ABSTRACT
This study analysed the occurrence of carbapenem resistance among Acinetobacter baumannii isolates from a tertiary-care hospital in Poland, together with the molecular epidemiology of these isolates and the risk-factors for their acquisition and possible nosocomial spread. The medical charts of 21 patients with Acinetobacter infection or colonisation revealed that A. baumannii isolates were obtained most frequently from intensive care unit and surgical patients (particularly those receiving transplantation surgery). First isolation occurred, on average, on day 21 following admission (range 5-45 days). Infection with Acinetobacter contributed directly to the death of seven patients. Several patients were infected with more than one strain, and molecular typing revealed the co-circulation of three predominant clones, of which two belonged to the Acinetobacter lineages designated as European clones I and II. All three clones encoded an OXA-51-type carbapenemase, but were negative for carbapenemases belonging to the OXA-23, OXA-24 and OXA-58 families. The OXA-51 gene was found in both resistant and susceptible isolates, and was not associated directly with carbapenem resistance. Etests with imipenem and imipenem plus EDTA indicated production of a metallo-beta-lactamase (MBL) in carbapenem-resistant isolates. PCRs for IMP-type MBLs were negative, but PCR using consensus primers for VIM-type MBLs were positive for carbapenem-resistant isolates belonging to the European clone II lineage. The occurrence of a VIM-type MBL in association with one of the epidemic lineages of A. baumannii is a cause for concern. Further studies are needed to evaluate possible inter-hospital spread of resistant A. baumannii strains in Poland.
Subject(s)
Acinetobacter Infections/epidemiology , Acinetobacter baumannii , Carbapenems/pharmacology , Cross Infection/microbiology , Drug Resistance, Multiple, Bacterial , beta-Lactamases/genetics , Acinetobacter Infections/drug therapy , Acinetobacter Infections/genetics , Acinetobacter baumannii/drug effects , Acinetobacter baumannii/genetics , Acinetobacter baumannii/pathogenicity , Adult , Aged , Community-Acquired Infections/drug therapy , Community-Acquired Infections/genetics , Community-Acquired Infections/microbiology , Cross Infection/drug therapy , Cross Infection/epidemiology , Female , Hospitals, University , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Poland/epidemiology , Retrospective Studies , beta-Lactamases/classificationABSTRACT
An outbreak of nosocomial meningitis caused by Acinetobacter baumannii, which developed postoperatively in seven neurosurgical patients is described. The clinical isolates of A. baumannii were typed by biochemical profiles and antibiogram patterns, and by random amplified polymorphic DNA polymerase chain reaction (RAPD-PCR) and amplified fragment length polymorphism (AFLP) fingerprinting. The implicated strain was multi-drug resistant, however, susceptibility to imipenem and netilmicin was detected. An extensive search for the environmental source of the epidemic strain was carried out. Two of several isolates from hospital environment, corresponded to the A. baumannii outbreak strain, one being cultured from the suctioning equipment used in the care of these patients. The introduction of multiresistant epidemic A. baumannii into a neurosurgical unit is a severe risk factor for patients undergoing neurosurgical procedures. Genotypic typing methods are important for definitive identification of these strains in patients and their environment.
Subject(s)
Acinetobacter Infections/etiology , Acinetobacter baumannii , Cross Infection/etiology , Disease Outbreaks/statistics & numerical data , Meningitis, Bacterial/etiology , Neurosurgical Procedures/adverse effects , Acinetobacter Infections/diagnosis , Acinetobacter Infections/epidemiology , Acinetobacter Infections/transmission , Acinetobacter baumannii/genetics , Bacterial Typing Techniques , Cerebrospinal Fluid/microbiology , Cluster Analysis , Cross Infection/diagnosis , Cross Infection/epidemiology , Cross Infection/transmission , DNA Fingerprinting , DNA, Bacterial/analysis , DNA, Bacterial/genetics , Disease Outbreaks/prevention & control , Drug Resistance, Multiple, Bacterial , Environmental Monitoring , Epidemiological Monitoring , Equipment Contamination/prevention & control , Equipment Contamination/statistics & numerical data , Genotype , Hospital Mortality , Humans , Infection Control/methods , Meningitis, Bacterial/diagnosis , Meningitis, Bacterial/epidemiology , Meningitis, Bacterial/transmission , Microbial Sensitivity Tests , Polymorphism, Restriction Fragment Length , Random Amplified Polymorphic DNA Technique , Retrospective Studies , Risk Factors , Suction/instrumentationABSTRACT
The study comprised strains of Candida albicans isolated from patients hospitalised in a tertiary care hospital during a 2-year period. In total 851 strains were cultured, including 379 (44.5%) strains from internal medicine patients, 243 (28.6%) from surgical patients and 229 (26.9%) from patients in the surgical intensive care unit. The strains were tested for susceptibility to the triazoles: fluconazole and itraconazole. There were 523 (61.5%) strains susceptible, 11 strains (1.3%) showed intermediate susceptibility and 317 (37.2%) were resistant to fluconazole, while 403 (47.3%) strains were susceptible, 43 (5.1%) intermediately susceptible and 405 (47.6%) resistant to itraconazole. Regular surveillance of fungal resistance patterns should be carried out and there should be prudent use of hospital triazole usage.
Subject(s)
Antifungal Agents/pharmacology , Candida albicans/drug effects , Candidiasis/microbiology , Drug Resistance, Fungal , Fluconazole/pharmacology , Itraconazole/pharmacology , Candidiasis/epidemiology , Cross Infection/epidemiology , Cross Infection/microbiology , Humans , Retrospective StudiesABSTRACT
The bacteria most frequently isolated from blood cultures of haematology patients in Warsaw were staphylococci (58.0%), Enterobacteriaceae (18.6%), non-fermenting rods (6.9%), enterococci (4.3%) and anaerobes (4.3%). Coagulase-negative staphylococci were the most common species isolated (92.7%) with 83.2% of these strains resistant to methicillin. Among enteric bacteria, 17.3% strains produced extended-spectrum-beta-lactamases. All eight isolates of enterococci showed high level resistance to aminoglycosides.
