Biofilm is an example of bacterial group behavior. We investigated the effect of N-acetylcysteine (NAC) alone and in combination with ciprofloxacin on Pseudomonas aeruginosa biofilm formation. Four groups (each contains six molds) of standardized bone cement molds were infected. NAC, ciprofloxacin each alone, and NAC/ciprofloxacin combination were evaluated in point of inhibiting and eradicating biofilm capacity using microbiological and electron microscopical evaluation techniques. Microbial counts and electron microscopical observations showed that the effect of NAC and ciprofloxacin combination on biofilm formation in bone cement is valuable. NAC enhances the beneficial effect of ciprofloxacin when used in combination with it in bone cement. SCANNING 38:766-770, 2016. © 2016 Wiley Periodicals, Inc.

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Bacteria producing New Delhi metallo-beta-lactamase-1 (NDM-1) exhibit high level resistance to beta-lactams including carbapenems. This broad-spectrum resistance limits treatment options for infections caused by NDM-1 producers. NDM-1 was first isolated from an Indian patient in Sweden; since then, NDM-1 producing isolates have been identified in many countries including Turkey. In this study, we investigated the presence of NDM-1 by PCR method in various gram-negative isolates recovered from clinical specimens in tertiary care hospitals in Samsun, Turkey. A total of 210 carbapenem-resistant gramnegative isolates (132 Acinetobacter baumannii, 54 Pseudomonas aeruginosa, 5 Pseudomonas putida, 8 Enterobacter cloacae, 3 Enterobacter aerogenes, 3 Klebsiella pneumoniae, 2 Providencia rettgeri, 2 Escherichia coli and 1 Citrobacter freundii) were included in the study. Identification and antibiotic susceptibility testing of the isolates were performed by using Vitek-2 Compact (bioMerieux, France) and BD Phoenix (BD Diagnostic Systems, MD) automated systems. The results of antibiotic susceptibility testing were interpreted according to the CLSI recommendations. In our study, NDM-1 gene was not detected in any of the clinical isolates by PCR. There was only one case study that reported the presence of NDM-1 in clinical isolates from Turkey [Poirel L et al. Antimicrob Agents Chemother 2012;56:2784]. Our data, together with the others, indicated that the existence of NDM-1 in clinical isolates is not common in Turkey. However, since NDM-1 is a plasmid-encoded enzyme, there is always a risk of spread of this resistance through the bacterial strains in our country. Therefore, continuous surveillance and investigation of carbapenem-resistant isolates with resistance patterns suggestive of NDM-1 may enable to identify NDM-1 producing isolates. Meanwhile special care should be given on rational antibiotic use and establishment of appropriate infection control policies to prevent the spread of NDM-1 producers and other potential resistant strains.