The frequency of most common organisms causing urinary tract infection in pediatric patients and their susceptibility to antimicrobial drugs

Infekcije mokracnog sustava (IMS) ceste su u djece, po ucestalosti odmah iza infekcija dišnih putova. U male djece su pokazatelj abnormalnosti mokracnog sustava, a u novorodencadi mogu biti izvor bakterijemije/sepse. Ako se pravovremeno ne otkriju i ne lijece, mogu dovesti do trajnog oštecenja bubrega i hipertenzije. Svrha ovog istraživanja bila je utvrditi ucestalost najcešcih uzrocnika IMS-a u uzorcima mokrace pacijenata Klinike za pedijatriju, te osjetljivost/otpornost tih uzrocnika na najcešce upotrebljavane antimikrobne lijekove u toj populaciji. Za urinokulture zasijano je, pomocu kalibrirane pipete, po 0,01 ml nerazrijedene mokrace na standardne cvrste hranjive podloge. Obradeno je 550 uzoraka. Iz urinokultura sa znacajnim brojem bakterija najcešce je izdvojena Ecshcerichia coli (71%), zatim Proteus mirabilis (11%), Klebsiella pneumoniae (7%), Enterococcus (7%), Pseudomonas (2%) i Morganella morganii (2%). Proteus je cešce naden u djecaka (9/15), a klebsijela u djevojcica (7/9). Od izdvojenih sojeva E. coli, 70% je otporno prema ampicilinu, a 30% prema kotrimoksazolu, pa ti lijekovi nisu prikladni za empirijsku profilaksu, ni za lijecenje. Najdjelotvorniji su cefalosporini II.i III. generacije. U pretraženom uzorku bilo je 13% ESBL-pozitivnih sojeva E. coli, 9/12 u djecaka, 6/9 u prvom mjesecu života. Preporuca se stalno pracenje spektra osjetljivosti/otpornosti u najcešce izdvojenih uzrocnika IMS-a u djece, radi procjene odabira pravog lijeka za empirijsku primjenu.After respiratory infections, urinary tract infections (UTI) are most common in pediatric patients. In young children, UTI is a marker for urinary tract abnormalities and in the newborn it may be associated with bacteraemia. In infants/early school age children it may lead to renal scarring, hypertension and rarely to the end stage renal failure. The aim of the present study was to identify the most common bacteria, causative agents of UTI in urine of pediatric patients, as well as their susceptibility to antimicrobial drugs commonly used for UTI prevention and treatment in children. Urine cultures were seeded (inoculated), 0,01 ml of undiluted urine samples, with calibrated pipette on standard nutrient media. In urine cultures with signifficant bacterial count, Escherichia coli was the most common organism isolated (71%), followed by Proteus mirabilis (11%), Klebsiella pneumoniae (7%), Enterococcus (7%), Pseudomonas (2%) and Morganella morganii (2%). Proteus is more often found in boys (9/15) and Klebsiella in girls (7/9) .Resistance against ampicillin in isolated E. coli strains were 70% against otrimoxasol 30% . Their use in empirical treatment is inadequate. In the investigated samples 13% ESBL-positive strains of E. coli were found, 9/12 in boys, 6/9 during the first month of life. To evaluate the options for empirical treatment, permanent follow up of sensitivity/resistance pattern in the most commonly isolated causative agents of UTI in pediatric patients is recommended

Mikrobiološki uzročnici kroničnog rinosinuitisa i njihova antimikrobna osjetljivost - utjecaj na antibiotsku profilaksu i liječenje

Chronic rhinosinusitis (CRS) is debilitating condition comprising inflammation of the mucosa of the nasal and paranasal sinuses, requiring conservative and often surgical treatment. Functional endoscopic sinus surgery (FESS) is a CRS treatment during which a microbiological diagnostic procedure may be conducted. Preoperative antibiotic prophylaxis is administrated before FESS. When indicated, the administered empiric antibiotic therapy must cover most common causing microbial agents. The aims of this study were to identify microbial pathogens isolated from sinonasal cavities in patients undergoing endoscopic sinus surgery, to determine bacterial antibiotic susceptibility patterns and compare them with guidelines for treatment and perioperative prophylactic use of antimicrobial agents. A retrospective cohort study on 456 samples collected between 2016 and 2019 was conducted at the Department of Otorhinolaryngology, Head and Neck Surgery and the Department of Microbiology, Parasitology and Hospital Infections in the Clinical University Centre Sestre milordnice, Zagreb. The most common isolated pathogens were Peptostreptococcus spp., Propionibacterium spp., Staphylococcus aureus, Pseudomonas spp., Fusobacterium spp. and Haemophilus influenzae. According to antibiotic susceptibility patterns, empiric antibiotic treatment with amoxicillin- clavulanic acid was appropriate. Due to high rates of antibiotic resistance of anaerobic bacterial isolates to metronidazole, it cannot be recommended in empirical antibiotic treatment or preoperative surgical antibiotic prophylaxis.Kronični rinosinuitis (KRS) je iscrpljujuće stanje koje čini upala nosne sluznice i sluznice paranazalnih sinusa, a zahtjeva konzervativnu i, ponekad, kiruršku terapiju. Funkcionalna endoskopska operacija sinusa je kirurška procedura koja se primjenjuje za KRS. Tijekom takve procedure može se vršiti i druga dodatna dijagnostika. Prije samog zahvata provodi se preoperativna antibiotska profilaksa. U tom slučaju, empirijski aplicirana antibiotska terapija treba pokrivati najčešće mikrobne uzročnike za navedeno stanje. Cilj ove studije bio je identificirati mikrobne uzročnike izolirane iz sino-nazalnih šupljina kod pacijenata koji su bili podvrgnuti endoskopskoj operaciji sinusa te im odrediti bakterijsku osjetljivost kako bi se dobiveni podaci mogli potom usporediti s trenutno važećim smjernicama za antibiotsko liječenje i perioperativnu antibiotsku profilaksu. Provedeno je retrospektivno kohortno istraživanje na 456 uzoraka prikupljenih od 2016. do 2019. godine u sklopu Klinike za otorinolaringologiju i kirurgije glave i vrata i Zavoda za mikrobiologiju, parazitologiju i hospitalne infekcije na Kliničkoj bolnici Sestara milosrdnica u Zagrebu. Najčešće izolirani patogeni bili su Peptostreptococcus spp., Propionibacterium spp., Staphylococcus aureus, Pseudomonas spp., Fusobacterium spp. i Haemophilus influenzae. Prema dobivenim antibiogramima može se zaključiti da je empirijska terapija amoksicilin-klavulanskom kiselinom za ove uzročnike zadovoljavajuća. Međutim, primjena metronidazola empirijski ili za preoperativnu kiruršku profilaksu se ne preporučuje zbog visokog udjela rezistencije na navedeni antibiotik unutar skupine anaerobnih bakterija

Sepsis and septic shock – an observational study of the incidence, management, and mortality predictors in a medical intensive care unit

Aim To prospectively determine the number of patients with sepsis and septic shock in a medical intensive care unit (ICU) using the Sepsis-3 definition; to analyze patients’ characteristics, clinical signs, diagnostic test results, treat - ment and outcomes; and to define independent risk fac - tors for ICU mortality. Methods This prospective observational study enrolled all patients with the diagnosis of sepsis treated in the medical ICU of “Sestre Milosrdnice” University Hospital Center, Za - greb, between April 2017 and May 2018. Results Out of 116 patients with sepsis, 54.3% were fe - male. The median age was 73.5 years (IQR 63-82). The lead - ing source of infection was the genitourinary tract (56.9%), followed by the lower respiratory tract (22.4%). A total of 35.3% of the patients experienced septic shock. Total ICU mortality for sepsis was 37.9%: 63.4% in patients with sep - tic shock and 24.0% in patients without shock. Indepen - dent risk factors for ICU mortality were reduced mobility level (odds ratio [OR] 11.16, 95% confidence interval [CI] 2.45-50.91), failure to early recognize sepsis in the emer - gency department (OR 6.59, 95% CI 1.09-39.75), higher Se - quential Organ Failure Assessment score at admission (OR 2.37, 95% CI 1.59-3.52), and inappropriate antimicrobial treatment (OR 9.99, 95% CI 2.57-38.87). Conclusion While reduced mobility level and SOFA score are predetermined characteristics, early recognition of sep - sis and the choice of appropriate antimicrobial treatment could be subject to change. Raising awareness of sepsis among emergency department physicians could improve its early recognition and increase the number of timely ob - tained specimens for microbial cultures

Sepsis and septic shock - an observational study of the incidence, management, and mortality predictors in a medical intensive care unit

Aim: To prospectively determine the number of patients with sepsis and septic shock in a medical intensive care unit (ICU) using the Sepsis-3 definition; to analyze patients' characteristics, clinical signs, diagnostic test results, treatment and outcomes; and to define independent risk factors for ICU mortality. ----- Methods: This prospective observational study enrolled all patients with the diagnosis of sepsis treated in the medical ICU of "Sestre Milosrdnice" University Hospital Center, Zagreb, between April 2017 and May 2018. ----- Results: Out of 116 patients with sepsis, 54.3% were female. The median age was 73.5 years (IQR 63-82). The leading source of infection was the genitourinary tract (56.9%), followed by the lower respiratory tract (22.4%). A total of 35.3% of the patients experienced septic shock. Total ICU mortality for sepsis was 37.9%: 63.4% in patients with septic shock and 24.0% in patients without shock. Independent risk factors for ICU mortality were reduced mobility level (odds ratio [OR] 11.16, 95% confidence interval [CI] 2.45-50.91), failure to early recognize sepsis in the emergency department (OR 6.59, 95% CI 1.09-39.75), higher Sequential Organ Failure Assessment score at admission (OR 2.37, 95% CI 1.59-3.52), and inappropriate antimicrobial treatment (OR 9.99, 95% CI 2.57-38.87). ----- Conclusion: While reduced mobility level and SOFA score are predetermined characteristics, early recognition of sepsis and the choice of appropriate antimicrobial treatment could be subject to change. Raising awareness of sepsis among emergency department physicians could improve its early recognition and increase the number of timely obtained specimens for microbial cultures