Sibel Gundes

Extended-spectrum beta-lactamases in ceftazidime-resistant Escherichia coli and Klebsiella pneumoniae isolates in Turkish hospitals.

PURPOSE To study the prevalence of TEM-, SHV- and GES-type beta -lactamases among Escherichia coli and Klebsiella pneumoniae strains having ceftazidime MICs higher than 2 mg/L. METHODS A total of 63 E. coli and 41 K. pneumoniae isolated from five different university hospitals were studied for the existence of TEM-, SHV- and GES-type beta -lactamases. Susceptibility tests were carried out according to the criteria of National Committee for Clinical Laboratory Standards. MICs were obtained by agar dilution method. Existence of extended-spectrum beta -lactamases (ESBLs) were assessed by double-disc synergy test (DDST). Existence of the above-mentioned beta -lactamase genes were studied both by PCR with specific oligonucleotide primers and isoelectric focusing methods. RESULTS None of the isolates were carbapenem-resistant. DDSTs were positive in 50 (79.3%) and 33 (80.5%) of E. coli and K. pneumoniae , respectively. TEM gene was detected in 41 (65.1%) and 19 (46.3%), whereas SHV gene in 18 (28.6%) and 20 (48.8%) of E. coli and K. pneumoniae strains, respectively. GES genes were not detected. CONCLUSIONS TEM and SHV genes are highly prevalent among ESBL-producing E. coli and K. pneumoniae , whereas GES-type ESBLs are absent and found not to be responsible of ceftazidime resistance in Turkish hospitals.

A national survey of surgical antibiotic prophylaxis in Turkey.

OBJECTIVE To assess the quality of antibiotic prophylaxis for clean and clean-contaminated elective surgical procedures. DESIGN A cross-sectional, country-wide survey. SETTING Thirty-six hospitals in 12 cities in Turkey. PARTICIPANTS Four hundred thirty-nine surgeons from 6 different specialties who performed selected procedures of interest. METHODS A random sample of surgeons from different hospitals was selected. A standardized data collection form was used to record the type of procedure, the names, doses, timing of the first doses, and duration of antibiotics, important decisive factors, and problems in the management of prophylactic antibiotic use for surgical procedures. RESULTS Fifty-five percent of surgeons addressed completed the survey. For clean-contaminated procedures, 6% of surgeons did not use antibiotic prophylaxis, whereas 88% used more than a single dose. Inappropriate antibiotics were chosen for 32% of procedures. In 39% of procedures, the first dose of antibiotics was not administered during induction of anesthesia. Duration of prophylaxis was longer than 24 hours in 80% and longer than 48 hours in 46% of all procedures. Only 112 surgeons (26%) were using definitely appropriate prophylaxis in all ways. Multivariate analysis revealed that surgeons in university hospitals (OR, 2.353; CI95, 1.426-3.884; P = .001) and general surgeons (OR, 4.986; CI95, 2.890-8.604; P < .001) used antibiotic prophylaxis more appropriately. Patients not covered by health insurance (OR, 0.417; CI95 0.225-0.772; P < .001) were associated with inappropriate prophylaxis. CONCLUSION Given the high frequency of antibiotics prescribed for surgical prophylaxis in Turkey, adherence to surgical prophylaxis guidelines is urgently needed.

Efficacy and Tolerability of Antibiotic Combinations in Neurobrucellosis: Results of the Istanbul Study

ABSTRACT No data on whether brucellar meningitis or meningoencephalitis can be treated with oral antibiotics or whether an intravenous extended-spectrum cephalosporin, namely, ceftriaxone, which does not accumulate in phagocytes, should be added to the regimen exist in the literature. The aim of a study conducted in Istanbul, Turkey, was to compare the efficacy and tolerability of ceftriaxone-based antibiotic treatment regimens with those of an oral treatment protocol in patients with these conditions. This retrospective study enrolled 215 adult patients in 28 health care institutions from four different countries. The first protocol (P1) comprised ceftriaxone, rifampin, and doxycycline. The second protocol (P2) consisted of trimethoprim-sulfamethoxazole, rifampin, and doxycycline. In the third protocol (P3), the patients started with P1 and transferred to P2 when ceftriaxone was stopped. The treatment period was shorter with the regimens which included ceftriaxone (4.40 ± 2.47 months in P1, 6.52 ± 4.15 months in P2, and 5.18 ± 2.27 months in P3) (P = 0.002). In seven patients, therapy was modified due to antibiotic side effects. When these cases were excluded, therapeutic failure did not differ significantly between ceftriaxone-based regimens (n = 5/166, 3.0%) and the oral therapy (n = 4/42, 9.5%) (P = 0.084). The efficacy of the ceftriaxone-based regimens was found to be better (n = 6/166 [3.6%] versus n = 6/42 [14.3%]; P = 0.017) when a composite negative outcome (CNO; relapse plus therapeutic failure) was considered. Accordingly, CNO was greatest in P2 (14.3%, n = 6/42) compared to P1 (2.6%, n = 3/117) and P3 (6.1%, n = 3/49) (P = 0.020). Seemingly, ceftriaxone-based regimens are more successful and require shorter therapy than the oral treatment protocol.

Genetic and Enzymatic Properties of Metallo-β-Lactamase VIM-5 from a Clinical Isolate of Enterobacter cloacae

ABSTRACT A VIM-5-producing Enterobacter cloacae isolate (EDV/1) was identified in a collection of clinical strains stored before 2002. The gene, blaVIM-5, was located on a 2,712-bp BamHI-HindIII fragment of a 23-kbp (approximately) nonconjugative plasmid (pEDV5) in a class 1 integron as a single gene cassette.

Characterization of Extended-Spectrum β-Lactamase (TEM-52)-Producing Strains of Salmonella enterica Serovar Typhimurium with Diverse Resistance Phenotypes

ABSTRACT Two Salmonellaenterica serovar Typhimurium strains from different clonal origins, both producing an extended-spectrum β-lactamase (TEM-52), were isolated from a patient. This enzyme was encoded on a single plasmid and was found at very low levels in one strain, while being encoded on multiple plasmids and in multiple different EcoRI fragments in the other strain.

Transient Increase in Diarrheal Diseases after the Devastating Earthquake in Kocaeli, Turkey: Results of an infectious disease surveillance study

Immediately after the devastating earthquake in Turkey in August 1999, an infectious disease surveillance system was established in Kocaeli Province (the biggest area affected). This surveillance study was mainly focused on diarrheal diseases. During a 33-day period, 1,468 stool cultures were processed. Diarrheal diseases increased step-by-step and later decreased to the initial level by the end of this period. Cases were scattered throughout the entire region, and the identified causes were various, indicating a multifocal increase. Of the identified causes, Shigella species were the most common. Nevertheless, Shigella isolates also belonged to distinct serotypes and clones. This study indicated a multifocal, multiclonal increase in diarrheal diseases after this massive disaster, thus indicating the necessity to set up infectious disease surveillance systems after such events.

Mortality indicators in pneumococcal meningitis: therapeutic implications

BACKGROUND The aim of this study was to delineate mortality indicators in pneumococcal meningitis with special emphasis on therapeutic implications. METHODS This retrospective, multicenter cohort study involved a 15-year period (1998-2012). Culture-positive cases (n=306) were included solely from 38 centers. RESULTS Fifty-eight patients received ceftriaxone plus vancomycin empirically. The rest were given a third-generation cephalosporin alone. Overall, 246 (79.1%) isolates were found to be penicillin-susceptible, 38 (12.2%) strains were penicillin-resistant, and 22 (7.1%) were oxacillin-resistant (without further minimum inhibitory concentration testing for penicillin). Being a critical case (odds ratio (OR) 7.089, 95% confidence interval (CI) 3.230-15.557) and age over 50 years (OR 3.908, 95% CI 1.820-8.390) were independent predictors of mortality, while infection with a penicillin-susceptible isolate (OR 0.441, 95% CI 0.195-0.996) was found to be protective. Empirical vancomycin use did not provide significant benefit (OR 2.159, 95% CI 0.949-4.912). CONCLUSIONS Ceftriaxone alone is not adequate in the management of pneumococcal meningitis due to penicillin-resistant pneumococci, which is a major concern worldwide. Although vancomycin showed a trend towards improving the prognosis of pneumococcal meningitis, significant correlation in statistical terms could not be established in this study. Thus, further studies are needed for the optimization of pneumococcal meningitis treatment.

Isolated Necrotizing Epiglottitis: Report of a Case in a Neutropenic Patient and Review of the Literature

Isolated necrotizing epiglottitis (INE) is an unusual condition that may develop in immunocompromised patients. Only 3 cases of INE have been reported in the English-language literature; this is the fourth case, one in a 27-year-old woman who had neutropenia due to cytomegalovirus infection. Stenotrophomonas maltophilia and Candida albicans were isolated from the culture of necrotic material. The features of INE are discussed here by reviewing the literature and by examining the characteristics of this case.

Effect of vancomycin, teicoplanin, and cefuroxime on Staphylococcus epidermidis adherence to intraocular lenses

PURPOSE: To compare the adherence of Staphylococcus epidermidis on AcrySof (Alcon) and poly(methyl methacrylate) (PMMA) intraocular lenses (IOLs) treated with vancomycin, teicoplanin, and cefuroxime. SETTING: Kocaeli University, School of Medicine, Kocaeli, Turkey. METHODS: The lenses were contaminated with S epidermidis solutions containing 108 colony‐ forming units. Intraocular lenses were placed in sterile triptic soy broth after being held in antibiotic solutions for 15 minutes. After that, sonication and vortex procedures were performed to remove all the attached bacteria that could not be removed by antibiotics. Ten microliters from each broth were taken and inoculated into sheep blood agar. The colonies were counted overnight. The statistical analyses were made using Mann‐Whitney U and Kruskal‐Wallis tests, and a P value less than 0.05 was considered statistically significant. RESULTS: Regarding the inhibitory effect of antibiotics on bacterial adhesion, there was no statistically significant difference between AcrySof and PMMA lenses. In the cefuroxime group, the mean numbers of colony‐forming units on AcrySof and PMMA lenses were 35.2 ± 6.94 and 30.8 ± 18.69, respectively (P>.05). In the teicoplanin group, the mean number of colony‐forming units on AcrySof lenses was 100.1 ± 20.97 and 70.6 ± 43.75 on the PMMA lenses. The adherence in the vancomycin group was 245 ± 273.74 colony‐forming units for AcrySof lenses and 159.8 ± 101.94 for PMMA lenses (P>.05). Regarding the inhibitory effect of antibiotics, cefuroxime was the most effective, followed by teicoplanin and vancomycin, respectively. Overall, the mean numbers of colony‐forming units on the lenses that were held in cefuroxime, teicoplanin, and vancomycin solutions were 33.0 ± 13.90, 85.35 ± 36.66, and 202.4 ± 205.74, respectively (P = .000). CONCLUSIONS: The results suggest that cefuroxime, teicoplanin, and vancomycin significantly inhibit bacterial adherence to IOLs. The effect of cefuroxime on adherence inhibition was significantly higher than that of teicoplanin and vancomycin. Bacterial adherence is an important factor in bacterial virulence. Antibiotics, especially cefuroxime, can successfully inhibit bacterial adherence.

Primary brucellar psoas abscess: presentation of a rare case of psoas abscess caused by Brucella melitensis without any osteoarticular involvement

The psoas abscess is an entity, sometimes forgotten in our daily practice, because of infrequency and difficulties in diagnosis. Primary psoas abscess is very rare and gram‐positive micro‐organisms account for more than 80% of the cases. Our case, a 62‐year‐old man was admitted with a 5‐year history of back pain and fever. Physical examination was normal, except a palpable hepatomegaly with a mild tenderness over his lower right abdominal quadrant. The Brucella agglutination test was strongly positive with a titre of 1/640, as Rose Bengal Spot test. Blood cultures for brucella was positive on the fourth day and became negative, as the specific therapy started. Further examination with ultrasonography and computed tomography revealed an abscess of 40 + 75 mm in the psoas muscle. Complete resolution of symptoms achieved within 6 weeks. Although clinical presentation of psoas abscesses is often similar and non‐specific, early aetiological diagnosis is extremely important, because of high achievement with appropriate antibiotic regimens. Brucellar psoas abscess seems very rare even in Turkey, where Brucella is still highly endemic. Such a case has not been previously reported from Turkey, as far as we know.