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Background: Oxidative stress is defined as a disturbance of balance between free radicals and antioxidant defense system. This study investigated oxidative stress in patients with chronic hepatitis B., Methods: Sixty nine patients with chronic hepatitis B admitted to the Department of the Infectious Diseases and Clinical Microbiology of Medical Faculty of Ondokuz Mayis University were enrolled into study. Twenty healthy persons were included as a control group. The study group was divided into three groups: healthy controls (group 1), chronic hepatitis B (group 2), and inactive hepatitis B carriers (group 3). Antioxidant status of plasma, including glutathione, glutathione peroxidase, vitamin E, and vitamin C levels were measured. Carbonyl and lipid peroxidation levels were measured as parameters of oxidative stress., Results: Glutathione, glutathione peroxidase, vitamin E, and vitamin C levels were found to be significantly decreased in the chronic hepatitis B group when compared with the control group (9.5 vs. 13.8, p < 0.05; 22.98 vs. 32.4, p < 0.05; 15.1 vs. 16.4, p < 0.05; 12.9 vs. 18.4, p < 0.05, respectively). Carbonyl and lipid peroxidation levels were significantly increased in the chronic hepatitis B group compared to controls (0.7 vs. 0.5, p < 0.05; 2 vs. 0.7, p < 0.05, respectively). However, whereas the glutathione and carbonyl level correlation with HBV DNA levels were mild to moderate (glutathione vs. HBV DNA, r:-0.288, p < 0.05; carbonyl vs. HBV DNA, r:0.317, p < 0.05), the lipid peroxidation levels were strongly related with HBV DNA levels in chronic hepatitis B (r:0.545, p < 0.05)., Conclusions: Oxidative stress was significantly increased in hepatitis B patients. Consequently, decreases were seen at the level of protective antioxidative parameters in the blood of these patients.

Background: The International Nosocomial Infection Control Consortium (INICC) was established in 15 developing countries to reduce infection rates in resource-limited hospitals by focusing on education and feedback of outcome surveillance (infection rates) and process surveillance (adherence to infection control measures). We report a time-sequence analysis of the effectiveness of this approach in reducing rates of central line-associated bloodstream infection (CLABSI) and associated deaths in 86 intensive care units with a minimum of 6-month INICC membership., Methods: Pooled CLABSI rates during the first 3 months (baseline) were compared with rates at 6-month intervals during the first 24 months in 53,719 patients (190,905 central line-days). Process surveillance results at baseline were compared with intervention period data., Results: During the first 6 months, CLABSI incidence decreased by 33% (from 14.5 to 9.7 CLABSIs per 1,000 central line-days). Over the first 24 months there was a cumulative reduction from baseline of 54% (from 16.0 to 7.4 CLABSIs per 1,000 central line-days; relative risk, 0.46 [95% confidence interval, 0.33-0.63]; P < .001). The number of deaths in patients with CLABSI decreased by 58%. During the intervention period, hand hygiene adherence improved from 50% to 60% (P < .001); the percentage of intensive care units that used maximal sterile barriers at insertion increased from 45% to 85% (P < .001), that adopted chlorhexidine for antisepsis increased from 7% to 27% (P < .001), and that sought to remove unneeded catheters increased from 37% to 83% (P < .001); and the duration of central line placement decreased from 4.1 to 3.5 days (P < .001)., Conclusions: Education, performance feedback, and outcome and process surveillance of CLABSI rates significantly improved infection control adherence, reducing the CLABSI incidence by 54% and the number of CLABSI-associated deaths by 58% in INICC hospitals during the first 2 years.

Crimean-Congo haemorrhagic fever (CCHF) is a tick-borne infectious disease characterized by fever, malaise, headache, nausea, vomiting, diarrhoea, sore throat, muscle aches, haemorrhage and thrombocytopenia. It is a challenge for the population of endemic rural areas, and for healthcare workers, and carries a considerable mortality. The disease is widely distributed in Africa, Europe and Asia, and has become a serious threat to public health in Eurasia. The intention of this review is to summarize the current status of CCHF in Eurasia., (Copyright © 2010 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.)

We report the results of the International Infection Control Consortium (INICC) surveillance study from January 2003 through December 2008 in 173 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study, using Centers for Disease Control and Prevention (CDC) US National Healthcare Safety Network (NHSN; formerly the National Nosocomial Infection Surveillance system [NNIS]) definitions for device-associated health care-associated infection, we collected prospective data from 155,358 patients hospitalized in the consortium's hospital ICUs for an aggregate of 923,624 days. Although device utilization in the developing countries' ICUs was remarkably similar to that reported from US ICUs in the CDC's NHSN, rates of device-associated nosocomial infection were markedly higher in the ICUs of the INICC hospitals: the pooled rate of central venous catheter (CVC)-associated bloodstream infections (BSI) in the INICC ICUs, 7.6 per 1000 CVC-days, is nearly 3-fold higher than the 2.0 per 1000 CVC-days reported from comparable US ICUs, and the overall rate of ventilator-associated pneumonia (VAP) was also far higher, 13.6 versus 3.3 per 1000 ventilator-days, respectively, as was the rate of catheter-associated urinary tract infection (CAUTI), 6.3 versus 3.3 per 1000 catheter-days, respectively. Most strikingly, the frequencies of resistance of Staphylococcus aureus isolates to methicillin (MRSA) (84.1% vs 56.8%, respectively), Klebsiella pneumoniae to ceftazidime or ceftriaxone (76.1% vs 27.1%, respectively), Acinetobacter baumannii to imipenem (46.3% vs 29.2%, respectively), and Pseudomonas aeruginosa to piperacillin (78.0% vs 20.2%, respectively) were also far higher in the consortium's ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 23.6% (CVC-associated bloodstream infections) to 29.3% (VAP)., (2010 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.)

Objective: Neopterin (NT) is a compound of low molecule-based pteridine. It is secreted by macrophages as a response to the stimulation of cytokines such as interferon-gamma, interferon-1beta, tumor necrosis factor alpha or bacteria compounds such as lipopolysaccharides. Procalcitonin (PCT) levels may increase in the course of bacterial, parasitic, and fungal infections. Therefore, it can be used for the differential diagnosis of the infection, especially in cases of serious inflammation. In this study, the role of NT, and PCT in sepsis as a prognostic factor, and the relationship between the two parameters are examined., Methods: From November 1, 2005 through December 31, 2005, fifty patients with sepsis admitted to the Department of the Infectious Diseases and Clinical Microbiology and/or Department of Anaesthesiology and Reanimation were enrolled in the study. Patients were divided in two subgroups according to their survival: group I (n=23) nonsurviving patients and group II (n=27) surviving patients., Results: Serum NT levels have been found to be increased in group I (median: 15 ng/mL, range: 2-69) when compared to group II (median: 5 ng/mL, range: 2-130). The difference was statistically significant (P=0.03). Other laboratory parameters and PCT levels (group I median: 0.13; group II median: 0.08; P<0.05) were not different between the two groups., Conclusions: NT was found to be a prognostic factor in patients with sepsis.

Objective: The aim of this study was to evaluate the efficacy of oral ribavirin treatment in patients with Crimean-Congo haemorrhagic fever (CCHF)., Methods: In 2004, all patients diagnosed with CCHF were treated with oral ribavirin, however in 2003 none of the CCHF patients had been given treatment due to lack of confirmatory diagnostic information at that time in Turkey. In this study, patients treated with ribavirin in 2004 (n=126) were compared with ribavirin-untreated CCHF patients (n=92) in 2003. Patients only with a definitive diagnosis of CCHF (clinical symptoms plus the presence of specific IgM antibodies against CCHF virus and presence of viral antigen) were included in this study., Results: There was no difference in the case-fatality rate between treated and untreated patients (7.1% vs. 11.9%; P>0.05). A Cox Proportional Hazards regression analysis revealed that altered sensorium and prolonged international normalized ratio were independent predictors of mortality., Conclusion: Our results showed that oral ribavirin treatment did not improve the survival rate in CCHF patients. Ribavirin and supportive care are the only available choices for treatment of CCHF patients, but to ascertain the efficacy of ribavirin, more laboratory and observational studies are necessary and ultimately, to elucidate these conflicting results and evaluate the efficacy undoubtedly, a multicenter randomised controlled trial will be needed.

Objective: The aim of this study was to identify the potential factors associated with infection sources and modes of transmission during a recent outbreak (October 2004) of tularemia in Suluova, Turkey., Methods: Following the diagnosis of five patients with tularemia in October 2004, active surveillance was initiated to identify further cases. This was a matched case-control study with analysis based on the first 43 cases of tularemia (probable or suspected) and 43 matched controls. A probable case was defined as a patient, resident in Suluova, who had signs and symptoms (regional lymphadenopathy and fever) compatible with tularemia and a positive serology or PCR for Francisella tularensis during the period October 21 to November 31, 2004. A suspected case was defined as a patient with compatible signs and symptoms who did not meet the laboratory criteria for a probable case, who also had no laboratory evidence of infection by other microorganisms, and who was resident in Suluova between the same dates. The microagglutination test was used for serological diagnosis. A standardized questionnaire was used to collect information on general demographics, exposure to all known sources of tularemia infection, potential risk factors related to water and animals (i.e., fishing, farming, hunting, and other activities), and the environmental conditions of the house. PCR was used to screen for evidence of the tularemia agents in clinical samples from patients and water samples., Results: The overall attack rate was 2.3 per 1000 population (86/38000). Twenty-eight suspected cases and 15 probable cases of tularemia were included in the study. The most common presenting symptom was lymphadenopathy present in 95.3%, followed by fever (83.7%) and sore throat (79.1%). Twenty-eight out of 43 were reported to have painful lymph nodes. F. tularensis was detected by PCR in samples obtained from the ulcerated lesions of two patients. In the multivariate logistic regression model, keeping a domestic animal in the garden was associated with an increased risk of contracting the disease (OR=10.87; 95% CI: 1.26-93.65; p=0.03). F. tularensis was detected by PCR in the water sample obtained from the rivulet that passes through Suluova., Conclusions: The results of this study show that case-control studies may be useful for analyzing epidemics and for identifying the source of infection. In order to prevent water-related zoonotic infections, water and sewerage systems should be improved.

Here, we describe a 38-year-old male with an abrupt manifestation acute panniculitis as unusual presentation of brucellosis. Brucellosis is a reemerging disease in Turkey, and the disease is primarily transmitted from farm animals to humans. Farmers and shepherds are the major risk groups for brucellosis in Anatolia. Brucellosis may involve almost all systems and organs, including the skin, and may mimic a wide range of illness and syndromes. Although the cutaneous manifestation of brucellosis is not disease specific, but it occurs in about 6%-13% of patients with brucellosis. Some of these lesions including rashes, papules, ulcers, abscess, erythema nodosum, ecchymosed skin rash, purpura, and vasculitis may be seen frequently in brucellosis, but panniculitis is rarely described. The case confirmed by positive blood culture had manifest skin lesion as an initial finding represented by lobular panniculitis with vasculitis.

In this study, we examined the adherence of slime-producing standard Staphylococcus epidermidis strain ATCC 12228 to Dacron and polytetrafluoroethylene (PTFE) grafts in in vitro medium either containing salicylate or not. Dacron and PTFE graft pieces of standard size were placed in trypticase soy broth either containing 5 mM acetylsalicylic acid solution or not. These soy broths also contained 1 x 10(7) colony-forming units/mL S. epidermidis ATCC 12228. The incubation period lasted for 18 hr at 37 degrees C. The bacteria on the graft were freed by vortexing. The obtained bacteria suspension was diluted serially. Afterward, the suspension was plated on 5% sheep blood agar and counted after overnight incubation. In this study, we demonstrate that aspirin of an ideal concentration (5 mM) decreased the adherence of slime-producing S. epidermidis strain to Dacron and PTFE grafts. The mean number of colonies was significantly lower for both Dacron and PTFE groups in salicylated medium. We believe that aspirin provided in the postoperative period can, by maintaining the ideal serum level, decrease graft infections emerging due to coagulase-negative staphylococcus.

Background: Health care-associated infections from invasive medical devices in the intensive care unit (ICU) are a major threat to patient safety. Most published studies of ICU-acquired infections have come from industrialized western countries. In a Centers for Disease Control and Prevention (CDC) National Nosocomial Infections Surveillance (NNIS) System report, the U.S. pooled mean rates of central venous catheter (CVC)-related bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections were 4.0 per 1000 CVC days, 5.4 per 1000 mechanical ventilator days, and 3.9 per Foley catheter days, respectively., Objective: To ascertain the incidence of device-associated infections in the ICUs of developing countries., Design: Multicenter, prospective cohort surveillance of device-associated infection by using the CDC NNIS System definitions., Setting: 55 ICUs of 46 hospitals in Argentina, Brazil, Colombia, India, Mexico, Morocco, Peru, and Turkey that are members of the International Nosocomial Infection Control Consortium (INICC)., Measurements: Rates of device-associated infection per 100 patients and per 1000 device days., Results: During 2002-2005, 21,069 patients who were hospitalized in ICUs for an aggregate 137,740 days acquired 3095 device-associated infections for an overall rate of 14.7% or 22.5 infections per 1000 ICU days. Ventilator-associated pneumonia posed the greatest risk (41% of all device-associated infections or 24.1 cases [range, 10.0 to 52.7 cases] per 1000 ventilator days), followed by CVC-related bloodstream infections (30% of all device-associated infections or 12.5 cases [range, 7.8 to 18.5 cases] per 1000 catheter days) and catheter-associated urinary tract infections (29% of all device-associated infections or 8.9 cases [range, 1.7 to 12.8 cases] per 1000 catheter days). Notably, 84% of Staphylococcus aureus infections were caused by methicillin-resistant strains, 51% of Enterobacteriaceae isolates were resistant to ceftriaxone, and 59% of Pseudomonas aeruginosa isolates were resistant to fluoroquinolones. The crude mortality rate for patients with device-associated infections ranged from 35.2% (for CVC-associated bloodstream infection) to 44.9% (for ventilator-associated pneumonia)., Limitations: These initial data are not adequate to represent any entire country, and likely variations in the efficiency of surveillance and institutional resources may have affected the rates that were detected., Conclusions: Device-associated infections in the ICUs of these developing countries pose greater threats to patient safety than in U.S. ICUs. Active infection control programs that perform surveillance of infection and implement guidelines for prevention can improve patient safety and must become a priority in every country.

Infective endocarditis related to pacemaker is a rare but serious condition in permanent venous tracing. A 65-year-old man was admitted to the hospital with high fever and chills. A DDD pacemaker had been implanted via the right subclavian vein because of sick sinus syndrome 6 years earlier. Transesophageal echocardiogram identified an oscillating round hyperechoic mass with a stalk near the tricuspid valve. Blood cultures grew Staphylococcus hominis. The patient was treated with antibiotics and operated on after the acute phase of the illness had subsided. We hereby report a case of lead endocarditis caused by S. hominis in a patient with pacemaker, which has been rarely reported in the English literature.

Objective: The aim of our study was to establish the etiology of and risk factors for infective endocarditis (IE) and determine the prognostic factors for adverse outcome during hospital admission in a Turkish population., Material and Methods: Between January 2002 and January 2004, the clinical and laboratory features of 112 consecutive adult patients (>18 years) with diagnosis of IE who were referred to the infectious diseases clinics/departments of 17 teaching hospitals in Turkey were evaluated. Cases of IE were defined according to the modified Duke Criteria. Mortality was defined as death occurring within 30 days or during hospital stay period. Univariate and multivariate analyses were performed to predict the factors related to fatal outcome., Results: A total of 112 consecutive patients presented with 101 definite and 11 probable IE episodes were defined according to the modified Duke Criteria. The mean age was 45.2+/-19.9. Fifty percent of the patients were male. Ninety (60.4%) of the 112 patients had risk factors for IE and 48 (42.9%) of them had >or=2 risk factors. On the other hand, 49.1% of patients had cardiac risk factors. Blood cultures were positive in 94 (83.9%) cases. Staphylococci were the most common agents (50.0%), followed by streptococci (28.7%) and enterococci (16.0%). Native cardiac valves were detected in 93 (83%) of the episodes of suspected IE. Valvular involvement was present in 103 (92%) patients; the mitral valve, alone or in combination with other valves, was affected in 70 (62.5%) of the patients. Echocardiography detected vegetations in 105 patients (93.8%). The mortality rate was 28.6%. Three factors were independently associated with mortality: haemodialysis OR: 14.5 (95% CI: 1.5-138.2), mobile vegetation OR: 4.8 (95% CI: 1.5-15.4) and mental alteration OR: 4.1 (95% CI: 1.1-15.6)., Conclusion: Mortality is still high in IE. Our data indicate that patients with altered mental status, mobile vegetation, or on haemodialysis had poorer prognosis.

We report a common-source outbreak of anthrax. The source of infection was the carcass of a cow. Three patients developed anthrax, which affects meninx, skin and larynx. The patient with meningitis died. In all, 20 people who contacted or ate the cooked meat of the dead cow were given prophylactic tetracycline and remained well. This small outbreak calls for the increased awareness of physicians to this clinical entity in locations in which anthrax is endemic and for health education.

Objective: This study was conducted to investigate the applicability of Thwaites' diagnostic criteria in order to differentiate tuberculous from bacterial meningitis., Material and Methods: The study was done retrospectively in HIV-negative patients (n = 126) with meningitis. Of the 126 patients, 103 had bacterial meningitis and 23 patients had tuberculous meningitis. The diagnosis was confirmed microbiologically in 59 and 12 patients with bacterial and tuberculous meningitis, respectively. The prediction of tuberculous meningitis was determined by Thwaites' diagnostic scoring using parameters such as age, history of illness, white blood cell count, total cerebrospinal fluid (CSF) white cell count and the percent of neutrophils in CSF. The diagnostic value of the model was assessed by calculating the area under the receiver operating characteristic (ROC) curves., Results: The sensitivity and the specificity of Thwaites' diagnostic scoring were 95.6% (22/23) and 70.8% (73/103), respectively. In microbiologically proven cases the sensitivity and the specificity were 91.7% (11/12), 79.7% (57/59), respectively. The area under the ROC curve value for the diagnostic scoring was 0.92., Conclusions: Thwaites' diagnostic score was found to be helpful in differential diagnosis of tuberculous meningitis, however, the usefulness of diagnostic scoring should be validated in large series especially in patients with viral meningitis and low CSF glucose levels.

Aim: Hepatitis B virus (HBV) strains isolated worldwide has been classified into eight genomic groups deduced from genome comparisons and designated as genotypes A to H. We aimed to investigate prevalence of HBV genotypes and subtypes in Turkey., Methods: A total of 88 chronic hepatitis B (CHB) patients from 15 hospitals throughout the country were included. Patients who were HBsAg positive in serum at least for 6 mo, who had HBV-DNA in serum and elevation of ALT levels more than two times upper limit of normal, and who had percutaneous liver biopsy within 6 mo were included. Genotyping of HBV was done by restriction fragment length polymorphism (RFLP). The patients received subcutaneous 9 MU interferon-alpha 2a thrice a week for a period of 6 mo., Results: Genotype D was detected in 78 of 88 (88.7%) patients, however, genotyping failed in two patients (2.3%), while no product was obtained in eight (9.0%) patients. Regarding subtypes, D2 was more prevalent (67 patients between 78% and 85.9%) followed by subtype D2+deletion (seven patients of 78 or 8.9%), subtype D1 (three patients of 78% or 3.9%) and subtype D3 (one patient of 78% or 1.3%). Thirty-three patients (37.5%) were HBeAg positive compared to 55 (62.5%) anti-HBe positive patients. The endpoint for the viral response of HBeAg positive patients was 27.2%, while it was found 52.7% in HBeAg negative patients (P<0.05). Long-term persistent viral response was 29.5% for all patients., Conclusion: This multi-center study indicates that the predominant genotype with CHB patients in Turkey like in other Mediterranean countries is genotype D.

Background: Helicobacter pylori, occurring throughout the world and causing gastroduodenal diseases, is one of the most common chronic bacterial agents in humans. The purpose of this study was to measure the general practitioners' (GPs) knowledge and practices pertaining to H. pylori infection., Methods: A cross-sectional type questionnaire survey was conducted in all of 19 primary health care centres (PHCC) in Samsun, Turkey, between November 1 and December 31, 2003. The questionnaire was sent to 124 GPs and 109 (87.9 %) of those filled in. They were requested to answer the questions on the knowledge, sources of medical information, diagnostic tests and treatment to H. pylori., Results: Medical journals were the most frequently used source of information on H. pylori, being cited by 86 (78.9%) of GPs. Ninety-two (84.4%) of the GPs reported having used one or more tests and 17 (15.6%) never used any test for the diagnosis of H. pylori infection. Only 9.8% had used stool antigen test for diagnosis. GPs reported that they would prescribe symptomatic treatment without ordering diagnostic tests for 29 (26.6%). 54.1% of the GPs explain that they sent patients with H. pylori infection to a specialist, and most used a triple drug regimen containing a PPI. Treatment duration varies between 7 to 28 days. 80.7 of the GPs treat patients for 14 days., Conclusion: GPs may not have enough knowledge about the importance of stool antigen test or possibility of usage of this test. GPs have not sufficient knowledge about the difference between symptomatic and asymptomatic individuals. It is thought that GPs preferred to treat the patients with suspected ulcer empirically or to send them to a specialist because of the limited diagnostic conditions. The efforts to educate the GPs about the algorithms regarding the management of H. pylori infection during post-graduation period should be improved in PHCCs.

Background: Infections caused by hepatitis B virus (HBV) and hepatitis C virus (HCV) are considered to be important health problems worldwide. The purpose of this study was to measure the general practitioners (GPs)' basic knowledge on HBV and HCV risk factors in determining their practice about this subject., Methods: A cross-sectional type questionnaire survey was carried out at all of 32 primary healthcare centers (PHCCs) in Samsun, Turkey, between March 1 and April 31, 2002. The questionnaires were sent to 160 GPs and 129 (80.6%) of them answered the questionnaires. Knowledge, role responsibility, self-efficacy and attitudes and beliefs regarding to viral hepatitis B and hepatitis C were asked., Results: Most of the GPs had adequate knowledge about transmission of HBV and HCV and also about risk factors for transmission of viruses. Most of the GPs (83.7%) were aware of recommendations for approach to a baby, born from HBsAg positive mother. They have limited facilities in diagnosis of viral hepatitis. Of the participants, 108 (83.7%) expressed that they could not diagnose HBV infections and 126 (97.7%) of them stated that they could not make the diagnoses of HCV infection in their local healthcare centers. The knowledge about treatment of chronic viral hepatitis B (21.8%) and C patients (17.8%) with elevated ALT is not sufficient., Conclusion: GPs' knowledge about risks of viral hepatitis was adequate in this study. They were not able to diagnose and follow up of these infections at PHCCs because of limited knowledge about chronic viral hepatitis and diagnostic facilities. GPs should be informed about current advice in diagnosis and treatment of chronic of HBV and HCV infections.

In order to determine the prevalence of intensive care unit (ICU)-acquired infection at ICUs in Turkey and to identify associated risk factors, predominant infecting organisms and mortality rates, a 1-d point prevalence study was carried out on 19 September 2001. A total of 56 ICUs from 22 university and teaching hospitals participated and a total of 236 completed case report forms were accepted for analyses. A total of 115 patients (48.7%) had 1 or more ICU- related nosocomial infections on the study d. Pneumonia and lower respiratory tract infection (28.0%), laboratory confirmed blood stream infection (23.3%) and urinary tract infection (15.7%) were the most frequent types. Endotracheal tube, urinary catheter, multi-trauma on admission, stress ulcer prophylaxis, nasogastric feeding and mechanical ventilation were risk factors. The most frequently reported isolates were Pseudomonas aeruginosa (20.8%), Staphylococcus aureus (18.2%), Acinetobacter spp. (18.2%) and Klebsiella spp. (16.1%). Of the patients, 72.9% were receiving antimicrobials on the study d for treatment or prophylaxis. Most frequently administered antimicrobials were aminoglycosides (37.2%), carbapenems (31.4%), glycopeptides (23.3%), cephalosporins (18.0%) and antifungals (5.8%). According to a 4-week follow-up, 70 (29.7%) patients died, 22 (9.3%) of whom died from ICU related infections. In conclusion this study showed that ICU related infections are common and often associated with resistant microorganisms. The results provide epidemiological information that will help to implement infection control policies in ICUs.

Resistance emergence to carbapenem antibiotics was studied in a rat-thigh abscess model. Abscesses were developed in three groups with a total of 15 P. aeruginosa strains (three rats per strain). Groups were assigned to imipenem or meropenem treatment while one was left antibiotic-free. Test strains were fully susceptible to these antibiotics and the "Mutant Preventing Concentrations" of imipenem and meropenem over these strains were comparable. Antibiotic serum levels, assessed by serum bioassay test, were similar among therats. After four days, rats (n=45) were sacrificed and carbapenem resistant mutants were selected on imipenem (4 mg/L) and meropenem (4 mg/L) supplemented agar plates. Resistant variants of three strains, from four abscesses, were detected; one in the meropenem group, two in the imipenem and one in the untreated group. The MICs of imipenem and meropenem for the mutants were increased fourfold times or even higher of their counterparts. Resistance emergence under antibiotic pressure in P. aeruginosa has been shown in various conditions. To our knowledge, however, resistance emergence in abscess and also the comparison of imipenem and meropenem in this regard has not been studied before.

Blood brother/sisterhood is a ritual that involves the exchange of a small amount of venous blood via the binding of excisions. Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) could be transmitted by this ritual. Two cases infected with HIV and HBV by a blood brotherhood ritual are reported.

The aim of this study was to evaluate the diagnostic and therapeutic approach to urinary tract infections (UTIs) by primary care physicians, in Samsun, Turkey. Data were obtained from the records of 2083 visits at eight primary care areas. Trained research students were stationed on site at each of the eight primary care centres between 1 June, 1999 and 1 July, 1999. Patients who had acute cystitis, recurrent UTIs, acute pyelonephritis and acute urethritis were included in the study. A total of 2083 office visits were recorded and 419 (20.1%) of the patients had UTIs and acute urethritis. Antibiotics were prescribed for 94.7% of the patients with UTIs and urethritis. Some 74% of prescriptions were consistent with current recommendation, but only 41% of the antibiotic prescriptions were rational according to dosage, dosage interval and duration of therapy. Urinary antiseptic agents were prescribed to 75% of patients with UTIs. These data indicate that polypharmacy is widespread in our region; primary care physicians need to review their knowledge about the diagnosis and treatment of UTIs and acute urethritis., (Copyright 2002 Elsevier Science B.V. and International Society of Chemotherapy)

Unlabelled: Hepatitis C virus (HCV) infection becomes chronic in about 85 % of individuals as demonstrated by the persistence of HCV. It is necessary to treat acute hepatitis C infection. Interferon-alpha is generally used for the treatment of acute HCV infection., Case Presentation: A 55-year-old woman with a history of fatigue and icter was diagnosed as acute hepatitis C virus infection. She was treated with interferon-alpha 2b 3 million unite sc three times in a week and ribavirin 1000 mg daily for 6 months. Within 2 weeks of therapy, the alanine aminotransferase (ALT) had became normal. At the end of the 3 months of therapy, HCV RNA was negative and remained negative 6 months after the end of interferon treatment (sustained response)., Conclusion: This report suggests that interferon-alpha 2b and ribavirin may have a role in treatment of acute hepatitis C virus infection.

Objectives: Outcome after acute hepatitis B virus (HBV) infection may be determined by the host immune system. We studied the distribution of major histocompatibility (MHC) antigens in patients who developed natural immunity against HBV and those with chronic hepatitis B., Methods: Thirty patients positive for IgG anti-HBs and anti-HBc ('naturally immune'), 30 patients with HBsAg-positive chronic hepatitis and 30 subjects with no serological markers of HBV infection (controls) were studied. MHC class-I antigens were detected by the standard Terasaki microlymphocytotoxicity test and the MHC class-II antigens by a polymerase chain reaction using sequence-specific primers., Results: In the naturally immune group, A11, B73, CW3, DRB1*16 and DQB1*05 antigens were significantly more frequent than in the control group, and B73, DRB1*04 and DRB1*13 antigens were more frequent than in the chronic hepatitis group. In the chronic hepatitis group, CW6, DRB5 and DQB1*05 antigens were significantly more frequent than in the control group, and B8, CW7, DRB1*03 and DQB1*02 antigens were more frequent than in the naturally immune group., Conclusions: Differences in alleleic frequencies of HLA among persons with natural immunity against HBV and those with chronic hepatitis B may suggest a genetic basis for persistence of HBV infection and occurrence of chronic liver disease.

Recently, an extended-spectrum beta-lactamase (PER-1) was found to be disseminated among Acinetobacter spp. and Pseudomonasaeruginosa isolates in Turkey. A population-based cohort study was conducted to elucidate predictive mortality factors in patients with nosocomial infections caused by Acinetobacter spp. and P. aeruginosa, with particular reference to PER-1-type extended-spectrum beta-lactamase (ESBL) production. The study group comprised 16 and 21 non-survivors and 82 and 126 survivors in cohorts infected with Acinetobacter and P. aeruginosa, respectively. In the Acinetobacter-infected cohort, nosocomial pneumonia, hypotension and infection with a PER-positive isolate were independent predictors of mortality. In the P. aeruginosa-infected cohort, impaired consciousness, a PER-positive isolate, male sex and (with a negative relative risk) urinary tract infection were independent predictors of death. This study demonstrated the relationship of PER-1-type ESBL-producing Acinetobacter spp. and P. aeruginosa with poor clinical outcome.

Leptospirosis, a common form of zoonosis, especially in rainy countries, is caused by Leptospira interrogans. In our region of Turkey this type of disease has often been encountered in connection with rice harvesting and we therefore attempted to evaluate the prevalence of L. interrogans in wild rats in our region. Fifty-nine Rattus norvegicus rats were trapped alive in different areas of an approximately 100 km stretch of seashore in the Middle Black Sea region of Turkey. L. interrogans was determined by PCR in sera, kidney and brain tissue. Sixteen (27.1%) kidney samples and 10 brain tissue samples (16.9%) were positive for L. interrogans. No PCR positivity was seen in sera samples. Five sera were positive by microagglutination test. A large proportion of wild rats in our region were found to be carriers of L. interrogans. We conclude that people who are exposed to rat urine in their daily life are at risk of acquiring L. interrogans.

Some anti-HBc positive subjects have been encountered in the absence of hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (anti-HBs). The aim of this study was to evaluate the response to hepatitis B vaccination in such cases. A total of 33 subjects who were HBsAg and anti-HBs negative, anti-HBc positive, with normal serum aminotransferase levels were included in the study. A recombinant hepatitis B vaccine was administered to subjects. Sera samples were obtained 1 month after each vaccination and tested for anti-HBs. HBV DNA and HBeAg were not detected in any subject. Anti-HBs levels were measured above 10 > or = mIU/ml in 48.4% of cases after the first vaccination, 63.6% after the second vaccination and 90.9% after the third vaccination. Only 3 subjects (9.1%) lacked antibody response in spite of the 3-dose vaccination. In conclusion, preventive antibody levels were obtained after HBV vaccination in most of the HBsAg, anti-HBs negative, anti-HBc positive persons.

The presence of extended spectrum beta-lactamases (ESbetaLs) in 129 Escherichia coli and 128 Klebsiella pneumoniae strains was determined with the E test. beta-lactamases were detected in 66 (51.2%) of E.coli and 107 (83.6%) of K. pneumoniae by the nitrocefin disk method. Putative ESbetaL production was observed in 15.5% of E. coli and 55.5% of K. pneumoniae with the E test. Among the putative ESbetaL-producer strains 11 were found to be susceptible to ceftizoxime, 6 to ceftazidime, 2 to ceftriaxone, cefotaxime and aztreonam, and one to cefoperazone according to the disk diffusion test. All putative ESbetaL-producers were resistant to cefodizime, thus it may be a good indicator of the presence of mainly TEM-type ESbetaL. The E test was also found to be practicable for the detection of ESbetaLs in clinical laboratory. Further studies are needed to clarify whether ESbetaL can be identified reliably in species that, in addition to plasmid mediated ESbetaL production, chromosomally encoded AmpC beta-lactamases and other class A ESbetaLs by disk diffusion test.

The epidemiological distribution and clinical features of 12 cases of Weil's disease from Turkey, are reviewed. The disease is most common in male farmers from rural areas. Myalgia and jaundice were recorded in all patients. Signs included vomiting in 9 patients, haemorrhages in 6, and renal function was impaired in 6. Creatine phosphokinase levels were found above normal limits in 75% of the cases. Leptospires were demonstrated with dark-field microscopy in the blood of 9 and in the urine of 5 of these patients. The diagnosis was confirmed with microscopic agglutination test (MAT) as well as with ELISA. Ig M antibodies were detected in 11 (92%) of the patients and is an accurate marker for acute leptospirosis. Penicillin was used for therapy and the outcome was favorable in 10 patients. Two patients died. It should be kept in mind that leptospirosis is an extremely severe disease which requires appropriate examinations at the right moment.