Katarzyna Kwiecień

The Effect of Lactobacillus plantarum 299v on the Incidence of Clostridium difficile Infection in High Risk Patients Treated with Antibiotics

Background: Lactobacillus plantarum 299v (LP299v) has been used in order to reduce gastrointestinal symptoms during antibiotic exposure. However, it remains controversial whether or not probiotics are effective in the prevention of Clostridium difficile infections (CDI) among patients receiving antibiotics. The aim of this study was to analyze the CDI among patients receiving antibiotics and hospitalized in the period before and after starting routine use of LP299v as a prevention of this infection. Methods: Among 3533 patients hospitalized in the nephrology and transplantation ward during a two-year period, 23 patients with CDI were diagnosed and enrolled in this retrospective study. Since November 2013, prevention of CDI with oral use of LP299v was performed in all patients treated with antibiotics and who were at a high risk of developing CDI. The observation period was divided into two twelve-month intervals before and after initiation of the use of LP299v as a prophylactic against CDI. Results: A significant (p = 0.0001) reduction of the number of cases of CDI was found after routinely using LP299v (n = 2; 0.11% of all hospitalized patients) compared with the previous twelve-month period of observation (n = 21; 1.21% of all hospitalized patients). Conclusions: Routine use of LP299v during treatment with antibiotics may prevent C. difficile infection in the nephrology and transplantation ward.

Analysis of Clostridium difficile infections in patients hospitalized at the nephrological ward in Poland.

BACKGROUND Few studies have evaluated the incidence and risk factors of Clostridium difficile infection (CDI) in the adult Polish population, in particular in solid organ recipients hospitalized at the nephrological ward. AIM The aim of this study was to analyze Clostridium difficile infections (CDI) among patients hospitalized in the Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice. MATERIAL/METHODS Thirty-seven patients with Clostridium difficile infection diagnosed between October 2011 and November 2013 (26 months), identified among a total of 3728 patients hospitalized in this department during this period, were included in this retrospective, single-center study. The CDI definition was based on the current recommendations of the European Society of Clinical Microbiology and Infectious Diseases. RESULTS The observation period was divided into two 13-month intervals. Increased incidence (of borderline significance) of CDI in the second period compared to the first period was observed (1.33% vs 0.65% respectively; p=0.057). Patients after kidney (n=11), kidney and pancreas (n=2) and liver (n=5) transplantation represented 48% of the analyzed CDI patients, and in half of these patients (50%) CDI symptoms occurred within the first 3 months after transplantation. Clostridium difficile infection leads to irreversible deterioration of graft function in 38% of kidney recipients. Most incidents of CDI (70%) were identified as nosocomial infection. CONCLUSIONS 1. Clostridium difficile infection is particularly common among patients in the early period after solid organ transplantation. 2. Clostridium difficile infection may lead to irreversible deterioration of transplanted kidney function.

Unexpected characteristics of cirrhotic liver tumors

187 cirrhosis, the most probable diagnosis was hepa‐ tocellular carcinoma (HCC) despite only a slight‐ ly elevated level of alpha ‐fetoprotein. HCC con‐ stitutes 85% to 90% of primary liver tumors and is more common in men. Approximately 80% of HCC cases worldwide are associated with chron‐ ic hepatitis B virus or HCV infection, and almost 90% of cases occur in patients with cirrhosis.1 Due to the possibility of liver transplantation in the patient who had portal hypertension and the unclear origin of the tumors, the tumor lo‐ cated outside the liver was removed during ab‐ dominal laparotomy. Microwave ablation was per‐ formed on the tumors in the right lobe of the liv‐ er after biopsy. The histological examination re‐ vealed that the extrahepatic tumor was part of the spleen (FIGURE 1C). The newly discovered tu‐ mors in the right lobe of the liver were diagnosed as focal liver steatosis (FIGURE 1D). In this case, the spleen disintegrated into small‐ er fragments probably after the accident at work. A 64 ‐year old man with liver cirrhosis caused by hepatitis C virus (HCV) infection was admitted to the hospital and diagnosed with focal liver lesions. In 1989, the patient experienced a trauma at work that affected multiple organs. Then, the patient underwent a splenectomy and left nephrectomy. Twenty years later, in 2009, the patient was di‐ agnosed with HCV infection and advanced liver fibrosis. Two courses of interferon ‐based ther‐ apy were ineffective. He was later treated with sofosbuvir /ledipasvir in 2016. In 2011, abdom‐ inal computed tomography (CT) scans revealed a tumor between the left lobe of the liver and the stomach (FIGURE 1A). Further diagnostic work‐ up using magnetic resonance imaging (MRI), en‐ doscopic ultrasound, and consecutive CT scans could not determine the type of the tumor. There was no increase in the tumor size until August 2015 when a CT showed 2 tumors of 20 mm in diameter in the right lobe of the liver (FIGURE 1B). Due to the long ‐term HCV infection and liver CLINICAL IMAGE

Lactobacillus plantarum 299v Reduces the Incidence of Clostridium difficile Infection in Nephrology and Transplantation Ward—Results of One Year Extended Study

Background:Lactobacillus plantarum 299v (LP299v) is a probiotic strain which influences on the intestinal bacterial flora. This is why, it has been introduced into clinical practice for the prevention and treatment of diarrheal disorders and alleviation of their symptoms in patients during antibiotic therapy. However, the use of probiotics in the prophylaxis of Clostridium difficile infections (CDI) in these patients is problematic. The aim of this clinical, retrospective, single-centre study was to analyse the incidence of CDI among patients hospitalized in the nephrology and transplantation ward in the period before, during and after stopping of LP299v prophylaxis. Methods: Among 5341 patients hospitalized in the nephrology and transplantation ward over a three year period, 34 patients with CDI were diagnosed and included in this analysis. From December 2013 to December 2014 all patients under antibiotic and immunosuppressive therapies received LP299v as a prophylaxis of CDI. The observation period consisted of three twelve-months periods: before, during LP299v use and after stopping of such method of CDI prevention. Results: A significant (p = 0.0003) reduction of CDI incidence during LP299v use (0.11%) was observed compared to two other periods, that is, before and after LP299v use (1.03% and 0.77%, respectively). Conclusions: Routine use of LP299v as a CDI prophylaxis may prevent CDI during antibiotics therapy in patients treated with immunosuppressive agents in nephrology and transplantation ward.

Different Relevance of Peripheral, Central or Nighttime Blood Pressure Measurements in the Prediction of Chronic Kidney Disease Progression in Patients with Mild or No-Proteinuria

Background/Aims: Arterial hypertension is one of the leading factors aggravating the course of chronic kidney disease (CKD). It seems that the novel parameters used in the assessment of the blood pressure (BP) load (i.e. central blood pressure, nighttime blood pressure) may be more precise in predicting the cardiovascular risk and the progression of CKD in comparison with the traditional peripheral blood pressure measurements in the office conditions. The aim of the study was to assess the impact of the central, or nighttime blood pressure on the progression of CKD in patients with mild or no-proteinuria (autosomal, dominant polycystic kidney disease or IgA nephropathy). Methods: In each of the enrolled 46 patients with CKD stage 3 or 4, serum creatinine concentration was assessed, eGFR (MDRD) was calculated, also central blood pressure and pulse wave velocity (PWV) was assessed and the 24-hour ambulatory blood pressure monitoring (ABPM) was conducted at the beginning of the study and then repeated after one-year observation period. Results: During the observation period mean eGFR decreased from 44.1 (33.2-50.6) mL/min to 36.7 (29.7-46.3) mL/min. No significant differences were observed in the peripheral blood pressure or central blood pressure parameters. After one-year observation period the values of diastolic blood pressure dipping during the night significantly decreased from 16 (13-19) mmHg to 12 (10-15) mmHg; p< 0.05. The values of systolic dipping during the night or the mean BP values recorded in ABPM did not change significantly. Additionally, no significant differences in the PWV values were found. In the multivariate regression model the change of serum creatinine concentration was explained by the initial diastolic dipping values. Conclusion: 1. In patients with CKD stages 3 or 4 and mild or no- proteinuria, peripheral and central blood pressure did not change significantly during a one-year observation period despite the significant decline of eGFR and seems not to participate in the CKD progression. 2. Reduced magnitude of the diastolic dipping, which reflects the increase of diastolic blood pressure load during the nighttime, may play an important role in the pathogenesis of deterioration of kidney function in these patients.

Central blood pressure and nighttime blood pressure in patients with non-diabetic chronic kidney disease

Introduction. Arterial hypertension is a well-known risk factor of both cardiovascular complications and faster progression of chronic kidney disease (CKD). There is growing evidence that central blood pressure (BP) and nighttime BP may have an advantage in predicting the risk of cardiovascular complications and the progression of CKD in comparison with the traditional office BP measurements. The aim of this study was to evaluate the central BP and nighttime BP in non-diabetic CKD patients with no, or only mild proteinuria i.e. autosomal dominant polycystic kidney disease (ADPKD) or IgA nephropathy (IgAN). Material and methods. Forty patients with CKD stage 3 or 4 were enrolled into the study. In each patient the measurement of peripheral and central BP was conducted, as well as the assessment of pulse wave velocity (PWV) and the 24-hour blood pressure monitoring (ABPM). Results. Despite the lower office and central BP values in patients with IgAN in comparison to patients with ADPKD, both studied groups did not differ in the mean BP in the 24-hour ABPM. In the entire studied group a significant positive correlation was found between the augmentation pressure and age, as well as between the augmentation index - AIx% and age. Moreover, a significant positive correlation between the decrease of nighttime BP and eGFR was observed. Additionally, a significant positive correlation between PWV and age was found. Conclusions. 1. Patients with ADPKD and IgAN, despite the differences in office and central BP do not differ in respect of the mean BP in the 24-hour ABPM. 2. In both groups of patients vascular stiffness increases with age and deteriorating kidney function. 3. Lower decrease of nighttime blood pressure is related to the worse kidney function in patients with non-diabetic CKD.