Süleyman Durmaz

Locking Tunneled Hemodialysis Catheters with Hypertonic Saline (26% NaCl) and Heparin to Prevent Catheter-Related Bloodstream Infections and Thrombosis: A Randomized, Prospective Trial

Objective: Tunneled cuffed dual-lumen catheters (TCCs) are commonly used for vascular access in hemodialysis (HD) patients. Catheter-related bloodstream infection (CRBSI) is the major problem leading to morbidity and mortality. We investigated whether 26% NaCl solution has any favorable effect on the infections and thrombosis caused by HD catheters. Methods: TCCs were locked with either 26% NaCl and heparin or standard heparin. The primer end point of the study was the CRBSI or thrombosis of the TCC. We compared the antimicrobial activity of the NaCl solutions (6.5%, 13%, 26%) with 0.9% NaCl solution by time–kill kinetic assay. All tests were performed in triplicate by incubation of test fluids with Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, and Staphylococcus epidermidis. Results: The mean catheter survival was significantly higher in the 26% NaCl and heparin group (129.5 ± 50.1 catheter days to 103.3 ± 59.8, p = 0.008). CRBSI rates (10–15.4%) did not differ significantly between the two groups (p = 0.54). The hypertonic 13% NaCl solution had bactericidal effects on E. coli and P. aeruginosa, but had bacteriostatic effect on S. aureus and S. epidermidis. Conclusion: In this study we demonstrated that the 13% NaCl solution and more hypertonic NaCl solutions revealed potent in vitro antimicrobial properties against all checked Gram-negative microorganisms.

Bir hastanede gaita örneklerinde direkt mikroskopik inceleme ve ELISA ile Entamoeba histolitika araştırılması

Objectives: Stool antigen assay has been shown to be as sensitive and specific as culture with isoenzyme analysis and to outperform microscopy for the detection of E.histolytica in endemic area. The aim of the present study is to investigate the presence of E.histolytica by direct microscopic examination and ELISA in stool samples, comparatively. Materials and methods: Between September 2010 and May 2011, a total of 975 stool samples of patients in different age groups were sent to microbiology laboratory

Diarrhea in peripheral stem cell transplant recipients: a developing country's experience

INTRODUCTION We aimed to determine the frequency and microbiological causes of diarrhea occurring during the first 100 days in allogeneic (allo-) and autologous (auto-) stem cell transplantation (SCT) patients. METHODOLOGY A total of 452 patients who underwent transplantation due to hematological or solid organ malignancy were included. From the administration of the conditioning regimen up to day 100 post-transplant, diarrhea cases lasting at least three days with a minimum of three episodes per day were evaluated. RESULTS Cases of diarrhea were observed in 94 patients out of 227 subjects who received allo-SCT and in 107 patients out of 225 who received auto-SCT. The incidence rate of diarrhea in both patients undergoing autologous and allogeneic transplant was 47.5% and 41.4%, respectively. The cause of the diarrhea could be detected in 20.5% of auto-SCT patients and in 30.8% of allo-SCT patients. Parasitic infections were frequently observed in both autologous and allogeneic transplant patients in the first 20 days. In the late period, significantly more patients developed diarrhea in the allo-SCT recipient group than in the auto-SCT recipients due to graft versus host disease (GVHD) and cytomegalovirus (CMV) colitis. CONCLUSIONS This study revealed the causes of diarrhea and the prevalence and factors of parasitic infections in transplant patients in Turkey. All causative factors of diarrhea should be considered in detail, feces analyses should be evaluated for each patient, and endoscopic biopsy samples should be obtained when required in immunosuppressive patients undergoing stem cell transplantation.

In vitro antimicrobial efficiency of different root canal sealers against Enterecoccus faecalis

Objective: The antibacterial effectiveness of four different sealers AH Plus, EndoRez, mineral trioxide aggregate (MTA) Fillapex, iRoot SP against Enterococcus faecalis was evaluated by time kill assay method in vitro . Materials and Methods: Four sealers are used in this study: An epoxy resin-based sealer, AH Plus (Dentsply, Maillefer, Switzerland), a polymethacrylate resin-based sealer, EndoRez (Ultradent, South Jordan, UT) and two calcium silicate-based sealers, MTA Fillapex (Angelus Solucxoes Odontologicas, Londrina, Brazil), iRoot SP (Innovative BioCreamix Inc., Vancouver, Canada). Each sealer was mixed according to manufacturers instructions. Five mg of each sealer was added to sterile tubes separately and evaluated at 20 min, 24 h, 7 days, and 30 days. Two tubes were used as positive and negative. Results: At the 20 th min AH Plus and iRoot SP were bactericidal, MTA Fillapex, and EndoRez were ineffective at the 20 th min. At the 1 st day MTA Fillapex was ineffective and rest of the sealers was bacteriostatic. At the 7 th day, only MTA Fillapex showed bactericidal effect, AH Plus, iRoot SP and EndoRez were bacteriostatic. At the 30 th day, MTA Fillapex was still bactericidal, AH Plus, iRoot SP, and EndoRez were still bacteriostatic. Conclusion: All root canal sealers tested were effective against E. faecalis . Fresh iRoot SP and fresh AH Plus had bactericidal action against E. faecalis . EndoRez has bacteriostatic behavior against E. faecalis . MTA Fillapex was the only sealer that could be bacteriocidal at 7 th and 30 th day.

Investigation of Epstein-Barr Virus and Parvovirus B19 DNA in Allogeneic Stem Cell Transplant Patients

Objective: We aimed to investigate posttransplant Epstein-Barr virus (EBV) and parvovirus B19 DNA in allogeneic stem cell transplant patients between 2009 and 2010. Materials and Methods: Forty-five adult patients in whom allogeneic stem cell transplantation was performed between April 2009 and November 2010 in the Erciyes University Faculty of Medicine, Department of Internal Medicine, Division of Hematology and Oncology, were included in the study. EBV and parvovirus B19 DNA positivity was investigated by using real-time polymerase chain reaction technique in 135 plasma samples obtained after transplantation at between 1 and 6 months. Pretransplant serological markers of EBV and parvovirus B19 were provided from patient files. Results: In 32 (71.1%) of the patients, EBV antibodies in the pretransplantation period were as follows: anti-EBNA-1 IgG (+), VCA IgM (-), and VCA IgG (+). In 2 patients (4.45%), these antibodies were as follows: anti-EBNA-1 IgG (+), VCA IgM (-), and VCA IgG (-). In 1 patient (2.2%), they were as follows: anti-EBNA-1 IgG (-), VCA IgM (-), and VCA IgG (+). EBV serological markers were negative in 2 (2.2%) out of 45 patients before transplantation. There was low DNA positivity (<600 copies/mL) in 4 patients (8.9%), and VCA IgM was negative and VCA IgG was positive in these same 4 patients. In spite of low viral load, there were no symptoms related to EBV, and posttransplant lymphoproliferative disorder (PTLD) did not occur. While in 44 (99.7%) of 45 patients parvovirus B19 IgM was negative and IgG was positive, parvovirus B19 IgM was positive and IgG was negative in 1 (2.3%) patient. Parvovirus B19 DNA was not identified in any of the samples obtained from these 45 patients. Conclusion: In this study, EBV and parvovirus B19 DNA were investigated in allogeneic stem cell transplant patients. None of the patients developed PTLD and parvovirus B19 DNA positivity was not detected. However, this issue needs to be further evaluated in prospective, multicenter studies with larger series of patients.

Molecular epidemiology of quinolon resistant strains of extended spectrum beta-lactamase producing Escherichia coli

Objective: To determine the clonal relationship of ESBL-producing and quinolone resistant E.coli strains and to investigate the risk factors for infections with these microorganisms. Methods: A total of 95 ESBL-producing and quinolone resistant E.coli strains isolated from various clinical specimens of inpatients and outpatients in our hospital were included in the study. Risk factors for infections with ESBL-producing E.coli and demographic data of the patients were obtained from hospital records. The rep-PCR method was used for the determination of the genetic relationship of the strains. Results: Of the strains included in the study, 33(34.7%) were isolated from inpatients and 62(65.3%) from outpatients. At least one risk factor has been identified in all patients for infection with ESBL producing E.coli and the mean of the risk factors of patients was 4.2. The most common risk factor was urinary catheter insertion (57.9%). The distribution of the strains in each clone was as fallows: clone A: 9(9.5%), clone B: 10(10.5%), clone C: 38(40%), clone D: 12(12.5%), clone E: 6(6.3%), clone F: 7(7.3%) and clone G 5(5.3%). The clones A, D and C (dominant clone) were isolated from hospital and community acquired infections. Clones E, F and G were identified as nosocomial clones. Conclusion: Infections with multidrug resistant bacteria may be related to the hospital although they were isolated from outpatients. Developing a medical record system is vitally important to prevent the occurence and spread of resistant bacterial infections in the community.