Kolonizacija vankomicin rezistentnom bakterijom Enterococcus faecium i Clostridium difficile infekcija u hematološke bolesnice

Vancomycin-resistant enterococci (VRE), especially Enterococcus faecium, have emerged as significant nosocomial pathogens and patients with impaired host defenses are at a particular risk of VRE infection. The most common occurrence is asymptomatic colonization of the gastrointestinal tract that can persist for a long time and serve as a reservoir for transmission of VRE to other patients. We present a case of a patient who was diagnosed with acute myelogenous leukemia and suffered from bone marrow aplasia following induction therapy. The patient received prolonged broad-spectrum antimicrobial therapy. During hospital stay, the patient developed Clostridium difficile infection (CDI) and was found to be colonized with a strain of Enterococcus faecium resistant to vancomycin during therapy for CDI. This case also highlights the role of risk factors that could contribute to development of resistance, particularly CDI. Early detection of VRE colonization or infection is a crucial component in hospital program designed to prevent transmission of nosocomial infections. Surveillance cultures of such patients should be mandatory.Vankomicin-rezistentni enterokoki (VRE), naročito Enterococcus faecium, spadaju među najznačajnije bolničke patogene, pri čemu su naročito ugroženi bolesnici oslabljenog imunosnog statusa. Pritom je najčešća pojava asimptomatske kolonizacije probavnog sustava koja može ustrajati duže vremena i biti rezervoar za širenje VRE na ostale bolesnike. Donosimo prikaz slučaja bolesnice s dijagnozom akutne mijelomonocitne leukemije praćene aplazijom koštane srži nakon indukcijske terapije. Bolesnica je liječena antibioticima širokog spektra. Tijekom hospitalizacije u bolesnice se razvila infekcija bakterijom Clostridium difficile (CDI) uz dokazanu kolonizaciju sojem Enterococcus faecium rezistentnog na vankomicin tijekom terapije zbog CDI. Također su prikazani čimbenici rizika koji su u navedenom slučaju mogli poslužiti kao potencijalni okidač za razvoj rezistencije, s osobitim naglaskom na CDI. Rano otkrivanje kolonizacije ili infekcije navedenim sojevima je iznimno značajan čimbenik bolničkog programa za prevenciju širenja bolničkih infekcija. Mikrobiološki nadzor uzimanjem nadzornih kultura mora biti obvezni dio protokola pri hospitalizaciji takvih bolesnika

Klinički prikaz genitourinarne tuberkuloze sa sumnjom na abdominalnu neoplazmu

Genital tuberculosis is a rare and unexpected disease in European countries including Croatia. Diagnosis of female genital tract tuberculosis is challenging and is rarely pin-pointed by clinical symptoms because of their low specificity. The authors decided to present a case of genitourinary tuberculosis in a young, immunocompetent fertile woman with high clinical suspicion of abdominal tumor mass. Although considered a desease of the past, rare clinical presentation of genital tuberculosis should be expected and taken into account.Genitalna tuberkuloza rijetka je i neočekivana bolest u zemljama Europske unije uključujući i Hrvatsku. Postavljanje dijagnoze tuberkuloze genitalnog sustava otežano je nespecifičnim simptomima. Prikazujemo slučaj genitourinarne tuberkuloze kod mlade imunokompetentne žene generativne dobi gdje je klinička dijagnoza upućivala na abdominalnu neoplazmu. U vremenu velikih društvenih promjena prisutnih posljednjih godina rijetke kliničke prezentacije tuberkuloze i dalje su moguće kao diferencijalna dijagnoza

Comparison of the novel Uroquattro HB&L™ system and classical phenotypic method for rapid screening of multidrug-resistant organism colonization at the University Hospital Centre Split, Croatia

Uvod: Infekcije uzrokovane višestruko otpornim organizmima (MDRO) se teško liječe i često imaju nepovoljan ishod za bolesnika. Budući da infekciji najčešće prethodi kolonizacija, rana identifikacija koloniziranih bolesnika je neophodna u prevenciji nastanka infekcije. Za probir MDRO najčešće se koriste kultivacijske metode kojima vrijeme potrebno za izdavanje nalaza (TAT) iznosi od 48 do 72 h. Cilj ove studije bio je usporediti rezultate nove, brze, poluautomatske metode za detekciju MDRO (HB&L Uroquattro, Alifax) sa standardnom kultivacijom na selektivnim podlogama. Metode/materijali: Tijekom dva nasumično odabrana dana, bolesnicima hospitaliziranima u Kliničkom bolničkom centru Split, uzorkovano je ukupno 21 aksilarnih, 19 rektalnih te 20 briseva vestibuluma nosa. Svaki obrisak je prikupljen u duplikatu, jedan za kultivacijsku, a drugi za brzu poluatomatsku metodu. Brisevi su kultivirani i MDRO izolati identificirani na selektivnim podlogama (Chromagar MRSA i Chromagar ESBL) prema standardnom laboratorijskom protokolu. Nova Alifaxova metoda je provedena prema uputama proizvođača. Rezultati: U usporedbi s klasičnom metodom, TAT nove metode je bio značajno kraći (6,5 h). Klasičnom metodom je na Chromagar ESBL selektivnom mediju izolirano 10 sojeva koji stvaraju ß-laktamaze proširenog spektra (ESBL) iz 10 različitih rektalnih uzoraka. Isti uzorci su bili pozitivni na prisustvo ESBL- producirajućih bakterija brzom Alifaxovom metodom. Kultivacijom na selektivnom Chromagar MRSA mediju i brzom metodom otkriveno je 11 uzoraka pozitivnih na prisustvo MDRO. Zaključak: Visoki stupanj podudarnosti otkrivanja pozitivnih i negativnih uzoraka dobiven klasičnom i novom metodom, kao i značajno skraćivanje TAT-a novom metodom je ohrabrujući. Budući je studija provedena na relativno malom uzorku, potrebno je istraživanje proširiti na veći broj ispitanika.Background. Infections caused by multidrug-resistant organisms (MDRO) are difficult to treat and associated with poor outcomes for patients. Therefore, early identification and management of colonization are essential as first steps in infection prevention. Culture-based methods have been widely used for MDRO screening. The turnaround time (TAT) for the identification of carriers varies between 48-72 h with this method. The aim of our study was to compare the performance of the new rapid semiautomatic method for detection of MDRO (HB&L Uroquattro, Alifax) with standard cultivation on selective media. Methods. Twenty-one axillary, 20 nose and 19 rectal swabs were taken in duplicate on two selected days at the University Hospital Centre Split, Croatia. Swabs were cultivated and MDRO isolates were identified on selective media (Chromagar MRSA and Chromagar ESBL) according to the standard operating procedure. Novel Alifax method was performed according to manufacturer’s instructions. Results. TAT for the new method was significantly lower (6.5 h) in comparison to the classical method. With classical method, 10 extended spectrum ß-lactamases (ESBL) producing strains from 10 different rectal specimens were isolated on Chromagar ESBL media. Exactly the same specimens were positive for the presence of ESBL-producing bacteria by rapid Alifax method. On selective Chromagar MRSA media, 11 MDRO were isolated, while rapid method detected 11 MDRO from the same specimens. Conclusions. High concordance of positive and negative results obtained with classical and rapid method is encouraging. However, our study was performed on a small sample size and further research with larger sample size is needed