Antimicrobial resistance in gram-negative hospital isolates: results of the Turkish HITIT-2 Surveillance Study of 2007.

Resistance rates to amikacin, ciprofloxacin, ceftazidime, cefepime, imipenem, cefoperazone/sulbactam and piperacillin/tazobactam in Escherichia coli (n= 438), Klebsiella pneumoniae (n= 444), Pseudomonas aeruginosa (n= 210) and Acinetobacter baumanni (n=200) were determined with e-test in a multicenter surveillance study (Hitit-2) in 2007. ESBL production in Escherichia coli and K. pneumoniae was investigated following the CLSI guidelines. Overall 42.0% of E.coli and 41.4% of K. pneumoniae were ESBL producers. In E. coli , resistance to imipenem was not observed, resistance to ciprofloxacin and amikacin was 58.0% and 5.5% respectively. In K. pneumoniae resistance to imipenem, ciprofloxacin and amikacin was 3.1%, 17.8% 12.4% respectively. In P. aeruginosa the lowest rate of resistance was observed with piperacillin/tazobactam (18.1%). A. baumanni isolates were highly resistant to all the antimicrobial agents, the lowest level of resistance was observed against cefoperazone/sulbactam (52.0%) followed by imipenem (55.5%). this study showed that resistance rates to antimicrobials are high in nosocomial isolates and show variations among the centers.

An outbreak of oropharyngeal tularaemia linked to natural spring water.

A tularaemia outbreak was investigated involving 188 suspected cases in the Kocaeli region of Turkey between December 2004 and April 2005. A case-control study comprising 135 laboratory-confirmed cases and 55 controls was undertaken to identify risk factors for the development of the outbreak and to evaluate laboratory diagnostic methods. Tularaemia was confirmed by a microagglutination test (MAT) titre of >or=1 : 160 in 90 of the patients. In MAT-negative sera, 23/44 (52 %) were positive by ELISA with Francisella tularensis LPS and 1/9 (11 %) by Western blotting with this antigen. A species-specific PCR was positive in 16/25 (64 %) throat swabs and 8/13 (62 %) lymph node aspirates. Multivariate analysis showed that drinking natural spring water was the leading risk factor for the development of tularaemia (P=0.0001, odds ratio 0.165, 95 % CI 0.790-0.346). The outbreak ceased after abandonment of the suspected natural water springs.

Antimicrobial resistance patterns and serotype distribution among Salmonella enterica strains in Turkey, 2000-2002.

Since Turkey currently lacks a national reference center for Salmonella infections, the present study was conducted to document the distribution of serotypes and antimicrobial resistance patterns among Salmonella enterica isolates recovered from clinical samples in ten Turkish provinces over a 2-year period. Among the 620 Salmonella enterica isolates recovered between 1 July 2000 and 30 June 2002, strains belonging to the serotypes Enteritidis (47.7%), Typhimurium (34.7%), Paratyphi B (6.0%), Typhi (2.9%), Paratyphi A (0.2%) and serogroup C (8.5%) were found. Resistance to multiple antimicrobial agents was particularly high among Salmonella Typhimurium isolates (76.7%), and resistance or decreased susceptibility to ciprofloxacin (MIC> or =0.125 mg/l) was demonstrated in Salmonella Paratyphi B, Salmonella Typhimurium and Salmonella Enteritidis strains. All of the Salmonella Typhi isolates were susceptible to ciprofloxacin. The results indicate that decreased susceptibility to ciprofloxacin is an emerging problem in Salmonella enterica in Turkey, particularly in multiresistant strains.

Tularemia in Bursa, Turkey: 205 cases in ten years.

Tularemia is a zoonotic disease caused by the coccobacillus F. tularensis. Small epidemics and sporadic cases were seen around Bursa since November 1988. In this study, a total of 205 cases of tularemia were observed. All the cases were diagnosed on clinical, bacteriological and serological grounds. The epidemics were thought to be waterborne. The majority of the patients were young and female. In most of the cases the disease presented itself in oropharyngeal form (83%). Analysing sera from the patients with microagglutination method demonstrated that titers were > or = 1:160 in approximately 85% of the cases, including the ones in subclinical form. Five of ten patients from who the bacteria was isolated were seronegative. Streptomycin was given to the most of the patients by combining with tetracycline, doxycycline or chloramphenicol. The early administration of these antibiotics (before the third week of disease) was found to be much more effective to resolve the infection. As a result, the main mode of transmission of F. tularensis is waterborne in our region. In our region, tularemia should be considered in differential diagnosis for the cases with fever, tonsillopharyngitis and cervical lymphadenopathy to make an early diagnosis and to design relevant treatment.

Influences of alternate therapy protocol and continuous infectious disease consultation on antibiotic susceptibility in ICU.

In this study, the effects of alternate use of imipenem and cefoperazone/sulbactam(CFP/Sul) on antibiotic resistance in the intensive care unit (ICU) were investigated. Between 1 April 1993 and 1 April 1994, the infectious diseases consultant saw patients when required and there was no alternative therapy for antibiotics. For the following 2 years, the same consultant followed up each patient from admission to discharge by daily visits to the ICU and an alternative therapy protocol was initiated. The most common microorganisms were found to be Acinetobacter baumannii and Staphylococcus aureus, followed by Pseudomonas aeruginosa and Klebsiella pneumoniae, respectively, in the two periods. This study demonstrated that sensitivity rates of imipenem, ciprofloxacin and aminoglycosides were improved as a result of this protocol.

Detection of Brucella melitensis by BACTEC NR 730 and BACTEC 9120 systems.

In many parts of the world, brucellosis has significantly decreased, but it is still a problem in some regions of Turkey. In our laboratory we have isolated 58 Brucella spp. through BACTEC NR 730 and 30 Brucella spp. through BACTEC 9120 systems. 31 of the 58 isolates were detected by BACTEC NR 730 system in 72 hours. The majority of the growth values were between 45-65. BACTEC 9120 system detected all the isolates in 84 hours.

Effect of CO2 pneumoperitoneum on bacteremia in experimental peritonitis.

Bacteria transfer to the blood from the peritoneum is thought to be augmented when the diaphragmatic stomata are activated by an increased intra-abdominal pressure. Therefore, it may be expected that the increase in intra-abdominal pressure during laparoscopic surgery can augment the absorption of bacteria from the peritoneum to the blood. The present study examines the effect of pneumoperitoneum on bacteremia in experimental Escherichia coli peritonitis in rabbits. Twenty-four rabbits were divided into three groups. 10(9) colony forming units of E. coli were inoculated intraperitoneally into group 1 (n = 8). Group 2 (n = 8) received an identical bacterial inoculum and underwent a midline laparotomy at the 2nd hour. Group 3 (n = 8) also had an identical bacterial inoculum which was followed by 15 mm Hg CO2 pneumoperitoneum for 1 h at the 2nd hour. In all groups, the growth value (GV) was measured in the 3rd- and 6th-hour blood cultures using the Bactec NR 730 system. There was no difference in the 3rd- and 6th-hour GVs (p > 0.05) among the three groups. In conclusion, pneumoperitoneum with 15 mm Hg CO2 in experimental E. coli peritonitis did not increase the bacteremia when compared with the control and laparotomy groups.

[Salmonella typhimurium in food-producing animals in Bursa]. / Bursa yöresinde besi hayvanlarinda Salmonella typhimurium arastirmasi.

Role of food-producing animals in Salmonella typhimurium infections was investigated in this study. Salmonella typhimurium antibodies with the ratios of 63.3% among the slaughter house staff and 78.1% in the animals slaughtered were established. Multiresistant Salmonella typhimurium bacteria was isolated in the faecal cultures of 3 among 301 animals.

[A serological study of Yersinia enterocolitica]. / Yersinia enterocolitica ile serolojik bir çalisma.

In this study, the incidence of Yersinia enterocolitica was investigated at neighbourhood of Bursa and 13.26 percentage seropositivity was determined.

[Salmonella typhimurium infections in the area of Bursa]. / Salmonella typhimurium enfeksiyonlarinin Bursa yöresindeki durumu.

Salmonella typhimurium infections encountered at the neighbourhood of Bursa since January 1987 were evaluated in regard to the antibiotic resistance and treatment. High proportion of resistance was determined to the antibacterial agents such as ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, tetracycline and more sensitivity to ofloxacin, amikacin, ceftriaxone and cefotaxime was established in 383 Salmonella typhimurium strains isolated within two years of period. No antibiotic therapy was required to adult uncomplicated patients. A combination therapy with cefotaxime and amikacin was found to be satisfactory in the newborn cases with septicemia.

[Immunotoxins]. / Immünotoksinler.

An immunologic approach besides surgical, radiotherapeutic, chemotherapeutic methods in the treatment of cancer was proposed for the first time by Paul Ehrlich in 1906. The structure, produced by conjugating the antibodies against the tumor cells with a toxin molecule by Moolten and Cooperband (1970) was named as Immunotoxins. Producing antibodies with the desired amount and purity was achieved by improving the Hybridoma technology, Immunotoxins were tried to be produced by conjugating the monoclonal antibodies with the different toxic agents. Removing the receptor binding region of the toxin molecule was demonstrated to be more effective although good results were obtained from the studies utilising the toxin of Corynebacterium diphtheriae. Toxin production with the desired amount and structure was accomplished by the improved genetic methods. Although in vivo applications of the immunotoxins are still limited, it is believed that they will be important therapeutic agents in the future.

[Distribution of Cryptococcus neoformans in pigeon feces]. / Cryptococcus neoformans'in güvercin diskilarindaki dagilimi.

C neoformans has been investigated in fecal droppings obtained from pigeon coops that placed in several suburbs of Bursa City. In sixteen of the 115 samples (13.9%), C neoformans strains has been isolated and studied their morphological and biochemical properties. But no isolation has been obtained from 8 soil samples and 14 samples of chicken dung.

[The distribution of clostridia in soil samples from Bursa]. / Bursa'da toprak örneklerinde Klostridium'larin dagilimi.

In the soil samples taken from different places of Bursa, distribution of the Clostridia were searched by anaerobic jar and immunofluorescence reaction (FAT). In our study, 122 bacteria belonging to 11 Clostridium species were isolated in 35 soil samples. These strains were identified by studying morphological and biochemical properties, lecithinase C and lipase activities, toxin neutralization characteristics. In addition, FAT were used for 4 Clostridium species.

[Bacterial evaluation of wound infections]. / Yara enfeksiyonlarinin bakteriyolojik olarak degerlendirilmesi.

Collected wound samples were received by Hospital Microbiology Laboratory were examined for bacterial isolation, their antibiotic susceptibility and distribution in terms of clinical departments were determined. S. aureus was found to be the major causative agent with the ratio of % 38.92. Wound infections were frequently encountered in the Pediatric department (% 43.83) and the isolated strains were found to be highly resistant to the most of the antibiotics.

[The incidence of intestinal helminths in Samsun district]. / Barsak helmintlerinin Samsun yöresinde dagilimi.

17954 stool specimens that were brought to the Microbiology department of Ondokuzmayis University were investigated in regard to the intestinal helminth eggs and the incidence was found to be 16% and 62% of them being Ascaris lumbricoides. The incidence of the intestinal helminth which was %21.08 in 1978 was found to be decreased to %10.45 in 1984.