Epidemiologie Mikrobiologie Imunologie最新文献

A case report is presented of a patient with suspected septicaemia from whose blood culture a new strain of Corynebacterium sp. was isolated. Until now, no report of this strain isolated from human clinical materials has been available in the literature. In addition to a brief clinical description of the case, the article also features morphological, biochemical properties as well as antibiogram of the bacterium. It describes also methods used for the identification of this isolate. The aim of the work was to highlight a novel and rare coryneform strain.

In times of COVID-19 pandemics, the upcoming period of the year when influenza activity usually increases in the Northern Hemisphere brings new medical and public health challenges. These challenges include the risk of mixed infections and/or a possible collision of the two epidemics (“twindemia”) with a potentially serious impact on individual health and public health. In this report, we discuss the results of the published stu-dies and conclude that the catastrophic collision of the seasonal influenza and COVID-19 epidemics is unlikely when efficient non-pharmaceutical public health measures are applied to control or mitigate the spread of the COVID-19 epidemic. This conclusion is supported by several lines of evidence, including the extremely low seasonal influenza activity registered in the Southern Hemisphere in 2020. On the other hand, the existence of mixed SARS-CoV-2 and influenza virus infections has been demonstrated in humans. The continuing uncertainty about the occurrence and potential severity of these mixed infections emphasizes the importance of seasonal influenza vaccination in the current epidemiological situation and raises the need to: (i) ensure vaccine availability, (ii) facilitate access to safe seasonal influenza vaccination under the conditions of the ongoing COVID-19 epidemic, and (iii) promote the vaccine to the public.

Objective: The article presents the results of a study of family clusters of COVID-19 whose aim was to describe the clinical course of the disease in children, to identify secondary transmission in households with infected children, and to find out the differences in the antibody response between children and adults. Data were collected from 3 March 2020 to 25 October 2020, that is at the time when the alpha or delta variants were not dominant.

Methods: A retrospective analysis of data on infected children in the Ústí nad Labem Region collected by the Regional Public Health Authority along with questionnaire data reported by their families. Serological tests were performed in study volunteers.

Results: The most common symptoms in children were headache, runny nose, and loss of smell and taste. The hospital admission rates were 0.8% in children and 2.4% in adults. The secondary transmission rate in families where the index case was a child reached 22.6%. It was higher when the index case was a child 11-15 years of age or asymptomatic. The secondary transmission rate in families where the index case was an adult equalled 77.1%. Children had higher IgG antibody levels than adults at post-infection months 4 and 5, but their seropositivity rate was comparable to that of adults.

Conclusion: Children have a nonspecific clinical course of the disease, which is quite similar as other viroses, and rarely require hospital admission. Secondary transmission in families where the index case was a child is not uncommon and is also possible through contact with an asymptomatic child. After recovery, children have higher levels of antibodies at post-infection months 4 and 5.

Objectives: Intra-abdominal candidiasis (IAC) is an invasive fungal infection representing the most common type of invasive Candida infection in surgical intensive care units (ICUs). Recently, decreased antifungal susceptibility and progressive shift in the aetiology of invasive candidiasis has been observed worldwide. We explored IAC epidemiology in surgical ICU.

Material and methods: We retrospectively reviewed the records of 64 patients with IAC admitted at our surgical ICU over a 4-year period (2013-2016). IAC incidence, microbiological results, antifungal therapy, and mortality were analysed.

Results: The cumulative IAC incidence was 18.4 cases per 1000 admissions (2013: 12.6; 2014: 17.7; 2015: 16.8; 2016: 24.5), including hospital-acquired IAC incidence (2013: 9.8; 2014: 13.3; 2015 10.1; 2016: 13.3) and community-acquired IAC incidence (2013: 2.8; 2014: 4.4; 2015: 6.7; 2016: 11.2). Candida albicans represented the most common species (n = 35, 50.0%) followed by Candida glabrata (n = 15, 21.4%), Candida tropicalis (n = 6, 8.6%) and other yeasts (each < 5.0%). Incidence rate of C. albicans (2013: 7(78%); 2014: 10(59%); 2015: 6(35%); 2016: 12(44%)) and incidence rate of C. non-albicans (2013: 2(22%); 2014: 7(41%); 2015: 9(53%); 2016: 14(52%)) were different in trend. All fungal isolates were susceptible to echinocandins, amphotericin B and voriconazole. Regarding fluconazole susceptibility, C. krusei (n = 3) was resistant and C. glabrata (n = 9) was susceptible-dose dependent (SDD). The ratio of SDD C. glabrata isolates to all isolated C. glabrata strains was 9/15 (60%) (2013: 0/2; 2014: 0/2; 2015: 1/3; 2016: 8/8). Decreased fluconazole susceptibility for C. glabrata isolates was reported in both community-acquired IAC (n = 3) and hospital-acquired IAC (n = 6). Overall 30-day mortality rate was 25.0% (16/64).

Conclusions: We have revealed slowly raising of overall IAC incidence, more increasing trend in incidence of community-acquired IAC compared to rather steady incidence of hospital-acquired IAC. During period 2013-2016 we have observed a significant shift in the aetiology of IAC towards an increased proportion of non-albicans Candida species, particularly C. glabrata. Acquired decreased fluconazole susceptibility was related to C. glabrata isolates exclusively. Emergence of decreased antifungal susceptibility has been preceded by increase of non-albicans Candida isolates.

Aims: Pharmacotherapy in geriatric patients is challenging due to frequent multimorbidity, polypharmacy, increased risk of adverse drug effects, and altered pharmacokinetics and pharmacodynamics associated with aging. Therapeutic drug monitoring (TDM) is a dosing individualisation strategy that helps to minimise toxicity whilst maximising the efficacy of the agent. Routine TDM of vancomycin is recommended in clinical practice in order to optimise drug exposure. Guidelines by Rybak et al. from 2009 on vancomycin TDM promote monitoring of trough concentrations only, with higher target ranges for dosage adjustment. The aim of the study was to evaluate the practice of vancomycin TDM in geriatric (aged 65 ys) and non-geriatric patients, compare two methods of dosing adjustment (trough-based vs. AUC-based approach), and finally determine covariates enabling to choose an appropriate initial vancomycin maintenance dosing regimen in geriatric patients.   Methods: A retrospective analysis of all vancomycin plasma concentrations determined during a five year period in patients treated with IV vancomycin in the University Hospital Olomouc was performed. Haemodialysis patients were excluded. Each trough value was compared with the guidelines by Rybak et al. and subsequently, pharmacokinetic modelling was performed to assess individual AUC24 values.

Results: A total of 1,458 vancomycin concentrations were included, which represented 799 individual monitoring events in 380 patients. Vancomycin was most commonly prescribed for sepsis (41.6% of all patients). Pathogens with MIC > 1 mg/L were responsible for 16.7% of all infections. Initial dosing led to optimum vancomycin exposure in 37.8% of patients. Vancomycin dosage based on the guidelines by Rybak et al. from 2009 would agree with the AUC-based dosing adjustments in 65% of all monitoring events. Approximately 19.1% of trough concentrations were below the minimum target suggested by the guidelines despite the fact that their corresponding AUC24/MIC ratios were high enough ( 400), and in further 6.1% of monitoring events, the trough-only approach would fail to accurately identify supratherapeutic concentrations. Initial dosing of 1 g twice daily was prescribed to 62.9% of patients, although it would be considered as optimal only in 32.1% of all patients. For 48 % of patients in the non-geriatric cohort, higher dosing (3 to 4 g daily) would be necessary to achieve optimum vancomycin exposure, whereas for 56% of geriatric patients, lower dosage regimens (up to 1.5 g daily) would be considered optimal. The estimated glomerular filtration rate was the most significant covariate in the pharmacokinetic model enabling the construction of a dosing nomogram.

Conclusion: AUC-based vancomycin monitoring is superior to trough-based approach as the latter can lead to unnecessarily aggressive dosing in over a quarter of patients. A simple nomogram using th

Nowadays, free flap reconstruction in devastating lower limb trauma is a standard procedure in reconstructive surgery. The greatest factor directly affecting limb salvage is still the risk of infectious complications, whether local or systemic. Fungal wound infections are not among the most common infection complications in surgery, but their low incidence is compensated for by their fulminant and serious course, as well as severe local tissue destruction and strong angio-invasive potential together with the possibility of dissemination. In this case study, we present an example of a devastating lower leg injury, solved using latissimus free flap reconstruction, with subsequent difficult and prolonged healing, due to an invasive filamentous fungi infection. In the final part of the article, we focus briefly on the occurrence of similar cases in the literature.

Vancomycin-resistant enterococci (VRE) have been a major public health concern for years. These pathogens are highly resistant, which facilitates their spread in health care settings where they may cause infections difficult to treat with antibiotics, particularly in immunocompromised patients. Over recent years, a considerable increase in VRE has also been observed in the Hradec Králové University Hospital. In 2017, 59 cases of VRE colonization or infection were newly diagnosed in inpatients. Based on a retrospective investigation, infected patients were identified, and from the hospital information system data, clinical and epidemiological factors possibly linked to VRE were analysed. It was concluded that one of the reasons behind the increase in VRE was poor compliance with the hygienic antiepidemic rules in general and with hand hygiene in particular, which was confirmed by the changed epidemiological situation the following year after more stringent rules were adopted. Raising awareness of health care workers about good practices to reduce the risk of the spread of resistant pathogens is crucial for the prevention of these infections.

MAIT cells are a separate cell population differentiating in the thymus. They are mostly present in the peripheral blood, liver, intestine, and lungs, less often in other tissues, and infrequently in the lymph nodes. The presentation molecules for MAIT cells are MR1 proteins. They are evolutionarily conserved and non-polymorphic, resemble class I HLA molecules, and are expressed by all cell types. They present bacterial and yeast vitamin metabolites which arise during the synthesis of vitamin B2. The effector functions of MAIT cells are promoted through cytokine synthesis. They also act cytotoxically, directly killing infected or tumour cells. MAIT cells may also play a role in pathological processes. Their involvement in the development of rheumatoid arthritis, systemic lupus erythematosus, autoimmune diabetes mellitus, Crohn's disease, and bronchial asthma has been demonstrated. In practical terms, MAIT cells are very sensitive to therapeutic doses of glucocorticoids. Treatment of patients with BA or chronic obstructive pulmonary disease with glucocorticoids increases their susceptibility to pneumonia, especially when caused by Streptococcus pneumoniae.

Introduction: Human papillomavirus (HPV) infection plays an important role in the etiopathogenesis of oropharyngeal squamous cell carcinomas. HPV detection in these tumours is a positive prognostic marker. The p16 protein expression, which is detected immunohistochemically, is an indirect marker of active HPV infection. Unlike in oropharyngeal carcinoma, in oral carcinoma, the prognostic significance of HPV/p16 positivity is unclear. Some studies even show a worse prognosis in patients with HPV/p16 positive oral carcinoma. The aim of our study is to consider the significance of p16 protein expression in relation to clinicopathological parameters and prognosis in patients with oral squamous cell carcinomas.  Methods: One hundred and twenty patients treated surgically for oral carcinoma were enrolled in the study. The most common anatomical sites of oral carcinoma were the tongue body (54; 45% of cases) and floor of mouth (35; 29.2% of cases). All tumours were analysed immunohistochemically for p16 protein expression. The results were correlated with the clinicopathological parameters and analysed statistically.

Results: Ten patients (8.3%) tested positive for p16 expression. In the study cohort, p16 expression was identified as the most significant factor with a negative effect on survival (p=0.019). Based on the Cox proportional hazard model, the p16-positive patients had four times worse survival than the p16-negative ones. Other factors with a statistically significant effect on survival were T status, N status, and recurrence.

Conclusion: The significance of p16 expression differs between oral and oropharyngeal carcinomas. The p16 positivity seems to be a negative prognostic factor in oral carcinomas. Nevertheless, the significance of HPV presence in tumours outside the oropharyngeal area remains unclear.