Etiology and bacterial susceptibility to antibiotics in patients with recurrent lower urinary tract infections.

INTRODUCTION: Recurrent urinary tract infections (UTIs) are a frequent health problem and a common reason for treatment resistance. OBJECTIVES: The purpose of the study was to evaluate the etiology of community­ acquired lower recurrent UTI and bacterial antibiotic susceptibility. PATIENTS AND METHODS: A total of 796 microbiological urine cultures from 332 patients (280 women and 52 men) treated in a single nephrology outpatient department in central Poland in years 2016 to 2018 were analyzed. The most frequent species responsible for recurrent lower UTI were identified and the susceptibility of all the microbes to specific antibiotics was assessed. The patients' kidney function and inflammation parameters were evaluated. RESULTS: The median (interquartile range [IQR]) age of the patients was 65 (59-77) years (women, 69 [57-78] years; men, 67 [62-77] years), median (IQR) glomerular filtration rate was 56.6 (40.2-81.3) ml/min/1.73 m2 with median (IQR) C­ reactive protein concentration of 3.2 (1.5-7.0) mg/l. There were 43 bacterial species identified: 24 gram­positive and 19 gram-negative. The analyzed urine cultures contained 977 microbial samples (563 gram­negative bacteria, 408 gram-positive, 6 fungi). The most common bacteria was Escherichia coli (39.6%) which showed 100% susceptibility to carbapenems, 98.9% to amikacin, 96.5% to piperacillin / tazobactam, and 94.3% to gentamicin. With regard to oral antibiotics, its highest susceptibility was to fosfomycin 95.5%, nitrofurantoin 85.5%, and cefuroxime 82.3%. In 39.9% of cases, E. coli was resistant to fluoroquinolones and in 46.6% to trimethoprim / sulfamethoxazole. CONCLUSIONS: The most frequently occurring bacteria causing recurrent lower UTI are characterized by significant resistance to the antimicrobial therapy recommended as the first­ line treatment: fluoroquinolones and trimethoprim / sulfamethoxazole. It seems that the first choice in the treatment of lower UTIs should be: fosfomycin, nitrofurantoin, or cefuroxime.

Bacterial infections in Intensive Care Unit patients analyzed on the example of the Lodz Medical University Hospital No 1 in the period 2002-2015.

INTRODUCTION: In the present study, nosocomial infections, increased resistance to carbapenem among clinical isolates of Pseudomonas aeruginosa and Acinetobacter spp. are analyzed on the example of the intensive care unit (ICU) at the Lodz Medical University Hospital No I in a long period of time (2002-2015). METHODS: In the period from 2002 to 2015, 19870 bacteriological cultures were made from 4289 patients hospitalized at the ICU. Material for the study were swab from the surgical wound, blood, urine and bronchoalveolar lavage (BAL). The identification of the species and drug resistance were performed using VAITEC (BioMerieux@) by 2004, next PHENIX (Becton Dickinson) by 2012 and VITEC 2 - compact (BioMerieux?) until now. The blood was incubated in the BACTEC 9050. RESULTS: Gram negative bacilli, predominantly Klebsiella pneumoniae and Pseudomonas aeruginosa, as well as staphylococci Staphylococcus aureus are a major cause of lower respiratory tract infections in ICU. The profile of bloodstream infections has changed over the period considered. Staphylococci was the main cause of bloodstream infections in the period 2002-2005, but since 2005 Klebsiella pneumoniae has dominated. Gram negative bacilli, mainly Escherichia coli and Klebsiella pneumoniae, were the most common pathogens to cause urinary tract infections. In the years 2014-2015, a significant increase in infections caused by Enterobacteriaceae strains ESBL(+) (extended-spectrum beta- lactamases) was observed. CONCLUSIONS: Klebsiella pneumoniae is a major cause of nosocomial infections in intensive care unit patients at the Lodz Medical University Hospital No 1. Increasing prevalence of antimicrobial resistance to P-lactam antibiotics (including carbapenems) among Pseudomonas aeruginosa and Acinetobacter spp. has been observed. Therefore, it is necessary to limit the use of carbapenems for the hospital treatment.

[Fungal infections in patients of an intensive care unit analyzed on the example of the Lodz Medical University Hospital No 1 in the period of 2002-2012]. / Analiza zakazen grzybiczych u chorych leczonych na Oddziale Intensywnej Terapii Uniwersyteckiego Szpitala Klinicznego nr 1 w Lodzi w latach 2002-2012.

INTRODUCTION: The objective of this study was to analyze the fungal infections in patients of an intensive care unit (ICU) in a long period (2002-2012) on the example of the Lodz Medical University Hospital No 1. This analysis was focused on the study of the effect of antimicrobial therapy on the level of these infections. METHODS: A total of 291 strains of fungi were isolated from blood, tips of central intravenous catheters, lower respiratory tract, urine, wounds, pressure sores, and cerebrospinal fluid of 3177 patients. An automatic system Bactec 9050, Yeast ID Phoenix BD panels and E-tests (BioMerieux) were used for the fungi analysis. RESULTS: The studies were mainly concentrated on the Candida infections, distinguishing cases caused by C. albicans and C. non-albicans pathogens. Changes in the number of these infections in consecutive years have been associated with epidemiological and therapeutic activities in the ICU. Particularly, relationships between the number of infections and the use ofceftazidime were discussed. A statistically significant positive correlation of the count of Candida infections and the ceftazidime consumption was found in the period to 2006. In the later years, the correlation was destroyed as a result of other important therapeutic factors (eg, immunosuppressive drugs). CONCLUSIONS: It has been found that the number of Candida infections in the ICU depends on the consumption of antimicrobial drugs. This conclusion is based on quantitative example of ceftazidime. Only close cooperation between the ICU and microbiologists is able to provide a reduction in nosocomial fungal infections.

[Candida and Aspergillus infections in the light of a new list of alarm factors on the example of the Lodz Medical University Hospital No. 1]. / Zakazenia Candida oraz Aspergillus w swietle nowej listy czynników alarmowych na przykladzie uniwersyteckiego szpitala klinicznego nr 1 w Lodzi.

INTRODUCTION: In 2011, the Polish Ministry of Health introduced Candida sp. resistant to fluconazole and Aspergillus sp. to the list of Alarm Factors as alert pathogens. The purpose of this paper is to confirm the validity of continuous monitoring of fungal infections caused by the pathogens mentioned above. The role offluconazole therapy in the Candida sp. infections is also discussed. The analysis of the fungal infections is performed based on the results obtained in the University Clinic Hospital (UCH) No. 1 in Lodz in 2009-2011. METHODS: The swabs were plated on Sabouraud's agar. Body fluids and blood were incubated in an automated system Bactec 9050. Yeast ID Phoenix BD panels were used to determine the species of fungi. In turn, antimicrobial susceptibility testing was carried out by E-tests (bioMerieux). RESULTS: In the analysis of fungal infections occurring among patients in the UCH No. 1 in Lodz in 2009-2011, C. albicans, C. non-albicans and Aspergillus sp. infections are taken into account. This analysis is performed based on relations of the number of infections (per 100 patients) versus six-month periods. As one can see in Fig. 1, a clear, linear and statistically significant increase in the number of C. albicans and C. non-albicans infections is observed throughout the entire time period under discussion. On the other hand, the number of Aspergillus sp. infections remains at an almost constant low level. The more detailed analysis of fungal infections in the different hospital units, which are particularly exposed to this type of infections (Figs. 2-6), shows that there is a clear correlation between the number of C. non-albicans infections and the frequency of therapy with fluconazole. CONCLUSIONS: The results presented in this paper show in the example of the UCH No. 1 in Lodz that the number of infections caused by C. albicans and C. non-albicans resistant to fluconazole is clearly increasing in a hospital environment in recent years, which is a great clinical problem. Although the number of Aspergillus sp. infections is relatively much lower in comparison to that of Candidia sp., these infections also constitute a problem of clinical importance. In light of the presented analysis, it should be assessed positively the fact that Candida sp. resistant to fluconazole and Aspergillus sp. are considered to be alert pathogens that require the continuous monitoring.

[Influence of antibiotic-therapy on the selection of multi-drug resistant pathogens]. / Wplyw terapii antybiotykowej na selekcje wielolekoopornych szczepów bakteryjnych.

In this paper, relations between the number of nosocomial infections caused by multi-drug resistant pathogens and antibiotic-therapy were investigated. It was found that the number of MRSA infections is directly proportional to the amount of CAZ (ceftazidime) used in the therapy. It was also stated that CAZ, Amc (amoxicillin-clavulan acid) and IPM (imipenem) are strong inductors of ESBL. A good correlation between the number of infections caused by ESBL(+) strains and the total consumption of these antibiotics was found. A growing number of infections generated by Ps. aeruginosa and Acinetobacter spp. strains resistant to carbapenems as a result of IPM therapy is also an anxiety-provoking fact. In this case, the changes in the number of isolated IPM-R streins occur only after approx. half an year from the changes in the IPM consumption.

[Nosocomial infection control in intensive therapy]. / Zakazenia szpitalne w Oddziale Intensywnej Terapii Uniwersteckiego Szpitala Klinicznego.

BACKGROUND: Nosocomial infections are common among patients treated in ITU settings. The lower airway and genitourinary systems are frequently infected with multiresistant pathogens, and present a serious epidemiological problem. In 2002, at the Lódz Medical University Hospital, strict infection control measures were developed and introduced to minimize the risk of infections in the ITU. METHODS: Between 2002-2006, the prophylactic use of imipenem, amoxicillin and fluconazole was forbidden and the use of vancomycin and aminoglycosides was limited. Strict microbiological analysis became mandatory in all ITU patients. To achieve this, isolates from the lower airway and genitourinary track from 1330 ITU patients were analyzed using the disc-diffusion method and the E-test method (for MIC values). The VITEK (BioMerieux) automatic analyzing system was used. RESULTS: The number of nosocomial infections of the lower airway was reduced from 48.8/100 patients in 2002 to 19.0/100 patients in the period 2005-2006. Infections of the genitourinary, system decreased from 27.0/100 patients in 2002 to 4.7/100 patients in 2006. MRSA, Pseudomonas aeruginosa, Enterobacteriacae, and Acinetobacter species were the most commonly isolated pathogens. CONCLUSIONS: Although it is impossible to eliminate nosocomial infections, particularly in the ITU setting, close co-operation between clinicians and microbiologists, and monitoring of nosocomial infection patients can markedly reduce the frequency.

[Sepsis--a new life-threat or better defined old disease entity]. / Sepsa--nowe zagrozenie czy lepiej definiowana stara jednostka chorobowa.

The presence of multiresistant pathogens in a hospital leads very often to a severe sepsis that threatens the patients' life. For this reason, in the interests of the patients in the Intensive Care Unite (ICU) of the Lodz Medical University Hospital No.1, a wide monitoring of the epidemiological situation and the rational antibiotic therapy, taking the resistance mechanisms of pathogens into account, have been started since 2002. Restrictive procedures of the insertion of central venous and dialysis catheters were elaborated as well as the permanent monitoring of the MRSA carrier state among the medical staff was undertaken. A procedure of the primary bacteriological examination for all new patients in the ICU was also introduced. All these actions resulted in a considerable, statistically significant (p=0.043), decrease in bloodstream infections from 14.2 infections per 100 patients in 2002 to 2.0 infections per 100 patients in 2006. A drop in the number of infections of central venous catheters was also observed: from 4.3 infections per 100 patients in 2002 to 1.9 infections per 100 patients in 2006 (p=0.025). Administration of ceftazidime and clavulanic acid, which are MRSA inductors, only in the events of guided therapy when other therapeutic options were failed as well as the reduction of the MRSA carrier state among the medical staff brought about a radical elimination of MRSA from the bloodstream infections. The obtained results show that the severe infections caused by multiresistant pathogens in hospitals can be effectively reduced due to cooperation between clinicians and microbiology laboratories.

[Analysis of the epidemiological situation and the resistance phenotype of pathogens isolated from patients in the intensive care unite of the Lodz Medical University Hospital No.1 in 2002-2006]. / Analiza sytuacji epidemiologicznej oraz fenotypu opornosci patogenów wyizolowanych od pacjentów oddzialu intensywnej terapii USK nr 1 w Lodzi w latach 2002-2006.

In the period of 2002-2006, total 5152 isolates were obtained from 1330 patients in the Intensive Care Unite (ICU) of the Lodz Medical University Hospital No.1. A detailed analysis of the epidemiological situation concerned, first of all, MRSA, Ps. aeruginosa, Acinetobacter and Enterobacteriacae. As a result of extended action aimed at reducing the infections caused by these pathogens, a permanent improvement of the epidemiological situation in the ICU was observed in 2005-2006. However, in spite of a decrease in the total number of the infections, the concentration of ESBL(+) and carbapene-resistant strains increased. These results are indicative of the need for cooperation between clinicians and microbiology laboratory towards a strictly controlled antibiotic policy in the hospital.

[Bacteriological evaluation in chronic otitis media]. / Ocena bakteriologiczna w przewleklym zapaleniu ucha srodkowego.

INTRODUCTION: In chronic otitis media bacterial infection is often a cause of exacerbation in the clinical course and failure in treatment. The aim of the study was to investigate the incidence and profile of the aerobic bacterial flora in chronic otitis media and to determine the drug susceptibility of selected isolated bacteria. MATERIAL AND METHODS: The samples of 274 consecutive middle ear discharges taken from 228 patients with chronic otitis media were analysed (which constitutes 41.3% all bacteriological examinations made during 3 years). The smears were obtained using sterile cotton swabs, then incubated and identified. Drug susceptibility was determined by disc-diffusion method. RESULTS: Monocultures were observed in 77% and mixed infections in 17.5% of smears, no growth was found in 5.5%. The 308 pathogen isolates were recovered, among them--273 bacterial (88.6%) and 35--fungal (11.4%). Twenty five species of bacterial microorganisms were found, among them the most common isolates were Staphylococcus aureus--42.9% and Pseudomonas aeruginosa---19.8%. Rarely were recovered Acinetobacter spp.--4.1%, Proteus mirabilis--37%, Proteus vulgaris--3.3% and methicillin-resistant Staphylococcus--1.5% of bacterial isolates. Among fungal pathogens (n=35) Aspergillus spp. was isolated in 37.1%, and Candida albicans--22.9% of cases. CONCLUSIONS: (1) Aerobic pathogens ---aphylococcus aureus and Pseudomonas aeruginosa were most frequently found microorganisms in chronic otitis media. (2) Mixed infections comprised only a 17.5% of all cultured cases of chronic otitis media. (3) Pseudomonas aeruginosa was highly susceptible in vitro to imipenem (100%), piperacillin-tazobactam (100%), ceftazidime (98%) and amikacin (89.7%), less susceptible to ciprofloxacin (77.6%) and much less susceptible to pefloxacin (33.6%) and cefotaxim (33.3%).