Yesim Gurol

Rotavirus and adenovirus frequency among patients with acute gastroenteritis and their relationship to clinical parameters: a retrospective study in Turkey

BackgroundDiarrhea is the third leading cause of death related to infectious diseases all over the world. The diseases related to viral gastroenteritis are gradually increasing, particularly in the developed countries. The purpose of our study was to determine the frequency and to investigate the clinical manifestations of acute rotavirus and adenovirus gatroenteritis and to assess the diagnostic value of the related clinical findings.MethodsIn 2007-2008 patients with diarrhea and/or vomiting attended to Yeditepe University Hospital and related clinics, Istanbul, were studied. The rotavirus and/or adenovirus antigen in stool of these patients were investigated. Data regarding clinical findings were collected from the electronic records, retrospectively. Age, gender, symptoms, fever, antibiotic use, vomiting, number of vomiting and diarrhaeae, dehydration, abdominal pain, the other pathological physical examination findings were analyzed by the physicians in the study group. To investigate the rotavirus and adenovirus antigen CerTest Rota-Adeno Blister Test (CerTest, Biotec, Spain), a qualitative immunochromotographic assay was used. Statistical analysis wasperformed with SPSS v. 11,5 statistical software. X2 test was used for bivariate and logistic regression analysis was used for multivariate analysis.ResultsRotavirus positivity was 18,7% (n = 126). Concomitantly, in 596 cases adenovirus antigen test were also performed. Adenovirus positivity was 8,9% (n = 53) and rota-adenovirus co-infection was 4,4% (n = 26). Most of rotavirus positive cases were seen in December, January, February and March (p < 0.001). In clinical parameters, there was a significant difference between rotavirus positive cases and negative cases regarding to vomiting, dehydration and vomiting and diarrhea coexistence (respectively p = 0.010, p < 0.00, p = 0.007).ConclusionRotavirus can be seen in all age groups, but more frequently in childhood. Although there is no clinical gold standard to distinguish the rotavirus cases from the other gastroenteritis agents, the findings of dehydration and vomiting-diarrhea coexistence, considering months of referral may lead clinician to perform rapid antigen tests and affect approach to the treatment. Prospective studies with representative samples are needed to determine the rotavirus and adenovirus incidence and to develop safe and reliable protective policies in our country.

The sensitivity and the specifity of rapid antigen test in streptococcal upper respiratory tract infections.

BACKGROUND It is aimed to detect the sensitivity and specificity of rapid antigen detection of group A beta hemolytic streptococci from throat specimen compared with throat culture. The other goal of the study is to help in giving clinical decisions in upper respiratory tract infections according to the age group, by detection of sensitivity and positive predictive values of the rapid tests and throat cultures. MATERIALS AND METHODS Rapid antigen detection and throat culture results for group A beta hemolytic streptococci from outpatients attending to our university hospital between the first of November 2005 and 31st of December 2008 were evaluated retrospectively. Throat samples were obtained by swabs from the throat and transported in the Stuart medium and Quickvue Strep A [Quidel, San Diego, USA] cassette test was applied and for culture, specimen was inoculated on 5% blood sheep agar and identified according to bacitracin and trimethoprim-sulphametaxazole susceptibility from beta hemolytic colonies. RESULTS During the dates between the first of November 2005 and 31st of December 2008, from 453 patients both rapid antigen detection and throat culture were evaluated. Rapid antigen detection sensitivity and specificity were found to be 64.6% and 96.79%, respectively. The positive predictive value was 80.95% whereas negative predictive value was 92.82%. Kappa index was 0.91. When the results were evaluated according to the age groups, the sensitivity and the positive predictive value of rapid antigen detection in children were 70%, 90.3% and in adults 59.4%, 70.4%. DISCUSSION When bacterial infection is concerned to prevent unnecessary antibiotic use, rapid streptococcal antigen test (RSAT) is a reliable method to begin immediate treatment. To get the maximum sensitivity of RSAT, the specimen collection technique used and education of the health care workers is important. While giving clinical decision, it must be taken into consideration that the sensitivity and the positive predictive value of the RSAT is quite lower in adult age group than in pediatric age group.

Do antibacterial mouthrinses affect bacteraemia in third molar surgery? A pilot study

BACKGROUND The aim of this pilot study was to evaluate the effects of mouthrinses containing 7.5% povidone iodine and 0.2% chlorhexidine on bacteraemia following impacted third molar surgery. METHODS Thirty-four patients were enrolled in this study. Patients in the first group were asked to rinse their mouth with the mouthrinse containing 7.5% povidone iodine, patients in the second group were asked to rinse with the mouthrinse containing 0.2% chlorhexidine and patients in the third group were asked to rinse with 0.9% NaCl (sterile saline) solution. All rinses were used for one minute preoperatively. Peripheral venous blood samples were collected at baseline (preoperatively), 1 and 15 minutes after the completion of surgical tooth removal. Each blood sample was divided in two, placed in aerobic and anaerobic culture bottles and processed for microbiological examination. RESULTS Bactaeremia was detected in 33% of the povidone iodine group, 33% of the chlorhexidine group and 50% of the control group. Isolated bacteria were 58% anaerobes and predominantly 92%Streptococcus species. Incidence of bacteraemia was reduced with chlorhexidine and povidone iodine mouthrinses in third molar surgery, although the difference was not statistically significant (p > 0.05). CONCLUSIONS Bacteraemia was reduced with antibacterial mouthrinses in third molar surgery. The results of this study should be confirmed with further studies conducted on a larger patient population and with different antibacterial mouthrinses.

A Retrospective Analysis of Acute Gastroenteritis Agents in Children Admitted to a University Hospital Pediatric Emergency Unit

Background: Acute gastroenteritis is responsible observed in all age groups, especially infants and children. The etiology and clinical course of acute gastroenteritis may vary with age and etiological agents. In developing countries, the morbidity and mortality associated with infectious diarrhea is higher in children younger than five-years-of-age. Objectives: The aim of this study was to determine the prevalence and seasonal distribution of the major agents of acute gastroenteritis in children who were admitted to a Turkish university hospital pediatric emergency unit during 2009. Patients and Methods: Seasonal distribution within a one year period and quantitative distribution were analyzed with demographic data and laboratory findings. A total of 644 subjects were enrolled in the study, with a mean age of 4.14 years. Pathogens were detected in 183 (28.4%) stool samples in children less than 16 years, admitted with acute gastroenteritis. Results: Pathogens were detected in 184 (28.4%) stool samples. The age distributions of the cases were 0 - 24 months (n = 59), 2 - 5 years (n = 100), and > 5 years (n = 25). The detection rate of rotavirus, norovirus and adenovirus were; 12.7% (75/588), 9.8% (51/520) and 4.9% (28/575), respectively. Bacterial agents were detected in 36 cases. The main agent was norovirus in the 0 - 24 months group (n = 25, 42.4%), and rotavirus for ages 2 - 5 years (n = 43, 43%) and > 5 years. On the monthly distribution, cases of rotavirus were found to be more frequent in the first four months of the year. Discussion: Viruses were the major pathogens in all age groups. Norovirus was the leading pathogen in the first two years. For the age groups 2 - 5 years and 6 - 16 years, rotavirus was the major pathogen.

Isolation rates and antibiotic susceptibilities of different Enterobacteriaceae species as urinary tract infection agents in Turkey: a systematic review

BACKGROUND/AIM In Turkey, few systematic reviews have analyzed the results of studies on the isolation rates of urinary tract infection agents and their antibiotic susceptibilities. This review was done to fill this gap and enable the correct application of guideline-based medical therapy by determining the isolation rates and antibiotic susceptibilities of different Enterobacteriaceae species in Turkey. MATERIALS AND METHODS Relevant studies found from various databases with the help of previously specified search strategies were examined and eliminated according to eligibility criteria. The remaining 22 studies were included in this systematic review. RESULTS Escherichia coli was the most frequently isolated species among all agents in both in- and outpatient settings. Only the antibiotic susceptibility data of E. coli could be analyzed because among the 22 studies only E. coli had adequate antibiotic susceptibility data to be analyzed. The calculated resistance rates of the most frequently preferred antibiotics (trimethoprim/sulfamethoxazole, ciprofloxacin, and ceftriaxone) were 46%, 32%, and 19% for outpatients and 54%, 48%, and 28% for inpatients, respectively. CONCLUSION The resistance profiles of commonly used antimicrobial agents are much higher than the thresholds set by international guidelines. Hence, treatment algorithms for urinary tract infections should be designed according to Turkeys antimicrobial resistance patterns.

How are ethical issues in the laboratory medicine held in Turkey? A perspective view through medical ethics and clinical laboratory science

In an era of “hi-tech” medicine; efficiency, technical sophistication and innovation cause many complicated ethical problems in Laboratory Ethics. Today up to 70% of medical diagnoses rely on different laboratory analyses and this situation emphasises the crucial role that laboratory ethics plays in patient care [1]. Although sustaining high ethical standards remains crucial in both clinical and laboratory practise, and ethical dilemmas are faced daily by laboratory physicians’; ethics does not receive the attention it deserves. Although personal knowledge of the patient is often lacking, the laboratory physician does have intimate knowledge of at least a part of the patientthe specimen-and an unusual three-way contract is made between clinician, laboratory physician and patient. This paper provides an overview on the main ethical issues of laboratory ethics through the perspectives of medical ethics and laboratory science. It is also aimed to show the necessity of education for the laboratory ethics.

An important agent in gastroenteritis: Campylobacter

Campylobacter infections are common in both developed and developing countries. The reported incidence of culture confirmed infections shows variability among countries due to culturing procedures. (1). Here we report laboratory-based surveillance data collected between 2013 and 2015 in Yeditepe University Hospital Microbiology Laboratory. Among 2807 feces cultures, Salmonella spp. (n=135), Campylobacter spp. (n=118), Aeromonas spp. (n=6) and Shigella spp. (n=3), isolates were detected. Out of 118 Campylobacter spp. isolates, the distribution was as follows: C. jejuni (n=101), C. upsaliensis (n=8), C. coli (n=6) and other species (n=3). The fecal samples were cultured in Campylobacter-BAP medium (Salubris, Turkey) and incubated under microaerophilic conditions (CampyGen, Oxoid, UK) at 42°C for 48 hours. Suspected colonies were examined by Gram stain and evaluated for oxidase and catalase positivity; and then were first confirmed by Campylobacter latex agglutination test (Dryspot, Oxoid, UK). They were identified by API CAMPY biochemical identification system (BioMerieux, France). Antimicrobial susceptibility of isolates against erythromycin was also tested with API CAMPY system (BioMerieux, France); ciprofloxacin and gentamicin susceptibilies were tested by E-test (bioMerieux, France). The distribution of isolates, demographic information and seasonal epidemiology in patients with Campylobacter positive cultures are shown. It seems there is no definite season for campylobacteriosis. We mostly isolate from the pediatric patients. (Table 1, Figure 1) Beyond detecting difficulties by culture, antibiotic resistance becomes a problem. In the EFSA/ECDC report 2013, the highest frequency of resistance was observed for nalidixic acid (47.8%) and ciprofloxacin (44.4%) followed by ampicillin (35.3%) and tetracycline (30.5%); low resistance levels were observed to erythromycin (3.5%) and gentamicin (0.4%). According to FDA/CDC/UDSA Report 2013 resistance to tetracycline was most common (45.9%), followed by ciprofloxacin (23.5% in C. jejuni and 35.8% in C. coli). Macrolide resistance was observed in 1.7%-2.7% (2). During the study period, our resistance rates were detected as 13% for erythromycin, 11% for ciprofloxacin. It seems a slight increase in erythromycin resistance in our strains comparing to 2009-2012 rates (from 7% to 13%) (3). No resistance was seen in gentamicin. Fecal culture procedures should be applied in our routine laboratories to see the surveillance of Campylobacteriosis and find our national rate in resistance to antibiotics.

ISO 15189 accreditation experience at the Microbiology Laboratory of a Turkish University Hospital

We aimed to share the experience of the ISO/IEC 15189:2007 accreditation process in a University Hospital’s Medical Microbiology Laboratory before and after the assessment, and tried to seek answers to some questions in applying the standard. Our ISO 15189 accreditation process began in 2008 after having acquired JCI accreditation in 2007. The aim was to be the first accreditated university hospital laboratory in our country. The applied tests in bacteriology, mycology, parasitology, virology, immunology and molecular serology were accreditated. We completed the validation and verification procedures mostly applied to quantitative analyses. Regarding the external quality controls and the internal controls, the corrective actions provided us great control and self correction. We increased the rate of success in the quality controls. We encouraged our laboratory personnel to fill out a laboratory discrepancy form to control our process and to arrange training. During the course of 2009, 60 of the 85 forms were completed in the microbiology laboratory among the central laboratories. Statistical analyses were performed throughout a year and this information helped us in making improvements. The number of training hours in one year was found as 78 h and 30 min during the routine laboratory process. We should provide support in bringing quality to laboratories in our country. As a matter of fact, having our own external quality controls is believed to bring cost effectiveness in acquiring an accreditation process.