Klinicka mikrobiologie a infekcni lekarstvi最新文献

Blood culture is the gold standard method for identifying the etiological agents of bloodstream infections. A relatively low sensitivity and a long time to detection are its main disadvantages, resulting in delayed administration of pathogen-specific antibiotic therapy and the need to initiate empiric treatment with broad-spectrum antibiotics. Such an approach negatively affects overall treatment outcomes and contributes to the spread of antibiotic resistance. Research in recent years has allowed the introduction of methods for rapid identification of pathogenic microbes from positive blood cultures, as well as methods for direct detection of bacteria and fungi from whole blood without the need for prior culture. Direct detection tests from whole blood have dramatically reduced the time to identify the causative pathogen of a bloodstream infection, but they also have their limitations. Methods that combine PCR and T2-weighted magnetic resonance imaging appear promising. This article provides an overview of diagnostic tests and a detailed description of the T2Bacteria Panel, its advantages and disadvantages based on prospective observational studies and review articles. Future implementation of these methods in the diagnosis of bloodstream infections and potentially localized infections could have a positive impact on the early administration of pathogen-specific antimicrobial therapy and subsequently on overall treatment outcomes, as well as on reducing the spread of antibiotic resistance.

Pseudomonas aeruginosa (PSAE) is known for its ability to form biofilm and produce other virulence factors associated with a resistant phenotype. Multidrug-resistant (MDR) PSAE strains represent a serious problem in healthcare and are the focus of an increasing number of studies dealing with the therapy of infections caused by these bacteria. Nowadays, a number of studies focus on the presence of virulence factors rather than on the mechanisms of resistance to the antibiotics used, as it is the study of virulence factors that makes it possible to expand the possibilities of effective and efficient therapy. This review describes the virulence factors produced by the one of the five PSAE secretion systems that have the potential to become targets for so-called antivirulence therapy, have been described. These are mainly alkaline protease, elastase B, exotoxins A, S and Y and pyocyanin. In addition to specific virulence factors, recent studies have focused on the components of the PSAE secretion systems that mediate the transport of toxins and lytic enzymes out of the bacterial cell. Inhibition of specific molecules for type 2 and 3 secretion systems may prevent secretion of virulence factors into the extracellular space and host cells, which would have a significant impact on reducing PSAE virulence.

Objectives: The period of the COVID-19 pandemic had a significant impact on the healthcare system, including its effect on compliance with the established procedures of a rational antibiotic policy, especially in the context of nosocomial pneumonia, where it was very difficult to distinguish a possible bacterial superinfection from a severe inflammatory reaction caused by the SARS-CoV-2 virus. The aim of the present study was to analyze the antimicrobial resistance of bacterial pathogens isolated from the lower respiratory tract and their clonality in intensive care patients in 2022 and to compare it with the previous COVID-19 period.

Material and methods: Bacterial strains isolated from the lower respiratory tract (LRT) of patients hospitalized at the Department of Anaesthesiology, Resuscitation and Intensive Care, Olomouc University Hospital (DARIC) over a three-year period (January 1, 2020 - December 31, 2022) were included in the study. The susceptibility to antibiotics was determined by the standard microdilution method according to the EUCAST criteria, and selected isolates were compared using pulsed-field gel electrophoresis (PFGE).

Results: The resistance of the most common bacterial pathogens isolated from the LRT of patients hospitalized at DARIC did not change significantly during the COVID-19 (2020-2021) and post-COVID-19 (2022) periods, with the exception of Serratia marcescens and Enterococcus faecium species. These two showed an increase in the number of strains during the COVID-19 pandemic, as well as a significant increase in the proportion of resistant strains. In the case of Serratia marcescens, there was a subsequent decrease in the number of isolates and their resistance in 2022. For Enterococcus faecium, the total number of isolates also decreased significantly, but the frequency of vancomycin-resistant isolates (VRE) continued to increase. During the COVID-19 pandemic, increased VRE detection can be linked to proven clonal spread, but significant clonality was no longer confirmed in 2022. Comparison of similarity by PFGE in other bacterial species also did not reveal significant horizontal transmission between patients in the post-COVID-19 period, as most isolates (85%) showed a unique restriction profile.

Conclusions: The results indicate that the frequency and antimicrobial resistance of the majority of the most common bacterial pathogens from the LRT of patients hospitalized at DARIC in the post-pandemic period remain comparable to the time before and during the COVID-19 pandemic outbreak. An exception is Enterococcus faecium, which showed an increase in vancomycin resistance in both the COVID-19 and the post-COVID-19 periods.

In the Czech Republic, botulism is a rare life-threatening disease. A total of 155 cases have been reported since 1960; according to the ISIN (formerly EPIDAT) database, there have been only three isolated cases since 2013, with the exception of a single occurrence of familial botulism in 2013. In our work, we present the occurrence of botulism after ingestion of pâté of untraceable origin by a couple who were hospitalized for botulotoxin food poisoning in July 2022. Their neurological symptoms were dominated by dysarthria. After administration of antibotulinum serum, their condition improved significantly. Patient samples were analyzed using affinity carriers and MALDI mass spectrometry, a modern highly sensitive technique for detecting the presence of botulinum neurotoxins. Unlike traditional detection by a difficult and costly biological experiment on mice, the above analysis does not require the killing of laboratory animals.

Whole-genome sequencing (WGS) is a modern method that allows deep understanding of studied organisms and is currently gaining importance in molecular microbiology. Data obtained by whole-genome sequencing can be used for a number of different analyses, specifically in bacterial epidemiology. The authors provide an overview of the methods that are used for bacterial typing, description of their principles with subsequent possibilities for evaluation of the obtained data and applications in hospital research.

Overcoming infection with coronavirus disease 2019 (COVID-19) can lead to the persistence of various symptoms in some patients. The complex of symptoms causally related to severe acute respiratory coronavirus 2 infection is called post-COVID syndrome. One of the most common respiratory complications is pulmonary fibrosis, especially after critical course of the disease. In some patients, however, only the peripheral airways are affected by the air-trapping seen on high-resolution computed tomography scans. Less common respiratory complications include sarcoidosis and pneumatoceles. This narrative review summarizes current knowledge about pulmonary involvement as part of post-COVID syndrome.

Introduction: Chloramphenicol is an antibiotic with a broad spectrum of action and excellent tissue penetration. It had been widely used in clinical practice until the 1970s, but due to its potential myelotoxicity, it was gradually replaced by newly introduced antibiotics in the following years. The aim of the study was to find out to what extent and with what experience it is currently used in the Czech Republic.

Methods: A questionnaire survey was conducted in July and August 2022. The heads of all inpatient infectious diseases departments, hospital infectious diseases specialists and consulting microbiologists from antibiotic centers in large teaching hospitals without an infectious diseases department were asked to fill out the questionnaire.

Results: Thirty-five out of 39 hospitals contacted took part in the study, a response rate of 90 %. Chloramphenicol is used in 37 % of participating hospitals, with a frequency of up to 10 patients treated per year. The most common indications are brain abscesses, purulent meningitis, intra-abdominal, pelvic and lung abscesses, and polymicrobial infections with anaerobes. Chloramphenicol is almost always administered as an alternative antibiotic because of polyvalent allergy, bacterial resistance, and failure of previous treatment. Sixty-six percent of respondents described the effect as reliable or partially reliable, 34 % did not rate the effect. Fifty-two percent of respondents considered a dose of 8-9 g to be the maximum dose for an adult patient. In practice, 60 % of respondents did not encounter or could not assess the myelotoxic effects of chloramphenicol, 37 % observed reversible bone marrow suppression at least once, and only one respondent encountered aplastic anemia once.

Conclusion: Unfortunately, chloramphenicol is currently used in less than half of hospitals in the Czech Republic. Because of its unique properties, it still has a place in today's anti-infective treatment. When properly indicated and after weighing the benefits and risks, it can be a suitable and sometimes life-saving alternative.

Neuroleptic malignant syndrome is a life-threatening condition that can be fatal if unrecognized and inadequately treated. This disease is rarely seen in infectious diseases wards. As infectiologists, however, we are confronted with an increasingly broader spectrum of diagnoses and this disease should therefore be considered in any patient taking psychiatric medication who develops the typical symptoms of hyperthermia, rigidity and muscle tremors, autonomic lability and impaired consciousness. A case report is presented of a young man with schizophrenia admitted to the intensive care unit with COVID-19, who was treated with antipsychotics (formerly known as neuroleptics) for restlessness and who developed neuroleptic malignant syndrome. In cooperation with psychiatrists, a targeted therapy was initiated, after which the symptoms subsided and the patient's clinical condition resolved.

The updated Czech guidelines differ in some aspects from the 2021 guidelines issued by the ESCMID Study Group for Clostridium difficile. The key points of these Czech recommendations may be summarized as follows: • The drug of choice for hospitalized patients is orally administered fidaxomicin or vancomycin. In outpatients with a mild first episode of C. difficile infection, metronidazole can also be used. • If the patient's response to treatment is good and there are no complications, the duration of antibiotic treatment can be reduced (e.g. to 5 days in case of fidaxomicin or to 6-7 days in case of vancomycin). • If oral therapy is impossible, the drug of choice is tigecycline, 100 mg i.v., b.i.d., with initial shortening of the interval between the first and second doses for faster saturation. If the severity of the disease progresses during this antibiotic treatment, it is necessary to access the ileum or cecum, i.e. to perform double ileostomy or percutaneous endoscopic cecostomy, and to instill vancomycin or fidaxomicin lavages. • Fulminant C. difficile colitis should be treated with oral fidaxomicin ± tigecycline i.v. If peristalsis ceases, fidaxomicin should be administered into the ileum or cecum as described above. If sepsis develops, a broad-spectrum beta-lactam antibiotic (piperacillin/tazobactam, carbapenem) i.v. is added to topically administered fidaxomicin instead of tigecycline i.v.; at the same time, colectomy should be considered as the last resort. • To treat first recurrence, fidaxomicin or vancomycin is administered with a subsequent fecal microbiota transplant (FMT) from a healthy donor. For second or subsequent recurrence, administration of fidaxomicin is of little benefit; the therapy of choice is oral vancomycin and subsequent FMT. Prolonged vancomycin or fidaxomicin taper and pulse treatment is appropriate only when FMT cannot be performed.

Colorectal cancer is a very common malignancy with high mortality. Many factors influencing both the development and subsequent treatment, such as age, gender or genetic predisposition, are not modifiable. Others, such as stress, diet, physical activity or smoking, may be prevented by each individual. The gut microbiota is an important factor involved in both the development and treatment outcomes. With the advancing study of the gut microbiota, the relationship between its composition and various diseases is better understood. The proportions of members of the phyla Firmicutes (as beneficial microbiota) and Bacteroidetes (as mostly disease-associated microbiota) seem to be particularly important. Some studies suggest that certain bacteria may contribute to postoperative anastomotic leaks that prolong hospital stays, are a burden to patients, increase costs and may be fatal. Bacteria associated with the complication are, for example, enterococci, pseudomonads or bifidobacteria. Better understanding of the pathognomonic relationship between increased detection of certain bacteria and a complication may lead to individualized therapy aimed to reduce complications during surgical management of colorectal cancer.