Analysis of Human Milk Composition After Preterm Delivery With and Without Fortification.

Human milk is often assumed to have a consistent composition, and when fortification is needed, fortifiers are added at fixed doses. However, if the milk contains less than the assumed quantities of nutrients, then the infant drinking that milk may receive inadequate nutrition. In this study, we compared changes in the concentrations of the main constituents of human breast milk before and after fortification. We tested the hypothesis that the protein concentration would increase less than that of other nutrients. Thirty breast milk samples were obtained from mothers of preterm infants (gestational age 28-36 weeks; birthweight 900-2,470 g). The concentrations of fat, carbohydrates, dry matter, protein and energy in the breast milk samples were analyzed and compared with the concentrations of these nutrients in the same samples of milk fortified with a standard amount of HMF FM 85. Dry matter and energy content increased the most after fortification. Although protein also increased, the magnitude of this increase was small relative to the increases in the other components. Lipid concentrations did not significantly change with fortification. Protein is needed for adequate growth in premature infants; however, fortification of breast milk from the mothers of preterm infants resulted in only a small increase in this essential nutrient. Based on these results, we conclude that fortification of human milk must be individually adjusted based on continuous analysis of breast milk composition. Customized fortification would provide more optimal nutrition to preterm infants to support better growth and development.

Antibiotic consumption and its influence on the resistance in Enterobacteriaceae.

BACKGROUND: Increasing bacterial resistance to antibiotics is one of the most serious problems in current medicine. An important factor contributing to the growing prevalence of multiresistant bacteria is application of antibiotics. This study aimed at analyzing the development of resistance of Enterobacteriaceae to selected beta-lactam, fluoroquinolone and aminoglycoside antibiotics in the University Hospital Olomouc and assessing the effect of selection pressure of these antibiotics. METHODS: For the period between 1 January 2000 and 31 December 2011, resistance of Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae and Proteus mirabilis to third- and fourth-generation cephalosporins, meropenem, piperacillin/tazobactam, fluoroquinolones and aminoglycosides was retrospectively studied. For the assessment of selection pressure of antibiotics, a parameter of defined daily dose in absolute annual consumption (DDDatb) based on the ATC/DDD classification and in relative annual consumption (RDDDatb) as the number of defined daily doses per 100 bed-days was used. The relationship between frequency of strains resistant to a particular antibiotic and antibiotic consumption was assessed by linear regression analysis using Spearman's correlation. The level of statistical significance was set at p < 0.05. RESULTS: A total of 113,027 isolates from the Enterobacteriaceae family were analyzed. There was a significant effect of selection pressure of the primary antibiotic in the following cases: piperacillin/tazobactam in Klebsiella pneumoniae, gentamicin in Klebsiella pneumoniae and Escherichia coli and amikacin in Escherichia coli and Enterobacter cloacae. Also, there was significant correlation between resistance to ceftazidime and consumption of piperacillin/tazobactam in Klebsiella pneumoniae and Escherichia coli. No relationship was found between consumption of third- and fourth-generation cephalosporins and resistance to ceftazidime or between fluoroquinolone consumption and resistance to ciprofloxacin. CONCLUSION: The study showed the effects of both direct and indirect selection pressure on increasing resistance to gentamicin, amikacin, piperacillin/tazobactam and ceftazidime. Given the fact that no correlation was found between resistance to fluoroquinolones and consumption of either primary or secondary antibiotics, we assume that the increasing resistance to fluoroquinolones is probably due to circulation of resistance genes in the bacterial population and that this resistance was not affected by reduced use of these antibiotics.

[Effect of colistin consumption and prevalence of colistin-resistant bacteria]. / Vliv spotreby kolistinu na vyskyt kolistin-rezistentnich bakterii.

OBJECTIVE: Recently, there has been a renaissance of the use of the antibiotic colistin resulting from increasing resistance of bacterial pathogens, particularly in intensive care patients. The study aimed at assessing the impact of colistin consumption on the prevalence of colistin-resistant bacteria in the University Hospital Olomouc (UHO). METHODS: A laboratory database was retrospectively searched to identify all clinically significant colistin-resistant bacterial strains isolated between 2007 and 2011. These data were compared with colistin consumption over the same period and the results were statistically processed. RESULTS: Over the study period, a total of 6 338 clinically significant colistin-resistant strains were detected in the UHO (Acinetobacter spp., Burkholderia cepacia complex, Citrobacter spp., Enterobacter spp., Escherichia coli, Klebsiella spp., Morganella morganii, Proteus spp., Providencia spp., Pseudomonas spp., Serratia marcesces and Stenotrophomonas maltophilia). Over the same period, the consumption of colistin increased nearly 10-fold. With the increasing colistin consumption, the numbers of colistin-resistant strains of Pseudomonas aeruginosa and Acinetobacter spp. decreased over that period of time. By contrast, there was an increase in the rates of naturally Burkholderia cepacia complex strains naturally resistant to colistin. An alarming finding is that the prevalence of colistin-resistant strains of Klebsiella pneumoniae increased in the last years of the study period, especially in intensive care patients. CONCLUSIONS: In the UHO, higher consumption of colistin was accompanied by increased numbers of colistin-resistant strains. There was a marked increase of Burkholderia cepacia complex strains and, recently, a statistically insignificant but alarming increase in colistin-resistant Klebsiella pneumoniae strains.

Antibiotic utilization and Pseudomonas aeruginosa resistance in intensive care units.

Pseudomonas aeruginosa is one of the most frequent and dangerous pathogens involved in the etiology of severe nosocomial infections. A retrospective observational study was conducted at all intensive care units of the University Hospital in Olomouc, Czech Republic (155 ICU beds). Complete antibiotic utilization data of the ICUs in the period of 1999 to 2008 were processed according to ATC/DDD system and expressed in defined daily doses per 100 bed-days (DBD). Utilization of meropenem, imipenem, ciprofloxacin, ofloxacin, pefloxacin, gentamicin, amikacin, ceftazidime, cefoperazone, cefoperazone/sulbactam and piperacillin/tazobactam was measured. Pseudomonas aeruginosa strains were isolated from clinical material obtained from patients hospitalized in ICUs. During the ten-year period, utilization of the entire group of antibiotics monitored grew. It increased from 23.52 DBD in 1999 to 27.48 DBD in 2008 with a peak of 33.04 DBD in 2007. P. aeruginosa accounted for as much as 42% of pneumonias and 23% of surgical wound infections. Our results show that P. aeruginosa strains became gradually resistant to all antibiotics used in the treatment of the infections caused by them, with the exception of amikacin and piperacillin/tazobactam.

[Pharmacokinetics of tetracyclines and glycylcyclines]. / Farmakokinetika tetracyklinu a glycylcyklinu.

Glycylcyclines were derived from the chemical structure of tetracyclines. After they started to be used in clinical practice, tetracycline group came into focus as a whole. First-generation tetracyclines feature low lipophilia and they are usually available in peroral form only, except rolitetracycline. Moreover, their absorption is highly variable and incomplete, ranging usually from 25 % to 60 % (absorption of tetracycline ranges from 77 % to 88 %). The majority of first-generation tetracyclines are not metabolized (though 5 % of tetracycline is metabolized to a less active metabolite). Instead, they are most often eliminated by renal excretion. Second-generation tetracyclines are 3 to 5 times more lipophilic, which enhances their tissue penetration. Doxycycline, the most common member of this group, features more than 80 % bioavailability. Bile concentration of doxycycline is 10 to 25 times higher as compared with its serum concentration. High concentrations of doxycycline are found also in kidneys, liver and bowel. Primarily, doxycycline is excreted in bile to feces. Part of doxycycline is inactivated in the liver and 40 % of it is excreted by kidneys in urine. Tigecycline is administered intravenously and it shows high tissue penetration, especially in bones, skin, liver and lungs. Less than 20 % of tigecycline is metabolized before it is excreted. Primarily, it is eliminated by biliary/fecal excretion in unchanged form. Small part of tigecycline is eliminated as metabolites. Secondary routes of elimination are glucuronidation and renal excretion.