Prevalence of Beijing genotype Mycobacterium tuberculosis strains in Istanbul.

To determine the prevalence of Beijing genotype Mycobacterium tuberculosis in Istanbul, 4069 strains were subjected to DNA fingerprinting. This is the first study to reveal the presence of the Beijing genotype in Istanbul. The prevalence rate was estimated as 1.13%, and it was shown that these strains were carried over from countries of the former Soviet Union. The study also showed that the prevalence of the Beijing genotype among at least rifampicin (RMP) resistant strains was significantly higher (2.7%) than among RMP-susceptible strains (0.9%).

Epidemiology and etiology of catheter-related nosocomial infections in a Turkish hospital.

In this study a total of 219 patients who developed nosocomial infections and were treated in Sisli Etfal Training and Research Hospital between January 2001 and March 2003 were evaluated retrospectively. In all, 337 bacterial strains were isolated in these patients. The aim of our study was to assess the causative agents of catheter-related nosocomial infections, the distribution rate of causative agents due to hospital units, infection sites and catheter types, and determine the risk factors which facilitate such nosocomial infections. The most frequently isolated causative agents in catheter infections were Pseudomonas spp. (17%), Klebsiella spp. (16%), E. coli (13%), Acinetobacter spp. (12%), Coagulase Negative Staphylococci (CNS) (11%) and Methicillin-Resistant S. aureus (MRSA) (9%). In 136 (59%) patients infections were due to urinary catheterization and in 52 patients (23%) due to tracheal aspiration catheters. Of the 229 catheters applied, the polymicrobial infection rate was found to be 24% (55 patients). Multiple drug resistant strains were more frequently isolated in Intensive Care Units (ICU). It was emphasized that as ICUs are important risk factors for the development of catheter infections, the resistance patterns of the isolated microorganisms from the unit should be taken into consideration for the selection of appropriate antibiotics. We also conclude that it is important to avoid unnecessary catheterization and that preventive measures should be properly applied.

Acute renal failure: a common manifestation of leptospirosis.

Leptospirosis is an infectious disease caused by pathogenic leptospires and may vary in degree from an asymptomatic infection to severe and fatal illness. Sixteen patients (all males; aged 40+/-17 years) with leptospirosis were admitted to Sisli Etfal Training and Research Hospital between July 1998 and August 2003 and were retrospectively reviewed. Age, gender, occupation, clinical presentation, laboratory features, seasonal distribution of the disease, diagnostical approach, and prognostic factors were evaluated. Eleven patients were cured with no complication; four patients died of hepatic and/or renal failure. Eight patients presented with acute renal failure; seven of them needed dialytic support. One patient developed chronic renal failure and had to undergo regular hemodialysis. All deceased patients (aged 61+/-7 years) were anuric at admission and their serum bilirubin changed between 39-44 mg/dL (mean 41.3+/-2.2 mg/dL). Cured patients ranged in age from 14-62 years (34+/-14 years) and their serum bilirubin levels ranged from 9-35 mg/dL (23.1+/-11.4 mg/dL). Crystalline penicillin G 12 million U/day was administered to all patients. Six patients also received hepatic coma treatment. This study emphasizes that leptospirosis presenting with renal failure is a severe disease, and mortality is frequently related to delays in diagnosis due to lack of clinical understanding. The association of acute renal failure and jaundice should lead the clinician to suspect leptospirosis. We concluded that old age, oliguria/anuria, high serum bilirubin levels (>36 mg/dL), and high serum potassium levels might be risk factors that increase mortality in leptospirosis.

Detection of hepatitis B surface antigen in aqueous humor.

We detected hepatitis B surface antigen (HBsAg) in tears and aqueous humor of 18 patients who upon preliminary examination were seropositive for HBsAg and were scheduled to undergo cataract extractions. HBsAg remained detectable in the serum of 10 of these patients on the day of operation, and of these, 7 were found to have detectable levels of HBsAg in their tears and aqueous humor. Based on our findings, we caution ophthalmologists to take all the necessary precautions in both surgical and nonsurgical treatment of patients at high risk for hepatitis B infection.