Prevalence study on carbapenemase-producing Escherichia coli and Klebsiella pneumoniae isolates in Czech hospitals--results from Czech Part of European Survey on Carbapenemase--Producing Enterobacteriaceae (EuSCAPE).

OBJECTIVE: One of the most important threats of current medicine is the spread of multiresistant Gram-negative bacteria. We report here data from a six-month prevalence study on carbapenemase-producing K. pneumoniae and E. coli performed in Czech hospitals participating on European Survey on Carbapenemase-Producing Enterobacteriaceae (EuSCAPE). METHODS: Ten hospitals covering all regions of the Czech Republic were selected. During the study period (1st November 2013 to 30th April 2014), first ten carbapenem non-susceptible isolates of K. pneumoniae or E. coli isolated from non-surveillance specimens (i.e., blood, lower respiratory tract secretions, urine, puncture fluids, and wound secretions) of single successive patients were collected. Successive carbapenem-susceptible isolates of the same species were also preserved as controls. Susceptibility to 15 antibiotics was determined using EUCAST recommendations. Carbapenemase activity was detected by MALDI-TOF MS meropenem hydrolysis assay. Positive isolates were subjected for molecular typing (multi-locus sequence typing, identification of carbapenemase gene). RESULTS: During the study period, thirty non-susceptible isolates (K. pneumoniae n=28, E. coli n=2) were identified in 5 hospitals. Only two of them were confirmed to be carbapenemase producers. A NDM-1-producing K. pneumoniae ST11 was recovered from a patient, transferred from Ukraine, being injured during a Maidan revolution. The second isolate, an OXA-48-producing K. pneumoniae, belonging to ST101, was recovered from a patient admitted to a hospital for an ischemic stroke. CONCLUSIONS: This study again confirmed that the Czech Republic still belongs to the countries with low prevalence of carbapenemase-producing Enterobacteriaceae (CPE). Cases of CPE are usually restricted to an import from high-prevalence countries or countries with unknown epidemiological situation.

[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:-.

Treatment failure in case of typhoid fever imported from India to Czech Republic, December 2008--January 2009.

In this report we describe a case of typhoid fever in a Czech patient with history of travel to India and discuss antibiotic treatment failure which led to the relapse of fever.

Prevalence of extended-spectrum beta-lactamase-positive Klebsiella pneumoniae isolates in the Czech Republic.

This study focused on the prevalence and molecular biology of extended-spectrum beta-lactamase (ESBL)-positive Klebsiella pneumoniae isolates collected in the Czech Republic. Clinical material from patients hospitalised in 16 Czech hospitals in September 2004 was used to isolate K. pneumoniae strains. Strains were identified by standard identification procedures. Susceptibility of the strains to antibiotics was tested using a microdilution method. The double-disk synergy test and combination disk method were used to determine ESBL production. Molecular biology characteristics of ESBL-positive isolates were determined using genomic DNA isolation, XbaI restriction digestion and pulsed-field gel electrophoresis differentiation. The acquired restriction maps of individual isolates were compared using GelCompar II software and their relationships were determined. During the 3-week period, 483 K. pneumoniae strains causing clinically detectable diseases were isolated. Of these, 117 (24.2%) were determined to be ESBL-positive. The prevalence of ESBL-positive isolates was 38.9% in Intensive Care Units (ICUs) and 13.1% in standard wards. More than 50% of ESBL-positive isolates were treated effectively only with meropenem (98%), cefoperazone/sulbactam (61%) and amikacin (54%). Conversely, ESBL-negative isolates showed high susceptibility to all tested antibiotics (76-99%). Molecular biology analysis identified 18 clonal types containing two to six identical isolates. Seventeen clones usually contained isolates from only one hospital; isolates from two hospitals were identified only in one clone. Based on the abovementioned results, the prevalence of ESBL-positive K. pneumoniae isolates in the Czech Republic can be perceived as relatively high, especially in ICUs. Extensive spread of 'epidemic clones' within Czech hospitals and, to a limited extent, between them can be demonstrated.

Isolation of Carnobacterium piscicola from human pus--case report.

Carnobacterium piscicola was first described in 1984. These bacteria are often isolated from fish afflicted with bacterial infections. To date, there has been no reported isolation of this bacterium from human specimens. We report here the isolation of C. piscicola from the pus following traumatic amputation of the right hand in the wrist of a 35-year-old man. The traumatic amputation occurred with an industrial water sawmill. The identity of the human strain was determined biochemically, by 16S rDNA sequence similarity and by fatty-acid methyl-ester profile from bacterial cell.

Two nosocomial strains of Stenotrophomonas maltophilia transferring antibiotic resistance to Proteus mirabilis P-38 recipient strain.

In this report we describe a specific transfer of carbenicillin and cephaloridine resistance determinants from two different strains of Stenotrophomonas maltophilia: No. 215 and 221 isolated from two critically ill patients treated in different Intensive Care Units of a large University Hospital in Ostrava, Czech Republic. These strains were resistant to flouroquinolones and the following beta-lactam drugs: carbenicillin, cephaloridine, cefotaxime, ceftazidime, cefepime, imipenem, meropenem and aztreonam. Both strains transferred carbenicillin and cephaloridine resistance determinants, with rather different frequency, to Proteus mirabilis P-38. All carbenicillin-selected transconjugants were found by an indirect selection method to be co-resistant to cephaloridine only. In a second cycle of transfers Proteus mirabilis R+ strains directly transferred carbenicillin and cephalothin determinants to Escherichia coli K-12 No. 185 nal+ lac+ recipient strain.

Evaluation of the effects of a new Water-Jel system on specific bacterial and yeast strains in laboratory conditions.

In three previous studies the Water-Jel (WJ) system was found to protect burn wounds from microbial contamination, to have excellent analgesic and cooling effects when used as a first-aid dressing and to be bactericidal to 15 microorganisms including yeasts tested from the Ostrava Burn Unit. Now a new WJ system has been introduced without povidone iodine. An extensive bacteriological laboratory evaluation of the new WJ system showed quite clearly its excellent antimicrobial and antimycotic properties for 13 of the 15 strains of microorganisms tested, the only exceptions being Clostridium difficile and partially Streptococcus faecalis. In a preliminary study, the new WJ system was used for 24-48 h in 74 burned patients with superficial partial and deep partial skin thickness burns. In 89 per cent of them there were no signs of infection on their burn wound after 48 h. The new WJ system was well tolerated and no allergic reactions appeared.

[Methods for the detection of resistance to oxacillin in strains of Staphylococcus aureus]. / Metody prukazu rezistence k oxacilinu u kmenu Staphylococcus aureus.

Methods suitable for detection of resistance of staphylococci to oxacillin were tested in a group of 77 strains of Staphylococcus aureus (39 strains sensitive and 38 strains resistant to oxacillin). The influence of the composition of the medium, the growth phase of the inoculum and time of incubation on detection of resistant strains was investigated. By none of the methods resistance to oxacillin was proved in the control group of sensitive strains. For evidence of oxacillin resistance after 24 hours' incubation the standard micro-method is suitable and the diffuse method with 1 microgram disc of oxacillin which both detected 100% of resistant strains, and the screening method with a yield of 97% strains. The growth phase of the inoculum and the incubation period do not influence the results of these methods. The micromethod in MH broth, the diffuse method with a 10 micrograms oxacillin disc and the dilution plate method were influenced to a considerable extent by the composition of the medium, the growth phase of the inoculum, the incubation period and they revealed a small number of resistant strains.

[The incidence of Streptococcus pneumonia strains with resistance to penicillin]. / Výskyt kmenu Streptococcus pneumoniae s rezistencí k penicilínu.

In the submitted paper the authors give an account of the incidence of 10 strains of Streptococcus pneumoniae resistant to penicillin and other antibacterial substances in children under one year. In the majority otitis media was involved (8 x), in one instance with septic manifestations and detection of pneumococci also from the haemoculture. From a total number of 580 strains of Streptococcus pneumoniae isolated from the end of 1986 to the first half of 1988 the ratio of penicillin resistant strains was 1.72%. The values of penicillin resistance varied within the range of MIC from 1 mg/l to more than 16 mg/l. The strains were also resistant to ampicillin, oxacillin, cephalotine and tetracycline. One strain was moreover resistant also to erythromycin and lincomycin. There was also one strain resistant to cotrimoxazole with a MIC of 64 mg/ml.