Klinicka mikrobiologie a infekcni lekarstvi最新文献

Objective: To evaluate the quality of care provided to patients with febrile neutropenia (FN) hospitalized at the Depart-ment of Infectious Diseases, Military University Hospital Prague, as a foundation for improving the management of this condition.

Material and methods: A retrospective observational analysis of patients diagnosed with the ICD-10 code D70 from 1 January 2015 to 1 June 2023. All evaluated parameters were selected primarily to facilitate the assessment of care quality and compliance with recommended practices.

Results: Of 32 evaluated patients, 19 met the criteria for FN. A history of conditions or treatments predisposing to neutropenia was noted in 74 % of patients. Seventy-four percent were admitted following evaluation or referral from an emergency department or another specialist. Blood cultures (at least two sets) were initially obtained in 80 % of cases. Antibiotics were initially administered correctly to all patients. However, considering antibiotic combinations would have been appropriate in 40 % of cases. No patients received antibiotics within one hour of initial contact with a healthcare facility. Antifungals were therapeutically administered to 58% of patients, though 37 % of these had no clear indication. A hematologist was consulted in 75 % of cases, and a stimulating factor (filgrastim) was administered in 88 % of cases. All patients were treated in isolation. An infection source was identified in 74 % of cases.

Conclusion: The analysis highlighted areas for improving the quality of care for patients with FN. Based on this study, an internal procedure is now being developed that will focus on coordination with emergency and other departments, emphasize obtaining blood cultures, and ensure the timely and correct administration of antibiotics, including their possible combinations, as well as antifungals.

Myiasis is a parasitic infestation caused by the larvae of dipteran flies, affecting living or necrotic tissues in humans and animals. It is classified into obligatory and facultative forms, depending on the relationship between the parasite and the host. Clinically, myiasis may present as cutaneous, wound, cavity, intestinal, urogenital, or blood-feeding larval infestations. Diagnosis is based on the characteristic clinical presentation, with definitive identification provided by a parasitological examination of the larvae. Treatment involves the mechanical removal of the larvae and appropriate wound care. Myiasis should be considered in the differential diagnosis of furuncular and non-healing wounds in travelers returning from tropical or subtropical regions. This article presents a case of scrotal myiasis caused by Dermatobia hominis in a traveler coming back from Ecuador. Keywords: myiasis, larvae, travel-related infection.

Acute bacterial skin and soft tissue infections represent a common clinical problem, and accurate diagnosis is crucial for initiating appropriate therapy. However, conditions such as cellulitis and erysipelas can be clinically mimicked by a variety of non-infectious conditions, including eczematous, venous, lymphatic, and autoimmune diseases. This review summarizes the key differences in clinical presentation, patient history, and laboratory findings that help distinguish true infections from their non-infectious mimickers. Special attention is given to conditions such as microbial eczema, herpes zoster, stasis dermatitis, lymphedema, vasculitis, and other less common causes. Accurate differential diagnosis is essential for preventing unnecessary antibiotic use, minimizing complications, and initiating targeted therapy. Keywords: bacterial skin diseases, soft tissue infections, cellulitis, phlegmon, erysipelas, differential diagnosis.

Skin and soft tissue infections (SSTIs) represent a diverse spectrum of conditions, including erysipelas, cellulitis, cutaneous abscesses, necrotizing fasciitis, and myonecrosis. Erysipelas and cellulitis are the most common community-acquired SSTIs. Erysipelas is typically caused by pyogenic streptococci, while cellulitis often has a staphylococcal etiology. Dia-gnosis of erysipelas and cellulitis is primarily clinical and may be supported by the NEW HAvUN scoring system. Treat-ment is based on the use of narrow-spectrum antibiotics primarily targeting gram-positive bacteria. In the Czech Republic, intramuscular forms of penicillin G (procaine penicillin G for treatment and benzathine penicillin G for prophylaxis) are used for erysipelas in certain situations for historical reasons. For cellulitis, oxacillin, flucloxacillin, or cefazolin are commonly employed. The use of broad-spectrum antibiotics is only justified when an atypical etiology is suspected (including gram-negative or anaerobic bacteria), in high-risk patient groups, or following animal bites or exposure to aquatic environments. The article also lists second-line antibiotics for patients with a beta-lactam allergy. The standard duration of antibiotic therapy should not exceed 10 days, and it is often shorter (five to seven days). In cases of necrotizing fasciitis or myonecrosis, early diagnosis, prompt surgical intervention, intensive care, and antibiotic treatment - typically a combination of a beta-lactam and clindamycin, based on the likely pathogen and entry site - are crucial. The text highlights the importance of sound clinical judgment and appropriate antibiotic use as essential strategies to prevent the overuse of broad-spectrum antibiotics and curb antimicrobial resistance. Keywords: erysipelas, cellulitis, skin abscess, necrotizing fasciitis, myonecrosis.

Capnocytophaga spp. are typical members of the commensal microflora of the oral cavity. However, C. canimorsus can also be a dangerous pathogen, often causing fatal systemic infections, usually from contact with the saliva of dogs or cats. The article discusses the clinical significance of zoonotic infections with this bacterium as well as its natural occurrence, pathogenic adaptation, and the current problem of antimicrobial resistance. Keywords: Capnocytophaga spp., zoonosis, bite wound infection, oral microflora.

Introduction: Correct and safe use of personal protective equipment (PPE) is a basic competency for nurses. We asked doctors about the level of knowledge, skills, and proficiency they observed in nurses when using PPE in their workplace during the COVID-19 pandemic.

Methods: The study had a descriptive, cross-sectional design. Representative sociological research was performed. Data were collected via a non-standardized questionnaire. The study aimed to identify doctors' views on nurses' competency in using PPE, divided into three domains: knowledge, skills, and proficiency. Data were collected using a standardized structured interview with respondents in the Czech Republic from 28 November to 18 December 2022, by 230 inter-viewers from the INRES-SONES agency. Out of 1 410 randomly selected doctors, 1 203 (85.3 %) agreed to participate in the study. This sample was representative of doctors in Czechia with respect to gender, age, and region.

Results: Of the 1 203 responding doctors, 243 (20.2 %) worked most of their time in COVID-19-dedicated units, 369 (30.7 %) in primary care and 591 (49.1 %) in units with low numbers of COVID-19 patients. The majority of the 1 203 respondents fully or partially agreed that nurses in their workplace had the necessary knowledge (87.6 %), skills (86.4 %), and proficiency (78.3 %) when using PPE. A significantly higher proportion of doctors who were not satisfied with the nurses' level of competency was noted among those who were younger and worked in hospital wards, especially in COVID-19-dedicated units.

Discussion: After more than two years of using PPE, one out of seven respondents stated that nurses in their workplace had less than the necessary knowledge (12.4 %) or skills (13.6 %). One-fifth of doctors (21.7 %) did not agree that nurses in their workplace had the necessary proficiency to use PPE properly. While respondents in private practice and primary care e usually trained nurses in PPE use and procured PPE, the lack of control over PPE procurement and training processes in COVID-19-dedicated units might have caused the lower level of satisfaction. The cross-sectional design of the study did not allow for a deeper analysis of the factors that led doctors to disagree with the statement that nurses in their workplace had sufficient knowledge, skills, and proficiency in using PPE.

Conclusion: Acquiring the necessary knowledge, skills, and proficiency in using PPE should be part of the undergraduate and postgraduate training of nurses, as well as part of the plans for the preparedness of healthcare teams for any future viral respiratory pandemic.

Objectives: The aim of this study was to compare methicillin-resistant Staphylococcus aureus (MRSA) isolates originating from the human population (hospitalized patients) with those from the animal sector (livestock and companion animals).

Material and methods: Over an 11-month period from 2023 to 2024, MRSA isolates were obtained from both human and animal sources. The collected bacterial strains underwent antimicrobial susceptibility testing using the standard microdilution method according to EUCAST criteria. Additionally, a molecular biological analysis was performed to detect the presence of the mecA/C genes, selected virulence factors (PVL, TSST-1, enterotoxins, and exfoliatins), and spa type classification.

Results: From clinical samples obtained from patients at the University Hospital Olomouc and the Military Hospital in Olomouc, 3 189 Staphylococcus aureus (SA) isolates were detected. Of these, 60 were identified as MRSA using standard laboratory methods (2 % prevalence). These isolates were most frequently classified as spa type t003 (45 %), with 89 % of the identified MRSA isolates possessing at least one of the selected virulence genes. In 19 % of the isolates, genes for Panton-Valentine leukocidin (PVL) were identified. In animal samples (a total of 113 SA isolates), the MRSA prevalence was 17 %, with the most common spa type being t034 (53 %). The MRSA isolates of animal origin did not possess any of the tested virulence factors.

Conclusions: The low observed prevalence of MRSA in humans indicates effective adherence to hygiene standards in healthcare facilities. Conversely, the high carriage rate of MRSA in the animal population should not be overlooked. Companion animals colonized by MRSA may pose a risk to themselves and their owners. Livestock colonized by MRSA strains may present a potential risk to personnel handling them and could also serve as a source of contaminated food products.

Artificial intelligence (AI) is no longer confined to the realm of science fiction; it has become an integral part of many fields, including healthcare. This article provides a concise overview of AI's history, operating principles, and specific applications in medicine, particularly in imaging techniques, medical documentation analysis, and clinical decision support. Although AI offers numerous benefits, such as faster diagnosis and improved predictive accuracy, its use faces significant challenges, including the potential for errors, ethical dilemmas, and the risk of misuse. Successful implementation hinges on rigorous validation, transparency, and integration with expert clinical judgment. Future developments will likely focus on improving algorithm accuracy, strengthening resilience against bias, and ensuring the safe application of AI for patient benefit - all through multidisciplinary collaboration. Keywords: artificial intelligence, machine learning, deep learning, neural networks, healthcare, diagnosis, imaging techniques, data analysis, clinical decision-making, AI ethics, safety, medical informatics.

A 35-year-old woman with Crohn´s disease who was receiving long-term immunosuppressive therapy with azathioprine developed a primary cytomegalovirus (CMV) infection, likely transmitted by her son after he started attending kindergarten. The infection took a severe course, characterized by a high viral load, sepsis, and subsequent CMV pneumonitis requiring mechanical ventilation. The patient was successfully treated with intravenous ganciclovir to which she responded favorably. At a follow-up three months after discharge, she was in good clinical condition, with no pathological findings on a high-resolution CT scan of her lungs. This case highlights the risk of severe primary CMV infection in immunosuppressed patients and underscores the importance of early diagnosis and appropriate antiviral therapy. Keywords: cytomegalovirus, primary infection, immunosuppression, sepsis, pneumonitis, ganciclovir.

Due to increasing bacterial resistance to a wide range of antibiotics, there is a renaissance of colistin, an old polymyxin antibiotic that was previously abandoned for its adverse effects and is now increasingly used worldwide as a reserve antibiotic, especially in intensive care patients. Given the global increase in the prevalence of multidrug-resistant bacteria, this study focuses on secondary colistin resistance in clinically significant gram-negative non-fermenting bacteria Acinetobacter baumannii, Pseudomonas aeruginosa and Stenotrophomonas maltophilia at the University Hospital Olomouc in 2018-2023. According to the results of the present study, the prevalence of colistin-resistant isolates of Acinetobacter baumannii, Pseudomonas aeruginosa and Stenotrophomonas maltophilia at the hospital was 1 %, 2 % and 45 %, respectively, with none of the species showing an increasing trend over the six-year period. Additionally, no increase in the prevalence of multidrug-resistant and extensively drug-resistant isolates was observed in colistin-resistant gram-negative non-fermenting bacteria. The highest proportion of colistin-resistant Stenotrophomonas maltophilia strains was detected in departments providing the highest level of acute intensive care, which correlates with the nature of these facilities. Colistin consumption peaked in the COVID-19 year 2021, but returned to its original level by the end of the study period. In the selected set of colistin-resistant Pseudomonas aeruginosa isolates, no plasmid-mediated mcr 1-5 genes were detected. A significant finding was the detection of clonal spread of colistin-resistant Pseudomonas aeruginosa strains between acute admission and intensive care units, em-phasizing the need for strict adherence to preventive measures in these departments.