Antifungal and genotoxic effects of Thymus serpyllum as a root canal irrigant.

OBJECTIVES: The aim of this study was the assessment of the efficiency of the ethyl acetate (EthOAc) extract of Thymus serpyllum against Candida albicans and to compare it with sodium hypochlorite (NaOCl) and chlorhexidine (CHX), as well as their genotoxic effect. MATERIAL AND METHODS: The antifungal effectiveness of the EthOAc extract of Thymus serpyllum was determined using the agar disk diffusion method. The inhibition zones induced by the EthOAc extract were compared after 5 min, 60 min, and 24 h to those induced by standard solutions (2% CHX and 2% NaOCl). An in vitro genotoxicity assay was performed in cultured lymphocytes from the blood of human volunteers to observe micronuclei formation. Statistical analysis of the results was performed using the Kruskal-Wallis test and one-way analysis of variance. RESULTS: The inhibition zone of combination of CHX with EthOAc extract of Thymus serpyllum against C. albicans was 29.7 mm after 5 min, 28.3 mm after 60 min, and 29 mm after 24 h. The inhibition zone of NaOCl in combination with EthOAc extract of Thymus serpyllum against C. albicans was 0 mm. The EthOAc extract of Thymus serpyllum did not show a genotoxic effect on lymphocyte cells. CONCLUSIONS: The EthOAc extract of Thymus serpyllum in combination with CHX may be a useful root canal disinfection in endodontic therapy.

Antibacterial Effect of Matricaria chamomilla L. Extract Against Enterococcus faecalis.

Purpose: With the demand for better efficiency during endodontic therapy, the purpose of this in vitro study was to evaluate the efficiency of ethyl acetate (EthOAc) extract of Matricaria chamomilla (L.) against Enterococcus faecalis and compare with standard root canal irrigation solutions. Material and Methods: The antibacterial effect against Enterococcus faecalis of the EthOAc extract of Matricaria chamomilla was assessed without, or with dentine powder, using agar disk diffusion method. The inhibition zones induced by the EthOAc extract were observed after 5 minutes, 60 minutes, and 24 hours and compared with standard irrigation solutions (2% chlorhexidine and 2% sodium hypochlorite) without, or after mixing with dentine powder. Statistical analysis of the results were analysed with the Kruskal-Wallis test and one-way ANOVA. Results: There was no inhibition zone in samples with and without dentine powder after combination of ethyl acetate extract of Matricaria chamomilla with sodium hypochlorite. When the extract was used alone in samples without dentine powder, the inhibition zone was 9.7 mm after 24 h, but this zone was decreased after adding dentine powder (7.7 mm). When the extract was used in combination with CHX, the inhibition zone in samples with dentine powder was 25.3 mm, but it was decreased after adding dentine powder (21.7 mm). Conclusion: The EthOAc extract of Matricaria chamomilla as alternative root canal irrigant may be a useful natural agent with antibacterial activity against Enterococcus faecalis. Also, it showed promising results in endodontic therapy after combination with chlorhexidine in Enterococcus faecalis eradication.

Comparison of Sealing Abilities Among Zinc Oxide Eugenol Root-Canal Filling Cement, Antibacterial Bioceramic Paste, and Epoxy Resin, using Enterococcus faecalis as a Microbial Tracer.

BACKGROUND This study aimed to compare sealing abilities among 3 root canal sealers, using Enterococcus faecalis as a microbial tracer. MATERIAL AND METHODS Sixty-six straight single-rooted teeth were subjected to crown removal at the cementoenamel junction. Root canals were instrumented using the crown-down technique. Prepared teeth were randomly divided into 3 groups of 22 teeth each, according to the sealer used: Canason zinc oxide eugenol root-canal filling cement, Well-Root ST antibacterial bioceramic paste, and AH 26 epoxy resin. Root canals were obturated using the lateral condensation technique, then stored at 37°C and 100% humidity for 1 week to allow sealers to set completely. Subsequently, bacterial leakage was tested using a 2-chamber method. Twice weekly, fresh E. faecalis was placed into the coronal portion of the filled root canal. Specimens were monitored at 24-h intervals for 33 days. The number of leaking samples and mean interval until leakage were compared among groups. RESULTS The mean intervals until leakage were 5.8 days in the Canason group, 1.5 days in the Well-Root ST group, and 13.3 days in the AH 26 group. These mean intervals significantly differed between the Canason and Well-Root ST groups (P=0.035) and between the AH 26 and Well-Root ST groups (P=0.012). After 33 days, survival rates were 31.8% in the Canason group, 90.9% in the Well-Root ST group, and 68.2% in the AH 26 group (P.

Antifungal and Synergistic Effects of the Ethyl Acetate Extract of Tanacetum vulgare (L.) Against Candida albicans.

BACKGROUND With the continued demand for new, effective, and safe endodontic therapies, the aim of this study was assessment of efficiency of the ethyl acetate (EthOAc) extract of Tanacetum vulgare (L.) against Candida albicans. MATERIAL AND METHODS The antifungal effectiveness of the EthOAc extract of T. vulgare was determined using the agar disk diffusion method. The inhibition zones induced by the EthOAc extract were compared after 5 minutes, 60 minutes, and 24 hours to those induced by standard solutions (2% chlorhexidine, saturated calcium hydroxide, and 2% sodium hypochlorite). Statistical analysis of the results was performed using the Kruskal-Wallis test and one-way ANOVA. RESULTS The inhibition zone of chlorhexidine against C. albicans was 30.3-19.3 mm, but in combination with EthOAc extract (100 mg/mL) of T. vulgare, this inhibition was from 32.7-30 mm, indicating that this combination exerted a marked synergistic effect against C. albicans. The inhibition zone of sodium hypochlorite (69.7-65 mm) was higher than the inhibition zone of EthOAc extract and chlorhexidine. The combination of EthOAc extract with sodium hypochlorite resulted in a loss of antifungal activity. Furthermore, the activity of the EthOAc extract against C. albicans was decreased after mixing the extract with dentine at a concentration of 25 mg/50 µL (30.3-20.7 mm). The EthOAc extract did not show a genotoxic effect on lymphocyte cells. CONCLUSIONS The EthOAc extract of T. vulgare may be a useful tool to discover natural bioactive agents that have antifungal activity against C. albicans and could be used as endodontic therapies.

Drug resistance profile of Mycobacterium tuberculosis isolates from patients referred to tuberculosis reference laboratory in Kosovo.

BACKGROUND: Drug-resistant tuberculosis (TB) continues to threaten TB control and remains a major global public health concern. The poor patient adherence in TB treatment is the cornerstone of emerging multidrug-resistant TB (MDR-TB). The aim of this study was to evaluate the resistance of Mycobacterium tuberculosis to the first-line TB drugs among isolates from clinical specimens. METHODS: A laboratory-based study was conducted in the Department of Microbiology, within the National Institute of Public Health of Kosovo, from January 2017 to September 2018. Sputum and other clinical specimens were obtained from patients with pulmonary and extrapulmonary TB. The specimens were stained with Ziehl-Neelsen, inoculated on Löwenstein-Jensen media for 6-8 weeks, and tested for sensitivity against the first-line TB drugs (isoniazid [INH], rifampicin [RIF], ethambutol [EMB], and streptomycin [SM]). RESULTS: Of the 316 M. tuberculosis isolates collected, 31.6% showed resistance to first-line TB drugs. Among these resistant isolates, 31% showed resistance to at least one of the first-line TB drugs and 0.3% showed MDR. Resistance to EMB, INH, RIF, and SM was seen in 17%, 8%, 3%, and 72% of isolates, respectively. Polyresistance was seen in 3% of the isolates. CONCLUSION: Our study confirms that resistance to streptomycin was the most common phenomenon. The resistance pattern identified in this study could assist clinicians in providing appropriate treatment regimen to TB patients and improve their clinical outcome.

Molecular epidemiology of Pseudomonas aeruginosa in University Clinical Center of Kosovo.

BACKGROUND: Pseudomonas aeruginosa is an important opportunistic pathogen. It is frequently resistant to many commonly used antibiotics and develops easily resistant forms. Colonization with this organism often precedes infection, and its prevention is, therefore, critical. There is no information on molecular epidemiological investigation of outbreaks caused by P. aeruginosa in Kosovo. MATERIALS AND METHODS: The present investigation was carried out to enlighten molecular epidemiology of P. aeruginosa in University Clinical Center of Kosovo (UCCK) using pulsed-field gel electrophoresis (PFGE). During our study period, 80 isolates of P. aeruginosa were included. The overall antimicrobial susceptibility pattern showed a high level of resistance against amino-glycosides and the lowest against carbapenems. Forty isolates of P. aeruginosa were subjected to genotyping, of whom 31 (77.5%) were male patients and nine (22.5%) were female patients. RESULTS: The most common diagnosis upon admission was polytrauma, sepsis, and coma cerebri. Majority of the patients were in mechanical ventilation (76.2%). Bacterial isolates were most frequently recovered from respiratory tract specimens (60%) and wounds (22.5%). Majority of the samples were recovered from intensive care unit (ICU) (47.5%). The length of ICU stay was higher compared to patients from other units. Genotype analysis of P. aeruginosa isolates identified seven distinct PFGE patterns, with the predominance of PFGE clone A (40%) and PFGE clone N (12.5%). All of these isolates were indistinguishable. The appearance of the indistinguishable genotypes supports the possibility of a cross and horizontal transmission of P. aeruginosa due to insufficient preventive measures. CONCLUSION: The results emphasize the need for strict infection control measures to prevent the nosocomial transmission of P. aeruginosa in our hospital.

Public knowledge, attitudes and practices regarding antibiotic use in Kosovo.

BACKGROUND: Antimicrobial resistance is becoming a major public health challenge worldwide, caused primarily by the misuse of antibiotics. Antibiotic use is closely related to the knowledge, attitudes and behaviour of a population. OBJECTIVE: The objective of this study was to assess the level of knowledge, attitudes and practices about antibiotic use among the general public in Kosovo. METHODS: A cross-sectional face-to-face survey was carried out with a sample of 811 randomly selected Kosovo residents. The methodology used for this survey was based on the European Commission Eurobarometer survey on antimicrobial resistance. RESULTS: More than half of respondents (58.7%) have used antibiotics during the past year. A quarter of respondents consumed antibiotics without a medical prescription. The most common reasons for usage were flu (23.8%), followed by sore throat (20.2%), cold (13%) and common cold (7.6%). 42.5% of respondents think that antibiotics are effective against viral infections. Almost half of respondents (46.7%) received information about the unnecessary use of antibiotics and 32.5% of them report having changed their views and behaviours after receiving this information. Health care workers were identified as the most trustworthy source of information on antibiotic use (67.2%). CONCLUSION: These results provide quantitative baseline data on Kosovar knowledge, attitudes and practice regarding the use of antibiotic. These findings have potential to empower educational campaigns to promote the prudent use of antibiotics in both community and health care settings.

The prevalence and resistance patterns of Pseudomonas aeruginosa in a tertiary care hospital in Kosovo.

Pseudomonas aeruginosa is a Gram-negative bacterium that continues to a leading cause of opportunistic nosocomial infections. The rapid increase in drug resistance in clinical isolates of this pathogen is a worldwide concern. The aim of this study was to investigate the distribution rate, prevalence and resistance patterns of P. aeruginosa in clinical specimens from the University Clinical Centre of Kosovo (UCCK). During a three-year period, 553 P. aeruginosa isolates were collected from patients admitted to a variety of UCCK units. The P. aeruginosa isolates were identified using standard laboratory procedures, and the susceptibility of the isolates to antimicrobial agents was investigated using the Kirby-Bauer disk diffusion assay according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) (2013-2015) guidelines. P. aeruginosa was the second most frequently isolated pathogen. The isolation rate of P. aeruginosa was 7.6%, 10.1% and 8.6% in 2013, 2014 and 2015, respectively. Most clinical samples were from ICU (380, 68.7%). There was a statistically significant difference between ICU and non-ICU (p<0.05). P. aeruginosa isolates were most frequently isolated from the respiratory tract (323, 58.4%). The rate of resistance against most of the tested antimicrobials has increased, especially for carbapenems. Imipenem resistance was 25.2%, 26.5%, and 37.7% and meropenem resistance was 20.1%, 23.4%, and 36% in 2013, 2014 and 2015, respectively. This study provides important data on current antimicrobial resistance, and the results demonstrate that the resistance rates are progressively increasing. There is an urgent need to emphasise the prudent use of antibiotics and strictly adhere to the concept of "reserve drugs" to minimise the misuse of available antimicrobials. The acquisition and analysis of prevalence and resistance data will be an important tool to identify targets for quality improvement in Kosovo and will support the preparation of guidelines and protocols for the prudent use of antibiotics.

Public knowledge, attitudes and practices regarding antibiotic use in Kosovo

Background: Antimicrobial resistance is becoming a major public health challenge worldwide, caused primarily by the misuse of antibiotics. Antibiotic use is closely related to the knowledge, attitudes and behaviour of a population. Objective: The objective of this study was to assess the level of knowledge, attitudes and practices about antibiotic use among the general public in Kosovo. Methods: A cross-sectional face-to-face survey was carried out with a sample of 811 randomly selected Kosovo residents. The methodology used for this survey was based on the European Commission Eurobarometer survey on antimicrobial resistance. Results: More than half of respondents (58.7%) have used antibiotics during the past year. A quarter of respondents consumed antibiotics without a medical prescription. The most common reasons for usage were flu (23.8%), followed by sore throat (20.2%), cold (13%) and common cold (7.6%). 42.5% of respondents think that antibiotics are effective against viral infections. Almost half of respondents (46.7%) received information about the unnecessary use of antibiotics and 32.5% of them report having changed their views and behaviours after receiving this information. Health care workers were identified as the most trustworthy source of information on antibiotic use (67.2%). Conclusion: These results provide quantitative baseline data on Kosovar knowledge, attitudes and practice regarding the use of antibiotic. These findings have potential to empower educational campaigns to promote the prudent use of antibiotics in both community and health care settings (AU)

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Comparison of GeneXpert MTB/RIF and conventional methods for the diagnosis of tuberculosis in Kosovo.

INTRODUCTION: Tuberculosis (TB) is a major public health problem worldwide, with the highest mortality occurring in developing countries. The burden of TB in Kosovo is among the highest in Europe. The aim of this study was to compare Cepheid GeneXpert MTB/RIF assay for direct detection of Mycobacterium tuberculosis complex (MTBC) and rifampin (RIF) resistance with conventional methods. METHODOLOGY: A cross-sectional design to evaluate diagnostic tests was carried out at the Department of Microbiology, National Institute of Public Health of Kosovo and Lung Clinic, from January to June 2014. The detection of MTBC and RIF resistance using the Xpert MTB/RIF assay was assessed in 116 specimens received from 110 patients suspected of having TB and compared with conventional smear microscopy and culture methods. RESULTS: Fifty-eight patients (52.7%) were male, and the mean age was 48.6±18.1 years. Twenty-nine patients (26.4%) had underlying lung diseases. Of the 116 specimens investigated, 28 (24.1%) were MTBC-positive by culture, while 34 (29.3%) were positive by Xpert assay. Two samples showed false-negative Xpert results. Compared with culture, the Xpert assay achieved 82.3% (95% CI: 65.5%-93.2%) sensitivity, and 97.6% (95% CI: 91.5%-99.7%) specificity. GeneXpert could detect 11.7% and 50% additional positive cases as compared to Lowenstein-Jensen culture and smear microscopy, respectively. Three cases with resistance to rifampin were detected from clinical isolates. CONCLUSIONS: The GeneXpert MTB/RIF assay is a helpful tool for rapid diagnosis and prompt treatment of TB.

Surgical site infections in an abdominal surgical ward at Kosovo Teaching Hospital.

BACKGROUND: Abdominal surgical site infections (SSI) cause substantial morbidity and mortality for patients undergoing operative procedures. We determined the incidence of and risk factors for SSI after abdominal surgery in the Department of Abdominal Surgery at the University Clinical Centre of Kosovo (UCCK). METHODOLOGY: Prospective surveillance of patients undergoing abdominal surgery was performed between December 2005 and June 2006. CDC definitions were followed to detect SSI and study forms were based on Europe Link for Infection Control through Surveillance (HELICS) protocol. RESULTS: A total of 253 surgical interventions in 225 patients were evaluated. The median age of patients was 42 years and 55.1% of them were male. The overall incidence rate of SSI was 12%. Follow-up was achieved for 84.1% of the procedures. For patients with an SSI, the median duration of hospitalization was 9 days compared with 4 days for those without an SSI (p < 0.001). Surgical procedures were classified as emergent in 53.3% of cases. Superficial incisional SSI was most common (55%). Clinical infections were culture positive in 40.7% of cases. Duration of operation, duration of preoperative stay, wound class, ASA score > 2, use of antibiotic prophylaxis and NNIS class of > 2 were all significant at p < .001. The SSI rates for the NNIS System risk classes 0, 1 and 2-3 were 4.2%, 46.7% and 100%, respectively. CONCLUSIONS: SSI caused considerable morbidity among surgical patients in UCCK. Appropriate active surveillance and infection control measures should be introduced during preoperative, intra-operative, and postoperative care to reduce infection rates.

Surgical site infections in an abdominal surgical ward at Kosovo Teaching Hospital.

BACKGROUND: Abdominal surgical site infections (SSI) cause substantial morbidity and mortality for patients undergoing operative procedures. We determined the incidence of and risk factors for SSI after abdominal surgery in the Department of Abdominal Surgery at the University Clinical Centre of Kosovo (UCCK). METHODOLOGY: Prospective surveillance of patients undergoing abdominal surgery was performed between December 2005 and June 2006. CDC definitions were followed to detect SSI and study forms were based on Europe Link for Infection Control through Surveillance (HELICS) protocol. RESULTS: A total of 253 surgical interventions in 225 patients were evaluated. The median age of patients was 42 years and 55.1% of them were male. The overall incidence rate of SSI was 12%. Follow-up was achieved for 84.1% of the procedures. For patients with an SSI, the median duration of hospitalization was 9 days compared with 4 days for those without an SSI (p2, use of antibiotic prophylaxis and NNIS class of >2 were all significant at p < .001. The SSI rates for the NNIS System risk classes 0, 1 and 2-3 were 4.2%, 46.7% and 100%, respectively. CONCLUSIONS: SSI caused considerable morbidity among surgical patients in UCCK. Appropriate active surveillance and infection control measures should be introduced during preoperative, intra-operative, and postoperative care to reduce infection rates.

Etiology and susceptibility of urinary tract isolates in Kosova.

Urinary tract infections are amongst the most common pathogenic infections with an increasing resistance to antimicrobials. The objective of this study was to determine the etiology and antimicrobial susceptibility patterns of urinary tract infection pathogens isolated in Kosovo. A retrospective study was carried from urine samples of both inpatients and outpatients that were received in our laboratory throughout 2001. During the study period, 16500 urine samples were analysed, of which 4260 (25.8%) had significant bacteriuria obtained from 1420 patients. Of this, 1059 (74.6%) were collected from females and 361 (25.4%) from males. Urine samples processed from outpatients were 72.5% (1029), whereas 27.5% (391) were from hospitalised patients. Escherichia coli was the most common aetiologic agent isolated (80.5%), followed by Proteus spp. (6.1%), Klebsiella spp. (5.9%), Citrobacter (5.1%) and Mycobacterium tuberculosis (0.8%). Gram-positive bacteria accounted for only 0.3%. Pseudomonas aeruginosa was only isolated from inpatients and was responsible for 0.6% of infections. Amoxicillin, ampicillin and trimethoprim-sulphamethoxazole resistance rates were 48.7, 46.5 and 32.1%, respectively. Nitrofurantoin, cefalexin and ciprofloxacin expressed the highest susceptibility among these isolates. E. coli isolates from inpatients and outpatients showed more than 25% resistance to trimethoprim-sulphamethoxazole. Of all isolates, 16% (225) were resistant to three or more agents and considered multi-drug resistant. Current data on the prevalence of multidrug resistance among urinary tract isolates should be a consideration to change the current empiric treatment of urinary tract infections.