EVALUATION OF RELATIONSHIP BETWEEN THE AGENTS OF URINARY TRACT INFECTIONS WITH AGE AND SEX IN CHILDREN

Amaç: İdrar yolu infeksiyonları (İYE) ön tanısı ile laboratuara gönderilen idrar örneklerindeki üreme oranı ve etkenlerin cinsiyet ve yaş gruplarındaki dağılımını araştırmaktır. Gereç ve yöntem: 2004- 2005 yıllarında, mikrobiyoloji laboratuarına idrar yolu enfeksiyonu ön tanısı ile idrar örnekleri gönderilen 0-12 yaş arası çocuklarda yapıldı. Çalışma grubu yaş gruplarına göre A grubu (0- 6 yaş) ve B grubu (7 - 12 yaş) olmak üzere iki gruba ayrıldı. A grubu ise A1 (0- 1 yaş) ve A2 (2- 6 yaş) olmak üzere iki alt grupta incelendi. İdrar örnekleri idarını tutamayan çocuklarda steril idrar torbası ile, tutabilenlerde ise orta akım idrar örneği steril idrar alma prensiplerine uygun olarak toplandı. 0,01 ml miktarında idrar %5 koyun kanlı agar ve Eosine Methylene Blue (EMB) besiyerlerine ekildi. 18-24 saat inkübasyonu takiben değerlendirme yapıldı. 105 koloni/ml ve üzeri değerler pozitif kabul edildi. Bulgular: Toplam 1100 örnekten 204 (%8,5)'ünde üreme saptandı ve bu örnekler 104 (% 51,0)'ü erkek, 100 (%49,0)'ü kız çocuklardan alınmış idi. Genel olarak izole edilen mikroorganizmalar sıklık sırasıyla; E.coli (%51,0), K.pneumoniae,(%15,2), E. faecalis (%8,2) idi. A1 grubunda erkek çocuklarda İYE sıklığı kızlara oranla yaklaşık iki kat yüksek iken, B grubunda ise bu oran kız çocuklarda yaklaşık yedi kat artmaktadır. İnfeksiyon sıklığı açısından cinsiyete göre yaş grupları arasındaki farklılık anlamlı bulunmuştur (p<0,01). 0-1 ve 2-6 yaş gruplarında kız ve erkeklerde en sık izole edilen etken E.coli iken, 2-6 yaş grubunda erkeklerde izolasyon sıklığı azalmıştır. 7 -12 yaş grubunda ise kızlarda E.coli' nin sıklığı %75,9 ‘a yükselirken, erkelerde hiç izole edilmemiştir. Sonuç: Çocuklarda İYE etkeni olan mikroorganizmaların çoğunlukla enterik kaynaklı olduğu, yaşa ve cinse göre etkenlerin değişim gösterdiği görülmüştür. Objective: To investigate the frequency of growth in urine specimens suspected of urinary tract infection (UTI) and distribution regarding to age and sex. Material and method: The study was performed with the urine specimens of children aged between 0-12, that were suspected of UTI and sent to the microbiology laboratory in years 2004-2005. The study group was divided into A (0- 6 years) and B (7- 12 years) groups according to ages. Group A is divided into two subgroups as, A1 (0- 1 years) ve A2 (2- 6 years). Urine specimens were collected by sterile bags in incontinent children and mid urine stream was collected in continent children. Urine specimens were inoculated onto 5% sheep blood and Eosine Methylene Blue (EMB) agars, and the results were evaluated after 18-24 hours of incubation. Growth more than10 5 CFU/ml of a single pathogen was considered to be the infectious agent. Results: Growth was obtained in 204 (18.5%) of 1100 specimens and 104(51%) were from boys and 100(49%) were from girls. The frequency of the isolates was, E.coli (51%), K.pneumoniae,( 15.2%), E. faecalis (8.2%) respectively. In the first group the rate of infection was about two folds higher in boys than girls, but between 7-12 years this was about seven folds higher in girls. The infection rate according to age and sex was found considerably different (p=0.000).The most frequent agent was E.coli in 0-1 and 2-6 years, the frequency was decreased in 2-6 years in boys. In 7-12 years the isolation rate of E.coli was 75.9% in girls, whereas no growth was obtained in boys in this group. Conclusion: The agents of UTI are generally originated from intestinal flora members and variated due to age and sex

Prevalence of Helicobacter pylori in symptomatic patients and detection of clarithromycin resistance using melting curve analysis

AbstractBackground:Clarithromycin is often a component of combination therapies for Helicobacter pylori eradication; however, increases in resistance rates have decreased the success of the treatment.Objective:This study was designed to determine the prevalence of H pylori infection in symptomatic patients and to detect clarithromycin resistance rates using melting curve analysis.Methods:Patients scheduled for upper endoscopy at the Endoscopy Unit of the Department of Gastroenterology, Duzce University, Medical Faculty Hospital, Konuralp/Duzce, Turkey, were assessed for enrollment in the study. Two pairs of gastric biopsy specimens (antrum and corpus) were obtained from each study patient. Histopathologic examination, rapid urease test, culture, and polymerase chain reaction (PCR) of the specimens were used to identify H pylori infection. Clarithromycin resistance was detected using melting curve analysis.Results:Seventy-five patients (41 women, 34 men; mean [SD]age, 42.6 [14.5] years [range, 17–70 years]) were included in the study. Using histopathology and rapid urease test, H pylori was detected in 40 (53.3%) of the 75 specimens. H pylori was detected using PCR in 40 (53.3%) specimens and by culture in 10 (13.3%) specimens. The specificity and sensitivity of PCR and culture were interpreted by comparing them with the results of histopathologic examination and urease tests. The specificity and sensitivity of PCR were 68.6% and 72.5%, respectively, and the specificity and sensitivity of culture were 97.1% and 22.5%, respectively. Of the 40 isolates, 21 (52.5%) were susceptible to clarithromycin, 12 (30.0%) were resistant, and a mixed susceptibility pattern was detected in 7 (17.5%) specimens. H pylori isolates from 19 (79.2%) of the 24 patients who had formerly used clarithromycin showed clarithromycin resistance.Conclusions:The prevalence of H pylori infection was 53.3% for the symptomatic patients in this study, and 47.5% of the isolates showed clarithromycin resistance using melting curve analysis. The PCR-based system used in this study was accurate for the detection of H pylori infection as well as clarithromycin susceptibility testing directly in biopsy specimens

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)

The susceptibility of Escherichia coli isolates from community-acquired urinary infections to fosfomycin and other antibiotics frequently used in urinary infections

İdrar yolu infeksiyonlarının en sık etkeni olan Escherichia coli, son yıllarda oral antibiyotikler için görülen yüksek direnç nedeni ile tedavi sorunlarına neden olmaktadır. Bu çalışmada, hastanemizde toplum kökenli idrar yolu infeksiyonu etkeni olarak izole edilen E.coli kökenlerinde antibiyotik duyarlılıklarının araştırılması amaçlanmıştır. Laboratuvarımıza Mart-Kasım 2007 arasında çeşitli polikliniklerden gönderilen idrar örneklerinden izole edilen E.coli kökenlerinin bu infeksiyonlarda sık kullanılan bazı antibiyotikler ile fosfomisine duyarlılıkları Kirby-Bauer disk difüzyon yöntemi kullanılarak belirlenmiştir. Kökenlerin % 53’ü ampisiline, % 41’i amoksisilin-klavulanata, % 14’ü seftriaksona ve sefepime, % 6’sı sefoperazon-sulbaktama, % 21’i gentamisine, % 29’u siprofloksasine, % 36’sı trimetoprim-sulfametoksazole, birer köken imipenem ve amikasine dirençli bulunurken fosfomisine dirençli kökene rastlanmamıştır. Toplum kaynaklı kökenlerde fosfomisin dışında oral kullanılan antibiyotiklere yüksek oranlarda direnç dikkati çekmiştir. Oral yoldan tek doz kullanılabilen, gebelerde kullanımı güvenli olan ve üriner infeksiyonlarda en sık etken olan E.coli kökenlerine çalışmamızda direnç saptanmayan fosfomisinin idrar yolu infeksiyonlarının ampirik tedavisinde iyi bir seçenek olduğu kanısına varılmıştır.Escherichia coli is the most frequent cause of community-acquired urinary infections and its high resistance rates to many oral antibiotics cause treatment failures. In this study susceptibilities of such strains isolated in the period of March- November 2007 to fosfomycin and to frequently used antibiotics was determined by Kirby-Bauer disk diffusion method. No resistance was found to fosfomycin while 53 % of the strains were resistant to ampicillin, 41 % to amoxicillin-clavulanic acid, 14 % to ceftriaxone and cefepime, 6 % to cefoperazone-sulbactam, 21 % to gentamicin, 29 % to ciprofloxacin, 36 % to co-trimoxazole and 1 strain to each of imipenem and amikacin. The high rates of resistance for oral antibiotics were found striking. Fosfomycin, which can be used orally as one dose and be safely used in pregnants, can be regarded as a choice of drug in the empirical treatment of urinary infections

Comparison of various phenotypic methods in detection of extended-spectrum beta-lactamases

Genişlemiş spektrumlu beta-laktamaz (GSBL) enzimi bazı Gram negatif bakterilerde sefalosporinlere, geniş spektrumlu penisilinlere ve monobaktamlara karşı direnç sorununa neden olmaktadır. Tedavi başarısını arttırmak için bu enzimlerin varlığı çeşitli yöntemlerle araştırılmaktadır. Çalışmamızda Düzce Üniversitesi Araştırma ve Uygulama Hastanesi Klinik Mikrobiyoloji Laboratuvarında üretilen Escherichia coli ve Klebsiella suşlarında GSBL saptanmasında kullanılan fenotipik testlerin [disk difüzyon tarama testi (DDTT), çift disk sinerji testi (ÇDST), E-test] etkinliği karşılaştırılmıştır. Klebsiella spp. ve K.pneumoniae suşlarında, tarama testi ve E-test benzer sonuçlar vermiş iken ÇDST diğer testlerin saptayabildiği GSBL’lerin hepsini saptayamamıştır. Bu testin etkinliği, E-test ile karşılaştırıldığında Klebsiella spp. için p0.002 ve K.pneumoniae için p0.041 düzeyinde ve tarama testi ile karşılaştırıldığında Klebsiella spp. için p0.001 ve K.pneumoniae için p0.041 düzeyinde, anlamlı olarak düşük bulunmuştur. E.coli suşlarında ise farklı olarak; ÇDST ile E-test sonuçları benzer iken (p0.187), tarama testi ÇDST’ne göre anlamlı derecede daha etkin bulunmuştur (p0.05). Sonuç olarak, Gram negatif bakteri kaynaklı infeksiyonların tedavisinde antibiyotiklerin hastaya uygulanıp uygulanmaması konusunda karar verirken ÇDST’nin tek başına kullanılmaması gerektiği, DDTT yapılmasının çok önemli olduğu ve E-test ile doğrulanması gerektiği düşünülmüştür.Extended-spectrum beta-lactamase (ESBL) enzymes of some gram-negative bacteria cause resistance to cephalosporins, broad-spectrum penicillins and monobactams. The presence of these enzymes must be investigated by various methods for the success of the treatment. In this study, the effectiveness of various phenotypic methods for detection of extended-spectrum beta-lactamases [disk diffusion screening test (DDTT), double-disk synergy test (DDST), and E-test] in Escherichia coli and Klebsiella strains isolated in Clinical Microbiology Laboratory of Duzce University, Medical Faculty were compared. Similar results were obtained with screening test and E-test, whereas DDST was found insufficient in detecting ESBL&#8217;s that were determined by other methods. The effectivity of this test was found significantly low, when compared with E-test, with results for Klebsiella spp. (p0.002) and K.pneumoniae (p0.041) and screening test, with results for the Klebsiella spp. (p0.001) and K.pneumoniae (p0.041). For E.coli strains, results obtained with DDST and E-test (p0.187) were found similar but, screening test was significantly effective than DDST (p<0.05). As a result, for the decision of the choice of antibiotics in the treatment of Gram-negative bacterial infections, DDST should not be used alone. Use of DDTT is very important and E-test should be used for verification

Do baby wet wipes change periurethral aerobic flora?

WOS: 000248492400019PubMed: 17642540There is massive enteric bacterial colonization in the periurethral region during infancy. Fecal soiling is considered to be responsible for this colonization. We hypothesized that baby wet wipes containing chemical cleansing compounds, which are used for the cleaning of babies after diaper soiling, could be a contributing factor in this colonization. Thus, the effect on periurethral flora of two different methods of baby cleaning was compared. Periurethral culture samples were obtained from 173 infants who were cleaned with baby wet wipes (Group A, n = 96) or water and napkins (Group B, n = 77) after diaper soiling. The colonization of uropathogens and the presence of flora were analyzed. The results of the periurethral cultures were similar in both groups. The rates of uropathogen colonization only, uropathogen and skin flora colonization, and skin flora only or no growth in Groups A and B were 18.7, 61.5, and 19.8%, and 14.3, 66.2, and 19.5, respectively. The differences between the groups were statistically insignificant (P > 0.05); however, there was no significant difference in the frequency of uropathogen isolation between males and females. We therefore concluded that baby wet wipes are as safe as water for the cleaning of babies after diaper soiling

Prevalence of Helicobacter pylori in symptomatic patients and detection of clarithromycin resistance using melting curve analysis

WOS: 000248245200003PubMed: 24683206Background: Clarithromycin is often a component of combination therapies for Helicobacter pylori eradication; however, increases in resistance rates have decreased the success of the treatment. Objective: This study was designed to determine the prevalence of H pylori infection in symptomatic patients and to detect clarithromycin resistance rates using melting curve analysis. Methods: Patients scheduled for upper endoscopy at the Endoscopy Unit of the Department of Gastroenterology, Duzce University, Medical Faculty Hospital, Konuralp/Duzce, Turkey, were assessed for enrollment in the study. Two pairs of gastric biopsy specimens (antrum and corpus) were obtained from each study patient. Histopathologic examination, rapid urease test, culture, and polymerase chain reaction (PCR) of the specimens were used to identify H pylori infection. Clarithromycin resistance was detected using melting curve analysis. Results: Seventy-five patients (41 women, 34 men; mean [SD] age, 42.6 [14.5] years [range, 17-70 years]) were included in the study. Using histopathology and rapid urease test, H pylori was detected in 40 (53.3%) of the 75 specimens. H pylori was detected using PCR in 40 (53.3%) specimens and by culture in 10 (13.3%) specimens. The specificity and sensitivity of PCR and culture were interpreted by comparing them with the results of histopathologic examination and urease tests. The specificity and sensitivity of PCR were 68.6% and 72.5%, respectively, and the specificity and sensitivity of culture were 97.1% and 22.5%, respectively. Of the 40 isolates, 21 (52.5%) were susceptible to clarithromycin, 12 (30.0%) were resistant, and a mixed susceptibility pattern was detected in 7 (17.5%) specimens. H pylori isolates from 19 (79.2%) of the 24 patients who had formerly used clarithromycin showed clarithromycin resistance. Conclusions: The prevalence of H pylori infection was 53.3% for the symptomatic patients in this study, and 47.5% of the isolates showed clarithromycin resistance using melting curve analysis. The PCR-based system used in this study was accurate for the detection of H pylori infection as well as clarithromycin susceptibility testing directly in biopsy specimens