[When should empirical antibiotic therapy be indicated in acute community-onset diarrhea of suspected bacterial etiology]. / Kdy indikovat empirickou antibiotickou lécbu u akutní komunitní gastroenyerokolitidy suspektní bakteriální etiologie?

BACKGROUND: The aims of this study were to describe the basic parameters of adult patients with acute community-onset salmonellosis or campylobacteriosis responsible for more than 90 % of all cases of community-onset diarrhea in the Czech Republic, and, according to the results of this analysis, to update the diagnostic and therapeutic algorithms. MATERIALS AND METHODS: The data were collected retrospectively between January 1, 2011 and December 31, 2013. Patients with systemic signs of infection having at least 2 signs of systemic inflammatory response syndrome (SIRS) or with elevated serum procalcitonin levels (more than 0.5 ng/ml) were classified as being at risk for the invasive form of the disease. The remaining patients were classified as having the simple intestinal form of the disease. Patients with community-onset post-antibiotic diarrhea were excluded. The data were statistically processed. RESULTS: The following clinical factors were statistically significantly correlated with the high-risk form of the disease: duration of illness of less than 3 days before admission and any of the following (some of them are part of the SIRS classification), even after being adjusted for age: body temperature above 38 °C, peripheral blood white cell count (WBC) above 12 × 109/l, neutrophil count above 9 × 109/l and CRP level above 150 mg/l. The risk form of the disease occurred in 60 cases (18.7 %). The mean WBC was 9.4 × 109/l (median, 8.4; range, 1.7-89.0). The WBC within the normal range was seen in 194 cases (60.4 %). The mean CRP level was 92.9 mg/l (median, 77.0; range, 1.0-342.0). An elevated procalcitonin level was seen in 21 patients; the marker was not routinely measured. Positive blood culture results were obtained in 2 persons with salmonellosis; the examination was not routinely performed. There were 34 patients (10.6 %) with documented immune system dysfunction; the risk form of salmonellosis or campylobacteriosis was seen in only 11 of them (3.4 %). A total of 306 patients (95.3 %) were treated with antibiotics; the mean duration of antibiotic therapy was 8.7 days (median, 7; range, 2-31). CONCLUSIONS: Antibiotic treatment in salmonellosis/campylobacteriosis should not be indicated only due to elevated CRP levels but rather after comprehensive evaluation of the duration of symptoms, individual risk factors and dynamic changes in markers of inflammation. Blood culture tests should be carried out more frequently.

[A study of patients with Clostridium difficile infection hospitalized at Brno Clinic of Infectious Diseases in 2007-2010]. / Analýza souboru pacientu s onemocnením vyvolaným toxinem Clostridium difficile hospitalizovaných na Klinice infeckcních chorob v Brne v letech 2007-2010.

BACKGROUND: To describe a set of patients hospitalized at the Clinic of Infectious Diseases of the University Hospital Brno with Clostridium difficile infection (CDI), to interpret clinical and epidemiological data, and to determine the risk factors for the disease and its complications. MATERIAL AND METHODS: A retrospective study of 284 patients with confirmed diagnosis of Clostridium difficile infection hospitalized between 1 January 2007 and 31 December 2010. Epidemiological, clinical and laboratory data were collected from their clinical documentation. RESULTS: Of the 284 patients with a mean age of 73.2 years, 38.0 % were men. Risk factors for developing CDI include the use of antibiotics in the previous 8 weeks (89.1 % of patients), age over 65 years (77.6 %), hospitalization in the previous 4 weeks (65.5 %), and the use of proton pump inhibitors (41.9 %). Recurrence was noted in 89 (31.3 %) cases. Sixty-six (23.2 %) patients required intensive care and 50 (14.6 %) patients died during their hospitalization. Isolates of C. difficile from the stool of 4 patients were sent for ribotyping and identified as ribotype 176. CONCLUSIONS: The CDI rates at the clinic KICH have increased in the recent years. The rise is consistent with the global trends. The study confirmed the disease risk factors reported in the literature. The disease is associated with a high percentage of relapses and complications.

[First experiences with faecal bacteriotherapy in the treatment of relapsing pseudomembranous colitis due to Clostridium difficile]. / První zkusenost s fekální bakterioterapií v lécbe relabujíci pseudomembranózni kolitidy zpusobené Clostridium difficile.

BACKGROUND: The aim was to prove the effectiveness and safety of faecal bacteriotherapy in the treatment of relapsing pseudomembranous colitis due to Clostridium difficile in clinical practice. METHODS: The protocol of faecal bacteriotherapy was adopted from foreign authors (Bakken JS, Aas J, MacConnachie AA). After six months, the success rate was not satisfying and the method was modified so that 40-50 g of stool were administered instead of 20-30 g. RESULTS: A total of 77.8 % of patients included in the study were successfully treated. The study achieved results comparable with foreign literature where the lowest success rate is about 80 %. Neither complications nor death were noticed (0 % mortality rate). CONCLUSIONS: Faecal bacteriotherapy is a safe and simple method capable of curing chronically relapsing forms of pseudomembranous colitis.

[A sepsis caused by Capnocytophaga canimorsus: diagnostic and therapeutic options]. / Sepse vyvolaná bakterií Capnocytophaga canimorsus, moznosti diagnostiky a lécby.

The authors present a case report of a patient with sepsis caused by Gram negative rod Capnocytophaga canimorsus resulting from a dog bite. The infection had a course of septic shock progressing into multiorgan failure and serious ischemic damage to the extremities. The etiologic agent was identified utilizing molecular genetic methods and its detailed microbiologic characteristics are provided below. The report also outlines diagnostic and therapeutic options of this otherwise most likely under-diagnosed infection.

[Marseille fever imported from Spain]. / Marseilleská horecka importovaná ze Spanelska.

The authors are presenting a case of young female with Marseille fever contracted in Spain. The clinical manifestation of the illness was characterized by fevers, exanthema, headache and a typical skin rash ("the black spot") and prompted the authors to strongly consider the diagnosis of Marseille fever and to initiate appropriate antibiotic therapy. The diagnosis was confirmed later by serology. The article introduces new taxonomy of Rickettsial species and presents an overview and epidemiological aspects of specific diseases caused by them. The clinical manifestation, diagnosis and treatment of Marseille fever are discussed in greater detail.