[Methods of phenotypic determination of New Delhi metallo-beta-lactamase (NDM-1) in Klebsiella penumoniae isolated in Slovakia].

OBJECTIVES: Reported is the first isolation and phenotypic determination of Klebsiella pneumoniae producing New Delhi metallo-beta-lactamase (NDM-1) isolated from patients in the Slovak Republic. MATERIAL AND METHODS: Between 27 October 2012 and 22 January 2013, twenty-five isolates of Klebsiella pneumoniae collected from 5 patients were identified with MIC of meropenem ≥ 32 mg/L and MIC of ertapenem ≥ 4 mg/L in screening tests. Next, all isolates were assessed with the modified Hodge test, combined disk test with EDTA, double disk synergy test with EDTA and MBL E-test. To confirm production of MBL in isolated strains of Klebsiella pneumoniae, all strains were sent to the National Reference Center for Antibiotic Resistance in Bratislava. RESULTS: All strains were positive in all phenotypic tests. In the first carbapenem-resistant isolate, NDM-1 production was confirmed by PCR amplification, sequencing and comparison with the GenBank. CONCLUSIONS: To the best of our knowledge, this is the first case of isolation of NDM-1 from Klebsiella pneumoniae in the Slovak Republic. As of 31 January 2014, with well-established and strict epidemiological and preventive measures, there was no further spread or another outbreak of NDM-1 producing Enterobacteriaceae in Louis Pasteur University Hospital in Kosice.

[Infectious complications in patients with liver cirrhosis]. / Infekcné komplikácie u pacientov s cirhózou pecene.

AIM OF THE STUDY: To assess the objective incidence of infectious complications in liver cirrhosis, to find out correlation among stage of liver cirrhosis, number of infectious complications and mortality in cirrhotic patients. PATIENTS AND METHODS: 93 patients with liver cirrhosis were hospitalized from June 1996 to November 1998 (age: 53,44 I 8,03 years, Child-Pugh score: 11,58 I 2,12). 6 patients were in class B, 87 in class C of Child-Pugh classification. Ascites was found in 81 patients, pleural effusion was found in 14 patients. Chest X-ray, examination of ascites and pleural efussion an urine culture were performed by admission, the other infections were actively screened after clinical signs. RESULTS: Spontaneous bacterial peritonitis was found in 17 patients (18,28 %), secondary bacterial peritonitis in 5 patients (5,38 %), spontaneous bacteremia in 3 patients (3,23 %), spontaneous bacterial pleuritis in 3 patients (3,23 %), bronchopneumonia and infections of respiratory tract in 22 patients (23,66 %), uro-infection in 69 patients (74,19 %) and the other kinds of infection in 14 patients (15,05 %). Mortality of patients correlates with stage of liver cirrhosis and number of infectious complications. CONCLUSION: Infections are common complications in hospitalized cirrhotics. Infectious complications are the most common cause of mortality of cirrhosis, patients with bronchopneumonia, secondary bacterial peritonitis or spontaneous bacterial pleuritis had bad prognosis. Early antibiotic treatment at the base of culture and sensitivity is an optimal therapeutic approach in cirrhotics with infections.

[Spontaneous bacterial peritonitis in the patients with liver cirrhosis]. / Spontánna baktériová peritonitída u pacientov s cirhózu pecene.

AIM OF THE STUDY: To assess objective incidence of spontaneous bacterial peritonitis (SBP), laboratory findings, effectivity of the treatment and mortality of cirrhotics with ascites and SBP. PATIENTS AND METHODS: From June 1994 to June 1999 we performed 692 abdominal paracenteses in 169 cirrhotic patients (mean age 52,63 +/- 8,02 years, mean Child-Pugh score 10,41 +/- 3,02). Culture of ascitic fluid, total leucocyte and granulocyte count in ascites and total protein, albumin and cholesterol levels in ascites and serum were examinated. Diagnosis of SBP was established by criteria of Wilcox and Dismukes. RESULTS: SBP was found in 27 patients by 1st paracentesis (16,0 %), in the other 13 patients by repeated paracentesis (7,7 %). 51 episodes of SBP (7,4 % of all paracenteses) were found in 40 patients. 48 episodes of SBP (94,7 %) were succesfully treated by ATB therapy, 8 patients with SBP died during hospitalization (15,7 %). Patients with SBP had significant lower total protein, albumin and cholesterol levels in serum and ascites compared to patients without ascites infection (all paramethers p <0,01). CONCLUSION: SBP is a common complication in patients with advanced liver cirrhosis and ascites. Despite of effectivity of ATB therapy the hospital mortality of patients with SBP is high. KEYWORDS: liver cirrhosis, ascites, spontaneous bacterial peritonitis, mortality.

[Microbiological findings in children with an indwelling central venous catheter]. / Mikrobiologické nálezy u detí so zavedeným centrálnym zilovým katétrom.

INTRODUCTION: Besides their obvious advantages for the patient, central venous catheters (CVC) also carry the risk of possible infectious complications. The purpose of our investigation was to carry out a microbiological evaluation of a 5-year set of paediatric patients with indwelling CVCs. PATIENTS AND METHODS: In the group were 218 CVCs inserted to 165 children over a period of 5 years. There were 26 multi-lumen catheters (11.927 %) and 192 single-lumen catheters (88.073 %). The mean indwelling period was 10.1 days per 1 CVC. Blood for microbiology was removed by a physician from the CVC after disinfecting its opening under standard sterile conditions into a commercial sampling vessel HEMOD (Imuna, Sarisske Michalany, Slovak Republic) or into a vessel of an automated haemoculture system BactecPeds PLUS/F (Becton Dickinson and Comp., Spark,MA, USA). When removing the tip of the CVC we disinfected, before removing the CVC, the area around the insertion with isopropyl or ethyl alcohol. We released the fixed CVC and 1 minute after disinfection we pulled out the CVC and cut off the end or rather the tip of the catheter (approx. 1-3 cm of the tip) into a sterile test tube. To establish the diagnosis of infectious complications we used the 1995 Sirges-Serra classification and the CDC criteria. RESULTS: In 5 years (1995-1999) we had 71 infectious complications. There were 31 contaminated catheters, 27 cases of catheter sepsis and 11 cases of catheter bacteraemia. With 147 catheters (67.43%) there were no infectious complications. Dominant microbes were Staphylococcus epidermidis (32 cases - 11 from haemocultures and 21 from CVCs) and Candida spp. (30 cases, 17 from haemocultures and 13 from CVCs). Among the microbiological agents of catheter sepsis predominated Gram-negative bacteria. Out of the whole analysed group 41 children (24.8 %) died. CVC as the cause of death was demonstrated in 6 children (3.636 % of patients with CVC). CONCLUSIONS: Microbiological findings in our group are in line with literary data. To reduce the incidence of infectious complications it is important to limit sampling from CVC to a minimum. Insertion of CVCs under strict sterile conditions and aseptic handling of all entries into the central bloodstream reduces to a minimum the risk of infectious complications.