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Drug-resistant tuberculosis is increasing day by day and is a significant threat to tuberculosis control because there are few drugs effective against Mycobacterium tuberculosis. This study evaluates the resistance of the microorganism to primary anti-tuberculosis drugs over the 21-y period 1976-97. Records from the bacteriology laboratory of the Department of Chest Diseases and Tuberculosis, Ankara University Medical Faculty were evaluated retrospectively. Among 3,418 mycobacteria strains, 3,319 (97.1%,) M. tuberculosis were isolated and their susceptibility was examined by the proportion method in Loewenstein-Jensen medium. It was found that 60.8% of isolated strains were susceptible, whereas 39.2%, were resistant to at least one drug. Multi-drug resistant tuberculosis (MDR-TB) was found in 194 (5.8%) materials. Over the 21-y period studied, total resistance to isoniazid (INH), rifampicin (RF) and streptomycin (SM) were determined as 10.5, 6.9 and 7.0%, respectively. It was also observed that the resistance rates to INH or SM increased, whereas resistance to RF was not changed within this period. While resistance to the 2-drug combination RF+SM increased, resistance to INH+SM decreased significantly. There was no change in resistance to the 2-drug INH + RF or 3-drug INH + RF + SM combinations in the same period. In conclusion, combined therapy is still useful and available for the treatment of resistant tuberculosis, and INH should be included in the chemotherapeutic regimen even if high resistance rates are shown to exist.

Endoscopic procedures performed worldwide have increased considerably in recent years. In addition to diagnosis, many cases previously necessitating surgery now often can be carried out by endoscopic techniques. However, endoscopy has introduced its own infection risk. Most reports of gastrointestinal endoscopy-associated infection describe sepsis after endoscopic retrograde cholangiopancreatography (ERCP) in patients with biliary tract obstruction. During this study, which was conducted by Infection Control Committee of Ankara University Hospital, 13 out of 1147 (1.1%) and 17 out of 922 patients (1.8%) had ERCP related sepsis in 2002 and 2003 respectively, at the ERCP Unit of Gastroenterology Department. Sepsis-caused mortality were 23.1 and 29.4% in 2002 and 2003 respectively. The first four causative agents were Escherichia coli, Pseudomonas spp, Klebsiella spp and Enterobacter spp. Type and frequency of the causative agents remind that both endogenous and exogenous mechanisms are together responsible for the infections emerging from ERCP Unit. Besides, increasing isolation of Pseudomonas spp. brings out the strong need for re-evaluation of infection control measures, mainly effective cleansing and disinfection of endoscopes.

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Antimicrobial resistance among bacteria has arisen ever since antimicrobial agents were introduced in the clinic. Unfortunately, it seems that resistance is now emerging at a more rapid rate than ever before, as a consequence of the widespread use of antimicrobial agents. The spread of these multiresistant microorganisms is an increasing threat in many countries. The human intestinal flora is a huge potential reservoir of resistant microorganisms. Antimicrobial resistance in clinical isolates may cause serious infections and treatment failure, and lead to the use of higher doses or more toxic alternative drugs. This study was planned so as to compare the effects of hospitalization and antibiotic usage on the aerobic intestinal flora and included 43 hospitalized adult patients without any previous history of hospitalization and antibiotic usage during the last 30 d. Patients were divided according to their antimicrobial therapy, into treated and untreated groups. The individual use of antimicrobials was recorded. Antibiotic usage was found to be more effective on the aerobic intestinal flora compared with hospitalization without such medication.

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