Assessment of the requisites of microbiology based infectious disease training under the pressure of consultation needs

<p>Abstract</p> <p>Background</p> <p>Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists.</p> <p>Methods</p> <p>A cross-sectional study was carried out between June 1, 2010 and September 15, 2010 in 32 ID departments in Turkey. Only patients hospitalized and followed up in the ID departments between January-June 2010 who required consultation with other disciplines were included.</p> <p>Results</p> <p>A total of 605 patients undergoing 1343 consultations were included, with pulmonology, neurology, cardiology, gastroenterology, nephrology, dermatology, haematology, and endocrinology being the most frequent consultation specialties. The consultation patterns were quite similar and were not affected by either the nature of infections or the critical clinical status of ID patients.</p> <p>Conclusions</p> <p>The results of our study show that certain internal medicine subdisciplines such as pulmonology, neurology and dermatology appear to be the principal clinical requisites in the training of ID specialists, rather than internal medicine as a whole.</p

Nosocomial Gram-Negative Microorganisms: What Changed Over a 10-Year Period?

Introduction: In this study, the changes in the epidemiology and resistance profiles among nosocomial gram-negative microorganisms over a 10-year period were compared. Materials and Methods: The surveillance data accumulated in Gazi University Hospital during the periods January-July 1998 and January-December 2008 were compared. Nosocomial gram-negative microorganisms were obtained from the clinical specimens of the patients. The clinical and laboratory data of the patients were obtained from patient files, fever and drug charts and clinicians. Only the isolates related to nosocomial infections were included in the study. Antimicrobial susceptibility tests were performed by agar dilution method in 1998 and by disk diffusion test in 2008. Results: 251 gram-negative microorganisms isolated in 1998 and 888 isolated in 2008 were included in the study. The most frequently isolated microorganisms were Escherichia coli, Pseudomonas spp., Acinetobacter baumannii and Klebsiella spp. in 1998 and A. baumannii, E. coli, Pseudomonas spp. and Klebsiella spp. in 2008. An increase in the frequency of Acinetobacter isolates and a decrease in Pseudomonas and E. coli isolates were found to be statistically significant between 1998 and 2008. The percentages of gramnegative microorganisms isolated from intensive care units were 42% and 70% in 1998 and 2008, respectively. The most frequently seen nosocomial infection type was urinary tract infection in 1998 and pneumonia in 2008. Antimicrobial susceptibility test results revealed a statistically significant increase in resistance rates among the gram-negative microorganisms, especially in the Acinetobacter species, between 1998 and 2008. Conclusion: The frequency of Acinetobacter infections significantly increased over the study period. An increasing number of intensive care unit beds in our hospital resulted in changes in the frequency of nosocomial pathogens and nosocomial infection types, as well as a remarkable increase in resistance rates to antibiotics. The rapid development of antibiotic resistance among the gram-negative microorganisms, including to new antibiotics, necessitates the application of proper infection control measures and rational antibiotic use

Susceptibility to Teicoplanin and Daptomycin among Coagulase-Negative Staphylococci Isolated from Bloodstream Infections in Patients with Hematological Malignancies

Introduction: Recently, a decreased susceptibility to teicoplanin has been observed among coagulase-negative staphylococci (CNS) isolated from bloodstream infections in patients with hematological malignancies. In this study, we aimed to determine the minimum inhibitory concentrations (MIC) of teicoplanin, which is frequently used in the empirical treatment, and of a new agent, daptomycin, against CNS isolated from bloodstream infections. Materials and Methods: The study was performed on CNS strains isolated from bloodstream infections of patients with hematological malignancies during the period 2009-2011. Susceptibility to oxacillin was tested by disk diffusion method. Daptomycin and teicoplanin MIC were determined using the E-test method. Results: A total of 179 CNS strains causing bloodstream infections were studied. Among them, S. epidermidis (36.3%) and S. haemolyticus (35.2%) were the most frequent CNS species. The oxacillin resistance rate was found statistically higher among S. haemolyticus (61%) strains than among S. epidermidis (32%) (p= 0.001). Although teicoplanin and daptomycin resistance was not detected among the CNS isolates, two (1.1%) of the isolates demonstrated intermediate susceptibility to teicoplanin. Conclusions: S. haemolyticus and S. epidermidis were the major causes of bloodstream infections in patients with hematological malignancies. Oxacillin resistance was more frequent among S. haemolyticus isolates. Teicoplanin resistance was not detected among the CNS isolates. However, because two of the isolates demonstrated decreased susceptibility to teicoplanin, resistance rates to teicoplanin should be closely monitored. Daptomycin was found to be effective against both oxacillin-resistant and teicoplanin-intermediate CNS isolates

Community Acquired Lower Urinary Tract Infections in Primary Care: Causative Agents and Antimicrobial Susceptibility

Introduction: The aim of this study was to determine the causative agents of community-acquired lower urinary tract infections (CALUTIs) in primary care. We also aimed to evaluate the antimicrobial susceptibility rates of urinary Escherichia coli isolates to various oral antibiotics and to assist primary care physicians with antibiotic selection. Materials and Methods: The study was performed in 55 primary care centers in 13 cities between May and July 2009. Adult patients with at least two of dysuria, pollakiuria, nocturia, suprapubic tenderness, or blurred urine symptoms, but not fever, were included in the study. Urinary samples were obtained and patient data were recorded at the primary care centers. Results: Totally, 400 patients were enrolled. In 175 (43.8%) patients, urine cultures yielded a urinary pathogen. The most frequently encountered pathogen was E. coli (62.8%). Among E. coli isolates, the lowest resistance rates were detected for nitrofurantoin (0.9%) and fosfomycin (3.6%) and the highest for trimethoprim/sulfamethoxazole (43.6%) and amoxicillin/clavulanate (41%). Resistance rates to quinolones were 23.6% for ciprofloxacin and 21% for levofloxacin. Minimum inhibitory concentration (MIC)50 and MIC90 values for ciprofloxacin and levofloxacin were 0.015 and 32 μg/mL and 0.06 and 16 μg/mL, respectively. Quinolone resistance was significantly higher in patients who received an antimicrobial treatment within the last three months (p< 0.001). Extended spectrum beta-lactamase (ESBL) positivity was detected in 15 of 110 (13.6%) E. coli isolates. Quinolone resistance was significantly higher among ESBL positive than ESBL negative strains (53.3% vs. 15.8%, p= 0.002). Conclusion: In conclusion, the most frequent causative agent in CALUTIs was E. coli. The lowest resistance rates among E. coli isolates were detected for nitrofurantoin and fosfomycin. Resistance rates to quinolones were over 20% in our study. Our identifikasyostudy provides important data about the causative agents and their antibiotic susceptibilities and also contains valuable data for rational antibiotic usage in the treatment of CALUTI in Turkey

Assessment of the requisites of microbiology based infectious disease training under the pressure of consultation needs

Background: Training of infectious disease (ID) specialists is structured on classical clinical microbiology training in Turkey and ID specialists work as clinical microbiologists at the same time. Hence, this study aimed to determine the clinical skills and knowledge required by clinical microbiologists