Trial helplessness of defendant healthcare facilities in cases concerning nosocomial infections / Nieporadnosc procesowa pozwanych jednostek ochrony zdrowia w sprawach o zakazenia szpitalne.

The number of pecuniary cases involving patient claims due to nosocomial infections has been increasing for many years, and with it, the amount of adjudged compensations has also been increasing. In this situation, it is important for defendant healthcare facilities to implement a proper policy, both before the trial and during the court proceedings. Unfortunately, as a rule, defendant facilities commit a variety of errors, such as: wrong strategy, inability to cooperate on the part of those involved in the matter and improper preparation and usage of evidence. The result is that the risk of unfavorable assessment of the case increases significantly.

Comparison of in vitro activity of doripenem, imipenem and meropenem against clinical isolates of Enterobacteriaceae, Pseudomonas and Acinetobacter in Southern Poland.

UNLABELLED: In the study we tested drug sensitivity to 3 carbapenems (doripenem, imipenem and meropenem) of Gram-negative clinical isolates from Southern Poland. MATERIAL AND METHODS: 89 strains were examined: 42 from Pseudomonas genus, 16 Acinetobacter baumannii strains and 31 Enterobacteriaceae strains. Etests were used according to the producers instructions, MIC values were interpreted using EUCAST criteria. RESULTS: Highest in vitro activity against Pseudomonas spp. was shown for doripenem, then meropenem and the lowest for imipenem (MIC values were definitely lower for doripenem; differences were statistically significant); A. baumannii strains showed similar sensitivity to doripenem, meropenem and imipenem (differences non-significant); all Enterobacteriaceae strains showed sensitivity to the tested antimicrobials. CONCLUSIONS: As a conclusion-doripenem, which has high in vitro activity (almost the same as imipenem and meropenem) as well as beneficial pharmacologic properties, may be an alternative solution in the treatment of multiresistant Gram-negative bacteria, especially in patients in severe status who require restrictive antibiotic regimens.

[A case of sepsis in ILBW infant caused by Bacillus cereus]. / Zakazenie bacillus cereus u noworodka z niewiarygodnie mala urodzeniowa masa ciala.

Bacillus cereus is an aerobic or facultative anaerobic Gram-positive rod which is ubiquitous in the environment. The incidence of neonatal infections is very low. The clinical course is serious, usually life- threatening or permanently damaging the central nervous system. The immature immune system, subjected to invasive procedures, increases the morbidity risk in this age group, especially in extremely low birth weight infants. Diagnostic difficulties and insusceptibility to ''first- line'' antibiotics can delay effective therapy and increase the risk of its failure. We report a 730 g preterm neonate, delivered at 27 weeks gestation with late- onset sepsis due to Bacillus cereus. The disease course was complicated by development of brain abscesses. We describe the clinical course of infection, diagnostic difficulties and the treatment. After the 140 days of hospitalization and relatively long period of therapy with different antibiotics, the patient was discharged from hospital in good condition. Despite of transmission of infection to the central nervous system, the introduced therapy prevented severe neurological disabilities as confirmed during the evaluation according to the Bayley Scale of Infant Development, performed at 29 months of life.

[Voice on the treatment of ureaplasmas infections]. / Glos w sprawie leczenia zakazen ureaplazmowych.

The aim of the study was to determine susceptibility of ureaplasmas for selected antimicrobials belonging to 3 groups, which are applied clinically. Study was conducted on 39 U. parvum and 26 U. urealyticum clinical isolates. Doxycyclin, azithromycin and levofloxacin were applied during the study. In case of azithromycin U. urealyticum strains were more susceptible; MIC90 = 1 microg/ml and MIC range for both species mean that only a few strains are resistant (only U. parvum). In case of doxycyclin U. parvum strains were more susceptible and MIC ranges mean that there are no resistant strains in both species. In case of levofloxacin wide MIC range with values signifying resistance was found. Doxycyclin is a good choice for empirical treatment of infections with ureaplasma aetiology. In case of macrolides higher dosage is indicated, because there is a risk of clinical failure at lower doses. Quinolones should not be used in empirical treatment of ureaplasma infections.

[Studies on the possible application of molecular methods in diagnosing carriers and in similarity analysis of group B streptococci (Streptococcus agalactiae)]. / Ocena mozliwosci zastosowania metod molekularnych do diagnostyki nosicielstwa oraz analizy podobienstwa izolatów Streptococcus agalactiae.

The most popular method of GBS identification in Poland currently is by culturing on enriched agar and verifying the Lancefield Group using special latex agglutination kits. However, the classical methods are time-consuming and their sensitivity is insufficient therefore it is becoming more common to try and apply molecular methods which are characterized by high sensitivity and rapid results. Moreover, molecular methods give us the possibility to carry out epidemiological investigations and gene detection, for instance for antibiotic resistance. It was confirmed that PCR and FISH procedures may be effective in rapid detection of GBS. Thanks to RAPD methods we showed that newborns born to colonized mothers were colonized by GBS strains which originated from the mother, irrespective of the way and the course of labour. Additionally, we detected GBS colonization in children who were born to mothers who were not colonized by GBS. These children were probably colonized with strains coming from hospital environment. More studies are needed to elucidate the route of transmission and the role of colonization of the medical staff. Using multiplex PCR we showed the presence of ermA, ermB and ermC genes in phenotypically confirmed MLS, GBS strains.

[Increasing Streptococcus agalactiae colonization of pregnant women and newborns in south-eastern region of Poland]. / Narastanie stopnia kolonizacji kobiet w ciazy i noworodków przez Streptococcus agalactiae na obszarze Polski poludniowo-wschodniej.

Streptococcus agalactiae, group B streptococci (GBS) are a constituent of normal vaginal bacterial microflora which often do not give any clinical symptoms. On the other hand, during pregnancy there are optimal conditions for GBS multiplication in the vagina, which may have very serious consequences for both the mother and her child. The women (n = 563) that participated in our study were in their 3rd trimester and they were divided into groups: normal pregnancy or high risk pregnancy. We also examined their newborns. GBS identification was done basing on traditional culture method and its modification recommended by the CDC. We showed a slightly improved (about 4%) effectiveness of GBS detection in pregnant women using the CDC method. In high risk pregnancy GBS colonization was 20% (among them 35% newborns were colonized) and in normal pregnancy it was found to be 17.2% (among them 26.7% newborns were colonized). Both in the high risk group and their newborns we confirmed a higher and statistically significant frequency of detection of GBS strains which had MLS(B) mechanism of antibiotic resistance. In newborns we confirmed two cases which were fatal. The results of our study show the need and necessity for implementing unified procedures recommended by the CDC in Poland.

[Antimicrobial susceptibility of Ureaplasma urealyticum and ureaplasma parvum isolated from premature infants with respiratory disorders]. / Wrazliwosc na antybiotyki i chemioterapeutyki Ureaplasma urealyticum i Ureaplasma parvum izolowanych od noworodków z zaburzeniami oddechowymi.

UNLABELLED: The aim of the study was to analyse antimicrobial susceptibility of ureaplasmas isolated from the tracheal aspirates from premature infants with respiratory disorders. The study encompassed 73 ureaplasma strains, 47 belonging to U parvum (U.p.) species and 26 to U. urealyticum (U.u.). The strains were isolated paralelly on BioMerieux as well as liquid and solid PPLO media. Identification of studied strains was perfomed using PCR with primers specific to both ureaplasma species. Susceptibility to doxycycline (DOX), tetracyclin (TET), josamycin (JOS), azithromycin (AZY), erythromycin (ERY), clarytromycin (CLA), ofloxacin (OFL), ciprofloxacin (CIP), pristinamycin (PRI) was tested using a BioMerieux Mycoplasma IST 2 kit. RESULTS: in 7 of 9 examined antimicrobials the percentage of susceptible U.u. was lower thain the percentage of U.p. susceptible strains. CONCLUSIONS: The biggest differences related to susceptibility reffered to macrolides. Higher resistance of U.u. species to antimicrobials may suggest its higher pathogenecity.