Klinik ve çevre örneklerinde Legionella Pneumophila'nın kültür yöntemi ile araştırılması

Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.6. ÖZET Legionella pneumophila pnömonisi, toplumdan edinilmiş veya nozokomiyal olabilmekte, sporadik ve epidemik olgular meydana getirebilmektedir. Doğal ve yapay su sistemlerinde yaygın olarak bulunabilen lejyonella türleri, bu sistemlerden çeşitli şekillerde yayılarak lejyoner hastalığına yol açabilmektedir. Bu çalışmada, EÜTF Hastanesi'nin çeşitli kliniklerinde izlenilen, radyolojik ve klinik bulguları ile pnömoni düşünülmüş 103 olguya ait 134 alt solunum yolu örneği ve hastane su sistemlerinde L. pneumophila 'nın varlığı kültür yöntemi ile araştırıldı. Ekimler için BCYEa besiyeri ve BMPA seçici besiyerleri kullanıldı. Kuşkulu kolonilerin tanımlanması için DFA testi uygulandı. Çalışmada; klinik ve çevre örneklerinde, L. pneumophila saptanamadı, örneklerden, L. pneumophildma. soyutlanamamış olması bölgemizde pnömoni etkenleri arasında önemli bir rolü olmadığım düşündürmekle birlikte, özellikle risk grubunda bulunan hastalarda, lejyoner hastalığına ilişkin tam yöntemlerinin rutin uygulanımı ile daha geniş hasta serilerinin taranmasının ve hastane su sistemlerinin belirli aralıklarla kontrol edilmesinin uygun olduğu sonucuna varıldı. 4

Cephalic tetanus as a result of rooster pecking: An unusual case

In this paper, a case of cephalic tetanus caused by rooster pecking to the face is presented. Cephalic tetanus is a rare type of tetanus defined by trismus and paralysis of 1 or more cranial nerves. On admission to hospital the patient had facial palsy and trismus. With proper medical management she recovered without any relapse

Emergence of phenotypic resistance to ciprofloxacin and levofloxacin in methicillin-resistant and methicillin-sensitive Staphylococcus aureus strains

The emergence of phenotypic resistance to ciprofloxacin and levofloxacin in methicillin-sensitive and methicillin-resistant Staphylococcus aureus (MRSA) strains was studied. Twenty MRSA and 77 methicillin-sensitive S.aureus (MSSA) strains susceptible to both quinolones were investigated for resistance after single step or serial passages. No growth of 20 MRSA strains was observed at 4×MIC of levofloxacin after 48 h incubation, but 4 of 77 (5%) MSSA strains grew at the same concentration. At 4×MIC concentration of ciprofloxacin, 10 MSSA (13%) and five MRSA (25%) strains were grown. In the serial passages of MRSA strains, resistance to ciprofloxacin was 75 and 5% for levofloxacin by the third passage. In the seventh passage this resistance was 100 and 15%, respectively. In MSSA strains, resistance to ciprofloxacin was 75 and 19% to levofloxacin at the third passage and at the seventh passage, 100 and 61%, respectively. Emergence of ciprofloxacin resistance was more common and developed more rapidly than resistance to levofloxacin in both MRSA and MSSA strains. © 2003 Elsevier Science B.V. and the International Society of Chemotherapy. All rights reserved

Experimentally induced rhinosinusitis in rabbits

Objective: The purpose of this study was to develop an experimental rhinosinusitis model by using bacteria-added absorbable material for temporary ostial obstruction. Method: Absorbable gelatin sponge was inserted between the endoturbinals and the ostium of the sinus. In the first group, the effects of surgical procedure and Gelfoam on ostial mucosa were examined macroscopically. In the second group, Gelfoam was moistened with Staphylococcus aureus (ATCC 25923). The sinuses of rabbits were examined by coronal computed tomography before each surgical procedure and sacrifice. The animals were sacrificed at the first, second, fourth, eighth, and tenth weeks. Histologic and microbiologic examinations were performed. Results: In the first group, fibrotic bands and adhesions were observed between the ostium of the maxillary sinus and the endoturbinals in the first and second week. In the second group, a thick purulent discharge that invariably filled the sinuses of the inoculated side was seen after the first week of induction, and opacity, which was determined radiologically, did not disappear until the end of the study. Conclusion: In this study, an experimental rhinosinusitis model was accomplished. It is currently believed that obstruction of the ostium with mucosal edema, polyps, or tumour leads to maxillary sinusitis. In this model, the pathogenesis of human sinusitis was imitated by temporary occlusion of the ostium with bacteria-added Gelfoam. This model can be used in further studies to explore the role of the ostium in the pathogenesis of sinusitis

Experimental sinusitis in nasally catheterised rabbits

Aim: The aim of the study was to create an experimental rabbit model for investigating the effects of nasal catheterization on rhinosinus mucosa, bacterial flora and observing the development of bacterial sinusitis. Methods: Healthy adult white rabbits of either sex and with body weights of 2,5-3 kg were used. Rabbits were randomly separated into two groups; the first group was catheterized by 12 French and the second group was catheterized by 8 French catheters blindly and the non-catheterized left sides were accepted as control. Three randomly chosen rabbits from each group were examined by computerized tomography scans (CT) and sacrified in the first, second and the fourth week of the study. Microbiological and histopathological examinations were performed. Results: In both study groups after the first week of nasal catheterization, opacity or air-fluid level was detected in maxillary sinuses by CT scans, which was significant in group 1. Inflammation spread by the prolongation of nasal catheterization and rapidly development of sinusitis was observed by thicker catheters' usage. Conclusion: In this study, the role of nasal catheterization as a predisposing factor in the development of sinusitis and the increase of sinusitis development risk in relation with the catheterization period and the catheters' thickness was shown

Experimental Sinusitis in a Rhinogenic Model

Objectives/Hypothesis: The objectives were to determine the optimal sinusitis induction period and to examine microbiological and histopathological changes of sinusitis recovery stage in a rhinogenic sinusitis model. Methods: A synthetic sponge was inserted into the right-side nasal cavities of rabbits. The sponge was impregnated with a Streptococcus pneumoniae strain in group 1 and with sterile saline solution in groups 2 and 3. After the fourth day of sponge insertion, sinuses were examined by coronal computed tomography scans at two-day intervals until any radiological evidence of sinusitis was observed. When sinusitis was detected radiologically, five rabbits each from groups 1 and 2 were killed for histological examination. To determine the recovery period of sinusitis, sponges were removed from the rest of the rabbits in groups 1 and 2. Rabbits were selected randomly and killed on the 15th and the 30th days of the recovery period, immediately after radiological examinations. Group 3 was considered a sham group. Results: Sinusitis induction was performed in all rabbits in groups 1 and 2 until the 8th day. After the sponges were removed, inflammation persisted until the 30th day of the study. Conclusion: In a rhinogenic sinusitis model, although histological features of sinusitis were demonstrated, further studies are required to standardize this model and to examine whether or not the studied bacterial strain spreads from nasal cavity into sinus

Antifungal Kullanımının Değerlendirilmesi: Türkiyenin Batısına Ait Çok Merkezli Nokta Prevelans Çalışması

Giriş ve Amaç: Son yıllarda yeni ajanların da kullanıma girmesiyle birlikte antifungal tüketimi giderek artmıştır. Bu durum, direnç gelişimi konusunda endişelere neden olmaktadır. Ülkemizde antifungal tüketimine ait veriler oldukça sınırlıdır. Bu çalışmada, Türkiye’nin batısındaki yedi üniversite hastanesinde yatan hastalarda antifungal kullanımının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Çalışma ekibi tarafından hazırlanan antifungal kullanım formu, tüm merkezler tarafından, aynı gün içinde, antifungal kullanan tüm hastalar için, nokta prevalans yöntemi ile dolduruldu, elde edilen verilerSPSS programı ile değerlendirildi. Bulgular: Toplam hasta sayısı 4969 idi. Hastaların 112(%2.2) ’si antifungal tedavi almaktaydı. Bu 112 hastanın verileri değerlendirildiğinde; antifungal kullanan hastaların 56 (%50)’sı hematoloji-onkoloji, 20 (%17,8)’si yoğun bakım (YB), 23 (%20,5)’ü dahili bilimler ve 13 (%11,6)’ü cerrahi bilimlerde izlenmekteydi. En sık kullanılan antifungal flukonazol [44(%39,3)] olup %34.1’i profilaksi amacı ile kullanılmaktaydı. Tedavilerin %38’i hedefe yönelik, %26.8’i ampirik ve %18,8’i preemptif olarak tanımlanmıştı. Yattığı kliniğe göre tedavi endikasyonları değerlendirildiğinde en çok pre-emptif antifungal kullanımı hemato-onkoloji kliniğinde %71.4 (15/21) görülürken ampirik tedavi en çok yoğun bakımlarda %50 olmuştur. Sonuç: Çalışmamızda antifungal tüketim oranı %2.2 olup, antifungal ajanlar daha çok hematoloji ve dahili birimlerde kullanılmıştır. Antifungal tedaviye başlama nedeni en fazla 'kanıtlanmış mantar infeksiyonu' olarak gözlenmiştir. En sık izole edilen patojenler Candida türleri olmasına rağmen, antifungal ajan seçimi hastanın yattığı kliniğe bağlıdır. Antifungal tüketim açısından yedi merkez arasında anlamlı fark gözlenmemiştir. Bu durum ülkemizdeki antifungal kullanımı politikası ile açıklanabilir. Bu sonuçlara bağlı olarak her hastane kendi verilerini izlemelidir ve izole edilen fungal patojenlere göre antifungal tedavi politikası geliştirilmelidir