Carriage of ESBL- and AmpC-positive Enterobacteriaceae in the gastrointestinal tract of community subjects and hospitalized patients in the Czech Republic.

AIM: The study aimed at analyzing ESBL- and AmpC-positive Enterobacteriaceae in the gastrointestinal tracts of university hospital inpatients and persons from the Olomouc Region community, and comparing the results with data from 2007. METHODS: Bacteria were isolated from rectal swabs inoculated onto the ChromID(TM) ESBL selective medium (bioMérieux). Production of ESBL-type beta-lactamases was confirmed by the modified double-disk synergy test and AmpC enzyme production was detected by the AmpC disk test. ESBL- and AmpC-positive isolates were subjected to basic genetic analysis aimed at detecting the bla(TEM), bla(SHV), bla(CTX-M) and bla(AmpC) genes. RESULTS: Over the study period (1 March 2010 - 1 May 2010), a total of 1,279 rectal swabs (70.4% of community subjects) were analyzed on the above medium. The prevalence rates of ESBL-positive Enterobacteriaceae were 8.2% in hospitalized patients and 3.2% in community subjects. Production of the AmpC enzyme was detected in 1.1% of bacterial isolates from the community and in one (0.3%) hospital isolate. Among ESBL, the most frequent genes encoding enzymes were from the CTX-M-1-like genes. Detected AmpC beta-lactamases belonged to the CIT, DHA and EBC groups. CONCLUSION: When compared with the year 2007, the rates of carriers of ESBL-positive bacteria increased in both hospitalized patients (from 3% to 8%) and community subjects (from 1% to 3%) in 2010. Given the fact that production of extended-spectrum beta-lactamases is clinically significant, knowing the epidemiological situation is very important for selecting adequate antibiotic therapy.

Prevalence of ESBL-positive bacteria in the community in the Czech Republic.

BACKGROUND: Problematic bacteria in the community include enterobacteria which produce extended-spectrum beta-lactamases. As yet there is no description of the prevalence of these bacteria in persons in the community in the Czech Republic. Therefore the main goal of this study was to determine the prevalence of ESBL-positive enterobacteria in the gastrointestinal tracts of subjects in the community in the Czech Republic. MATERIAL/METHODS: Rectal swabs from the investigated subjects were inoculated onto chromID ESBL selective medium and enterobacteria were identified by the Vitek2 automated system. ESBL were detected using a modified DDST test. The results were confirmed by PCR and direct sequencing of CTX-M-positive amplicons. RESULTS: A total of 579 rectal swabs from subjects in the community were analyzed and ESBL production was both phenotypically and genotypically confirmed in 7 isolates. Thus the prevalence of ESBL-positive bacteria in the gastrointestinal tracts of the persons in the community was 1.2%. All the cases were Escherichia coli strains producing the CTX-M-type ESBL. CTX-M-15 was the most prevalent type in this group of isolates. CONCLUSIONS: The presented results are in accord with other authors' studies and suggest that the epidemiologic profile of ESBL-positive enterobacteria in the Czech Republic is comparable to that in other European countries.

Prevalence of vancomycin-resistant enterococci in hospitalized patients and those living in the community in the Czech Republic.

Between July 1, 2002 and December 31, 2003, rectal swabs from both hospitalized patients and community subjects in the Czech Republic were taken to ascertain the prevalence of vancomycin-resistant enterococci (VRE). The swabs were used for isolating and identifying enterococci and their susceptibility to antibiotics. Vancomycin resistance phenotypes were verified by PCR detection of vanA, vanB, vanC1 and vanC2 genes. A molecular biology analysis was performed in Enterococcus faecium VanA strains. During the observed period, 2691 rectal swabs from the hospitalized patients and 6529 rectal swabs from the subjects in community setting were examined. In total, 31 VRE of hospital origin and 13 community-population strains were isolated. The prevalence of VRE in the gastrointestinal tract was 1.9% in the hospitalized patients and 0.4% in the community subjects. The prevailing strains were Enterococcus faecium VanA (61.3%) in the VRE of hospital origin and Enterococcus gallinarum VanC (46.2%) in the community VRE. Mutual comparison between the hospital and community Enterococcus faecium VanA strains showed no similarity.

Occurrence of vancomycin-resistant enterococci in humans and animals in the Czech Republic between 2002 and 2004.

In the period between September 2002 and May 2004, a total of 6023 rectal swabs from humans in the Czech Republic were evaluated and 821 Enterococcus spp. strains were isolated. Nine strains (1.1 %) were identified as vancomycin-resistant enterococci (VRE). Two strains were VanA Enterococcus faecium, one strain was VanB Enterococcus faecalis and six strains were VanC Enterococcus casseliflavus. In total, 527 Enterococcus spp. strains were isolated from poultry breeds of which 11 (2.1 %) were VRE. Most (54.5 %) were identified as VanA E. faecium. Cluster analysis of SmaI-generated macrorestriction patterns showed high variability in both human and animal VRE strains and no relatedness between strains from the two sources.

Utilisation of macrolides and the development of Streptococcus pyogenes resistance to erythromycin.

OBJECTIVES: The aim of the study was to evaluate the relationship between the development of the resistance of Streptococcus pyogenes strains to erythromycin and the utilisation of macrolides in the Olomouc region, Czech Republic. METHOD: During the period 1997-2001, data for utilisation of macrolides was obtained from the database of the regional General Health Insurance Company and expressed indefined daily doses per 1,000 patients per day. S. pyogenes strains were isolated from community patients suffering from acute bacterial tonsillitis. Their susceptibility to antibiotics was assessed by the disk diffusion method. RESULTS: Utilisation of macrolides increased by 13% in the period 1997-2001; their utilisation represented 11.40% of total antibiotic prescription in 1997 and 15.48% in 2001. Occurrence of erythromycin-resistant S. pyogenes strains increased significantly from 14% in 1997 to 32% in the year 2001 (P < 0.01). In 2000, macrolides consumption decreased non-significantly, but with no concomitant decrease in erythromycin-resistant S. pyogenes strains occurrence. Absolute susceptibility of S. pyogenes, the most important bacterial pathogen in community-acquired bacterial tonsillitis, to penicillin contrasts with increasing macrolide resistance. CONCLUSIONS: The study documents the influence of increased utilisation of macrolides on bacterial resistance. Penicillin should be a first-choice antibiotic in acute bacterial tornsillitis; macrolides should only be reserved for patients allergic to penicillins.

[Prevalence of vancomycin-resistant enterococci in hospital and community environment.].

AIM OF THE STUDY: The presented study aimed at determining the prevalence of vancomycin-resistant enterococci (VRE) in rectal swabs taken from both patients in the Teaching Hospital in Olomouc (THO), Czech Republic, and subjects from the community setting of the hospital's catchment area. MATERIALS AND METHODS: Between July 1, 2002 and July 1, 2003, rectal swabs were taken from the THO patients as well as individuals from the community catchment area to be utilized for isolating and identifying enterococci and their suscetibility to antibiotics. Vancomycin resistance phenotypes were verified by PCR detection of vanA, vanB, vanC1 and vanC2 genes. A molecular biology analysis was performed in VanA Enterococcus faecium strains. To determine the relationship of strains, macrorestriction analysis of the total chromosomal DNA digested with SmaI restriction endonuclease was used. RESULTS: During the observed period, 2,157 rectal swabs from the hospitalized patients and 4,874 rectal swabs from the subjects in community setting were examined. In total, 27 VRE of hospital origin and 13 community-population strains were isolated. The prevalence of VRE in the gastrointestinal tract was 2.3 % in the hospitalized patients and 0.6 % in the community subjects. The prevailing strains were Enterococcus faecium VanA (70.4 %) in the VRE of hospital origin and Enterococcus gallinarum VanC (46.2 %) in the community VRE. Mutual comparison between the hospital and community VRE showed no similarity. CONCLUSION: In the Czech Republic, VRE were proved both in community and hospital settings. Their prevalence in rectal swabs is low and does not exceed the values reported in other European countries. The author describes the chief characteristics of the most important quinolone antibiotics, including preparations either in their development stage or whose development has been prematurely interrupted because of adverse side-effects. The list includes all preparations that are or were temporarily registered in the Czech Republic.

Utilization of fluoroquinolones and Escherichia coli resistance in urinary tract infection: inpatients and outpatients.

OBJECTIVES: The aim of this study was to evaluate the dependence of Escherichia coli resistance to fluoroquinolones on their use in the outpatients and inpatients in the Olomouc region of the Czech Republic. METHODS: Data on inpatient antibiotic use were obtained from the database of the Department of Pharmacology and expressed as defined daily dose per 100 bed-days (DBD). Data on outpatient prescriptions were obtained from the database of General Health Insurance Company and expressed in defined daily doses per 1000 clients per day (DID). Escherichia coli strains were isolated from samples of urine of both community and hospitalized patients suffering from acute bacterial urinary tract infection, examined using aerobic cultivation, and determined by standard biochemical procedures. RESULTS: The utilization of fluoroquinolones in inpatients has significantly (p < 0.01) increased from 2.52 DBD in 1997 to 4.29 DBD in 2002. In outpatients, fluoroquinolone utilization has also increased significantly from 0.14 to 0.95 DID (p < 0.01). In the same period, 9192 E. coli strains were isolated from inpatients and outpatients suffering by urinary tract infections and tested for the susceptibility to fluoroquinolones. Resistance increased significantly (p < 0.01) both in the hospital (from 2 to 9%) and in the community (from 1 to 10%). The development of E. coli resistance to fluoroquinolones correlates significantly with their utilization both in the hospital (r = 0.944, p = 0.005) and in the community (r = 0.859, p = 0.029). CONCLUSIONS: Results of this study shows the impact of fluoroquinolone utilization on E. coli resistance and support the need of controlled use of these effective antibiotics.

Molecular-biological analysis of vancomycin-resistant enterococci isolated from a community in the Czech Republic.

OBJECTIVE: To determine the occurrence of vancomycin-resistant enterococci (VRE) in a community of the Czech Republic and a molecular-biological analysis of the VRE isolated. METHODS: Enterococci were isolated from the rectal swabs of healthy people in the Olomouc region (population 300,000), Czech Republic in the period of January-December 2003. The molecular-biological analysis of VRE was performed by analysis of isolated DNA, which was cleaved by restriction enzyme SmaI and separated by pulse field gel electrophoresis (PFGE). RESULTS: A total number of 5,283 swabs were evaluated and 558 Enterococcus sp. strains were isolated during the follow-up period. 9 strains (1.6%) were identified as VRE. Two strains were E. faecium phenotype VanA, one strain was E. faecalis phenotype VanB, two strains were E. gallinarum phenotype VanC and four strains were E. casseliflavus phenotype VanC. PFGE was used to obtain 9 different restriction profiles of VRE strains. The analysis showed closer a similarity of E. casseliflavus strains (80-95%) than between E. faecium strains (41%). CONCLUSIONS: The presence of VRE in a sample community of the Czech population was confirmed. It is clear that it is necessary to take into account the possibility of VRE spreading from the community into health care facilities.