Usporedba osobitosti bakterijskih izolata iz hemokultura Županijske bolnice čakovec i Splošne bolnišnice Murska Sobota u petogodišnjem razdoblju

Za odgovarajuće liječenje sepse, iznimno značajnog kliničkog entiteta u kojem treba pravovremeno djelovati odgovarajućom antibiotskom terapijom potrebno je poznavati i najčešće uzročnike. Ovaj rad imao je za   cilj retrospektivnom analizom utvrditi najčešće bakterijske izolate iz uzoraka krvi kod bolesnika sa sumnjom na sepsu i njihovu osjetljivost na antibiotike u dvije bolnice, Županijskoj bolnici čakovec i Splošnoj bolnišnici Murska Sobota u dvije susjedne države Republika Hrvatska i Republika Slovenija. Period praćenja uključivao je razdoblje od 2005. do 2009. godine. Za obradu hemokultura, kod sumnje na bakterijemiju, obje bolnice koriste komercijalne uređaje za hemokulture i odgovarajuće tekuće hranjive podloge ( čakovec: Bact Alert, bio Merieux; Murska Sobota: Bactec 9120, Becton Dickinson). Osjetljivost na antibiotike izoliranih bakterija određivana je disk difuzijskom metodom u skladu s američkim Clinical and Laboratory Standards Institute (CLSI) standardima u oba laboratorija. U radu je prikazana osjetljivost na antibiotike bakterijskih izolata koji su uključeni u praćenje osjetljivosti kroz europski projekt European Antimicrobial Resistance Surveillance System (EARSS) (E. coli; S. aureus; K. pneumoniae; S. pneumoniae; P. aeruginosa; E. faecalis; E. faecium). Broj pozitivnih bočica (HK) po bolesniku iznosio je   u   Splošnoj bolnišnici Murska Sobota   9%, a u Županijskoj bolnici čakovec 10,2% . Vodeća tri mjesta među izolatima iz hemokultura u obje bolnice zauzimaju istim redosljedom   E. coli; S. aureus i K. pneumoniae. Udio ESBL sojeva među izolatima E. coli u Murskoj Soboti iznosi 5,5%, dok je njihov udio u čakovcu niži i čini 2,8%   Kod   kinolona se uočava najznačajniji trend smanjenja osjetljivosti E. coli u čakovcu (od 97% do 80%), što nije slučaj i u Murskoj Soboti. U obje sredine nema zabilježenih sojeva rezistentnih na imipenem. Značajna razlika postoji u udjelu MRSA izolata, odnosno značajno veća zastupljenost (13%) u ŽB čakovec u odnosu na Splošnu bolnišnicu Murska Sobota ( 4%.). U istom vremenskom razdoblju u obje bolnice izoliran je jednak broj izolata K. pneumoniae, s vrlo sličnim rezistogramom. ESBL sojeva ( «extended spectrum beta-lactamases ») u čakovcu ima 8%, a u Murskoj Soboti 10%. Rezistencija na karbapeneme nije zabilježena. Najznačajnija razlika u ispitivanju osjetljivosti P. aeruginosa u dvije susjedne bolnice je pojava rezistentnih sojeva na karbapeneme u čakovcu (15%), što nije zabilježeno i u Murskoj Soboti (0%). U obje ustanove, enterokoki su rijetki izolati iz hemokultura. Među izolatima enterokoka dominira E. faecalis vrsta. Niti u čakovcu, niti u Murskoj Soboti nisu zabilježeni sojevi S. pneumoniae smanjene osjetljivosti na prnicilin izolirani iz hemokultura. U Murskoj Soboti penicilin ne može biti lijek izbora za empirijsku terapiju infekcija središnjeg živčanog sustava zbog   rezistencije na penicilin koja iznosi 20,5%, a u skladu s interpretativnim kriterijima za izolate pneumokoka iz središnjeg živčanoog sustava. U svakoj sredini je neophodno dobro poznavati očekivane patogene i pratiti njihovu osjetljivost na antibiotike, kako bi se na tome zasnivala dobra empirijska terapija. Ova retrospektivna analiza   pružila je jasan   uvid u kretanje najčešćih bakterijskih izolaza iz hemokultura te ukazala na brojne sličnosti, ali i značajne razlike u osjetljivosti bakterijskih izolata koji su zastupljeni u uzorcima kvi bolesnika sa slikom sepse u dvije regije

GROUP B AND G BETA-HEMOLYTIC STREPTOCOCCI IN POMURJE REGION – CHARACTERISTICS OF ANTIMICROBIAL RESISTANT ISOLATES

Background. Macrolide-resistant strains of betahemolytic streptococci have been isolated in Pomurje region in Slovenia. The aim of the study was to determine phenotypes of macrolide-lincozamide resistance and patterns of resistance to selected antibiotics in these isolates.Methods. Twenty-one erythromycin-resistant isolates from group B and group G beta-hemolytic streptococci, obtained from patients in Pomurje were analyzed. Phenotypes of macrolide-lincozamide resistance were determined in all isolates. In group B and group G streptococci susceptibility to 8 and 14 antibiotics was tested, respectively.Results. All 42 isolates were susceptible to penicillin and vancomycin. The majority of erythromycin-resistant group B streptococci isolates was tetracycline-resistant but susceptible to chloramphenicol and ofloxacin. In erythromycin-resistant isolates of group G streptococci 5 different resistance patterns were found. The most frequent pattern was a resistance to multiple antibiotics (besides erythromycin also to midekamycin, clindamycin, tetracycline, chloramphenicol and several fluoroquinolones).Conclusions. These resistant isolates are unique and represent novel example of a strong bacterial ability to adapt to changes in their environment and consequently survive in the presence of antibiotics.</p

A Balanced Mixture of Antagonistic Pressures Promotes the Evolution of Parallel Movement

A common hypothesis about the origins of collective behaviour suggests that animals might live and move in groups to increase their chances of surviving predator attacks. This hypothesis is supported by several studies that use computational models to simulate natural evolution. These studies, however, either tune an ad-hoc model to ‘reproduce’ collective behaviour, or concentrate on a single type of predation pressure, or infer the emergence of collective behaviour from an increase in prey density. In nature, prey are often targeted by multiple predator species simultaneously and this might have played a pivotal role in the evolution of collective behaviour. We expand on previous research by using an evolutionary rule-based system to simulate the evolution of prey behaviour when prey are subject to multiple simultaneous predation pressures. We analyse the evolved behaviour via prey density, polarization, and angular momentum. Our results suggest that a mixture of antagonistic external pressures that simultaneously steer prey towards grouping and dispersing might be required for prey individuals to evolve dynamic parallel movement

HUMAN CALICIVIRUS OUTBREAK OF ACUTE GASTROENTERITIS IN AN AGED-CARE FACILITY

Background. Human caliciviruses represent a genetically and antigenetically diverse group of single-stranded RNA viruses associated with acute gastroenteritis in humans. In last two years the number of notified gastroenteric cases in Slovenia is increasing. From January till November 2002 already 574 calicivirus cases have been confirmed. Majority of cases were observed in preschool and school children but no cases were described in the aged-care facility.Methods. An outbreak of gastroenteritis in an aged-care facility occured. After onset of the outbreak an epidemiological questionnaire and inspection of local conditions were realized. Stool samples from home residents were analysed to find out bacteriological and/or viral aetiology. Direct electron microscopy and RT-PCR assay was performed to detect caliciviruses. Viral RNA was amplified using specific primers and PCR products were identified in hybridisation test.Results. The outbreak started suddenly on the second floor, where the attack rate was the highest. On the other floors the illness started later and the attack rate was lower. Sixty-one (40,1%) residents from 152 became ill and additionally 15 (22,4%) employees from 67. The outbreak ended after ten days. Electron microscopy or/and RT-PCR revealed Norovirus members of family Caliciviridae in 9 of 10 stool specimens. As determined by RT-PCR and hybridisation assay viruses corresponded to genogroup II, genetic cluster 1 (closely related to the Hawaii virus) and genetic cluster 4 (closely related to the Lordsdale virus).Conclusions. Presented data support a significant role for caliciviruses as causative agents of gastroenteritis in elderly persons in Slovenia.</p

Diversity of C. difficile PCR ribotypes isolated from hospitalised patients in Slovenia during two-winter-month period

Izhodišča: Clostridium difficile je trenutno v svetu med najpomembnejšimi povzročitelji bolnišničnih črevesnih okužb. Seve lahko nadalje razlikujemo z ribotipizacijo. Nekateri ribotipi (npr. 027) so v številnih evropskih državah povezani z obširnimi izbruhi, povišano obolevnostjo in povišano smrtnostjo. V tem prispevku opisujemo razširjenost različnih ribotipov na območju celotne Slovenije. Metode: Seve bakterije C. difficile, ki so jih osamili v vseh osmih laboratorijih, kjer v Sloveniji diagnosticirajo bakterijo C. difficile, smo ribotpizirali. Prav tako smo zbrali podatke o skupnem številu opravljenih preiskav na C. difficile ter demografske podatke (starost in spol bolnikov). Rezultati: V dvomesečnem zimskem obdobju je bilo v Sloveniji testiranih skupaj 860 vzorcev, od teh je bilo pozitivnih 154 (17,9 %) vzorcev pri 125 bolnikih. Odstotek pozitivnih vzorcev v posameznem laboratoriju se je gibal od 13,3 do 43,2 %. Dva od osmih laboratorijev (oba iz primorsko-obalne regije) v času študije nista imela pozitivnih vzorcev. Tipiziranih je bilo 149 sevov. Uvrstili smo jih v 35 ribotipov, vendar je bilo več kot polovica sevov (57,7 %) v samo dveh ribotipih, 027 in 014/020. Ribotip 027 v Sloveniji do leta 2010 ni bil zaznan, v tej študiji je bil najpogostejši ribotip, prevladoval pa je v severovzhodni regiji. Zaključki: Raznolikost sevov C. difficile v Sloveniji je velika. Prevladovanje ribotipa 027 in visok odstotek pozitivnih vzorcev v nekaterih regijah kažejo na možnost izbruhov okužbe.Background: Clostridium difficile is an important cause of nosocomial diarrhoea. Strains arefurther differentiated into PCR ribotypes, andsome ribotypes (e.g. 027) are often associated with outbreaks, increased disease severity and increased mortality. Here we describe the diversity of C. difficile among human isolates in Slovenia. Methods: All eight microbiological diagnostic laboratories providing C. difficile diagnostics in Slovenia have participated. Isolates from two month- winter period were collected and ribotyped.The following data were also collected from the laboratories: number of all tested samples, number of all positive samples, and patient age and gender. Results: In a two-month period, altogether 860 samples were tested for C. difficile in all participating laboratories. Of those, 154 (17.9 %) samples from 125 patients were positive. The percentage of positive samples in different laboratories ranged from 13.3 to 43.2%. Two out of eight laboratoriesdid not have positive samples. C. difficile strains(n= 149) were grouped into 35 ribotypes. However, 57.7% of all strains belonged only to two PC Rribotypes (027 and 014/020). PCR ribotype 027 was not present in Slovenia until 2010, but was in this study the most prevalent PCR ribotype and present mainly in the northeast region. Conclusions: There is a substantial diversity of C. difficile ribotypes in Slovenia. A high prevalence of ribotype 027 and a high percentage of positive samples in some laboratories indicate the presence of C. difficile outbreaks

Genetska opredelitev za meticilin občutljivih in proti meticilinu odpornih sevov Staphylococcus aureus, izoliranih iz hemokultur v slovenskih bolnišnicah, s tipizacijo SPA

Staphylococcus aureus je drugi najpogostejši bakterijski povzročitelj invazivnih okužb v Sloveniji. S tipizacijo izolatov za meticilin občutljivih S. aureus (MSSA) in proti meticilinu odpornih S. aureus (MRSA) iz hemokultur bolnikov z bakteriemijo iz vse Slovenije v 6- mesečnem obdobju smo poskušali ugotoviti, katerim spa tipom pripadajo invazivni izolati MSSA in MRSA v Sloveniji, kakšna je genetska raznolikost MSSA in MRSA ter preveriti uporabnost tipizacije spa za epidemiološke raziskave S. aureus v Sloveniji. Od 1. septembra 2006 do 28. februarja 2007 smo v 11 slovenskih laboratorijih, ki izvajajo mikrobiološko diagnostiko za 15 bolnišnic, zbirali zaporedno izolirane primoizolate MSSA (največ pet) in zaporedno izolirane primoizolate MRSA (največ pet) iz hemokultur bolnikov. Izolate S. aureus smo tipizirali s tipizacijo spa, to je z določanjem nukleotidnega zaporedja polimorfnega X dela gena spa, ki kodira protein A. Od 58 zbranih izolatov S. aureus iz vse Slovenije smo uspeli tipizirati 54 izolatov. Prevladujoči spa tipi med izolatiMSSA so bili t091, t015 in t005, med izolati MRSA pa t041. Ugotovili smo, da spa tipi, ki prevladujejo med invazivnimi izolati S. aureus pri nas, prevladujejo tudi v sosednjih državah. Tipizacija S. aureus z metodo spa je pokazala veliko genetsko raznolikost invazivnih sevov MSSA in manjšo raznolikost invazivnih sevov MRSA. Tipizacija spa je uporabna tipizacijska metoda za lokalno epidemiologijo MSSA v kratkem in daljšem časovnem obdobju.Staphylococcus aureus is the second leading cause of invasive bacterial infections in Slovenia. The aims of this 6-month study were to identify the most prevalent spa types among invasive isolates of methicillin-susceptible S.aureus (MSSA) and methicillin-resistant S. aureus (MRSA) in Slovene hospitals, to determine genetic diversity of MSSA and MRSA, and to test the applicability of spa typing to epidemiological studies of S. aureus in Slovenia. Over a period of six months(1 September 2006 - 28 February 2007), upto five successive methicillin-susceptible (MSSA) blood culture isolates anda maximum of five successive methicillin- resistant (MRSA) blood culture isolates per hospital were obtained from different patients with bacteremia. The isolates were characterized by spa typing based on sequencing of polymorphic region X of the S. aureus protein A gene. Among the 58 isolates collected 54 were succesfully spa typed. The predominant spa types among MSSA isolates were t091, t015, t005, and among MRSA, t041 . The predominant spa types among invasive S. aureus strains isolated in Slovenia predominated also in the neighbouring countries. The study showed high genetic diversity of invasive MSSA isolates and lower genetic diversity of invasive MRSA isolates in Slovenia. Spa typing is a good typing method for short- and long-term epidemiological studies of MSSA on a local scale

Selective reporting of antibiotic susceptibility test results in European countries: an ESCMID cross-sectional survey

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