OBJECTIVES: To investigate the relationship between Clostridium (Clostridioides) difficile strain characteristics and C. difficile infection (CDI) outcome. METHODS: Between October and December 2017, 16 hospitals collected epidemiological data according to the European Centre for Disease Prevention and Control (ECDC) surveillance protocol for CDI. C. difficile isolates were characterized by ribotyping, toxin genes detection and antibiotic susceptibility testing to metronidazole, vancomycin and moxifloxacin. RESULTS: The overall mean CDI incidence density was 4.5 [95% CI 3.6-5.3] cases per 10,000 patient-days. From the 433 CDI cases, 330 (76.2%) were healthcare-associated, 52 (12.0%) cases were community-associated or of unknown origin and 51 (11.8%) CDI cases recurrent; a complicated course of CDI was reported in 65 cases (15.0%). Eighty-eight (20.3%) of patients died and 59 of them within 30 days after the CDI diagnosis. From the 379 C. difficile isolates, the most prevalent PCR ribotypes were 001 (n = 127, 33.5%) and 176 (n = 44, 11.6%). A total of 186 (49.1%) isolates showed a reduced susceptibility to moxifloxacin (> 4 mg/L) and 96.4% of them had Thr82Ile in the GyrA. Nineteen isolates revealed reduced susceptibility to metronidazole and two isolates to vancomycin (> 2 mg/L). A fatal outcome was associated with a reduced susceptibility to moxifloxacin, the advanced age of the patients and a complicated course of CDI (p<0.05). No association between ribotype, binary toxin and a reduced susceptibility to moxifloxacin and complicated course or recurrent CDI was found. CONCLUSIONS: A reduced susceptibility to moxifloxacin, in causative C. difficile strains was associated with fatal outcome of the patients, therefore it is an important marker in surveillance of CDI.
- MeSH
- antibakteriální látky terapeutické užití MeSH
- Clostridioides difficile účinky léků MeSH
- feces mikrobiologie MeSH
- infekce spojené se zdravotní péčí MeSH
- klostridiové infekce farmakoterapie mikrobiologie mortalita MeSH
- lidé MeSH
- mikrobiální testy citlivosti MeSH
- moxifloxacin terapeutické užití MeSH
- ribotypizace MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
Nowadays, dental diseases are one of the most common illnesses in the world. Some of them can lead to translocation of oral bacteria to the bloodstream causing intermittent bacteraemia. Therefore, a potential association between oral infection and cardiovascular diseases has been discussed in recent years as a result of adhesion of oral microbes to the heart valves. The aim of this study was to detect oral bacteria on pathologically changed heart valves not caused by infective endocarditis. In the study, patients with pathologically changed heart valves were involved. Samples of heart valves removed during heart valve replacement surgery were cut into two parts. One aliquot was cultivated aerobically and anaerobically. Bacterial DNA was extracted using Ultra-Deep Microbiome Prep (Molzym GmbH, Bremen, Germany) followed by a 16S rRNA gene PCR amplification using Mastermix 16S Complete kit (Molzym GmbH, Bremen, Germany). Positive PCR products were sequenced and the sequences were analyzed using BLAST database ( http://www.ncbi.nlm.nih/BLAST ). During the study period, 41 samples were processed. Bacterial DNA of the following bacteria was detected in 21 samples: Cutibacterium acnes (formerly Propionibacterium acnes) (n = 11; 52.38% of patients with positive bacterial DNA detection), Staphylococcus sp. (n = 9; 42.86%), Streptococcus sp. (n = 1; 4.76%), Streptococcus sanguinis (n = 4; 19.05%), Streptococcus oralis (n = 1; 4.76%), Carnobacterium sp. (n = 1; 4.76%), Bacillus sp. (n = 2; 9.52%), and Bergeyella sp. (n = 1; 4.76%). In nine samples, multiple bacteria were found. Our results showed significant appearance of bacteria on pathologically changed heart valves in patients with no symptoms of infective endocarditis.
- MeSH
- amplifikace genu * MeSH
- Bacteria klasifikace genetika MeSH
- bakteriální endokarditida mikrobiologie mortalita patologie terapie MeSH
- chirurgická náhrada chlopně metody MeSH
- DNA bakterií * MeSH
- lidé středního věku MeSH
- lidé MeSH
- polymerázová řetězová reakce MeSH
- RNA ribozomální 16S * MeSH
- sekvenční analýza DNA MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- srdeční chlopně mikrobiologie patologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
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 patient's isolate and RT027 isolate collected in the German hospital.
- MeSH
- cestování * MeSH
- Clostridioides difficile klasifikace genetika izolace a purifikace MeSH
- hospitalizace MeSH
- klostridiové infekce diagnóza mikrobiologie MeSH
- lidé MeSH
- minisatelitní repetice MeSH
- polymerázová řetězová reakce * MeSH
- ribotypizace * MeSH
- senioři nad 80 let MeSH
- Check Tag
- lidé MeSH
- senioři nad 80 let MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
- Německo MeSH
OBJECTIVE: Clostridium difficile infection (CDI) has been increasing in incidence, with significant morbidity and mortality, and is subject to geographical and institutional variability. We aimed to characterize epidemiology and clinical manifestations of CDI in a Czech tertiary care center and to identify risk factors of fulminant course. METHODS: All adult patients hospitalized with primary CDI in a 3-year period were retrospectively identified. Epidemiological and clinically descriptive data were extracted from medical records. Multivariate analysis was used to identify the risk factors of fulminant course. The relationship between incidence of CDI and antibiotic consumption was evaluated. RESULTS: Overall, 183 CDI patients, median age 67 years, were enrolled. Hospital-acquired CDI was present in 85% of cases. The incidence of CDI was 1/10,000 patient-days. Hospital-acquired CDI hospital mortality was 22.4%. Severe CDI (SCDI) was identified in 15.8% of patients, with 62% mortality. SCDI patients had longer onset of symptoms to diagnosis interval compared with mild CDI (P=0.05). Multivariate analysis showed that SCDI patients were older (P=0.018), and more frequently had abnormal abdominal physical findings (P=0.001), higher inflammatory markers (P<0.001), higher creatinine (P=0.002), and lower albumin (P<0.001) than patients with mild CDI. Analysis of antibiotic consumption at departments with the highest incidence of CDI showed a trend toward higher incidence of CDI associated with penicillin use (P=0.08) and a negative correlation of CDI incidence with nitroimidazoles consumption (P=0.03). CONCLUSION: CDI is less frequent in the conditions studied compared with literary data; however, the fulminant form has a very high mortality. Delayed recognition and treatment is a crucial determinant of the severity of CDI. The association between CDI and antibiotic consumption is less clear.
- MeSH
- antibakteriální látky terapeutické užití MeSH
- časná diagnóza MeSH
- centra terciární péče MeSH
- délka pobytu statistika a číselné údaje MeSH
- hospitalizace MeSH
- incidence MeSH
- infekce spojené se zdravotní péčí epidemiologie přenos MeSH
- lidé středního věku MeSH
- lidé MeSH
- mortalita v nemocnicích MeSH
- prognóza MeSH
- pseudomembranózní enterokolitida diagnóza farmakoterapie epidemiologie přenos MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři MeSH
- spotřeba léčiv statistika a číselné údaje MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
PURPOSE OF THE STUDY To make comprehensive diagnoses of the infections associated with revision total knee and hip arthroplasties in our group of patients. MATERIAL AND METHODS From September 2002 till November 2004, a group of 69 patients undergoing revision total joint replacement (65 hips and four knees) were evaluated. The period between primary and revision surgery ranged from 6 months to 25 years. The patients were examined for CRP, erythrocyte sedimentation rate (ESR) and white blood cell (WBC) counts. The samples of their periprosthetic tissue were assessed for biopsy and microbial findings. The removed prosthetic components were sonicated. The samples were cultured in both aerobic and anaerobic conditions for 16 days. A finding of more than 10 neutrophils per viewing field was taken as a positive biopsy result. The definition of an infection was based on the detection of a microorganism with the identical phenotype in two or more samples. RESULTS Before surgery, 13 patients had a suspected infection which was subsequently diagnosed. A positive culture result in at least one of the collected samples was found in 48 patients; of these, a positive culture finding of a phenotypically identical microorganism in two or three samples was in 32 patients, who thus met the definition of infection. The average values for the whole group were: CRP, 16 mg/L (1-109); ESR, 25 mm/h (3-110); peripheral WBC count, 6.2x109/L (3.6-11.6). The microorganisms most frequently growing in culture were coagulase-negative staphylococci and propionibacteria accounting for 41 % and 29 % of the total isolates obtained, respectively. From the total number of samples, positive culture results were obtained in 36 % of sonicate femoral components; 40 % of sonicate acetabular cups, 51 % of periprosthetic tissues and 48 % of swabs. In these positive microbial cultures strictly anaerobic microorganisms were found in 41 % of femoral component, 49 % acetabular component and 42 % periprosthetic tissue samples and in 27 % of swabs taken at arthrotomy. Prolonged cultivation of the 151 isolates initially obtained yielded 81 (54%) isolates which would have failed to be detected by primary culture. The results of laboratory tests in the patients with negative culture findings, in those with a phenotypically identical microorganism found in one sample, and in those with positive findings in two or more samples were: CRP, 4.3 mg/L; 9.8 mg/L; and 21.7 mg/L, respectively; ERS, 13.5 mm/h; 20.1 mm/h; and 33.0 mm/h, respectively; and WBC counts, 6.27x109/L; 6.25x109/L; and 6.16x109/L, respectively. The t-test was used for the statistical analysis of CRP, ESR and WBC count values, and it revealed a significant differences between the patients with negative microbial findings and those with positive microbial findings in two and more samples in all three values, i.e., CRP (p=0.01), ESR (p=0.01) and WBCs (p=0.96). Biopsy findings showed a sensitivity of 62.5 % and a specificity of 91 % in relation to the microbial findings. DISCUSSION Our results as well as relevant literature data suggest that microorganisms may survive on implant surfaces even in the cases regarded as aseptic. They often grow slowly and, theoretically, can have an adverse effect on the longevity of revision arthroplasty. However, because of current endoprosthetic practices and the ubiquitous presence of microorganisms, contamination of some samples cannot be excluded. CONCLUSIONS In our group of patients, the CRP and ESR values proved to be useful in making the diagnosis of infection. For this purpose, WBC counts in blood samples were not sensitive enough. Biopsy findings had low sensitivity, but appeared to be a specific marker of infection. Prolonged cultivations of samples and cultivation under anaerobic conditions resulted in a marked increase in isolates obtained, as compared with the routine cultivation technique.
- MeSH
- absces farmakoterapie mikrobiologie MeSH
- Actinomyces účinky léků izolace a purifikace MeSH
- aktinomykóza farmakoterapie mikrobiologie MeSH
- antibakteriální látky farmakologie terapeutické užití MeSH
- dospělí MeSH
- lidé MeSH
- mikrobiální testy citlivosti MeSH
- mladiství MeSH
- molekulární sekvence - údaje MeSH
- nemoci anu farmakoterapie mikrobiologie MeSH
- nemoci mužských pohlavních orgánů farmakoterapie mikrobiologie MeSH
- senioři MeSH
- skrotum mikrobiologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- dopisy MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
In this review article the authors present history, etiology, epidemiology, pathophysiology and clinical symptoms of the cervicofacial actinomycosis. The recommendation for the diagnostic success improvement and the treatment strategies focused on the individualized short-term antibiotic therapy of this infection are also reported.
- Klíčová slova
- aktinomycety, drúzy,
- MeSH
- aktinomykóza cervikofaciální diagnóza farmakoterapie mikrobiologie MeSH
- antibakteriální látky aplikace a dávkování MeSH
- lidé MeSH
- mikrobiologické techniky metody MeSH
- Check Tag
- lidé MeSH
