Crecimiento de bacterias en agentes de infusión: El propofol al 2% sustenta el crecimiento, mientras que el remifentanilo y el pantoprazol no

ResumenExperiencia y objetivosFueron evaluados los riesgos de la contaminación de propofol al 2%, remifentanilo y pantoprazol y los efectos de esos agentes in vitro en el crecimiento de agen- tes infecciosos comunes en las unidades de cuidados intensivos.MétodosPara la detección del riesgo de contaminación, fueron testados agentes prepara- dos para el uso inmediato bajo condiciones de la unidad de cuidados intensivos. También se investigaron los efectos de esos tres agentes en el crecimiento bacteriano. Los agentes fueron preparados en las concentraciones utilizadas en la unidad de cuidados intensivos e inoculados con patógenos comunes; enseguida fueron incubados a 4°C, 22°C y 36°C. Fueron obtenidos subcultivos a 0, 2, 4 y 8h y se evaluaron los conteos de las colonias. Fueron determinados los valores de concentración inhibitoria mínima para todos los agentes a 4°C, 22°C y 36°C.ResultadosNo se observó el crecimiento en los agentes preparados en la unidad de cuida- dos intensivos. El Propofol soportó el crecimiento, mientras que el remifentanilo inhibió el crecimiento bacteriano. El efecto de pantoprazol varió dependiendo de la bacteria testada. Ninguno de los agentes demostró actividad antibacteriana en las concentraciones máximas que pueden ser alcanzadas en la sangre de los pacientes.ConclusionesEl Propofol sustenta vigorosamente el crecimiento de los microrganismos testa- dos, lo que no ocurre con el remifentanilo y el pantoprazol. Por tanto, es importante que se practiquen técnicas asépticas rígidas en la preparación del propofol

Macrolide Resistance Mechanisms and in Vitro Susceptibility Patterns of Viridans Group Streptococci Isolated from Blood Cultures

Objectives: Our aim was to study the macrolide resistance mechanisms and antimicrobial susceptibilities of viridans group streptococci (VGS) isolated from blood cultures. Methods: In vitro susceptibilities to nine antimicrobials were studied for 85 VGS isolated from blood cultures by agar dilution. Pheno- and genotyping of erythromycin-resistant isolates were studied by the double disc test and PCR. Results: Resistance to erythromycin was found in 27% (n = 23) of the isolates. Erythromycin-resistant Streptococcus oralis (n = 13) predominated among the other erythromycin-resistant species isolated. The phenotypes among 23 erythromycin-resistant isolates were as follows: 12 constitutive macrolide– lincosamide–streptogramin (cMLSB) resistance phenotype and 11 macrolide (M) resistance phenotype. Of the cMLSB isolates 11 had erm(B) genes and 11 of the M phenotype isolates had mef(A) genes. Four of the cMLSB isolates had both erm(B) and mef(A) genes. None of the isolates had erm(TR) genes. Combined resistance to erythromycin with penicillin, clindamycin, chloramphenicol, tetracycline and quinupristin/dalfopristin was found in 100, 61, 74, 100 and 100% of the isolates, respectively. No resistance was found for vancomycin, linezolid and levofloxacin. Conclusions: The macrolide resistance mechanisms of our VGS isolates revealed that the cMLSB phenotype associated with erm(B) and the M phenotype associated with mef(A) genes are found with similar frequencies.Scopu

Detection of Phospholipase Activity in Candida albicans Isolates

Secretion of phospholipases is one of the major putative virulence factors of Candida albicans isolates. The present study was designed to examine the phospholipase activity in 258 C. albicans strains isolated from miscellaneous clinical sources (89 urine, 77 oral lesion swab, 40 vaginal secretion, 7 blood and 45 samples other than noted). The activity of the enzyme was measured by modified Price method. Overall, phospholipase activity was detected in 78.7% of the isolates. The enzyme was positive in 76.4%, 77.9%, 82.5%, and 82.2% of the urine, oral swab, vaginal secretion and other isolates, respectively. Five of seven blood isolates were also noted to produce phospholipase. There was no significant difference between the rates of phospholipase positivities in terms of the clinical source of the isolate. The results of the current study indicate that, phospholipase enzyme activity is encountered in majority of the clinical C. albicans isolates

An Investigation of the Bactericidal Activity of Chlorhexidine Digluconate Against Multidrug-Resistant Hospital Isolates

Background/aim: Hospital infections are among the most prominent medical problems around the world. Using proper biocides in an appropriate way is critically important in overcoming this problem. Several reports have suggested that microorganisms may develop resistance or reduce their susceptibility to biocides, similar to the case with antibiotics. In this study we aimed to determine the antimicrobial activity of chlorhexidine digluconate against clinical isolates. Materials and methods: The susceptibility of 120 hospital isolated strains of 7 bacterial genera against chlorhexidine digluconate was determined by agar dilution test, using minimum inhibitory concentration (MIC) values and the EN 1040 Basic Bactericidal Activity Test to determine the bactericidal activity. According to MIC values, Pseudomonas aeruginosa and Stenotrophomonas maltophilia were found to be less susceptible to chlorhexidine digluconate. Results: Quantitative suspension test results showed that 4% chlorhexidine digluconate was effective against antibiotic resistant and susceptible bacteria after 5 min of contact time and can be safely used in our hospital. However, concentrations below 4% chlorhexidine digluconate caused a decrease in bactericidal activity, especially for Staphylococcus aureus and P. aeruginosa. Conclusion: It is crucial to use biocides at appropriate concentrations and to perform surveillance studies to trace resistance or low susceptibility patterns of S. aureus, P. aeruginosa, and other hospital isolates.WoSScopu

The Detection of Genital Actinomyces by Cytological and Microbiological Methods

OBJECTIVE: To detect the genital Actinomyces in women by both cytological and microbiological methods. STUDY DESIGN: Cervico-vaginal samples were obtained from 200 patients attending the Gynecology and Obstetrics Clinics of Hacettepe University. All these samples were screened in view of Actinomyceslike organisms (ALOs) cytologically and were examined microbiologically by the BBL Crystal Identification System with regard to the presence of Actinomyces. RESULTS: ALOs was detected in 6 (3%) women by cytological method and Actinomyces positivity was found in 7 (3.5%) samples by the BBL Crystal ID System. Of 6 samples that gave positive results by Pap-staining, only one was positive by the BBL Crystal ID system. We found a lack of agreement statistically between these methods (p>0.05) for the detection of Actinomyces. CONCLUSION: The detection of genital Actinomyces both in smears and cultures might be more sensitive to prevent the misdiagnosed and undiagnosed cases and for early diagnosis and treatment

The Association of Bacterial Vaginosis with Gynecologic Complaints and Clinical Data

OBJECTIVES: To investigate the relationship between Bacterial vaginosis (BV) and various gynecologic complaints or clinical data. STUDY DESIGN: Cervico-vaginal smears from 200 patients were examined by both cytologic and microbiologic methods in view of BV. Gynecologic complaints were also completed for each woman and these data were recorded on the computer for statistical analysis. RESULTS: Thirteen cases (6.5%) were diagnosed as BV both by cytological and microbiological techniques. These cases were accepted as a study group. Cases without infectious agents (n=187) were the control group. There was a significant correlation between the presence of BV and some parameters such as fishy odor vaginal discharge and abortion( p<0.05), but there was no significant difference between BV and other complaints, such as irregular menstrual cycle, abnormal vaginal bleeding, hormone replacement therapy, myoma, operation or usage of IUD (p>0.05). CONCLUSION: The type and odor of vaginal discharge and abortion play important role for correct detection of BV cytologically and microbiologically. Awareness of these findings warn not only the gynecologist examining the patients but also the cytopathologist

Prospective Evaluation of Infection Episodes in Cancer Patients in a Tertiary Care Academic Center: Microbiological Features and Risk Factors for Mortality

Objective: We aimed to determine the frequency, type, and etiology of infections and the risk factors for infections and mortality in hospitalized cancer patients. Materials and Methods: We prospectively enrolled adult cancer patients hospitalized in the internal medicine wards of a tertiary care academic center between January and August 2004. Patients were followed during their hospitalization periods for neutropenia, infections, culture results, and mortality. Results: We followed 473 cancer patients with 818 hospitalization episodes and 384 infection episodes in total. Seventy-nine percent of the infections were nosocomial, and febrile neutropenia (FN) was observed in 196 (51%) of the infection episodes. Bacteremia was found in 29% of FN episodes and in 8% of nonneutropenic patients. Gram-positive bacteria were the leading cause of bacteremia in both neutropenic and nonneutropenic cases (70% and 58%, respectively). Presence of an indwelling central catheter increased bacteremia risk by 3-fold. The overall mortality rate was 17%, whereas 34% of the patients with bloodstream infections died. Presence of bacteremia and advanced disease stage increased overall mortality by 6.1-fold and 3.7-fold, respectively. Conclusion: Nearly half of the cancer patients developed an infection during their hospital stays, with gram-positive bacteria being the predominant etiologic microorganisms. This demonstrates the changing trends in infections considering that, until 2004, gram-negative bacteria were the most predominant microorganisms among cancer patients in our institute.PubMedWoSScopu

Türk toplumu örnekleminde alkole bağlı olmayan steatohepatit hastalığının demir yüklenmesi ve insülin direnci ile ilişkisi

Aim: We investigated the role ofthe H63D mutation on the development of hepatic iron overload and hepatic injury in non-alcoholic Steatohepatitis patients and its association with insulin resistance and metabolic alterations. Material and Methods: Thirty-two patients with NASH, who were diagnosed at Hacettepe University Gastroenterology Outpatient Clinic depending on clinic and laboratory findings, were included into study. Metabolic syndrome was sought. Waist hip ratio and body mass index were calculated. H63D gene mutation, iron level at serum and liver biopsy specimens and histopathologic exam on liver biopsy specimens were studied in study group. Fasting and post-prandial blood sugar, lipid profile, 75-gr-glucose tolerance test and HOMA insulin resistance were measured to document the insulin resistance and metabolic syndrome. Results: Thirty-two patients with mean body mass index was 28.1 kg/m2i3,3 were included in study. Hypertension, obesity, hypercholesterolemia, hypertriglyceridemia, insulin resistance were found at 25 %, 37 %, 56 %, 28 and 39 %, respectively. Serum ferritin and transferrin saturation values were within normal limits in all but except patients. Hepatic iron concentration was 1600ug in 12 (41%) of patients. H63D mutation was homozygote in (3%) and heterozygote 12 (40%) patients. Therefore the H63D allele frequencies were 3.3% for homozygous, 20% for heterozygous and as total 23.4%. The patients with H63D mutation had normal serum and tissue iron parameters. There was no statistically significant relationship between H63D mutation and histopathological findings. Two hour blood sugar levels were higher in Stage patients than in Stage patients (p=0.05), and also higher in Class patients than in Class S3 patients (p=0.05). Conclusion: The H63D mutation did not affected either serum iron parameters or histopathology. However, the insulin resistance was related with fibrosis in non-alcoholic steatohepatitis patients.Amaç: Bu çalışmada alkole bağlı olmayan steatohepatit (NASH) tanısı olan hastalarda H63D mutasyonunun demir yüklenmesi ve karaciğer hasarı üzerindeki etkisi; insülin direnci ve metabolik sendrom ile ilişkisi araştırıldı. Yöntem ve Gereçler: Hacettepe Üniversitesi, Gastroenteroloji polikliniğinde klinik ve laboratuar olarak NASH tanısı alan 32 hasta çalışmaya alındı. Hastalar metabolik sendrom açısından sorgulandı. Bel kalça oranı ve vücut kitle indeksleri hesaplandı. H63D gen mutasyonu, serum ve karaciğer dokusunda demir parametreleri ve boyanması; karaciğer histopatolojik özellikleri incelendi. İnsülin direnci ve metabolik sendrom ile ilişkili olarak açlık ve tokluk kan şekeri, lipid profili, 75-gr oral glukoz tolerans testi ve HOMA insulin direnci hesaplaması yapıldı. Sonuç: Ortalama vücut--kitle indeksi (VKİ) 28,1i33 kg/m2 olan 32 hasta çalışmaya alındı. Hipertansiyon (%25), obezite (%37), hiperkolesterolemi (%56), hipertrigliseridemi (%28) ve insülin direnci (%39) oldukça sıktı. İki hasta hariç tüm hastaların ferritin ve transferrin saturasyonu normaldi. Hastaların %41'inde HIC 1600 ug/g'ın üzerinde saptandı. H63D mutasyonu 12 (%40) hastada heterezigot, (%3) hastada ise homozigot saptandı. NASH hastalarında H63D alel frekansı %23,4 idi (%3,3 homozigot, %20 heterozigot). H63D mutasyonu olan hastalarda serum ve doku demir belirteçleri normal idi. H63D mutasyonu ile histopatolojik bulgular arasında ilişki saptanmadı. 2. saat kan şekeri ölçümü evre fibrozisi olan hastalarda evre olan hastalara göre, sınıf hastalarında sınıf s3 olan hastalara göre istatistiksel olarak yüksek saptandı. Sonuç: H63D mutasyonunun serum demir belirteçlerine veya histopatolojiye etkisi saptanmadı. Bununla birlikte non--alkolik steatohepatit hastalarında insülin direnci fibrosis ile iliskili bulundu

A Fully Microfabricated Electrochemical Sensor and its Implementation for Detection of Methicillin Resistance in Staphylococcus aureus

On-chip detection of biological analytes can enable diagnosis at the point of care. Combining the advantages of microelectromechanical system (MEMS) technology and molecular methods, we present the design of an integrated microfluidic platform, a microelectrochemical sensor (mu ECS), and its implementation for the detection of methicillin resistance in Staphylococcus aureus. This platform is capable of electrochemically sensing the target analyte in a microfluidic reactor without the usage of bulky electrodes, rendering it useful for in vitro diagnostics. In our experiments, the functionality of the sensor was tested for detecting specific DNA sequences of mecA gene (an indicator of methicillin resistance) over a range of concentrations of DNA (down to 10 pM). Synthetic oligonucleotides and bacterial PCR product were used as a target analyte in Hoechst 33258 marker-based detection and horseradish peroxidase-based detection, respectively. The results revealed that this platform has high sensitivity and selectivity. Also, its compatibility to MEMS processes enables its use with different applications ranging from detecting various types of cancers to endemics. The designed mu ECS can enable the detection of biological analytes of interest at low cost and high throughput

Epidemiology, Clinical and Microbiological Characteristics of Invasive Streptococcal Infections in Turkey, 2010-2011

A one-year active surveillance study was conducted to investigate the epidemiological and microbiological characteristics of invasive group A streptococci (GAS) infections in Turkey and to provide data for the establishment of national preventive strategies related to invasive GAS infections. A total of 46 clinical microbiology laboratories from 12 different regions of Turkey (Istanbul; Eastern and Western Marmara; Eastern and Western Blacksea; Aegean; Mediterranean; Western, Central, Northeastern, Middle-eastern and Southeastern Anatolia) participated in the study. Accordingly, GAS strains isolated from sterile body sites (blood, cerebrospinal, synovial, pleural, peritoneal, pericardial fluids) in the study centers between June 2010-June 2011, were sent to Maltepe University Hospital Clinical Microbiology Laboratory for microbiological confirmation and further analysis. The isolates were identified by conventional methods, and for serotyping, opacity factor (OF) and T protein types were investigated. For genotyping GAS lysate preparation, emm gene amplification and sequencing were performed by using the protocols recommended by Centers for Disease Control and Prevention. A total of 65 invasive GAS strains were isolated in 15 of the participant centers, during the study period. The rate of invasive GAS isolation exhibited regional variation, with the highest rates in the Eastern Blacksea (Trabzon, n=19), followed by Istanbul (n=17) and Western Anatolia (Ankara, Konya, n=14). Of the patients with invasive GAS infection 33 were female, 32 were male, with the age range of 0-89 years. GAS strains were most commonly isolated from soft tissue specimens (n=18), followed by abscess material (n=10), sterile body fluids (n=8) and blood (n=7) samples. Serotyping revealed that 55% (36/65) of the strains were OF positive, and the majority of T protein was polygroup T (n=20), followed by U (n=14), B (n=5), X (n=3) and Y (n=2). T protein was not detected in 22 isolates. The strains were found to have 17 different emm types; emm1 (n=13), emm4 (n=6), emm6 (n=6), emm12 (n=6), emm24 (n=4), emm14 (n=3) and emm28 (n=3). Nine of the strains could not be typed by sequencing. The correlation between emm typing and serotyping was detected as 58%. It was observed that 26-valent vaccines included 70.5% of the invasive GAS strains included in this study. Our study provided initial data concerning the epidemiological properties of invasive GAS infections and characterization of GAS strains in Turkey. The incidence of invasive GAS infections is low in our country. Although immunization programme by 26-valent GAS vaccine is not currently an urgent public health issue for our country, the results of this study indicated that emm types 4 and 24 should better be included in such a vaccine to be used in Turkey. Additionally, since epidemiological features of GAS infections and the microbiological characteristics of the strains can vary by time, for the diagnosis of invasive streptococcal infections and to take the necessary preventive measures, epidemiological studies should be conducted repeatedly