BACKGROUND: Sedation is an essential part of clinical practice. Despite this fact, we still lack data describing the exact impact of sedation on heart function. PURPOSE: To compare the changes in heart function, induced after sedation with either midazolam or dexmedetomidine, using cardiac magnetic resonance imaging (MRI). METHODS: A total number of 30 volunteers were randomized into two groups: 15 participants in the midazolam group (MID) and 15 participants in the dexmedetomidine group (DEX). Every participant underwent a one-session cardiac MRI before and after sedation onset. The following parameters were recorded: left and right ventricle stroke volume (Ao-vol and Pul-vol resp.) and maximum fl ow velocity through the mitral valve during early (E-diast) and late diastole (L-diast). A monitor recorded values of mean blood pressure (MAP), pulse (P) and blood oxygen saturation (SpO2 ) in 5-minute intervals. RESULTS: Dexmedetomidine led to a statistically signifi cant decrease in Ao-vol (p = 0.006) and Pul-vol (p = 0.003), while midazolam decreased E-diast (p = 0.019) Ao-vol (p = 0.001) and Pul-vol (p = 0.01). The late diastolic fi lling was not infl uenced by the sedation technique. CONCLUSION: Both sedation regimens worsened the systolic function of both ventricles. Midazolam moreover attenuated early diastolic fi lling of the left ventricle (Tab. 3, Fig. 4, Ref. 19).
- MeSH
- Conscious Sedation classification methods adverse effects MeSH
- Dexmedetomidine * pharmacology adverse effects therapeutic use MeSH
- Heart Function Tests classification methods MeSH
- Humans MeSH
- Magnetic Resonance Imaging methods MeSH
- Midazolam * pharmacology adverse effects therapeutic use MeSH
- Cardiac Output drug effects MeSH
- Systole drug effects MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
OBJECTIVES: To gain data on the current molecular epidemiology and resistance of MRSA in the Czech Republic. METHODS: Between September 2017 and January 2018, a total of 441 single-patient MRSA isolates were collected from 11 Czech hospitals and analysed by spa typing, SCCmec typing, antibiotic susceptibility testing, detection of the PVL toxin and the arcA gene. RESULTS: Of all MRSA isolates, 81.41% (n = 359) belonged to the CC5-MRSA clone represented by the spa types t003 (n = 136), t586 (n = 92), t014 (n = 81), t002 (n = 20) and other spa types (n = 30); a majority of the CC5 isolates (n = 348, 96.94%) carried SCCmec type II. The occurrence of CC5-MRSA was more likely in older inpatients and associated with a healthcare origin (P < 0.001). The CC5-MRSA isolates were resistant to more antimicrobial drugs compared with the other MRSAs (P < 0.001). Interestingly, t586 was detected in blood samples more often than the other spa types and, contrary to other spa types belonging to CC5-MRSA, t586 was not associated with patients of advanced age. Other frequently found lineages were CC8 (n = 17), CC398 (n = 11) and CC59 (n = 10). The presence of the PVL was detected in 8.62% (n = 38) of the MRSA isolates. CONCLUSIONS: The healthcare-associated CC5-MRSA-II lineage (t003, t586, t014) was found to be predominant in the Czech Republic. t586 is a newly emerging spa type in the Czech Republic, yet reported rarely in other countries. Our observations stress the need for MRSA surveillance in the Czech Republic in order to monitor changes in MRSA epidemiology.
- MeSH
- Anti-Bacterial Agents pharmacology MeSH
- Genotype MeSH
- Humans MeSH
- Methicillin-Resistant Staphylococcus aureus * genetics MeSH
- Microbial Sensitivity Tests MeSH
- Molecular Epidemiology MeSH
- Aged MeSH
- Staphylococcal Infections * epidemiology MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Czech Republic MeSH
Introduction: Fluoroquinolones are a frequently prescribed class of antibiotics, which has been blacklisted in recent years because of a growing evidence of the connection with serious undesirable effects, infections Clostridioides difficile, and a connection with the occurrence of multiresistant strains.Methods: In the University Hospital Hradec Kralove in the course of the years 2009-2019, several antibiotic stewardship restrictive and educational interventions were performed by the Antibiotic Centre aiming to decrease quinolone antibiotics administration. The data of the consumption of quinolone antibiotics were retrospectively evaluated and correlated with the development of sensitivity and occurrence of multiresistance of selected bacteria in the hospital.Results: In the period under investigation, consumption of fluoroquinolone antibiotics significantly decreased (p<0.001) in 10 years by 71.8% to 26.7 DDD/1000 patient day. Sensitivity of Escherichia coli and Pseudomonas aeruginosa to fluoroquinolones in the period under investigation increased by 4.8% (respectively by 15%); on the other hand, sensitivity of Staphylococcus aureus decreased by 4.2% to 85.5% share of sensitive strains. The incidence of the multiresistant isolates Pseudomonas aeruginosa decreased by 8.1%, but the occurrence of ESBL-producing Klebsiella pneumoniae was increased in the period under investigation. The occurrence of methicillin-resistant Staphylococcus aureus did not show a stable trend and finally it was moderately increased by 2.9%.Conclusion: Implementation of programmes of antimicrobial stewardship for hospitalized patients resulted in a decrease and a rationalization of fluoroquinolone administration. The reduction of their consumption in our hospital resulted in a statistically insignificant increase in the sensitivity of Escherichia coli and Pseudomonas aeruginosa, but not Staphylococcus aureus.
Rapid identification of methicillin-resistant Staphylococcus aureus (MRSA) is essential for proper initial antibiotic therapy and timely set up of hygienic measures. Recently, detection of MRSA using MALDI-TOF mass spectrometer mediated by the peptide-phenol-soluble modulin (PSM-mec)-linked to the class A mec gene complex present in SCCmec cassettes types II, III, and VIII of MRSA strains, has been commercially available. We present here a multicentre study on MALDI-TOF MS detection of MRSA evincing a poor repeatability and reproducibility of the assay. The sensitivity of the assay varies between 50 and 90% in strains carrying psmMEC and psmδ genes encoding for PSM-mec and δ-toxin (a member of the PSM peptide family), respectively. No false positive results were found. The very major error calculation was 30% and the major error achieved 0%. Interlaboratory repeatability varies between 0 and 100%. No significant difference was observed with the use of different cultivation media. Our data showed a poor sensitivity of the method excluding it from the use in routine laboratory testing.
- MeSH
- Bacterial Toxins genetics MeSH
- Diagnostic Errors MeSH
- Molecular Diagnostic Techniques * MeSH
- Diagnostic Tests, Routine MeSH
- Humans MeSH
- Methicillin-Resistant Staphylococcus aureus genetics isolation & purification MeSH
- Reproducibility of Results MeSH
- Sensitivity and Specificity MeSH
- Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization * MeSH
- Staphylococcal Infections diagnosis microbiology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
Hospitalized patients with wounds face an increased risk of infection with multi-drug-resistant nosocomial bacteria. In this study, samples from almost 10,000 patients from big hospitals in Czech Republic with infected wounds were analyzed for the presence of bacterial pathogens. In 7693 patients (78.8%), bacterial etiological agents were identified. Members of the Enterobacterales (37.1%) and Staphyloccus aureus (21.1%) were the most prevalent pathogens. Staphyloccus aureus showed methicillin resistance in 8.6%. Almost half of the Klebsiella pneumoniae isolates were ESBL-positive and 25.6% of the Enterobacter spp. isolates were AmpC-positive. The third most prevalent Pseudomonas aeruginosa showed resistance to 19-32% of the antipseudomonal antibiotics tested. Based on the results, amoxicillin/clavulanic acid, ampicillin/sulbactam or piperacillin/tazobactam combined with gentamicin can be recommended for antibiotic treatment of infected wounds. Once the etiological agent is identified, the therapy should be adjusted according to the species and its resistance.
- Publication type
- Journal Article MeSH
Staphylococcus argenteus (S. argenteus)je nový druh koaguláza-pozitivního stafylokoka popsaného v roce 2015. Jedná se o druh, který je fenotypově velmi podobný a geneticky úzce příbuzný se Staphylococcus aureus (S. aureus). Odlišení bylo donedávna možné pouze s použitím molekulárně genetických metod; multilokusové sekvenční typizace a celogenomové sekvenace, které se v rutinních laboratořích vzhledem k časové a finanční náročnosti většinou nepoužívají. Velkým posunem v určování S. argenteus je aplikace metody MALDI-TOF MS, v případě použití aktualizované referenční databáze hmotnostních spekter. V krátkém sdělení bychom chtěli informovat o prvním potvrzeném kmenu S. argenteus izolovaném od pacienta v České republice a pravděpodobně i prvním publikovaném nálezu kmenu S. argenteus ve střední a východní Evropě.
Staphylococcus argenteus (S. argenteus) is a novel species of coagulase-positive staphylococci described in 2015. This species is phenotypically highly similar and genetically closely related to Staphylococcus aureus (S. aureus). Until recently, differentiation was only possible by molecular genetic methods, multilocus sequence typing and whole-genome sequencing, which are not generally used in routine laboratories due to time-consumingness and expensiveness. A major improvement in the identification of S. argenteus is the application of MALDI-TOF MS, if the available updated mass spectrum reference database is used. In the short report, we would like to present the first confirmed S. argenteus strain isolated from a patient in the Czech Republic and probably the first published S. argenteus strain in Central and Eastern Europe.
The aim of this study was to trace the dynamic changes of methicillin-resistant Staphylococcus aureus (MRSA) lineages in the local hospital in both the national and international context. We describe genotypic and phenotypic characterization of 62 non-duplicate MRSA isolates collected during 2010-2016 at University Hospital in Hradec Kralove, Czech Republic. The isolates were characterized by multilocus sequence typing (MLST), spa typing, and staphylococcal cassette chromosome mec typing (SCCmec typing). Eight different genotypes were described; ST225-t003-II (32/62, 52%), ST5-t002-II (13/62, 22%), and ST225-t014-II (12/62, 21%) were constantly detected over the 7-year follow-up period. The genotypes ST225-t151-II, ST225-t1282-II, ST225-t1623-II, ST78-t2832-II, and ST225-t8799-II occurred only once in the period reported. The majority of the strains, represented by ST225, belonged to clonal complex 5 (CC5).
- MeSH
- Anti-Bacterial Agents pharmacology MeSH
- Bacteremia epidemiology microbiology MeSH
- Child MeSH
- Adult MeSH
- Phenotype MeSH
- Genotype MeSH
- Infant MeSH
- Middle Aged MeSH
- Humans MeSH
- Methicillin-Resistant Staphylococcus aureus classification drug effects isolation & purification MeSH
- Microbial Sensitivity Tests MeSH
- Adolescent MeSH
- Young Adult MeSH
- Multilocus Sequence Typing MeSH
- Hospitals, University MeSH
- Child, Preschool MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Staphylococcal Infections epidemiology MeSH
- Bacterial Typing Techniques MeSH
- Check Tag
- Child MeSH
- Adult MeSH
- Infant MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Child, Preschool MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic MeSH
BACKGROUND: Cases of colonization or infection caused by Methicillin-resistant Staphylococcus aureus (MRSA) are frequently reported in people who work with animals, including veterinary personnel. The aim of this study was to determine the prevalence of MRSA colonization among veterinary professionals. A total of 134 nasal swabs from healthy attendees of a veterinary conference held in the Czech Republic were tested for presence of MRSA. The stains were further genotypically and phenotypically characterized. RESULTS: Nine isolated MRSA strains were characterized with sequence type (ST), spa type (t) and Staphylococcal Cassette Chromosome mec type. Five different genotypes were described, including ST398-t011-IV (n = 5), ST398-t2330-IV (n = 1), ST398-t034-V (n = 1), ST225-t003-II (n = 1) and ST4894-t011-IV (n = 1). The carriage of the animal MRSA strain was confirmed in 8 cases, characteristics of one strain corresponded to the possible nosocomial origin. Among animal strains were described three spa types (t011, t034, t2330) belonging into one dominating clonal complex spa-CC11. CONCLUSION: According to our results, the prevalence of nasal carriage of MRSA in veterinary personnel is 6.72%. Although we described an increase compared to the results of previous study (year 2008), the prevalence in the Czech Republic is still remaining lower than reported from neighboring countries. Our results also indicate that healthcare - associated MRSA strains are still not spread among animals.
- MeSH
- Adult MeSH
- Genotype MeSH
- Middle Aged MeSH
- Humans MeSH
- Methicillin-Resistant Staphylococcus aureus classification genetics isolation & purification MeSH
- Nose microbiology MeSH
- Occupational Exposure MeSH
- Carrier State epidemiology microbiology MeSH
- Prevalence MeSH
- Aged MeSH
- Staphylococcal Infections epidemiology MeSH
- Students MeSH
- Education, Veterinary MeSH
- Veterinarians * MeSH
- Animals MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Aged MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic MeSH
Bakteriální rezistence patří k nejzávažnějším fenoménům moderní medicíny. Staphylococcus aureus je jednou z bakterií, u kterých výskyt rezistence na antibiotika představuje závažnou komplikaci při účinné léčbě infekčních onemocnění. Meticilin‑rezistentní S. aureus (MRSA) je typickým původcem infekcí u pacientů s anamnézou pobytu v nemocničním prostředí. Vyvolává obdobné spektrum onemocnění jako meticilin‑senzitivní kmeny, nevyznačuje se vyšší virulencí. Pochopení patogeneze stafylokokových infekcí a mechanismů vzniku antibiotické rezistence je základní podmínkou pro vývoj nových účinných léků. Tento přehledový článek popisuje rozdělení MRSA dle genetických a epidemiologických charakteristik na komunitní, nemocniční a zvířecí kmeny. Informuje o jejich charakteristice, odlišnostech a rozšíření, což má praktický dopad při volbě optimální terapie a preventivních opatření. Čtenáři je podán ucelený přehled možností terapie infekcí způsobených MRSA a nastíněn genetický podklad i základní mechanismy stafylokokové antibiotické rezistence.
Bacterial resistance counts to the most serious problems of modern medicine. Staphylococcus aureus is one of the bacteria in which the incidence of antibiotic resistance is a problem complicating the effective treatment of infectious diseases. Methicillin‑resistant S. aureus (MRSA) is a typical pathogen in patients with a history of medical hospitalization. It induces a similar spectrum of diseases like methicillin‑sensitive S. aureus strains, there is no higher virulence in MRSA strains. Understanding the pathogenesis of staphylococcal infections and mechanisms of antibiotic resistance is essential for the development of new effective drugs. This article provides comprehensive information on the division of MRSA strains according to genetic and epidemiological characteristics to community, hospital and animal strains, their characteristics, differences and distribution. This has a practical impact on the choice of optimal therapy and preventive measures. This review also summarizes MRSA treatment possibilities, the genetic background, and basic mechanisms of staphylococcal antibiotic resistance.
- Keywords
- telavancin,
- MeSH
- Aminoglycosides therapeutic use MeSH
- Anti-Bacterial Agents adverse effects therapeutic use MeSH
- Drug Resistance, Bacterial MeSH
- Bacteremia drug therapy microbiology MeSH
- beta-Lactam Resistance MeSH
- Daptomycin therapeutic use MeSH
- Cross Infection * drug therapy microbiology MeSH
- Community-Acquired Infections drug therapy microbiology MeSH
- Humans MeSH
- Methicillin-Resistant Staphylococcus aureus * genetics isolation & purification pathogenicity drug effects MeSH
- Minocycline therapeutic use MeSH
- Vancomycin Resistance MeSH
- Staphylococcal Infections * drug therapy microbiology transmission MeSH
- Staphylococcus aureus genetics MeSH
- Teicoplanin administration & dosage therapeutic use MeSH
- Tigecycline MeSH
- Vancomycin * administration & dosage therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
- MeSH
- Spondylitis, Ankylosing complications MeSH
- Chylothorax * etiology therapy MeSH
- Spinal Fractures complications MeSH
- Thoracic Vertebrae injuries MeSH
- Humans MeSH
- Aged MeSH
- Wounds, Nonpenetrating complications MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- Research Support, Non-U.S. Gov't MeSH
