Klinicka mikrobiologie a infekcni lekarstvi最新文献

Presented are two cases of vascular prosthesis infections complicated by peritonitis with a lethal course. The authors describe complicated antibiotic therapy with findings, exhausted options for surgical therapy and subsequent decision that the condition was untreatable and palliative care was initiated.

Malaria represents the most important parasitic infection imported from the tropics causing death in 1-2 % of travelers with this diagnosis. Around 30 cases of malaria are diagnosed in the Czech Republic every year. Fever is the most common clinical presentation. The most severe forms of malaria are caused by Plasmodium falciparum. The diagnosis of malaria is based on examination of stained thick and thin blood smears. This method enables determination of Plasmodium species and parasite count. The treatment of ma-laria has to be initiated immediately after the laboratory confirmation. In the Czech Republic, uncomplicated falciparum malaria is treated by oral administration of artemether/lumefantrine or atovaquone/proguanil. Complicated falciparum malaria is treated by parenteral administration of quinine in combination with clindamycin. For the chemoprophylaxis of malaria in travelers to the highly endemic regions, atovaquone/proguanil, doxycycline or mefloquine are recommended.

The new recommendations reflect the increase in knowledge that has been reported since the release of previous Czech guidelines in September 2014. The basis for these guidelines were the European Association for the Study of the Liver guidelines from April 2017. According to qualified estimates, there are 240 million people with chronic hepatitis B (HBV) infection worldwide. The Czech Republic is among the countries with a low prevalence of HBV infection. According to the latest seroprevalence study, 0.56 % of the Czech citizens were chronically infected with HBV in 2001. A similar study conducted in only two regions of the Czech Republic in 2013 showed a prevalence of only 0.064 %. HBV infection can lead to serious life-threatening liver damage - fulminant hepatitis, liver cirrhosis and hepatocellular carcinoma (HCC). The main goals of treatment are to prolong the length of life and improve its quality by preventing the progression of chronic hepatitis to cirrhosis, cirrhosis decompensation and development of HCC. The goals may be achieved if HBV replication is suppressed in a sustained manner. Additional goals are prevention of vertical transmission from mother to newborn, inhibition of HBV reactivation and therapy of HBV-related extrahepatic manifestations. Generally, there are two different strategies of chronic hepatitis B therapy available - treatment with nucleoside or nucleotide inhibitors (NIs) or with pegylated interferon alfa. Currently, the vast majority of Czech and European patients are treated with NIs. The NIs that have been approved for HBV treatment in the European Union include lamivudine, adefovir dipivoxil, entecavir (ETV), telbivudin (TBV), tenofovir disoproxil fumarate (TDF) and tenofovir alafenamide (TAF). TAF and TBV have not yet been marketed in the Czech Republic. The main advantages of treatment with potent NIs with a high barrier to resistance (ETV, TDF, TAF) are their predictable high long-term antiviral efficacy leading to undetectable HBV DNA levels in the vast majority of compliant patients as well as their favorable safety profiles. These drugs can be used in any HBV infected patient and represent the only treatment option for patients with decompensated liver cirrhosis, liver transplants, extrahepatic HBV-related manifestations, severe acute hepatitis B or chronic HBV reactivation.

Objective: Ceftolozane/tazobactam is an antibiotic effective against Gram-negative bacteria(including Pseudomonas aeruginosa).The study aimed at determining the effectiveness of the novel antibiotic in the Czech Republic.

Material and methods: The effectiveness of the antibiotic was studied in 16 Czech laboratories in 822 Enterobacteriaceae isolates (including AmpC and ESBL producers) and P. aeruginosa causing complicated intraabdominal or urinary tract infections. Minimum inhibitory concentrations were determined using the Etest. With the exception of Citrobacter freundii and Enterobacter cloacae, ceftozolane/tazobactam proved to be very effective against Enterobacteriaceae; no P. aeruginosa strain was resistant to the antibiotic.

Conclusion: The results confirmed good activity of ceftozolane/tazobactam in vitro against Enterobacteriaceae (Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Proteus mirabilis) and P. aeruginosa in the Czech Republic.

Definitive diagnosis and therapy proved challenging in the case of a 60-year-old male with malaria and rickettsiosis. Returning travellers who are unwell can present practical difficulties in diagnosis and treatment and the focus here is on conditions relevant to the Republic of South Africa. Malaria, rickettsiosis and Q fever are discussed.

Hepatitis C virus infection (HCV) is one of the leading causes of chronic liver disease worldwide. The new fixed-dose combination of the highly potent second wave first generation NS5A inhibitor elbasvir (50 mg) and the second generation protease inhibitor grazoprevir (100 mg) is contained in the drug Zepatier. This combination is indicated for the treatment of patients chronically infected with HCV genotypes 1 or 4. Between June and August 2017, the treatment was initiated in 22 patients with chronic viral hepatitis C, with 17 patients being treated in the Department of Infectious Diseases University Hospital Brno and five patients in the Center of Cardiovascular and Transplant Surgery in Brno. All patients were infected with HCV subtype 1b. In all cases, the duration of Zepatier monotherapy (without simultaneous ribavirin administration) was 12 weeks. At the moment, only preliminary results are available. All 22 patients achieved end-of-treatment virologic response. In nine patients, it was already possible to evaluate the virologic response at four weeks after the end of treatment, with sustained virological response (SVR12) was observed in all these patients. The most common complaints were fatigue (3 patients, 14 %) and headache (2.9 %). These problems were not serious and did not interfere with normal daily activities of treated persons.

Acute bacterial meningitis is a severe infectious disease of the central nervous system. Its incidence decreases but lethality and sequelae remain high. The early initiation of appropriate treatment is a factor strongly determining the patient´s prognosis. The authors submit the Czech national guideline for diagnosis and treatment of community-acquired acute bacterial meningitis which has to provide clear and simple recommendations for clinicans involved in the care of meningitis in adults and children. The national guideline was based on the European guideline published in 2016 and adapted for the situation in the Czech Republic. It was acknowledged (approved? ratified?) by the Society for Epidemiology and Microbiology and the Society for Medical Microbiology of the Czech Medical Association.

Reported is a case of enteritis caused by Salmonella Oranienburg in an approximately one-month-old infant due to indirect contact with reptiles. An epidemiological investigation included tests of faeces of bearded dragons (Pogona vitticeps) kept in the patient's household that revealed Salmonella Oranienburg. The comparison of Salmonella isolates obtained from the infant's stools and the reptiles' faeces using macrorestriction analysis showed 100% similarity, confirming that the reptiles were the source of the infection. The transfer of Salmonella was probably indirect through the other family members. The detection of rare Salmonella serotypes should -lead to inclusion of less common sources of infection such as reptiles into epidemiological investigations.

Plasmid-mediated resistance to colistin is a recently described phenomenon. The study reports this new type of colistin resistance in food isolates of Escherichia coli in the Czech Republic. Strains with phenotypically determined colistin resistance were studied for presence of the mcr-1 and mcr-2 genes. A positive finding of E. coli harboring the mcr-1 gene was confirmed in a sample of raw minced turkey meat imported from Poland. Two different strains of E. coli carrying the mcr-1 gene were detected in the same sample. This is the first reported case of this type of resistance in E. coli strains isolated from foods at retail in the Czech Republic.