Antibiotic stewardship in "Staphylococcus aureus" bloodstream infection treatment : analysis based on 29,747 patients from one hospital

Some of the most serious healthcare-associated infections (HAI) are highly deadly bloodstream infections (BSIs) caused by Staphylococcus aureus. The aim of the study was to analyse compliance of treatment practice with clinical guidelines in patients with S. aureus BSIs. The study was conducted at the Sosnowiec Hospital, Poland in 2019. During the study, 29,747 patients were hospitalized and 41 S. aureus BSIs (only HAIs) episodes were observed. According to local clinical practice guidelines, each case of BSI required blood cultures, echocardiography and control culture after the implementation of the targeted therapy. Incidence rate of S. aureus BSI was 0.8/1000 admissions; the greatest department admission rates were in the ICU (19.3/1000 admissions) and in the Nephrology Department (8.7/1000 admissions). Only 2 patients were treated following the protocol (4.8%); the most common errors were the use of an inappropriate drug or incorrect duration of antibiotic treatment. No patient underwent echocardiography, and control cultures were performed in 70% of cases. The case fatality rate was 7.3%. A satisfactorily low case fatality rate was found despite the poor antibiotic stewardship. Lack of discipline concerning antibiotic use can strongly impact the observed high drug resistance in HAIs and high Clostridioides difficile incidence rate in the studied hospital

Consumption of antibiotics and epidemiology of "Clostridioides difficile" in the European Union in 2016 : opportunity for practical application of aggregate ECDC data

Background: The most important pathomechanism of Clostridioides difficile infections (CDI) is post-antibiotic intestinal dysbiosis. CDI affects both ambulatory and hospital patients. Aim: The objective of the study was to analyze the possibility of utilizing databases from the European Centre for Disease Prevention and Control subject to surveillance for the purpose of identifying areas that require intervention with respect to public health. Methods: The analysis encompassed data concerning CDI incidence and antibiotic consumption expressed as defined daily doses (DDD) and quality indicators for antimicrobial-consumption involving both ambulatory and hospital patients in 2016. Results: In 2016, in the European Union countries, total antibiotic consumption in hospital and outpatient treatment amounted to 20.4 DDD (SD 7.89, range 11.04–39.69); in ambulatory treatment using average of ten times more antibiotics than hospitals. In total, 44.9% of antibiotics used in outpatient procedures were broad-spectrum antibiotics. We have found a significant relationship between the quality of antibiotics and their consumption: The more broad-spectrum antibiotics prescribed, the higher the sales of antibiotics both in the community sector and in total. CDI incidence did not statistically significantly correlate with the remaining factors analyzed on a country-wide level. Conclusion: Antibiotic consumption and the CDI incidence may depend on many national variables associated with local systems of healthcare organization and financing. Their interpretation in international comparisons does not give clear-cut answers and requires caution

Multidrug-resistant micro-organisms associated with urinary tract infections in orthopedic patients : a retrospective laboratory-based study

Background: The risk of healthcare-associated infections (HAIs) in surgical wards remains closely related to the type of surgery and procedures performed on patients. Those factors also condition the risk of various forms of clinical infections, especially urinary tract infections (UTIs). UTIs are most frequently (70–80% of cases) caused by the use of bladder catheter in the perioperative period. The aim of this study was to perform an epidemiological and microbiological analysis of UTIs in orthopedic patients, with an emphasis on multidrug-resistant (MDR) micro-organisms. Methods: The study was conducted in a 38-bed Department of Orthopedic-Traumatic Surgery in Sosnowiec, Poland. 5239 patients, operated on in 2013–2015, were included in the study. The urinary catheter use rate was 30.7%. Laboratory-based study used the UTI definition of the HAI-Net program. A micro-organism was declared MDR if it was resistant to at least one antibiotic from three or more groups of antibacterial drugs, and extensively drug-resistant (XDR) if it was sensitive to antibiotics from no more than two groups of drugs. Results: The UTI incidence was 3.2% (168 cases), the CA-UTI incidence density was 9.6/1000 catheter days. The highest risk of UTI was found in patients aged 75 or older. Monomicrobial cultures were detected in 163 specimens (78% of all microbiologically confirmed UTIs). Gram-negative flora prevailed among the micro-organisms, the predominantly isolated Enterobacteriaceae being Escherichiacoli and Klebsiellapneumoniae. In 16 patients (7.7% of microbiologically confirmed UTIs), yeast infection was confirmed. Isolated micro-organisms were fully sensitive to carbapenems. Gram-negative bacilli showed the lowest sensitivity to extended substrate spectrum penicillins and fluoroquinolones (37–64%), as well as to trimethoprim-sulfamethoxazole (50%). The MDR prevalence was 24.4%. Conclusions: The presented data indicates that UTIs are a significant problem in the studied population, so is antimicrobial resistance, especially to quinolones, and extended-spectrum cephalosporins, which are often used as first-line therapy. To tackle the problem of high UTI incidence and MDR prevalence, reducing the UTI risk factors should be prioritized

Long-term antibiotic prophylaxis in urology and high incidence of "Clostridioides difficile" infections in surgical adult patients

Clostridioides difficile infections are the main cause of antibiotic-related diarrhea. Most of them come in the form of healthcare-associated Clostridioides difficile infections (HA-CDI). The aim of the study was to analyze HA-CDI epidemiology and the relationship between antibiotic consumption and CDI epidemiology at St Luke’s Provincial Hospital in Tarnow, Poland. In 2012–2018, surveillance of CDI was carried out in adult surgical wards at St Luke’s Provincial Hospital. The data were collected in accordance with the methodology of the Healthcare-Associated Infections Surveillance Network (HAI-Net), European Centre for Disease Prevention and Control (ECDC), and the ATC/DDD system (Anatomical Therapeutic Chemical Classification System) of the World Health Organization. In total, in the study period, 51 cases of CDI involved CA-CDI (24.5%) and 147 were HA-CDIs (75.5%). The most CA-CDIs were found in the general surgery (32.6%) and urology (17.0%) wards. CA-CDI incidence was 0.7/1000 patients and for HA-CDI it was 2/1000 patients (4.4/10,000 patientdays (pds)). The highest HA-CDI incidence was in the neurosurgical departments (18/10,000 pds) and oncological surgery (8.4/10,000) pds. There was a significant positive correlation between CA-CDI and HA-CDI (correlation of 0.943, p < 0.001) and between the number of patients hospitalized and HA-CDI (correlation of 0.865, p = 0.012). The total antibiotic consumption amounted to 0.7 DDD/10,000 pds; it was the highest in the urology ward (0.84/10,000 pds) and 49.5% of the antibiotics were fluoroquinolones (0.41/10,000 pds). On the basis of regression coefficients, a positive correlation was demonstrated between the use of fluoroquinolones and the HA-CDI incidence rate. Both a high percentage of CDI cases and a high intake of antibiotics were recorded in the urology department. About half of all antibiotics were fluoroquinolones

SARS-CoV-2 antibody response after mRNA vaccination in healthcare workers with and without previous COVID-19, a follow-up study from a university hospital in Poland during 6 months 2021

IntroductionHealthcare workers (HCWs) from the beginning of the pandemic have been at risk of exposure to SARS-CoV-2, so they were vaccinated as first.ObjectivesThe purpose of the study was to determine the level of antibodies against SARS-CoV-2 in HCWs before and after vaccination with mRNA preparations according to previous COVID- 19.Patients and methodsThe HCWs from the University Hospital in Krakow completed two surveys: the baseline survey before receiving the first dose of vaccine (in January 2021) and the follow-up survey in June 2021. In parallel, two blood samples were collected from each participant at baseline and at follow-up. Total anti-SARS-CoV-2 antibody levels were measured using the ECLIA technique.ResultsAt baseline, 41.1% of HCWs had positive antibody test results, and at follow-up, the vaccinated HCWs had almost 100 times higher antibody levels than the unvaccinated HCWs. Participants under 30 years of age had significantly higher antibody levels in June than older HCWs. Among participants with positive antibody test results in January, HCWs who had experienced asymptomatic COVID-19 had more than five times higher antibody levels in June than HCWs self-reported severe COVID-19. In total, 86.9% of HCWs received Comirnaty or Spikevax. The incidence rate of COVID-19 in the unvaccinated vs. vaccinated group was 13 times higher, 20.5% and 1.9% respectively.ConclusionsThese results confirm the effectiveness of vaccination in the prevention of COVID-19 in HCWs. It is worth getting vaccinated regardless of previous infection. Furthermore, vaccination among HCWs under 30 years of age induced more effective antibody production compared to older individuals

Post-Discharge Clostridioides difficile Infection after Arthroplasties in Poland, Infection Prevention and Control as the Key Element of Prevention of C. difficile Infections

Clostridioides difficile is still one of the most common causes of hospital-acquired infectious diarrhea (CDI), and the incidence of CDI is one of the indicators that allows conclusions to be derived on the correctness of antibiotic administration. The objective of this observational study was the analysis of post-discharge CDI incidence in patients undergoing hip or knee arthroplasty, in order to specify optimum conditions for the surgical procedures and outpatient postoperative care. One-year observational study. Public Polish hospitals. Retrospective records for 83,525 surgery patients having undergone hip or knee arthroplasty were extracted from the Polish National Health Fund databases. CDI and/or antibiotic prescriptions in the 30 day post-surgery period were expressed per 1000 surgeries with antibiotic prescription on discharge or in ambulatory care, respectively. The CDI incidence rate was 34.4 per 10,000 patients, and 7.7 cases per 100,000 post-surgery patient-days. Patients who were prescribed at least one antibiotic were diagnosed with CDI more often than patients who had no antibiotic treatment (55.0/1000 patients vs. 1.8/1000 patients). In the multifactorial analysis, the following factors were significant: being at least 65 years of age, trauma as the cause of surgery, length of stay over 7 days, HAIs other than CDI and taking beta-lactams and/or quinolones but not macrolides in the post-discharge period. Postoperative antibiotic prescription in patients undergoing joint replacement surgery is the main risk factor for CDI. These observations indicate the necessity of improvement of infection control programs as the key factor for CDI prevention

Infectious agents in carcinogenesis

Wprowadzenie i cel pracy. Etiologia wielu chorób nowotworowych pozostaje obszarem nadal niezbyt dobrze poznanym. Szacuje się, że około 20% nowotworów można powiązać z obecnością czynnika zakaźnego, w szczególności wirusów, chociaż nie tylko. Celem niniejszej publikacji jest przedstawienie aktualnego stanu wiedzy na temat czynników zakaźnych jako inicjatorów procesu nowotworzenia. Skrócony opis stanu wiedzy. Dotychczas udowodniono wpływ m.in. HPV, HBV, HCV, EBV, Helicobacter pylori i Opisthorchis viverrini na złośliwą transformację komórek. Udokumentowano właściwości onkogenne poszczególnych białek wirusowych. Istotną rolę w kancerogenezie związanej z obecnością HPV mają białka E6 i E7, które rozregulowują cykl komórkowy. Infekcja HBV indukuje powstawanie onkogennego wirusowego białka X, które ma właściwości transaktywacyjne. Na indukowanie złośliwej transformacji komórek mają prawdopodobnie wpływ: białko rdzeniowe i białko p70 wirusa HCV. Za onkogenne zostały uznane też proteiny wirusa EBV – EBNA-2 i LMP-1. Istnieje większe prawdopodobieństwo wystąpienia nowotworów u osób chorych na AIDS, gdyż wirus HIV upośledza odpowiedź immunologiczną, atakując limfocyty T o fenotypie CD4+. Oprócz infekcji wirusowych z kancerogenezą łączy się zakażenia bakteryjne i zarażenia pasożytami. Udowodniono, że długotrwała infekcja Helicobacter pylori i Chlamydia spp. może prowadzić do procesu nowotworowego. Obecność przywry Opisthorchis viverrini i wytwarzanych przez nią metabolitów łączone są z rakiem przewodów żółciowych. Podsumowanie. Wirusy, ale również niektóre drobnoustroje bakteryjne, a nawet pasożyty uważane są za czynnik ryzyka w rozwoju określonych nowotworów. Szczególne niebezpieczeństwo w tym kontekście stwarza przewlekła postać zakażenia czynnikiem infekcyjnym.Etiology of many cancers remains an area still insufficiently well known. It is estimated that approximately 20% of cancers can be linked to the presence of infectious agents, in particular viruses, although not only. The purpose of this publication is to present current knowledge on infectious agents as initiators of the oncogenesis. Hitherto, the effect of several infectious agents, among others, HPV, HBV, HCV, EBV, Helicobacter pylori, and Opisthorchis viverrini, on malicious transformation of cells has been proved. The oncogenic properties of the particular viral proteins have been documented. It has been shown that the E6 and E7 proteins of HPV are associated with the deregulation of the cell cycle, playing an important role in the carcinogenesis. HBV infection induces the formation of oncogenic viral protein X, which has transactivation properties. The HCV core protein and p70 protein are considered to be a factor that can induce a malicious cell transformation. The EBNA-2 and LMP-1 proteins of EBV are also identified as the oncogenic factors. The risk of developing cancer increases in people infected with HIV because the virus impairs the immune response by attacking and destroying the CD4+ T-cells. Bacterial and parasitic infections also influence carcinogenesis. It has been shown that long-lasting infection of Helicobacter pylori or Chlamydia spp., can lead to a cancerous process. Furthermore, the infections caused by Opisthorchis viverrini can also initiate oncogenesis, as the metabolites produced by the flukes are thought to be responsible for the development of bile ducts cancer. Viruses, but also some bacterial microorganisms and even parasites, are considered as risk factors in the development of cancer. In particular, chronic infections pose a major threat in this context

Infectious agents in carcinogenesis

Wprowadzenie i cel pracy. Etiologia wielu chorób nowotworowych pozostaje obszarem nadal niezbyt dobrze poznanym. Szacuje się, że około 20% nowotworów można powiązać z obecnością czynnika zakaźnego, w szczególności wirusów, chociaż nie tylko. Celem niniejszej publikacji jest przedstawienie aktualnego stanu wiedzy na temat czynników zakaźnych jako inicjatorów procesu nowotworzenia. Skrócony opis stanu wiedzy. Dotychczas udowodniono wpływ m.in. HPV, HBV, HCV, EBV, Helicobacter pylori i Opisthorchis viverrini na złośliwą transformację komórek. Udokumentowano właściwości onkogenne poszczególnych białek wirusowych. Istotną rolę w kancerogenezie związanej z obecnością HPV mają białka E6 i E7, które rozregulowują cykl komórkowy. Infekcja HBV indukuje powstawanie onkogennego wirusowego białka X, które ma właściwości transaktywacyjne. Na indukowanie złośliwej transformacji komórek mają prawdopodobnie wpływ: białko rdzeniowe i białko p70 wirusa HCV. Za onkogenne zostały uznane też proteiny wirusa EBV – EBNA-2 i LMP-1. Istnieje większe prawdopodobieństwo wystąpienia nowotworów u osób chorych na AIDS, gdyż wirus HIV upośledza odpowiedź immunologiczną, atakując limfocyty T o fenotypie CD4+. Oprócz infekcji wirusowych z kancerogenezą łączy się zakażenia bakteryjne i zarażenia pasożytami. Udowodniono, że długotrwała infekcja Helicobacter pylori i Chlamydia spp. może prowadzić do procesu nowotworowego. Obecność przywry Opisthorchis viverrini i wytwarzanych przez nią metabolitów łączone są z rakiem przewodów żółciowych. Podsumowanie. Wirusy, ale również niektóre drobnoustroje bakteryjne, a nawet pasożyty uważane są za czynnik ryzyka w rozwoju określonych nowotworów. Szczególne niebezpieczeństwo w tym kontekście stwarza przewlekła postać zakażenia czynnikiem infekcyjnym.Etiology of many cancers remains an area still insufficiently well known. It is estimated that approximately 20% of cancers can be linked to the presence of infectious agents, in particular viruses, although not only. The purpose of this publication is to present current knowledge on infectious agents as initiators of the oncogenesis. Hitherto, the effect of several infectious agents, among others, HPV, HBV, HCV, EBV, Helicobacter pylori, and Opisthorchis viverrini, on malicious transformation of cells has been proved. The oncogenic properties of the particular viral proteins have been documented. It has been shown that the E6 and E7 proteins of HPV are associated with the deregulation of the cell cycle, playing an important role in the carcinogenesis. HBV infection induces the formation of oncogenic viral protein X, which has transactivation properties. The HCV core protein and p70 protein are considered to be a factor that can induce a malicious cell transformation. The EBNA-2 and LMP-1 proteins of EBV are also identified as the oncogenic factors. The risk of developing cancer increases in people infected with HIV because the virus impairs the immune response by attacking and destroying the CD4+ T-cells. Bacterial and parasitic infections also influence carcinogenesis. It has been shown that long-lasting infection of Helicobacter pylori or Chlamydia spp., can lead to a cancerous process. Furthermore, the infections caused by Opisthorchis viverrini can also initiate oncogenesis, as the metabolites produced by the flukes are thought to be responsible for the development of bile ducts cancer. Viruses, but also some bacterial microorganisms and even parasites, are considered as risk factors in the development of cancer. In particular, chronic infections pose a major threat in this context