Bacitracin and PYR Tests for the Diagnosis of Group A Beta Haemolytic Streptococci in Throat Cultures

In throat cultures, unless a special request in recommended, only group A streptococci are investigated. In this study, our aim was to determine the routine culture and test procedures of a laboratory for throat cultures with minimum cost and reliable results. Although not recommended, in our country in most of the laboratories, for throat cultures human blood containing culture media are used. In accordance with that possibility, performing the routinely used bacitracin and a more rapid PYR test on human blood and sheep blood containing culture media, specificity and sensitivity of those tests were investigated. The highest sensitivity (96.2%) and specificity (97.7%) was found as belonging to PYR test applied on sheep blood containing culture media. On the other hand, in accordence with the cost, using sheep blood containing culture media and performing bacitracin test, was found as the most suitable procedure

In Vitro Activity of Fosfomycin Trometamol Against Extended-Spectrum Beta-Lactamase Producing Escherichia coli Strains Isolated from Community-Acquired Urinary Tract Infections

Introduction: Escherichia coli is the most common microorganism in community acquired UTIs. Treating infections caused by extended-spectrum beta-lactamase (ESBL) producing E. coli strains is problematic. In recent years, in our country and the world, susceptibility of E. coli strains to commonly used antibiotics in the treatment of UTIs has decreased. The aim of this study was to investigate the in vitro activity of fosfomycin in ESBL positive E. coli strainst isolated from community-acquired UTIs. Materials and Methods: The study included E. coli positive urine samples taken from outpatients in the Department of Infectious Disease and Clinical Microbiology at Ankara Training and Research Hospital between June 2012 and January 2013. Antibiotic susceptibilities of the isolates were determined by Kirby-Bauer disc diffusion method and ESBL production was confirmed by double-disc diffusion method according to the recommendations of CLSI (Clinical and Laboratory Standards Institute). Minimum inhibitor concentration (MIC) values for fosfomycin were detected by E-test method. Results: Thirty-five of the 80 E. coli strains (43.7%) producing ESBL was included into the study. However, ESBL-non producing isolates weren’t resistant to fosfomycin but ESBL-producing isolates were 8.6% resistant to fosfomycin (determined by Kirby-Bauer disc diffusion method according to CLSI recommendations). Regarding fosfomycin MIC breakpoints defined by CLSI, 100% of ESBL-producing and non-producing isolates were found susceptible to fosfomycin, indicating no significant difference between the two groups (p= 0.457). Conclusion: It isconcluded that fosfomycin isan appropriate alternative antibiotic in the treatment of community-acquired UTIs because of its high susceptibility rates

Determination of Susceptibility Rates of Nosocomial Acinetobacter baumannii Isolates to Sulbactam by E-test Method

Hastane infeksiyonlarına yol açan etkenler arasında Acinetobacter cinsi bakteriler önemli bir yer tutmaktadır. Çoklu ilaç dirençli Acinetobacter infeksiyonları dünyada artan oranlarda görülmektedir. Bu nedenle, terapötik seçenekler sınırlı hale gelmektedir. Duyarlılık oranları net olarak bilinmese de, tek başına sulbaktam veya sulbaktam-ampisilin, Acinetobacter infeksiyonlarının tedavisinde kombinasyonlarda yer almaktadır. Bu çalışmada, çoğul dirençli Acinetobacter baumannii kökenlerinde, sulbaktamın minimum inhibitör konsantrasyonu (MİK) değerleri E-test yöntemi ile incelenmiştir. Materyal ve Metod: Çalışmaya, 15 Haziran 2011-15 Haziran 2013 tarihleri arasında, Sağlık Bakanlığı Ankara Eğitim ve Araştırma Hastanesinde yatan hastalardan alınan klinik örneklerden izole edilen, karbapenem direncini de barındıran çoklu ilaca dirençli 100 A. baumannii kökeni alındı. Antibiyotik duyarlılıkları ve tür düzeyinde tanımlaması konvansiyonel yöntemler ve VITEK 2 (bioMérieux SA, Fransa) sistemi ile yapılmıştır. Üç veya daha fazla ilaç grubuna karşı direnç saptanması çoğul ilaç direnci olarak kabul edildi. Yüz izolat çalışma gününe kadar -80ºC'de gliserollü "brain heart" besiyerinde (Oxoid, UK) saklandı. Kontrol kökeni olarak Escherichia coli ATCC (American Type Culture Collection) 25922 kullanıldı. Sulbaktamın 100 izolata karşı E-test yöntemi ile saptanan MİK değerleri (µg/mL), MİK50 ve MİK90 değerleri (µg/mL) kaydedildi. Tek başına sulbaktamın Acinetobacter'e karşı belirlenmiş bir duyarlılık sınırı olmadığı için, duyarlılık oranları, literatürde rapor edilen MİK sınır değerleri dikkate alınarak hesaplanmıştır (<= 4 µg/mL ve <= 8 µg/mL). Bulgular: Acinetobacter izolatlarına karşı sulbaktam MİK değerleri geniş bir aralıkta dağılmıştı (1 µg/mL ile 256 µg/mL arasında); MİK50 ve MİK90 değerleri ise sırasıyla 12 µg/mL ve 96 µg/mL saptandı. Duyarlılık sınırı 8 µg/mL kabul edildiğinde, izolatların %44'ü duyarlı saptanmışken, sınır 4 µg/mL kabul edildiğinde bu oran %21 ile sınırlı kaldı. Sonuç: Çalışmamızdaki sulbaktam MİK değerleri göz önüne alındığında, çoklu ilaca dirençli A. baumannii tedavisinde sulbaktam umut verici bir ajan olarak görülmektedir. Ancak, özellikle klinik etkinlik konusunda farklı çalışmalara ihtiyaç vardır.Bacteria of the genus Acinetobacter play an important role as causative agents of hospital-acquired infections. Especially in recent years, multidrug-resistant Acinetobacter infections have increasingly been observed worldwide. In parallel with the increasing rate of infections, therapeutic options are becoming limited. Although the susceptibility rates are not exactly known, sulbactam alone or sulbactam with ampicillin play a part in combination therapies against Acinetobacter infections. This study aimed to determine the minimum inhibitory concentrations (MICs) of sulbactam against multidrug-resistant Acinetobacter baumannii strains using the E-test method and to deduce the susceptibility rates based on literature data.Materials and Methods: The study included 100 multidrug-resistant A. baumannii strains isolated from clinical samples obtained from patients hospitalized in intensive care units of the Ministry of Health Ankara Training and Research Hospital between June 15, 2011 and June 15, 2013. Antibiotic susceptibility testing and strain identification were performed using conventional methods and the VITEK 2 (bioM&eacute;rieux SA, France) system. Resistance to three or more drugs was considered as multidrug resistance. MIC, MICMIC values (&micro;g/mL) of sulbactam against the 100 isolates were determined using the E test method. Since the breakpoint MIC of sulbactam against Acinetobacter had not been established, the susceptibility rates were estimated based on the MIC values reported in the literature (&lt;= 4 or 8 &micro;g/mL).Results: The MIC values of sulbactam against the Acinetobacter isolates ranged widely (between 1 and 256 &micro;g/mL), and the MICand MIC values were determined to be 12 and 96 &micro;g/mL, respectively. When 8 &micro;g/mL was considered as the susceptibility breakpoint, 44% of the isolates were found to be susceptible; however, the rate was only 21% when 4 &micro;g/mL was considered as the breakpoint.Conclusion: Based on its MIC values determined in our study, sulbactam appeared to be a promising agent for the treatment of infections caused by multidrug-resistant A. baumannii isolates. Nonetheless, more studies are needed, especially on its clinical effectiveness

Evaluation of 22 Tuberculous Meningitis Cases

Introduction: Tuberculous meningitis is an important health issue in developing countries. Clinical spectrum may vary from mild headache to coma. Patients and Methods: In this retrospective study clinical and laboratory features, treatment options and prognosis of tuberculous meningitis cases were evaluated. Between January 2000 and December 2005, 22 patients were enrolled to the study. Results: Eleven (50%) of 22 cases were male. Patient’s ages ranged from 15 to 74 years with mean 35 years. The most frequent complaints were headache (100%), fever (82%) and unconsciousness (77%) and the most frequent physical examination findings were alteration in consciousness (77%) neck stiffness (73%) and fever (54%). Mean leucocyte count, protein and glucose concentration of cerebrospinal fluid (CSF) were 556 ± 538 cell/mm3, 1656 ± 1439 mg/L and 29.5 ± 19.2 mg/dL, respectively. Only one patient had a positive CSF smear for acide resistant bacilli. Mycobacterium tuberculosis was isolated from CSF in 8 of 22 patients. All patients were treated with isoniazid, rifampicin, ethambutole and morphozinamid combination. Prednisolon treatment was added to the treatment in 16 patients. During follow up, complications of tuberculous meningitis were detected in 13 patients and 3 patients died. Conclusion: In conclusion, tuberculous meningitis should be thought in the differential diagnosis of meningitis in patients who had long duration of symptoms and empirical antituberculous treatment should be started

Lung Abscess in Crimean-Congo Hemorrhagic Fever: A Case Report

Crimean-Congo hemorrhagic fever is a viral zoonotic infection that affects multiple organs and systems, and causes various complications and death. Here, we present a case of a Crimean-Congo hemmorrhagic fever with pulmonary abscess complication, which has not been previously reported

Nosocomial Infection and Mortality in a Neurology-Neurosurgery Intensive Care Unit

Introduction: Increased mortality has been reported among intensive care unit (ICU) patients with nosocomial infection. Few previous studies have evaluated the relationship between nosocomial infection and mortality in neurology-neurosurgery ICU. The aim of this study was to evaluate effect of ICU-acquired infection and other factors on mortality in a neurology-neurosurgery ICU. Patients and Methods: The study was conducted in Ankara Training and Research Hospital, which is 600-bed tertiary level hospital. The patients treated for more than 48 hours in 14-bed neurology-neurosurgery ICU were enrolled to the study during the study period from 15 May 2006 to 1 November 2006. The patients were followed until death or 2 days after discharge by prospective daily surveillance. Risk factors were recorded and analysed for ICU-mortality. Results: Fifty-four ICU-acquired infections occurred in 44 (31%) of 142 patients during 1190 patient days. The overall rate of ICU-acquired infection was 38.3/100 patients and 45.4/1000 patient-days. Seventyseven of 142 patients included to the study has died (54.2%). In logistic regression analysis a low Glasgow coma scale score, being a neurology patient, infection on admission, ICU-acquired infection remained as independent risk factors for ICU-mortality. Conclusion: Investigation of the factors affecting mortality will guide for preventive measures for specific patient group like neurology and neurosurgery