Significance of Screening Tests and the Incidence of New Delhi Metallo-beta-lactamase-Producing Gram-negative Bacilli in the Surgery and Transplantation Wards of a Warsaw Medical Center During the Period From April 2014 to May 2017.

BACKGROUND: The first New Delhi metallo-beta-lactamase (NDM)-producing bacteria were isolated in 2008 in the world, and in 2011 in Poland. Due to the high clonal diversity (17 types) of their blaNDM gene, encoded on (Tn125-like) mobile genetic elements, these strains usually exhibit resistance to nearly all available antibiotics, which is particularly dangerous for organ transplant recipients. PURPOSE: To assess of the prevalence of Gram-negative NDM-positive bacilli in surgery/transplantation wards of a teaching hospital in Warsaw and to ascertain the significance of screening tests on the rates and nature of colonization. MATERIALS AND METHODS: The evaluated strains were isolated from 30 patients (between April 2014 and May 2017). The species were identified with VITEK-MS, antibiotic susceptibility was determined with VITEK 2, disk-diffusion, and/or E-test methods, according to EUCAST guidelines. The presence of the blaNDM-1 gene was confirmed using the polymerase chain reaction technique. RESULTS AND CONCLUSIONS: There were 77 blaNDM-1-positive Klebsiella pneumoniae strains isolated from 30 patients. Cultures from individual patients, mainly from rectal swabs (53.9%) and urine samples (39.8%), yielded 1-11 isolates. Fifteen patients were already colonized on admission, and the other 15 developed a symptomatic infection. In total, 24 (80%) patients were carriers, and their colonizations persisted for <1-20 months. Most isolates were susceptible only to colistin, gentamicin, amikacin, tigecycline, and/or sulfamethoxazole/trimethoprim. Gastrointestinal-tract-colonizing K pneumoniae are the main reservoir of the blaNDM-1 gene. Following the introduction of on-admission mandatory screening for carbapenem-resistant strains, the rates of NDM-producing K pneumoniae isolation increased (7.5-fold), while the rates of isolation from patients with symptomatic infections considerably decreased (2.8-fold).

Comparison of bacteria isolated from urinary tract infections in patients on transplant versus urologic wards.

OBJECTIVE: Urinary tract infections (UTI) are the most common hospital infections. Complications include sepsis and shock. Immunosuppressed transplant surgery patients may experience loss of the graft due to UTI. The purpose of this study was to determine the main microorganisms responsible for UTIs among patients of transplant wards compared to urologic wards. Additionally, drug susceptibility profiles of the most frequent microorganisms were analyzed. MATERIALS AND METHODS: We analyzed the results of positive urine cultures from patients on 2 transplant versus 1 urologic ward in 2010. RESULTS: The most common pathogen in urine samples from all 3 wards was Escherichia coli. Often, other Gram-negative bacilli of the genus Klebsiella spp, were cultured as well as Gram-positive cocci (Enterococcus spp). Yeasts of the genus Candida were only found in urine of patients of transplant wards. The percentage of resistant bacteria was much higher among bacteria from transplant patients. CONCLUSIONS: The high level of antimicrobial resistance of microorganisms isolated from the urine of transplant patients and the relatively high incidence of fungal infections, demand an especially quick, accurate microbiological diagnosis for this group of patients.

[Dominant etiological factors of urinary tract infections in various hospital departments and their resistance to chemotherapeutic agents]. / Czynniki etiologiczne zakazen ukladu moczowego dominujace na róznych oddzialach szpitalnych i ich opornosc na chemioterapeutyki.

PURPOSE: The purpose of this study was the determination of the incidence of urinary tract infection (UTI) in patients hospitalized in specific wards, and the analysis of the factors influencing the incidence of infection. METHODS: 329,608 hospital infection registration cards taken from the Polish national program for registration of hospital infections were analysed. This programme is based on a unified registration card system and on the definitions of particular types of hospital-acquired infections provided by the CDC (Centers for Disease Control, Atlanta, Georgia, USA). Statistical analysis was performed using the Statistica programme. RESULTS: 1,422 cases of hospital-acquired UTI, making up 21% of total hospital-acquired infections, were found. Six hundred sixty-six microbes were isolated from this total number of cases. The dominant pathogens were: Escherichia coli (31%), followed by Pseudomonas aeruginosa (13%), and Enterococcus sp. (12%). Hospital-acquired UTI occurred most often in maternity wards, gynaecology departments and intensive care units. Microbiological confirmation was obtained for only 45% of the clinically diagnosed cases of UTI. A disquieting increase of Pseudomonas aeruginosa resistant to chinolones was observed as well as extremely high resistance to aminoglycosides in Enterococcus sp. CONCLUSIONS: Urinary tract infections (UTIs) are the second most common form of hospital-acquired infection. Causal agents of hospital-acquired UTIs differed, depending upon the specific ward to which the patient is admitted. The most frequently isolated pathogens were Escherichia coli, Pseudomonas aeruginosa and Enterococcus sp. Microbiological confirmation of the clinically diagnosed cases of urinary tract infection is absolutely necessary, as well as a better cooperation between practicing physicians and microbiologists in the detection of hospital-acquired infection and interpretation of results.

[Mortality associated with hospital acquired infections. Analysis based upon data from the Polish National Program for Control of Infection in 1998]. / Smiertelnosc zwiazana z zakazeniami szpitalnymi. Analiza oparta na danych uzyskanych w ramach ogólnopolskiego programu kontroli zakazen w 1998 roku.

OBJECTIVE: The purpose of this study was to analyse patient mortality connected with hospital acquired infections in Polish hospitals during the year 1998. METHODS: Data was taken from 96 hospitals involved in the National Programme for the Registration of Hospital-Acquired Infections which was established in 1998. The data concerning the presence or absence of 19 specific infection forms was gathered using the passive method. RESULTS: The mortality of patients during 1998 in which hospital acquired infections were the direct or indirect cause of death was 6.9% Pneumonia and blood stream infections were the most frequent causes of death in patients hospitalised in Intensive Care Units. The most important risk factors for the development of hospital acquired infections, included old age, mechanical ventilation and urinary bladder catheterization. CONCLUSIONS: Selected epidemiological indicators for mortality rate were similar to those reported in countries with high quality infection control. A marked difference, however, was seen when comparing dating involving blood stream infections. The level of morbidity was found to be less in Poland than in developed countries. The authors feel that this low morbidity may be secondary to the decreased frequency of blood culture testing in Poland.