Methicillin-Resistant Staphylococcus Strains Isolated from Adult Intensive Care Units with E-test MIC Values of Different Antibiotic Research

Objective: Nasocomial infections are major health problems due to their high morbidity and mortality, prolonged hospital duration and higher treatment costs. Methicillin-resistant staphylococcus species became one of the leading bacteria causing nasocomial infections especially in intensive care units, recently. The minimum inhibitory concentration value of an antibiotic gives the concentration of antibiotic needed to inhibit the bacteria in the infection area. Careful monitoring of minimal inhibitory concentration (MIC) values is necessary especially during long-term treatments of meticillin-resistant Staphylococcus aureus (MRSA) and meticillin-resistant coagulase-negative staphylococci (MRCoNS) infections1,2. Increasing antibiotic resistance in methicillin-resistant staphylococci, has led to the need for different antibiotics. Methods: A total of 60 meticillin-resistant staphylococci strains isolated in Microbiology Laboratory of Dicle University Hospital, from clinical specimens of patients in adult İntensive Care Units (ICUs) between April 2013 and March 2014 were included in this study. After identification with conventional and automated system, the antibiotic susceptibility rates of vancomycin, teicoplanin, daptomycin, linezolid, quinupristin/dalfopristin, tigecycline, ceftaroline were determined by E-test method. Results: The majority of the samples (26.7%) were sent from Pulmonary Diseases and Tuberculosis intensive care unit and the blood samples were the most common materials (80%) . All staphylococcal strains in our study were determined as susceptible to vancomycin, daptomycin, linezolid, teicoplanin and tigecycline. One (1.6%) MRCoNS isolate was resistant to quinupristin/dalfopristin while 11 (36.6%) of the MRSA isolates were resistant to ceftaroline. In comparison with the MIC values of MRSA and MRCoNS, only tigecycline was significantly different. Thirty MRSA strains were evaluated in terms of vancomycin-intermediate Staphylococcus aureus/heteroresistant vancomycin-intermediate Staphylococcus aureus (VISA/hVISA) with macro E-test method; any VISA/hVISA isolate was not detected. Antibiotic concentrations below the MIC level, not only leads to treatment failure but also causes mutant bacteria to appear. In order to control the resistance to antibiotics in the treatment of infections due to MRSA and MRCoNS agents, the clinician should be notified of the MIC values of the drugs and the treatment should be planned accordingly. VISA/hVISA isolates should be considered in treatment failures of infections due to MRSA which are in vitro susceptible to vancomycin. Further testing is needed to detect these isolates. Despite the fact that ceftaroline is not a drug used in our country, the high resistance rate in our study is remarkable. This situation may be due to the intensive use of other beta-lactam antibiotics. Therefore, antibiotic susceptibility results should be taken into consideration during planning the treatment of infections. The high average MIC values of tigecycline in MRCoNS infections should also be monitored carefull

Güneydoğu Anadolu Bölgesi’nde Rutin Hepatit B Aşı Programının Etkisi

Diyarbakır is the largest residential area in the Southeastern Anatolia of Turkey. Routine HBV vaccination has begun to be implemented by the Ministry of Health in Turkey in 1998. The purposes of this study were to detect the levels of HBV DNA in patients with HBVin 2017, and compare the results of the years 2002 and 2012 according to age groups. HBV DNA results of patients were divided in to seven age groups (0-14, 15-20, 21-30, 31-40, 41-50, 51-60, >61) and for comparison of HBV DNA levels of 2002, 2012. A statistically significant decrease was seen in the number of indiviuals in 0-14 age group in 2017 compared with 2002 and 2012

MENTHA SPİCATA UÇUCU YAĞ EKSTRESİNİN İÇERİK ANALİZİYLE, SIÇANLARDA YARA İYİLEŞMESİNE ETKİSİNİN İNCELENMESİ

Amaç: Bu çalışmadaki amacımız Mentha spicata (MS) türünün uçucu yağ ekstresinin kimyasal ve antioksidan kompozisyonunu, bu bitkiye ait ekstrenin antibakteriyel aktivitesini ve sıçan damak bölgesinde yara iyileşmesi üzerindeki etkinliğini değerlendirmektir. Yöntem ve gereçler: MS ekstresinin antioksidan aktivitesi DPPH serbest radikal giderim, ABTS katyon radikal giderim ve CUPRAC yöntemleri ile tayin edildi. Ayrıca türün antiaging poptansiyeli elastaz ve kollajenaz enzim aktiviteleri ile belirlenerek uçucu yağ içeriği GC-MS/FID ile analiz edildi. Yara iyileşmesindeki etkinliğin değerlendirilmesi amacıyla da 8-10 haftalık, 56 adet Wistar albino türü erkek ratın damağında 4 mm çapında eksizyonal yara bölgesi oluşturuldu. Denekler; kontrol grubu (K), ve Mentha spicata (MS) grubu şeklinde 2 eşit gruba bölündü ve 3, 7, 14 ve 21.günlerde sakrifiye edildi. Yara bölgelerinden histopatolojik inceleme için doku örnekleri alındı. Histopatolojik olarak; vaskülarizasyon, polimorfonükleer lökosit (PMN) sayısı, kollajen dejenerasyonu, fibrozis, vasküler endotelyal büyüme faktörü (VEGF) ve vimentin parametreleri değerlendirildi. Antimikrobiyal etkinliğin saptanmasında ise Streptococcus mitis (S. mitis) ve Aggregatibacter actinomycetemcomitans (Aa) bakterileri kullanıldı. Bulgular: Antioksidan değerlendirmede; daha çok monoterpenlerden oluşan MS uçucu yağ ekstresi orta derecede aktif bulundu. Yara iyileşmesindeki istatistiksel analiz sonuçlarına göre ise; MS grubu, kontrol grubu ile karşılaştırıldığında, 14 ve 21.günlerde anlamlı olarak azalmış vaskülarizasyon, PMN, kollajen dejenerasyonu, fibrozis ve vimentin değerleri görülürken; aynı günlerde VEGF değerleri anlamlı olarak fazla bulundu. MS’nin S. mitis ve Aa bakterileri bir antibakteriyel etkisi tespit edilmedi. Sonuç: Mentha spicata’nın ise ağız içi yara iyileşmesinde orta derecede etkili olduğu görüldü. Anahtar kelimeler: Antibakteriyel, Antioksidan, Kloroben, Mentha Spicata, Yara İyileşmes

Gözler açık/kapalı durumunda EEG bantlarındaki frekans değişiminin Güç Spektral Yoğunluğu ile belirlenmesi

Makale Gönderme Tarihi: 12.09.2015 olarak kullanılmaktadır. Bu çalışmada, gözün açık ve kapalı durumunda EEG de görülen değişimin güç spektral yoğunluğu (GSY) incelenmiş olup, frekans değişiminin hangi aralıkta etkin olduğu farklı yaklaşımlar ile kabaca belirlenmiştir. Belirlenme sürecinde dalgacık yöntemi (DD) kullanılarak, işaret alt bandlarına ayrıştırılmıştır. GSY tahmini için klasik yöntemlerden Welch metodu ile işaret modelleme sürecini kullanan parametrik yöntemlerden Burg ve Yule-Walker yöntemleri kullanılmıştır. Gözler açık durumuna göre gözler kapalı iken EEG'de alfa ritminde yer alan frekansların baskın olduğu görülmüştür. Güç spektral yoğunluk hesabında, parametrik yöntemler ile işaretlerdeki var olan farklılıkların daha belirgin görülebilmesine olanak sağladığı görülmüştü

Evaluation of the diagnostic value of the ELISA tests developed by Using EgHF, Em2 and EmII/3-10 antigens in the serological diagnosis of alveolar echinococcosis

Alveoler ekinokokkoz (AE), insanda Echinococcus multilocularis larvasının neden olduğu ölümcül paraziter hastalıklardan biri olup, özellikle kuzey yarımküredeki birçok ülkede önemli bir halk sağlığı sorunudur. Ülkemizdeki yaşam koşulları ve halkımızın alışkanlıklarıyla parazitin hayat döngüsü arasındaki etkileşim dikkate alındığında, hastalığın bugüne kadar, büyük çoğunluğu Doğu Anadolu bölgesinden bildirilen olgu serilerinden daha yaygın olduğu düşünülmektedir. AE’nin tanısında, dünyada başarıyla kullanılan özgüllüğü yüksek serolojik tanı yöntemlerinin ülkemizde uygulanmıyor olması, radyolo- jik olarak karaciğer lezyonları saptanan hastalarda hatalı malignensi tanılarına yol açmaktadır. Bu çalışmada, AE’nin serolojik tanısında, üç farklı antijen (EgHF, Em2, EmII/3-10) kullanılarak hazırlanan laboratuvar yapımı ELISA testlerinin tanısal etkinliklerinin araştırılması amaçlanmıştır. Çalışmamızda, testlerin duyarlılık ve özgüllüğünü değerlendirmek amacıyla, Bern Üniversitesi Parazitoloji Enstitüsünden sağlanan, tamamı klinik ve parazitolojik ve/veya histopatolojik olarak doğrulanmış, 10 farklı helmint ile enfekte (E.multilocularis, E.granulosus, Taenia solium, Wuchereria bancrofti, Strongyloides stercolaris, Ascaris lumbricoides, Toxocara canis, Trichinella spiralis, Fasciola hepatica, Schistosoma haematobium) 10’ar hasta olmak üzere toplam 100 hastadan alınan serum örnekleri kullanılmıştır. Antijen olarak kullanılan EgHF (E.granulosus hydatid fluid antigen) laboratuvarımızda kistik ekinokokkozlu koyun karaciğer kist sıvılarından hazırlanmış; Em2 (E.multilocularis metacestode-purified laminated layer antigen) ve EmII/3-10 (E.multilocularis recombinant protoscolex tegument antigen) ise Bern Üniversitesi Parazitoloji Enstitüsünden sağlanmıştır. Düz tabanlı ELISA plakları; çukur başına antijen konsantrasyonu EgHF, Em2 ve EmII/3-10 için sırasıyla 2.5 ?g, 1 ?g ve 0.18 ?g olacak şekilde kaplanmış ve EgHF-ELISA, Em2-ELISA ve EmII/3-10-ELISA yöntemleri tüm serumlara uygulanmıştır. Her üç test için belirlenen eşik değerinin (negatif kontrollerin OD ortalaması+2 SD) üstünde reaksiyon veren örnekler pozitif kabul edilmiştir. Çalışmada, EgHF, Em2 ve Em2II/3-10 antijenleri ile uygulanan ELISA yöntemlerinin duyarlılık değerleri sırasıyla %100, %90 ve %90; özgüllük değerleri ise sırasıyla %63, %91 ve %91 olarak hesaplanmıştır. Em2-ELISA ve EmII/3-10- ELISA ile saptanan pozitiflikler birlikte değerlendirildiğinde ise özgüllüğün %96’ya yükseldiği izlenmiştir. Bu verilere göre, AE’nin serolojik tanısı için üç farklı antijenin kullanıldığı ELISA testlerinin birlikte uygulanması halinde, yüksek duyarlılık (EgHF-ELISA ile %100) ve özgüllüğün (Em2-ELISA + EmII/3-10- ELISA ile %96) sağlanacağı görülmektedir. Sonuç olarak, AE açısından endemik olan ülkemizde, büyük ölçüde görüntüleme yöntemleriyle tanımlanan AE’nin erken ve doğru tanısında, Em2-ELISA ve EmII/3- 10-ELISA gibi özgüllüğü yüksek serolojik yöntemlerin güvenle kullanılabileceği ve radyolojik verilere önemli katkıda bulunacağı kanısına varılmıştır.Alveolar echinococcosis (AE), caused by larva stage of Echinococcus multilocularis, is one of the lethal parasitic diseases of man and a major public health problem in many countries in the northern hemi- sphere. When the living conditions and habits in Turkey were considered in terms of relation with the life cycle of the parasite, it was suggested that AE has been much more common than reported mainly from the Eastern Anatolia region of Turkey. Since in vitro serologic diagnosis tests with high specificity for AE have not been used in our country, most of the cases with liver lesions were misdiagnosed by radiological investigations as malignancies. The aim of this study was to evaluate the diagnostic value of the in-house ELISA methods developed by using three different antigens (EgHF, Em2, EmII/3-10) in the serological diagnosis of AE. The study samples included a total of 100 sera provided by Bern University Parasitology Institute where samples were obtained from patients with helminthiasis and all were confirmed by clinical, parasitological and/or histopathological means. Ten samples from each of the cases infected by E.multilocularis, E.granulosus, Taenia solium, Wuchereria bancrofti, Strongyloides stercolaris, Ascaris lumbricoides, Toxocara canis, Trichinella spiralis, Fasciola hepatica and Schistosoma hae- matobium were studied. In the study, EgHF (E.granulosus hydatid fluid) antigens were prepared in our laboratory from the liver cyst fluids of sheeps with cystic echinococcosis, however Em2 (E.multilocularis metacestode-purified laminated layer) and EmII/3-10 (E.multilocularis recombinant protoscolex tegu- ment) antigens were provided by Bern University Parasitology Institute. Flat bottom ELISA plates were covered with EgHF, Em2 and EmII/3-10 antigens in the concentrations of 2.5 μg, 1 μg and 0.18 μg per well, respectively, and all sera were tested by EgHF-ELISA, Em2-ELISA and EmII/3-10-ELISA methods. For each tests, the samples which were reactive above the cut-off value (mean OD of negative controls+2 SD) were accepted as positive. The sensitivity of the ELISA tests performed with EgHF, Em2 and Em2II/3- 10 antigens were estimated as 100%, 90% and 90%, respectively, whereas the specificity were 63%, 91% and 91%, respectively. When Em2-ELISA and EmII/3-10-ELISA tests were evaluated together, the specificity increased to 96%. Our data indicated that the highest sensitivity (100% with EgHF-ELISA) and specificity (96% with Em2-ELISA + EmII/3-10-ELISA) for the serodiagnosis of AE can be achieved by the combined use of the ELISA tests with three different antigens. It was concluded that the early and accurate diagnosis of AE in our country which is endemic for that disease, could be supported by the use of highly specific serological tests such as Em2-ELISA ve EmII/3-10-ELISA contributing radiological data

Evaluation of the Ehrlich-Ziehi-Neelsen (EZN) and Amplified Mycobacterium tuberculosis Direct Test according to the BACTEC method in respiratory and nonrespiratory samples

Aim: Tuberculosis remains a significant and threatening disease, particularly in developing countries. Mycobacterium tuberculosis should be detected and identified as soon as possible to ensure the prevention of the spread of the disease. For this purpose, use of fast and reliable laboratory diagnostic methods with high sensitivity and specificity was initiated in recent years

An evaluation of patients with culture-proven sepsis in a neonatal intensive care unit

Objective: Despite in diagnosis, treatment and the development of the neonatal intensive care, neonatal sepsis continues to be an important cause of morbidity and mortality. In this study, we aimed to evaluate that having followed and treated in neonates with culture-proven sepsis. Methods: Between September 2012 -2014, the retrospective analysis was performed in the diagnosis of neonatal patients with culture-proven sepsis. For this purpose, 52 patients who had been diagnosed with culture-proven sepsis were admitted in the study. Results: The mean gestational age of patients was 32,75±1,45 weeks, and the average weight was 1895±516,49 grams. The patients were 35 (67.3%) premature and 17 (32.7%) term newborn. From sum of 1641 patients in our study had been diagnosed with sepsis 137 patients (8%), and 52 of them (3.2%) had a diagnosis of proven sepsis in patients with culture. Growth rate in culture for clinical sepsis patients were 38% (52/137). They were diagnosed 3 patients (5.8%) early neonatal sepsis and 49 (94,2%) patients late neonatal sepsis. Retraction was the most common finding 50% (26/52), bradycardia second 42.3% (22/52) and feeding intolerance the third 38.5% (20/52) were other common findings. The first three agents in positive blood cultures were Coagulase-negative staphylococci 46.1% (24/52), Klebsiella pneumoniae 21.2% (11/52) and Escherichia coli 9.6% (5/52). Conclusion: Blood culture results obtained may vary between units and also vary in sensitivity to antimicrobial therapy. Therefore, each unit should establish treatment strategies for sepsis in units according to the culture results are obtained

Antimicrobial Susceptibilities and Distribution of Stenotrophomonas maltophilia Strains Isolated from Clinical Specimens

Objective: Stenotrophomonas maltophilia is an opportu­nistic pathogen of increasing importance. Since it is intrin­sically resistant to many antimicrobial agents, the treat­ment of S. maltophilia infections is quite difficult. The aim of this study was to investigate the distribution and anti­microbial susceptibility patterns of S. maltophilia strains isolated in four years’ time. Methods: In this study; a total of 53 S. maltophilia strains, isolated from various clinical specimens between 2011- 2015 years were investigated in terms of antibiotic resis­tance rates. The isolates were identified and antibiotic susceptibility tests performed by conventional methods and BD Phoenix 100 automated system (Becton Dickin­son Diagnostic Systems, Sparks, USA). Results: S. maltophilia infections were mostly encoun­tered in the intensive care units. The most effective anti­microbial agents against S. maltophilia strains were found as trimethoprim-sulfamethoxazole and levofloxacin. Conclusion: Antimicrobial susceptibility tests should be performed for nosocomial infections caused by S. malto­philia due to high antimicrobial resistance rates. If this is not possible, trimethoprim-sulfamethoxazole and levo­floxacin could be good choices for empiric treatment