Changing pattern of infection in the Bratislava Burn Center.

Infection still remains one of the major problems in burn treatment. The authors investigated the occurrence of burn wound pathogens in burn wound biopsies and/or semiquantitative wound surface off-prints. As the results have shown, trends of a decreased contribution of "classical pathogens", like Staphylococcus aureus and Pseudomonas aeruginosa, to burn wound infections were observed. The role of "other pathogens", like Enterobacter, Acinetobacter, etc., which were quite rare in the past, is on the opposite, increasing. One of the explanations can be the increasing rate of early surgical treatment methods of deep burns. The results were in accordance with similar studies from other burn centres.

Aminoglycoside resistance. Enzymatic mechanisms in clinical bacterial strains in Slovakia during the last decade.

We determined the importance and dissemination of enzymatic mechanisms of aminoglycoside resistance in 239 gentamicin-resistant strains of Gram-negative bacilli isolated in Slovakia during the past decade. Over the past 5 years, the resistance to tobramycin has risen by 1.1% to netilmicin by 27.4%, to amikacin by 78.3%, and resistance to isepamicin was high too (81.9%). Sixteen different aminoglycoside-modifying enzymes were detected and their significance for resistance to aminoglycosides was confirmed. It is evident that within the past 5 years gentamicin-resistant bacterial have obtained genetic information on resistance to the other aminoglycosides tested and the percentage of strains with different enzyme combinations has risen. These observations confirm the continuously increasing complexity of antibiotic resistance in clinical bacterial isolates under study in Slovakia during the last decade.

[Liver abscess after elective cholecystectomy]. / Absces pecene po elektívnej cholecystectomii.

The authors submit the case-history of a 39-year-old patient with elective cholecystectomy where the immediate postoperative course was complicated by a liver abscess. The authors discuss aetiological factors, diagnosis and treatment of liver abscesses. In the conclusion they submit a proposal of ATB prophylaxis in severe inflammations of the gallbladder and biliary pathways. In the department of the authors ATB prophylaxis is not used before elective cholecystectomy.

Evaluation of the resistance of Enterobacteriaceae strains to antibiotics--comparison of strains from clinical material versus environment.

The authors analyzed resistance to antibiotics of bacterial strains from the family of enterobacteriaceae comparing the resistance of two sets of strains, one set being strains isolated from clinical material of patients, the other being those isolated from municipal waste water of the 4th district of Bratislava. Referring to higher index of resistance in strains isolated from outer environment, they draw attention to high number of strains resistant to ampicillin and tetracyclin in clinical material and that of gentamicin-resistant ones from outer environment. Some views on standardization of empirical antibiotic therapy of infections due to strains from clinical material and outer environment are formulated and changes in the antibiotic spectrum effectivity as compared with past results as well as possible unsatisfactory success in treatment by means of currently applied broad spectrum antibiotics in cases of empiric therapy of infections are pointed to. Information on incidence of polyresistant strains of Enterobacteriaceae in outer environment and municipal waste water is presented.

Aminoglycoside resistance patterns in clinical isolates of Enterobacteriaceae from Czechoslovakia.

Multi-resistant Enterobacteriaceae isolated mainly from urine specimens from patients at the Department of Urology, Kramáre Hospital, Bratislava, were characterized for resistance phenotype. Seventeen gentamicin-resistant isolates were further studied for the presence of aminoglycoside-modifying enzymes. Five enzymes were detected: AAC(2'), AAC(3)-II, AAC non-characterized, ANT(2") and APH(3')-I. The substrate range of these enzymes was found to correlate with the resistance phenotype in most isolates. In our collection the AAC(3)-II enzyme that inactivates gentamicin, sisomicin, tobramycin and netilmicin was predominant. Predominance of this type of modifying enzyme has been observed also in resistant Gram-negative strains in Belgium, The Netherlands and Chile, in contrast to the United States, Federal Republic of Germany, Switzerland, Greece and Turkey, where ANT(2") has been the most common enzyme.

Transferable amikacin and cefamandole resistance: Pseudomonas maltophilia and Acinetobacter strains as possible reservoirs of R plasmids.

Three strains belonging to gramnegative non-fermenting rods, i.e. a Pseudomonas maltophilia strain and two strains of Acinetobacter, were tested, as representatives of different types of nosocomial strains, for transferability of their multiple drug resistance. As all of them posed difficulties in demonstrating the transferability of their resistance by conventional methods, a three-step procedure was developed that includes a transfer to rifampicin-resistant P. aeruginosa recipients, then to susceptible P. aeruginosa intermediate strains, and, finally, from these strains to rifampicin-resistant Enterobacteriaceae. In three strains studied three genetically different types of R plasmids have been demonstrated. P. maltophilia transferred Amikacin resistance, as well as resistance to other antibiotics, to P. aeruginosa and then to Enterobacteria. In contrast, an Amikacin-resistant Acinetobacter with quite identical multiple drug resistance spectrum transferred its resistance to P. aeruginosa only, but not to Enterobacteria. Finally, another Acinetobacter strain, resistant to Gentamicin but susceptible to Amikacin transferred this resistance directly to Enterobacteria (and, separately, to P. aeruginosa, too). All three strains transferred Cefamandole resistance together with other resistances. Non-fermenting rods, thus, might be a source of transmissible resistance to reserve antibiotics as Amikacin, and advanced-type Cephalosporins.

Sensitivity of strains of Candida albicans to jaritin, haloprogin, clotrimazole and miconazole.

The antifungal activity of jaritin and haloprogin against Candida albicans is similar. In vitro they had less activity than clotrimazole and miconazole, but the activity was independent of inoculum size.

Fosfomycin therapy of experimental infections in mice.

Fosfomycin inhibits the development of severe pyogenic infection by Staphylococcus aureus in kidneys if administered during establishment of infection. It inhibits the development of lethal infection by Escherichia coli. It has a positive therapeutic effect on listeria infection in mice even with a fosfomycin resistant mutant.