Carbapenemase-producing Klebsiella pneumoniae in the Czech Republic in 2011.

Carbapenemase-producing Enterobacteriaceae and Pseudomonas spp. are increasingly reported in many countries all over the world. Due to the resistance of those bacteria to almost all antibiotics (e.g.beta-lactams, aminoglycosides, fluoroquinolones),treatment options are seriously limited. In the Czech Republic, the incidence of carbapenemase-producing Enterobacteriaceae seems to be low, restricted to only three cases detected between 2009 and 2010.Here, we describe molecular typing of 15 carbapenemase-producing Klebsiella pneumoniae isolates identified in the Czech Republic during 2011. Five VIM-1-producing isolates belonging to sequence type (ST)11 and one VIM-4-producing isolate of ST1029 have been detected. blaVIM-1 and blaVIM-4 as a part of class 1 integrons were chromosomally located or carried by a plasmid belonging to A/C replicon type (blaVIM-4). KPC-3-producing isolates of ST512, recovered from six patients, caused an outbreak. Three more isolates producing KPC-2 enzyme belonged to ST258. Both blaKPCgenes were part of the Tn4401a transposon carried on plasmids of the pKpQIL type. The isolates were resistant to all antibiotics tested except colistin and/or gentamicin.Four of these 15 strains were recovered from patients repatriated to the Czech Republic from Greece and Italy. This is the first report of outbreaks caused by carbapenemase-producing Enterobacteriaceae in the Czech Republic.

NDM-1 producing Acinetobacter baumannii isolated from a patient repatriated to the Czech Republic from Egypt, July 2011.

We describe the isolation of an NDM-1-producing Acinetobacter baumannii in a Czech patient repatriated in July 2011 from Egypt. The infection spread to another patient on the same ward. Both isolates showed the same resistance pattern and were susceptible only to colistin. They had an identical PFGE pattern and belonged to the same sequence type ST 1. Sequencing of the blaNDM gene identified the NDM-1 variant of the carbapenemase, surrounded by two copies of insertion sequence ISAba125.

[Filamentous "contaminants" in the mycobacteriology laboratory; their culture, identification and clinical significance]. / Vlálmoté "kontaminanty" v mykobakteriologické laboratori, jejich kultivace, identifikace a klinický význam.

Frequent "contaminants" detected during mycobacterial culture of decontaminated samples are bacteria of the order Actinomycetales. These are usually bacteria classified as the family Corynebacterineae, genera Corynebacterium, Dietzia, Gordonia, Nocardia, Rhodococcus and Tsukamurella. These bacteria frequently colonize the airways and, under certain circumstances, they may cause life-threatening diseases. In severely immunocompromised patients, they regularly cause life-threatening infections with bacteria of the genus Nocardia. These filamentous bacteria, developing aerial mycelium in the culture, are partly acid-resistant and resistant to lysozyme. They cause nocardiosis, a rare but serious disease in patients with various types of immune deficiency. Differential diagnosis must distinguish between the genera Streptomyces, Actinomadura and Nocardiopsis and other soil saprophytes that are not acid-resistant, sensitive to lysozyme and faster growing. They frequently colonize the airways of patients with lung disease but very rarely cause diseases. The diagnosis of aerobic actinomycetes and determination of their sensitivity to antibiotics are problematic since they grow longer, are difficult to stain and are involved in atypical biochemical reactions. Precise identification of the genera and species requires polyphasic identification of isolates using molecular microbiology methods. If diagnosed early, infections caused by aerobic actinomycetes are easy to treat with targeted antibiotic therapy.

Long-term survival of patients treated for Hodgkin's disease in 1971-1996 depending on the clinical stage of the disease, patient's fertility after therapy and cause of death analysis.

The long-term survival in a group of 370 patients treated for Hodgkin's disease in the years 1971-1996 was retrospectively analyzed. Up to now 191 patients live. 179 patients have died. Since the year 1978 the uniform diagnostic and therapy protocol has been used. The therapy consisted in the combination of a radiation therapy (usual dose 40 Gy) with the COPP chemotherapy (6 cycles). Since the year 1988 the alternation of the ABVD and COPP chemotherapy has been used. According to the stage of the Hodgkin's disease and the patient's age the modification of the therapy was introduced. One chemotherapy cycle was removed for each 10 years above the 50 year age of the patient. The radiation therapy was not applied to the areas of the reproductive organs in young patients to preserve their fertility. The percentage of surviving patients for thirty years was 58.8% for Stage I and IIA,B and for Stage IIIA was 60.72%. In the group of surviving patients, we have registered 11 fathers and 34 females with up to 3 children. All together 75 children without health problems are monitored.

First identification of metallo-beta-lactamase-producing Pseudomonas aeruginosa in the Czech Republic.

Since 2005, invasive isolates of Pseudomonas aeruginosa have been collected in the Czech Republic as part of the European Antibiotic Resistance Surveillance System (EARSS). Forty-eight microbiology laboratories throughout the country including approximately 81% of the population provide consecutive isolates from blood and cerebrospinal fluid. Surprisingly, no metallo-beta-lactamase (MBL) was found in 1,259 invasive isolates tested over the past three years until the detection of two MBL-producing strains in mid-2008. Both strains were isolated from patients hospitalised in one regional hospital. The MBL was identified as IMP-7, which had been seen previously in Canada, Japan, Malaysia and Slovakia.

Carriage of methicillin-resistant Staphylococcus aureus in veterinary personnel.

A survey of 280 attendees at a veterinary meeting in the Czech Republic in 2008 revealed a carriage rate of 0.7% for methicillin-resistant Staphylococcus aureus (MRSA). The two strains isolated were of distinct genetic lineages, carried type IV SCCmec determinants and were negative for Panton-Valentine leukocidin genes. The MRSA positivity rates for veterinarians in the Czech Republic is considerably lower than reported elsewhere.

[Results of the monitoring the group of patients treated for the Hodgkin disease in the period of 1971 to 1996. Part 1: long-time survival in dependence of the clinical stage of the disease]. / Výsledky sledování souboru pacientu lécených pro Hodgkinovu nemoc v létech 1971 az 1996. I. cást: Dlouhodobé prezití pacientu v záivislosti na klinickém stádiu onemocnení.

BACKGROUND: This authors team has been dealing with the Hodgkin disease problems since 1971. The MORHO study started at eight working places in 1978 according to unified diagnostic and medical protocol. PATIENTS AND METHODS: 370 patients were treated. The treatment consisted in the combination of radiation and chemotherapy COPP and since 1988 in alternance of COPP and ABVD. Therapy was modificated with accordance to clinical stages and patient's histological type and age. Treatment of the patients over 50 was reduced in decades of one chemotherapy cycle less. RESULTS: Results from the clinical study are--patients with the stage IIA, IIB and IIIA survive 30 years in 59.29%, 57.86% and 60.72%. Patients diagnosed as stage IIIB survive after 30 years 36.78%, while patients in stages IVA and IVB survived 10 years 24.51% and 23.32% and 20 years 8.61% in stage IVB. Women survived longer than men. Histological types had no influence to the lenght of survival. The total number of relapses in the group was 55. There were 39 men and 16 women from that. 64% was in stage III and IV and in 73% mediastinal nodules were affected. 42% of relapses was till 1 year after the treatment. After the treatment 75 children were born to the patients from the group. 60 children from that were born to the women under treatment. CONCLUSION: The success of therapy of Hodgkin's disease according to protocol created by expert group of study MORHO is comparable with results of similar studies in the world. The most important contribution of this study was unification of treatment protocol in Czechoslovakia. This study changed the formerly paliative therapy to real curative treatment.

[Results of the monitoring the group of patients treated for the Hodgkin disease in the period of 1971 to 1996. Part 2: fertility after therapy]. / Výsledky sledování souboru pacientu lécených pro hodgkinovu nemoc v letech 1971-1996. II: fertilita po terapii.

BACKGROUND: This authors team has been dealing with the Hodgkin disease problems since 1971. The MORHO study started at eight working places in 1978 according to unified diagnostic and medical protocol. The aim of this study is evaluation of influence of Hodgkin disease therapy on the fertility in young patients. PATIENTS AND METHODS: Group of patients treated for Hodgkin disease in years 1971-1996 at workplaces using the same treatment protocol has been analyzed and the results have been compared with results of other medical centers in the world. Some of the young patients in fertile age became parents after the treatment. RESULTS: Information of number of pregnancies and of children born, long term surveillance and complications of treatment has been collected and discussed. Many patients stayed fertile also after therapy of numerous relapses. There was 75 children born to 34 women and 11 men previously treated for Hodgkin disease. CONCLUSION: The results of our study are comparable with results of statistial evaluation of similar studies in the world cancer research centers.