Candidaemia in polish hospitals - a multicentre survey.

Significant changes in the frequency of candidaemia and the distribution of causative species have been noted worldwide in the last two decades. In this study, we present the results of the first multicentre survey of fungaemia in Polish hospitals. A total of 302 candidaemia episodes in 294 patients were identified in 20 hospitals during a 2-year period. The highest number of infections was found in intensive care (30.8%) and surgical (29.5%) units, followed by haematological (15.9%), 'others' (19.2%) and neonatological (4.6%) units. Candida albicans was isolated from 50.96% of episodes; its prevalence was higher in intensive care unit and neonatology (61.22% and 73.33%, respectively), and significantly lower in haematology (22%; P < 0.001). The frequency of C. krusei and C. tropicalis was significantly higher (24% and 18%) in haematology (P < 0.02); whereas, the distribution of C. glabrata (14.1%) and C. parapsilosis (13.1%) did not possess statistically significant differences between compared departments. Obtained data indicates that species distribution of Candida blood isolates in Polish hospitals reflects worldwide trends, particularly a decrease in the prevalence of infections due to C. albicans.

[Is autosomal dominant polycystic kidney disease associated with asymptomatic bacteriuria?]. / Czy u chorych z autosomalna dominujaca wielotorbielowatoscia nerek wystepuje bakteriomocz bezobjawowy?

UNLABELLED: Urinary tract infections (UTIs) are a common complication in patients with autosomal dominant polycystic kidney disease (ADPKD). Asymptomatic bacteriuria (AB) is a factor predisposing to UTI in other populations. The aim of the study was to determine whether AB is more frequent in a group of ADPKD patients with normal kidney function and no diabetes than in a healthy control group. MATERIAL AND METHODS: A group of 49 ADPKD patients (19 men and 30 women) with normal kidney function (creatinine level < 1.35 mg/dl) and no diabetes, with an average age of 35.9 +/- 11.1 years was compared with a group of 50 healthy controls (22 men, 28 women) with similar age (36.7 +/- 9.2 years). All subject were evaluated using medical history and physical examination, urine culture, urinalysis (biochemical and morphological), kidney ultrasonography, oral glucose tolerance test (with 75 g of glucose) and serum creatinine testing. RESULTS: UTIs were significantly more frequent in medical history of ADPKD patients than in control group (26% vs. 0%, p < 0.001). Asymptomatic bacteriuria was found in 2% of ADPKD patients and in 4% of control group (p = 0.69). The presence of protein in urinalysis was observed in 6% of ADPKD and in none of the control patients. Other urine measurements like pH, specific gravity, and morphological examination were normal and did not substantially differ between groups. The kidneys of ADPKD patients were significantly longer than in control group (p < 0.001). CONCLUSIONS: Asymptomatic bacteriuria is not present more frequently in ADPKD patients with normal kidney function and no diabetes, than in healthy people.

[Is it necessary to treat Helicobacter pylori infection in patients with end-stage renal failure and in renal transplant recipients?]. / Czy nalezy leczyc zakazenie Helicobacter pylori u chorych w okresie skrajnej niewydolnosci nerek i po przeszczepieniu nerek?

Uraemic patients frequently complain of gastrointestinal ailments. There are a lot of factors responsible for the occurrence of these symptoms. It is considered--among other things--that high level of urea in gastric juice and hypergastrinaemia contribute to the damage of stomach and duodenum mucosa. Does H. pylori infection also produce pathological changes within upper gastrointestinal tract in these patients? The aim of the study was to determine the prevalence of H. pylori infection and macroscopic and microscopic estimation of oesophagus, stomach and duodenum mucosa in haemodialysis patients and renal transplant recipients. A total of 39 patients were taken under investigation: 27 among them were treated with haemodialyses and 12 were after kidney transplantation. In all patients upper gastrointestinal endoscopies were performed with collection of biopsy specimens for histological analysis and a urease test. Serological examinations were carried out in order to detect anti-CagA H. pylori antibody. In summary, we found that prevalence of H. pylori infection in uremic patients on chronic haemodialysis and renal transplant recipients was significantly lower than that in patients with normal renal function. This may be a consequence of medication and/or protection by a high urea concentration. Elevated blood urea seems to correlate with a high prevalence of gastroduodenal mucosal lesions.

Antibodies to Chlamydia pneumoniae and haemostatic factors in acute coronary syndrome without ST segment elevation.

BACKGROUND: Various chronic infections, including Chlamydia pneumoniae (C. pneumoniae), are regarded as one of the possible factors which initiates, progresses and exacerbates atherosclerotic process. The relationship between C. pneumoniae infection and haemostatic factors which also may promote atherosclerosis, has not yet been established. AIM: To assess the relationship between C. pneumoniae-specific IgA and IgG serum antibodies and haemostatic factors in patients with acute coronary syndrome (ACS). METHODS: The study group consisted of 31 patients (17 males, mean age 62 years, and 14 females, mean age 60.6 years) with ACS and without ST segment elevation in whom antibodies to C. pneumoniae and such haemostatic factors as von Willebrand factor (vWF), thrombomodulin (TM), tissue plasmin activator (tPA), tPA inhibitor (PAI-1) and fibrinogen were measured. RESULTS: The proportion of patients with C. pneumoniae seropositivity was 35.4% in our study which is lower than that reported in literature. No significant relationship between vWF, TM, tPA and PAI-1 levels, and C. pneumoniae infection was found whereas a significant (p=0.05) relationship between C. pneumoniae-specific IgG antibodies and fibrinogen level was detected. CONCLUSIONS: Excluding fibrinogen, the presence of antibodies to C. pneumoniae is not associated with increased levels of haemostatic factors in patients with ACS without ST segment elevation.

Endothelial dysfunction in acute coronary syndrome without ST segment elevation in the presence of Helicobacter pylori infection.

BACKGROUND: Helicobacter pylori (H. pylori) infection is one of the most common chronic infections in humans. While a causative relationship between H. pylori infection and several gastrointestinal disorders has been well established, the association between this condition and the development of atherosclerosis and coronary artery diseases (CAD) is less clear. AIM: To examine the relationship between H. pylori infection and endothelial function in patients with acute coronary syndrome (ACS) without ST segment elevation. METHODS: The study group consisted of 31 patients (17 males aged 38-78 years and 14 females aged 45-80 years) with ACS and without ST segment elevation in whom we measured antibodies to H. pylori and haemostatic factors indicating endothelial function, such as von Willebrand factor (vWF), thrombomodulin (TM), tissue plasmin activator (tPA:Ag), tPA inhibitor (PAI-1:Ag) and fibrinogen. RESULTS: The proportion of patients with H. pylori seropositivity was 93.5%. No significant relationship between parameters of endothelial function and IgG antibodies to H. pylori were found. There was a significant association between antibodies to p54 protein and vWF (p=0.027) and between antibodies to p33 protein and PAI:Ag concentration (p=0.019). CONCLUSIONS: These results suggest that the type of H. pylori antigens and antibodies to these antigens rather than the presence of IgG antibodies to H. pylori may play a role in the development of CAD.