Улогата на пробиотикот „Диастоп пробио” во превенција на колонизација и инфекција со Clostridium difficile кај хоспитализирани пациенти

Mechanisms for adaptation of microbes from the intestinal microbiome determine their quantitative and qualitative presence in the intestinal tract. One of the most important disturbing factors of the intestinal microbiome, which enable oportunistic bacteria of the gut to reveal their pathogenic properties and cause infections is the antibiotic treatment of infections with different locations. Clostridium difficile infection is a typical example of this kind. The aim of our study was to investigate the possibility of the probiotic Diastop probio in preventing colonization and infection of intestine with Clostridium difficile, in hospitalized patients. Material and methods: A total of 32 patients who were treated with any two of the following antibiotics: Ampicillin, Ceftriaxon, Clindamycin, Ciprofloxacin, Imipenem, Meropenem, Amikacin, were included in the study. Sixteen patients represented the respondent group that received the probiotic "Diastop probio" simultaneously with their antibiotic treatment and the other 16 patients represented the control group who were treated with antibiotics only. Two specimens from each patient were obtained for detection of C.difficile colonization or infection with classical microbiological methods. Qualitative presence of normal intestinal flora was simultaneously analyzed. Results: The percentage of toxigenic  C.difficile strains was three times higher in the respondent group of patients than in the control group of patients (p< 0.05). A significantly lower percentage of disbalance in the normal intestinal flora was registered in patients receiving probiotic simultaneously with their antibiotic treatment. In all patients who had not received probiotics, the normal intestinal flora was reduced or completely absent and in 43.57% of them other pathogenic microorganisms: P. aeruginosa, VRE, ESBL+ E. coli and Candida albicans were detected. Conclusions: The treatment of hospitalised patients with probiotic "Diastop probio" simultaneously with their antimicrobial treatment, contributes to: significant decrease of intestinal flora disturbance, as an important prerequisite for colonization of C. difficile, significant decrease of the frequency of C.difficile infection, which decreases the risk for development of life- threatening complications. Treatment of hospitalized patients with the examined probiotic simultaneously with their antimicrobial treatment should prevent gut colonization with microorganisms, known as causes of hospital infections.Механизмите за адаптација со кои располагаат микроорганизмите од цревниот микробиом го одредуваат нивното квалитативно и квантитативно присуство. Еден од најзначајните фактори кои значајно го нарушуваат цревниот микробиом, овозможувајќи им на условно патогените бактерии да предизвикаат инфекции, е употребата на антибиотиците во терапија на голем број инфекции. Токму таква е инфекцијата која ја предизвикува C. difficile. Целта на нашата студија беше да се испита дали пробиотикот „Диастоп пробио” може да ја превенира колонизацијата и инфекција со C. difficile кај хоспитализирани пациенти. Материјал и методи: Во студијата беа вклучени вкупно 32 пациенти, кои беа третирани истовремено со два од наведените антибиотици: Ceftriaxon, Clindamycin, Ciprofloxacin, Imipenem, Meropenem и Amikacin. Шеснаесет пациенти ја сочинуваа групата на испитаници, кои го примаа и пробиотикот „Диастоп пробио”, а другите 16 пациенти од контролната група не добиваа пробиотик. Од сите пациенти беа добивани по два примерока за детекција на колонизација или инфекција со C. difficile, со класични микробиолошки техники. Истовремено беше проценувана и квалитативната застапеност на нормалната цревна флора. Резултати: Кај пациентите од групата испитаници, процентот на детектираните токсични соеви на C. difficile беше 3 пати повисок во однос на пациентите од контролната група (p<0,05). Истовремено кај пациентите кои примаа пробиотик  беше забележан сигнификантно помал процент на дизбаланс во нормалната цревна флора (p<0,05). Кај сите пациенти кои не примаа пробиотик нормалната цревна флора беше редуцирана или потполно отсутна, а 43,75% од нив беа носители на патогени микроорганизми: P. aeruginosa, VRE, ESBL+ E. coli и Candida albicans. Заклучок: Третирањето на хоспитализираните пациенти со пробиотикот „Диастоп пробио”, како дополнување на нивната антибиотска терапија, придонесува за: значајно намалување на дизбалансот во цревната флора, кој е важен предуслов за колонизација со C. difficile, значајно намалување на фреквенцијата на инфекцијата со C. difficile, што резултира со намален ризик за развивање на некоја од можните живото загрозувачки компликации. Ординирањето на испитуваниот пробиотик истовремено со спроведување на антибиотската терапија кај хоспитализираните пациенти би го спречило населувањето на нивниот дигестивен тракт со значајни микроорганизми, за кои е познато дека предизвикуваат интрахоспитални инфекции

Mediterranean winter rainfall in phase with African monsoons during the past 1.36 million years

Mediterranean climates are characterized by strong seasonal contrasts between dry summers and wet winters. Changes in winter rainfall are critical for regional socioeconomic development, but are difficult to simulate accurately1 and reconstruct on Quaternary timescales. This is partly because regional hydroclimate records that cover multiple glacial–interglacial cycles2,3 with different orbital geometries, global ice volume and atmospheric greenhouse gas concentrations are scarce. Moreover, the underlying mechanisms of change and their persistence remain unexplored. Here we show that, over the past 1.36 million years, wet winters in the northcentral Mediterranean tend to occur with high contrasts in local, seasonal insolation and a vigorous African summer monsoon. Our proxy time series from Lake Ohrid on the Balkan Peninsula, together with a 784,000-year transient climate model hindcast, suggest that increased sea surface temperatures amplify local cyclone development and refuel North Atlantic low-pressure systems that enter the Mediterranean during phases of low continental ice volume and high concentrations of atmospheric greenhouse gases. A comparison with modern reanalysis data shows that current drivers of the amount of rainfall in the Mediterranean share some similarities to those that drive the reconstructed increases in precipitation. Our data cover multiple insolation maxima and are therefore an important benchmark for testing climate model performance

Evaluation of the knowledge of the personnel included in control of the intrahospital infections as an indicator for training and education

Objective: The aim of the paper is making an evaluation of the knowledge of the personnel included in controlling the air and inanimate nature in the hospitals in Republic of Macedonia. Materials and methods: In the paper are analyzed data obtained by testing 38 doctors (microbiologists, epidemiologists and clinical doctors) and 46 nurses included in control teams for intrahospital infections from different cities in the country. The questions in the test were about methods of the microbiologic screening on the hygienic safety of the air and the disinfection and hygiene of hands. Results: On each question individually, the right answers were between 92% and 100% for the doctors and between 78% and 90% for the nurses. Taking in consideration all of the questions there is no significant difference between the results of the doctors and the nurses ( p > 0,05 ). Conclusion: Doctors and nurses included in control teams for intrahospital infections in the hospitals in Republic of Macedonia are well educated for the control of the air and the inanimate nature

Report from implementation of INNIC multidimension hand hygiene approach (IMHHA) among health care workers (HCWs) in nephrology ICU

Apropriate hand hygiene before patient contact is a fundamental tool for the prevention of cross-transmited infections. In aim to improve HH among HCWs, IMHHA was implemented from January 2014 in University Clinic for Neprhology in Skopje. An observational, interventional, prospective study was conducted from the same time, and follow up in next six months. The IMHHA includes following elements: administrative support, supplies availability, education and training, reminders in workplaces, process surveillances and performance feedback. Training was provided at the beginig of each month, poster reminders with 5 step-procedure of proper HH were displayed around hospital settings. HH practice was monitored by an observers without awarness of HCWs respecting “Five moments for HH” by WHO (sex, professional category, work shift, type of contact, type of ICU). Study achived 100% administrative support and educated HCWs. According the results study there was a higher compliance, in nurses v.s. medical doctors, an invasive contact v.s. non-invasive contact and morning shift versus afternoon and evening shift. There was no significant difference in compliance in females v.s. males

Important changes in dynamic balance and resistance of hospital eco system in surgical intensive care unit in the period of 15 years

Continual monitoring of hospital ECO system and its antimicrobial susceptibility is an imperative in prevention of endemic hospital infection. The aim of this paper was to present the significant changes in dynamic balance and antibiotic resistance in the hospital ECO system of the surgical Intensive Care Unit in the period of 15 years (1991-2007). The results obtained have shown decreased isolation of gram negative bacilli from 90% (1991) to 63% (2007)and significant increased isolation of Staphylococcus aureus. Structure of microorganisms found in hospital setting during 1991-1994 was: Pseudomonas aeruginosa (41%), Acinetobacter spp. 2006-07:Staphylococcus aureus (32%), Acinetobacter spp.(27%), Pseudomonas aeruginosa (14%), and Klebsiella aerogenes (11%) Proteus mirabilis (9%), E. coli (5%). The analysis revealed that Pseudomonas aeruginosa was pushed out from the first to the third place, being replaced by Staphylococcus aureus, mainly MRSA(87% out of the total SA). There were endemic strains of enterobacteria (multiresistant Proteus mirabilis, E.coli and Klebsiellaaerogenes), which had no significant importance in causing infection in ICU 15 years ago. Acinetobacter spp. has proved to be a very important hospital pathogen over the last 3 years within its population there has been an increase of strains of extremely multiresistant mutants that are susceptible only to imipenem (10% of resistance) and greatly enlarged resistance percentage to amikacyn (80%). Conclusion 1. The MRSA has become a common nosocomial pathogen in investigated ICU instead of Pseudomonas aeruginosa. 2. Continual monitoring of ICU should be implemented in order to perceive changes in the ICU dynamic balance on time

Carbapenem resistant Acinetobacter baumanii versus MRSA isolates in ICU in Clinical Center Skopje

Backgorund: Acinetobacter baumannii is often referred to as the “Gram-negative methicillin-resistant Staphylococcus aureus”, because it is frequently resistant to antibiotics. Clonal outbreaks of carbapenem-resistant and OXA-23–producing A. baumannii have been reported worldwide. Aim: The goal of this study was to promote the phenomenon of disbalance in endemic hospital ECO system which included increase of carbapenemase-resistant Acinetobacter baumanii on account of reduction of MRSA rate in surgical ICU and it’s clonal relatedness as well as the specific precautions. Material nad Methods: Computer database from 1994 – 2012 from surgical ICU patients in the Clinical Center Skopje was used as basic material for this study. Comparative study indicated 2007/8 as a break point period in which almost a twofold decrease of MRSA rates (from over 80% to 45%) versus increased rates of Acinetobacter baumanii (from 29% to 40%) was observed. In 2011 the very first eight strains of carbapenem resistant (resistant to imipenem and meropenem) A. baumannii, were observed. Disc diffusion and VITEK were used for antibiotic susceptibility testing. Resultes: Three distinct strains were detected by PFEGE and were designated as UKIM01AC-1 (5 strains),UKIM01AC-2 (two strains) and 642/2 (one strain). UKIM01AC-1 representatives were PCR positive for bla (OXA-23-like), in addition to the bla (OXA- 51-like) gene which is intrinsic in Acinetobacter baumannii. All isolated strains belonged to European clone II lineage. Conclusion: This clone dispersed very fast in 2012 and achieved the rate of 61.9%. This implicated changes in infection control precautions. Keywords: Acinetobacter, Carbapenem Resistance, Clonal Distribution, Endemic ECO Syste

Implementation of Proper Hand Hygiene among Microbiological Laboratory Workers Respectively to WHO Guidelines

Background: Hand hygiene has a fundamental role in the prevention of one of the most challenging problems in the management of modern hospitals: nosocomial infections and occupational diseases. Aim: This survey presents the experience of laboratorians in the Microbiology Department in the Clinical Center in Skopje in promoting proper hand hygiene by participating in a training course and implementation of WHO guidelines among laboratory staff. Material and Methods: The group of 36 Health Care Workers (HCW) has been divided in to seven different groups, based on their specific work in the Institute of Microbiology. The investigation was conducted in two phases: phase-1 was before the training course and phase-2 immediately after taking the training course. During phase-2, hand samples were taken with the technique of the moist swab on the left hand and the fingertips touch method on the right hand. Results: It was found that 17% of the cultures from the left hand detected pathogenic bacteria and 39% on the samples taken from the right one (there is significant difference (p = 0.041). Conclusion: The Touch Method appears to be the more sensitive method than swabbing the critical areas of the palms. It is also evident (significant) that awareness of the problem of the staff, obtain some changes in their attitude and practice

Health safety on plastic materials that come into contact with food and children toys about migration of primary aromatic amines examination in IPH- Skopje in period 01.01.2013 – 31.12.2013

Humans can be exposed to primary aromatic amines (PAAs) by the usage of a variety of synthetic products which come in contact with food and plastic children toys. PAAs are mainly originated from synthetic azo dyes widely applied as colorants on plastics and also from the use of adhesives based on polyurethanes (PU) in laminated food packing materials. Legislation introduced in the European Union countries limiting the migration level of PAAs into foodstuffs is 0.01 mg/kg. Aim of the study was establishing method for routine examination of PAAs in items made of plastics that come into direct contact with food and plastic toys. Material and Methods: Quantitative determination of sum of PAAs, expressed as aniline on 727 items of which 363 plastic toys, and 364 plastic containers, plastic utensils and plastic items that come in direct contact with food. Was using spectrophotometric method based on diazotization of PAAs and subsequent coupling of the obtained diazonium salts with N-(1-naphthyl) ethylenediamine dihydrochloride. Calibration was carried out using known amounts of aniline hydrochloride as standard. Detection limit (DL) and quantification limit (QL) evaluated for direct spectrophotometric method amounted to 0,000715 mg/l and 0,002165 mg/l, respectively. Only 6 tested samples were not correct in terms of increased concentration of PAAs in simulant solution. From the faulty samples 4 were toys, and 2 black kitchen sets which coming in contact with food. Conclusion: Requires increased sanitary inspection market, amid frequent occurrence of PAAs in plastic kitchen utensils, especially kitchen utensils in black and children toys made in China. Keywords: Food Contact Materials (FCM), Toys, Primary Aromatic Amines (PAAs), Migration, Safet

Unusual appearance of Stenotrophomonas maltophilia in entubated patients hospitalized in Clinic for anestesiology, reanimation and intensive care) - KARIL Skopje

Stenotrophomonas maltophilia-associated infection is increasingly recognized as an nosocomial infection which occurs, in immunosuppressed individuals but not exclusively. Many strains of the bacterium manifest resistance to multiple antibiotics. It is considered an environmental bacterium, although little is known of the epidemiology of S. maltophilia, its sources and reservoirs. Even less is known of pathogenic mechanisms and virulence factors and this, reflects over difficulties in distinguishing colonization from true infection, which has fostered the view that the bacterium is essentially non-pathogenic.This study is generaly case report of unusual isolation of originated from medical devices (endotracheal tubes) used to support immunosuppressed surgical patients in KARIL and attempt to distinguish colonization from infection. During our continious monitoring procedure in KARIL, we have isolated 9 multi-drug resistant strains of Stenotrophomonas maltophilia (100% resistance to cefixime, ceftriaxone, cefuroxime, cefotaxime, coamoxiclav,imipenem). Automatic VITEK technique has been used for identification as well as for antibiotik susceptibility testing, to confirm traditional microbiological tecniques (morphology of colonies on blood agar plates and positive oxidase test,diskdifussion method and E-test).All patients suffered from traumatic haemoragical shock syndrome. Clinical significance has been confirmed in 2 cases with clinical signs for lower respiratory infection (high body temperatute 38.5oC, and Ro confirmation). These patients have been treated with clindamycin and ceftriaxone with recovering period in 4 days. Keywords:Stenotrophomonas maltophilia, ICU, clinical significance, endotracheal tub

Chronic kidney disease – public health problem in Republic of Macedonia

Main goal: The goal of the study is to determine the distribution and to test the significance of differences between patients with chronic kidney disease who are treated with ambulatory and hospital haemodialysis in Institute of Nephrology – Struga in agreement with the gender, age, place of living (city/village), nationality, marital status, level of education, social status, primary disease, duration of the primary disease, duration of the haemodialysis treatment; To evaluate the patients’ satisfaction of the way of communication with the health care personnel, the information about their health condition and further treatment provided by the doctors, as well as retention of the right of equal treatment while providing health care. Materials and methods: The research was conducted in the Institute of Nephrology – Struga, in the period from 01 November to 01 December 2011. In the study were included and analyzed a total of 80 patients who were on haemodialysis in the institute in the test period, in which the patients were divided in two test groups: (N1) – Patients on chronic haemodialysis program (CHP) which receive ambulatory dialysis 2 to 3 times a week, that mainly live in the Ohrid – Struga region and (N2) – patients on CHP which do dialysis in a hospital, because the lack of space in the Centre for haemodialysis in or near the place of living. Because of that they are obligated on hospitalization in the Institute for Nephrology in Struga. Results: According to the patients’ gender, the occurrence was almost equal in men and women (p = 0,8473). The examinees, whose haemodialysis was performed ambulant (N1), were approximately 56,8 ± 11,5 years old, while the patients who were done a hospital treatment (N2) were 60,3 ± 15 years old – the differences were not significant (p = 0,2386). According to the nationality, between the examinees from both groups, there is a significant difference (p = 0,0354). Bad social status was confirmed by 18 (45%) patients that were treated ambulatory and 17 (42,5%) patients who were treated in a hospital. In both groups, in most of the cases (35% of N1 and 40% of N2), as a primary disease which led to CKD stadium 5 was noted chronic glomerulonephritis. According to the age of the patients during the diagnostic procedure of the primary disease there is no significant difference between the patients of the both groups (p = 0,0652). From the total of 80 examinees included in the study, 50 (62,5%) consider that they have an equal treatment as the other patients on haemodialysis in the country. Concluson: In our country, as well as the rest of the world, patients with CKD treated with haemodialysis are considered as a major public-health problem which should be solved systematically, in advantage of the patients. The country and the health institutions should find a way and resources for improving the conditions for treatment of these patients with which they will enjoy all rights that they deserve according to the Law for protection of patients’ rights. Key words: chronic kidney disease, haemodialysis, patient satisfactio