Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal unit: control of an outbreak using a new ADSRRS technique.

Extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae (EPKP) strains are frequently implicated in outbreaks in neonatal units. From April 2002 to January 2003, 149 neonates were colonized/infected with EPKP in the Neonatal Clinic of the Teaching Hospital at the Medical University of Gdansk, Poland. A novel assay based on suppression of PCR, ADSRRS-fingerprinting, was successfully evaluated for typing EPKP isolates. The results showed that the genotypes of all outbreak-related strains were identical, which suggested that the outbreak originated from a single clone. This conclusion was confirmed by using different methods--RAPD and PFGE. The outbreak was stopped by adopting improved hygiene and instituting outbreak control measures.

[Spontaneous bacterial peritonitis in patients with decompensated liver cirrhosis based on bacteriological and biochemical results]. / Samoistne bakteryjne zapalenie otrzewnej w niewyrównanej marskosci watroby na podstawie wyników badan bakteriologicznych i biochemicznych.

UNLABELLED: Spontaneous bacterial peritonitis (SBP) is frequent and insidious complication of liver cirrhosis regardless of its aetiology. The aim of the study was to assess the usefulness of biochemical markers in the blood and ascitic fluid, including the concentration of proinflammatory cytokines in the diagnosis of SBP in the patients with decompensated liver cirrhosis. The material and methods: 117 examinations in 88 patients were performed as following: ascitic fluid and blood cultures, throat and anus smears, biochemical examinations in the serum and ascitic fluid including concentration of procalcitonin, TNF-alpha, IL-6 and neopterin. THE RESULTS: 25% of patients have died during the hospitalisation, the positive blood cultures were found in 7 cases (5.9%), whereas the positive ascitic culture in 17 (14.5%) cases. The procalcitonin level were increased in 56.6% of the cases, the remaining levels of cytokines were increased considerably in one case with SBP. Biochemical examinations in the blood, performed on the admission, revealed: hyperbilirubineamia, increased level of ALT, AST, GGTP, alkaline phosphatase, creatinine, WBC and gamma-protein and decreased level of haemoglobin and albumin. CONCLUSIONS: We have obtained Gram positive bacteria in 57% of cases in the ascitic fluid and Gram negative in the 43%. THE RESULTS of the cytokines concentration seam do not have significant importance in the SBP diagnosis. However our study was performed on the small amount of the cases and requires further investigations including the control group.

[Cefepime: the new option of target antibiotic therapy]. / Cefepim--nowa alternatywa celowanej antybiotykoterapii.

Treatment of hospital infections caused by multidrugresistant pathogens like Pseudomonas, Acinetobacter, Enterobacter, Klebsiella needs microbiological monitoring from the beginning of therapy. Inadequate antimicrobial therapy decreases the possibility of positive outcome. Risk of resistance development should be monitored for every new antimicrobial agent. Cefepime is a new, parenteral, broad-spectrum, fourth-generation cephalosporin, an effective agent in the treatment of bacterial infections. Modification of the cefepime molecule gives rapid penetration into the bacterial cell, resulting in rapid bactericidal effect. Cefepime does not have the propensity to provoke septic shock due to bacterial endotoxins. It is also one of the three available antimicrobials (carbapenems, piperacylin/tazobactam, cefepime) with very good activity against many resistant nosocomial pathogens. Combination of cefepime with amikacin is thought as the most effective treatment of infections due to multidrugresistant Pseudomonas spp.

[Microorganisms isolated from clinical specimens of patients from the Department of Thoracic Surgery]. / Drobnoustroje izolowane z materialów klinicznych torakochirurgicznej chorych z kliniki.

The clinical specimens received from patients hospitalized in Department of Thoracic Surgery between 1997 and 2001 were microbiologically examined. The main specimen for microbiological examination was pleural fluid (median 34%). The frequency of specimens from bronchial tree increased significantly (from 4% to 26%) with concurrent decrease of sputum (from 29% to 6%). Among isolated pathogens, Gram negative rods were the most frequent (median 48%) and Pseudomonas sp. was the main pathogen among them. Occurrence of staphylococci was median 22% and Staphylococcus aureus, with a little decrease in analyzed period, was still the main Gram positive pathogen. Simultaneously the occurrence of MRSA in the last three years dropped three times. The number of isolations of yeasts have risen from 5.8% to 10.3%.

[Infections in patients after thoracic surgery]. / Zakazenia u chorych po operacjach torakochirurgicznych.

UNLABELLED: Purpose of this paper was estimation of occurrence of postoperative complications caused by most common infection agents. Research covered 1662 hospitalised patients during 2000-2001. Clinical records of patients and results from bacteriological research were analysed. Analysis of etiological agents were based on 779 clinical samples. In postoperative period infection was observed in 138 patients (9.2%). Among them 158 episodes of infection occurred. Totally for 138 patients, 158 infections were observed in postoperative period. 9% of all (1662)-operated patients had postoperative infections. In that number were: 98 (6.5%)--bronchopulmonary infection, 25 (1.7%)--empyema, 21 (1.4%)--wound infections, 10 (0.7%)--urinary tract infection, 4 (0.3%)--sepsis. All those complications caused 14 deaths. CONCLUSIONS: 1. Thoracic surgeries were connected with quite high risk of postoperative infections. 2. The most common postoperative complication was bronchopneumonia. 3. The most common etiological agent in thoracic surgery infections was Pseudomonas aeruginosa.