Răspândirea mondială a enterobacterales carbapenemrezistente

Introduction. Gram-negative bacilli belonging to the order Enterobacterales are normal inhabitants of the human gut, which also are the most common causative agents of both nosocomial and community acquired infections in patients of all ages. Although not even a century has passed since Fleming's discovery of penicillin, the scientists have been alarmed by the fact that the "last resort antibiotics" viz. carbapenems have been compromised. Material and methods. The analysis of fifty-two articles and documents regarding this topic was peformed. Results. The main mechanism of resistance to carbapenems in Enterobacterales is production of carbapenemases, being enzymes that destroy all or almost all β-lactam antibiotics including carbapenems. According to Ambler’s classification β-lactamases can be distributed into four classes (A, B, C, and D) being based on primary amino acid sequence homology. The most important carbapenemases produced by Enterobacterales belong to class A (KPC), class B (metallo-β-lactamases NDM, VIM, IMP) and class D (OXA-48-like). Unlike other mechanisms of resistance, carbapenemase production is easily spread via plasmids making carbapenemase-producing Enterobacterales (CPE) a global challenge for healthcare providers. Conclusions. CPE are not readily detected in the laboratory but the ability to detect carbapenemase production in Enterobacterales has very important infection control implications and therefore is essential for local infection control programs and national and international surveillance systems. Furthermore, local epidemiology of multidrug resistant organisms has major influence on development of national clinical guidelines for antimicrobial use.Introducere. Bacilii gramnegativi din ordinul Enterobacterales habitează la nivelul intestinului uman, dar în același timp sunt și cei mai comuni agenți cauzali ai infecțiilor nozocomiale și comunitare la pacienții de toate vârstele. Deși nu a trecut nici măcar un secol de la descoperirea penicilinei de către Fleming, suntem deja într-o situație îngrijorătoare în care „antibioticele de ultimă instanță”, carbapenemele, au fost compromise. Material şi metode. Au fost analizate cincizeci și două de articole și documente pe tema analizată. Rezultate. Mecanismul principal de rezistență la carbapeneme la Enterobacterales este producerea enzimelor carbapenemaze, care distrug toate sau aproape toate antibioticele β-lactamice, inclusiv carbapenemele. Conform clasificării Ambler, β-lactamazele pot fi distribuite în patru clase (A, B, C și D) pe baza omologiei primare a secvenței aminoacizilor. Cele mai importante carbapenemaze produse de Enterobacterales aparțin clasei A (KPC), clasei B (metallo-β-lactamaze NDM, VIM, IMP) și clasei D (OXA-48-like). Spre deosebire de alte mecanisme de rezistență, producerea de carbapenemaze este ușor răspândită prin intermediul plasmidelor, făcând Enterobacterales (CPE) producătoare de carbapenemază o provocare globală pentru lucrătorii medicali. Concluzii. Nu este uşor de detectat CPE în laborator, dar abilitatea de a detecta producerea de carbapenemaze la Enterobacterales este foarte importantă în control infecției și, prin urmare, este esențială pentru programele locale de control al infecțiilor și sistemele de supraveghere naționale și internaționale. Mai mult, epidemiologia locală a organismelor multirezistente are o influență majoră asupra dezvoltării ghidurilor clinice naționale pentru utilizarea antimicrobienelor

The Efficacy of Gaseous Ozone on Some Cariogenic Bacteria

The aim of this study is to analyze ozone impact on some cariogenic bacteria in ex vivo and in vitro conditions. The in vitro part of study inoculated dentine with strains of Streptococcus mutans ATCC 33402 and Lactobacillus paracasei ATCC 11974 bacteria. Samples of dentine before and after 40s ozone treatment were collected and anaerobically incubated. Samples of cariogenic dentine (N=24) were collected from permanent molars within the ex vivo segment of the study, prior and after 40s ozone treatment and a number of colonies were counted after incubation. For the in vitro part of study, results have shown a statistically significant average value of reduction of Streptococcus mutans ATCC 33402 and Lactobacillus paracasei ATCC 11974 prior and after ozone treatment (p<0.001). The ex vivo segment of the study has also demonstrated a statistically significant difference in the number of bacteria prior and after ozone implementation (p<0.001). Gaseous ozone demonstrated a strong antimicrobial effect on cariogenic bacteria in both in vitro and ex vivo conditions and it can be used as an adjuvant in caries therapy

The Croatian version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR)

The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) is a new parent/patient reported outcome measure that enables a thorough assessment of the disease status in children with juvenile idiopathic arthritis (JIA). We report the results of the cross-cultural adaptation and validation of the parent and patient versions of the JAMAR in the Croatian language. The reading comprehension of the questionnaire was tested in 10 JIA parents and patients. Each participating centre was asked to collect demographic, clinical data and the JAMAR in 100 consecutive JIA patients or all consecutive patients seen in a 6-month period and to administer the JAMAR to 100 healthy children and their parents. The statistical validation phase explored descriptive statistics and the psychometric issues of the JAMAR: the 3 Likert assumptions, floor/ceiling effects, internal consistency, Cronbach\u2019s alpha, interscale correlations, test\u2013retest reliability and construct validity (convergent and discriminant validity). A total of 100 JIA patients (7% systemic, 38% oligoarticular, 19% RF negative polyarthritis, 36% other categories) and 100 healthy children, were enrolled in the paediatric rheumatology centres of the Clinical Hospital Center Sestre Milosrdnice and Childen\u2019s Hospital Srebrnjak in Zagreb. The JAMAR components discriminated well healthy subjects from JIA patients. All JAMAR components revealed satisfactory psychometric performances. In conclusion, the Croatian version of the JAMAR is a valid tool for the assessment of children with JIA and is suitable for use both in routine clinical practice and clinical research

Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis

Background: Infections due to antibiotic-resistant bacteria are threatening modern health care. However, estimating their incidence, complications, and attributable mortality is challenging. We aimed to estimate the burden of infections caused by antibiotic-resistant bacteria of public health concern in countries of the EU and European Economic Area (EEA) in 2015, measured in number of cases, attributable deaths, and disability-adjusted life-years (DALYs). Methods: We estimated the incidence of infections with 16 antibiotic resistance–bacterium combinations from European Antimicrobial Resistance Surveillance Network (EARS-Net) 2015 data that was country-corrected for population coverage. We multiplied the number of bloodstream infections (BSIs) by a conversion factor derived from the European Centre for Disease Prevention and Control point prevalence survey of health-care-associated infections in European acute care hospitals in 2011–12 to estimate the number of non-BSIs. We developed disease outcome models for five types of infection on the basis of systematic reviews of the literature. Findings: From EARS-Net data collected between Jan 1, 2015, and Dec 31, 2015, we estimated 671 689 (95% uncertainty interval [UI] 583 148–763 966) infections with antibiotic-resistant bacteria, of which 63·5% (426 277 of 671 689) were associated with health care. These infections accounted for an estimated 33 110 (28 480–38 430) attributable deaths and 874 541 (768 837–989 068) DALYs. The burden for the EU and EEA was highest in infants (aged <1 year) and people aged 65 years or older, had increased since 2007, and was highest in Italy and Greece. Interpretation: Our results present the health burden of five types of infection with antibiotic-resistant bacteria expressed, for the first time, in DALYs. The estimated burden of infections with antibiotic-resistant bacteria in the EU and EEA is substantial compared with that of other infectious diseases, and has increased since 2007. Our burden estimates provide useful information for public health decision-makers prioritising interventions for infectious diseases

Self-medication with Antimicrobial Drugs in Europe

Antimicrobial drug self-medication occurs most often in eastern and southern Europe and least often in northern and western Europe

MRSA surveillance programmes worldwide : moving towards a harmonised international approach

Multinational surveillance programmes for methicillin-resistant Staphylococcus aureus (MRSA) are dependent on national structures for data collection. This study aimed to capture the diversity of national MRSA surveillance programmes and to propose a framework for harmonisation of MRSA surveillance. The International Society of Antimicrobial Chemotherapy (ISAC) MRSA Working Group conducted a structured survey on MRSA surveillance programmes and organised a webinar to discuss the programmes’ strengths and challenges as well as guidelines for harmonisation. Completed surveys represented 24 MRSA surveillance programmes in 16 countries. Several countries reported separate epidemiological and microbiological surveillance. Informing clinicians and national policy-makers were the most common purposes of surveillance. Surveillance of bloodstream infections (BSIs) was present in all programmes. Other invasive infections were often included. Three countries reported active surveillance of MRSA carriage. Method- ology and reporting of antimicrobial susceptibility, virulence factors, molecular genotyping and epidemiological metadata varied greatly. Current MRSA surveillance programmes rely upon heterogeneous data collection systems, which hampers international epidemiological monitoring and research. To harmonise MRSA surveillance, we suggest improving the integration of microbiological and epidemiological data, implementation of central biobanks for MRSA isolate collection, and inclusion of a representative sample of skin and soft-tissue infection cases in addition to all BSI cases.peer-reviewe