 23.0 and 13.5% of these, a single, two and three agents were used, respectively. The purpose of antibiotic use was for prophylaxis in 23.9%, as an empiric decision in 71.4% and for therapeutic culture-based reasons in 4.7%. The rate of rational antibiotic use was 45.7% and it was statistically higher in those patients from whom specimens had been taken for culture than in patients receiving prophylactic or empiric antibiotics. On medical wards, rational antibiotic usage was 55.1%, while it was 26.3% in surgical wards (P<0.0001). The low rate of appropriate antibiotic use in our university hospital reflects the urgent need of rationalization.

Granulomatous hepatitis following intravesical bacillus Calmette-Guerin therapy.

Although intravesical bacillus Calmette-Guerin (BCG) administration is an effective method in the treatment of superficial urinary bladder carcinoma, some complications may arise such as a granulomatous reaction either in the urinary tract or, in rare cases, outside the urinary tract. We report in this paper a case of granulomatous hepatitis following intravesical BCG administration.