Otakar Nyc

Stenotrophomonas maltophilia: Significant contemporary hospital pathogen — review

Stenotrophomonas maltophilia (Sm) plays an important role as an opportunistic pathogen in immunocompromised individuals. The growing detection rates of this bacterium in hospitalized patients are associated with the invasiveness of therapeutic and diagnostic procedures and the selection pressure of antibiotic therapy. A broad range of infections that can be caused by Sm is frequently bound to biofilm. The high level of intrinsic resistance to many unrelated antibiotics and increasing acquired resistance to the drug of choice, trimethoprim-sulfamethoxazole pose a threat for the near future when our treatment options may become depleted. Prevention of colonization and infection consists in consequent implementation of the rules governing nosocomial infection control, rational use of antibiotics including the optimization of selection and testing of antimicrobial agents suitable for the treatment of stenotrophomonad infections.

Clostridium difficile PCR ribotype 176 in the Czech Republic and Poland

www.thelancet.com Vol 377 April 23, 2011 1407 See Online for webappendix 2 Millennium Project. UN Millennium Project “quick wins”. http://www.unmillennium project.org/resources/quickwins.htm (accessed April 6, 2011). 3 Feachem R. Fourth Board Meeting of the Global Fund: report of the Executive Director Richard G.A. Feachem. 29 January 2003. http:// www.theglobalfund.org/documents/ board/04/GF%20B4%2004%20Report%20 of%20the%20ED.pdf (accessed April 6, 2011). 4 Tedros AG. Achieving the health MDGs: country ownership in four steps. Lancet 2010; 376: 1127–28. 5 Ooms G, Hercot D, Assefa Y, Van Damme W. The new dichotomy in health systems strengthening and the role of global health initiatives: what can we learn from Ethiopia? J Public Health Policy 2010; 31: 102–09.

Successful therapy with ABLC, surgery and posaconazole for Rhizopus microsporus var. rhizopodiformis liver eumycetoma in a child with acute leukaemia

Invasive fungal infection negatively influences the morbidity and mortality in heavily immuno‐incompetent patients. Diagnosis of non‐Aspergillus mould infections remains challenging despite application of a wide spectrum of non‐culture‐based microbiological techniques. Invasive diagnostic procedures are often essential. In this article, we present the case of a 15‐month‐old boy diagnosed with Rhizopus microsporus var. rhizopodiformis liver mycetoma during induction chemotherapy for acute promyelocytic leukaemia. Following surgery, he was effectively treated with a combination of ABLC and posaconazole during ongoing intensive chemotherapy. Posaconazole was also used as long‐term secondary prophylaxis.

A case of imported Clostridium difficile PCR-ribotype 027 infection within the Czech Republic which has a high prevalence of C. difficile ribotype 176.

The first case of Clostridium difficile RT027 infection in the Czech Republic (CZ) was identified. The patient had been hospitalised in Germany prior to moving to CZ. Multiple-Locus Variable number tandem repeat Analysis revealed a genetic relatedness between the patients isolate and RT027 isolate collected in the German hospital.

Antibiotic profiling of Clostridium difficile ribotype 176 – A multidrug resistant relative to C. difficile ribotype 027

Antibiotic profiling of twenty Czech Clostridium difficile PCR-ribotype 176 isolates revealed a high level of resistance to erythromycin, ciprofloxacin and moxifloxacin (n = 20) and to rifampicin (n = 13). Accumulation of resistance mechanisms to multiple antibiotics highlight that PCR-ribotype 176 belong to problematic epidemic strains.

Clostridium difficile PCR ribotypes 001 and 176 - the common denominator of C. difficile infection epidemiology in the Czech Republic, 2014.

In 2014, 18 hospitals in the Czech Republic participated in a survey of the incidence of Clostridium difficile infections (CDI) in the country. The mean CDI incidence was 6.1 (standard deviation (SD):7.2) cases per 10,000 patient bed-days and 37.8 cases (SD: 41.4) per 10,000 admissions. The mean CDI testing frequency was 39.5 tests (SD: 25.4) per 10,000 patient bed-days and 255.8 tests (SD: 164.0) per 10,000 admissions. A total of 774 C. difficile isolates were investigated, of which 225 (29%) belonged to PCR ribotype 176, and 184 isolates (24%) belonged to PCR ribotype 001. Multilocus variable-number tandem repeat analysis (MLVA) revealed 27 clonal complexes formed by 84% (190/225) of PCR ribotype 176 isolates, and 14 clonal complexes formed by 77% (141/184) of PCR ribotype 001 isolates. Clonal clusters of PCR ribotypes 176 and 001 were observed in 11 and 7 hospitals, respectively. Our data demonstrate the spread of two C. difficile PCR ribotypes within 18 hospitals in the Czech Republic, stressing the importance of standardising CDI testing protocols and implementing mandatory CDI surveillance in the country.

Molecular characterisation of Czech Clostridium difficile isolates collected in 2013-2015

Clostridium difficile is a leading nosocomial pathogen and molecular typing is a crucial part of monitoring its occurrence and spread. Over a three-year period (2013-2015), clinical C. difficile isolates from 32 Czech hospitals were collected for molecular characterisation. Of 2201 C. difficile isolates, 177 (8%) were non-toxigenic, 2024 (92%) were toxigenic (tcdA and tcdB) and of these, 677 (33.5%) carried genes for binary toxin production (cdtA, cdtB). Capillary-electrophoresis (CE) ribotyping of the 2201 isolates yielded 166 different CE-ribotyping profiles, of which 53 were represented by at least two isolates for each profile. Of these, 29 CE-ribotyping patterns were common to the Leeds-Leiden C. difficile reference strain library and the WEBRIBO database (83.7% isolates), and 24 patterns were recognized only by the WEBRIBO database (11.2% isolates). Isolates belonging to these 53 CE-ribotyping profiles comprised 94.9% of all isolates. The ten most frequent CE-ribotyping profiles were 176 (n=588, 26.7%), 001 (n=456, 20.7%), 014 (n=176, 8%), 012 (n=127, 5.8%), 017 (n=85, 3.9%), 020 (n=68, 3.1%), 596 (n=55, 2.5%), 002-like (n=45, 2.1%), 010 (n=35, 1.6%) and 078 (n=34, 1.6%). Multi-locus sequence typing (MLST) of seven housekeeping genes performed in one isolate of each of 53 different CE-ribotyping profiles revealed 40 different sequence types (STs). We conclude that molecular characterisation of Czech C. difficile isolates revealed a high diversity of CE-ribotyping profiles; the prevailing RTs were 001 (20.7%) and 176 (027-like, 26.7%).

Treatment of orthopedic infections caused by resistant staphylococci.

During 1999–2005 we treated 15 patients with linezolid for relevant infections of locomotion apparatus (7 cases with endoprosthesis infection, 5× osteomyelitis and 3× another infection). With the exception of one case the antibiotic therapy was always combined with appropriate surgical intervention. Average period of linezolid administration was 26 d; linezolid was applied from the beginning intravenously on average for 10 d, and then orally for 16 d (average). There were no undesirable effects in the file. Success rate reached 86.6 %. MRSA strains were proved by standard methods: growth on Mueller-Hinton agar with increased concentration of NaCl and 2 mg/L of oxacilline, and measuring inhibitory zones around cephoxitine disk. The sensitivity to other antibiotics was specified by disk-diffusion test; that to linezolid was verified by E-test. Linezolid represents a medical reserve for the treatment of multiresistant Gram-positive infections or for emergencies, when allergy onset, high toxicity risk, intolerance,etc. do not allow to use other,in vitro effective, antibiotics.

Bone grafts as vancomycin carriers in local therapy of resistant infections

The level of an antibiotic capable of inhibiting the etiological agent at the site of infection is an essential prerequisite for successful antibiotic therapy. In some cases, locally applied antibiotics may compensate for limitations of systemic administration and shorten systemic therapy. We aimed at verifying to what extent vancomycin (Van) bound to ground bone grafts is usable in the treatment of serious infections. The levels of released Van significantly exceeded the Van minimum inhibitory concentration, which can suppress Van-sensitive staphylococci and Van intermediate Staphylococcus aureus, for the whole period of a 16-day measurement. Our results indicate that bone grafts can be used as Van carriers in therapy of osteomyelitis caused by Van-sensitive Staphylococcus strains.

Hospital antibiotic management in the Czech Republic--results of the ABS maturity survey of the ABS International group.

ZusammenfassungHINTERGRUND: Spitalsbasierte Antibiotika Stewardship-Programme sind für die langdauernde Qualität des Einsatzes von Antibiotika und auch im Sinne der Kontrolle der antimikrobiellen Resistenz im Krankenhaus essentiell. METHODEN: Im Mai 2007 wurde ein Fragebogen zur Selbstbeurteilung hinsichtlich der Qualität der Verwendung von Antibiotika an 60 tschechische Krankenhäuser gesandt. Die Befragung betraf diagnostische Belange, die Kontrolle des Antibiotikaverbrauchs, die Organisation und die Kooperation mit niedergelassenen Fachkollegen. ERGEBNIS: Von 80 adressierten Spitälern sandten 45 die Fragebogen ausgefüllt und auswertbar zurück (Antwortrate 56,3%). Diese 80 Spitäler versorgen etwa 85% der tschechischen Bevölkerung. Alle tschechischen Universitätsspitäler beantworteten die Fragebögen. Die diagnostischen Hilfsmittel sind in 45 von 45 Spitälern vorhanden. 44 von 45 Spitälern haben Überwachungssysteme für Antibiotikaresistenzraten. Antibiotikaverbrauchskontrolle ist teilweise verfügbar (in 42 von 45 Spitälern). Einige der Antibiotika Stewardship Hilfsmittel müssen verbessert werden und auch vermehrt klinisch eingesetzt werden. Die offizielle Anerkennung einer Job-beschreibung und eine bessere Finanzierung des Antibiotika Stewardship Programms ist notwendig, wie auch eine Weiterentwicklung der Antibiotika Stewardship Strukturen und -Funktionen. DISKUSSION: Die Grundlagen eines nationalen Antibiotika Stewardship Programms ist in tschechischen Spitälern vorhanden. Es gibt ein Netzwerk von Antibiotikazentren in der Tschechischen Republik seit 1970. Diese Antibiotikazentren fokussieren ihre Leistungen auch auf die optimale Verwendung von Antibiotika. Andererseits zeigte diese Umfrage die Notwendigkeit und die Möglichkeiten für weitere Verbesserung. Antibiotikaverbrauchskontrolle gibt es nicht in allen tschechischen Krankenhäusern, zudem können auch einige essentielle Antibiotikahilfsmittel verbessert und weiterverwendet werden.SummaryBACKGROUND: Hospital antibiotic stewardship (ABS) programs are essential for ensuring long-lasting quality of antibiotic usage and for controlling antimicrobial resistance in the hospital setting. METHODS: A questionnaire for self-assessment of a hospitals ABS maturity was sent to 80 Czech hospitals in May 2007. The survey was focused on diagnostic issues, control of antibiotic consumption, antibiotic-related organization and tools, antibiotic-related personnel development and antibiotic-related relationships to relevant environments. RESULTS: Of 80 addressed hospitals, 45 sent back processed questionnaires (response rate 56.3%). These 80 hospitals cover about 85% of the Czech population. All Czech university hospitals were included in the replying group. The listed diagnostic tools were declared available by all hospitals; 44 of 45 hospitals have surveillance systems for antibiotic resistance rates. Control of antibiotic consumption was available only partially in 42 of 45 hospitals. Some antibiotic tools need to be improved and must be used more frequently. Official recognition, job descriptions and better funding of antibiotic personnel are needed, as well as support for further development of ABS structures and functions. DISCUSSION: The basic structure of ABS is well developed in the Czech hospitals. A network of antibiotic centers focusing their services on optimization of antibiotic usage has been in place in the Czech Republic since the 1970s. Nevertheless, the survey revealed a clear need and many opportunities for further improvement. Control of antibiotic consumption is not implemented in all Czech hospitals and some of the essential antibiotic tools should be used more widely.