Serotype distribution of Streptococcus pneumonia in children with invasive disease in Turkey: 2015-2018

Objectives: To determine the serotype distribution of pneumococcus causing invasive pneumococcal disease (meningitidis, bacteremia and empyema) in children in Turkey, and to observe potential changes in this distribution in time to guide effective vaccine strategies.

Methods: We surveyed S. pneumoniae with conventional bacteriological techniques and with real-time polymerase chain reaction (RT-PCR) in samples of cerebrospinal fluid (CSF), blood and pleural fluid. S. pneumoniae strains were isolated from 33 different hospitals in Turkey, which are giving health services to approximately 60% of the Turkish population.

Results: A total of 167 cases were diagnosed with invasive pneumococcal disease between 2015 and 2018. We diagnosed 52 (31.1%) patients with meningitis, 104 (62.2%) patients with bacteremia, and 11 (6.6%) patients with empyema. Thirty-three percent of them were less than 2 years old and 56% less than 5 years old. Overall PCV13 serotypes accounted for 56.2% (94/167). The most common serotypes were 19 F (11.9%), 1 (10.7%) and 3 (10.1%).

Conclusions: Besides the increasing frequency of non-vaccine serotypes, vaccine serotypes continue to be a problem for Turkey despite routine and high-rate vaccination with PCV13 and significant reduction reported for the incidence of IPD in young children. Since new candidate pneumococcal conjugate vaccines with more serotype antigens are being developed, continuing IPD surveillance is a significant source of information for decision-making processes on pneumococcal vaccination.

Changes in the conjunctival bacterial flora of patients hospitalized in an intensive care unit

Purpose:

To identify the changes in aerobic conjunctival bacterial flora and to correlate culture results with physical health and the duration of patients' hospitalization in an intensive care unit (ICU).

Methods:

Patients hospitalized in the ICU were included in this study. Conjunctival cultures from all patients were obtained using a standard technique on days 1, 3, 7, and 14. Swabs were plated on nonselective (blood agar) and enriched (chocolate agar) media within one hour. Visible colonies were isolated, and standard microbiological techniques were used to identify the bacteria. The frequency, identity, and correlation of culture results with patients' physical findings and the duration of hospitalization were determined.

Results:

We obtained 478 cultures (day 1, 270; day 3, 156; day 7, 36; and day 14, 16) from 135 patients; 288 (60.2%) cultures were positive, and 331 microorganisms were isolated. The most frequently isolated microorganism from the cultures was coagulase-negative Staphylococcus species (n=210/331, 63.5%), and the others were Corynebacterium diphtheriae (n=52/331, 15.7%), S. aureus (n=26/331, 7.9%), gram-negative bacilli other than Pseudomonas (n=14/331, 4.2%), Neisseria species (n=8/331, 2.4%), Pseudomonas aeruginosa (n=6/331, 1.8%), Haemophilus influenzae (n=7/331, 2.1%), Acinetobacter species (n=6/331, 1.8%), and Streptococcus species (n=2/331, 0.6%). The frequency of positive cultures significantly increased (p<0.03) with time.

Conclusions:

Prolonged hospitalization significantly predisposes to bacterial colonization. The colonization rate of S. aureus and Neisseria spp. increased significantly after one week.

Randomized Clinical Trial to Evaluate MTA Indirect Pulp Capping in Deep Caries Lesions After 24-Months

OBJECTIVE

This clinical study aimed to assess the efficacies of mineral trioxide aggregate (MTA) and calcium hydroxide [Ca(OH)₂] in the treatment of deep carious lesions by the direct complete caries removal technique.

METHODS AND MATERIALS

A total of 100 permanent molar/premolar teeth were capped with either Ca(OH)₂ (n=49) or MTA (n=51) and restored with composite resin in 73 patients. Periapical radiographs were acquired prior to the treatment as well as at six, 12, and 24 months posttreatment. Two calibrated examiners performed the clinical and radiographic assessment of the periapical pathology and pulpal symptoms. Intergroup comparisons of the observed values were performed using the Fisher exact test. Significance was predetermined at α = 0.05.

RESULTS

The recall rates were 100% at six and 12 months posttreatment and 98.6% at 24 months posttreatment. Four teeth capped with Ca(OH)₂ (two each at six and 12 months posttreatment) and two capped with MTA (one each at 12 and 24 months posttreatment) received endodontic emergency treatment because of symptoms of irreversible pulpitis, which were clinically and/or radiographically established. There were no significant differences in pulp vitality between the two pulp-capping agents at six, 12, or 24 months posttreatment (p=0.238, p=0.606, and p=0.427, respectively).

CONCLUSIONS

Both pulp-capping materials were found to be clinically acceptable at 24 months posttreatment.

Serotype distribution of Streptococcus pneumoniae in children with invasive diseases in Turkey: 2008-2014

Successful vaccination policies for protection from invasive pneumococcal diseases (IPD) dependent on determination of the exact serotype distribution in each country. We aimed to identify serotypes of pneumococcal strains causing IPD in children in Turkey and emphasize the change in the serotypes before and after vaccination with 7-valent pneumococcal conjugate vaccine (PCV-7) was included and PCV-13 was newly changed in Turkish National Immunization Program. Streptococcus pneumoniae strains were isolated at 22 different hospitals of Turkey, which provide healthcare services to approximately 65% of the Turkish population. Of the 335 diagnosed cases with S. pneumoniae over the whole period of 2008-2014, the most common vaccine serotypes were 19F (15.8%), 6B (5.9%), 14 (5.9%), and 3 (5.9%). During the first 5 y of age, which is the target population for vaccination, the potential serotype coverage ranged from 57.5 % to 36.8%, from 65.0% to 44.7%, and from 77.4% to 60.5% for PCV-7, PCV-10, and PCV-13 in 2008-2014, respectively. The ratio of non-vaccine serotypes was 27.2% in 2008-2010 whereas was 37.6% in 2011-2014 (p=0.045). S. penumoniae serotypes was less non-susceptible to penicillin as compared to our previous results (33.7 vs 16.5 %, p=0.001). The reduction of those serotype coverage in years may be attributed to increasing vaccinated children in Turkey and the increasing non-vaccine serotype may be explained by serotype replacement. Our ongoing IPD surveillance is a significant source of information for the decision-making processes on pneumococcal vaccination.

Methicillin-resistant S. aureus colonization in intensive care unit patients: Early identification and molecular typing

INTRODUCTION

Early detection of methicillin-resistant Staphylococcus aureus (MRSA) in colonized patients is very important for infection control procedures to prevent MRSA spread. We aimed to monitor MRSA carriage in intensive care unit (ICU) patients and to evaluate the speed and efficiency of conventional culture, immunological, chromogenic, and molecular methods together with genotyping.

METHODOLOGY

Nasal and axillar swab specimens were obtained from patients in the ICUs of the general surgery and neurosurgery wards in a tertiary hospital once a week over four weeks between December 2009 and July 2010. Oxacillin and cefoxitin disk diffusion tests, oxacillin agar screening test, latex agglutination test, chromogenic agar, and real-time polymerase chain reaction (PCR) tests were used for isolation and identification of MRSA. MRSA isolates were typed using ribotyping and pulsed-field gel electrophoresis (PFGE) typing.

RESULTS

MRSA colonization was detected in 48 of 306 patients by real-time PCR. The MRSA colonization rate was 6.2%, 15.5%, and 38.5% at admission and in the first and second weeks, respectively. Sensitivity, specificity, positive and negative predictive values for all phenotypic tests were 98%, 99.6%, 98%, and 99.6%, respectively. The shortest handle time was observed in PCR. A total of three banding patterns were obtained from MRSA isolates by ribotyping, and PFGE analyses revealed 17 different pulsotypes varying from 11 to 18 distinct bands, showing high genetic diversity among the samples.

CONCLUSION

Phenotypic MRSA screening tests in our study exhibited similar performances. The superiority of real-time PCR is its short turnaround time.

Clinical Performance of Composite Restorations with Resin-modified Glass Ionomer Lining in Root Surface Carious Lesions

Objective: The purpose of this study was to evaluate the clinical performance of composite restorations in root surface carious lesions with or without resin-modified glass ionomer lining.

Methods and Materials: The sample consisted of 25 female and 14 male patients. A maximum of four lesions were included for each patient. After caries removal, the depth, length, and width of the cavity were measured. Lesions in the same patient were randomly divided into two groups, and the dentin surfaces were either lined with resin-modified glass ionomer liner (Glass Liner II) or left as they were. Self-etch adhesive (All Bond SE) was applied and cured for 20 seconds. All cavities were restored with nanohybrid anterior composite resin (Clearfil Majesty Esthetic). Two experienced clinicians evaluated the marginal adaptation (retention) rate, anatomic form, secondary caries, sensitivity, and marginal staining of restorations at the end of the first week and at six, 12, and 18 months posttreatment. The data were statistically analyzed using the Chi-square and two-way repeated measures tests.

Results: At the end of 18 months, a total of five lined and three unlined restorations were lost. There was no significant relationship between marginal adaptation and cavity lining at six, 12, and 18 months (p&gt;0.05). Although marginal stainings of restorations were mostly localized, the total number of localized or generalized discolored restorations increased with time (p&lt;0.001). There was a statistically significant relationship between marginal staining and smoking (p&gt;0.05). There was no significant relationship between marginal staining and frequency of toothbrushing at six, 12, and 18 months (p=0.286, p=0.098, and p=0.408, respectively).

Conclusion: Within the limitations of this study, both restorative applications were accepted as clinically appropriate.

Effects of isolation rooms on the prevalence of hospital acquired pneumonia in a respiratory ICU

BACKGROUND

The incidence of hospital acquired pneumonia (HAP) varies according to the type of intensive care units (ICUs).

AIM

The aims of this study were to determine the frequency of hospital acquired pneumonia (HAP) and the effect of isolation rooms on the frequency of pneumonia in the ICU.

MATERIALS AND METHODS

The present investigation was carried out between January 2004 and July 2008. The ICU, which was 4-bed ward-type between January 2004 and February 2006 (1st period), was reconfigured as isolated rooms with only 2 beds each after March 2006 (2nd period). 153 and 379 patients were followed up in the ICU in the 1st and 2nd periods, respectively. Blood, sputum, and deep tracheal aspiration cultures were used for the isolation of the causative agents.

RESULTS

No significant difference was detected between the general characteristics of patients. HAP developed in 101 patients (19%). The prevalence of HAP was 22.9% in the 1st period and 17.4% in the 2nd period. During the 1st and 2nd periods, the HAP infection densities were 22.2 and 16.1/1000 patient-days and the ventilator-associated pneumonia densities were 48.1 and 37.6/1000 ventilator-days, respectively. Eighty-six percent of HAP was ventilator-associated pneumonia (VAP).

CONCLUSIONS

Isolation rooms in the ICU may be an effective strategy to control and decrease the rate of pneumonia in the ICU in addition to other preventive strategies.

Do local anesthetics have antibacterial effect on Staphylococcus aureus under in vivo conditions? An experimental study

OBJECTIVE

The antimicrobial properties against Staphylococcus aureus of some common local anesthetic preparations such as prilocaine, bupivacaine, articaine, and combinations were evaluated in a live rat surgical wound model.

METHODS

This study was conducted at the animal research laboratory of Eskisehir Osmangazi University in 2003. Clean surgical wounds were created after local anesthetic application and inoculated with S. aureus (10(2) colony forming units/mL). Four days later, tissue cultures were harvested from control animals and animals given local anesthetic to determine the quantity of bacteria.

RESULTS

The tissue cultures demonstrated that none of the local anesthetics used in the study showed any inhibitory or bactericidal activity on S. aureus. There was no statistical difference in bacterial count between the local anesthetic-treated and control group wounds.

CONCLUSION

The results of the present study did not show any antimicrobial activity of above-mentioned local anesthetics in surgically created wounds of rats.

Tigecycline treatment of multi-drug-resistant Corynebacterium jeikeium infection in a child with relapsing and refractory acute lymphoblastic leukemia

Corynebacterium jeikeium has been recognized as an important cause of infection, particularly among neutropenic patients who have central venous catheter (CVC). Routine use of tigecycline in children is not yet approved. Here in we present a child with relapsed-refractory lymphoblastic leukemia who was successfully treated with tigecyline due to multi-drug-resistant C. jeikeium sepsis without removal of CVC. Our case highlights the use of tigecycline where there are no alternatives. Further studies regarding the efficacy and safety of tigecycline in pediatric patients are needed.

Evaluation of the GenoType Mycobacteria Direct assay for direct detection of the Mycobacterium tuberculosis complex obtained from sputum samples

An increase in the prevalence of tuberculosis (TB) in recent years has accelerated the search for novel tools for the rapid diagnosis of TB infection. This study evaluated the GenoType Mycobacteria Direct (GTMD) assay (Hain Lifescience) for direct detection of the Mycobacterium tuberculosis complex (MTBC) from sputum samples and compared it with conventional methods. The GTMD test is a commercial assay produced using strip techniques and works based on a nucleic acid sequence-based amplification technique. This test allows 23S rRNA amplification-based detection of MTBC, Mycobacterium avium, Mycobacterium intracellulare, Mycobacterium kansasii and Mycobacterium malmoense directly from decontaminated clinical samples within 6 h. In the present study, 115 sputum samples were processed to detect acid-fast bacilli (AFB) using two microscopy methods (carbol fuchsin and fluorescent staining), two culture methods [Löwenstein-Jensen (LJ) and BACTEC 12B media] and the GTMD test. The results showed that 86 of the samples were positive by direct microscopy, 84 were positive by BACTEC 12B culture, 73 were positive by LJ culture and 95 were positive by the GTMD test. All of the isolates turned out to be MTBC. Moreover, the sensitivity and specificity of the GTMD test for MTBC in patients were 97 and 58 %, respectively, taking the culture combination as the gold standard. When the test was compared with culture of samples from anti-TB-treated patients, the sensitivity and specificity for the test were 100 and 15 %, respectively. Low specificity in treated people might arise from depressed proliferation of AFB. As the two methods target the same living bacilli, the difference is obviously notable. When the culture results and clinical findings of the patients were evaluated together (true-positive specimens), the sensitivity and specificity values of the GTMD test for all patients were 97 and 90 %, respectively. However, both of these values increased to 100 % for the patients receiving anti-TB treatment. These results implied that, to determine whether the patient's sputum contains living AFB, more sensitive techniques should be employed during the follow-up of the patients. These observations suggest that the GTMD method can be useful for early diagnosis of clinically and radiologically suspicious TB cases where smears are negative for Mycobacterium. In addition, the use of a GTMD test in smear-positive cases is helpful and practical in order to identify MTBC quickly. This allows more rapid treatment decisions and infection control precautions.

Six-year Clinical Evaluation of Packable Composite Restorations

As a posterior composite, Filtek P60 exhibited very good clinical performance in Class II cavities for six years.

Rapid detection of Mycobacterium tuberculosis from sputum specimens using the FASTPlaqueTB test

OBJECTIVES

To determine the performance of the FASTPlaqueTB test, based on bacteriophage amplification technology, by comparison with the BACTEC 460 TB culture system, the Löwenstein-Jensen (LJ) medium culture method and Ziehl-Neelsen (ZN) staining.

METHODS

Of 400 sputum specimens studied in our laboratory, 19 were excluded due to contaminant growth. The FASTPlaqueTB test was performed according to the manufacturer's instructions.

RESULTS

Only 42 of the 381 specimens examined were positive on at least one test: 30 were positive with ZN staining, 34 with LJ medium, 36 with the FASTPlaqueTB test and 39 with BACTEC 460 TB. The combination of BACTEC 460 TB and LJ medium culture was considered the gold standard. The sensitivity and specificity were 70.7% and 99.7% for ZN staining, 87.8% and 100% for the FASTPlaqueTB test, 82.9% and 100% for LJ, and 95.1% and 100% for BACTEC 460 TB.

CONCLUSIONS

The FASTPlaqueTB test is useful in the rapid diagnosis of TB.

Effectiveness of ciprofloxacin prophylaxis in preventing bacteriuria caused by urodynamic study: A blind, randomized study of 192 patients

OBJECTIVES

To determine the efficacy of prophylactic ciprofloxacin in preventing urinary tract infections caused by urodynamic study (UDS).

METHODS

A total of 210 patients presenting for UDS during a 16-month period were offered enrollment in the study. A clean-catch midstream urine sample was taken 24 hours before and 48 to 72 hours after the procedure and after microscopic examination and culture were done. All patients underwent a standard UDS. The 192 patients who had sterile urine before intervention were included in the study. Randomly, 98 of the 192 patients were orally given 500 mg of ciprofloxacin 1 hour before the urodynamic intervention and 94 were not given anything. The patients who were found to have significant bacteriuria after UDS were followed up and treated properly.

RESULTS

Eighteen patients (8.6%) who had significant bacteriuria in the urine culture before UDS were excluded from the study. The rate of significant bacteriuria in the urine culture after UDS was 7.3% overall, 1% in the prophylaxis group, and 14% in the controls, a significant difference (P = 0.002). The most common uropathogen was Escherichia coli (57%). Three independent risk factors were identified: not giving antibiotic prophylaxis before UDS; antibiotic use in the preceding month; and the presence of pyuria before UDS.

CONCLUSIONS

Urinary tract infections after UDS decreased from 14% to 1% with a single dose of ciprofloxacin 500 mg orally before UDS. We recommend antibiotic prophylaxis for patients undergoing a UDS.

Antibiotic prescribing patterns for sore throat infections in a university-based primary care clinic

BACKGROUND

Recent studies reveal that a high percentage (over 50%) of episodes for upper respiratory tract infections (URTIs) are treated with antibiotics, regardless of appropriateness or the necessity for prescription. We identified antibiotic prescriptions in a primary health care centre (PHC) and evaluated their suitability for sore throat infections. We also explored whether symptoms, signs, diagnosis and antibiotics prescribed differed by gender.

PATIENTS AND METHODS

We collected data on all patients visiting the centre over a period of 12 weeks with a main complaint of sore throat who were prescribed antibiotics after taking a blood count and throat culture. Patients older than 16 years of age were included in the study irrespective of sex, nationality, marital status, occupation or location of residence. The chi square (chi2) statistical test was used in comparing categorical variables. A P value of < 0.05 was considered significant.

RESULTS

During the period of study, 579 patients with URTIs presented to the health centre, from which 339 patients with a sore throat were enrolled. Of the study group, 48.7% (165) were male and 51.3% (174) female, with the majority of patients being under 30 years old (54.3%). Throat cultures were positive in 56 patients (16.5%). Most of patients were diagnosed as having pharyngitis (22.7%), and the most frequently prescribed medicine was an oral penicillin (39.1%). Two hundred eight-six patients (84.4%) had 2 or fewer Centor criteria.

CONCLUSIONS

Throat cultures were positive in only 16.5% of the patients prescribed antibiotics. This indicates that physicians in the health centre of the university are prescribing antibiotics inappropriately and inconsistently. This also highlights the need for more prescriber education, especially as the range of medications available to the general practitioner for prescribing increases.

A 3-year clinical evaluation of a gallium restorative alloy

Several alternative materials have been suggested to take the place of amalgam, because of the environmental toxic effects of its mercury component. One such material is gallium-based alloy restoratives. The aim of this in vivo study was to compare the long-term clinical performance of a commercial gallium alloy with an admixed high copper amalgam alloy. For this purpose, 32 gallium and 32 amalgam restorations were placed in molar teeth in 14 human subjects. All the selected patients had at least two molar teeth that required restoration. In this way both restoratives were used in the same oral cavity. The restorations were examined at baseline, 6 months, 1, 2 and 3 years. At baseline, six teeth restored with gallium alloy showed post-operative sensitivity, whereas none of the amalgams were sensitive. At the end of 3 years, only a few amalgam restorations showed slight surface tarnish and marginal integrity loss. None of them needed replacement. Of the 32 gallium restorations placed, five had to be removed because of sensitivity, corrosion and tooth fracture. Also dramatic surface roughness and corrosion were noticed in 12 gallium restoration. According to the results of this clinical study, gallium-based restoratives should not be used before their physical properties are improved.

Optimum detection times for bacteria and yeast species with the BACTEC 9120 aerobic blood culture system: evaluation for a 5-year period in a Turkish university hospital

We tracked and documented the time of positivity of blood cultures by using the BACTEC 9120 (Becton Dickinson Diagnostic Instrument Systems) blood culture system over a 5-year study period. A 7-day protocol of the incubation period was selected, and a total of 11156 blood cultures were evaluated. The clinically significant microorganisms (32.95%) were isolated in 3676 specimens. Gram-positive and -negative bacterial isolation rates were found to be 41.07 and 44.88%, respectively. Yeasts were found in 14.03% of all pathogens. Both the false-positivity and -negativity rates were very low (0.1 and 0.3%, respectively). The mean detection times for all of the pathogens were determined to be 19.45 h. Yeasts, nonfermentative gram-negative bacteria, and Brucella melitensis strains were isolated within 5 days. By taking these data into account, we decided to establish a 5-day-incubation protocol in our laboratory instead of the 7 days that are commonly used.