Klinicka mikrobiologie a infekcni lekarstvi最新文献

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.

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.

Aim of the work: To assess the occurrence of linezolid-resistant enterococci (E. faecalis and E. faecium) in patients hospitalized at the centers and clinics of the Institute for Clinical and Experimental Medicine (IKEM).

Material and methods: For the period from 1. 1. 2017 to 31. 12. 2022, isolates of E. faecalis and E. faecium, which were tested for sensitivity to antibiotics, were retrospectively evaluated. Microbiological data were obtained from the laboratory information system ENVIS LIMS, and clinical data from the hospital information system IKEM. Enterococci were identified using a MALDI-TOF mass spectrometer. Susceptibility testing was performed using the disc diffusion method according to EUCAST criteria. Minimum inhibitory concentrations were determined by the Vitek automated system using the P592 card. Verification of resistance to linezolid and determination of the resistance mechanism took place at the National Reference Laboratory for Antibiotics of the National Institute of Public Health in Prague.

Results: In the monitored period, the sensitivity of 6900 strains of E. feacalis (67,0 %) and 3356 strains of E. faecium (33,0 %) was examined. A total of 14 linezolid-resistant enterococci (LRE) were identified - 5x E. faecalis (35,7 %) and 9x E. faecium (64,3 %). The most common mechanism of resistance to linezolid was the presence of the optrA gene in E. faecalis, and 23S rRNA mutation in E. faecium. The material with the largest LRE capture was urine (35,7 %) and secrets or punctates (28,6 %). Only in the species E. faecium, resistance to vancomycin and teicoplanin (LVRE) occurred at the same time. Three patients (21,4 %) developed an LRE infection requiring antibiotic treatment, the remaining eleven patients (78,6 %) were colonized.

Conclusion: The proportion of linezolid-resistant enterococci was in the mentioned period low - 0,14 %. Linezolid therefore remains a safe therapeutic alternative for enterococcal infections when first-line drugs cannot be used.

Vaccination against viral hepatitis B (VHB) is the most important preventive measure that reduces the frequency of hepatitis B (HBV) infection in the population. VHB vaccines, initially plasma, later recombinant, have been available since the 1980s, the administration of immunoglobulin against VHB has always been a complementary method. Vaccination of HBsAg (s antigen HBV) positive mothers, together with the vaccination of all infants in the endemic region of Southeast Asia, in the 1990s, dramatically reduced the incidence of VHB in a vaccinated population. Based on these results, the World Health Organization recommended that all countries start regular vaccination of children by 1997, optimally within 24 hours after birth. Gradually, the vaccination of newborns, infants, or larger children began to be introduced in developed countries, which initially preferred vaccination of risk groups, especially health professionals, newborns of HBsAg-positive mothers, and patients with renal failure.

Bacterial pneumonia in critically ill patients with COVID-19 pose a significant healthcare concern. The critical stage of COVID-19 encompasses patients who are experiencing acute respiratory failure (ARDS), septic shock, and multiorgan failure. Data from the University Hospital Olomouc indicates that the incidence of bacterial Community-Acquired Pneumonia (CAP) and Hospital-Acquired Pneumonia (HAP) in critically ill patients with COVID-19 can reach up to 27% and 46%, respectively. These patients with bacterial CAP and HAP have higher mortality rates (38% and 56%, respectively) compared to critical COVID-19 patients without bacterial infection (11%). Given the severity of these patients' conditions, concerns regarding delayed initiation of antibiotic therapy are justified, as it could result in the development or progression of sepsis and increased mortality. On the other hand, unnecessary antibiotic treatment leads to adverse effects, dysbiosis, increased risk of secondary bacterial infections, development of antimicrobial resistance, and ultimately increased mortality. The provided guidelines offer a comprehensive framework of strategies for the diagnosis and treatment of bacterial pneumonia in patients with critical-stage COVID-19.

Significant medical advances in the treatment and management of immunocompromised patients are currently leading to an ever-increasing incidence of invasive fungal infections (IFI). Due to the limited antifungal treatment options, the management of IFI remains a major challenge. The triazole antifungal drug isavuconazole (ISV) shows a broader spectrum of activity against Mucorales isolates and represents another therapeutic option for difficult-to-treat IFI. ISV is a broad-spectrum triazole antifungal II. generation, which is primarily intended for the treatment of invasive aspergillosis and mucormycosis, but in the future it also represents a promising therapeutic option for the treatment of other, rare IFIs (cryptococcosis, infections caused by dimorphic fungi). The article summarizes the basic knowledge and provides a brief overview of the pharmacodynamics, pharmacokinetics, mechanism of action, metabolism, indications, and dosage of isavuconazole in clinical practice. It also includes a brief analysis of selected clinical trials (SECURE, ACTIVE, VITAL) and recommendations of individual international societies.

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.

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.

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.

For the first time, a separate Czech guideline focuses exclusively on hepatitis D virus (HDV) infection. Until recently, HDV infection was only mentioned in guidelines concerning hepatitis B virus (HBV) infection, in chapters on HBV/HDV co-infection. The guideline is based on the July 2023 recommendations from the European Association for the Study of the Liver. HDV can either infect a susceptible host together with HBV (co-infection) or superinfect a person chronically infected with HBV. HBV/HDV coinfection usually leads to acute hepatitis with a wide clinical spectrum ranging from an asymptomatic course, to mild hepatitis, to acute liver failure. However, only a small proportion of cases (approximately 2%) progress to chronicity. In contrast, superinfection with HDV in patients with chronic HBV infection very often leads to severe acute hepatitis, which progresses to chronic hepatitis D (CHD) in up to 90% of cases and is associated with more severe chronic outcomes than HBV monoinfection. CHD has been shown to progress to liver cirrhosis more frequently and more rapidly than HBV monoinfection. Globally, an estimated 4.5-13% of HBsAg-positive individuals are infected with HDV, representing 12-72 million persons infected with HDV in absolute numbers. HDV infection is still rare in the Czech Republic, with at most a few dozen patients, almost exclusively foreigners coming from endemic areas, mainly from Mongolia and other Asian countries. With the increasing migration of people from endemic areas, the incidence and prevalence of hepatitis D in the country may increase rapidly. Experts estimate that the prevalence of HDV among HBsAg-positive patients in the Czech Republic is approximately 1%. Until 2020, interferon (IFN) α-based therapy was the only treatment option for CHD. Gradually, treatment with pegylated interferon (PEG-IFN) α proved to be more effective than treatment with conventional (standard) IFNα - 25% vs. 17% virological response at the end of 48 week of treatment. Subsequently, however, more than half of the successfully treated patients experienced a virological relapse. Extending the duration of PEG-IFNα treatment to two years did not increase treatment success, as shown by the results of most clinical trials. Bulevirtide (BLV) is a synthetic lipopeptide consisting of 47 amino acids from the preS1 domain of the large HBsAg protein, which binds to NTCP, thereby preventing HDV from entering hepatocytes. Clinical trials have evaluated the efficacy and safety of BLV treatment at doses of 2, 5 and 10 mg administered subcutaneously once daily, alone or in combination with PEG-IFNα. Since the optimal duration of BLV treatment has not yet been established, sustained virological response could not be assessed because BLV treatment was not discontinued in the studies. According to results of clinical trials, a higher dose of BLV (10 mg) provides no benefit compared to a dose of 2 mg once daily. In July 2020, BLV received conditional mar