Szczepy Enterobacteriaceae o obniżonej wrażliwości na karbapenemy

The aim of the study was to estimate the prevalence of Enterobacteriaceae with reduced susceptibility to carbapenems. Forty-five strains of Enterobacteriaceae with reduced susceptibility to carbapenems were investigated. The strains were cultured from patients treated at the Dr Antoni Jurasz University Hospital no.1 in Bydgoszcz. Identification of the strains was carried out based on the results of biochemical reactions performed in identification cards GN (bioMérieux). Susceptibility testing to carbapenems and determining Minimal Inhibitory Concentration (MIC) was carried out using E - test (bioMérieux) (for ertapenem and imipenem), and agar dilution method for meropenem. The analysed strains were isolated from: urine – 13 strains (28.9%), blood and bronchoalveolar lavage - six strains from each (13.3% ), 5 – wound swabs (11.2%) and other clinical materials – 15 (33.3%). 53.3% of the strains were identified as Klebsiella pneumoniae. 93.4% of the isolates were susceptible to meropenem. Only 4.5% of the analysed strains were susceptible to ertapenem. None of the analyzed strains produced carbapenemases.Celem pracy była ocena występowania szczepów z rodziny Enterobacteriaceae o obniżonej wrażliwości na karbapenemy. Badaniem objęto czterdzieści pięć szczepów z rodziny Enterobacteriaceae o obniżonej wrażliwości na karbapenemy. Badane szczepy zostały wyizolowane od pacjentów leczonych w Szpitalu Uniwersyteckim nr 1 im. dr. Antoniego Jurasza w Bydgoszczy. Drobnoustroje zidentyfikowano na podstawie reakcji biochemicznych z wykorzystaniem kart identyfikacyjnych GN (bioMérieux). Określenie wrażliwości na karbapenemy oraz najmniejszego stężenia hamującego (MIC – Minimal Inhibitory Concen-tration) przeprowadzono metodą E-testu (bioMérieux) (ertapenem i imipenem) oraz metodą rozdzieńczeń w podłożu stałym (meropenem). Analizowane szczepy wyizolowane zostały odpowiednio z: moczu – 13 szczepów (28,9%), krwi i popłuczyn oskrzelowo-pęcherzykowych – odpowiednio po 6 (13,3% ), 5 – wymazu z ran (11,2%) oraz z innych materiałów biologicznych – 15 (33,3%). Ponad połowę badanych 53,3% szczepów zidentyfikowano jak Klebsiella pneumoniae. 93,4% badanych szczepów było wrażliwych na meropenem. Jedynie 4,5% szczepów było wrażliwych na ertapenem. Żaden z analizowanych szczepów nie produkował karbapenemaz.

In Vitro Activity of “Old” and “New” Antimicrobials against the <i>Klebsiella pneumoniae</i> Complex

The Klebsiella pneumoniae complex is a commonly isolated bacteria in human infections. These opportunistic pathogens pose a serious threat to public health due to their potential transmission to the human population. Resistance to carbapenems is a significant antimicrobial resistance mechanism, leading to limited therapeutic options. Therefore, the aim of this study was to evaluate the in vitro activity of fosfomycin, colistin, ceftazidime–avibactam, and meropenem–vaborbactam against multidrug-resistant K. pneumoniae complex strains. This study involved 160 strains of Gram-negative rods, comprising 138 K. pneumoniae and 22 K. variicola. The minimal inhibitory concentration of fosfomycin was estimated using the agar dilution method, and for colistin, the microdilution method was employed. Susceptibility to ceftazidime–avibactam and meropenem–vaborbactam was determined using the gradient strip method. All analyzed K. pneumoniae complex isolates produced extended-spectrum β-lactamases, and 60.0% exhibited carbapenemases. The majority of the analyzed strains were susceptible to fosfomycin and colistin (62.5%). Among pandrug-resistant K. pneumoniae complex isolates, the highest susceptibility was observed with colistin (43.9%). Fosfomycin demonstrated good activity against ESβLs- and VIM-positive isolates from this complex. Colistin also exhibited satisfactory in vitro activity against VIM- and KPC-positive isolates from the K. pneumoniae complex. Ceftazidime–avibactam displayed good activity against K. pneumoniae complex strains producing ESβLs, KPC, and OXA enzymes. Additionally, meropenem–vaborbactam showed satisfactory in vitro activity against ESβLs- and KPC-positive isolates from this complex

The Evaluation of Eazyplex&reg; SuperBug CRE Assay Usefulness for the Detection of ESBLs and Carbapenemases Genes Directly from Urine Samples and Positive Blood Cultures

Increasing antimicrobial resistance of Gram-negative rods is an important diagnostic, clinical and epidemiological problem of modern medicine. Therefore, it is important to detect multi-drug resistant strains as early on as possible. This study aimed to evaluate Eazyplex&reg; SuperBug CRE assay usefulness for beta-lactamase gene detection among Gram-negative rods, directly from urine samples and positive blood cultures. The Eazyplex&reg; SuperBug CRE assay is based on a loop-mediated isothermal amplification of genetic material and allows for the detection of a selection of genes encoding carbapenemases, KPC, NDM, VIM, OXA-48, OXA-181 and extended-spectrum beta-lactamases from the CTX-M-1 and CTX-M-9 groups. A total of 120 clinical specimens were included in the study. The test gave valid results for 58 (96.7%) urine samples and 57 (95.0%) positive blood cultures. ESBL and/or carbapenemase enzymes genes were detected in 56 (93.3%) urine and 55 (91.7%) blood samples, respectively. The Eazyplex&reg; SuperBug CRE assay can be used for a rapid detection of the genes encoding the most important resistance mechanisms to beta-lactams in Gram-negative rods also without the necessity of bacterial culture

Increasing the effectiveness of health care by paying for results - specifics, examples and conditions for effective application

W artykule dokonano przeglądu najnowszej literatury zagranicznej (głównie amerykańskiej), przedstawiającej koncepcje oraz sposób wdrożenia systemów wynagradzania za wyniki (P4P) i kupowania w oparciu o wartość (V-BP) w opiece zdrowotnej. Ich celem jest wzrost efektywności, rozumianej jako udzielanie wysokiej jakości świadczeń zdrowotnych po uzasadnionym koszcie. Do podstawowych warunków ich zastosowania autorki zaliczyły opracowanie standardów medycznych oraz funkcjonowanie systemów informatycznych, rejestrujących wykonane procedury i osiągnięte efekty zdrowotne. Przedstawione doświadczenia zagraniczne pokazują, że sukces systemów typu P4P i V-BP zależy od dobrania właściwych kryteriów oceny (m.in. działania o udowodnionej skuteczności klinicznej, zależne od świadczeniodawców, różnorodne), a także od odpowiedniego powiązania wynagradzania z poziomem i dynamiką wartości tych kryteriów u usługodawców. Specyfika opieki zdrowotnej wymaga zatem ścisłej współpracy specjalistów ds. zarządzania z profesjonalistami medycznymi zarówno na etapie konstrukcji systemów, jak i wdrażania oraz zmian.A review of the recent literature (mainly American) on the concept and implementation of pay-for-performance (P4P) and value-based purchasing (V-BP) systems in health care has been elaborated in the article. The aim of these systems is to increase effectiveness - provision of high quality health care services at a reasonable cost. Development of medical standards and information systems, recording medical procedures and achieved health effects are among the basic conditions for implementation of P4P or V-BP like systems. The experience from abroad shows that the success of these systems depends on a proper selection of assessment criteria (evidencebased actions, fully controlled by providers, various) as well as a proper relationship between payments and the level and dynamics of the providers' implementation of the criteria. Therefore, health care requires a tight collaboration between management specialists and medical professionals at the construction stage as well as during the implementation and changes of the systems

The prevalence of infections and colonisation with Klebsiella pneumoniae strains isolated in ICU patients

Background: Klebsiella spp. are among the bacteria most commonly isolated from patients with infections in ICUs. The source of these infections may be the microflora of the patient or the hospital environment. Increasingly, Klebsiella strains are also being isolated from epidemic outbreaks. This situation is largely the result of widespread, irrational antibiotic use, the virulence of the bacterial strains and their ability to survive in the hospital environment. The purpose of this dissertation was to estimate the prevalence of Klebsiella pneumoniae strains isolated from patients hospitalised in a single ICU.Methods: Seventy-eight isolates of K. pneumoniae were studied. The identification and the susceptibility to selected antibiotics were tested by an automated system, VITEK2 Compact. For the analysed strains, the production of different beta-lactamases was noted.Results: Production of ESBL was detected in 64.1% of the K. pneumoniae strains isolated from infections and 74.4% from rectal swabs. Most of the strains were susceptible to imipenem (97.7%) and meropenem (96.1%). Sixty-nine (57.0%) of the analysed strains were identified as multidrug resistant.Conclusion: Most of the analysed Klebsiella pneumoniae strains produced ESBL-beta-lactamases. The frequency of colonisation and infection with multidrug resistant strains of K. pneumoniae in patients hospitalised in the ICU is very high.Background: Klebsiella spp. are among the bacteria most commonly isolated from patients with infections in ICUs. The source of these infections may be the microflora of the patient or the hospital environment. Increasingly, Klebsiella strains are also being isolated from epidemic outbreaks. This situation is largely the result of widespread, irrational antibiotic use, the virulence of the bacterial strains and their ability to survive in the hospital environment. The purpose of this dissertation was to estimate the prevalence of Klebsiella pneumoniae strains isolated from patients hospitalised in a single ICU.Methods: Seventy-eight isolates of K. pneumoniae were studied. The identification and the susceptibility to selected antibiotics were tested by an automated system, VITEK2 Compact. For the analysed strains, the production of different beta-lactamases was noted.Results: Production of ESBL was detected in 64.1% of the K. pneumoniae strains isolated from infections and 74.4% from rectal swabs. Most of the strains were susceptible to imipenem (97.7%) and meropenem (96.1%). Sixty-nine (57.0%) of the analysed strains were identified as multidrug resistant.Conclusion: Most of the analysed Klebsiella pneumoniae strains produced ESBL-beta-lactamases. The frequency of colonisation and infection with multidrug resistant strains of K. pneumoniae in patients hospitalised in the ICU is very high

A New 4-Thiazolidinone Derivative (Les-6490) as a Gut Microbiota Modulator: Antimicrobial and Prebiotic Perspectives

A novel 4-thiazolidinone derivative Les-6490 (pyrazol-4-thiazolidinone hybrid) was designed, synthesized, and characterized by spectral data. The compound was screened for its antimicrobial activity against some pathogenic bacteria and fungi and showed activity against Staphylococcus and Saccharomyces cerevisiae (the Minimum Inhibitory Concentration (MIC) 820 μM). The compound was studied in the rat adjuvant arthritis model (Freund’s Adjuvant) in vivo. Parietal and fecal microbial composition using 16S rRNA metagenome sequences was checked. We employed a range of analytical techniques, including Taxonomic Profiling (Taxa Analysis), Diversity Metrics (Alpha and Beta Diversity Analysis), Multivariate Statistical Methods (Principal Coordinates Analysis, Principal Component Analysis, Non-Metric Multidimensional Scaling), Clustering Analysis (Unweighted Pair-group Method with Arithmetic Mean), and Comparative Statistical Approaches (Community Differences Analysis, Between Group Variation Analysis, Metastat Analysis). The compound significantly impacted an increasing level of anti-inflammatory microorganisms (Blautia, Faecalibacterium prausnitzii, Succivibrionaceae, and Coriobacteriales) relative recovery of fecal microbiota composition. Anti-Treponemal activity in vivo was also noted. The tested compound Les-6490 has potential prebiotic activity with an indirect anti-inflammatory effect

Applications of Silk Fibroin in Human and Veterinary Medicine

The properties of silk make it a promising material for medical applications, both in human and veterinary medicine. Its predominant amino acids, glycine and alanine, exhibit low chemical reactivity, reducing the risk of graft rejection, a notable advantage over most synthetic polymers. Hence, silk is increasingly used as a material for 3D printing in biomedicine. It can be used to build cell scaffolding with the desired cytocompatibility and biodegradability. In combination with gelatine, silk can be used in the treatment of arthritis, and as a hydrogel, to regenerate chondrocytes and mesenchymal cells. When combined with gelatine and collagen, it can also make skin grafts and regenerate the integumentary system. In the treatment of bone tissue, it can be used in combination with polylactic acid and hydroxyapatite to produce bone clips having good mechanical properties and high immunological tolerance. Furthermore, silk can provide a good microenvironment for the proliferation of bone marrow stem cells. Moreover, research is underway to produce artificial blood vessels using silk in combination with glycidyl methacrylate. Silk vascular grafts have demonstrated a high degree of patency and a satisfactory degree of endothelial cells coverage