Comparison of efficiency of intravitreal ceftazidime and intravitreal cefepime in the treatment of experimental Pseudomonas aeruginosa endophthalmitis.

In this study, we evaluated the efficiency of cefepime in the treatment of experimental Pseudomonas aeruginosa endophthalmitis. We compared the findings with the standard dose of ceftazidime (1 mg/0.1 ml). Thirty-six New-Zealand White rabbits were divided into 6 equal groups and were treated with different methods (Group 1 = sham, Group 2 = 0.5 mg/0.1 ml cefepime, Group 3 = 1 mg/0.1 ml cefepime, Group 4 = 2 mg/0.1 ml cefepime, Group 5 = 1 mg/0.1 ml ceftazidime, Group 6 = control). The eyes of rabbits in each group were examined clinically on 1 st , 3 rd , and 6 th day of the experiment. At 6 th day, 0.1 ml vitreous humor aspirates were obtained and plated for quantification on the blood agar and the results were expressed as colony-forming unit/ml. Subsequently, the eyeballs were enucleated and the histopathological evaluation was performed. Our findings denoted beneficial effects of cefepime in treatment groups (especially, in Groups 3 and 4). Intravitreal cefepime may be an alternative drug in the treatment of P. aeruginosa endophthalmitis.

Serotypes of Streptococcus pneumoniae isolates from children with invasive pneumococcal disease in Turkey: baseline evaluation of the introduction of the pneumococcal conjugate vaccine nationwide.

Before use of the pneumococcal conjugate vaccine PCV7 became widespread in Turkey, 202 invasive pneumococcus isolates were analyzed. The most common serotypes were 19F and 6B. In children ≤2 years of age, the potential coverage rate of PCV7 was 69.5%. The most frequent non-PCV7 serotypes were 19A, 3, 1, 6A, and 8.

Investigation of a nosocomial outbreak by alginate-producing pan-antibiotic-resistant Pseudomonas aeruginosa.

BACKGROUND: The nosocomial spread of pan-antibiotic-resistant nonfermentative bacteria is an increasing concern. This study investigated the microbiologic and epidemiologic characteristics of a hospital outbreak due to alginate-producing, pan-antibiotic-resistant Pseudomonas aeruginosa (PAR-Pa). METHODS: All patients with infection with a P. aeruginosa strain that was resistant to all Clinic Laboratory Standards Institute-suggested antimicrobial agents between November 2004 and May 2005 were included in the study. Alginate production detection and pulsed-field gel electrophoresis (PFGE) typing were done for the patient and environmental surveillance isolates. A matched case-control study was performed to identify risk factors and evaluate outcomes. RESULTS: PFGE analysis of a total of 35 PAR-Pa isolates (28 patient and 7 environmental surveillance isolates) identified a single epidemic clone as responsible for the outbreak. All epidemic isolates were alginate-producing and susceptible only to colistin. The Student t-test demonstrated that a longer stay in the intensive care unit (ICU) (6.64 days vs 1.83 days; P < .05) significantly increased the risk of PAR-Pa infection. Systemic PAR-Pa infection resulted in higher mortality (85.7% vs 27.8%; P < .05). Multivariate analysis determined that therapeutic failure (odds ratio = 24.7; 95% confidence interval = 4.144 to 147.221; P < .05) was the independent risk factor related to this high mortality. Localized PAR-Pa infections were associated with longer hospital stays (46.2% vs 14.4%; P < .05) and higher rates of surgery (85.7% vs 15.4%; P < .05) and amputation (42.8% vs 0%; P < .05). The recovery of the pathogen from staff hands and frequently handled surfaces suggests possible handborne transmission. Improved hygienic standards and application of strict contact precautions, including isolation, reduced the spread of the pathogen. CONCLUSION: This study illustrates the ability of pan-antibiotic-resistant P. aeruginosa to cause an outbreak with significant mortality and stresses the need for precautions to prevent the spread of such highly resistant strains.

Synthesis and antimicrobial activity of some novel derivatives of benzofuran: part 2. The synthesis and antimicrobial activity of some novel 1-(1-benzofuran-2-yl)-2-mesitylethanone derivatives.

The reaction of salicylaldehyde with 1-chloro-3-mesitylacetone (2) and potassium carbonate was used to prepare 1-(1-benzofuran-2-yl)-2-mesitylethanone (4) for the starting reagent purposes. 1-(1-Benzofuran-2-yl)-2-mesitylethanoneoxime (5) was synthesized by the reaction of the compound (4) with hydroxylamine. New derivative of 1-(1-benzofuran-2-yl)-2-mesitylethanoneoxime (5) as 1-(1-benzofuran-2-yl)-2-mesitylethanonesemicarbazone (7) was obtained in very high yields. Alkyl substituted N-oxime ethers (8a-d) were obtained by the reaction compound 5 and various halogen contained compounds. The compounds 9a-d were synthesized by the reaction of the compound (5) and four different acyl chlorides. Some of the synthesized compounds were tested for antimicrobial activity against Staphylococcus aureus ATCC 6538, Escherichia coli ATCC 25922 and Candida albicans ATCC 10231. Among the synthesized compounds (E)-1-(1-benzofuran-2-yl)-2-mesitylethanone-O-benzoyloxime (9b) was found the most active derivative against S. aureus ATCC 6538 and E. coli ATCC 25922. The other compounds exhibited moderate activity against the other test microorganisms.

[Investigation of intestinal parasites and ectoparasites in three primary school students in Elazig]. / Elazig'daki üç ilkögretim okulu ögrencilerinde ektoparazit ve bagirsak paraziti yayginliginin arastirilmasi.

The aim of this study was to investigate the prevalence of intestinal parasites and ectoparasites among the students of three primary schools of different socioeconomic levels in Elazig. At first, a total of 448 students who attend different schools were examined for ectoparasites and then stool and cellophane tapes were collected. Intestinal parasites were found in 119 (26%) of the specimens. The most common parasite was Enterobius vermicularis (8%), followed by Entamoeba coli (8%), Ascaris species and Trichuris species (3%). No scabies were detected in the students, and 23 (5%) of the students had lice.

Spot urine 5-hydroxyindoleacetic acid levels in the early diagnosis of acute appendicitis.

BACKGROUND/PURPOSE: The significance of spot urine 5-hydroxyindoleacetic acid (5-HIAA) levels in the early diagnosis of acute appendicitis (AA) is questioned. METHODS: Forty young, pigmented, male rabbits were divided into 4 groups. Groups are summarized as follows: group 1, control (n = 10); group 2, laparotomy, sham (n = 10); group 3, peritonitis with cecal ligation and puncture (n = 10); and group 4, experimental appendicitis (n = 10). Spot urine samples were obtained for 5-HIAA determination, and appendectomy materials were examined histopathologically and peritoneal fluid cultures were obtained after 12 hours in the study groups. The results were analyzed statistically with 1-way analysis of variance and Scheffé and Tukey's HSD tests. RESULTS: The mean 5-HIAA levels in the control group was 5.7 +/- 0.6 mg/L, whereas it is 5.9 +/- 0.9 mg/L, 6.6 +/- 0.6 mg/L, 9.4 +/- 0.9 mg/L in the sham, peritonitis, and appendicitis groups, respectively. The levels of 5-HIAA in the appendicitis group were higher than those in the other groups, which was statistically significant (P < .001). CONCLUSIONS: Spot urine 5-HIAA determination may be a practical, objective, and noninvasive method in the early diagnosis of AA. Because other radiological and laboratory tests can be insufficient, especially in the early period of AA, this test may be used effectively instead. Clinical studies are necessary for further conclusions.

Bacteriemia during mastoidectomy and/or tympanoplasty.

OBJECTIVE: To investigate the risk of bacteriemia development during surgery in patients who underwent mastoidectomy and/or tympanoplasty for chronic otitis media. PATIENTS AND METHODS: A total of 59 patients with chronic otitis media who were undergoing tympanoplasty operation with or without mastoidectomy were enrolled in this study. Smear cultures were obtained from outer ear canal and/or middle ears of all patients before the operation. Venous blood samples were obtained before and after the operation for bacteriologic analysis. Smear cultures were also obtained from the pressure dressing material that was applied during the operation for retrieval of the outer ear canal pressure. RESULTS: There was a 13.5% difference between the outer ear canal and/or middle ear smear cultures and ear pressure dressing smear cultures of the same case. There was no growth in the blood cultures obtained before tympanoplasty in any of the involved cases, however, in 5 (8.4%) of the culture samples obtained immediately after the tympanoplasty operation, there was bacteriemia. In the pressure dressing smear cultures obtained after the operation, 11 patients had microbial growth. CONCLUSION: Risk of bacteriemia should be considered in the preoperative period for the patients undergoing mastoidectomy especially in patients with cardiovascular diseases, this is of importance for the dramatic consequences that might arise after the operation. We also think that bacteriemia is also one of the factors that influences graft success rate.

In vitro activity of three different antimicrobial agents against ESBL producing Escherichia coli and Klebsiella pneumoniae blood isolates.

Extended spectrum beta-lactamases (ESBLs) usually associated with multiple drug resistance, including beta-lactam and non-beta-lactam antibiotics. This resistance can cause Limitation in the choice of drugs appropriate for using in clinical practice, especially in life-threatening infections. In this study we aimed to investigate in vitro activity of meropenem, ciprofloxacine and amikacin against ESBL-producing and non-producing blood isolates of Escherichia coli and Klebsiella pneumoniae strains. Fifty-eight E. coli (21 ESBL-producing, 37 non-ESBL producing) and 99 K. pneumoniae (54 ESBL-producing, 45 non-ESBL producing) strains were included in the study. The presence of ESBL was investigated by double disk synergy test and E-test methods. Antibiotic susceptibility test was done by microdilution method according to NCCLS guideline. In vitro susceptibilities of ESBL producing E. coli and K. pneumoniae strains were found as 100% for meropenem, 33.3% and 25.9% for ciprofloxacine, 94.5% and 83.3% for amikacin. It was observed that; meropenem was equally active agent in both ESBL-producing and non-producing strains, and its activity was not affected by ESBL production. Whereas amikacin activity was minimally affected and ciprofloxacine activity was markedly decreased by ESBL production. In conclusion, meropenem seems to be better choice of antibiotic should be used for ESBL positive life-threatening infections, because of remaining highest activity.

Spondylodiscitis developing after epidural catheter use by direct contamination.

Spondylodiscitis is a rare but serious complication of epidural catheter use. It is controversial as to which mechanism is responsible for development of this complication. It may develop due to direct contamination or hematogenous spreading. We report a 54-year-old woman who developed spondylodiscitis after epidural catheter was inserted and to whom analgesic and steroid treatment was given for chronic lumbar pain. In this case, each of 2 pathological mechanisms may be responsible. The diagnostic methods, mechanisms and management are discussed.

Detection of metallo beta-lactamase production and antibiotic resistance with E-test method in pseudomonas, acinetobacter and klebsiella strains, in Turkey.

The metallo beta-lactamase (MBL) mediated resistance patterns remain unknown in most countries. We aimed to investigate the existence and antimicrobial resistance of MBL-producing strains among carbapenem-resistant gram-negative bacteria that were isolated from nosocomial infections in patients in an university hospital in Turkey. Fifteen of 52 Pseudomonas aeruginosa strains (29%), 5 of 24 Acinetobacter baumanii strains (21%), and 2 of 2 Klebsiella pneumoniae strains (100%) were found to be metallo enzyme producers, with the Etest MBL technique. The in vitro antibiotic susceptibility of the MBL-positive organisms was investigated by the Etest method. Of the ten drugs tested, isepamicin was the most active agent against the MBL-producing strains. Overall, the rank order of activity of the ten antibiotics, in terms of the percentages of susceptible strains, was: isepamicin, 73%; ciprofloxacin, 64%; amikacin, 59%; aztreonam, 18%; tobramycin, 18%; meropenem, 14%; cefoperazone-sulbactam, 5%; piperacillin-tazobactam, 0%; ticarcillin-clavulanate, 0%; and cefepim, 0%. The meropenem minimum inhibitory concentrations (MICs) of the metallo enzyme-producing and nonproducing carbapenem-resistant strains were compared, and the MBL-producers were found to have higher meropenem MICs than the nonMBL-producing carbapenem-resistant strains. Early preventive measures should be taken against MBL-producing nosocomial pathogens that are associated with wide spread and high antimicrobial resistance.

Bacteriemia in septoplasty and septorhinoplasty surgery.

This study was conducted in an attempt to investigate whether bacteriemia developed in patients with septoplasty and septorhinoplasty in the postoperative period during which an anterior nasal pack was in their nose. Fifty-three patients who went through septoplasty or septorhinoplasty operations were followed in this study. Nasal smear cultures were obtained from all the subjects before the operation. After the packs were retrieved, smears were also obtained from the pack material. Venous blood samples were obtained from the patients immediately before the operation, after the operation and immediately following the retrieval of the pack. When preoperative nasal smear cultures and postoperative pack material cultures of the patients that were obtained at 48 hours were compared, it was seen that different microorganisms were present in 66% of the patients. Bacterial growth was not observed in any of the preoperative blood cultures; whereas 8 patients (15.0%) had bacteriemia in the blood samples obtained immediately after the operation and 9 (16.9%) had growth in the blood samples obtained following the retrieval of the pack. With these results we have seen that bacteriemia can develop in patients with septoplasty and septorhinoplasty. It did not cause serious clinical problems. However, in patients with cardiovascular problems, this possibility should be taken into consideration and relevant preoperative precautions should be implemented.