A review of the current place of glycopeptides in turkish medical practice

AbstractBackground: Glycopeptide antibiotics are considered by many investigators to be the last resort in the treatment of gram-positive bacterial infections.Objective: The aim of this review was to assess the place of glycopeptides in the treatment of common gram-positive bacteria in accordance with the current epidemiologic data in Turkey.Methods: A search of both the English- and Turkish-language literature indexed on MEDLINE, Ulakbim (Turkey), and Pleksus (Turkey) was performed using the terms: vancomycin, teicoplanin, and glycopeptides, or their Turkish-language counterparts. The complete texts of the articles found in these databases were obtained from the electronic library of Gulhane Medical Academy, Ankara, Turkey. Articles from regional journals, without the support of an electronic format, were obtained by direct communication. Articles of interest were those based on studies occurring in Turkish populations, with special consideration given to publications in press after 2002.Results: Staphylococci were the most frequent gram-positive pathogens encountered in Turkish hospitals. Studies have found that ∼74% of strains were Staphylococcus aureus and the remaining strains were coagulase-negative staphylococci (CoNS). Overall methicillin resistance in staphylococci was reported as ∼60%. In Turkey, S aureus was one of the most common infectious agents found inside hospitals and is deemed a growing threat in the community. While the rate of methicillin resistance in community-acquired isolates is ∼4%, the data from hospitals suggest that reduced resistance comprises most of the isolates. In the studies reviewed, older quinolones like ciprofloxacin and ofloxacin seem to be ineffective in nearly half of the S aureus isolates. Alternatives like rifampicin, gentamicin, tetracycline, trimethoprim/sulfamethoxazole (TMP/SMX), clindamycin, and erythromycin have had substantial resistance profiles in >50% of the strains. In recent Turkish studies, in vitro profiles of linezolid, quinupristin/dalfopristin (QD), and daptomycin have had positive results. As in the S aureus isolates, resistance trends have been observed in the CoNS group of pathogens. The possible use of β-lactams seems restricted, and alternative approaches have become necessary. Quinolones, gentamicin, tetracycline, TMP/SMX, clindamycin, and erythromycin have resistance profiles of >50%. Although glycopeptide resistance was not detected, the frequency of heterogenous vancomycin-intermediate S aureus, a precursor to future resistance, was 13% in 1 study. Current studies in Turkey have found that Enterococcus faecalis comprises three quarters of enterococci while the rest are comprised of Enterococcus faecium. Initial studies performed with linezolid, QD, and daptomycin suggest that these drugs might be effective alternatives for future enterococcal infections that may have high glycopeptide resistance. Approximately 8% of the Streptococcus pneumoniae strains had high-level resistance in Turkey. However, 10 million units of crystallized penicillin or 3 g of oral amoxicillin maintains the optimum treatment of pneumococcal infections outside the central nervous system (CNS). Resistance profiles in third-generation cephalosporins in Turkey range between 2% and 2.5%.Conclusions: In Turkey, a review of the existing literature found that the current use of glycopeptides in pneumococcal infections is restricted to CNS infections facing therapeutic failure in due course. However, the belief that these drugs are the last resort, either in staphylococcal or enterococcal infections, is no longer valid. If a patient has a critical status due to probable gram-positive microorganisms, clinicians should consider the empiric use of glycopeptides. However, new molecules such as linezolid, QD, and daptomycin, offered for use in the treatment of gram-positive bacterial diseases, should be reserved for the future, when glycopeptides eventually become obsolete

A surveillance of nosocomial candida infections: epidemiology and influences on mortalty in intensive care units

Introduction: it was aimed to investigate the frequency of Candida infections (CI) in the intensive care units (ICU), to determine typing of candida to evaluate risk factors associated with CI and mortality, and to evaluate influence of CI on mortality. Methods: the prospective cohort study was carried out between Jan 1, 2009 and Dec 31, 2010 in ICUs, and the patients were observed with active surveillance. VITEK 2 Compact System (BioMerieux, France) kits were used for the identification of isolates from various clinical samples. Results: a total of 2362 patients had enrolled for 16135 patients-days into the study. During the study, 63 (27,5%) of patients developed 77 episodes of CI were observed. Of the patients; 54% were male, 46% were female. Duration of hospitalization (OR=1,03, p=0,007), hyperglycemia (OR=17,93, p=0,009), and co- infections (OR=3,98, p=0,001) were identified as independent risk factors for CI. The most common infections were bloodstream (53%). 77 of 135 candida strains was isolated as causative pathogens. C. albicans (63,6%) was the most frequent species. Overall mortality rate was 78%. The rates of mortality attiributable to CI and candidemia were 27%, and 18,3% respectively. Species- specific mortality rates of C.albicans and C.tropicalis were determined as 12%. High APACHE II scores (OR=1,37; p=0,002), and the use of central venous catheter (OR=9,01; p=0,049) were assigned as independent risk factors for mortality. Conclusion: CI is an important problem in our hospital. CI and associated mortalty can be prevented by controlling of risk factors. Updating of epidemiological data is required for successful antifungal treatment

Korištenje otpadnog mulja i diatomita kao medija u proizvodnji sadnica običnog bora (Pinus sylvestris L.) i procjena preživljavanja sadnica na terenu

Although several organic and inorganic substrates are added to growing media for improving its physical and chemical characteristics, the need for search of new materials and/or mixtures that reduces the high-priced peat content in substrates is still interesting. This study evaluated the feasibility of reducing the peat content in substrates by replacing it with different amounts of diatomite and sewage sludge for Scots pine seedling (Pinus sylvestris L.) growth and their land performance. In order to evaluate the feasibility of reducing the peat content in substrates by replacing it with different amounts of diatomite and sewage sludge, an experiment was carried out in a temperature-controlled greenhouse under natural light. To evaluate the land performance of Scots pine seedlings grown in different substrates, a trial was established between the years 2013-2017 in Sarıkamış, Kars (NE Anatolia). Sewage sludge application, due to its high organic matter and macro and micronutrient content, has improved the composition of the rhizosphere, thereby resulting in growth acceleration. As a result of the evaluations made in terms of both seedling morphological characteristics and land performance; the best performance was determined in the 9th (50%P+50%SS) and 3rd (75%SS+25%DE) mixtures.Unatoč tome što se supstratu za uzgoj dodaju određeni organski i anorganski supstrati kako bi se poboljšale njegove fizičke i kemijske karakteristike, i dalje je zanimljiva potreba za istraživanjem novih materijala i/ili smjesa koje smanjuju udio skupocjenog treseta u supstratima. U ovom radu procijenit će se izvedivost smanjenja sadržaja treseta u supstratima njegovom zamjenom s različitim količinama diatometa i mulja iz otpadnih voda za rast sadnica običnog bora (Pinus sylvestris L.) te njihovo preživljavanje na terenu. Kako bi se procijenila izvedivost smanjenja sadržaja treseta u supstratima zamjenom s različitim količinama diatometa i mulja iz otpadnih voda, provedeno je istraživanje u stakleniku, pod prirodnim svjetlom i u kontroliranim temperaturnim uvjetima. Između 2013. i 2017. godine u mjestu Sarıkamış, Kars (SI Anadolija) pokrenuto je istraživanje kojim će se procijeniti učinak koje zemljište ima na sadnice običnog bora koje rastu u različitim supstratima. Visoko organske tvari te makro i mikrohranjivi sastojci koji se nalaze u mulju iz otpadnih voda poboljšali su sastav rizosfere. što je rezultiralo bržim rastom sadnica. Kao rezultat evaluacija obavljenih u pogledu morfoloških karakteristika sadnica i utjecaja koji zemljište ima na preživljavanje sadnica; najbolji učinak postignut je u 9. (50%P + 50%SS) i 3. smjesi (75%SS + 25%DE)

Effect of carvedilol on silent anthracycline-induced cardiotoxicity assessed by strain imaging: A prospective randomized controlled study with six-month follow-up

Background: The use of antracycline (ANT) in breast cancer has been associated with adverse cardiac events. Two-dimensional (2D) strain imaging (SI) can provide a more sensitive measure of altered left ventricular (LV) systolic function. We aimed to evaluate the preventive effect of carvedilol administration assessed by SI in a patient with breast cancer treated with ANT.Methods: Patients receiving ANT were randomly assigned to the carvedilol- or placebo-receiving group. Each received an echocardiographic examination with conventional 2D echocardiography, pulsed tissue Doppler, and 2D SI prior to and 6 months post ANT treatment.Results: During the 6-month follow-up period there were no patient deaths or interrupted chemotherapy treatments due to doxorubicin-induced cardiotoxicity. Both left ventricular ejection fraction (LVEF) and fractional shortening (FS) were within normal limits for all patients before and after ANT therapy. EF, FS and LV dimensions were measured using M-mode echocardiography and found to be similar in both groups before and after ANT therapy. The mean EF, FS, and LV echocardiograph baseline and control dimensions were similar in both groups after 6 months. Though baseline SI parameters were similar between the groups, there was a significant decrease in LV basal septal and basal lateral peak systolic strain in the control group compared to the carvedilol group.Conclusions: These results indicate that carvedilol has a protective effect against the cardiotoxicity induced by ANT.

N-(Di)icosyl-substituted benzo[a]phenoxazinium chlorides : synthesis and evaluation as near-infrared membrane probes

Five benzo[a]phenoxazinium chlorides containing alkyl chains with twenty carbon atoms on 5- or 9-positions of the tetracyclic ring were efficiently synthesised and characterised by UV/Vis/NIR spectroscopy. The absorption and emission maxima in ethanol lie in the range 627-641 nm and 645-676 nm, respectively, with quantum yields varying from 0.14 to 0.38. Preliminary photophysical studies with these fluorochromophores in zwitterionic (2,3- bis(palmitoyl-oxy)propyl-2-(trimethylammonio)ethyl phosphate, DPPC) and cationic (N,N-dimethyl-N-octadecyloctadecan-1-aminium bromide, DODAB) vesicles were carried out. The results showed that the new benzo[a]phenoxazinium derivatives are able to detect the gel to liquid-crystalline lipid phase transition through variations, either in the H-aggregation extent or in an acid-base equilibrium.Fundação para a Ciência e Tecnologia (FCT) - REDE/1517/RMN/2005Fundo Europeu de Desenvolvimento Regional (FEDER) - POCI 201

Dobrava Hantavirus Infection Complicated by Panhypopituitarism, Istanbul, Turkey, 2010

We identified Dobrava-Belgrade virus infection in Turkey (from a strain related to hantavirus strains from nearby countries) in a patient who had severe symptoms leading to panhypopituitarism, but no known risk for hantavirus. Our findings emphasize the need for increased awareness of hantaviruses in the region and assessment of symptomatic persons without known risk factors for infection

Bifosfonat Kullanımına Bağlı Olarak Maksillada Kemik Nekrozu Oluşumu: Bir Olgu Sunumu

Amaç: Bifosfonatlar, metastatik kemik kanserlerin önlenmesinde ve osteopörözün tedavisinde kullanılmaktadır. İntravenöz (i.v) bifosfonat (pamidronat, zoledronat) tedavisine bağlı olarak çene kemiklerinde osteonekroz gelişmektedir. Bu vaka raporu ile kliniğimize başvuran hastanın tedavisi sunulmuştur. Vaka Raporu: Kliniğimize başvuran 51 yaşındaki kadın hastada, uzun süreli intravenöz bifosfonat kullanımına bağlı sol maksilla molar bölgesinde asemptomatik osteonekroz görülmüştür. Hastaya gerekli debridman, sekestrasyon ve hiperbarik oksijen tedavisi uygulanmıştır. Hasta belirli aralıklarla takip edilmektedir. Sonuç: Bifosfonat kullanımına bağlı oluşan osteonekroz, i.v. bifosfonat kullanımının artmasına bağlı olarak daha sık görülmektedir. Bu nedenle bifosfonat tedavisi görecek olan hastaların oluşabilecek komplikasyonların engellenmesi amacıyla, tedavi öncesinde diş hekimine yönlendirilip, tüm dental tedavilerinin yapılması önerilmektedir

Time kill-assays of antibiotic combinations for multidrug resistant clinical isolates of OXA-48 carbapenemase producing Klebsiella pneumoniae

Treatment of infections caused by OXA-48 carbapenemase producing multidrug-resistant isolates often necessitates combination therapy. In vitro effect of different antibiotic combinations against multidrug-resistant (MDR) Klebsiella pneumoniae isolates were evaluated in this study.Meropenem-tobramycin (MER+TOB), meropenem-ciprofloxacin (MER+CIP), colistin-mer-openem (COL+MER), colistin-ciprofloxacin (COL+CIP) and colistin-tobramycin (COL+TOB) combinations were tested by time kill-assays. Each antibiotic alone and in combination at their Cmax values were tested against 4 clinical K. pneumoniae isolates at 1, 2, 4, 6, 8, 12 and 24 h. Effect of colistin and its associations were also assessed at 30 min. Bactericidal activity was defined as >= 3log10 CFU mL-1 decrease compared with initial inoculum. Synergy was defined as >= 2log10CFU mL-1 decrease by the combination compared with the most active single agent. Presence of blaOXA-48, blaNDM, blaVIM, blaIMP, blaKPC and blaCTX-M-1 genes was screened by PCR using specific primers.The blaOXA-48 gene was identified together with blaCTXM-1 group gene in all isolates. COL+MER demonstrated to be synergistic and bactericidal. MER+TOB showed synergistic and bactericidal effect on two strains although, regrowth was seen on other two strains at 24 h. MER+CIP exhibited indif-ferent effect on the strains.Combination therapy could be a potential alternative to treat MDR K. pneumoniae infections. This combination might prevent resistance development and secondary effects of colistin monotherapy. MER+TOB and MER+CIP might have an isolate-dependent effect, that may not always result in synergism