ABSTRACT
The aim of this study was to prospectively investigate 120 cases of viridans streptococcal bacteraemia (VSB) in 117 patients in major university hospitals in Slovakia in 2000-2002 (3 y) for antibacterial susceptibility, risk factors and outcome. From 127 episodes, 16 (13%) of VSB were caused by PEN-R strains and 13 (10%) by ERY-R strains. 32 cases had cancer as underlying disease (20 haematological), 41 had endocarditis and 35 were elderly (>65 y of age) patients. Concerning mortality, 29 of 127 patients died (24%). There were several risk factors associated with mortality. Solid tumour as underlying disease (p<0.02), stroke (p<0.002), concomitant lung infection (p<0.01), endoscopic procedure (p<0.036), intubation (p<0.0008), ventilatory support (p<0.002), and coma (p<0.009) were associated with more deaths. A comparison of 115 bacteraemias to 13 bacteraemias caused by erythromycin-resistant strains of Streptococcus viridans was performed. There were no significant differences in underlying disease, risk factors and mortality. Erythromycin resistance in bacteraemias caused by S. viridans did not have significant impact on outcome of the patients, nor did it show specific relation to analysed risk factors in our study. 14.5% of VSB were cause by PEN-resistant viridans streptococci. Risk factors for penicillin resistance were ventilatory support (p<0.01), intubation (p<0.001) and resistance to other antibiotics: 8 of 16 (50%) of PEN-R VSB were resistant also to erythromycin or cotrimoxazole or tetracycline compared with 9% of PEN-R VSB (p<0.005). Endoscopic procedures in the upper respiratory system were at risk for development of PEN-R VSB. There was also difference in outcome; 71% vs 22.5% (p<0.0002) of cases infected with PEN-R VSB died compared to PEN-S VSB. PEN-R is therefore clinically significant in VSB.
Subject(s)
Anti-Bacterial Agents/pharmacology , Bacteremia/microbiology , Bacteremia/mortality , Drug Resistance, Bacterial , Viridans Streptococci/drug effects , Aged , Bacteremia/complications , Child, Preschool , Erythromycin/pharmacology , Health Surveys , Humans , Microbial Sensitivity Tests , Penicillin Resistance , Prospective Studies , Risk Factors , Slovakia , Streptococcal Infections/complications , Streptococcal Infections/microbiology , Streptococcal Infections/mortality , Viridans Streptococci/isolation & purification , Viridans Streptococci/pathogenicitySubject(s)
Acinetobacter Infections/epidemiology , Acinetobacter Infections/microbiology , Acinetobacter/isolation & purification , Bacteremia/epidemiology , Bacteremia/microbiology , Acinetobacter/classification , Adult , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Slovakia/epidemiologySubject(s)
Acinetobacter Infections/epidemiology , Bacteremia/microbiology , Neoplasms/complications , Female , Humans , Logistic Models , Male , Risk FactorsSubject(s)
Anti-Bacterial Agents/pharmacology , Bacteremia/drug therapy , Gentamicins/pharmacology , Gram-Positive Bacterial Infections/drug therapy , Bacteremia/microbiology , Drug Resistance, Microbial , Enterococcus/drug effects , Enterococcus/isolation & purification , Gram-Positive Bacterial Infections/microbiology , Humans , In Vitro Techniques , SlovakiaSubject(s)
Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Bacteremia/mortality , Enterococcus , Gram-Positive Bacterial Infections/drug therapy , Gram-Positive Bacterial Infections/mortality , Medication Errors , Bacteremia/microbiology , Gram-Positive Bacterial Infections/microbiology , HumansABSTRACT
Amphotericin B (AmB) resistance in Candida spp. is very rare. Three cases of fungemia, due to amphotericin B-resistant Candida spp. in pediatric patients after previous neurosurgery for brain tumors, are reported. The Candida strains - one C. guillermondii, one C. lusitaniae, and one C. parapsilosis - showed minimum inhibitory concentrations (MICs) to AmB of 2-4 microg/ml. Two of the three patients had been pretreated with AmB for 5-11 days. All three patients were successfully treated with intravenous fluconazole (6-10 mg/kg per day) for 16-28 days, and all survived. Despite AmB resistance in Candida spp. being very rare, C. lusitaniae, C. guillermondii, and C. parapsilosis isolates in documented infections should be tested for AmB resistance, mainly in patients not responding to therapy with AmB.
Subject(s)
Amphotericin B/pharmacology , Antifungal Agents/pharmacology , Brain Neoplasms/surgery , Candida/drug effects , Candidiasis/microbiology , Craniotomy , Cross Infection/microbiology , Fungemia/microbiology , Postoperative Complications/microbiology , Adolescent , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Brain Neoplasms/complications , Candida/isolation & purification , Candidiasis/drug therapy , Catheterization, Central Venous/adverse effects , Child , Child, Preschool , Cross Infection/drug therapy , Drug Resistance, Microbial , Equipment Contamination , Fluconazole/therapeutic use , Fungemia/drug therapy , Hospitals, Pediatric/statistics & numerical data , Humans , Microbial Sensitivity Tests , Postoperative Complications/drug therapy , Slovakia , Species Specificity , Ventriculoperitoneal Shunt/adverse effectsSubject(s)
Anti-Bacterial Agents/pharmacology , Bacteremia/microbiology , Gram-Negative Bacterial Infections/microbiology , Neoplasms/microbiology , Stenotrophomonas maltophilia/drug effects , Anti-Bacterial Agents/therapeutic use , Bacteremia/complications , Humans , Microbial Sensitivity Tests , Neoplasms/complications , Stenotrophomonas maltophilia/isolation & purificationSubject(s)
Bacteremia/microbiology , Enterococcus faecium/pathogenicity , Gram-Positive Bacterial Infections/microbiology , Vancomycin Resistance , Bacteremia/mortality , Enterococcus faecium/drug effects , Gram-Positive Bacterial Infections/mortality , Humans , Neutropenia/microbiology , Predictive Value of Tests , Retrospective Studies , Vancomycin/pharmacologyABSTRACT
This study prospectively investigated all 157 cases of Acinetobacter baumannii bacteremia occurring in major university hospitals or tertiary care institutions in Slovakia during 1999 in order to determine the antimicrobial susceptibility, risk factors and outcome. Resistance to meropenem was 7.4, gentamicin 35.6, amikacin 26.5, cefepime 20.4 and ciprofloxacin 32.7%, but was only 17.3% to cefoperazone/sulbactam or ampicillin/sulbactam. Antimicrobial susceptibility of A. baumanii was lowest among isolates from cancer patients (ceftazidime 58%, piperacillin/tazobactam 52% and azthreonam 48%; p < or = 0.01-0.001). In univariate analysis, several risk factors, such as wound infection (p < or = 0.01) and ventilatory support (p < or = 0.0001), were significantly related to A. baumannii bacteremia in surgical patients. Neutropenia (p < or = 0.0001), antineoplastic chemotherapy (p < or = 0.0001) and prior antibiotic therapy (p < or = 0.0006) were significant risk factors for A. baumannii bacteremia in cancer patients. In addition, ventilatory support and surgery (p < or = 0.0001) and prior antibiotic therapy (p < or = 0.01) were significantly related to A. baumannii bacteremia in children. Colonization at other body sites (p < or = 0.05), diabetes mellitus (p < or = 0.04) and decubital ulcers/burns (p < or = 0.002) as underlying disease were significantly related to death due to A. baumannii bacteremia. In a multiple logistic regression model, decubital ulcers/burns as underlying disease (p < or = 0.0006; relative risk 5.08) and nosocomial pneumonia (p < or = 0.045; relative risk 5.08) were independent predictors of mortality. Mortality was similar between cancer and surgical patients but significantly lower in children vs. adults (p < or = 0.009).
Subject(s)
Acinetobacter Infections/etiology , Acinetobacter/drug effects , Anti-Bacterial Agents/pharmacology , Acinetobacter/isolation & purification , Acinetobacter Infections/drug therapy , Acinetobacter Infections/mortality , Adult , Anti-Bacterial Agents/therapeutic use , Child , Cross Infection/drug therapy , Cross Infection/epidemiology , Drug Resistance, Bacterial , Hospitals, University , Humans , Logistic Models , Microbial Sensitivity Tests , Neoplasms/complications , Neoplasms/drug therapy , Postoperative Complications , Prospective Studies , Risk Factors , Slovakia/epidemiology , Treatment OutcomeABSTRACT
To assess the antibiotic policies of Central European countries, we performed an overview of antibiotic stewardship, prescription habits and antibiotic prescription regulatory procedures. Since most Central European countries have had centralized health care and drug policies, the situation 10 years after decentralization is surprising. Only 3 of 10 Central European countries have some regulation of prescription of antibiotics, only 4 restrict some antibiotics, only 5 have hospital and only 3 national antibiotic policies. In all but 3 countries physicians can prescribe quinolones and/or 3rd generation oral cephalosporins as first-line antibiotics. Information on local and national antibiotic policies in Central and Eastern European countries is given including prescription guidelines for antibiotic use in community and hospital.