[Antibiotic resistance in nontyphoidal salmonellae serovars in the Czech Republic]. / Antibiotická rezistence u netyfových sérovaru Salmonella spp. v Ceské republice.

STUDY AIM: To determine antibiotic resistance and incidence of multidrug resistance among Nontyphoidal salmonellae serovars isolated from humans. MATERIAL AND METHODS: Consecutive Salmonella isolates from patients, recovered in 48 microbiology laboratories in May 2012, were analyzed in the respective reference laboratories at the National Institute of Public Health. Strains were re-identified and differentiated into serovars. Their minimum inhibitory concentrations (MICs) to 11 antibiotics were determined by the microdilution method. RESULTS: Of 25 serovars identified among 637 strains of Salmonella enterica, the most frequent were Enteritidis (87.0 %), Typhimurium (4.9 %), and monophasic Typhimurium 4,[5],12:i:- (2.0 %) and Mbandaka (0.6 %); other serovars were rare. Altogether 558 strains (87.6 %) were susceptible to all antibiotics tested and the remaining 79 strains were resistant to one or more antibiotics. The prevalence rates of resistance to individual antibiotics among 637 study strains were as follows: ampicillin 8.5%, tetracycline 5.7%, sulfamethoxazole 5.2%, cipro-floxacin 3.8%, and chloramphenicol 2.5%. Resistance to gentamicin, trimethoprim, and third and fourth generation cephalosporins was rare ( 0.5%) and none of the study strains showed resistance to meropenem. Three producers of extended spectrum beta-lactamase were multidrug resistant and two of them recovered from twins exhibited a different pattern of resistance. Resistant strains were most often assigned to the following serovars: Enteritidis (49.4%), Typhimurium (26.6%), and monophasic Typhimurium (15.2%). While only 7% (39 of 554 strains) of Enteritidis strains were resistant, the serovars Typhimurium and its monophasic variant 4,[5],12:i:- showed high rates of resistance, i.e. 66.7 and 92.3%, respectively. Furthermore, resistance was revealed in all strains of the serovars Virchow (n = 3), Kentucky (n = 1), and Newport (n = 1), in two of three strains of the serovar Infantis, and in one of two strains of the serovar Stanley. All five blood isolates were assigned to the serovar Enteritidis and one of them showed resistance to ciprofloxacin. Of 79 resistant strains, 26.6% showed resistance to ampicillin only and 24.1% to ciprofloxacin only, with multidrug resistance, i.e. resistance to three or more antibiotics, confirmed in 43.0% of strains. CONCLUSION: Despite a relatively low prevalence of resistance to the antibiotics tested among 637 study strains, the following alarming findings were made: Detection of Salmonella enterica strains resistant to ciprofloxacin as the drug of choice or to higher generation cephalosporins and multidrug resistance revealed in two thirds of the strains of the serovar Typhimurium and in all but one strains of its monophasic variant 4,[5],12:i:-.

[Prevention of infectious complications by reducing prophylactic administration of antibiotics and observing the hygienic and epidemiologic policies of the intensive care unit]. / Prevence infekcních komplikací snízením profylaktického podávání antibiotik a dodrzováním hygienicko epidemiologického rezimu na jednotce intenzivní péce.

OBJECTIVE: The authors investigated in a prospective one-year study the incidence of nosocomial infections in patients hospitalized at the intensive care unit with reduced prophylactic administration of antibiotics and adherence to the hygienic epidemiological regime. METHOD: At the intensive care unit of the Neurocentre of the Liberec Hospital nosocomial infection were investigated during the prophylactic administration of antibiotics, most frequently in one dose for a maximum of 24-48 hours. For therapy antibiotics were indicated in proved or suspected bacterial infection. They were not administered in case of colonization of the patient. Concurrently the hygienic and epidemiological regime was ensured. It involved adherence to cleanliness, disinfection, in particular hygienic disinfection of the hands, sterilization, barrier nursing techniques, single-use equipment, closed systems, enhanced regime in case of colonization of the patient with resistant strains and introduction of standard procedures. RESULTS: The one-year prospective study comprised 529 patients hospitalized at the intensive care unit at the age of 9 to 85 years with a mean hospitalization period of 4.9 days. 57.1% patients had cerebral diseases, 31.9% diseases of the vertebral column, and other diagnoses accounted for 11%. A total of 78% patients were operated. Antibiotics were administered prophylactically to 76% patients. In the majority this was in conjunction with the surgical operation (98%). To 93% patients the antibiotic was administered only in one dose, only to 3% patients it was administered for 24 hours and to 4% patients for 48 hours. For therapy antibiotics were administered to 10% patients, including 2% patients where treatment was started at another department. Nosocomial infections were recorded in 5.4% patients. Most frequently infections at the site of operation were involved (2.5%) and infections of the urinary pathways (2.1%). Infections of the airways were recorded in 0.8% patients and infections of vascular catheters were not recorded at all. CONCLUSIONS: Adherence to the hygienic and epidemiological regime and rational administration of antibiotics leads at intensive care units to a reduced incidence of nosocomial infection and thus to reduced financial costs.

R plasmids coding for supra-levels of gentamicin, tobramycin and sisomicin resistance in Proteus morganii and P. mirabilis: high-level resistant strains from two hospitals.

Transfer of high-level gentamycin-tobramycin-sisomycin resistance could be easily demonstrated in strains of P. morganii and P. mirabilis which emerged, in two hospitals, at the end of 1976. First such strains were demonstrated in a patient of a urological ward who died, in September 1976, from generalised sepsis caused by a high-level gentamycin-tobramycin-sisomycin-resistant P. morganii. Since that event, at least nine such strains were isolated in 1976, and the presence of transferable resistant to the antibiotics listed plus other antibacterial substances including carbenicillin and more classical antibiotics could be demonstrated either by a high-frequence direct transfer to suitable recipient strains of Gentamycin or Tobramycin resistance, or by indirect selection, i.e. by analysis of exconjugants selected with kanamycin, streptomycin or carbenicillin. Further numerous strains of P. morganii highly resistant to gentamycin, tobramycin and sisomycin (M.I.C. over 128 mcg/ml) still emerge from wards in the two hospitals monitored and their transferability is under experimental study. It is stressed that, in order to demonstrate a transfer of gentamycin or tobramycin resistance in strains resistant to these substances, it is inevitable to examine properly also exconjugnants showing direct transfer to other, more classical antibiotics. We could not demonstrate, in our strains, any prodromal signs of resistance to netilmycin or amikacin.