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

Exacerbations of chronic rhinosinusitis : microbiology and perspectives of phage therapy

The chronically inflamed mucosa in patients with chronic rhinosinusitis (CRS) can additionally be infected by bacteria, which results in an acute exacerbation of the disease (AECRS). Currently, AECRS is universally treated with antibiotics following the guidelines for acute bacterial rhinosinusitis (ABRS), as our understanding of its microbiology is insufficient to establish specific treatment recommendations. Unfortunately, antibiotics frequently fail to control the symptoms of AECRS due to biofilm formation, disruption of the natural microbiota, and arising antibiotic resistance. These issues can potentially be addressed by phage therapy. In this study, the endoscopically-guided cultures were postoperatively obtained from 50 patients in order to explore the microbiology of AECRS, evaluate options for antibiotic treatment, and, most importantly, assess a possibility of efficient phage therapy. Staphylococcus aureus and coagulase-negative staphylococci were the most frequently isolated bacteria, followed by Haemophilus influenzae, Pseudomonas aeruginosa, and Enterobacteriaceae. Alarmingly, mechanisms of antibiotic resistance were detected in the isolates from 46% of the patients. Bacteria not sensitive to amoxicillin were carried by 28% of the patients. The lowest rates of resistance were noted for fluoroquinolones and aminoglycosides. Fortunately, 60% of the patients carried bacterial strains that were sensitive to bacteriophages from the Biophage Pharma collection and 81% of the antibiotic-resistant strains turned out to be sensitive to bacteriophages. The results showed that microbiology of AECRS is distinct from ABRS and amoxicillin should not be the antibiotic of first choice. Currently available bacteriophages could be used instead of antibiotics or as an adjunct to antibiotics in the majority of patients with AECRS

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

The general status of patients and limited physical activity as risk factors of Methicillin-resistant Staphylococcus aureus occurrence in long-term care facilities residents in Krakow, Poland

BACKGROUND: The aim of this study was to investigate the epidemiology and resistance of methicillin-resistant Staphylococcus aureus (MRSA) isolates from long-term care facilities (LTCF) residents and to analyze the potential risk factors for MRSA occurrence, defined as MRSA colonization and/or infection. METHODS: Point prevalence (PPS) and prospective incidence continuous study (CS) was carried out on a group of 193 residents in 2009-2010. RESULTS: Overall MRSA occurred (with or without infection) among 17.6% of residents. There was 16 cases of infections with SA aetiology, of which 10 (58.8%) were caused by MRSA. The MRSA prevalence in PPS was 12.9%, in CS infection incidence rate was 5.2%. Factors associated with MRSA occurrence were: general status of patients, limited physical activity, wound infections (odds ratio, OR 4.6), ulcers in PPS (OR 2.1), diabetes (OR 1.6), urinary catheterization (OR 1.6) and stool incontinence (OR 1.2). CONCLUSIONS: Our data indicate a need for screening of MRSA before hospitalization or transfer to rehabilitation centres, especially in a group of residents with limitations in physical activity – i.e. with the highest risk of MRSA. Results also suggest the need for contact precautions in patients with high risk of MRSA occurrence, only. Focus on the high-risk population might be a solution for the cost-effective surveillance

Age and other risk factors of pneumonia among residents of Polish long-term care facilities

SummaryBackgroundPneumonia is one of the leading causes of morbidity and mortality in the elderly population. Nursing home-acquired pneumonia (NHAP) is probably the largest health problem in long-term care facilities (LTCFs). It is the second most common infection in LTCFs and frequently requires hospitalization. The aim of this study was to investigate the incidence rate of NHAP among LTCF residents, its microbial etiology, and the frequency of multidrug-resistant microorganisms. Risk factors for NHAP were analyzed.MethodsThis was a prospective study conducted on a group of 217 elderly subjects aged ≥65 years, recruited from the inhabitants of LTCFs, with disabled elderly individuals living in the community serving as controls. Continuous surveillance was carried out from December 1, 2009 to November 30, 2010.ResultsThe incidence rate of NHAP in the observed population of Polish residents was 0.6/1000 resident-days. Vulnerability to NHAP was due to the poor general condition of residents, expressed by low Barthel index values (relative risk (RR) 1.6), the activities of daily living (ADL) score (RR 1.7), the Katz scale (RR 1.2), and limited physical activity (RR 1.6). Also significant were malnutrition (RR 2.3), the use of a bladder catheter (RR 1.3), dysphagia (RR 1.7), tracheotomy tube (RR 3.1), and gastric feeding tube (RR 3.5). Enterobacteriaceae were the predominant etiological agents of NHAP (56.3%).ConclusionsThe significance of risk factors for NHAP among residents in LTCFs was confirmed. Unfortunately, we also found that a lack of proper supervision with regard to the microbiology of infections is characteristic of Polish health care and LTCFs. There is an opportunity to improve the medical care of patients with severe disabilities, limit the rise in antimicrobial resistance and the need for hospitalization, and improve the prognosis

Virulence factors genes and drug resistance in Pseudomonas aeruginosa strains derived from different forms of community and healthcare associated infections

Background: The pathogenesis of Pseudomonas aeruginosa (PA) infection is multifactorial and depends mainly on two types of virulence determinants: virulence factors involved in acute infections and membrane bound factors, and virulence factors involved in chronic infections. The aim of this laboratory-based study was to analyse the resistance and virulence of PA strains isolated from different types of infections in hospitalised and non-hospitalised patients in Southern Poland. Material/Methods: Non-repetitive samples from urinary tract infections (UTI), bloodstream infections (BSI) and pneumonia (PNU) were collected. Isolates were screened for the presence of virulence factors by PCR method. Antimicrobial susceptibility testing was performed using disc diffusion method. Metallo-beta-lactamases (MBLs) were detected using an imipenem-EDTA double-disc synergy test. Results: There were 232 specimens collected: UTI-152, PNU-69, BSI-11. Fifty-one (22%) strains were classified as multidrug resistant (MDR), 23 (10%) as extensively-drug resistant (XDR). MDR/XDR strains were more frequently isolated from pneumonia (OR = 2.28). The prevalence values for the genes of effector proteins were 82.8% for exoS, 89% for exoY, and 24% for exoU. The simultaneous detection of four effector proteins was confirmed in 10.4% of the strains. pilB was more prevalent in isolates from the elderly (p=0.013). lasB occurred more frequently in PNU (p=0.048). Three of the genes were more prevalent in isolates from patients hospitalised in ICU (lasB (p=0.017), aprA (p=0.022), phzS (p=0.039)). Conclusions: Understanding the contribution of selected virulence genes to the outcome of an infection may be important for the therapeutic management of patients infected with PA. Simultaneous detection of virulence factors and antimicrobial resistance might be particularly useful because both are clinically important during an infection