Hakan Aydogan

Assessment of the bacterial contamination on hands of hospital food handlers

This study was performed in order to determine the level of bacterial contamination on the hands of food handlers (n=30) who work in the kitchen of a military training hospital. A total of 180 samples were collected from bare and gloved hands before and during food preparation. A total of 16 different bacteria were isolated, of which the most common was Staphylococcus aureus (126/180; 70%), followed by coagulase-negative staphylococci (102/180; 56.7%), diphtheroid bacilli (39/180; 21.7%), Bacillus spp. (19/180; 10.5%), and Escherichia coli (14/180; 7.8%). Fifty-one of 60 (85%) gloved hand samples were collected during work, 57 (95%) of the bare hand samples were collected before work all of the bare hand samples collected during work were positive. Poor hand hygiene was indicated by high levels of S. aureus and E. coli on samples taken from bare and gloved hands. Although bacterial loads on gloved hand samples were found to be significantly lower (p<0.05) than ungloved hand samples, these loads were not within acceptable limits. These results show that the hands of food handlers are an important contamination source in this establishment. In this study, 203 bacterial isolates were from right hand samples while 166 bacterial isolates were from left hand samples (χ2=1.913; p<0.05). All of the food handlers were right-handed. Bacterial load isolated from the inexperienced food handlers was higher than those from experienced ones (χ2=2.024; p<0.05). As a result, the poor hand hygiene and improper glove use by the food handlers was emphasized and we concluded that the training in personal hygiene and food safety should be improved, and inexperienced personnel should not be employed in kitchens without being well trained. On the other hand, if glove use principles are performed correctly, it may be efficacious for decreasing of bacterial load on hands, particularly, establishments where hand hygiene control can not performed properly or inexperienced personnel are employed.

Acinetobacter septicus sp. nov. Association with a Nosocomial Outbreak of Bacteremia in a Neonatal Intensive Care Unit

ABSTRACT Acinetobacter species other than Acinetobacter baumannii have rarely been reported to be associated with nosocomial outbreaks of bloodstream infections. Within a period of 1 week, seven Acinetobacter-like isolates were recovered from peripheral blood and catheter specimens of five patients at a neonatal intensive care unit (NICU) in a tertiary hospital in Turkey. All five patients had placement of central venous catheters and had received total parenteral nutrition before the onset of bacteremia. Two of the five patients died. Medical devices, tap water, aerators, water samples, various surfaces, intravenous fluids, and the hands of health care workers in the NICU were sampled and were culture negative for the bacterium. All seven of the isolates had identical biochemical reactions, antimicrobial susceptibility results, and pulsed-field gel electrophoresis patterns, indicating a clonal nosocomial outbreak. A panel of standard biochemical reaction profiles and three phenotypic commercial identification systems failed to identify these isolates. Phenotypically, the isolate differed from Acinetobacter ursingii by its hemolysis on sheep blood agar and its negative citrate utilization. Sequences of the full 16S rRNA gene, which contained at least three different gene copies with polymorphic sequences between nucleotide positions 70 and 206, were determined from the first recovered isolate. The complete 1,529- to 1,531-bp 16S rRNA gene sequences and partial 801-bp rpoB gene sequences had similarities of 99.5% and 97.2%, respectively, to an A. ursingii isolate. The DNA-DNA similarities of the strain against the type strain of A. ursingii were 64.7 and 68.7%, which were lower than the recommended threshold value of 70% for the definition of bacterial species. These data indicate that a novel Acinetobacter organism caused the nosocomial outbreak of bacteremia in the NICU unit. We propose the designation of Acinetobacter septicus sp. nov. for these isolates, with isolate AK001 as the type strain.

Clinical presentations of chlamydial and non-chlamydial reactive arthritis

The aim of this study was to investigate the triggering micro-organisms and the clinical as well as laboratory differences between Chlamydial and non-chlamydial reactive arthritis (ReA) in a prospective study on 98 patients with acute/subacute arthritis. An inciting organism was found in 42 patients. Eighteen of these were chlamydial. Fifty-seven percent of all ReA patients were carriers for HLA-B27, which increased to 67% in the chlamydial group. Chlamydial ReA patients had more urethritis (P<0.05) with a longer period between arthritis and inciting infection, significantly lower CRP levels, and involved joint counts (P<0.05). Additionally, sacroiliitis was more frequent besides extra-articular manifestations in chlamydial ReA group. This study shows that chlamydial ReA differs in some points from non-chlamydial ReA, which in turn may affect the evaluation of an arthritic patient. ReA due to chlamydia more frequently encompasses a monoarticular or oligoarticular clinical picture with predominant distal extremity involvement. Non-chlamydial ReA presents higher joint counts and may involve upper extremity joints.