Virulence and antimicrobial resistance of Staphylococcus aureus isolated from bloodstream infections and pneumonia in Southern Poland.

OBJECTIVES: Staphylococcus aureus remains the most important cause of infections in hospitals and long-term care facilities. The aim of this study was to analyse the resistance, virulence, and epidemiological and genetic relationships of S. aureus from bloodstream infections (BSIs) and pneumonia from patients in Southern Poland. METHODS: All strains were tested for antimicrobial susceptibility using the disk diffusion method. Etest was also performed for vancomycin, teicoplanin, tigecycline, oxacillin, cefoxitin and penicillin. PCR amplification was used to detect selected virulence genes. The genetic similarity of methicillin-resistant S. aureus (MRSA) isolates was determined by spa typing and pulsed-field gel electrophoresis (PFGE). Using the BURP algorithm and the Ridom SpaServer database, spa types were clustered into different clonal complexes (spa-CCs). RESULTS AND CONCLUSIONS: MRSA strains were observed at a prevalence of 26.7%, but 88.6% of hospital-acquired infections were MRSA, with no difference between BSIs and pneumonia. The highest resistance was observed to erythromycin and tobramycin. None of the strains were resistant to linezolid, glycopeptides or tigecycline. The strains had no significant virulence factors and the number of virulence genes present did not correlate with the degree of drug resistance. PFGE typing showed relatively high diversity of strains. The majority of isolates belonged to spa type t003 (CC5).

Longevity and gender as the risk factors of methicillin-resistant Staphylococcus aureus infections in southern Poland.

BACKGROUND: The proportion of older people among the general population has risen. Staphylococcus aureus (SA) constitutes a significant problem. Underlying disease and functional debility, predispose the older adult to staphylococcal carriage and infection, specially bloodstream infection and pneumonia. METHODS: This is a retrospective cohort study of older patients with SA infections. We analyzed a database containing the results of laboratory cultures from patients treated in 2013 for SA infections and selected 613 hospitalized and non-hospitalized people aged ≥60 years. RESULTS: The prevalence of Methicillin-resistant SA (MRSA) were significantly different in categories of patients: from 14.1% in young old, 19.5% in old old and 26.7 in longevity. MRSA was significantly more frequently reported in cases of pneumonia, 40.4% of SA strains (p < 0.0001, OR 0.3, 95%CI 0.14-0.49). The nosocomial MRSA infections were more common in ICU departments: prevalence 36.8%, than in non-ICU departments: prevalence 17.3% (OR 2.8, 95%CI 1.06-7.34, p = 0.014). Bloodstream infections, which accounted for 6% of all infections, were more frequent in males (p = 0.0231, OR 2.25, 95%CI 1.098-4.604). The greatest increase in antibiotic resistance was related to trimethoprim/sulfamethoxazole (TMP/SXT), which increased to over 80% in the older study groups. All age groups demonstrated increased MIC90 values for glycopeptide and tigecycline. Although strains isolated from patients in all age groups remained sensitive to vancomycin, strains isolated from patients in the old-old and longevity groups demonstrated resistance to teicoplanin. The MIC90 for tigecycline was the highest in the group aged >90 years. CONCLUSIONS: MRSA constitutes a significant epidemiological problem in cases of hospital-treated pneumonia. The findings were similar for long-term-care facilities, where MRSA appears to affect male residents in particular, although there were fewer male residents than female residents. The low sensitivity to TMP/SXT of SA strains isolated from the oldest patients indicates potentially serious challenges pertaining to efficacious treatment of SA infections.

[Molecular characterization of Staphylococcus aureus strains isolated from surgical site infections of patients in southern Poland].

INTRODUCTION: The aim of the study was a molecular characterization of Staphylococcus aureus strains isolated from surgical site infections (SSIs) from patients in southern Poland, undergoing different surgical procedures, together with evaluation of the prevalence of antimicrobial resistance and the presence of virulence factors. MATERIALS AND METHODS: In this laboratory-based, multicenter study, non-repetitive 162 samples from SSI were collected from hospitalized patients (12 hospitals, n=139) or outpatients (n=23) in southern Poland between January 1 and December 31, 2013. In all S. aureus isolates, we investigated antimicrobial susceptibility, the presence of selected virulence genes (lukE, pvl, tsst-l and eta), and also conducted spa typing. RESULTS: Patients with SSI had a median age of 61 years; 54.9% were male. Prevalence of MRSA (29 strains, 17.9%) SSI per surgery type was 8.7% in orthopaedic, 17.7% in general and 42.9% in vascular surgery. Over 20% of strains were resistant for erythromycin (27.2%), clindamycin (23.5%). No resistance was found for linezolid, glycopeptides or tigecycline. Gene of Leukocidin (lukE) was the most frequently found gene. Spa typing identified 10 spa types; the two dominant types were t003 (41.4%) and t138(17.2%). CONCLUSIONS: The results show that after vascular surgery, there was an unexpectedly high prevalence of MRSA in SSIs in southern Poland. Conversely, the prevalence of MRSA was unexpectedly low following orthopaedics procedures. The surprisingly observation was the low virulence of the S. aureus strains among older patients.

Anatomy of Guyon's canal - a systematic review.

Carpal tunnel syndrome is the first on the list of peripheral nerve lesions in the upper limb. Most of the anatomical facts about this syndrome are widely known. The Guyoun's canal is the second reason for compression syndrome in the wrist. Anatomy of this is region still remains controversial. This is why authors tried to compile some latest findings accompanied by their own observation, and added some clinical notes, which might be useful both for orthopedic surgeons and well as for representatives of basic sciences.

Topography of ulnar nerve and its variations with special respect to carpal region.

Ulnar nerve supplies small muscles of the hand and apart from the median nerve is the main coordinator of precise movements performed both in the medical and dental practice. Based on their anatomical and clinical experience, authors revised a knowledge on this nerve with special respect to its topography, variation in the wrist.