Mikrobiyol Bul
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Drug resistance in tuberculosis is a growing global problem. The emergence of multi-drug resistant tuberculosis cases, particularly in the 1990s, has become an important health problem and threatens tuberculosis control worldwide. Resistance to isoniazid and rifampicin, two of the most potent anti-tuberculosis drugs currently available, in multi-drug resistant tuberculosis cases is clinically quite important. ⋯ Recently, a new form of tuberculosis, resistant to all first-and second-line anti-tuberculosis drugs seen in just a few number of cases, has been defined as extremely drug resistant tuberculosis and this is the end point in resistance problem in tuberculosis. In the view of this situation the stages of tuberculosis in terms of developing resistance are as follows: drugsensitive tuberculosis, mono-drug resistant tuberculosis, poly-drug resistant tuberculosis, multi-drug resistant tuberculosis, extensively drug resistant tuberculosis, and extensively drug resistant tuberculosis. In this review, the recent information about drug resistant tuberculosis forms, particularly extremely drug resistant tuberculosis that has been popular since 2005, has been discussed.
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The majority of catheter-related bloodstream infections (CR-BSI) are associated with central venous catheters (CVCs) and most of them develop in patients staying at intensive care units (ICUs). The aim of this study was to assess the performance of different methods for the diagnosis of CR-BSI in neurology and neurosurgery ICUs of our hospital. This prospective study was carried out between January 2007 and January 2008 and all of the patients were followed daily for CR-BSI after the insertion of CVCs. ⋯ Sensitivity and NPV of the isolation method of the same microorganism from blood culture drawn through the catheter and drawn from the peripheral vein were 100%, specificity was 85% and PPV was 88% for the diagnosis of CR-BSI. Sensitivity, specificity, PPV and NPVs of Gram and drawn simultaneously from the peripheral vein and quantitative and semiquantitative cultures of the catheter tip in patients with removed catheter, were important factors in terms of diagnosis of CR-BSI. It was also concluded that AO staining could provide additional benefit in the diagnosis of CR-BSI since it has higher sensitivity, specificity, PPV and NPVs for peripheral blood cultures and catheter tip cultures compared to Gram staining.
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Infections caused by extended-spectrum beta-lactamase (ESBL) producing Escherichia coli and Klebsiella spp. constitute severe problems. Carbapenems are commonly used to treat these infections. However, infections caused by carbapenem-resistant gram-negative bacteria show an increasing trend recently. ⋯ While two Klebsiella spp. İsolates were resistant to all of the tested carbapenems (MIC > 32 µg/ml), two E.coli isolates were resistant to ertapenem (MIC > 32 µg/ml) but susceptible to imipenem (MIC= 0.25 µg/ml) and meropenem (MIC= 0.5 µg/ml). Carbapenemase production was demonstrated by modified Hodge test in all of the carbapenem-resistant isolates. In conclusion, ESBL-producing gram-negative isolates should be routinely tested with a screening method for carbapenemase activity and confirmation tests should be performed in suspected cases.
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Toxigenic Clostridium difficile strains cause a spectrum of antibiotic-associated diseases ranging from self-limited diarrhea to severe life-threatening colitis. Pathogenesis primarily involves the action of two important cytotoxins, namely toxin A and toxin B. However, epidemics of C.difficile-associated disease due to the novel, highly virulent strains of C.difficile (binary toxin positive and toxin A variant) have been recognised in hospitals of some countries. ⋯ Our results have also indicated that 77.8% (28/36) of patients who harbored toxigenic C.difficile strains have the history of beta-lactam antibiotic (penicillin, cephalosporin and imipenem) use. It was thought that the data of this study would constitute a database on the toxin gene profiles of C.difficile in hospitalized patients with diarrhea both in our hospital and Turkey. The current data have indicated that for the time being there were no risk for isolates producing new toxin variants or binary toxin, however, continuous monitorization of such C.difficile strains is of crucial importance in order to detect the emergence of those strains and establish necessary control and preventive measures.
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Tularemia is a disease caused by Francisella tularensis and widely seen at northern hemisphere of the world. In Turkey, oropharyngeal infections caused by a less virulent serotype F.tularensis subsp. Holarctica are more prevalent. ⋯ The cases presenting with throat sore, fever, lymphadenopathy (more than 2 cm), non-responsive to beta-lactam antibiotics, should be further investigated for tularemia. This work emphasizes that systematic setup and control of water disinfection systems are crucial to prevent tularemia outbreaks. Community and related authorities should be educated about the importance of water sanitation and chlorination.