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Endophthalmitis is described as bacterial and fungal infections of the vitreous and aqueous humor. It is the result of exogenous or endogenous contamination by microorganisms. Exogenous contamination results from ocular surgery and trauma while endogenous contamination results from microorganisms gaining access via bloodstream. Sterile endophthalmitis may result from various causes such as retained native lens material after an operation or toxic agents. Most of endophthalmitis cases are acute and require urgent medical attention. Delayed or inadequate treatment can result in irreversible loss of vision. Application of the proper treatment protocol against defined infectious agent increases success of the treatment. It is important to start the treatment against possible infectious agents particularly in patients requiring urgent attention. According to the research of Medline PubMed, ISI Web, Web of Science, Google Academic and Turkish Medline with key words including "endophthalmitis" and "Turkey", the exogenous endophthalmitis agents reported in Turkey are Burkholderiacepacia, Bacillus cereus, Chlamydia trachomatis, Stenotrophomonas maltophilia, Corynebacterium minutissimum, Staphylococcus epidermidis, S. aureus, Pseudomonas spp., Streptococcus pneumoniae, Propionobacterium acnes, Nocardia asteroides, P. aeruginosa, Acinetobacter spp., Cellulosimicrobium cellulans, Ochrobactrum anthropi, coagulase-negative staphylococci, S. pyogenes, a-haemolitic streptococci, group G streptococci and Acinetobacter baumannii. Endogenous endophthalmitis agents are diphteroid bacilli, Klebsiella pneumoniae and methicillin susceptible S. aureus. Fungal endophthalmitis agents are Candida albicans, C. pelliculosa, Fusarium solani, Fusarium spp., Aspergillus ustus, A. flavus, and Scopulariopsis spp. There is a wide variety of bacterial agents causing endophthalmitis in Turkey. These bacteria cannot colonize a healthy eye, but they can be transmitted to eye exogenously by operations or trauma. It is important to take maximal sterilization and antisepsis precautions during eye manipulations to prevent from endophthalmitis because microorganisms mentioned above are commonly available in hospital settings. This review evaluated the causative agents of endophthalmitis in Turkey. © 2013, AVES Ibrahim Kara. All rights reserved.

Objective: In this study, the presence of Panton-Valentine Leukocidin (PVL) was investigated in the Staphylococcus aureus clinical isolates by PCR. Material and Methods: In this study, 130 MRSA and 20 methicillin-sus-ceptible S. aureus (MSSA) isolates were tested among various clinical samples between February 2006 and June 2008. Confi rmation of S. au-reus isolates and the methicillin resistance of these isolates were made by multiplex PCR. The presence of PVL was tested by both multiplex PCR and single target PCR. Results: The presence of PVL was determined in 3 isolates. Two of the isolates were from MRSA isolates, one was from MSSA isolates. One of the PVL positive MRSA isolate was recovered from a wound specimen, the other was from blood culture. PVL positive MSSA isolate was recovered from an urine specimen. All of the three PVL positive isolates were resistant to tetracycline. One of the PVL positive MRSA isolates which was recovered from blood culture was resistant to gentamicin and ciprofloxacin, while the other PVL positive isolate was susceptible. Conclusion: Further studies are needed to determine the prevalence and genetic characteristics of PVL positive isolates and to prevent dissemination of PVL positive isolates both in the hospital environment and the community. © Trakya University Faculty of Medicine.

The aim of this study was to asses the effects of environmental pH changes to acidic range on nitric oxide (NO) synthesis from macrophages.Human monocyte derived macrophages were obtained from peripheral blood of healthy human volunteers by using Ficoll-Hypaque density gradient method. Isolated monocytes were seeded into tissue culture flasks and incubated at 37°C in a 5 %C02 humidified incubator for 7 days in RPMI (Roswell Park Memorial Institute)-1640 medium with 10% Fetal-calf serum (FCS). Macrophages were then harvested and seeded in 96-wellplates at 105 cells/well. RPMI 1640 containing 10% FCS at three different pH ranges of 7.4. 7.0 and 6.8 was added to all wells. Samples from each well were taken for determining nitrite concentration at 3, 6, 24 and 48 hours time.Substitution of the medium of adherent macrophages with media at different pH modified NO production as reflected by changes in nitrite accumulation; as the pH became more acidic, more nitrite was detected in the culture media. The results indicate that the state of pH to which macrophages exposed to causes significant improvement in NO synthesis. İnsan Monosit-Derive Makrofajlann Nitrik Oksit (NO) Sentezine Düşük pH'ın EtkileriÇalışmada, asidik karakterde çevresel pH değişikliklerinin makrofajlann nitrik oksit (NO) sentezine etkilerinin araştınlması amaçlanmıştır. İnsan monosit derive makrofajlar sağlıklı gönüllülerin periferal kanlarından Ficoll-Hypaque density graident metod kullanılarak elde edilmiştir. İzole edilen monositler doku kültür flasklanna dağıtıldıktan sonra %10 fetal-calf serumlu (FCS) RPMI (Roswell Park Memorial Institute)-1640 besiyerinde 7 gün 37CC ve %5 C07 içeren ortamda inkübe edilmiştir. Oluşan makrofajlar 96 kuyucuklu plaklara 105 hücre/kuyucuk olacak şekilde dağıtılmıştır. Tüm kuyucuklara pH 7.4, 7.0 ve 6.8 olan %10 FCS'lu RPMI 1640 ilave edilmiştir. 3. 6, 24 ve 48 saat sonra kuyucuklardan alınan örneklerdeki nitrit kon-santrasyonlan tespit edilmiştir.Farklı pH'daki besiyerleri ile adherent makrofajlann besiyerleri değiştirildiğinde NO üretiminin bir göstergesi olan nitrit birikiminde değişiklik olmaktadır. pH daha asidik olunca kültür ortamında daha çok nitrit tespit edilmektedir. Sonuçlar göstermektedir ki. makrofajlann maruz kaldığı pH'ın durumu NO sentezinde belirgin bir artışa neden olmaktadır.

The Investigation of The Efficacy of Nitric Oxide Against Mycobacterium tuberculosis In VitroIn this study, the efficacy of NO against 15 Mycobacterium tuberculosis clinical isolates was examined. DETA-NO was used as NO donor. Minimum inhibitor concentrations (MIC) for NO detected with microdilution method by using Middlebrook 7H9 broth with OADC (oleic acid, albumin, dextroz, catalase). In this assay detected MIC values for clinical isolates were found in a range of 0.015-0.125 mg/ml. According to our results NO was efficient to M. tuberculosis.Çalışmada, nitrik oksit (NO)'in 15 klinik Mycobacterium tuberculosis izolatma karşı etkinliği araştırılmıştır. NO donorü olarak DETA-NO kullanılmıştır. NO için minimum inhibitor konsantrasyonlar (MİK) OADC (oleik asit, albumin, dekstroz, katalaz)'li Midd-lebrook 7H9 buyyonda mikrodilüsyon yöntemi ile tespit edilmiştir. Çalışmada klinik izolatlar için elde edilen MİK değerleri 0.015-0.125 mg/ml arasında bulunmuştur. NO'nun M. tuberculosis izolatlarma karşı etkili olduğu sonucuna varılmıştır.

PubMed: 17001854 In this study, the prevalence and risk factors of fecal carriage of vancomycin resistant enterococci (VRE) among patients in Ondokuz Mayis University Pediatric Hematology and Oncology Clinics have been investigated. During two months, rectal swab samples were collected weekly from all of the patients hospitalized in Pediatric Hematology and Oncology Clinics, for the surveillance cultures. During the study a total of 85 rectal swabs were obtained from 34 patients who had been hospitalized in the inpatient clinic with 20 bed capacity. The number of samples obtained from the patients varied between 1-6 cultures. All of the patients (100%) had peripheral venous catheters and 27(79%) of patients had used antibiotics. All of the samples were inoculated onto 8 ?g/mL gentamicin containing blood agar media, and enterococci were identified by Gram staining, catalase test and at species level by VITEK 2 (bioMérieux, France) automated system. Vancomycin resistance was screened by using 6 ?g/mL vancomycin containing brain-heart infusion agar according to CLSI guidelines. The vancomycin MIC values of the strains grown in this medium were determined by microdilution test proposed by CLSI. As a result, a total of 50 samples (59%) belonging to 24 patients yielded enterococci, and the species distribution was as follows; E.faecium (in 16 cases), E.faecalis (in 8 cases), E.casseliflavus (in 6 cases), E.avium (in 3 cases) and E.durans (in 1 case). In our study no vancomycin resistance nor VRE colonization was detected in the patients.

PubMed: 16358496 Vancomycin resistant enterococcus (VRE) was recovered from the urine culture of a 61 years old female patient, who was being treated for sepsis, on the 15th day of hospitalization in Ondokuz Mayis University Hospital Infectious Disease Unit. The underlying diseases of this patient were chronic renal failure and diabetes mellitus. The patient died due to septic shock on the day of VRE isolation. Since this case was the first VRE infection in our hospital, a point prevalence study was planned. For this purpose, rectal swab samples collected from 10 patients from the same unit and 27 personnel who worked in the same unit, were screened for the presence of VRE. Nasal swabs and finger tip samples were also taken from the staff to determine if the transmission has occured in this way. As a result, a second VRE strain was isolated from another patient with chronic renal failure who was under treatment due to multiple pulmonary abscesses. Immediate isolation of this patient prevented a possible epidemic in this specific unit. In this report, the importance of VRE screening and isolation of the patients after the recovery of VRE has been emphasized.

PubMed: 15293898 In this study, effects of eflux pump inhibitors, phe-arg-?-naphthylamide (MC-207,110), verapamil, omeprazole and lansoprazole, on ciprofloxacin minimal inhibitory concentrations (MIC) against Escherichia coli clinical isolates with high level fluoroquinolone (FQ) resistance, were evaluated. Fourteen FQ resistant clinical isolates of E.coli isolated from urine samples and identified by BD BBL CRYSTAL Identification Systems Enteric/Nonfermenter ID kit (Becton Dickinson and Company Sparks, USA) were tested. In order to investigate the effects of inhibitory agents, MIC values were determined by broth microdilution method in the absence or presence of 20 ?g/ml MC-207,110, verapamil, omeprazole and lansoprazole. All 14 clinical isolates were resistant to ciprofloxacin (MIC range; 16-512 ?g/ml). No difference was observed on ciprofloxacin MIC values in the presence of 20 ?g/ml omeprazole, whereas MIC values were decreased 2 folds in 2 isolates in the presence of verapamil and lansoprazole, 2 folds in 6 isolates and 4 folds in 2 isolates in the presence of MC-207,110. In conclusion, we observed that there were no effects of the compounds used in our study, on ciprofloxacin resistance of E.coli clinical isolates.

PubMed: 15490847 Pseudomonas stulzeri is a saprophytic microorganism that rarely causes severe infections. In this report, a 28 days old male patient with meningomyelocele at birth was presented. The patient was admitted to the hospital with fever, and diagnosed as meningitis on the basis of physical examination and leukocytosis (blood: 16.380/mm3, cerebrospinal fluid (CSF): 130/mm3; 90% PMNL). Following diagnosis ceftriaxone therapy was started led to improvement in clinical and laboratory findings. However on the 20th day, the clinical signs and symptoms became worse, and the patient was diagnosed to develop a second meningitis attack by laboratory examination of CSF. Pstutzeri was isolated from the CSF culture, and the isolate was found to be resistant to ceftriaxone. Upon this result the therapy has changed to meropenem. On the 5th day of the therapy, the patient has slightly improved and he was discharged due to the wishes of his parents, however he died two days after discharge. This first case of Pstutzeri meningitis in neonates was presented to withdraw attention to this clinical entity.

PubMed: 14593897 In this study, the antibacterial effects of nitric oxide (NO) have been investigated against 4 strains of multidrug-resistant Mycobacterium tuberculosis and 8 Klebsiella, 7 Escherichia coli, 7 Staphylococcus, 5 Enterobacter, 7 Pseudomonas and 7 Proteus clinical isolates by using DETA-NO ((Z)-1-[N-(2aminoethyl)-N-(2-ammonioethyl)amino]diazen-1-ium-1,2-diolate) as the NO donor. Minimum inhibitory concentrations (MICs) were determined by broth microdilution method for all tested microorganisms. The MIC values found in our study were as follows; 0.25 mg/ml for all of the multidrug-resistant Mycobacterium tuberculosis strains, 1 mg/ml for Staphylococcus strains, and approximetely 2 mg/ml for the rest of the bacterial strains. These results showed that NO (or NO donor DETANO) was more effective on multidrug-resistant M.tuberculosis strains than the other bacterial species. It can be concluded that further studies are needed to explain the clinical use of NO donor DETA-NO, especially, in patients infected with multidrug-resistant M.tuberculosis.

In this study, the efficacy of NO against 15 Mycobacterium tuberculosis clinical isolates was examined. DETA-NO was used as NO donor. Minimum inhibitor concentrations (MIC) for NO detected with microdilution method by using Middlebrook 7H9 broth with OADC (oleic acid, albumin, dextroz, catalase). In this assay detected MIC values for clinical isolates were found in a range of 0.015-0.125 mg/ml. According to our results NO was efficient to M. tuberculosis.

PubMed: 12476776 [No abstract available]

The aim of this study was to asses the effects of environmental pH changes to acidic range on nitric oxide (NO) synthesis from macrophages. Human monocyte derived macrophages were obtained from peripheral blood of healthy human volunteers by using Ficoll-Hypaque density gradient method. Isolated monocytes were seeded into tissue culture flasks and incubated at 37°C in a 5 %CO2 humidified incubator for 7 days in RPMI (Roswell Park Memorial Institute)-1640 medium with 10% Fetal-calf serum (FCS). Macrophages were then harvested and seeded in 96-well plates at 105 cells/well. RPMI 1640 containing 10% FCS at three different pH ranges of 7.4. 7.0 and 6.8 was added to all wells. Samples from each well were taken for determining nitrite concentration at 3, 6, 24 and 48 hours time. Substitution of the medium of adherent macrophages with media at different pH modified NO production as reflected by changes in nitrite accumulation; as the pH became more acidic, more nitrite was detected in the culture media. The results indicate that the state of pH to which macrophages exposed to causes significant improvement in NO synthesis.

The present study was carried out to determine the effects of ampicillin, ciprofloxacin, ofloxacin, isoniazid, rifampicin, streptomycin and ethambutol on the nitric oxide (NO) synthesis by human macrophages. Human macrophages were obtained by Ficoll-Hypaque density gradient method and after dispersing into the 96-well plate (104 macrophages per well), 1 ?g/ml ampicillin, 0.250 ?g/ml ofloxacin, 0.06 ?g/ml ciprofloxacin, 1 ?g/ml isoniazid, 1 ?g/ml rifampicin, 2 ?g/ml streptomycin and 2 ?g/ml ethambutol were added to each well. The nitrite levels in the culture supernatants were measured by Griess reagent at 3rd, 6th and 24th hours. As a result the nitrite levels were found to be significantly increased in the well containing isoniazid, ampicillin, ofloxacilin, streptomycin and ethambutol.

In this study, the antibiotic susceptibilities of 50 Mycobacterium tuberculosis strains against isoniazide, rifampicin, streptomycin and ethambutol were investigated by proportion method on both Löwenstein-Jensen (LJ) medium and Middlebrook 7H10 agar. The concordance between two media was assessed by McNemar statistical test, and the accordance of the media used for isoniazide, rifampicin, streptomycin and ethambutol susceptibilities was found to be 88%, 74%, 68% and 90%, respectively. The differences between the media for the detection of resistance to streptomycin and rifampicin, were found to be statistically significant (p

The present study was carried out to determine the effects of isoniazid, rifampicin, streptomycin and ethambutol on the nitric oxide (NO) synthesis by human macrophages induced by Mycobacterium tuberculosis H37Rv. Human macrophages were obtained by Ficoll-Hypaque density gradient method, dispersed into the microplate wells (105 macrophages/well) and incubated at 37°C overnight. The next day, M. tuberculosis H37Rv suspensions (104 cfu/ml per well) were added into the wells and after incubation at 37°C for one hour, the antibiotic solutions which will be studied were added. The NO synthesis has been evaluated by measuring the nitrite levels with Griess reagent at 3rd, 6th, 24th and 48th hours of the culture supernatants. In each trial, the control wells containing macrophages alone and macrophages + M. tuberculosis, were included to the study. As a result, nitrite levels were found to be increased by virulent M.tuberculosis (H37Rv) and the nitrite level in the isoniazid well was detected significantly higher than the other antibiotic wells, statistically (p