Virulence Genes and Antibiotic Susceptibilities of Uropathogenic E. coli Strains

BACKGROUND

The aim of this study is to detect the presence of and possible relation between virulence genes and antibiotic resistance in E. coli strains isolated from patients with acute, uncomplicated urinary tract infections (UTI).

METHODS

62 E. coli strains isolated from patients with acute, uncomplicated urinary tract infections (50 strains isolated from acute uncomplicated cystitis cases (AUC); 12 strains from acute uncomplicated pyelonephritis cases (AUP)) were screened for virulence genes [pap (pyelonephritis-associated pili), sfa/foc (S and F1C fimbriae), afa (afimbrial adhesins), hly (hemolysin), cnf1 (cytotoxic necrotizing factor), aer (aerobactin), PAI (pathogenicity island marker), iroN (catecholate siderophore receptor), ompT (outer membrane protein T), usp (uropathogenic specific protein)] by PCR and for antimicrobial resistance by disk diffusion method according to CLSI criteria.

RESULTS

It was found that 56 strains (90.3%) carried at least one virulence gene. The most common virulence genes were ompT (79%), aer (51.6%), PAI (51.6%) and usp (56.5%). 60% of the strains were resistant to at least one antibiotic. The highest resistance rates were against ampicillin (79%) and co-trimoxazole (41.9%). Fifty percent of the E. coli strains (31 strains) were found to be multiple resistant. Eight (12.9%) out of 62 strains were found to be ESBL positive. Statistically significant relationships were found between the absence of usp and AMP - SXT resistance, iroN and OFX - CIP resistance, PAI and SXT resistance, cnf1 and AMP resistance, and a significant relationship was also found between the presence of the afa and OFX resistance.

CONCLUSIONS

No difference between E. coli strains isolated from two different clinical presentations was found in terms of virulence genes and antibiotic susceptibility.

[Two imported and relapsed of Plasmodium vivax malaria cases and primaquine prophylaxis]

Malaria is a worldwide infection causing serious health and financial problems. Turkey is in the elimination phase, and malaria cases have been observed in patients who have come from abroad recently. In this study, 2 relapsed Plasmodium vivax (Pv) cases that returned from Afghanistan to our country at least 6 months ago were presented. The first case had received irregular chemoprophylaxis during travel, 6 months after returning to Turkey occurred malaria clinic. The second case had not received chemoprophlaxis during his travel, and he had experienced 2 previous episodes of malaria. He had used inappropriate anti-malarial drugs before returning to Turkey. Two separate incubation periods for P. vivax and P. ovale have been described. One of them is defined as late infection, or relapse, which is maturation of dormant bacilli in the liver, known as the hypnozoite stage. We thought that relapses of Pv infection could result from activation of hypnozoites in these cases. These 2 cases were treated with chloroquine and primaquine. The purpose of presenting these 2 cases is that primaquine should be considered for primer prophylaxis in short travels, especially after traveling to endemic areas, and the patient's relapse should be considered.

[A case report: elephantiasis]

Klippel-Trenaunay syndrome (KTS) is a rare disease and a syndrome that is characterized by the triad of congenital port wine stains,venous malformations with or without varicose veins, bone or soft tissue hypertrophy. Lymphatic filariasis is a filarial disease which usually occurs with genital anomalies, pathologies associated with lymphedema or elephantiasis caused by a filarial infectious agent. In this case report, a 20-year-old male patient admitted to our clinic for diagnosis and treatment with right leg edema and lesions compatible with dermatological manifestations. In the list of differential diagnosis, filarial elephantiasis was also thought, consequently KTS was diagnosed. (Turkiye Parazitol Derg 2012; 36: 188-90).

[Meningococcemia and meningitis due to Neisseria meningitidis W135 developed in two cases vaccinated with bivalent (A/C) meningococcal vaccine]

Meningococcal infections may develop as episodic or endemic cases particularly among children attending day-care centers, boarding schools or among military personnel. Bivalent (A/C) meningococcal vaccine is applied to all new military stuff since 1993 in Turkey. In this report two cases of meningococcemia and meningitis, developed in two soldiers vaccinated with meningococcal vaccine, were presented. The first case was a 21 years old male patient who was admitted to the emergency service with the complaints of high fever, headache, fatigue and vomiting. He was conscious, cooperative and oriented with normal neurological findings. Maculopapular exanthems were detected at the lower extremities. The patient was hospitalized with the initial diagnosis of sepsis or meningococcemia and empirical treatment was initiated with ceftriaxone and dexamethasone. Cerebrospinal fluid (CSF) examination yielded 10 cells/mm3 (lymphocytes) with normal CSF biochemical parameters. A few hours later skin rashes spread over the body rapidly, the symptoms got worse, confusion, disorientation and disorientation developed, and the patient died due to cardiac and respiratory arrest at the seventh hour of his admission. The second case was also a 21 years old male patient who was admitted to the hospital with the complaints of fever, headache, painful urination, confusion and agitation. He was initially diagnosed as acute bacterial meningitis due to clinical (stiff neck, positive Kernig and Brudzinsky signs) and CSF (8000 cells/mm3; 80% polymorphonuclear leukocytes, increased protein and decreased glucose levels) findings. Empirical antibiotic therapy with ceftriaxone was initiated and continued for 14 days. The patient was discharged with complete cure and no complication was detected in his follow-up visit after two months. The first case had an history of vaccination with bivalent (A/C) meningococcal vaccine three months ago and the second case had been vaccinated one month ago. The bacteria isolated from the blood culture of the first case and the CFS culture of the second case, were identified as Neisseria meningitidis by conventional and API NH system (BioMerieux, France). The isolates were serogrouped as W135 by slide agglutination method (Difco, USA), and both were found to be susceptible to penicillin and ceftriaxone. As far as the last decade's literature and these two cases were considered, it might be concluded that N.meningitidis W135 strains which were not included in the current bivalent meningococcal vaccine, gained endemic potential in Turkey. Since N.meningitidis W135 strains may lead to serious diseases, vaccination of the risk population with the conjugate tetravalent meningococcal vaccine (A/C/Y/W135) should be taken into consideration in Turkey.

Relationship between serum soluble E‐selectin levels and development of diabetic retinopathy in patients with type 2 diabetes

OBJECTIVE

To investigate whether diabetic retinopathy is associated with serum soluble E-selectin (ssE-selectin) level in type 2 diabetic patients.

MATERIAL AND METHODS

Fifty-six patients with type 2 diabetes classified as Groups A, B, C and D according to grade of retinopathy were enrolled in the study. Sixteen age- and gender-matched healthy control subjects were also enrolled. Levels of ssE-selectin were measured using enzyme-linked immunosorbent assays (ELISAs) in all patients and control subjects. Clinical characteristics and ssE-selectin levels were compared between the groups.

RESULTS

There was no statistically significant difference in ssE-selectin levels between diabetic patients and non-diabetic control subjects (p>0.05). There was also no statistically significant difference in levels of ss E-selectin between diabetic subgroups (Groups A, B, C, D) (p>0.05). No correlation was found between ssE-selectin level and HbA1c, or duration of diabetes in the whole group of diabetic patients (r = 0.10, p>0.05 and r = -0.12, p>0.05, respectively).

CONCLUSIONS

The study shows that no significant elevation of ssE-selectin occurs in patients with type 2 diabetes in comparison with control subjects. Our results also indicate that there is no statistically significant correlation between ssE-selectin level and the development or grade of diabetic retinopathy.

[A case of brucellosis complicated with endocarditis, pyelonephritis, sacroileitis and thyroiditis]

Brucellosis which is a endemic in Turkey, is a systemic infection which can affect any organ or system in the body. Since signs and symptoms of brucellosis resemble many other diseases, misdiagnosis and related increase in morbidity rate, are common. In this report, a case of brucellosis complicated with endocarditis, pyelonephritis, sacroileitis and thyroiditis, was presented. The case was a 32-years-old female patient in whom the diagnosis of brucellosis was delayed by 12 months since it was not taken into consideration during the clinical follow-up of the patient in various clinical centers. The patient was admitted to our center with the complaints of fever, headache, back pain, night sweats, fatigue, loss of appetite, weight loss, dysuria and polyuria. The patient had a history of consumption of raw milk and dairy products. Positive Brucella tube agglutination test (1/1280) and isolation of Brucella spp. in blood cultures led to the diagnosis of brucellosis. Sacroileitis was diagnosed upon pain on right hip joint movements, pain and restriction at the same joint in FABER test. The detection of vegetation during echocardiography, cardiac murmur during physical examination and the determination of increased ESR and CRP levels led to the diagnosis of endocarditis. Abdominal ultrasonography and urinalysis results (hematuria, proteinuria and pyuria) revealed pyelonephritis and increased free T3 and T4, decreased TSH and positive anti-thyroid autoantibodies (anti-TG, anti-TPO) revealed thyroiditis. Treatment was started with combination of rifampisin (1 x 600 mg/day) and doxycycline (2 x 100 mg/day). After the diagnosis of endocarditis, trimethoprim-sulfamethoxazole (3 x 960 mg/day) and streptomycin (1 x 1 g/day) were added to the treatment. Valve replacement surgery was planned, however, the patient didn't accept surgical intervention and antimicrobial treatment continued with streptomycin for 21 days and other antibiotics for six months. The patient exhibited significant improvement after the medical treatment. Although sacroileitis is a frequent complication of brucellosis, endocarditis, thyroiditis and pyelonephritis are among the rare complications. In cases of brucellosis with multiorgan involvement including endocarditis, successful results may be achieved by aggressive antimicrobial treatment. In endemic areas, brucellosis should always be taken into consideration in patients with fever of unknown origin and multisystem involvement.

Case report: primary localization of a hydatid cyst in the adductor brevis muscle

We present a rare case of primary muscular hydatidosis in the left thigh of a 20 year-old man, who presented with painless mass. Ultrasound and magnetic resonance imaging examinations revealed a multilocular intramuscular cyst in the posteromedial compartment of the left thigh mainly occupying the adductor brevis muscle. This site of localization has not been reported previously. The patient was treated successfully by preoperative and postoperative dual treatment of albendazole together with surgery. Hydatid disease should be included in the differential diagnosis of muscular masses, regardless of its location, especially in endemic areas.

[Case report: Löffler's syndrome due to Ascaris lumbricoides mimicking acute bacterial community--acquired pneumonia]

In this study we present a patient with Loeffler's syndrome caused by Ascaris lumbricoides who presented with the clinical findings of community-acquired pneumonia (CAP). Our patient, who was twenty-five years old, and who had had symptoms such as coughing, expectorating, dyspnea and fever for approximately ten days, was hospitalized. We auscultated polyphonic rhonchuses at the both hemithoraxes. A chest X-ray revealed bilateral lower zone patch consolidation. Acute bacterial community acquired pneumonia (CAP) was diagnosed due to these findings and empirical antibiotic treatment was begun. Repeated sputum Gram stains were negative, and both sputum and blood cultures were sterile. A sputum smear was negative for acid-fast bacilli. The patient's fever and respiratory complaint did not respond to the empirical antibiotics therapy. During the course of advanced investigations, we measured peripheric eosinophilia, and high levels of total Eo and total IgE, and observed Ascaris lumbricoides eggs during stool examination. The patient was given a diagnosis of Loeffler's syndrome. Thereupon the patient was treated successfully with one dose of albendazol 400 mg. In conclusion, we suggest that Loeffler's syndrome must be considered early in the differential diagnosis for CAP when peripheric eosinophilia is seen in patients if they live in an endemic area for parasitic disease.

Effects of three different topical antibacterial dressings on Acinetobacter baumannii-contaminated full-thickness burns in rats

In this animal study, three topical antibacterial dressings, Acticoat, chlorhexidine acetate 0.5% and silver sulfadiazine 1%, were compared in the treatment of Acinetobacter baumannii contamination of burns. All treatments were effective and prevented the organism invading the muscle and causing systemic infection, so there were significant differences between the results of the treatment groups and the control group. Mean eschar concentrations did not differ significantly between the silver sulfadiazine and chlorhexidine acetate groups, but there were significant differences between these and the Acticoat group, indicating that Acticoat eliminated A. baumannii from the tissues more effectively.

[Epidemiological features of Candida infections detected in intensive care units and risk factors affecting mortality]

The aim of this study was to describe the epidemiological features of nosocomial Candida infections in intensive care units and to detect the risk factors which increase the mortality rate. A total of 940 patients hospitalized in ICUs of Gulhane Military Medical Academy Haydarpasa Training Hospital, Istanbul, between January 01 and December 31, 2006 were prospectively enrolled into this study. Candida spp. were isolated from various clinical specimens (blood, urine, respiratory tract, wound) in 48 patients. Of these patients, 50% were male and 50% were female, and the mean age was 63.66 +/- 22.72 (age range: 8-92) years. The mean duration of hospital stay was 36.25 +/- 44.51 (min: 1, max: 90) days. Thirty five Candida infection attacks were observed in 29 of 48 patients. C. albicans was isolated in 18 infections and non-albicans Candida spp. in 17 infections. Nosocomial infection rate due to Candida spp. was 3.22 per 1000 patient-days. The most common Candida infections were bloodstream (42.9%) and urinary tract infections (37.1%). At the time of diagnosis, 89.6% of patients were being hospitalized for more than ten days and 69% of the patients were using three or more wide spectrum antibiotics. Diabetes mellitus and cardiovascular diseases were the most frequently detected co-morbid diseases. The overall mortality rate was 55.2%. Predictors of adverse outcome were diabetes mellitus (p= 0.016), need for mechanical ventilation (p= 0.010) and infection with non-albicans Candida spp. (p= 0.002). In conclusion, Candida infections in the intensive care patients are associated with high mortality. Mortality due to Candida infections could be reduced by defining the risk factors and starting preemptive antifungal treatment to patients who are under risk.

[Antimicrobial resistance profiles of community-acquired uropathogenic Escherichia coli isolates during 2004-2006 in a training hospital in Istanbul]

In order to reveal the antimicrobial resistance profiles against first-line antimicrobial agents in community-acquired acute uncomplicated urinary tract infections (UTIs), resistance patterns were determined for 1664 Escherichia coli strains collected between 2004 and 2006 in GATA Haydarpasa Training Hospital, Istanbul, Turkey. Of the isolates 38.2% were found to be susceptible to all of the tested antimicrobial agents, while the resistance rate to single antibiotic was 13.5%. Highest prevalence of antimicrobial resistance was observed for ampicillin (AMP) (49%), followed by amoxycillin-clavulanic acid (AMC) (34%), sulphamethoxazole/trimethoprim (SXT) (34%) and ciprofloxacin (CIP) (18%). The rate of multidrug resistant isolates was 33.5% and 48.4% of them were co-resistant. Resistance against two antimicrobials was identified in 244, against three antimicrobials in 205, against four antimicrobials in 160, against five antimicrobials in 63 and against six antimicrobials in 23 strains. Most frequent phenotypes indicating resistance against two, three and four antimicrobial agents were AMP/AMC (5.7%), AMP/AMC/SXT (5.4%) and AMP/AMC/cephazolin/SXT (2.6%), respectively. Extended spectrum beta-lactamase (ESBL) activity was detected in 40 (2.4%) of the isolates. Most prominent increases in resistance prevalence during the study period were observed for AMP (from 52% to 63%), AMC (from 33% to 45%) and CIP (from 15% to 22%). These results show that resistance to AMP, AMC and SXT are frequent in community-acquired E. coli strains and empirical initial treatment with these agents will most probably be inappropriate in our region.

[Strongyloidiosis and Loeffler's syndrome detected in a patient who used a short term steroid treatment]

Strongyloidiosis is widely distributed in tropical and subtropical areas but is a rarely reported parasitic infestation in Turkey. Disseminated strongyloidiosis may develop in patients with immunodeficiencies. We report a case of Strongyloides stercoralis infection and Loeffler's syndrome that developed in a patient who had received systemic prednisolone. The patient was a 20 year-old man, born in Hatay, Turkey. The patient presented at our department complaining of abdominal pain and leg pain. After he was admitted for further examination; headache, sore throat and cough developed. The differential-leukocytic count was characterized by 14% eosinophils. When a stool examination was performed, Strongyloides stercoralis larvae were observed. The patient was treated successfully with albendazole. His symptoms improved and Strongyloides stercoralis was not detected in subsequent follow-up examinations thereafter.

Phagocytic activity of neutrophils improves over the course of therapy of diabetic foot infections

AIMS

The aim of this study was to investigate changes in phagocytic activity of neutrophils of type 2 diabetic patients with foot infections over short treatment courses. The potential utility of the phagocytic index in determining the efficacy of treatment modalities and it's relationship with metabolic control parameters were evaluated.

METHODS

The phagocytic activity of neutrophils was determined in blood samples of 38 type 2 diabetic patients with foot infections (14 women and 24 men). Mean age and mean duration of diabetes were 66.3+/-9.4 and 19.1+/-11.2 (yrs), respectively. All patients received standard treatment (intensive insulin therapy, antibiotherapy, hyperbaric oxygen therapy and surgical debridement). Phagocytic activity of neutrophils was determined by a standard method. Phagocytic activity of neutrophils, acute phase proteins (C-reactive protein) and glycosylated haemoglobin was determined before therapy and two weeks later.

RESULTS

The phagocytic index before and after therapy were 47.7+/-11.4 and 62.5+/-15.6, respectively (p<0.05). There was a significant correlation between phagocytic index and both CRP and HbA1c (r=0.52, p<0.05 and r=-0.41, p<0.05, respectively).

CONCLUSIONS

Derangement of carbohydrate metabolism may underlie the impairment of bactericidal activity of neutrophils of poorly controlled diabetic patients. These data reveal that phagocytic activity improves during short-course standard therapy and might enable monitoring of efficacy of treatment modalities in diabetic patients with foot infections.

[Microorganisms isolated from middle ear cultures and their antibacterial susceptibility in patients with chronic suppurative otitis media]

OBJECTIVES

This study sought to determine causative microorganisms of chronic suppurative otitis media and their antibacterial susceptibility.

PATIENTS AND METHODS

Bacteriologic results of middle ear swabs, agent microorganisms, and their susceptibility to antibiotics were evaluated in 70 patients (65 males, 5 females; mean age 21.1+/-1.3 years; range 19 to 25 years) with chronic suppurative otitis media.

RESULTS

No bacteria were isolated in 14% of the patients. Of 60 patients in whom bacteria were isolated, the most common bacteria was Pseudomonas aeruginosa (23%), followed by Staphylococcus aureus (18%), and Proteus spp. (17%). P. aeruginosa strains were susceptible to ceftazidime and imipenem (100%), ciprofloxacin (92%), and amikacin and gentamycin (85%); S. aureus strains were susceptible to methicillin and vancomycin (100%), ciprofloxacin (91%), sulbactam-ampicillin (73%), and gentamycin and trimethoprim-sulfamethoxazole (63%). Proteus strains were susceptible to ciprofloxacin (100%), ceftazidime (90%), and imipenem and gentamycin (70%).

CONCLUSION

Appropriate knowledge of antibacterial susceptibility of microorganisms will contribute to rational antibiotic usage and the success of treatment for chronic suppurative otitis media.

Comparison of Silver-Coated Dressing (Acticoat???), Chlorhexidine Acetate 0.5% (Bactigrass??), and Silver Sulfadiazine 1% (Silverdin??) for Topical Antibacterial Effect in Pseudomonas Aeruginosa-Contaminated, Full-Skin Thickness Burn Wounds in Rats

Acticoat (Smith and Nephew, Istanbul, Turkey), chlorhexidine acetate 0.5%, and silver sulfadiazine 1% were compared to assess the antibacterial effect of their application on experimental burn wounds in contaminated with Pseudomonas aeruginosa in rats. All treatment modalities were effective against P. aeruginosa because there were significant differences between treatment groups and control groups. The mean eschar concentrations did not differ significantly between Acticoat and chlorhexidine acetate groups, but there were significant differences between the silver sulfadiazine group and the other treatment groups, indicating that silver sulfadiazine significantly eliminated P. aeruginosa more effectively in the tissues than did the other two agents. All treatment modalities were sufficient to prevent the P. aeruginosa from invading to the muscle and from causing systemic infection. In conclusion, silver sulfadiazine is the most effective agent in the treatment of the P. aeruginosa-contaminated burn wounds; Acticoat can be considered as a treatment choice because of its peculiar ability of limiting the frequency of replacing wound dressings.

Does N-acetyl cystein affect the sensitivity and specificity of Helicobacter pylori stool antigen test?

BACKGROUND

N-acetyl cystein, a mucolytic agent, might make Helicobacter pylori antigens shed more easily to stool, and might therefore contribute to the diagnostic accuracy of the Helicobacter pylori stool antigen test. The aim of this study is to investigate if N-acetyl cystein contributes to the diagnostic accuracy of the Helicobacter pylori stool antigen test by increasing the sensitivity and specificity of the test.

MATERIALS AND METHODS

107 patients were separated into treatment and placebo groups. The AC group (n = 53) was given 5 ml of acetyl cystein (4%) t.i.d. and the Placebo group (n = 54) was given placebo, for 3 days. Helicobacter pylori status was determined by both histology and CLOtest. Stool samples were assayed using a specific ELISA kit for Helicobacter pylori stool antigen.

RESULTS

The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Helicobacter pylori stool antigen test were 76%, 79%, 90%, 55%, and 77%, respectively, in AC group; and 85%, 89%, 93%, 76% and 86%, respectively, in placebo group.

CONCLUSIONS

N-acetyl cystein did not increase, and actually decreased, the sensitivity and specificity of the Helicobacter pylori stool antigen test according to our results. We believe that this finding can be taken into consideration when setting up the exclusion criteria for future studies, which will use Helicobacter pylori stool antigen tests.

Cutaneous anthrax in Turkey: a review of 32 cases

Anthrax, caused by the Gram-positive, rod-shaped, spore-forming bacterium Bacillus anthracis, is rarely seen in industrialized nations but is common in developing countries. Cutaneous anthrax accounts for 95% of cases and usually develops on exposed sites. This study reviews the clinical and laboratory findings of 32 patients diagnosed with cutaneous anthrax over a 4-y period in the eastern part of Turkey. All patients had a history of direct contact with infected animals. The patients, aged 6-72 y, comprised 17 (53%) males and 15 (47%) females. The most frequent localization site of skin lesions was the hands and fingers (31 patients), whereas the suborbital part of the face was invaded in 1 patient. The diagnosis was made as a result of typical clinical lesions, direct microscopy or bacterial isolation. All but 2 patients were successfully treated with penicillin; these other 2 patients were treated initially with sulbactam-ampicillin. All patients, including the patient with suborbital anthrax, were cured.

Serum interleukin 2 levels in patients with rheumatoid arthritis and correlation with insulin sensitivity

Interleukin 2 (IL-2), a Th1 lymphocyte-derived cytokine, is thought to play an important role in the pathogenesis of type 2 diabetes and rheumatoid arthritis (RA). The aim of our study was to evaluate changes in serum IL-2 levels and their correlation with glucose metabolism abnormalities, such as insulin resistance, in patients with RA. Thirty-six subjects with varying degrees of disease activity and 20 healthy age-, sex- and body mass index-matched control individuals were evaluated. Patients with any causes of peripheral insulin resistance were excluded. After a 12-h overnight fast, fasting insulin levels, homeostatic model assessment-insulin resistance (HOMA-IR) estimated insulin sensitivity, and serum IL-2 levels were significantly higher in all patients with RA than in the control individuals. Fasting insulin, HOMA-IR scores and IL-2 levels were correlated in the RA group. This study showed that patients with RA have altered IL-2 regulation, and that there was a significant correlation between serum IL-2 levels and insulin sensitivity.

Hospital-acquired infections following the 1999 Marmara earthquake

In this study, medical records of all casualties admitted to our hospital following the Marmara earthquake, which struck northwest Turkey and resulted in the destruction of several towns in the Marmara region, were evaluated retrospectively. The time buried under the rubble, demographic data, type of medical and surgical therapies performed, type of injury and data on infection were analysed. Between 17 August and 25 September 1999, 630 trauma victims were received at our hospital and 532 (84%) of them were hospitalized. The mean age of hospitalized patients (312 males, 220 females) was 32 years (2-90 years). Two hundred and twenty patients were hospitalized for more than 48 h. Forty-one of them (18.6%) had 43 hospital-acquired infection (HAI) episodes, which were mostly wound infections (46.5%). A total of 143 culture specimens was collected and 48 yielded the following potential pathogens: 15 Acinetobacter baumanii (31.2%), nine Staphylococcus aureus (18.7%), seven Pseudomonas aeruginosa (14.6%), six Escherichia coli (12.5%), six Klebsiella pneumoniae (12.5%), two Stenotrophomonas maltophilia (4.2%) and three various Pseudomonas spp. (6.3%). All S. aureus strains were found to be resistant to methicillin in vitro. Two strains of A. baumannii and one P. aeruginosa were found to be resistant to all antimicrobials including carbapenems. Fifty-three victims died (10%) and 36 of those died during the first 48 h because of severe injuries and multi-organ failure. After 48 h of hospitalization, the mortality rate was significantly higher in those patients with HAI (14/41) than those without (3/179) (34.1% vs. 1.7%, P<0.05). In conclusion, trauma is the significant factor associated with HAI and a high incidence of Acinetobacter strains was responsible for HAI in trauma patients.

Serum interleukin 1 alpha and interleukin 2 levels in patients with schizophrenia

It has been suggested that altered interleukin (IL) regulation may be involved in the pathogenesis of schizophrenia. In this cross-sectional, case-controlled study, patients with schizophrenia and a control group of healthy subjects, matched by age, sex and body mass index, were evaluated. The levels of IL-1 alpha and IL-2 in blood serum were measured by enzyme-linked immunosorbent assay. The fasting serum IL-2 levels were significantly higher in patients with schizophrenia compared with the control subjects, but there was no difference between the fasting serum levels of IL-1 alpha in patients with schizophrenia and the control subjects. Our results suggest that patients with schizophrenia have altered IL-2, but not IL-1 alpha, regulation.