Klinicka mikrobiologie a infekcni lekarstvi最新文献

Objective: This study aimed to evaluate the occurrence of methicillin-resistant Staphylococcus aureus (MRSA) at the University Hospital Olomouc (UHO) over a 10-year period (2013-2022).

Material and methods: Data was obtained from the ENVIS LIMS laboratory information system (DS Soft, Czech Republic, Olomouc) of the Department of Microbiology, UHO, for the period 1/1/2013-31/12/2022. Standard microbiological procedures using the MALDI-TOF MS system (Biotyper Microflex, Bruker Daltonics) were applied for the identification. Antimicrobial susceptibility was determined by the standard broth microdilution method according to EUCAST criteria. All Staphylococcus aureus strains were tested for methicillin resistance using selective diagnostic chromogenic media (ColorexTMMRSA, TRIOS) and an immunochromatographic test for PBP2a detection (PBP2a SA Culture Colony Test, AlereTM). Positive results were confirmed by mecA gene detection. Molecular typing to determine clonality/relatedness was performed on isolates from 2022 using pulsed-field gel electrophoresis (PFGE).

Results: The prevalence of MRSA at the UHO does not show an increasing trend and ranges between 3-6 %. The highest MRSA prevalence was detected in blood culture specimens (6 %), followed by lower respiratory tract specimens (5 %) and wound/abscess/aspirate specimens (5 %). The departments with the highest MRSA prevalence were the Geriatrics Department and the Second Internal Medicine Department. The antibiotic resistance patterns of MRSA were as follows: erythromycin 89 %, clindamycin 86 %, ciprofloxacin 80%, tetracycline 18 %, gentamicin 13 %, cotrimoxazole 7 %, and tigecycline 1 %. Resistance to antibiotics of choice for serious MRSA infections (vancomycin, ceftaroline, linezolid) was 0-1 %. Genetic analysis of selected MRSA isolates by PFGE revealed one cluster of five, two clusters of three, and two clusters of two isolates with indistinguishable restriction profiles.

Conclusion: The prevalence of MRSA at the UHO remains low, therefore oxacillin or possibly combined aminopenicillins (amoxicillin/clavulanic acid and ampicillin/sulbactam) or cefazolin can be relied upon for initial therapy of infections likely caused by Staphylococcus aureus.

Objectives: Staphylococcus aureus is part of the human microbiota, but at the same time, it is capable of causing a wide range of diseases. Due to the ever-increasing resistance to antimicrobial agents and the existence of methicillin-resistant S. aureus (MRSA) strains, there is a real possibility of carrying even this resistant bacterium, which can subsequently cause a severe infection. MRSA detection is part of microbiological examination procedures, and it is appropriate to use rapid methods for its identification, especially in high-risk patients.

Material and methods: Clinical samples from the respiratory tract of patients from the Department of Anesthesiology, Resuscitation and Intensive Medicine, and the Third Internal Medicine Department of the University Hospital Olomouc were included in this study. These were processed simultaneously using standard microbiological methods and the automated BD MAXTM system, designed for qualitative detection of bacteria directly from clinical samples using real-time PCR.

Results: Standard microbiological methods identified S. aureus in 7 % and MRSA in 1 % of respiratory samples tested. Using the automated BD MAXTM system with the StaphSR kit, S. aureus DNA was detected in 28 % of samples and MRSA DNA in 2 % of samples.

Conclusion: Direct testing of clinical samples using the BD MAXTM StaphSR system can aid in the prevention and control of infections caused by S. aureus and MRSA, especially in healthcare facilities. An important advantage of this system is that the result is available on the same day that the clinical material is delivered for microbiological testing.

This article reports a case of systemic infection caused by Pasteurella multocida. The infection was confirmed in a 79-year-old man who was admitted to the hospital after falling from a couch. The disease was manifested by the development of fever, chills, joint pain. Laboratory tests revealed elevated C-reactive protein levels, slightly elevated nitrogen metabolites, borderline leukocytosis, and thrombocytopenia. The pathogen was identified in a blood culture and a wound swab culture. The patient was initially treated with third-generation cephalosporin (cefotaxime) and later with cefuroxime. The article is supplemented with information on the etiologic agent, its history, and a literature review of documented complicated cases of pasteurellosis.

Introduction: Staphylococcus aureus is a gram-positive, facultatively anaerobic coccus capable of causing infectious diseases in animals and humans. Especially dangerous are multidrug-resistant forms with poor or even no response to available treatments.

Objectives: The study aimed to verify the effect of enzybiotics on the healing of S. aureus-infected skin wounds in an experimental pig model.

Methodology: Two pigs were included in the experiment and wounds (10/pig) of 5 × 5 cm in size with 2 cm spacing were made by incision on their backs. The wounds were infected with a methicillin (oxacillin) and amoxicillin-resistant strain of S. aureus (MRSA). The experimental groups consisted of individual wounds that were infected with one sequence type of S. aureus at a concentration of 2 × 109 CFU/mL. Two wounds were left untreated (N), four wounds were using hydrogel with added lysostaphin, and four wounds were treated using hydrogel with added lysostaphin and endolysin. Subsequently, samples were taken from each wound on days 4, 7, 11, and 14. The material was processed using a standard histological technique of paraffin blocks and the sections were stained with hematoxylineosin.

Results: The results show that these defects present a full spectrum of reparative changes with re-epithelialization with alternating sections of necrosis and newly formed granulation tissue with an accompanying round cell inflammatory infiltrate in edematous tissue and surface scabs. On the surface of the wounds and also in smaller groups in the newly formed granulation tissue, coccoid formations corresponding to S. aureus are visible. Compared to untreated wounds, hydrogel dressings with added lysostaphin or lysostaphin and endolysin trapped greater numbers of S. aureus cocci colonies, which subsequently died off to a large extent.

Conclusion: Enzybiotics may have interesting potential in the topical therapy of MRSA-infected skin wounds.

Corynebacteria, non-spore-forming, gram-positive, aerobic or facultative anaerobic, pleomorphic bacilli, are part of the normal skin, oropharyngeal, and intestinal flora in humans. However, this microorganism can rarely be associated with invasive infections such as bone and joint infections, bacteremia, endocarditis, meningitis, liver and spleen abscesses. We present a case of bacteremic arthritis of a native knee joint caused by non-toxigenic Corynebacterium diphtheriae in a patient with alcoholic liver cirrhosis. This case report emphasizes the importance of differential diagnosis and careful examination of immunocompromised patients and reviews the criteria for administration of C. diphtheriae antitoxin in case of invasive disease.

In parallel with the introduction of modern therapeutic and pharmacological interventions that have successfully resolved many diseases and conditions, previously deemed incompatible with life, there has been a significant increase in the number of patients experiencing secondary immunodeficiency. As a result, these patients are highly susceptible to various opportunistic infections. Among these infections, pneumocystis pneumonia (PCP) stands out as one of the most frequent and potentially life-threatening ones, necessitating prompt diagnosis and treatment. Observational studies have clearly shown that PCP affects an increasing number of patients with diverse underlying diseases and varying risk profiles that lead to immune system dysfunction. The population of at-risk patients and the range of these conditions continue to expand. Surprisingly, the diagnosis is now established in populations that were not initially considered at risk, such as patients on chronic glucocorticoid therapy. This disease often remains undiagnosed and contributes to a relatively high number of fatal outcomes in patients with various primary diseases. The text summarizes the basic epidemiological factors, risk factors, presumed pathophysiology, current diagnostic options, and typical clinical course of PCP in patients living with HIV and non-HIV patients, as well as the prophylaxis and treatment of PCP. It is important to note that in most patients with severe immunodeficiency, multiple agents are involved simultaneously in causing infectious complications. Coinfection with cytomegalovirus is a very common complication of PCP. In the context of multiple infections occurring simultaneously, if a coinfection goes unrecognized and untreated, it can render the treatment of PCP seemingly ineffective. Therefore, it is crucial to pay attention to potential coinfections already during the primary diagnosis.

The rapid advancement of modern pharmacological and surgical therapeutic interventions is often accompanied by potential disruptions to the immune system, both permanent and transient. Consequently, life-threatening infectious complications may emerge, which were either absent or exceedingly rare in the past. Observational studies have identified pneumocystis and cytomegalovirus pneumonia as one of the most prevalent coinfections. These diseases carry a high risk of a fatal course, making rapid and precise diagnosis and treatment absolutely crucial. Diagnostic and therapeutic procedures for coinfection with pneumocystis and cytomegalovirus pneumonia are based on empirical knowledge obtained from certain categories of patients and subsequently extrapolated to other categories. In cases where the immune system is dysfunctional, a significantly longer time interval is required before the effect of treatment becomes evident. Therefore, the treatment must be sufficiently prolonged compared to immunocompetent patients and administered with relatively high drug doses. The text highlights the fundamental epidemiological, clinical, diagnostic, and therapeutic aspects. We have attempted to address the questions that arose when confronted with similar situations, often facing ambiguous answers due to the lack of precisely documented data. With the increasing number of immunocompromised patients, particularly in countries with advanced healthcare systems, it becomes evident that the future will require the widespread availability of modern diagnostic methods and the development of drugs with significantly improved safety profiles. These advancements would enable extensive prophylaxis for at-risk patients.

Objectives: The use of nonadherent dressings is part of care for chronic wounds. In this paper, we present the results of in vitro activity of several such dressings on bacteria most commonly found in chronic wounds.

Material and methods: Selected bacterial strains were isolated from chronic wounds of patients in Pardubice Hospital in the period from February to May 2022. The following dressings were tested: Inadine and Aqvidine, both containing povidone iodine, Bactigras containing chlorhexidine acetate and Xeroform containing bismuth tribromophenate. The zone of inhibition size and the ability to inhibit growth after dressing removal were evaluated.

Results: Inadine and Aqvidine had significantly larger zones of inhibition than Bactigras or Xeroform. We found no significant differences between Inadine and Aqvidine (except for Klebsiella pneumoniae) or between Bactigras and Xeroform (except for Streptococcus pyogenes). Inadine and Aqvidine were able to inhibit bacterial growth after dressing removal (except for Proteus mirabilis and Pseudomonas aeruginosa). Bactigras and Xeroform did not exhibit this ability, which was only observed for Streptococcus pyogenes after removal of Bactigras.

Conclusions: The dressings Inadine and Aqvidine containing povidone iodine were more effective than Bactigras and Xeroform against all species tested and their antibacterial activity against most strains persisted even after removal. These differences in antibacterial -efficacy should be considered when selecting wound dressings.

Methicillin-resistant Staphylococcus aureus (MRSA) strains are emerging zoonotic pathogens that are of importance not only to human but also to veterinary medicine. MRSA strains spread among humans and animals and can also be transmitted through foods. In this article, we provide a summary of the prevalence of MRSA in the Czech Republic, focusing on the One Health concept, which explores the relationships between human and animal health and the environment. This approach, together with collaboration between health professionals, veterinarians and public health experts, can provide valuable insights and help in preventing and controlling MRSA outbreaks.