Nealkoholna masna bolest jetre povezana je s većom smrtnošću kod odraslih bolesnika s invazivnom bolešću uzrokovanom streptokokom grupe B

Background: Group B Streptococcus (GBS) is a significant cause of invasive disease among adult non-pregnant patients with increasing incidence and mortality rates. Although non-alcoholic fatty liver disease (NAFLD) is associated with components of metabolic syndrome previously recognized as risk factors for GBS, the impact of NAFLD on GBS course and outcomes is unknown. Methods: We conducted a retrospective cohort study of all non-pregnant adult patients diagnosed with invasive GBS infection during a 15-year period. Results: 102 patients were included in the study (46.1% males; median age 69, IQR 58-78 years). Disease primarily presented as bacteremia without a defined source (37; 36.3%), cellulitis/erysipelas (35; 34.3%), pneumonia (13; 12.7%) and endocarditis (8; 7.8%). The most common comorbidities were diabetes (42; 41.2%), dyslipidemia (39; 38.2%), cardiovascular disease (34; 33.3%), peripheral vascular disease (21; 20.6%), obesity (21; 20.6%) and malignancy (10; 9.8%). Based upon the results of abdominal ultrasound, the patients were divided into two groups: the ones with steatosis (44; 43.1%) and the ones without steatosis (58; 56.9%). There were no significant differences in clinical presentations and comorbidities between groups. In-hospital mortality was 29.5% (13/44) in patients with NAFLD and 10.3% (6/58) in the control group (p=0.0200). Endocarditis (OR 6.69; 95%CI 1.045-44.46, p=0.0410), acute renal failure (OR 13.92; 95%CI 3.00-77.71, p=0.0013), qSOFA > 2 (OR 23.93; 95%CI 4.66-171.2) and NAFLD (OR 6.64; 95%CI 1.23-47.88, p=0.0258) were independently associated with in-hospital mortality. Conclusions: NAFLD is associated with higher mortality in patients suffering from invasive GBS disease which appears to be independent of other components of the metabolic syndrome, such as obesity and diabetes mellitus.Uvod: Streptokok grupe B (GBS) značajan je uzrok invazivne bolesti kod odraslih bolesnika s porastom incidencije i smrtnosti. Iako je nealkoholna masna bolest jetre – NAFLD (engl. non-alcoholic fatty liver disease) povezana s komponentama metaboličkog sindroma koji su prepoznati kao čimbenici rizika za GBS, utjecaj NAFLD na tijek i ishode invazivne GBS bolesti još uvijek nije poznat. Metode: Proveli smo retrospektivno kohortno istraživanje svih odraslih bolesnika koji nisu trudni, a kojima je dijagnosticirana invazivna GBS infekcija tijekom 15-godišnjeg razdoblja. Rezultati: U istraživanje je uključeno 102 bolesnika (46,1% muškaraca; srednja dob 69, IQR 58-78 godina). Bolest se primarno prezentirala kao bakterijemija nepoznatog ishodišta (37; 36,3%), celulitis/erizipel (35; 34,3%), pneumonija (13; 12,7%) i endokarditis (8; 7,8%). Najčešći komorbiditeti bili su dijabetes (42; 41,2%), dislipidemija (39; 38,2%), kardiovaskularne bolesti (34; 33,3%), periferne vaskularne bolesti (21; 20,6%), pretilost (21; 20,6%) i maligna bolest (10; 9,8%). Prema nalazu ultrazvuka abdomena, bolesnici su podijeljeni u dvije skupine: bolesnici s NAFLD (44; 43,1%) i bolesnici bez steatoze jetre (58; 56,9%). Nije bilo značajnih razlika u kliničkoj prezentaciji i komorbiditetima među skupinama. Smrtnost za vrijeme hospitalizacije iznosila je 29,5% (13/44) kod bolesnika s NAFLD i 10,3% (6/58) u kontrolnoj skupini (p = 0,0200). Endokarditis (OR 6,69; 95% CI 1,045-44,46, p = 0,0410), akutno zatajenje bubrega (OR 13,92; 95% CI 3,00-77,71, p = 0,0013), qSOFA> 2 (OR 23,93; 95% CI 4,66-171,2) i NAFLD (OR 6,64; 95% CI 1,23-47,88, p = 0,0258) bili su neovisno povezani sa smrtnošću. Zaključci: NAFLD je povezan s većom smrtnošću kod bolesnika s invazivnom GBS bolešću i čini se da je to neovisno o drugim komponentama metaboličkog sindroma, kao što su pretilost i dijabetes melitus

Etiology and outcome of bacterial infections in patients with liver cirrhosis - a retrospective cohort study

Uvod: Bakterijske infekcije čest su uzrok komplikacija i dekompenzacije kod bolesnika s cirozom jetre. Cilj je ove studije proučiti etiologiju, kliničke manifestacije, tijek i ishod bakterijskih infekcija te identificirati prediktore mortaliteta kod bolesnika s cirozom jetre i sepsom. Materijali/metode: Proveli smo retrospektivnu kohortnu studiju u koju je uključeno 257 bolesnika s cirozom jetre koji su bili hospitalizirani u Klinici za infektivne bolesti „Dr. Fran Mihaljević“ (KZIB) u petogodišnjem razdoblju (2011. - 2015.). Analizirali smo demografske, kliničke te mikrobiološke podatke s ciljem identifikacije prediktora mortaliteta. Rezultati: Najčešći klinički sindrom kod prijema bolesnika bila je primarna bakterijemija nepoznatog ishodišta (40,8 %). Prethodno dijagnosticiranu kroničnu bolest jetre imalo je 39,2 % bolesnika. Kod 50 % bolesnika najčešći uzrok ciroze jetre bio je alkoholne geneze. Uzročnik je izoliran kod 71,4 % bolesnika, najčešće iz hemokultura (59,1 %). Korekcija empirijske terapije učinjena je u 11,2 % slučajeva, uzevši u obzir mikrobiološke izolate. Medijan do početka adekvatne antimikrobne terapije bio je 3 dana. Do komplikacija je došlo kod 62,2 % bolesnika. Ukupni mortalitet za vrijeme hospitalizacije iznosio je 28,5 %. Odgođena adekvatna antimikrobna terapija u razdoblju ≥ 72 sata, invazivna mehanička ventilacija i akutno bubrežno zatajenje pokazale su se neovisno povezanima sa smrtnim ishodom. Zaključak: Ovom smo studijom opisali epidemiologiju i etiologiju bakterijemija kod bolesnika s cirozom jetre u Hrvatskoj. S obzirom na to da je infekcija prvi prezentirajući znak ciroze u našoj kohorti, naglašava se potreba za sustavnijim probirom u svrhu ranog otkrivanja kronične bolesti jetre i sprječavanja komplikacija. Visoka stopa multiplo-rezistentnih infekcija iz opće populacije naglašava potrebu za izradom nacionalnih smjernica za empirijsko liječenje bakterijskih infekcija kod bolesnika s cirozom jetre.Introduction: Bacterial infections are a common cause of complications and decompensation in patients with liver cirrhosis. The objective of this study is to evaluate the etiology, clinical manifestations, course and outcome of bacterial infections and identify mortality predictors in patients with liver cirrhosis and sepsis. Materials/Methods: We conducted a retrospective cohort study involving 257 patients hospitalized at the University Hospital for Infectious Diseases, Zagreb over a five-year period (2011 - 2015). We analysed demographical, clinical, and microbiological data in order to identify the mortality predictors. Results: The most common clinical syndrome on admission was bacteremia of unknown origin. Chronic liver disease (CLD) was previously diagnosed in 39,2 % of patients. In 50,0 % of the cases, CLD was alcohol induced. The causative agent was isolated in 71,4 % of patients, mostly from blood cultures. Empirical therapy was corrected in 11,2 % of cases (according to microbiological findings). Median time of adequate antimicrobial therapy onset was 3 days. Complications occurred in 62,2 % of patients. Hospital stay mortality rate was 28,5 %. Delayed adequate antimicrobial therapy for a period ≥ 72 hours, invasive mechanical ventilation and acute renal failure were independently associated with fatal outcomes. Conclusion: This study describes the epidemiology and etiology of bacteriemia in liver cirrhosis patients in Croatia. Since infection is the initial sign of cirrhosis presence in our cohort, systematic screening for timely detection of CLD and prevention of complications is crucial. High rate of multiple drug resistant infections from the general population underscores the need to develop national guidelines for empirical treatment of bacterial infections in patients with liver cirrhosis

Distribucija serotipova i antimikrobna rezistencija u invazivnih izolata Streptococcus pneumoniae u Hrvatskoj

Aims: The general aim was to observe the characteristics (serotypes, antimicrobial resistance) of invasive S. pneumoniae strains depending on the time period and patient age and to determine the extent of coverage by currently available vaccines. Specific aims were to determine the serotype distribution and antimicrobial susceptibility of invasive S. pneumoniae and to determine the resistance mechanisms in macrolide and quinolone-resistant isolates. ------ Materials and methods: Invasive pneumococcal strains were collected through the microbiological laboratories engaged in the national antibiotic resistance surveillance organised as the Croatian Committee for Antibacterial Resistance Surveillance. Capsular typing was performed by the capsular swelling method (the Quellung reaction). In vitro susceptibility testing was performed according to the CLSI and the EUCAST guidelines. The presence of macrolide and fluoroquinolone resistance genes was detected by PCR. ----- Results: The overall incidence of invasive pneumococcal disease (IPD) was 2.92 confirmed cases per 100 000 population. Analysis was done in 1666 out of 1854 consecutively collected, non-copy isolates. A total of 32.6% strains were isolated in children <18 years and 30.9% in adults ≥65 years of age. The most prevalent serotypes among children were 14, 6B, 19A, 23F, 18C and 1, while serotypes 3, 14, 19A, 9V, 23F and 7F were the most prevalent among adults. The trend in the serotype distribution was observed only for serotype 1, which was decreasing. Pneumonia was the most common clinical presentation, in the overall population and among adults. Penicillin non-wild type strains (22%) and macrolide-resistant strains (29.4%), mostly belonged to serotypes 14 and 19A. Resistance to fluoroquinolones was detected in 4 isolates only. The coverage by 10-, 13- and 23-valent vaccines was 69%, 74.5% and 90.6%, respectively, for the target population. ------ Conclusions: The incidence of IPD and serotype distribution varied with patient age. All available vaccines have high coverage for the target population and strains with acquired resistance to the antibiotic.Ciljevi istraživanja: Analizirati karakteristike (serotipovi, antimikrobna rezistencija) invazivnih sojeva Streptococcus pneumoniae, utvrditi eventualne promjene ovisno o vremenskom razdoblju i dobi bolesnika, te opseg pokrivenosti trenutno dostupnim cjepivima. Specifični ciljevi su obuhvaćali distribuciju serotipova i antimikrobnu osjetljivost invazivnih pneumokoka, te mehanizme rezistencije među izolatima rezistentnima na makrolide i kinolone. ----- Materijali i metode: Invazivni sojevi Streptococcus pneumoniae su prikupljeni unutar mreže mikrobioloških laboratorija u sklopu Odbora za praćenje rezistencija bakterija na antibiotike u Hrvatskoj. Serotipizacija je učinjena metodom bubrenja kapsule (the Quellung reaction). Ispitivanje in vitro osjetljivosti na antibiotike je provedeno u skladu s američkim (CLSI) i europskim (EUCAST) laboratorijskim standardima. Metodom reakcije lančane polimeraze je ispitivana prisutnost gena rezistencije na makrolide i fluorokinolone. ----- Rezultati: Ukupna incidencija invazivne pneumokokne bolesti (IPB) je 2.92 dokazanih infekcija na 100 000 stanovnika. Analizom je obuhvaćeno 1666 od ukupno 1854 uzastopno prikupljenih izolata. Među pacijentima s dokazanom IPB 32.6% su bili djeca <18 godina i 30.9% odrasli ≥65 godina. Najčešće zastupljeni serotipovi među djecom su 14, 6B, 19A, 23F, 18C i 1, a među odraslima 3, 14, 19A, 9V, 23F i 7F. Promjena u distribuciji serotipova u promatranom razdoblju uočena je samo za serotip 1 koji je pokazao silazni trend. Pneumonija je bila najčešća klinička prezentacija u cijeloj populaciji i među odraslima. Pneumokoki smanjene osjetljivost na penicilin (22%) i rezistentni na makrolide (29.4%), većinom su pripadali serotipovima 14 i 19A. Rezistencija na fluorokinolone je dokaza u samo četiri izolata. Pokrivenost 10-, 13- i 23-valentnim cjepivima je iznosila 69%, 74.5% i 90.6% za ciljne dobne skupine. ----- Zaključci: Incidencija IPB i distribucija serotipova ovisi o dobi bolesnika. Sva dostupna cjepiva imaju visoku pokrivenost za ciljnu populaciju u Hrvatskoj i sojeve sa stečenom rezistancijom na antibiotike

Distribucija serotipova i antimikrobna rezistencija u invazivnih izolata Streptococcus pneumoniae u Hrvatskoj

Aims: The general aim was to observe the characteristics (serotypes, antimicrobial resistance) of invasive S. pneumoniae strains depending on the time period and patient age and to determine the extent of coverage by currently available vaccines. Specific aims were to determine the serotype distribution and antimicrobial susceptibility of invasive S. pneumoniae and to determine the resistance mechanisms in macrolide and quinolone-resistant isolates. ------ Materials and methods: Invasive pneumococcal strains were collected through the microbiological laboratories engaged in the national antibiotic resistance surveillance organised as the Croatian Committee for Antibacterial Resistance Surveillance. Capsular typing was performed by the capsular swelling method (the Quellung reaction). In vitro susceptibility testing was performed according to the CLSI and the EUCAST guidelines. The presence of macrolide and fluoroquinolone resistance genes was detected by PCR. ----- Results: The overall incidence of invasive pneumococcal disease (IPD) was 2.92 confirmed cases per 100 000 population. Analysis was done in 1666 out of 1854 consecutively collected, non-copy isolates. A total of 32.6% strains were isolated in children <18 years and 30.9% in adults ≥65 years of age. The most prevalent serotypes among children were 14, 6B, 19A, 23F, 18C and 1, while serotypes 3, 14, 19A, 9V, 23F and 7F were the most prevalent among adults. The trend in the serotype distribution was observed only for serotype 1, which was decreasing. Pneumonia was the most common clinical presentation, in the overall population and among adults. Penicillin non-wild type strains (22%) and macrolide-resistant strains (29.4%), mostly belonged to serotypes 14 and 19A. Resistance to fluoroquinolones was detected in 4 isolates only. The coverage by 10-, 13- and 23-valent vaccines was 69%, 74.5% and 90.6%, respectively, for the target population. ------ Conclusions: The incidence of IPD and serotype distribution varied with patient age. All available vaccines have high coverage for the target population and strains with acquired resistance to the antibiotic.Ciljevi istraživanja: Analizirati karakteristike (serotipovi, antimikrobna rezistencija) invazivnih sojeva Streptococcus pneumoniae, utvrditi eventualne promjene ovisno o vremenskom razdoblju i dobi bolesnika, te opseg pokrivenosti trenutno dostupnim cjepivima. Specifični ciljevi su obuhvaćali distribuciju serotipova i antimikrobnu osjetljivost invazivnih pneumokoka, te mehanizme rezistencije među izolatima rezistentnima na makrolide i kinolone. ----- Materijali i metode: Invazivni sojevi Streptococcus pneumoniae su prikupljeni unutar mreže mikrobioloških laboratorija u sklopu Odbora za praćenje rezistencija bakterija na antibiotike u Hrvatskoj. Serotipizacija je učinjena metodom bubrenja kapsule (the Quellung reaction). Ispitivanje in vitro osjetljivosti na antibiotike je provedeno u skladu s američkim (CLSI) i europskim (EUCAST) laboratorijskim standardima. Metodom reakcije lančane polimeraze je ispitivana prisutnost gena rezistencije na makrolide i fluorokinolone. ----- Rezultati: Ukupna incidencija invazivne pneumokokne bolesti (IPB) je 2.92 dokazanih infekcija na 100 000 stanovnika. Analizom je obuhvaćeno 1666 od ukupno 1854 uzastopno prikupljenih izolata. Među pacijentima s dokazanom IPB 32.6% su bili djeca <18 godina i 30.9% odrasli ≥65 godina. Najčešće zastupljeni serotipovi među djecom su 14, 6B, 19A, 23F, 18C i 1, a među odraslima 3, 14, 19A, 9V, 23F i 7F. Promjena u distribuciji serotipova u promatranom razdoblju uočena je samo za serotip 1 koji je pokazao silazni trend. Pneumonija je bila najčešća klinička prezentacija u cijeloj populaciji i među odraslima. Pneumokoki smanjene osjetljivost na penicilin (22%) i rezistentni na makrolide (29.4%), većinom su pripadali serotipovima 14 i 19A. Rezistencija na fluorokinolone je dokaza u samo četiri izolata. Pokrivenost 10-, 13- i 23-valentnim cjepivima je iznosila 69%, 74.5% i 90.6% za ciljne dobne skupine. ----- Zaključci: Incidencija IPB i distribucija serotipova ovisi o dobi bolesnika. Sva dostupna cjepiva imaju visoku pokrivenost za ciljnu populaciju u Hrvatskoj i sojeve sa stečenom rezistancijom na antibiotike

Distribucija serotipova i antimikrobna rezistencija u invazivnih izolata Streptococcus pneumoniae u Hrvatskoj

Aims: The general aim was to observe the characteristics (serotypes, antimicrobial resistance) of invasive S. pneumoniae strains depending on the time period and patient age and to determine the extent of coverage by currently available vaccines. Specific aims were to determine the serotype distribution and antimicrobial susceptibility of invasive S. pneumoniae and to determine the resistance mechanisms in macrolide and quinolone-resistant isolates. ------ Materials and methods: Invasive pneumococcal strains were collected through the microbiological laboratories engaged in the national antibiotic resistance surveillance organised as the Croatian Committee for Antibacterial Resistance Surveillance. Capsular typing was performed by the capsular swelling method (the Quellung reaction). In vitro susceptibility testing was performed according to the CLSI and the EUCAST guidelines. The presence of macrolide and fluoroquinolone resistance genes was detected by PCR. ----- Results: The overall incidence of invasive pneumococcal disease (IPD) was 2.92 confirmed cases per 100 000 population. Analysis was done in 1666 out of 1854 consecutively collected, non-copy isolates. A total of 32.6% strains were isolated in children <18 years and 30.9% in adults ≥65 years of age. The most prevalent serotypes among children were 14, 6B, 19A, 23F, 18C and 1, while serotypes 3, 14, 19A, 9V, 23F and 7F were the most prevalent among adults. The trend in the serotype distribution was observed only for serotype 1, which was decreasing. Pneumonia was the most common clinical presentation, in the overall population and among adults. Penicillin non-wild type strains (22%) and macrolide-resistant strains (29.4%), mostly belonged to serotypes 14 and 19A. Resistance to fluoroquinolones was detected in 4 isolates only. The coverage by 10-, 13- and 23-valent vaccines was 69%, 74.5% and 90.6%, respectively, for the target population. ------ Conclusions: The incidence of IPD and serotype distribution varied with patient age. All available vaccines have high coverage for the target population and strains with acquired resistance to the antibiotic.Ciljevi istraživanja: Analizirati karakteristike (serotipovi, antimikrobna rezistencija) invazivnih sojeva Streptococcus pneumoniae, utvrditi eventualne promjene ovisno o vremenskom razdoblju i dobi bolesnika, te opseg pokrivenosti trenutno dostupnim cjepivima. Specifični ciljevi su obuhvaćali distribuciju serotipova i antimikrobnu osjetljivost invazivnih pneumokoka, te mehanizme rezistencije među izolatima rezistentnima na makrolide i kinolone. ----- Materijali i metode: Invazivni sojevi Streptococcus pneumoniae su prikupljeni unutar mreže mikrobioloških laboratorija u sklopu Odbora za praćenje rezistencija bakterija na antibiotike u Hrvatskoj. Serotipizacija je učinjena metodom bubrenja kapsule (the Quellung reaction). Ispitivanje in vitro osjetljivosti na antibiotike je provedeno u skladu s američkim (CLSI) i europskim (EUCAST) laboratorijskim standardima. Metodom reakcije lančane polimeraze je ispitivana prisutnost gena rezistencije na makrolide i fluorokinolone. ----- Rezultati: Ukupna incidencija invazivne pneumokokne bolesti (IPB) je 2.92 dokazanih infekcija na 100 000 stanovnika. Analizom je obuhvaćeno 1666 od ukupno 1854 uzastopno prikupljenih izolata. Među pacijentima s dokazanom IPB 32.6% su bili djeca <18 godina i 30.9% odrasli ≥65 godina. Najčešće zastupljeni serotipovi među djecom su 14, 6B, 19A, 23F, 18C i 1, a među odraslima 3, 14, 19A, 9V, 23F i 7F. Promjena u distribuciji serotipova u promatranom razdoblju uočena je samo za serotip 1 koji je pokazao silazni trend. Pneumonija je bila najčešća klinička prezentacija u cijeloj populaciji i među odraslima. Pneumokoki smanjene osjetljivost na penicilin (22%) i rezistentni na makrolide (29.4%), većinom su pripadali serotipovima 14 i 19A. Rezistencija na fluorokinolone je dokaza u samo četiri izolata. Pokrivenost 10-, 13- i 23-valentnim cjepivima je iznosila 69%, 74.5% i 90.6% za ciljne dobne skupine. ----- Zaključci: Incidencija IPB i distribucija serotipova ovisi o dobi bolesnika. Sva dostupna cjepiva imaju visoku pokrivenost za ciljnu populaciju u Hrvatskoj i sojeve sa stečenom rezistancijom na antibiotike

Infekcija krvotoka uzrokovana Corynebacterium striatum kod COVID-19 pacijenta: prikaz bolesnika i pregled literature

Objectives: Recent research recognized coryneform bacteria as emerging opportunistic pathogens. Corynebacterium striatum appears as a significant pathogen in immunocompromised and immunocompetent patients. Methods: In this paper, we report a case of an adult COVID-19 patient with C. striatum bloodstream infection. In addition, we reviewed clinical cases of bloodstream infection caused by Corynebacterium spp, mainly C. striatum. Results: We present a 43-year-old patient hospitalized due to bilateral pneumonia caused by a SARS-CoV-2 infection. During hospitalization, the patient was connected to a veno-venous extracorporeal membrane oxygenation (ECMO) circuit. C. striatum was isolated in seven sets of blood cultures sampled over seven consecutive days. Based on identification done by MALDI- ToF, empirical therapy with vancomycin was initiated. Identification was confirmed by 16S ribosomal RNA gene sequencing. Although central venous catheter was replaced, C. striatum was persistently isolated in blood cultures in the following days. Although replacement of the ECMO cannula would be recommended, the procedure was not performed due to the severe patient\u27s condition. Fosfomycin was added to vancomycin as salvage therapy in order to reorganize the structure of the biofilm and enable better penetration and efficacy of vancomycin which resulted in sterile blood cultures in the following days. Conclusion: During the last decades, there have been many examples of bloodstream infections caused by skin contaminants. Although the central venous catheter is most commonly described as a route of entry of the skin microbiota in the bloodstream, other catheters such as pleural catheter and ECMO system, should not be neglected. It is well known that bacterial cells often form a biofilm on the surface of different medical devices such as central venous catheters, endoscopes, and urinary catheters. Fosfomycin has the potential to penetrate the biofilm, transform the biofilm structure and potentially increase the concentration of other antimicrobial agents in the biofilm.Cilj: Nedavna istraživanja prezentirala su korinebakterije kao uzročnike oportunističkih infekcija. Corynebacterium striatum pojavljuje se kao značajan uzročnik kod imunokompromitiranih i imunokompetentnih bolesnika. Metode: U ovom radu je prikazan slučaj odraslog pacijenta oboljelog od COVID-19 bolesti s infekcijom krvotoka uzrokovanom C. striatum. Uz to, predstavljeni su klinički slučajevi infekcija krvotoka uzrokovanih Corynebacterium spp., uglavnom C. striatum. Rezultati: Prikazujemo 43-godišnjeg pacijenta hospitaliziranog zbog bilateralne pneumonije uzrokovane virusom SARS-CoV-2. Tijekom liječenja primijenjen je postupak izvantjelesne membranske oksigenacije (engl. extracorporeal membrane oxygenation, ECMO). C. striatum izoliran je u sedam setova hemokultura uzorkovanih tijekom sedam uzastopnih dana. Na temelju identifikacije pomoću MALDI-ToF-a, započeta je empirijska terapija vankomicinom. Identifikacija je potvrđena sekvenciranjem gena 16S ribosomske RNA. Centralni venski kateter je zamijenjen, ali je C. striatum kontinuirano izoliran u hemokulturama sljedećih dana. Iako je preporučena zamjena ECMO kanile, postupak nije izveden zbog teškog stanja pacijenta. Vankomicinu je dodan fosfomicin kao „terapija spasa” kako bi se reorganizirala struktura biofilma te omogućila bolja penetracija i učinkovitost vankomicina što je rezultiralo sterilnim hemokulturama u narednim danima. Zaključak: Tijekom posljednjih desetljeća u literaturi je opisano mnogo primjera infekcija krvotoka uzrokovanih kontaminantima kože. Iako se centralni venski kateter najčešće opisuje kao put ulaska mikrobiote kože u krvotok, ne smiju se zanemariti ni drugi kateteri, poput pleuralnog katetera i ECMO sustava. Poznato je kako bakterijske stanice često stvaraju biofilm na površini različitih medicinskih uređaja, kao što su središnji venski kateteri, endoskopi i urinarni kateteri. Fosfomicin ima potencijal prodrijeti u biofilm, transformirati strukturu biofilma i potencijalno povećati koncentraciju drugih antimikrobnih sredstava u biofilmu

Impact of hand hygiene campaign on the rate of nosocomial bloodstream infections

Svjetska zdravstvena organizacija (SZO) donijela je preporuke za provođenje kampanje za higijenu ruku. Cilj istraživanja je analizirati utjecaj kampanje na incidenciju nozokomijalnih bakterijemija u jedinici intenzivnog liječenja (JIL) Klinike za infektivne bolesti. JIL ima 18 kreveta. Edukacijom u malim grupama tijekom rujna i listopada 2010. g. te rujna 2011. g. obuhvaćeno je ukupno 77% osoblja. U studenom 2011. g. provedeno je praćenje provođenja pravilne higijene ruku. Incidencija nozokomijalnih bakterijemija u JIL-u pratila se u prvim tromjesečjima 2010., 2011. i 2012. g. Jednomjesečnim praćenjem zabilježeno je 435 prilika za higijenu ruku. Ukupna suradljivost za odjelne medicinske sestre je bila 80%, a za odjelne liječnike 87%. Broj nozokomijalnih infekcija na 1000 bolničkih dana u navedenim razdobljima iznosio je 11,5, 15,1 i 7,3, a broj infekcija uzrokovanih Acinetobacter baumannii iznosio je 6,3, 4,1 i 2,0. Nakon provedene edukacije i praćenja suradljivosti uočen je pad incidencije nozokomijalnih bakterijemija, poglavito onih uzrokovanih Acinetobacter baumannii, no razlika nije dostigla statističku značajnost.WHO has issued recommendations on hand hygiene (HH) campaign. The aim of the study was to analyse the impact of HH campaign on the nosocomial bacteremia rate in the adult intensive care unit (ICU). Adult ICU has 18 beds. Education in small groups during September and October 2010 and again in September 2011 covered 77% of the ward staff. Compliance evaluation was performed in November 2011. Episodes of nosocomial bacteremia (NB) in ICU patients were analysed for the first trimester of 2010, 2011 and 2012. During the one month observation period a total of 435 opportunities were recorded. HH compliance was high for both doctors (87%) and nurses (80 %). NB rates per 100 bed days in the observed periods were 11.5, 15.1 and 7.3, respectively. The number of infections caused by Acinetobacter baumannii were 6.3, 4.1 and 2.0, respectively. The incidence of nosocomial bacteremia, especially those caused by Acinetobacter baumannii, decreased after staff education and compliance evaluation but the difference did not reach statistical significance

Characterization of Isolates Associated with Emergence of OXA-48-Producing Klebsiella pneumoniae in Croatia

Rad opisuje 12 izolata K. pneumoniae povezanih s pojavom i početnim širenjem rezistencije na karbapeneme proizvodnjom karbapenemaze OXA-48 na području RH

Resistant enterobacteria in Croatia – the role of national antibiotic resistance surveillance

Rezistencija enterobakterija na antibiotike već dugo ugrožava uspjeh empirijske antimikrobne terapije, no posebno zabrinjava pojava izolata rezistentnih na sve raspoložive antibiotike. U Hrvatskoj se rezistencija na antibiotike sustavno prati kroz rad Odbora za praćenje rezistencije Akademije medicinskih znanosti Hrvatske i Referentnog centra Ministarstva zdravlja za praćenje rezistencije (RC) pri Klinici za infektivne bolesti "Dr. Fran Mihaljević" i dio je nacionalnog programa kojeg provodi Interdisciplinarna sekcija za kontrolu rezistencije na antibiotike (ISKRA). U sklopu nacionalnog praćenja RC prikuplja izolate enterobakterija rijetkog fenotipa iz cijele Hrvatske, što je omogućilo uočavanje prvih sojeva s novim mehanizmima rezistencije: prvi izolati s plazmidnim AmpC β-laktamazama opisani su 2003. g., s NDM enzimom 2009. g., a izolati s KPC β-laktamazama 2011. g. Niti jedan od ovih enzima se još nije značajno proširio Hrvatskom. Pravodobno otkrivanje sojeva s novim mehanizmom rezistencije, pogotovo onih koji pokazuju i veliki epidemijski potencijal, poput ST 258 Klebsiella pneumoniae, preduvijet je za uspješno kontroliranje širenja rezistencije.Antibiotic resistance in enterobacteriaceae has for a long time greatly compromised empirical antibiotic therapy but of greatest concern is the emergence of isolates resistant to all available antibiotics. The Committee for Antibiotic Resistance Surveillance of the Croatian Academy of Medical Sciences and the Ministry of Health Reference Center for Antibiotic Resistance urveillance (RC) at the University Hospital for Infectious Diseases jointly conduct national resistance surveillance as a part of the national strategy coordinated by the Interdisciplinary Section for Antimicrobial Resistance Control (ISKRA). RC collects isolates with rare phenotypes from all over Croatia which enables detection of strains with novel resistance mechanisms: the first plasmid mediated AmpC β-lactamases were described in 2003, the first NDM enzyme in 2009 and the first KPC β-lactamase in 2011. None of these enzymes spread throughout Croatia as yet. Timely recognition of emergence of the new resistant strains, particularly the ones with an epidemic potential like the ST 258 Klebsiella pneumoniae, is a paramount in antibiotic resistance control

Impact of hand hygiene campaign on the rate of nosocomial bloodstream infections

Svjetska zdravstvena organizacija (SZO) donijela je preporuke za provođenje kampanje za higijenu ruku. Cilj istraživanja je analizirati utjecaj kampanje na incidenciju nozokomijalnih bakterijemija u jedinici intenzivnog liječenja (JIL) Klinike za infektivne bolesti. JIL ima 18 kreveta. Edukacijom u malim grupama tijekom rujna i listopada 2010. g. te rujna 2011. g. obuhvaćeno je ukupno 77% osoblja. U studenom 2011. g. provedeno je praćenje provođenja pravilne higijene ruku. Incidencija nozokomijalnih bakterijemija u JIL-u pratila se u prvim tromjesečjima 2010., 2011. i 2012. g. Jednomjesečnim praćenjem zabilježeno je 435 prilika za higijenu ruku. Ukupna suradljivost za odjelne medicinske sestre je bila 80%, a za odjelne liječnike 87%. Broj nozokomijalnih infekcija na 1000 bolničkih dana u navedenim razdobljima iznosio je 11,5, 15,1 i 7,3, a broj infekcija uzrokovanih Acinetobacter baumannii iznosio je 6,3, 4,1 i 2,0. Nakon provedene edukacije i praćenja suradljivosti uočen je pad incidencije nozokomijalnih bakterijemija, poglavito onih uzrokovanih Acinetobacter baumannii, no razlika nije dostigla statističku značajnost.WHO has issued recommendations on hand hygiene (HH) campaign. The aim of the study was to analyse the impact of HH campaign on the nosocomial bacteremia rate in the adult intensive care unit (ICU). Adult ICU has 18 beds. Education in small groups during September and October 2010 and again in September 2011 covered 77% of the ward staff. Compliance evaluation was performed in November 2011. Episodes of nosocomial bacteremia (NB) in ICU patients were analysed for the first trimester of 2010, 2011 and 2012. During the one month observation period a total of 435 opportunities were recorded. HH compliance was high for both doctors (87%) and nurses (80 %). NB rates per 100 bed days in the observed periods were 11.5, 15.1 and 7.3, respectively. The number of infections caused by Acinetobacter baumannii were 6.3, 4.1 and 2.0, respectively. The incidence of nosocomial bacteremia, especially those caused by Acinetobacter baumannii, decreased after staff education and compliance evaluation but the difference did not reach statistical significance