Analysis of Acinetobacter baumannii resistance patterns in patients with chronic obstructive pulmonary disease (COPD) in terms of choice of effective empiric antibiotic therapy.

Introduction. Multi-resistant Acinetobacter baumannii isolated from patients has become one of the most hazardous pathogens in health care settings. The aim of the study was to analyze pneumonia caused by Acinetobacter baumannii in patients hospitalized because of exacerbation of chronic obstructive pulmonary diseases (COPD), who were admitted to the Pulmonology Ward of the Masovian Specialistic Hospital in Radom (MSS). The incidence and drug sensitivity of these non-fermenting rods were evaluated, and compliance with antimicrobial procedure with the algorithm of the guidelines in applicable recommendations, was estimated. This should result in determining the local patterns of resistance and verifying therapeutic procedures in accordance with the assumptions of hospital antibiotic policy. In addition, the study examined the effectiveness of empiric and targeted therapy according to the clinical condition of the patient, and the eradication of A. baumannii, in comparison with the aggravating factors of the patient. Materials and Method. The retrospective study included 90 patients with exacerbation of COPD whose etiological factor of infection was A. baumannii, hospitalized in the Department of Pulmonology (MSS) in 2012-2016. Results. Studies were conducted on 90 patients with COPD exacerbation from which A. baumannii was isolated. Co-infections with other bacterial species among 41 patients were additionally noted. The majority of A. baumannii strains showed a high resistance (90%) to fluoroquinolones, ceftazidime, piperacillin/tazobactam. For strains causing a co-infection, drug resistance was successively 44-56%, 44%, 44%. All of patients received empirical therapy. The most commonly used drug was amoxicillin with a clavulanic acid, often combined with fluoroquinolone. This type of therapy was effective among 10% of patients. The mortality in this group was determined at 29%. Among 79% of patients with COPD, a targeted therapy was performed which proved to be effective in 58% of treated cases by susceptibility testing. The highest efficacy was observer after the use of colistin and carbapenems. Conclusion. In the performed study, the infections caused by multi-resistant Acinetobacter baumannii, were observed in COPD, which should be taken into consideration in choosing empirical antibiotic therapy. Simultaneously, the local resistance patterns of multi-drug-resistant (MDR) Gram-negative strains co-infecting COPD should be considered in empirical treatment. Moreover, both additional clinical complication and co-infections contribute to a more severe course of diseases. In this study, the mortality percent exceeded 29%.

Concurrent peritonsillar abscess and poststreptococcal reactive arthritis complicating acute streptococcal tonsillitis in a young healthy adult: a case report.

BACKGROUND: Streptococcus pyogenes is responsible for 5-15% and 20-30% of acute pharyngitis/tonsillitis in adults and children, respectively. It not only causes acute illness but also can give rise to local suppurative complications such as peritonsillar abscess as well as trigger the postinfectious syndromes of glomerulonephritis, acute rheumatic fever and poststreptococcal reactive arthritis. Here, we report a case of a young healthy adult in whom both peritonsillar abscess and poststreptococcal reactive arthritis developed as a complication of acute streptococcal tonsillitis. To the best of our knowledge, such a coincidence of poststreptococcal sequelae has not been reported previously. CASE PRESENTATION: A 32-year-old previously healthy woman was diagnosed with acute tonsillitis by her family doctor and treated empirically with amoxicillin/clavulanic acid (875/125 mg) twice daily for 5 days. Four days after completing antibiotic therapy, peritonsillar abscess of left tonsil developed. Needle aspiration followed by incision and drainage were performed by otolaryngologist at the Emergency Department. Next, the patient was discharged home on a 10-day course of cefuroxime and metronidazole. The symptoms of peritonsillar abscess were subsiding during treatment, however on the last day of antibiotic therapy, swelling and pain of the left ankle appeared. Five days later the patient was consulted by rheumatologist. Cultures of throat swabs and abscess aspirate collected 2 weeks before revealed the presence of Streptococcus pyogenes. Antistreptolysin O (ASO) titer was evaluated and proved to be 412 IU/ml (normal 0-200 IU/ml). The level of C-reactive protein was 13,0 mg/L (normal <5,0 mg/L). There was no known cardiac involvement. Poststreptococcal reactive arthritis was diagnosed. Left ankle arthralgia persisted for about 5-6 weeks. Six months after the presentation at the Emergency Department, the patient was well, with ASO titer reaching 262 IU/ml. CONCLUSIONS: Clinicians should be aware that appropriate choice of antibiotic, proper dose as well as duration of therapy of acute GAS pharyngitis/tonsillitis are crucial to prevent poststreptococcal sequelae.

[Leptospira spp. and Coxiella burnetii infections occuring in Radomskie District in people of selected professional groups]. / Zakazenia Leptospira spp. i Coxiella burnetii wystepujace w powiecie radomskim u ludzi z wybranych grup zawodowych.

INTRODUCTION: Leptospirosis and Q fever are a zoonotic diseases with global occurring. OBJECTIVES: The aim of this study was to determine the prevalence of Leptospira spp. and C. burnetii in humans, who have contacts with infected animals or are exposed to an environment potentially contaminated with these bacteria. MATERIAL AND METHODS. Blood serum samples originating from 177 veterinarians and farmers and 134 garbage collectors (blood samples) were examined. Control group consisted 43 blood samples derived from blood donors. For the detection of specific IgM and IgG antibodies of Leptospira spp., enzyme-linked immunosorbent assay (ELISA) was used. Indirect immunofluorescence method (IFA) was used for detection of specific IgG C. burnetii antibodies. DNA of Leptospira spp. and C. burnetii was detected by PCR method with appropriate pairs of primers. RESULTS: Specific IgG C. burnetii antibodies of phase II were detected in sera of 4.4% of the farmers and veterinarians, and in 12% of garbage men. Antibodies in blood donors was not found. Antibodies of Leptospira spp. were present in the serum of 23.6% of farmers and veterinarians, 26.2% of garbage men and 14% of blood donors. C. burnetii DNA was detected in one sample derived from the veterinarian (1.1%). Leptospira spp. DNA was not detected in tested material. Blood samples from farmers, veterinarians and garbage collectors showed the higher prevalence of antibodies of Leptospira spp. and C. burnetii as compared to the control group (blood donors). CONCLUSIONS: Beside farmers and veterinarians, garbage collectors should be consider as high risk group of contracting leptospirosis and Q fever. Both leptospirosis as well as Q fever should be considered in the differential diagnosis in humans with animals and animals' material contact when they reveal flu-like symptoms.