Browsing by Author "Kurutepe, S"
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Item Maternal carriage and antimicrobial resistance profile of group B StreptococcusArisoy, AS; Altinisik, B; Tünger, Ö; Kurutepe, S; Ispahi, ÇBackground: The aim of this study was to determine the prevalence of group B Streptococcus (GBS) colonization and to evaluate the antimicrobial resistance profile in women in the third trimester of pregnancy. Materials and Methods: A total of 310 pregnant women, referred in weeks 35 to 37 of gestation, were screened for GBS colonization during a 10-month period. Samples were collected from the vagina and the rectum. Results: The colonization rate was 10.6% and 22 women (66.7%) had both positive vaginal and rectal cultures. Rates of GBS colonization were significantly Lower in patients aged 24 years or older and in those with a third or Later pregnancy. None of the isolates were resistant to penicillin and ampicillin, whereas 21.2% and 9.1% showed resistance to erythromycin and clindamycin, respectively. Conclusion: Screening and antimicrobial susceptibility testing of GBS during pregnancy are important to guide appropiate therapy.Item Seroprevalence of West Nile virus, Crimean-Congo hemorrhagic fever virus, Francisella tularensis and Borrelia burgdorferi in rural population of Manisa, western TurkeyGazi, H; Özkütük, N; Ecemis, T; Atasoylu, G; Köroglu, G; Kurutepe, S; Horasan, GDBackground & objectives: Zoonotic diseases are well recognised threat to public health globally. The information of regional prevalence and associated risk factors allow the national programmes to determine and frame better strategies for their control, as they also provide the actual status of zoonosis in the region. The aim of this study was to determine the seroprevalence of West Nile virus (WNV), Crimean-Congo hemorrhagic fever virus (CCHFV), Francisella tularensis and Borrelia burgdorferi among the rural residents of Manisa region, Turkey and to identify the associated risk factors. Methods: Cross sectional study was conducted in rural parts of Manisa, Aegean region of western Turkey in 2012. Blood samples from 324 randomly selected subjects were screened for the presence of IgG antibodies to WNV, CCHFV, F. tularensis and B. burgdorferi with commercially available kits. The demographic structure of the rural residents and risk factors related to lifestyle such as outdoor agriculture activities, animal husbandry, hunting and history of tick bite were questioned and their relationships with positive results were analyzed statistically. Results: It was observed that 49 subjects (15%) had IgG antibodies to at least one of the zoonotic agents studied. The seroprevalence of F. tularensis was highest with a percentage of 7.1% (n = 23). Distribution of the positive results for WNV, CCHFV and B. burgdorferi were 4.3% (n = 14), 3.7% (n = 12) and 0.9% (n = 3), respectively. Older age and uncompleted secondary education were the statistically significant risk factors for seropositivity to at least one zoonotic agent investigated. Logistic regression analyses confirmed that older age (over 50) increased the risk of WNV and CCHFV seropositivity. Interpretation & conclusion: Seropositivity rates were not found to be higher than the expected rates. Further, studies are needed to evaluate the threat of vector borne zoonoses and associated risk factors in the study area.Item Drug-resistant pulmonary tuberculosis in western Turkey: prevalence, clinical characteristics and treatment outcomeSurucuoglu, S; Ozkutuk, N; Celik, P; Gazi, H; Dinc, G; Kurutepe, S; Koroglu, G; Havlucu, Y; Tuncay, GBACKGROUND: Although high antituberculosis (anti-TB) drug resistance rates have been reported in Turkey, the clinical characteristics and implications for the outcome of anti-TB treatment have not been fully investigated. We determined the prevalence of anti-TB drug resistance and examined demographic data, clinical characteristics and treatment outcome in relation to patterns of resistance. METHODS: From the TB case registry of a university hospital and the two largest dispensaries in Manisa city, we identified all pulmonary TB cases with a culture-proven definitive diagnosis and antimicrobial susceptibility results for a 7-year period. We collected and analyzed demographic and clinical data and information on treatment outcome for those cases in relationship to anti-TB drug resistance. RESULTS: Of 355 M. tuberculosis strains, 71.5% were susceptible to streptomycin, isoniazid, rifampicin and ethambutol. Any drug resistance and multi-drug resistance (MDR) rates were 21.1% and 7.3% and were higher in males (53% and 9%, respectively) than in females (22% and 1%, respectively). Drug resistance was significantly higher in old cases (acquired drug resistance) vs new cases (primary drug resistance), and was associated with treatment failure (P<0.001). The prevalence of MDR was significantly higher in the old cases (22.4%) than in the new cases (4.4%) (P<0.001). Symptoms, radiographic findings, associated diseases, and sputum smear positivity were unrelated to the development of resistance. The prevalence of any drug resistance and MDR was significantly higher in those with treatment failure than in patients with treatment success. CONCLUSION: High resistance rates, particularly for acquired MDR, indicate a need for improvement in the TB control programme in our region.Item Investigation of glycopeptid resistance in methicillin resistant staphylococcal isolatesHosgor-Limoncu, M; Ermertcan, S; Tasli, H; Kurutepe, SThe emergence of Staphylococcus aureus strains with intermediate resistance (VISA) and heterogen resistance (hVISA) to vancomycin leads to the occurence of severe therapeutic problems. The aim of this study was to investigate the vancomycin resistance in methicillin resistant S.aureus (MRSA) and coagulase-negative staphylococci (MRCoNS) isolated from clinical samples in Bacteriology Laboratory of Microbiology and Clinical Microbiology Department of Celal Bayar University Faculty of Medicine, Manisa (located in western Anatolia, Turkey). A total of 120 staphyloccoccal strains (92 MRSA and 28 MRCoNS) isolated from different clinical specimens (tracheal aspirate, blood, abscess, wound swabs, sputum, catheter tips, etc) between the period of June 2005 to December 2006 were included to the study. Vancomycin resistance were determined by agar screening method using brain hearth infusion agar plates containing 6 mu g/mL vancomycin. Standard E-test and macro E-test methods were performed for 17 (14%) staphylococcal strains (10 MRSA and 7 MRCoNS) which had grown in agar screening plates. Vancomycin and teicoplanin minimal inhibitory concentration (MIC) ranges of those strains were found as 1.5-4 mu g/mL and 2-4 mu g/mL, respectively, by standard E-test method. In our study, no VISA and hVISA isolates were detected when MIC value of >= 8 mu g/mL for vancomycin and teicoplanin, or >= 22 mu g/mL for teicoplanin only were accepted as the criteria for hVISA determination. Agar screening method which is preferably used in routine laboratories for practical and economical reasons, lower sensitivity and specificity than E-test. It can be concluded that, since agar screening method is not reliable for the detection of vancomycin resistance, further multi-center studies with the use of standard methods are needed in order to clarify the vancomycin resistance patterns of staphylococci in our country.Item Influence of oral intake of Saccharomyces boulardii on Escherichia coli in enteric floraAkil, I; Yilmaz, O; Kurutepe, S; Degerli, K; Kavukcu, SEnteric flora constitutes 95% of the cells in the human body. It has been shown that the bacterial content of this flora is affected by diet and changes in nutrition. Considering that urinary tract infections (UTI) are mostly due to ascending infections from the gut flora, the importance of the elements of this flora and their characteristics becomes more evident. The aim of this study was to evaluate the influence of oral Saccharomyces boulardii (S. boulardii) intake on the number of Escherichia coli (E. coli) colonies in the colon. This study was carried out with 14 boys and 10 girls (total of 24 children) aged between 36 and 192 months (mean: 104.3 +/- 45.1 months). A commercial capsule or powder containing 5 billion colony-forming units (cfu) of S. boulardii was administered once a day for 5 days. The number of E. coli and yeast colonies was measured in the stool samples of the study group before and after the use of this drug. Before treatment, the mean number of E. coli colonies in g/ml stool was 384,625 +/- 445,744. This number decreased significantly to 6,283 +/- 20,283 after treatment (p=0.00). S. boulardii was not detected in stool before treatment and the number of colonies increased to 11,047 +/- 26,754 in g/ml stool. S. boulardii may be effective in reducing the number of E. coli colonies in stool. The influence of this finding on clinical practice such as prevention of UTI needs to be clarified by further studies.Item THE RATE OF INDUCIBLE CLINDAMYCIN RESISTANCE AND SUSCEPTIBILITIES TO OTHER ANTIMICROBIAL AGENTS IN STAPHYLOCOCCIOguz, VA; Yapar, N; Sezak, N; Çavus, SA; Kurutepe, S; Peksel, H; Çakir, N; Yüce, AStaphylococci are one of the most common pathogens isolated from nosocomial and community acquired infections. Antibiotics used by oral route such as erythromycin, clindamycin, trimethoprim-sulphamethoxazole (TMP-SMX) and quinolones are of value especially in the treatment of community acquired infections and resistance to those antibiotics may lead to therapeutic failure. Therefore in this study, susceptibility of staphylococci to TMP-SMX, rifampin, tetracycline, gentamicin, ciprofloxacin and vancomycin and the presence of inducible clindamycin resistance were investigated in two distinct university hospitals in Turkey. A total of 286 staphylococcus strains [184 Staphylococcus aureus, 102 coagulase negative staphylococci (CoNS)] were studied. Of the 90 hospital-acquired S.aureus, 44.6% were methicillin-resistant while all of the community acquired strains were methicillin-susceptible. All of the CoNS strains were isolated from nosocomial infections and 71.6% of them were resistant to methicillin. Inducible clindamycin resistance rate of CoNS strains (34.3%) was higher than that of S.aureus strains (7.1%) and the difference was statistically significant (p = 0.00001). Positive D-test among CoNS were significantly higher in S.hominis strains (p = 0.00001). Susceptibilities of S.aureus strains to tetracycline, rifampin, ciprofloxacin, gentamicin and TMP-SMX were 56%, 59%, 56%, 56% and 99%, respectively. Susceptibilities of CoNS strains to tetracycline, rifampin, ciprofloxacin, gentamicin and TMP-SMX were 73%, 72%, 39%, 40% and 46%, respectively. None of these strains were vancomycin resistant. Differences between tetracycline, rifampin, ciprofloxacin and gentamicin resistance rates among D-test positive and negative S.aureus strains were found statistically significant. Although among CoNS isolates, no. statistically significant difference was found between the resistance rates, D-test positive strains were determined to be more resistant. Differences between tetracycline, rifampin, ciprofloxacin and gentamicin resistance rates among D-test positive S.aureus and CoNS strains were found statistically significant. It can be concluded that inducible clindamycin resistance should be tested for staphylococci during routine antibiotic susceptibility testing. According to the presented data, clindamycin still can be used empirically in methicillin-susceptible S.aureus infections in our region, however, the routine use of rapid, easy, reproducible and economic D-test for the determination of inducible clindamycin resistance in erythromycin resistant strains should be considered in clinical microbiology laboratories. Inducible clindamycin resistance must be anticipated carefully while considering therapeutic options especially for CoNS infections.Item Evaluation of Real-Time PCR Method for Rapid Diagnosis of Brucellosis with Different Clinical ManifestationsSurucuoglu, S; El, S; Ural, S; Gazi, H; Kurutepe, S; Taskiran, P; Yurtsever, SGIn this study, we tested the advantages of TaqMan real time PCR technique and compare it to conventional methods using serum samples from patients with different clinical forms of brucellosis. A total of 50 patients were included in the study. Blood culture using BACTEC 9240 system, Standard Wright's tube agglutination, and real time PCR methods were used. Control blood samples from 30 people with no history of brucellosis or exposure to Brucella spp. were examined too. Serological assay was positive for 49 patients (98%). Forty-four (88%) of the 50 patients had a positive PCR result, whereas Brucella spp were isolated from blood cultures of 18 patients (36%). STA test was all positive for focal brucellosis. Real time PCR test was positive in 9 patients with focal disease (90%), whereas blood culture was positive only in 4 patients (40%). The sensitivity, specificity, positive and negative predictive values of the real time PCR method were calculated as 88%, 100%, 100%, and 83%, respectively. Our results suggest that the high sensitivity and specificity of real time PCR method make it a useful tool for diagnosis of brucellosis with different clinical manifestations.Item In-vitro effects of various antimicrobial combinations against multidrug-resistant Acinetobacter baumannii strainsGüçkan, R; Kurutepe, S; Gazi, H; Kilinç, ÇIn recent years, Acinetobacter strains have emerged as one of the most important nosocomial pathogens, especially in patients admitted to an intensive care unit (ICU). The progressively increasing antibiotic resistance against A. baumannii is now a major problem in our country as it is throughout the world. This resistance against A. baumannii has increased and led clinicians to find alternative antibiotics or antibiotic combinations. In the present study, it is aimed to evaluate the interaction between colistin-rifampicin, colistin-imipenem, tigecycline-rifampicin and tigecycline-imipenem antibiotic combinations using microdilution checkerboard and E-test methods against ten multidrug resistant A. baumannii strains. Since A. baumannii strains have become frequently observed as an infection factor and since antimicrobial resistance rates have increased, there should be newly developed drugs for better treatments. In this study, 50 A. baumannii strains were isolated from various clinical specimens between June 2005 and September 2009 in Celal Bayar University, Faculty of Medicine, Department of Microbiology and Clinical Microbiology, and in Bacteriology Laboratory. Isolation and identification procedures were performed by using conventional biochemical tests as well as by BBL Crystal GN; N/F ID (Becton Dickinson, USA) or Phoenix 100 BD systems (Becton Dickinson, USA). The antibiotic susceptibilities of strains were investigated by using the disk diffusion method according to the recommendations of the Clinical and Laboratory Standards Institute. According to our in vitro study results, the checkerboard method, which was used to examine the synergy between colistin-rifampicin and colistin-imipenem, showed 80% synergistic activity. Tigecycline-imipenem combination had lowest synergetic (10%) efficiency and highest antagonistic effect (30%). The consistency between checkerboard and E-test methods was 52,5% (range 10-70%). Further comparison studies of the E-test synergy technique with the checkerboard and time-kill methods are warranted.Item Evaluation of Achromobacter xylosoxidans subsp. denitrificans Infections at an University HospitalSenol Akar, S; Dindar Demiray, EK; Alkan, S; Özer, D; Kurutepe, SIntroduction: Infections due to Achromobacter xylosoxidans (AX) type bacteria are very rare. There are few case reports from our country but knowledge about practical therapeutical applications is scarce. In this study we aimed to report AX denitrificans infections and clinical approach at our hospital. Materials and Methods: This study comprised patients over 18 years old who were hospitalised at Manisa Celal Bayar University Hafsa Sultan Hospital and who were positive for AX. denitrificans between 01.01.2016-31.12.2019. Data about these patients were obtained retrospectively from hospital records. Demographic clinical and bacteriologic data were analysed by suitable methods. Results: AX. denitrificans was detected in 16 cultures of 10 patients. Growth was detected from wound biopsy cultures in 11 specimens (68.7%). Nine patients were male and the mean age was 51.3 +/- 17. Seven of the patients had been hospitalised in the same clinic at different time intervals. The most common diagnosis was surgical site infection. All of AX. denitrificans induced infections were health care associated infections (HAI). Risc factors were found as being hospitalised and/or operated at the plastic and reconstructive surgery ward, antibiotic consumption within the last month and history of collagen tissue disorders. At the time of diagnosis with AX. denitrificans infection, 10 patients were using ampirical antibiotic for vairous reasons. One patient passed away before culture result was obtained. The most common ampirical antibiotic was found as third generation cephalosporins. When culture results were identified in 50% of the patients were receiving appropriate antibiotherapy. All 16 culture growths revealed sensitivity towards piperacillin/tazobactam. Conclusion: Even though AX. denitrificans is a rare community and hospital derived infectious agent, it should be kept in mind in clinics that show clustering and suitable ampiric therapy should be applied to keep the infection under control.Item In vitro effects of antibiofilm agents and antibiotics on coagulase-negative staphylococciÖztürk, I; Tekintas, Y; Temel, A; Ermertcan, S; Kurutepe, S; Hosgor Limoncu, MCoagulase negative staphylococci (CoNS) are important nosocomial pathogens that cause biofilm infections. Biofilm provides advantages for microorganisms to resist antibiotics and host immune systems. Considering the increased antibiotic resistance, alternative treatments are needed to combat biofilm infections. In the present study, the effects of antibiotics including gentamicin (GEN), ciprofloxacin, doxycycline (DOX), rifampicin (RIF) and antibiofilm agents including N-acetylcysteine (NAC), ethylenediaminetetraaceticacid (EDTA), nisin (NIS), farnesol (FAR) on clinical CoNSbiofilm and IS256, icaA gene expression levels were evaluated. Forty-five CoNS strains were isolated from patients' catheters, at Manisa Celal Bayar University Hospital. The minimum inhibitory concentrations (MICs) of agents were detected by broth microdilution method with European Committee for Antimicrobial Susceptibility Testing (EUCAST) criteria. The combined effects of agents were investigated by checkerboard method. The antibiofilm effects of combinations were investigated by spectrophotometric microplate method. The effects of combinations on IS256 and icaA gene expressions were evaluated by real-time quantitative reverse-transcriptase PCR. Twenty-four isolates (53.3%) were detected as strong biofilm producer. Biofilm production was inhibited in seven isolates in the presence of EDTA+RIF and NIS+DOX while NIS+GEN combination and RIF inhibited biofilm in six isolates. Nine combinations were found to have synergistic effect against isolate #6 which are resistant to four different antibiotics. The expressions of icaA and IS256 were downregulated in the presence of EDTA, NAC+CIP, NAC+GEN, NIS+GEN, FAR+GEN. Antibiofilm agent/antimicrobial combinations could have promising effects for preventing catheter colonization. The further studies on antibiofilm treatment strategies would be beneficial for decreasing morbidity-mortality rates and healthcare costs caused by biofilms.Item Correlation Between Intestinal Colony Numbers and Inflammation Markers (TNF-Alpha, IL-6, High-Sensitive CRP) Following the Use of Sevelamer in Rats with Kidney FailureKürsat, S; Çolak, H; Yilmaz, O; Kolatan, E; Ulman, C; Kurutepe, S; Özyurt, BObjective: Our aim was to investigate anti-inflammatory effect of sevelamer in experimentally induced renal failure (RF) and whether this effect was related to a decrease in Escherichia coli colony counts in feces. Material and Methods: Eighteen female Wistar albino rats weighted 200-250 g were divided into three groups. RF was induced by 5/6 nephrectomy. Group 1 was the control group. Group 2 rats were those with induced RF receiving a high phosphate diet. Group 3 contained rats with induced RF receiving a high phosphate diet + sevelamer. E.coli count in feces, plasma creatinine, high-sensitive C-reactive protein (hsCRP), interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) concentrations were determined at the beginning and at the end of 1st, 3rd and 6th weeks in all rats. Results: In Group 2 and 3, creatinine concentrations were found to be increased (p=0.03, p=0.02) in the 1st week. In Group 2, there was an increase in number of E. coli colony count in the 3rd week (p=0.05). In group 3, E. coli colony count and levels of inflammatory markers (IL-6, CRP, TNF-alfa) significantly were increased in comparison to the basal :+alues (p=0.042, p=0.021, p=0.042, respectively) in the 1st week. In group 3, in the sixth week, E. coli colony count (p=0.02) and levels of inflammatory markers (IL-6, hsCRP, TNFalpha) (p<0.05) were found to be significantly decreased in comparison to the 1st week levels. Conclusion: Anti-inflammatory effects of sevelamer might be explained by its effects on the bacterial colonization in colon.Item Prevalence and evaluation of a choromogenic medium for isolation of Escherichia coli O157 from children with acute gastroenteritisDegerli, K; Kurutepe, S; Gazi, H; Demirel, M; Gülkan, E; Sürücüoglu, SObjective: Comparative performance status of CHROMagar O157 (CHROM) sorbitol-MacConkey (SMAC) media for the detection of Escherichia coli (E. coli) O157 in stool specimens isolated from 339 children under 5 years of age who presented with acute gastroenteritis between September 2008 and September 2010 was determined. Methods: Stool specimens were inoculated onto Sorbitol-MacConkey agar (SMAC), CHROMagar O157, Selenit F, Salmonella-Shigella (SS) and MacConkey agars. All plates were incubated aerobically for 24 to 48 h at 35 degrees C. Colorless colonies on the SMAC plate and mauve colonies on the CHROM plate were selected for further identification by conventional biochemical tests as well as by semi-automated system. Colonies confirmed to be E. coli were screened for O157 antigen by Dry spot E. coli O157 latex particle agglutination test. Results: In 339 stool samples examined, Salmonella spp was isolated in 14 (4.1%), and Shigella spp. in 11 (3.2%), while Escherichia coli O157 was detected in only 1 (0.3%) sample. Suspect E. coli O157 stains grew on 8 CHROMagar (2.1%; 8/339) and 14 SMAC (14/339; 3.8%) plates. Rate of false positivity for colony picks from SMAC (n= 13; 65%) media was almost 2-fold higher than that for CHROM (n= 7; 35%). Conclusion: Routine use of chromogenic media for the investigation of E. coli O157' nin in the selected cases with bloody diarrhea is deemed appropriate.Item Seroprevalance of Measles, Rubella, Mumps, Varicella, Diphtheria, Tetanus and Hepatitis B in Healthcare WorkersCiliz, N; Gazi, H; Ecemis, T; Senol, S; Akcali, S; Kurutepe, SObjective: We aimed to determine the antibody levels of healthcare workers of Celal Bayar University Hospital against vaccinepreventable diseases such as measles, rubella, mumps, diphtheria, tetanus, varicella and hepatitis B, and encourage compliance to recommended vaccinations for non-immune staff. Methods: The antibody levels were tested by enzyme-linked immunosorbent assay (ELISA). Demographic characteristics were collected by a questionnaire, and the history of the diseases, immunization and the sharps-related injuries were queried. Results: 44% percent of 309 healthcare personnel were exposed to occupational injury at least once, and 78.3% of the injuries were needle-stick injuries. Injuries were found to be more common among doctors and nurses, and pediatric and surgical departments, respectively. Frequency of anti-HBs positivity among healthcare workers was 84.1%, while 71.5% of healthcare workers were immunized with HBV vaccine before starting to work, and the immunization status directly correlated with the level of education. In general, high seropositivity was noted for measles (99.7%), rubella (97.0%), mumps (99.7%) and varicella (99.7%), while diphtheria (60.8%) and tetanus (93.5%) antibody levels significantly decreased with age. Histories of the disease and vaccination were not reliable while verifying the immunity status. Conclusions: It is necessary to increase adherence to universal protective measures in healthcare workers and to take corrective and protective measures for sharps-related injuries. It is also essential to increase hepatitis B vaccination rates and to confirm the immune status of medical staff working in high risk departments and diphtheria and tetanus vaccinations should be repeated once every ten years.Item Roles of Phospholipase, Esterase and Slime Activities of Candida albicans Strains in Infection-Colonisation DifferentiationPekintürk, N; Degerli, K; Özkütük, N; Ecemis, T; Kurutepe, S; Özbakkaloglu, BObjective: This study investigated slime factor, phospholipase and esterase activities of C. albicans strains isolated as the infectious agent from healthy individuals, their effectiveness as virulence factors and interactions between each other. For this purpose, virulence factors of 50 C. albicans strains isolated from specimens as infectious agent (infection group) and 50 C. albicans isolates obtained from oral smears of the control group (control group) were analyzed and roles of virulence factors in differentiation of colonisation and infection were investigated. Material and Methods: C. albicans ATCC 10039 and 50 C. albicans strains isolated from clinical specimes of patients who were treated in various clinics of our hospital were used as reference strains. The strains isolated from sterile body sites and from clinical specimens containing pseuduhyphe on direct examination were considered as infectious agent and were identified as C. albicans by germ tube test and chlamidospore formation. Yolc sac agar medium was used to detect phospholipase activity, Tween 80 agar medium was used to detect esterase activity and Kongo red brain-heart infusion agar medium was used to detect slime activity. Results: There was no significant difference in terms of slime, phospholipase and esterase activities of C. albicans strains isolated from patients compared to controls (p=0.357, p=0.842, p=0.841). Consistency analysis between virulence factors revealed no significant difference in the patient group. In the other hand, in the control group, esterase/phospholipase coexistence consistency was significant (K value=+0.35, p=0.001). Conclusion: In conclusion, we suggest that many virulence factors of C. albicans have important roles in the development of C. albicans-related infections.Item In vitro susceptibility of Staphylococcus aureus and coagulase-negative Staphylococcus strains to fusidic acidTünger, Ö; Arisoy, A; Kurutepe, S; Akçali, S; Özbakkaloglu, BItem Increasing antimicrobial resistance in Escherichia coli isolates from community-acquired urinary tract infections during 1998-2003 in Manisa, TurkeyKurutepe, S; Surucuoglu, S; Sezgin, C; Gazi, H; Gulay, M; Ozbakkaloglu, BUrinary tract infections are among the most common infections with an increasing resistance to antimicrobials. The aim of this study was to determine the change in antimicrobial susceptibility of Escherichia coli isolates from patients with community-acquired urinary tract infection (UTI) for the years 1998 through 2003 and to suggest that the current empirical antibiotic therapy used for these patients is inappropriate. During the study period, 7,335 community urine samples of which 1,203 (16.4%) grew bacterial isolates were analyzed. Among the total of 1,203 isolates, 880 (73.2%) were E. coli. The range of resistance of E. coli to ampicillin was 47.8 to 64.6% and that to trimethoprim-sulfamethoxazole was 37.1 to 44.6% during the study period. The susceptibility pattern of E. coli to nitrofurantoin and cefuroxime did not vary significantly over the 6-year period. There was a significant increase in the susceptibility of E. coli to ciprofloxacin (11.3 - 26.7%), amoxicillin-clavulanate (18.4 - 29.2%) and gentamicin (7.0 - 25.6%) (P < 0.05). Empirical initial treatment with ampicillin and trimethoprim-sulfamethoxazole was thus inadequate in approximately half of UTI cases in our region.Item Pemphigus vegetans arising in umbilicus: Successful clearance with intralesional steroidÇetinarslan, TS; Ermertcan, AT; Temiz, P; Kurutepe, SItem Comparison of antimicrobial effects of dexmedetomidine and etomidate-lipuro with those of propofol and midazolamKeles, GT; Kurutepe, S; Tok, D; Gazi, H; Dinç, GBackground and objectives: The aim of our study was to investigate the antimicrobial effects of dexmedetomidine and etomidate-lipuro, and to compare these effects with those of midazolam and propofol on Staphylococcus aureus, Escherichia coli, Pseudomonas aeroginosa, Acinetobacter baumannii and extended-spectrum beta-lactamase Escherichia coli (E. coli ESBL). Methods: All hypnotic dilutions were exposed to micro-organisms for 0, 30, 60, 120 and 240 min at room temperature in vitro. The inoculums taken from diluted suspensions were re-inoculated on blood agar and incubated for 18-24 h at 35 degrees C after which a count of the colonies was compared. Results: Midazolam reduced the viable cells of S. aureus at 30, 60, 120 and 240 min, and also completely inhibited the growth of E. coli, R aeroginosa, A. baumannii and E. coli ESBL. Dexmedetomidine, etomidate-lipuro and propofol, however, did not inhibit any of the micro-organisms tested. Conclusion: In vitro, midazolam had an antimicrobial effect on E. coli, P aeroginosa, A. baumannii and E. coli ESBL. Like propofol and dexmedetomidine, etomidate-lipuro had no antimicrobial effect on any of the micro-organisms tested.Item Antimicrobial susceptibility of bacterial pathogens in the oropharynx of healthy school children in TurkeyGazi, H; Kurutepe, S; Sürücüoglu, S; Teker, A; Özbakkaloglu, BBackground & objectives: Information on oropharyngeal carriage rates of Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus Pyogenes and Moraxella catarrhalis and their resistance pattern in healthy school children in Turkey is lacking. The present study was undertaken to determine the carriage rates and antimicrobial resistance of these bacterial pathogens in such children aged 6-14 yr in Manisa, Turkey. Methods: A total of 1022 children were included from nine schools selected randomly from 32 schools. Throat swabs were cultured for bacteria which were identified using standard microbiological methods. Antimicrobial susceptibility was determined as per National Committee for Clinical Laboratory Standards guidelines. Results: Of the 1022 children 240 (23.4%) harboured S. pneumoniae, , 162 (15.8%) H. influenzae. 30 (2.9%) S. pyogenes and 82 (8%) M.. catarrhalis in their oropharynx. For S. peumoniae overall 17.9 per cent of the isolates were intermediately and 7 per cent were resistant to penicillin and resistance to erythromycin trimethoprim-sulphamethoxasole (TMP/SMX), and chloramphenicol was 13.7, 9.1 and 1.6 per cent, respectively. Ampicillin resistance observed in 20.9 per cent of H. influenzae isolates was associated with the presence of D-lactamase. except two isolates interpreted as -lactamase-negative ampicillin resistant strains. Resistance of H. influenzae to TMP/SMX, chloramphenicol, azithromycin, cefaclor and amoxicillin/clavulanic acid was 14.2. 2.4, 1.8, 1.2 and 1.2 per cent, respectively. M. catarrhalis isolates produced beta-lactamase in 80.5 per cent of the cases and all were susceptible to macrolides and clavulanic acid/amoxicillin combination; the highest rate of resistance of 17 per cent was for TMP/SMX. One (3.3%) isolate of S. pyogenes was resistant to macrolides tested. Interpretation & conclusion: Our data shows that upper respiratory tract of about 50 per cent children was colonized with respiratory pathogens. There is a need for surveillance of nasopharyngeal carriage of resistant strains in healthy school children.Item Rare Pathogen in Pediatric Patients: Chryseobacterium gleum SepsisErdem, ZN; Köktürk, ZBT; Ekim, G; Zengin, N; Kurutepe, SChryseobacterium gleum is a pathogen that is widespread in nature but rarely causes infections in humans. Most reported cases are nosocomial and are often associated with immunosuppression or indwelling catheters. In this study, we aimed to report a case of C. gleum-associated bacteremia. An 11 -year -old pediatric patient was admitted to the emergency department due to respiratory distress and transferred to the intensive care unit for treatment. On the 28 th day of hospitalization, the patient was diagnosed with sepsis, and the blood culture samples taken from the patient were sent to the medical microbiology laboratory. The morphologic gram -negative bacilli were identified as Chryseobacterium indologenes with the VITEK 2 Compact identification system (bioM & eacute;rieux, France) using the VITEK 2 GN ID card (bioM & eacute;rieux, France). To confirm the pathogen, the strain was also analyzed using the MALDITOF MS method, and the pathogen was identified as C. gleum. Using the VITEK 2 AST card (bioM & eacute;rieux, France), the pathogen was found to be sensitive to trimethoprim-sulfamethoxazole; sensitive to ciprofloxacin at high doses; resistant to amikacin, meropenem, imipenem, cefepime, piperacillin-tazobactam and aztreonam. The multidrug resistance of C. gleum makes this microorganism a worrying new pathogen. It is, therefore, important to monitor C. gleum as a possible cause of infection in patients with corresponding risk factors.