Klinicka mikrobiologie a infekcni lekarstvi最新文献

This draft of guidelines for the laboratory diagnosis of dermatomycoses was developed based on discussion among members of the Czech Society for Medical Microbiology Working Group on Mycology. The document Guidelines for the Laboratory Diagnosis of Dermatomycoses was published for discussion on the Czech Society for Medical Microbiology website on 23 March 2020. Until recently, recommendations concerning this area of laboratory diagnosis in mycology were only limited to information in manuals and no comprehensive and systematic document concerning these issues was available. In an effort to fill the gap, members of the working group developed recommendations covering various laboratory aspects of mycology, from obtaining a proper history, to adequate sampling techniques, sample analyses using conventional microscopy and culture techniques, to interpretation of results. Additional information was on the diagnostic potential of novel, modern technology, in particular molecular genetic methods and mass spectrometry. The recently developed European standards for testing the susceptibility of dermatophytes to antifungals were also included in the recommendations. The document will be regularly updated based on new findings.

Aim: The study aimed to characterize enterococcal infections at the University Hospital Olomouc and to define antibiotic treatment options.

Material and methods: The data was obtained from the ENVIS LIMS laboratory information system. Between 1 January 2015 and 31 December 2019, clinically relevant enterococci in the hospital and their resistance to antibiotics were retrospectively evaluated. Until mid-2016, criteria defined by Facklam and Collins and biochemical properties determined with the Encoccus test were used for identification. Subsequently, all enterococci were identified using the MALDI-TOF MS system. The susceptibility to antibiotics was determined using a standard microdilution method according to the EUCAST criteria.

Results: A total of 8 239 clinically relevant enterococci were isolated over the 5-year period. The most frequently isolated species were Enterococcus faecalis and Enterococcus faecium, which accounted for more than 90% in the period 2017-2019. Enterococci were most frequently isolated from urine (35 %), surgical wounds (17 %) and urethral/vaginal swabs (17 %). Clinically relevant enterococci were most commonly isolated from patients with oncological diagnoses (22%), those with urinary and genital diseases (15%) and respiratory diseases (9%). Enterococcus faecalis strains showed very low resistance to the antibiotics tested. Enterococcus faecium was shown to have 24 % proportion of vancomycin-resistant strains (VRE).

Conclusion: Primary antibiotics suitable for treating infections with the etiological role of Enterococcus faecalis include aminopenicillins, in case of severe infections in combination with aminoglycosides, in particular gentamicin. For Enterococcus faecium strains, glycopeptides must be chosen. To treat VRE, linezolid or tigecycline are indicated.

The aim of this mini-review is to draw attention to the risk aspects associated with antibiotic treatment in critically ill patients. These include antibiotic underdosing in the early phase of sepsis if treatment is governed by pharmacopoeia and unnecessarily long exposure to antibiotics if treatment is guided by traditional recommendations for the length of antibiotic administration. The need for discussing the loading dose of antibiotics and routine monitoring of serum antibiotic concentrations during treatment is stated. Antibiotic-induced mitochondrial dysfunction and oxidative stress are also discussed. Indeed, both of these mechanisms, otherwise effective in inhibiting the growth of tumor cells, may play an important role in the prolonged course of multiorgan failure if antibiotic treatment is too long.

The aim of this review is to point out the dark side of antibiotic treatment in critically ill patients. Although antibiotics are crucial for survival of patients with infection, the risk of organ dysfunction potentiated by them cannot be overlooked. Antibiotic classes and their influence on organ dysfunction and the development of bacterial resistance are discussed in the text. The risk of mitochondrial dysfunction is mentioned as well.

Antibiotics are considered to be one of the most important discoveries of medicine, which has significantly affected the mortality due to infectious diseases. Given their increasing use, certain problems arise over time, resulting from non-indicated and inadequate - administration of antibiotics. This results in increasing antibiotic resistance as well as a higher risk of side/adverse effects. Recently, these side effects of drugs have been used for indications other than those originally intended and approved. Such a process is called drug repositioning. Due to the recent increase in the cost of developing novel drugs and the high risk of failure in clinical trials, the pharmaceutical industry is trying to find new indications for existing drugs.

Broad spectrum antibiotics act against a wide range of disease-causing bacteria. However, their use may be associated with serious adverse reactions in patients. Inadequate antimicrobial treatment has been shown to increase mortality. Thus, it is essential to shorten the antibiotic treatment duration to the time necessary to fight the infection. The objectives of this review are to summarize the available options, controversies and evidence concerning the optimization of antibiotic therapy in ICUs; the options we have to achieve faster identification of the pathogen(s), to target the therapy, to use narrower spectrum antibiotics or to discontinue empirical antimicrobial treatment; and the options that are available to manage the treatment properly. Antibiotic de-escalation is a crucial strategy to minimize the risk of inadequate therapy as well as to decrease the risk of bacterial resistance development. Rapid tests and biomarkers may help to identify or rule out bacterial infections, helping clinicians to avoid unnecessary use of antibiotics and to shorten the treatment. These more accurate novel diagnostic tools can help us to improve patient outcomes.

Pathophysiological changes in a critically ill patient, in particular the volume of distribution and clearance, may considerably influence the pharmacokinetic and pharmacodynamic properties of an antibiotic. Data from studies have shown that the optimization of antibiotic dosing is equally important for both successful therapy and preventing the development of antibiotic resistance. Optimal dosing requires a sufficient loading dose, a dosing regimen taking into account characteristics of antibiotic classes and patients such as obese ones or those receiving renal replacement therapy and monitoring of serum antibiotic concentrations.

The authors present three case reports of bacteremia with very rare microorganisms being isolated in the patients. Each brief case report is accompanied by etiological considerations related to the diagnosis and clinical condition of the patient. Routine microbiology tests were performed by examining the biochemical properties using commercial kits. Two methods were used to determine the microorganism species in the State Institute of Public Health in Prague: MALDI-TOF MS and 16S rDNA sequencing. Antibiotic susceptibility was assessed by the disk diffusion test; minimum inhibitory concentrations were determined using broth microdilution and the gradient diffusion method (E tests). This is probably the first reported case of Stenotrophomonas acidaminiphila isolated from human clinical specimens.

Given their wide therapeutic index, beta-lactam antibiotics are commonly used to treat critically ill patients. It is in these patients that significant heterogeneity in pharmacokinetics was noted, compared to the population average, especially in the volume of distribution, drug clearance and biological half-life, with values increasing as much as two-fold or, in the case of biological half-life, as much as four-fold. Significant pharmacokinetic changes also occur in cases of morbid obesity or renal insufficiency and when complex surgical techniques such as extracorporeal circulation are used. Therapeutic monitoring of piperacillin/tazobactam is a way to personalize and optimize therapy for these groups of patients. Preclinical data show a correlation between the probability of therapeutic success and concentrations of the unbound fraction of an antibiotic exceeding the minimum inhibitory concentration (MIC) for 40-50 % of the dosing interval. This time appears to be the preferred pharmacodynamic target for beta-lactam antibiotics. In critically ill patients, however, an even higher target may be required, ideally 100 % fT > 4xMIC. A better pharmacodynamic profile can be obtained using prolonged or continuous infusion. The biggest obstacle to routine TDM in β-lactams is the speed of quality sample determination. Currently, the most widely used method of measuring plasma concentrations is liquid chromatography coupled with UV or MS detection.

This case report describes the first case of imported scrub typhus in a Czech traveler. The infection was diagnosed in a 38-year-old male traveler returning from a one-week business/tourist trip to Laos who presented with fever, chills, joint and muscle pain, localized inguinal lymphadenopathy, rash and a typical eschar. Although laboratory findings included elevation of CRP, hepatic aminotransferases and lactate dehydrogenase, complete blood count revealed only borderline leukocytosis with mild thrombocytopenia. The diagnosis of scrub typhus was made by serological detection of specific antibodies. The patient was treated with a 200 mg daily dose of oral doxycycline for 20 days. His clinical course was uncomplicated. The case underpins the need for a broader differential diagnosis in patients with travel-related health problems, especially those presenting with fever and rash, including less common or neglected tropical diseases.