Birgul Kacmaz

Kan dolaşımı enfeksiyonlarının saptanabilmesi için kan kültürü alınması gereklidir. Kan kültürleri şişe sayısı ile üreme oranları arasında kanıtlanmış bir ilişki mevcuttur. Rehberler 24 saatlik süre içinde iki-dört şişe kan kültürü alınmasını önermişlerdir. Bu çalışmada kan kültür şişelerinin sayılarının uygunluğu araştırılmıştır. Bu çalışma Kırıkkale Üniversitesi Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji laboratuarında yürütülmüştür. Mart 2013-Mart 2014 tarihleri arasında gelen her hastaya ait kan kültür şişelerinin sayısı değerlendirilmiştir. Rehberlere dayanarak iki ila dört kan kültür şişesi uygun olarak düşünülmüştür. Kan kültürleri hastaların cerrahi veya dahili kliniklere başvurmasına göre iki gruba ayrılmıştır. Verilerin analizi için SPSS 15.0 programı, grupların karşılaştırılması içinde ki kare testi kullanılmıştır. p<0.05 anlamlı kabul edilmiştir. Çalışma süresi boyunca laboratuarımıza 621 hastadan 1095 kan kültür şişesi gönderilmiştir. 435 hastanın uygun sayıda (iki-dört) kan kültür şişesine sahip olduğu bulunmuştur. 185 hastada sadece tek, bir hastada dörtten fazla kan kültür şişesinin gönderildiği saptanmıştır. Uygunsuz alım oranları cerrahi klinikler için %34.4 (66/192), dahili klinikler için %27.9 (120/429) olarak saptanmıştır (p= 0.107). Sonuçlarımıza göre her hastane uygun kan kültür şişesi oranlarını araştırmalı ve buna göre gerekli eğitim programlarını yürütmelidir. Anahtar kelimeler: kan kültürü, şişe sayısı Abstract For detecting blood stream infections blood cultures are essential. There is a proven relation between the number of blood cultures and growing rates. Guidelines offer that two to four blood cultures be obtained over a 24 hours period. The aim of this study was to examine the appropriateness of number of blood cultures. The study was conducted in Infectious Diseases Laboratory of Kirikkale University Hospital. From March 2013 to March 2014, the number of blood cultures obtained from each hospitalized patients and admitted to our laboratory were evaluated. In accordance with guidelines, two to four blood cultures were accepted as appropriate. Blood cultures were divided into two groups according to admission from internal diseases clinics or surgical clinics. SPSS 15.0 program was used for data analysis and chi-square test was used for comparing groups. p<0.05 was accepted as significant. During the study period, 1095 blood cultures from 621 patients had been admitted to our laboratory. 192 patients were staying in surgical clinics and 429 were in internal diseases clinics. 435 patients had an appropriate number (two to four) of blood cultures. While a single blood culture was obtained from 185 patients, more than four cultures were obtained from one patient. Inappropriateness number of blood cultures was 66 in surgical clinics and 120 in internal diseases clinics (p=0.107). According to our results all hospitals should detect their appropriateness of number of blood cultures and education programs ought to be conducted accordingly. Keywords: blood culture, number of bottle

Tr en Giriş : Üriner sistem enfeksiyonunun tanısında ilk adım idrarın piyüri varlığı için mikroskobik incelemesidir. Piyüri genellikle enfeksiyon ile ilişkilendirilir. Gereç ve Yöntem : Bu araştırmada idrar kültürü için laboratuarımıza gelen idrar örneklerinde piyüri varlığı araştırılmış, piyüri saptanan örnekler kültür üremesi ile karşılaştırılmıştır. Bulgular : Retrospektif olarak yapılan çalışmada laboratuvarımıza Ocak 2015 - Temmuz 2015 tarihleri arasında kültür amacıyla gönderilen toplam 3787 idrar örneği değerlendirilmiştir. 927 (%24) hastada piyüri saptanmış, bu örneklerin 336’sında (%36) anlamlı üreme görülmüştür. Sonuç : Çalışmanın sonucunda üriner sistem enfeksiyonu düşünülen hastalarda piyürinin tek başına tanı koydurucu bir test olmadığı ve bu hastalarda idrar kültüründe üremenin her zaman saptanamayabileceği bilinmelidir. Introduction : Introduction: Microscobic examination of the urine is the first step of the diagnosis of urinary tract infections. Pyuria is usually related with infection. Material and Method : In this study, the presence of pyuria in the urine samples, which had been sent to the laboratory of Kirikkale University Microbiology Laboratory between January 2015 - July 2015, were examinated retrospectively the positive samples were then compared with growth in the urine cultures. Results : Totally 3787 urine samples were examined. 927 (24%) samples had pyuria and 336 (36%) of them had significant growth in cultures. Conclusion : Accordingly our results, the presence of pyuria alone is not diagnostic in UTI and bacterial growth may not be always seen in the urine samples have pyuria.

The aims of this study were to investigate drug resistance rates, types of extended spectrum beta lactamases (ESBLs), and molecular epidemiological characteristics of 43 Shigella sonnei isolates. Ampicillin-sulbactam, amoxicillin-clavulanate, chloramphenicol, and ciprofloxacin were the most active antibiotics. Five isolates harbored blaSHV-12, blaTEM-1 and blaCTX-M-15. More than 90% of the isolates had an indistinguishable pulsotype.

Ampicillin-sulbactam (A/S) and amoxicillin-clavulanic acid (AUG) are thought to be equally efficacious clinically against the Enterobacteriaceae family. In this study, the in vitro activities of the A/S and AUG were evaluated and compared against Escherichia coli and Klebsiella spp. Antimicrobial susceptibility tests were performed by standard agar dilution and disc diffusion techniques according to the Clinical and Laboratory Standards Institute (CLSI). During the study period, 973 strains were isolated. Of the 973 bacteria isolated, 823 were E. coli and 150 Klebsiella spp. More organisms were found to be susceptible to AUG than A/S, regardless of the susceptibility testing methodology. The agar dilution results of the isolates that were found to be sensitive or resistant were also compatible with the disc diffusion results. However, some differences were seen in the agar dilution results of some isolates that were found to be intermediately resistant with disc diffusion. In E. coli isolates, 17 of the 76 AUG intermediately resistant isolates (by disc diffusion), and 17 of the 63 A/S intermediately resistant isolates (by disc diffusion) showed different resistant patterns by agar dilution. When the CLSI breakpoint criteria are applied it should be considered that AUG and A/S sensitivity in E. coli and Klebsiella spp. Strains may show differences.

In order to compare the performance of leukocyte esterase and nitrite urine dipstick tests with enhanced urinalysis (uncentrifuged urine white blood cell count/mm3 plus Gram stain) in detecting asymptomatic bacteriuria in obstetric patients, clean-catch midstream urine specimens were collected from 250 consecutive asymptomatic pregnant women. Ten of the women (4.0%) showed urine culture results indicating significant bacteriuria. The nitrite test was the most specific (99.2%) of these tests, however, its sensitivity was found to be the lowest (60.0%). The sensitivity of the leukocyte esterase test was 70.0%, on the other hand, while its positive predictive value was 28.0%. The sensitivity and specificity of enhanced urinalysis were found to be 50.0 and 96.7%, respectively. None of the rapid tests was found to be a reliable alternative for culture screening of all pregnant women. Nitrite tests are useful screening tests for detecting asymptomatic bacteriuria only if their limitations are fully understood, while leukocyte esterase and enhanced urinalysis tests are not suitable for screening for asymptomatic bacteriuria. Our findings support previous conclusions that quantitative urine cultures are required to rule out asymptomatic bacteriuria in pregnant women.