Beril Ozbakkaloglu

Evaluation of rational antibiotic use

The emergence of antibiotic resistant bacteria is a major problem throughout the world and a rational use of antibiotics is therefore very important. This study was performed to estimate the appropriateness of antimicrobial drug use in Celal Bayar University Hospital in Manisa. The data of all inpatients (n=937) between October and December 1998 were collected according to the Kunin and Jones criteria. Of the patients, 16.6% (n=156) were receiving antibiotics, and in 63.5, 23.0 and 13.5% of these, a single, two and three agents were used, respectively. The purpose of antibiotic use was for prophylaxis in 23.9%, as an empiric decision in 71.4% and for therapeutic culture-based reasons in 4.7%. The rate of rational antibiotic use was 45.7% and it was statistically higher in those patients from whom specimens had been taken for culture than in patients receiving prophylactic or empiric antibiotics. On medical wards, rational antibiotic usage was 55.1%, while it was 26.3% in surgical wards (P<0.0001). The low rate of appropriate antibiotic use in our university hospital reflects the urgent need of rationalization.

Nurses’ knowledge regarding patients with intravenous catheters and phlebitis interventions

This study was planned and applied in 2 stages. Stage I was applied to determine the knowledge of nurses working in the internal medicine, surgery, obstetrics and gynecology, pediatrics, and other services in Celal Bayar University Hospital about using intravenous catheter and intravenous fluid treatment, and the symptoms and treatment procedure for phlebitis. Stage II consisted of observation of all patients who had intravenous catheters for symptoms of phlebitis for 5 days and the interventions the nurses used for the patients who had phlebitis. In stage I, questionnaires were used to determine the knowledge of the nurses; in stage II, 2 investigators observed the patients. Results were evaluated using SPSS software with chi(2) statistical analysis. Nurses were found to have high knowledge levels, but their practices were not suitable to their knowledge levels. Of the patients who participated in the study, 67.24% showed symptoms of phlebitis. We found that there was a significant relationship (P <.05) between the selection of the vein and the occurrence of phlebitis in patients who had an intravenous catheter. We also found that the relationships between the age groups of the patients and phlebitis and the relationships between the diagnosis and phlebitis were statistically significant (P <.05).

The Necessity of Culture for the Diagnosis of Tinea Pedis

Background:This study examined the consistency between the clinical diagnosis of tinea pedis and the results of direct fungal examination, prepared with 10% potassium hydroxide, and culture. Methods:2427 patients clinically diagnosed with tinea pedis who presented to the mycology laboratory were reviewed retrospectively for the outcomes of direct fungal examination and culture. Results:Direct examination was positive in 54.3% and culture was positive in 36.6% of the cases. The sensitivity and specificity of direct microscopy were 95.7% and 69.6%, respectively Conclusions:The clinical diagnosis of tinea pedis can be misleading, since it features lesions that can also be present in some other skin diseases and direct microscopy may be insufficient to confirm the diagnosis. Therefore, we suggest using culture for a definitive diagnosis.

E-Test: An Alternative Method for Susceptibility Testing of Mycobacterium tuberculosis

Objective: The purpose of this study was to compare the agar proportion method with the E-test method for susceptibility testing of Mycobacterium tuberculosis.Materials and Methods: A total of 100 isolates were tested for isoniazid, rifampin, streptomycin and ethambutol susceptibility using an indirect-proportion method as well as the E-test method. Results:Categorical agreement between the methods was 100% for isoniazid, rifampin, streptomycin, and ethambutol. Conclusion: The E-test method appears to be an alternative method to agar proportion for testing the susceptibility of M. tuberculosis isolates to the first-line antituberculous agents.

In vitro activity of ciprofloxacin, ofloxacin and levofloxacin against Mycobacterium tuberculosis

BACKGROUND The increasing incidence of drug-resistant Mycobacterium tuberculosis necessitates therapeutic alternatives. The fluoroquinolones fulfill most of the criteria for an ideal class of antimycobacterial drugs. The aim of the present study was to determine to in vitro activities of ciprofloxacin, ofloxacin, and levofloxacin against M. tuberculosis strains. METHODS Susceptibility to four antituberculous drugs used in first-line treatment of tuberculosis was tested in 100 strains isolated from clinical samples. Nineteen strains (19%) were resistant to at least one of the four antituberculous drugs and 13 were multidrug resistant. The in vitro antimycobacterial activity of ciprofloxacin, ofloxacin, and levofloxacin was then determined against 100 M. tuberculosis strains using standard agar proportion dilution method. RESULTS Ciprofloxacin, ofloxacin, and levofloxacin were active against all tested strains of M. tuberculosis in vitro. CONCLUSIONS Ciprofloxacin, ofloxacin, and levofloxacin have relatively potent in vitro activity against M. tuberculosis. Further in vivo studies are needed to determine the role of these compounds in the treatment of tuberculosis, but use should be limited to special circumstances rather than first-line treatment.

Prevalence of GBV-C/hepatitis G virus viremia among chronic hepatitis B, chronic hepatitis C and hemodialysis patients in Turkey.

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Prevalence of Anti-HCV Positivity in Hemodialysis Patients

Accessible online at: www.karger.com/journals/nef Dear Sir, Hepatitis C viruses (HCV) play important roles in the genesis of both acute and chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. The most frequent modes of transmission of this virus are via blood and blood products and via body secretions such as semen, saliva, and sweat. For this reason, hemodialysis (HD) patients undergoing repeated venipunctures and frequent blood transfusions constitute one of the most important risk groups [1]. In this study, 85 HD patients were screened for anti-HCV antibody positivity; the factors that were thought to cause this positivity were also investigated. Anti-HCV positivity was detected by using third-generation enzyme-linked immunosorbent assay kits (Sorin Biomedica). The data thus obtained were processed with the aid of the SPSS version 6 package program using chisquare and Student’s t tests where appropriate. Thirty-three out of total 85 HD patients were women, the remaining 52 were men. Their average age was 49 B 14.4 (range 20– 79) years. Thirty-three out of 85 patients were found to be anti-HCV positive (38.8%). HCV RNA could not be detected because of financial problems. While a statistically significant correlation was found between antiHCV positivity and HD duration (p = 0.001), anti-HCV positivity could not be found to be correlated with factors such as age, number of blood transfusions, number of HD sessions per week, and alanine aminotransferase level elevations (p 1 0.05). The prevalence of anti-HCV positivity when compared with the healthy population and blood donors living in the same geographic region is considerably higher. While the prevalence of anti-HCV positivity in the general population of Turkey is below 1%, this figure shows an enormous increase in the different HD populations, ranging from 14.4 to 79.1% [2]. The prevalence of antiHCV positivity in our HD patients is an intermediate one. A number of studies were conducted in order to elucidate the factors responsible for this high anti-HCV prevalence. While some studies underlined the importance of blood transfusions, others insisted that the number of blood transfusions is not important, the duration of dialysis being the vital determinant. In our study, too, an important correlation was observed with regard to the dialysis duration (p = 0.001) but not for the number of blood transfusions. The probable reason for this was thought to be the widespread use of recombinant human erythropoietin and the screening of blood and blood products for HCV. The correlation with the duration of dialysis tempted us to assume that the HD procedure itself could constitute a risk factor for the transmission of HCV. Sampietro et al. [3] insisted on the possibility of a nosocomial transmission as a result of the observation of a relative homogeneity and a rare variance of HCV strains in their HD facility. In concordance with this hypothesis is the fact that the prevalence of anti-HCV positivity is relatively lower in continuous ambulatory peritoneal dialysis and home HD patients. The most probable route of transmission in HD units is said to be the dialysis procedure itself not performed under strict infection control precautions and asepsis, via materials contaminated with infectious blood [4]. In conclusion, HD patients must be screened for hepatitis B surface antigen and anti-HCV positivity periodically and in the case of positivity, if possible, must be dialyzed in different rooms by different personnel. The patients must be kept informed about the modes of transmission and the outcome of these infections.