Platelet aggregation in children with Helicobacter pylori infection.

This study was performed to investigate the platelet aggregation alterations in platelet-rich plasma (PRP) samples of children with Helicobacter pylori (H pylori) infection. Platelet aggregation induced by adenosine diphosphate (ADP), collagen, ristocetin, or epinephrine was studied with photometric aggregometry in 30 patients before and after eradication therapy and in a control group including 15 children. The pretreatment mean maximum aggregation values and slope were significantly lower (P < .0001) in the study group at 10 µmol/L concentrations of ADP (ADP-like defect). The maximum aggregation values and slope revealed no significant differences (P > 0.05) between the study group after therapy and the control group. We concluded that H pylori infection may cause dysfunction of platelets in children and can be reversed by H pylori eradication therapy. Further studies should be carried out to determine the mechanisms of platelet dysfunction in children with H pylori infection.

The effect of nurse-performed preoperative skin preparation on postoperative surgical site infections in abdominal surgery.

AIM: To determine the effect of preoperative skin preparation procedures performed by nurses on postoperative surgical site infection in abdominal surgery. BACKGROUND: Despite all interventions, postoperative SSIs still greatly affect mortality and morbidity. DESIGN: This is an experimental study. METHODS: Procedures developed for nurse application of preoperative skin preparations were tested on a control group (n = 39) and study group (n = 43). RESULTS: Only clinical routines for preoperative skin preparation were performed on the control group patients. Control group members' skins were mostly prepared by shaving with a razor blade (41%). For the study group members, the researchers used the preoperative skin preparation procedure. Clippers were used to prepare 55.8% of study group members while 44.2% of them were not treated with the clipper because their wounds were clean. As a requirement of the procedure, all members of the study group had a chlorhexidine bath at least twice after being hospitalised and at least once a night before the operation under controlled conditions. In the group where chlorhexidine bath was not applied, the infection risk was found to be 4.76 times (95%CI = 1.20-18.83) greater even after corrections for age and gender had been made. The difference between control group and study group with respect to surgical site infections was also statistically significant (p < 0.05). CONCLUSION: Preoperative skin preparation using clipper on the nights before an operation and a 50 ml chlorhexidine bath excluding head area taken twice in the pre-operative period are useful to reduce SSI during postoperative period. RELEVANCE TO CLINICAL PRACTICE: We find that preoperative skin preparation using the procedures developed as a result of findings of this study is useful in reducing surgical site infection during the postoperative period.

The effect of methylprednisolone on treatment in rats with induced sepsis.

In this study, an appropriate sepsis model was created in rats. Additionally, the effects of steroid treatments on survival, in connection with antibiotic treatment, were investigated. The sepsis model performed via intraperitoneal injection of 3 ml/kg fecal suspension was determined as the most appropriate model for our study. Fifteen rats were used to investigate the effect of piperacillin-tazobactam on sepsis treatment. Forty-five randomly selected rats were used to investigate the efficacy of the antibiotic-plus-steroid combination. The rats were divided into three groups of 15 rats each. Twelve hours after the administration of fecal suspension, methylprednisolone (MP) at the dose of 0.25, 0.5, and 2 mg/kg/day was given to each group, respectively, in addition to an antibiotic administered intravenously. In order to investigate the effect of steroids alone in the treatment of sepsis, 0.5 mg/kg/day MP was given intravenously to 15 rats, 12 h after the fecal suspension was administered. It was concluded that administration of MP alone shortens survival time in rats with sepsis, whereas antibiotic therapy alone increases survival time significantly in rats with sepsis. It was seen that the antibiotic-plus-steroid treatment increases survival significantly compared to rats with no treatment (p < 0.05). In addition, steroids, when added to an antibiotic treatment in sepsis, affect survival positively when compared to the group with antibiotic therapy alone, depending on the dose given. Although, not statistically significant, high doses decrease survival (p > 0.05), and very low doses increase survival and mean survival time (p > 0.05) on the basis of clinical observation and average life time. However, low doses were found to increase survival significantly (p < 0.05). We concluded that low-dose MP, in addition to the appropriate antibiotic therapy, is the optimal in the treatment of rats with intraabdominal sepsis.

Staphylococcal cassette chromosome mec (SCCmec) characterization and panton-valentine leukocidin gene occurrence for methicillin-resistant Staphylococcus aureus in Turkey, from 2003 to 2006.

Methicillin-resistant Staphylococcus aureus (MRSA) cause serious community-acquired and nosocomial diseases all over the world. We determined the SCCmec types and occurrence of the PVL gene by using TaqMan real-time PCR method, and correlated these with phenotypic antibiotic susceptibility patterns for MRSA strains collected from Gulhane Military Medical Academy Hospital (GMMAH) during 4 years study period. To our knowledge, this is the first report from Turkey of molecular SCCmec typing analysis of MRSA stains. A total of 385 clinical MRSA isolates collected in the clinical and Microbiology Laboratory at GMMAH between 2003 and 2006 were included in the study. Overall, SCCmec types-I, II, III, IV, V, nontypeable and PVL occurrence were detected in 11 (2.8%), 3 (0.8%), 316 (82.1%), 20 (5.1%), 20 (5.1%), 15 (3.9%) and 5 (1.3%) isolates, respectively. A total of 330 (85.5%) were SCCmec-I/II/III and 40 (10.3%) were SCCmec IV/V. SCCmec-I/II/III isolates were recovered more from patients with serious infections in surgical departments especially those with intensive care units than the SCCmec-IV/V isolates (chi(2) = 13.560, P < 0.001). SCCmec-I/II/III MRSA strains were predominantly recovered from blood stream (53.0%, P = 0.014), while SCCmec-IV/V strains were predominately isolated from skin and soft tissue and abscess (55.0%, P < 0.001). The PVL gene was detected in 10.0% of SCCmec-IV/V isolates in contrast to 0.3% in SCCmec-I/II/III (chi(2) = 25.164, P < 0.001). SCCmec-I/II/III MRSA strains were more resistant to clindamycin (chi(2) = 5.078, P = 0.024), amoxicillin-clavulanate (chi(2) = 84.912, P < 0.001), erythromycin (chi(2) = 4.651, P = 0.031), gentamicin (chi(2) = 24.869, P < 0.001), and rifampin (chi(2) = 18.878, P < 0.001) than SCCmec-IV/V MRSA strains. This data indicates that SCCmec-III MRSA strains that do not carry the PVL gene are the predominant MRSA strains in our hospital setting in Ankara, capital of Turkey and that SCCmec-I/II/III MRSA strains may cause serious infections in surgical departments especially those with intensive care units.

Molecular characterization of methicillin-resistant Staphylococcus aureus nasal isolates from Turkey.

Methicillin-resistant Staphylococcus aureus (MRSA) colonize most frequently in the anterior nares of the nose and cause serious infections all over the world. The aim of this study was to determine the nasal carriage rate of S. aureus and MRSA strains in Turkish elementary school children. We also analyzed molecular characterizations of MRSA strains by using pulse field gel electrophoresis (PFGE), multi locus sequence typing (MLST), staphylococcal chromosomal cassette mec (SCCmec) typing, and detection of the Panton-valentine leucocidin (PVL) gene. The nasal swabs were obtained from 4,050 children during a 4 month period in Ankara. In vitro antimicrobial susceptibility testing to 1 mug oxacillin and 30 mug cefoxitin was determined by a disk diffusion method. We found that the 1,001 of 4,050 (24.7%) children were colonized with S. aureus. Three S. aureus strains were resistant to oxacillin and cefoxitin. The rate of MRSA among all children was 0.07%. The MRSA strains revealed three different PFGE pattern. All MRSA isolates by harbored the SCCmec type IV element, but not the PVL gene. The two MRSA isolate belonged to sequence type (ST) 30, whereas the other one was a unique type. The results of this study demonstrated that S. aureus nasal carriage rate was consistent with previous studies. However, MRSA carriage rate was low. This study also indicated that the ST30-type IV without PVL gene MRSA clone may be expected to spread in Turkish community.

Acinetobacter septicus sp. nov. association with a nosocomial outbreak of bacteremia in a neonatal intensive care unit.

Acinetobacter species other than Acinetobacter baumannii have rarely been reported to be associated with nosocomial outbreaks of bloodstream infections. Within a period of 1 week, seven Acinetobacter-like isolates were recovered from peripheral blood and catheter specimens of five patients at a neonatal intensive care unit (NICU) in a tertiary hospital in Turkey. All five patients had placement of central venous catheters and had received total parenteral nutrition before the onset of bacteremia. Two of the five patients died. Medical devices, tap water, aerators, water samples, various surfaces, intravenous fluids, and the hands of health care workers in the NICU were sampled and were culture negative for the bacterium. All seven of the isolates had identical biochemical reactions, antimicrobial susceptibility results, and pulsed-field gel electrophoresis patterns, indicating a clonal nosocomial outbreak. A panel of standard biochemical reaction profiles and three phenotypic commercial identification systems failed to identify these isolates. Phenotypically, the isolate differed from Acinetobacter ursingii by its hemolysis on sheep blood agar and its negative citrate utilization. Sequences of the full 16S rRNA gene, which contained at least three different gene copies with polymorphic sequences between nucleotide positions 70 and 206, were determined from the first recovered isolate. The complete 1,529- to 1,531-bp 16S rRNA gene sequences and partial 801-bp rpoB gene sequences had similarities of 99.5% and 97.2%, respectively, to an A. ursingii isolate. The DNA-DNA similarities of the strain against the type strain of A. ursingii were 64.7 and 68.7%, which were lower than the recommended threshold value of 70% for the definition of bacterial species. These data indicate that a novel Acinetobacter organism caused the nosocomial outbreak of bacteremia in the NICU unit. We propose the designation of Acinetobacter septicus sp. nov. for these isolates, with isolate AK001 as the type strain.

Nosocomial outbreak of Sphingomonas paucimobilis bacteremia in a hemato/oncology unit.

Nosocomial Sphingomonas paucimobilis infections can arise from contaminated water and the contaminated hands of hospital staff. Within a 1-month period, we isolated six S. paucimobilis strains, including four from blood cultures of four patients and two from hospital environment specimens including tap water and a bathtub in a hemato/oncology unit. We described here these strains' molecular epidemiological analyses by pulsed-field gel electrophoresis (PFGE) and antibiotic susceptibilities by E-test. Although clinical and environmental isolates yielded three different antibiotic resistances and PFGE patterns, all four clinical strains had an identical pattern by both methods. Thus, the isolated clinical strain clone could be traced neither to health care workers nor to environmental samples. It was concluded that S. paucimobilis strains can cause outbreaks in hemato/oncology units. We did not demonstrate genetic relatedness between clinical and environmental isolates by PFGE, but did find PFGE a useful identification technique for epidemiological investigation.

Bacterial reduction by extensive versus conservative root canal instrumentation in vitro.

OBJECTIVE: This study aimed to test the hypothesis that aggressive dentin removal through greater-tapered instrumentation reduces the intracanal bacteria more effectively than conservative dimension instrumentation. MATERIAL AND METHODS: Twenty extracted human lower premolar teeth were used. After extirpation of the pulps, the teeth were autoclaved and immersed in a broth inoculated with Enterococcus faecalis and incubated for 7 days to allow infection of the dentinal tubules. The teeth were divided into 2 experimental groups, each comprising 10 teeth. The teeth were instrumented either with ProTaper or with Hero Shaper nickel-titanium rotary instrumentation techniques. It was calculated that ProTaper theoretically has the potential to remove at least twice the dentin volume compared with Hero Shaper. The apical preparation was standardized to file size 30. Saline solution was used for irrigation. Bacteriological samples were taken before and after instrumentation and plated onto tryptic soy agar, and the reduction in numbers was calculated. RESULTS: Both instrumentation techniques significantly reduced the number of bacteria in the root canal (p<0.05). Reduction in absolute bacterial numbers was up to 98%. There was no statistically significant difference between the two techniques. CONCLUSIONS: Preparation with an instrumentation technique removing substantial amounts of dentin did not reduce the intracanal bacteria more effectively than a more conservative instrumentation technique.

Evaluation of the BacT/ALERT and BACTEC 9240 automated blood culture systems for growth time of Brucella species in a Turkish tertiary hospital.

BACKGROUND: The isolation of Brucella species from blood may be achieved by using classic culture techniques, but detection of the organism is difficult due to its slow growth. The time-to-detection of Brucella can take up to 30 days using the Castaneda blood culture method. Automated blood culture systems have reduced the growth time of Brucella. MATERIAL/METHODS: In this report we would like to contribute our experience on detection time in the isolation of Brucella species from 33,039 blood culture sets using BacT/ALERT between 1995 and 2000 (13 isolates) and thereafter using both the BACTEC and BacT/ALERT systems (17 isolates). RESULTS: Thirty Brucella spp. (17 by both systems and 13 by BacT/ALERT only) were isolated from 33,039 blood culture sets between 1995 and 2002. Brucellae were recovered between 1.8 and 3.7 days (mean: 2.5 days) in the BacT/ALERT blood culture system and between 2.1 and 3.8 days (mean: 2.8 days) in BACTEC 9240 system. CONCLUSIONS: We concluded that the mean time-to-detection could be

A case of ventricular drainage infection with a rare pathogen in cerebrospinal fluid: vancomycin-resistant Enterococcus faecium.

The purpose of this study was to describe a patient, 7-month-old child with ventriculoperitoneal shunts for hydrocephalus with ventriculitis caused by vancomycin-resistant Enterococcus faecium. Two ventriculoperitoneal shunts were inserted just after birth and on the second month. On the sixth month, both shunts were removed because of dysfunction, and external drainage was inserted. The child developed fever, and lumbar puncture revealed a high leukocyte count and protein concentration after external drainage. Cerebrospinal fluid (CSF) cultures yielded E. faecium, which was resistant to ampicillin, erythromycin, gentamicin, penicillin G, vancomycin, and teicoplanin and was susceptible to chloramphenicol, ciprofloxacin, streptomycin, levofloxacin, and rifampin, as determined by the disk diffusion method. As a result of the antimicrobial susceptibility tests, multidrug antibiotic therapy was changed from vancomycin and ceftazidime to chloramphenicol, rifampin, and meropenem. In addition, a rifampin-clindamycin-impregnated shunt (The Codman Hakim Bactiseal, Raynham, MA) was inserted. The patient became afebrile, and CSF cultures were sterile after 15 days of yielding E. faecium. Implantation of the rifampin-clindamycin-impregnated shunt and timely use of appropriate antibiotics for 10 days according to antimicrobial susceptibility testing seem to be important in the resolution of vancomycin-resistant enterococci infections, especially in countries where linezolid and quinupristin-dalfopristin are not in use yet.

[Molecular analysis of vancomycin-resistant enterococci isolated from clinical samples]. / Klinik örneklerden izole edilen vankomisin dirençli enterokoklarin moleküler analizi.

Enterococcus species are the inhabitants of gastrointestinal flora and can cause endocarditis, urinary tract infections, and bacteremia. In recent years, infections caused by vancomycin-resistant enterococci (VRE) have increased in our country. The infections caused by VRE are treated with glycopeptide antibiotics like vancomycin and teicoplanin. Although seven different resistant genes have been described in VRE, VanA is the most frequently detected one in Turkey. The aim of this study was (i) to genotype four vancomycin-resistant Enterococcus faecium strains isolated in our hospital, by using pulsed field gel electrophoresis (PFGE); and (ii) to detect the type of Van gene by using polymerase chain reaction. Three of the strains were isolated from blood cultures and one from cerebrospinal fluid of the hospitalized patients between the years 2000-2004, and identified by both conventional methods and commercial kits. By using PFGE, we detected that isolates were different according to Tenover criteria and they had VanA genes. As a result, VanA carrying VRE cause sporadic infections in our hospital. The molecular epidemiologic investigation of resistant microorganisms is important in terms of infection control and epidemiology.

Is there a relationship between childhood Helicobacter pylori infection and iron deficiency anemia?

An association between Helicobacter pylori infection and iron deficiency anemia has been reported in children, and it has been proposed that H. pylori infection needs to be eradicated to treat absolutely iron deficiency anemia (IDA). We investigated whether there was any correlation between H. pylori infection and iron deficiency (ID) and IDA in children, and whether the eradication of H. pylori infection without iron treatment would lead to the resolution of ID. Hemoglobin and ferritin levels, H. pylori stool antigen test and (14)C urea breath test were measured in 140 children aged 6--16 years (median 9.5 years). Children with H. pylori infection were divided into three groups on the basis of hemoglobin, mean corpuscular volume (MCV), and serum ferritin levels: groups of IDA, ID, and control. All the children received anti-H. pylori combination therapy consisting of amoxicillin, clarithromycin, and lansoprazole. Hemoglobin and MCV values rose significantly compared with baseline values after H. pylori eradication without iron supplementation in children with IDA (p=0.002 and p=0.003, respectively). Ferritin values increased significantly after H. pylori eradication in children with ID (p<0.001). We conclude that complete recovery of ID and IDA can be achieved with H. pylori eradication without iron supplementation in children with H. pylori infection.

[Investigation of the in-vitro effectiveness of ertapenem against Pseudomonas aeruginosa strains isolated from intensive care unit patients]. / Yogun bakim ünitelerinde yatan hastalardan izole edilen Pseudomonas aeruginosa suslarina karsi ertapenemin in-vitro etkinliginin arastirilmasi.

Pseudomonas aeruginosa is one of the important cause of infections in intensive care unit (ICU) patients. The aim of this study was to investigate the effectiveness of ertapenem prior to its use in Turkey, against multiple-resistant P. aeruginosa strains isolated from ICUs. Susceptibility tests were performed by using Kirby-Bauer disk diffusion method and MicroScan MERCH MIC 8 panel (MicroScan 96, Dade Behring, USA). While the resistance rates of ertapenem, imipenem and meropenem were 59.2%, 50% and 48.1% by disk diffusion method, they were 57.4%, 46.2% and 42.5% by MicroScan, respectively. Ertapenem was found less effective against multiple-resistant P. aeruginosa isolates by both of the methods when compared with imipenem and meropenem. Piperacillin/tazobactam was detected as the most effective agent against these isolates by both of the methods. As a result, although carbapenems are frequently used for infections caused by P. aeruginosa, ertapenem, which is a new carbapenem, is not effective as much as the others. In case of confirmation of our results by larger scale studies, the empiric treatment of ICU infections caused by P. aeruginosa with ertapenem, should be carefully evaluated.

[Macrolide antibiotic resistance rates and phenotypes of group A beta hemolytic streptococci isolated between the years 1999-2000 and 2001-2002]. / 1999-2000 ve 2001-2002 yillarina ait grup A beta hemolitik streptokok izolatlarinin makrolid antibiyotiklere direnç oranlari ve fenotipleri.

Macrolide resistance in group A beta hemolytic streptococci (GABHS) have been reported with increasing frequency from various geographic regions in the world, and for the respective treatment alternatives and epidemiologic studies, macrolide resistance rates and phenotypes have been determined. In this study erythromycin, clarithromycin and azithromycin were tested with disc diffusion method against 560 GABHS, isolated from the throat samples collected between 1999-2002. NCCLS guidelines were followed for the susceptibility tests and MIC values were obtained by E-Test in resistant isolates. For determining the resistance phenotype, erythromycin and clindamycin discs were used. Only one isolate (0.27%) was found intermediately resistant to erythromycin, and clarithromycin, and resistant to azithromycin between May 1999-January 2000, whereas in the period between January 2001-June 2002, one isolate (%0.5) was found susceptible to erythromycin and clarithromycin, but intermediately resistant to azithromycin. In each period three isolates (0.83% and 1.5%, respectively) were found to be resistant to all the tested macrolides. There was no statistically significant difference between the resistance rates in these periods. Three of the resistant isolates had inducible type, and the other five isolates had M phenotype macrolide resistance. Testing for macrolide susceptibilities and screening the resistance phenotypes have crucial importance in case of GABHS infections, since these can be taken into consideration for epidemiological issues as well as a guide for empirical treatment protocols in any geographical setting, as well as in our country.