Antibiotic consumption in laboratory confirmed vs. non-confirmed bloodstream infections among very low birth weight neonates in Poland.

BACKGROUND: Newborns are a population in which antibiotic consumption is extremely high. Targeted antibiotic therapy should help to reduce antibiotics consumption. The aim of this study was an assessment of antibiotic usage in bloodstream infections treatment in the Polish Neonatology Surveillance Network (PNSN) and determining the possibility of applying this kind of data in infection control, especially for the evaluation of standard methods of microbiological diagnostics. METHODS: Data were collected between 01.01.2009 and 31.12.2013 in five teaching NICUs from the PNSN. The duration of treatment in days (DOT) and the defined daily doses (DDD) were used for the assessment of antibiotics consumption. RESULTS: The median DOT for a single case of BSI amounted to 8.0 days; whereas the median consumption expressed in DDD was 0.130. In the case of laboratory confirmed BSI, median DOT was 8 days, and consumption-0.120 DDD. Median length of therapy was shorter for unconfirmed cases: 7 days, while the consumption of antibiotics was higher-0.140 DDD (p < 0.0001). High consumption of glycopeptides expressed in DOTs was observed in studied population, taking into account etiology of infection. CONCLUSIONS: Even application of classical methods of microbiological diagnostics significantly reduces the consumption of antibiotics expressed by DDD. However, the high consumption of glycopeptides indicates the necessity of applying rapid diagnostic assays. Nevertheless, the assessment of antibiotic consumption in neonatal units represents a methodological challenge and requires the use of different measurement tools.

Infections and risk-adjusted length of stay and hospital mortality in Polish Neonatology Intensive Care Units.

BACKGROUND: The objectives of this study were to analyze the impact of infections on prolonging hospital stay with consideration of underlying risk factors and determining the mortality rates and its association with infections. METHODS: An electronic database developed from a continuous prospective targeted infection surveillance program was used in the study. Data were collected from 2009 to 2012 in five Polish tertiary academic neonatal intensive care units (NICUs). The length of stay (LOS) of 2,003 very low birth weight (VLBW) neonates was calculated as the sum of the number of days since birth until death or until reaching a weight of 1,800g. RESULTS: The median LOS for neonates with infections was twice as high as for neonates without infection. LOS was significantly affected by the overall general condition of the neonate, as expressed by both gestational age and birth weight as well as by the Clinical Risk Index for Babies (CRIB) score; another independent factor was presence of at least one infection. Risk of in-hospital mortality was significantly increased by male sex and vaginal birth and was lower among breastfed neonates. Deaths were significantly more frequent in neonates without infection. CONCLUSIONS: The general condition of VLBW infants statistically increase both their risk of mortality and LOS; this is in contrast to the presence of infection, which significantly prolonged LOS only.

Possible counter effect in newborns of 1936A>G (I646V) polymorphism in the AKAP10 gene encoding A-kinase-anchoring protein 10.

OBJECTIVE: Cyclic adenosine monophosphate/protein kinase A (PKA) is important in embryonic development. The human AKAP10 gene is polymorphic: 1936A>G results in changes to a PKA-binding domain and increased targeting to mitochondria. Previous studies found G1936 as 'deleterious' in adults, and this study investigates whether this holds true in preterm birth. STUDY DESIGN: Study group consisted of 80 preterm newborns (PTNs) born before the 38th gestation week. Control group consisted of 123 full-term healthy newborns born after the 37th gestation week with uncomplicated pregnancies. Genomic DNA was extracted from umbilical blood and AKAP10 genotypes were identified by PCR/restriction enzyme. RESULT: Significant differences in frequencies of 1936A>G genotypes/alleles between both groups were found. PTNs had increased frequency (55%) of AA homozygotes (odds ratio, AA versus AG+GG: 2.63 (95% confidence interval: 1.33 to 5.20), P=0.006) after adjustments: mothers with previous PTNs, smoking, first pregnancy, first delivery and Cesarean section. CONCLUSION: Results suggest G1936 is preventative factor against preterm birth, in contrast with previously asserted negative effects in adults.

Concentrations of procalcitonin and C-reactive protein, white blood cell count, and the immature-to-total neutrophil ratio in the blood of neonates with nosocomial infections: Gram-negative bacilli vs coagulase-negative staphylococci.

This study was undertaken to determine whether concentrations of procalcitonin in the blood of neonates with nosocomial infections depend on the type of pathogen. Qualification for the study group was based on the clinical signs of infection. We found that infections with Gram-positive (chiefly coagulase-negative staphylococci) and Gram-negative bacteria are accompanied by elevated concentrations of procalcitonin. In the case of Gram-positive bacteria, other laboratory signs of infection studied by us (concentration of C-reactive protein, white blood cell count, immature-to-total neutrophil ratio) were not discriminatory, confirming the diagnostic usefulness of procalcitonin measurements in nosocomial infections of the neonate with Gram-negative or Gram-positive bacteria.

Clinical forms of infections in neonates hospitalized in clinic of obstetrics and perinatology within the space of one year.

Because of their specificity, infections in neonatal units form one of the main clinical problems. Our research involved all neonates (1019) hospitalized in Clinic of Obstetrics and Perinatology within the space of one year. Clinically manifested infections were diagnosed in the total number of 47 (4.6%) newborns, including 23 (2.4%) neonates from the neonatal unit (NU) and 24 (46.2%)--from the Neonatal Intensive Care Unit (NICU). In both units, the most commonly observed were general infections (59.6%) and pneumonias (21.3%); cerebrospinal meningitis and necrotic enteritis were diagnosed in a few cases. Urinary system infections were only found in neonates hospitalized in the NU (30.5%). The course of infection was mild in most cases.

Clinical and microbiological characteristics of hospital infections in the neonatal intensive care unit.

Neonates hospitalized in intensive care units, are exposed to a higher risk of infectious complications. The research involved 52 neonates hospitalized in the Neonatal Intensive Care Unit (NICU), Chair and Clinic of Obstetrics and Perinatology over a span of one year. The incidence of hospital infections as well as etiological factors were analyzed. Clinically manifested hospital infections were diagnosed in 38.5% of babies with very low or extremely low birth weight, in boys twice as often as in girls. Generalised invasive infections prevailed; in most cases they were caused by Gram-negative rods, mainly Klebsiella spp.

[Postgraduate training for doctors between the wars in Poland, 1918-1939]. / Doksztalcanie podyplomowe lekarzy w Polsce w okresie miedzywojennym (1918-1939).

In the years between the Two World Wars in Poland, there have been made some meaningful changes in the approach towards the postgraduate education of the physicians. The widespread conviction about the need of widening the practical knowledge, was replaced in 1930 by a law, which made a year-long hospital practice obligatory for doctors who have accomplished their medical studies. The completion of this obligatory training was the condition of starting an independent professional practice. The aim of this complementary education, which comprised the basic branches of medicine, and which were conducted under the eyes of experienced doctors, was the complement of the theoretical academic knowledge by practical skills. The introduction of a law, which made a one-year-long postgraduate hospital practice obligatory, is undoubtedly one of the important achievements of the period between the Two World Wars, in the realisation of the idea of modern and complete education of the physicians in Poland.

[A case report of rubella embryopathy in pregnancy complicated by placental insufficiency]. / Opis przypadku embriopatii rózyczkowej powiklanej przewlekla niewydolnoscia lozyska.

This is a case report of sever rubella empryopathy confirmed by IgM and IgG titers estimation in newborn blood. This pregnancy was complicated by prolonged placenta insufficiency (oligohyramnions and IUGR). The cesarian section was done in 35 weeks of pregnancy. The newborn died in 9 days after delivery. Cause of death was sepsis, vitium cordis congenitum and respiratory insufficiency.

[The beginnings of postgraduate studies of doctors on the Polish territories at the time of partitions]. / Poczatki podyplomowego doksztalcania lekarzy na ziemiach polskich w okresie zaborów.

On the basis of the periodical press from the turn of the nineteenth and the twentieth centuries the author presented different forms of postgraduate studies of doctors on the Polish territories. The first summer university courses took place in 1902. She also described the organisation of the national and foreign hospital trainings as well as the role of scientific associations and organized since 1869 congresses of doctors and naturalists.

[About the medical advertising]. / O reklamie lekarskiej w Polsce.

The article is the part of the author's doctor thesis. She has presented in historical bearing the evolution of opinions started from the advertising of commercial character: the advertising of medicine produced by a physician, his special abilities etc. to the regulated by strict guidelines issued by the chambers of physicians = informations, necessary for the patients. Presenting in detail the rules binding in this range the author quite sceptically is treating their real observation in past.