Zefiryn Cybulski

Urinary tract infections in patients with malignant neoplasms of the genitourinary system

Summary Aim To diagnose the etiological factors involved in urinary tract infections (UTI) and to examine antibiotic sensitivities in bacteria – causative agents of UTI in female patients with genitourinary malignancies. Materials/Methods Nineteen patients aged between 35 and 75 years treated for genitourinary malignancies and with a diagnosis of UTI were examined. The majority of these patients (17) were treated with X rays to the pelvic region (tele – and brachytherapy). Six patients were treated for endometrial carcinoma. One patient was treated for ovarian cancer, and one for vaginal cancer. Significant bacteriuria was defined as 10 4 or more CFUs/ml in quantitative urine examination. Microorganisms were identified according to standard bacteriological methods using bio-Merieux tests. The isolated bacteria were tested for antibiotic sensitivity using the ATB Expression system. Results E. coli was the most frequently observed causative factor in cases of UTI. E. faecalis strains were the next most commonly observed species. One of 11 isolated E. coli strains was resistant to 5 antibiotics, a second was resistant to 3 antibiotics and three strains were resistant to 2 antibiotics. E. coli strains were classified into 9, and E. faecalis into 4, sensitivity patterns. UTI was diagnosed in four patients with stage I B, in four with stage III B and in one patient with stage IV cervical cancer. Conclusions E. coli and E. faecalis were the most frequently isolated species from the urine of female patients with genitourinary malignancies. These bacteria are among the main causative agents of UTI. The results of these investigations may be used for epidemiological purposes: to find the causes and sources of nosocomial infections and in the prophylaxis of these infections.

Usability application of multiplex polymerase chain reaction in the diagnosis of microorganisms isolated from urine of patients treated in cancer hospital

Abstract Background. The objective of this study was: i) to compare the results of urine culture with polymerase chain reaction (PCR) -based detection of microorganisms using two commercially available kits, ii) to assess antimicrobial susceptibility of urine isolates from cancer patients to chosen antimicrobial drugs and, if necessary, to update the recommendation of empirical therapy. Materials and methods. A one-year hospital-based prospective study has been conducted in Greater Poland Cancer Centre and Genetic Medicine Laboratory CBDNA Research Centre in 2011. Urine cultures and urine PCR assay from 72 patients were examined Results. Urine cultures and urine PCR assay from 72 patients were examined. Urine samples were positive for 128 strains from which 95 (74%) were identical in both tests. The most frequently isolated bacteria in both culture and PCR assay were coliform organisms and Enterococcus spp. The Gram negative bacilli were most resistant to cotrimoxazol. 77.2% of these bacilli and 100% of E. faecalis and S. agalactiae were sensitive to amoxicillin-clavulanic acid. 4.7% of Gram positive cocci were resistant to nitrofurantoin. Conclusions. The PCR method quickly finds the causative agent of urinary tract infection (UTI) and, therefore, it can help with making the choice of the proper antimicrobial therapy at an early stage. It appears to be a viable alternative to the recommendations made in general treatment guidelines, in cases where diversified sensitivity patterns of microorganisms have been found.

Lung surgery for metastatic epithelial tumours.

INTRODUCTION The aim of this study is to evaluate outcomes following the surgical treatment of pulmonary metastases in patients with different types of epithelial cancers, as well as to identify prognostic factors after metastasectomy. MATERIAL/METHODS We retrospectively reviewed data for 61 patients who underwent 76 curative resections of pulmonary metastases from epithelial tumours during 1997-2002 at our department. Potential prognostic factors affecting survival after lung metastasectomy were analysed: disease-free interval (DFI), gender, age, the size and number of metastases, mono- or bilateral tumour, number of operations and the extent of pulmonary resection. RESULTS The median survival was 36 months. Three factors were identified as prognostic for survival after metastasectomy: DFI<24 (p=0.0045), unilateral pulmonary metastases (p=0.0062) and no more than one operation (p=0.0065). CONCLUSIONS We concluded that: i) Resection of epithelial pulmonary metastases may offer a significant survival benefit for selected patients. ii) Good surgical candidates for pulmonary resection are those with a disease-free interval greater than 24 months. iii) The total number of thoracotomies, and metastases confined to one lung are factors defining patients who experience a better outcome after surgery. iv) Lung metastasectomy by conventional surgery is a safe procedure with low perioperative morbidity and mortality rates.

The anti-cancer actions of O6-methylguanine-DNA-methyltransferase in relation to colon polyps.

BACKGROUND Genetic variability in DNA repair genes may contribute to differences in DNA repair capacity and susceptibility to colon polyps and cancer. In this study, we examined the role of MGMT polymorphisms in colon polyps formation. METHODS PCR-SSCP analysis was performed included 254 patients with colon polyps and 330 controls. RESULTS The homozygous F84F genotype was significantly more prevalent in study group than in controls. The polymorphic allele 84F was more frequent appeared in group of older patients and in group of smoking patients. On the other hand, there were no association between 84F and gender, size of polyps, cancer family history. CONCLUSIONS We concluded that high frequency of 84F allele in the group of patients may suggest the role of the MGMT variant in colon polyps etiology.

Risk factors in superficial infections of surgical sites in colorectal carcinoma surgery

Summary Aim The aim of the paper was to conduct a retrospective analysis of a group of patients after surgery for colorectal cancer: to define aetiological factors for, and assess drug-sensitivity of bacteria causing infection. Materials/Methods Between January 2000 and June 2004, 350 patients underwent surgery for colorectal cancer. Within that group 17 (4,86%) patients developed postoperative wound infections within 30 days of the operation. In all cases we performed microbiological examinations. All the cases of infections were analysed, with special attention being paid to the following groups of risk factors: patient-related and perioperative procedures. Results In all, 17 cases of superficial infections were identified within the skin and subcutaneous tissues. The most frequently identified aetiological factors were colibacillus species and Enterococcus faecalis . Targeted antibiotic therapy was applied, based on the results of antibiograms. Rapid recovery was observed in all patients. The most important patient-related risk factors included: BMI over 25 kg/m 2 in 11 (64.7%) patients, high (3 rd ) degree of neoplastic advancement in 13 (76.5%) patients and preoperative radiotherapy in 7 (41.2%) patients. All infections were found in patients after resection of the sigmoid colon or rectum. Conclusions The most frequent aetiological factor identified, on the basis of cultures, was bacterial fl ora of the colorectum. 1. The most important risk factors include: degree of neoplastic advancement, obesity and preoperative radiotherapy. 2. The application of appropriate systems for the preparation of the patient during the perioperative period has a great infl uence on the frequency of infections. 3. Because high drug-resistance in bacterial cultures is a real possibility, it is essential to perform antibiograms in order to help select the most appropriate antibiotics for the treatment of infections.

300. Bakteryjne zakażenia układu moczowego u chorych z nowotworami narządów płciowych leczonych radioterapią

Zalozenia i cel pracy radioterapie stosuje sie u okolo 60% chorych leczonych z powodu nowotworow narządow plciowych. Moze byc ona cześcią leczenia skojarzonego np z operacją czy chemioterapią lub stanowic leczenie samoistne tych nowotworow. W leczeniu nowotworow narządow plciowych stosuje sie zarowno brachyterapie (dojamowo, środtkankowo) jak i teleradioterapie (external beam radiotherapy – EBRT). Chore leczone napromienianiem na obszar miednicy mniejszej z powodu tych nowotworow zglaszają czesto dolegliwości ze strony dolnego odcinka ukladu moczowego. Przyczyną tych dolegliwości mogą byc wystepujące w trakcie radioterapii ostre odczyny popromienne glownie ze strony pecherza moczowego i cewki moczowej jak i stany zapalne. Wśrod zakazen szpitalnych najcześciej obserwuje sie zakazenia ukladu moczowego (ZUM). Duze znaczenie w dochodzeniu epidemiologicznym ma określenie identyczności szczepow. Jedną z metod roznicowania szczepow bakteryjnych jest porownanie ich lekowrazliwości. Celem obecnej pracy byla diagnostyka i ocena lekowrazliwości szczepow bakteryjnych, stanowiących czynnik etiologicznych ZUM u chorych z nowotworem zlośliwym narządow plciowych leczonych radioterapią. Kolejny cel pracy stanowilo wykorzystanie informacji o lekowrazliwości w badaniu identyczności tych szczepow. Material i metodyka Badania obejmują chorych leczonych z powodu nowotworow zlośliwych narządow plciowych na Oddziale Radioterapii i Onkologii Ginekologicznej Wielkopolskiego Centrum Onkologii, u ktorych stwierdzono bakteriurie znamienną. Badanie jakościowe i ilościowe moczu wykonywano na podlozach CPS, D-Coccosel, Cetrimide, Albicans ID2 metodą ez kalibrowanych. Identyfikacje drobnoustrojow przeprowadzano wykorzystując testy bio-Merieux. Lekowrazliwośc drobnoustrojow badano w systemie ATB Expression przy uzyciu testow ATB Ur i ATB Strep. Wyniki Czynnikiem etiologicznym, ktory najcześciej wywolywal ZUM byly E. coli i E. faecalis. Wyhodowane szczepy zaklasyfikowano do 13-stu wzorow leko wrazliwości. Najwiekszą opornością na antybiotyki charakteryzowal sie szczep K. pneumoniae, ktory byl oporny na amoksycyline\kwas klawulanowy, cefotaksym, kotrymoksazol, gentamycyne, netylmycyne i amikacyne, a wrazliwy jedynie na norfloksacyne. Wnioski wykonywanie antybiogramow z uwzglednieniem szerokiego profilu antybiotykow jest przydatne w oznaczaniu identyczności szczepow E. coli i E. faecalis.

301. Zakażenia układu moczowego u chorych z chorobą nowotworową leczonych w OIOM w Wielkopolskim Centrum Onkologii

Zalozenia i cel pracy Najwiekszą grupe wśrod zakazen szpitalnych (30–40%) stanowią zakazenia ukladu moczowego (ZUM), bedąc jednym z czynnikow wyzszej umieralności oraz dluzszego pobytu w szpitalu. ZUM wystepuje cześciej u kobiet u niz mezczyzn. Szczegolnie narazeni na ZUM są ludzie starsi, chorzy cewnikowani, a takze chorzy, u ktorych wystepują zaburzenia immunologiczne. ZUM moze wystepowac jako objawowe lub bezobjawowe, przy czym jako kryterium objawowego ZUM przyjmuje sie gorączke >380 C i wystepowanie bakteriurii znamiennej. W dostepnym piśmiennictwie nie znaleziono publikacji dotyczących wplywu chorob nowotworowych na wystepowanie ZUM. Celem pracy bylo wykazanie, jakie czynniki etiologiczne wywolują bakteriurie znamienną u chorych z chorobą nowotworową, leczonych w OIOM w latach 1998–2002. Kolejnym celem bylo określenie lekowrazliwości wyhodowanych bakterii. Material i metodyka badaniami objeto 69 chorych doroslych (powyzej 18. roku zycia) leczonych > 48godz. na OIOM, u ktorych stwierdzono bakteriurie znamienną. Badanie ilościowe i jakościowe moczu wykonywano na podlozach CPS, D-Coccosel, Cetrimide oraz Albicans ID2 metodą ez kalibrowanych. Lekowrazliwośc wyhodowanych drobnoustrojow badano w systemie ATB Expression przy uzyciu testow antybiogramowych ATB Ur (93), ATB Ur 5 (00), ATB G- (95), ATB G- 5 ((7), ATB Strep (95), ATB Strep 5 (97), ATB Staph. Wyniki najcześciej czynnikami etiologicznymi wywolującymi ZUM byly: E. coli, inne paleczki z rodziny Enterobacteriaceae i E. faecalis Wyhodowane szczepy E. coli wykazywaly najmniejszą wrazliwośc na cefalotyne i kotrymoksazol. Paleczki z rodziny Enterobacteriaceae (inne niz E. coli) wykazywaly rowniez najwiekszą opornośc na cefalotyne. Wszystkie szczepy E. faecalis byly wrazliwe na vankomycyne i teikoplanine, natomiast 84,6% szczepow wykazywalo opornośc na ciprofloxacyne. Do najbardziej lekoopornych nalezaly paleczki A. baumannii oraz szczepy E. casseliflavus i P. aeruginosa. Wnioski wystepowanie szczepow wieloopornych (w tym E. coli opornych na ciprofloksacyne i ko-trymoksazol) wskazuje na koniecznośc badania lekowrazliwości szczepow wywolujących ZUM z uwzglednieniem szerokiego spektrum antybiotykow.