Mikrobiyol Bul
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Infections due to methicillin-resistant Staphylococcus aureus (MRSA) are important health care problems since they are usually multidrug resistant. Although MRSA is isolated especially from nosocomial infections, community-acquired MRSA infections are increasing. Methicillin resistance is due to the expression of mecA gene, which is located on SCCmec gene cassette. ⋯ Two of the three SCCmec type IV strains were type IVa. Ten (2.2%) PVL positive strains, three of which were from the control group; were all methicillin susceptible S.aureus (MSSA). Although PVL positive MRSA was not common, detection of SCCmec type IVa, a marker for CAMRSA, and PVL positive MSSA strains which might act as a reservoir for PVL positive MRSA, indicated the importance of ongoing surveillance for MRSA.
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Pseudomonas aeruginosa is a well-known cause of severe and potentially life-threatening infections including bacteremia, skin and wound infections, pulmonary disease, especially among individuals with cycstic fibrosis, nosocomial urinary tract infections, endocarditis and meningitis. The mechanism of resistance to broad-spectrum beta-lactams in P.aeruginosa are overexpression of cephalosporinases and/or class A, B and D beta-lactamases. Recently PER-1 type beta-lactamase has been reported from Turkey, France, Italy, Romania, Hungary, Belgium, Russia, South Korea and India. ⋯ The MEXR gene was identified in 52% of the isolates. Antibiotic resistance mechanisms in P.aeruginosa strains seems to be complex. Determination of the resistance mechanisms and antibiotic susceptibility rates in P.aeruginosa will guide the proper antimicrobial therapy, reducing the emergence of resistant strains.
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Q fever which is caused by Coxiella burnetii, is a worldwide zoonosis. Many species of wild and domestic mammals, birds, and arthropods, are reservoirs of C.burnetii in nature, however farm animals are the most frequent sources of human infection. The most frequent way of transmission is by inhalation of contaminated aerosols. ⋯ Acute Q fever diagnosis of the cases were based on the positive results obtained by C.burnetii Phase II IgM and IgG ELISA (Vircell SL, Spain) test, and the serological diagnosis were confirmed by Phase I and II immunofluorescence (Vircell SL, Spain) method. Both cases were treated with doxycycline for 14 days and became afebrile within four days. These cases were presented to emphasize that C.burnetii infection should be considered in the differential diagnosis of patients with fever and elevated serum transaminase levels, irrespective of the presence of abdominal pain and exposure to potentially infected animals.
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Helicobacter pylori is reported as the etiological agent of gastritis, gastric and duodenal ulcer, gastric adenoid carcinoma and mucosa-associated lymphoid tissue lymphoma. In the diagnosis of H.pylori infections invasive (culture, histopathological examination, rapid urease test and molecular tests) and non-invasive (urea breath test, serological tests, stool culture and stool antigen/nucleic acid tests) methods may be used. Clarithromycin, amoxicillin and combination of metronidazole and protonpump inhibitor or ranitidine bismuth citrate triple treatment protocol is applied in order to treat and eradicate the infection. ⋯ The sensitivity and specificity of urease and HpSA tests were found to be similar. In conclusion, in cases which endoscopy could not be done, non-invasive, rapid and practical HpSA method can be used in diagnosis and monitorization of the treatment. In the case of treatment failure, culture should be performed for antibiotic susceptibility testing of the isolate.
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Comparative Study
[Comparison of endotracheal aspiration and mini-BAL culture results in the diagnosis of ventilator-associated pneumonia].
The objective of this study was to compare the results of cultures obtained by mini-bronchoalveolar lavage (BAL) and endotracheal aspiration (ETA) techniques, used for rapid and accurate determination of pathogens causing ventilator-associated pneumonia (VAP) in intensive care units. Of the 92 patients on mechanical ventilation followed at the emergency intensive care unit of our hospital between June 2010 and June 2011, 30 (32.2%) patients were diagnosed as VAP and they were included in this study. VAP diagnosis were based on the clinical and radiological findings. ⋯ Similarly, of the six negative ETA samples, 5 (83%) yielded bacterial growth (two E.coli, two K.pneumoniae, one P.aeruginosa) in mini-BAL samples. Statistical analysis with Spearman test indicated no positive correlation between the culture results of mini-BAL and ETA (p= 0.464), and the concordance between the culture results of those methods was found as 50%. It was concluded that the use of mini-BAL instead of ETA samples for the isolation of causative microorganisms of VAP seemed to be more useful due to the high contamination risk in ETA culturing techniques and higher bacterial isolation rates in mini-BAL sampling.