Višestruko otporni mikroorganizmi i kirurška antibiotska profilaksa - prevalencija u KBC Sestre milosrdnice

Aim Emergence and spread of multidrug-resistant (MDR) microorganisms in healthcare settings, especially in Intensive Care Units (ICUs), cause concern worldwide. A particular problem is a lack of therapeutic options. One of the inducement factors for MDR microorganisms spread is antibiotic over- and wrong-prescribing. Surgical antibiotic prophylaxis is one of the misused antibiotic prescribing indications. The aims of our study were to determine the prevalence of five key MDR bacteria from blood and urine in order to establish surgical antibiotic prophylaxis compliance with the Croatian National Guidelines. Methods A point prevalence study was conducted. We present a laboratory-based WHO designed survey on MRSA, VRE, ESBL and CRE-producing Enterobacteriaceae, multi-resistant Acinetobacter spp., isolated from blood and urine of hospitalised patients. Surgical prophylaxis data were gathered from patients who had undergone operative procedures in the General Surgery Ward and Gynecology Ward. Results The prevalence of MRSA bloodstream infections was 1.64%, other MDR microorganisms were not isolated. The prevalence of urine MDR isolates was MRSA 0.07%, E. coli ESBL 1.43% (5.79% of overall E. coli isolates were ESBL producers), K. pneumonie 1.79% (26.3% of K. pneumoniae were ESBL producers) and Acinetobacter spp. 0.38%. The proportion of patients who continued surgical prophylaxis was 6.4%. Conclusion MDR microorganisms\u27 prevalence in our institution is low, but the proportion of resistant strains within isolated species corresponds to European reports. Surgical antibiotic prophylaxis compliance with the Croatian National Guidelines is high. Constant and recent surveillance data are a significant guide for empiric antimicrobial therapy, an indicator for activities concerning the prevention of MDR microorganisms spread and proper antibiotic stewardship.Cilj Pojava i širenje višestruko otpornih mikroorganizama (MDR) u okruženju zdravstvene njege, posebice u jedinicama za intenzivno liječenje, uzrokuju zabrinutost diljem svijeta. Poseban problem je nedostatak terapeutskih mogućnosti. Jedan od uzročnih faktora širenja MDR mikroorganizama je pretjerano ili pogrešno propisivanje antibiotika. Ciljevi ove studije bili su utvrditi prevalenciju pet najvažnijih MDR bakterija iz krvi i urina da bi se kirurška antibiotička profilaksa uskladila s Hrvatskim nacionalnim smjernicama. Metode Provedena je studija prevalencije infekcija u određenom vremenu. Prikazani su laboratorijski podaci o sljedećim bakterijskim uzročnicima infekcija: MRSA, VRE, ESBL i enterobakterije koje produciraju karbapenemaze, te višestruko otporna Acinetobacter spp., izolirane iz krvi i urina hospitaliziranih pacijenata. Podaci o kirurškoj profilaksi prikupljeni su od pacijenata koji su bili podvrgnuti operativnim zahvatima na Odjelu opće kirurgije i Odjelu ginekologije. Rezultati Prevalencija MRSA infekcija krvi bila je 1,64%, drugi MDR mikroorganizmi nisu bili izolirani. Prevalencija urinarnih MDR izolata bila je sljedeća: MRSA 0,07%, E. coli ESBL 1,43% (5,79% ukupnih E. coli izolata bilo je onih koji proizvode ESBL), K. pneumonie 1,79% (26,3% K. pneumoniae bilo je proizvođač ESBL-a) i Acinetobacter spp. 0,38%. Udio pacijenata koji su nastavili s kirurškom profilaksom bio je 6,4%. Zaključak Prevalencija MDR mikroorganizama u našoj instituciji je niska, no udio otpornih izolata među izoliranim vrstama odgovara europskim izvješćima. Usklađenost kirurške antibiotičke profilakse sa Smjernicama je visoka. Kontinuirani i aktualni podaci važna su uputa za provođenje empirijske antimikrobne terapije, pokazatelj za načine sprečavanja širenja MDR mikroorganizama i ispravno korištenje antibiotika

The HiT-1 e-course:

This paper explores ten years of experience from the Croatian Internet Course (HiT-1) of the University of Zagreb developed for students who do not know Croatian at all or only know its basics. Using an e-learning system, Moodle Community (MoD) students discover, study and practice new content. An above-average dropout rate, associated with a sense of loneliness and insufficient interaction with the teacher and other students, is considered a major shortcoming of e-courses. To counteract this, HiT-1 offers individual live lessons twice a week. During them the e-content is repeated, practiced, and expanded through similar materials. HiT-1 students have pointed out in evaluations that live lessons led to successful attendance and completion, and thus to a very low dropout rate. In live lessons, students are exposed to Croatian from the beginning and use it in conversation with teachers; sometimes the teacher is the only L1 speaker of Croatian with whom they can speak Croatian. Finally, language acquisition is greatly influenced by regular, systematic monitoring of student activities in the MoD system, an individual approach, constant support, and encouragement, either by chat or in live lessons. So far 260 students from around 50 countries have attended the course, and more than 6,200 hours of individual live lessons have been held

Konjugacijski tipovi u hrvatskom jeziku

This paper analyses a new classification of verb conjugation types in Croatian, which is based on both their canonical form – the infinitive, which is the non-finite verbal form par excellence, and the basic form – the present, which is on the other end of the finiteness scale. The first chapter provides a brief overview of Croatian conjugational typology, starting from the grammar by B. Kašić (1604) until the most recent grammars by Silić and Pranjković (2005), as well as Jelaska (2015), ranging from one up to twenty-nine categories. The recent typologies within structuralist, generative and cognitive approaches are described in more detail, especially in Jelaska and Bošnjak Botica (2012), where prototype-based categorization is argued for as the most appropriate categorization. The second part of the paper analyses some properties of the present classification into three groups (a, i, e) and ten types within them: the shape, productivity, size, usage and the relations between them. The data consists of 24,400 Croatian verbs, which are categorized into groups, types and subtypes. The first group has only one type as member (verbs such as gledati), the second has three members (verbs such as moliti, vidjeti and trčati), the third has six (verbs like pisati, smijati se, putovati, davati, viknuti, ići).Hrvatska je morfologija poprilično složena zbog različitih promjena oblika u fleksiji, a te su se promjene nastojale opisati i kategorizirati s različitih pristupa. U prvom se dijelu rada daje kratki pregled hrvatske konjugacijske tipologije počevši od prve hrvatske gramatike B. Kašića (1604.) do posljednje autora J. Silića i I. Pranjkovića (2005.). Iako se broj vrsta kreće od jedne do deset, podrobnijom se raščlambom uočava da se broj tipova penje na 29. U drugom se dijelu rada raščlanjuju neka načela razdiobe na tri skupine (a, e, i) i deset vrsta: brojnost, omjer osnovnih i prefigiranih glagola unutar vrste, posebno proširenost i njezina veza s brojnošću, odnos brojnosti i čestote, npr. broj članova svake vrste u rječniku koji raste od najčešćih 100 do najčešćih 6 tisuća riječi. Građu čini više od 24 000 hrvatskih glagola koji su podijeljeni u skupine, vrste i razrede s različitim stupnjem članstva unutar vrste. Prva se skupina sastoji samo od jednoga člana (glagoli tipa gledati), druga ima tri (glagoli tipa moliti, vidjeti i trčati), a treća šest (glagoli tipa pisati,smijati se, putovati, davati, viknuti i ići)

Distributed lags time series analysis versus linear correlation analysis (Pearson's r) in identifying the relationship between antipseudomonal antibiotic consumption and the susceptibility of Pseudomonas aeruginosa isolates in a single Intensive Care Unit of a tertiary hospital

The relationship between antibiotic consumption and selection of resistant strains has been studied mainly by employing conventional statistical methods. A time delay in effect must be anticipated and this has rarely been taken into account in previous studies. Therefore, distributed lags time series analysis and simple linear correlation were compared in their ability to evaluate this relationship. Data on monthly antibiotic consumption for ciprofloxacin, piperacillin/tazobactam, carbapenems and cefepime as well as Pseudomonas aeruginosa susceptibility were retrospectively collected for the period April 2006 to July 2007. Using distributed lags analysis, a significant temporal relationship was identified between ciprofloxacin, meropenem and cefepime consumption and the resistance rates of P. aeruginosa isolates to these antibiotics. This effect was lagged for ciprofloxacin and cefepime [1 month (R=0.827, P=0.039) and 2 months (R=0.962, P=0.001), respectively] and was simultaneous for meropenem (lag 0, R=0.876, P=0.002). Furthermore, a significant concomitant effect of meropenem consumption on the appearance of multidrug-resistant P. aeruginosa strains (resistant to three or more representatives of classes of antibiotics) was identified (lag 0, R=0.992, P<0.001). This effect was not delayed and it was therefore identified both by distributed lags analysis and the Pearson's correlation coefficient. Correlation coefficient analysis was not able to identify relationships between antibiotic consumption and bacterial resistance when the effect was delayed. These results indicate that the use of diverse statistical methods can yield significantly different results, thus leading to the introduction of possibly inappropriate infection control measures

Upala srednjeg uha [Middle ear infection]

Middle ear infection is one of the most common childhood infections and the leading reason for antibiotic prescriptions. Although the etiological diagnosis is rarely discovered, successful identification of pathogens depends on properly collected sample, chosen method and microbiological analysis made on time. The most common bacterial pathogen is Streptococcus pneumoniae. Others include Haemophilus influenzae, Moraxella catarrhalis and Pseudomonas aeruginosa, known as the most common bacterial pathogen of chronic inflamations. Viral or polimicrobial upper respiratory tract infections often precede this infection. Pneumococcal conjugate vaccines given during infancy decrease rates of acute middle ear inflammation. It is a self-limited disease with rare complications. The best treatment is watchful waiting for two days followed by amoxicillin during 7 days, only if it is necessary. If there is resistance, then combination of amoxicillin and beta lactamase inhibitor is second line. The best choice for patients allergic to penicillin are macrolides. Antibiotic treatment has contributed to frequent relapses and increase of multi-drug resistant pathogens by permitting their colonization, which eliminates protective nasopharyngeal flora

MIDDLE EAR INFECTION

Upala uha jedna je od najčešćih dječjih infekcija zbog koje se propisuju antibiotici. Premda se etiološka dijagnoza ne postavlja često, uspjeh identifikacije uzročnika ovisi o ispravnom uzimanju uzorka, odabiru metode i pravodobnoj mikrobiološkoj analizi. Najčešći bakterijski uzročnik je Streptococcus pneumoniae. Ostali uključuju Haemophilus influenzae, Moraxellu catarrhalis i P. aeruginosu, najčešćega bakterijskog uzročnika kronične upale. Akutnoj upali uha često prethode višestruke infekcije gornjega respiratornog trakta, virusne ili polimikrobne etiologije. Stoga su konjugirana cje­piva primijenjena u dječjoj dobi korisna u smanjenju incidencije bolesti. Akutna upala uha većinom je samolimitirajuća s rijetkim komplikacijama. Najefikasnija terapija je dvodnevno promatranje i naknadna primjena amoksicilina tijekom 7 dana samo ako je potrebno. Ako postoji rezistencija, primjenjuje se kombinacija amoksicilina s laktamskim inhibitorom, dok su makrolidi izbor kod alergije na penicilin. Česti recidivi i rezistencija na antibiotike posljedica su njihove široke primjene, koja pospješuje kolonizaciju patogena čime se mijenja protektivna fiziološka flora sluznice nazofarinksa.Middle ear infection is one of the most common childhood infections and the leading reason for antibiotic ­prescriptions. Although the etiological diagnosis is rarely discovered, successful identification of pathogens depends on properly collected sample, chosen method and microbiological analysis made on time. The most common bacterial pathogen is Streptococcus pneumoniae. Others include Haemophilus influenzae, Moraxella catarrhalis and Pseudomonas aeruginosa, known as the most common bacterial pathogen of chronic inflamations. Viral or polimicrobial upper respiratory tract infections often precede this infection. Pneumococcal conjugate vaccines given during infancy decrease rates of acute middle ear inflammation. It is a self-limited disease with rare complications. The best treatment is watchful waiting for two days followed by amoxicillin during 7 days, only if it is necessary. If there is resistance, then combination of amoxi­cillin and beta lactamase inhibitor is second line. The best choice for patients allergic to penicillin are macrolides. Anti­biotic treatment has contributed to frequent relapses and increase of multi-drug resistant pathogens by permitting their colonization, which eliminates protective nasopharyngeal flora

Nationwide Survey of Klebsiella Pneumoniae Strains Producing CTX-M Extended-spectrum b-lactamases in Croatia

Extended-spectrum β-lactamases (ESBL) producing bacteria have been increasingly reported in both hospital and community patients. Production of ESBLs is the major mechanism of resistance to oxymino-cephalosporins and aztreonam in Gram-negative bacteria 1,2. Recently a new family of ESBLs with predominant activity against cefotaxime (CTX-M β-lactamases) has been reported. Over 80 CTX-M enzymes have been described so far, which can be grouped into five main subgroups according to amino acid sequence identity (CTX-M-1, CTX-M-2, CTX-M-8, CTX-M-9 and CTX-M-25) 3 . In some countries, CTX-M β-lactamases are the most prevalent types of ESBLs, for instance in Russia 4, Greece 5 , Spain 6 , Switzerland 7, Japan 8, Taiwan 9, China 10 and Argentina 11 . These enzymes have been identified in countries near Croatia such is Italy 12, Hungary13 and Austria14 The aim of this study was to determine the prevalence and the types of CTX-M β lactamases produced by Klebsiella pneumoniae clinical isolates collected from October 2006 to January 2007 from both community- and hospital –based isolates were included (Figure 1.). 128 ESBL isolates were subjected to further analysis: screening with double disc diffusion test and confirmed by ESBL E test 15

APPLICATION OF THE CONSTANT MARKET SHARE METHOD ON THE HIGH VALUE ADDED SERVICES SECTOR EXPORT OF THE REPUBLIC OF CROATIA TO THE EUROPEAN UNION MARKET

U ovome radu po prvi puta se analizira promjena relativnog položaja izvoza uslužnoga sektora visoke dodane vrijednosti Republike Hrvatske na tržište Europske unije, u razdoblju od 2008. do 2012. godine, primjenom metode konstantnih tržišnih udjela, koja omogućuje utvrđivanje učinaka promjena tržišnog udjela neke zemlje. Promjena tržišnog udjela raščlanjuje se na strukturni učinak, koji pokazuje koliko na promjenu tržišnog udjela utječe sama struktura izvoza prema pojedinim uslugama (uslužna orijentacija), odnosno izvoznim tržištima (geografska orijentacija) te učinak konkurentnosti koji obuhvaća sve ostale čimbenike koji mogu utjecati na konkurentnost nekih usluga na određenom tržištu i posljedično na njihov tržišni udio. Rezultati provedenog istraživanja pokazuju da je porast udjela hrvatskog izvoza usluga visoke dodane vrijednosti na tržište Europske unije u razdoblju od 2008. do 2012. godine poglavito posljedica učinka konkurentnosti.The subject of the analysis in this paper is relative change of high value added services sector export of the Republic of Croatia to the European Union market in the period from 2008 to 2012 by applying constant market share method that enables determination of changes of certain countries market share. The change of market share is decomposed into structural effect which indicates how much market share is affected by the export structure according to certain services (service orientation), i.e. export markets (geographical orientation) and the competitiveness effect which consists of all other factors that may have impact on competitiveness of services on certain market and consequentially their market share. The results of conducted research indicate that increase of Croatian high value added services sector export to the European Union market in the period 2008-2012 is primarily the consequence of competitiveness effect