V předloženém textu je shrnuta problematika infekcí horních cest močových především z pohledu klinického mikrobiologa. Jsou zde prezentovány základní principy diagnostiky a léčby uroinfekcí s ohledem na současnou epidemiologickou situaci. Doporučení pro antibiotickou léčbu reflektují aktuální evropské a české doporučené postupy.
The presented text summarizes the issue of upper urinary tract infections, especially from the perspective of a clinical microbiologist. The basic principles of diagnosis and treatment of urinary tract infections with regard to the current epidemiological situation are presented. Recommendations for antibiotic treatment reflect current European and Czech guidelines.
- MeSH
- Diagnosis, Differential MeSH
- Escherichia coli pathogenicity MeSH
- Urinary Tract Infections * diagnosis etiology drug therapy classification MeSH
- Klebsiella pneumoniae pathogenicity MeSH
- Humans MeSH
- Microbial Sensitivity Tests classification methods MeSH
- Emergencies * classification MeSH
- Pyelonephritis diagnosis drug therapy classification microbiology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Background: Fosfomycin (FOS) is an older antimicrobial agent newly rediscovered as a possible treatment for infections with limited therapeutic options (e.g., Gram-negative bacteria with difficult-to-treat resistance, DTR), especially in intravenous form. However, for correct usage of FOS, it is necessary to have a reliable susceptibility testing method suitable for routine practice and robust interpretation criteria. Results: The results were interpreted according to 2023 interpretation criteria provided by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). DTR Gram-negatives were more likely to be resistant to FOS (45% in Enterobacterales and 20% in P. aeruginosa) than non-DTR (10% and 6.7%, resp.). All isolates of S. aureus were susceptible to FOS. In Gram-negatives, all agreement values were unacceptable. Etest® performed better in the DTR cohort (categorical agreement, CA, 80%) than in the non-DTR cohort (CA 45.7%). There were no very major errors (VREs) observed in P. aeruginosa. S. aureus had surprisingly low essential agreement (EA) rates (53% for MRSA and 47% for MSSA) for Etest®, but categorical agreement was 100%. Methods: A total of 130 bacterial isolates were tested and compared using the disc diffusion method (DD) and gradient strip method (Etest®) with the reference method (agar dilution, AD). The spectrum of isolates tested was as follows: 40 Enterobacterales (20 DTR vs. 20 non-DTR), 30 Pseudomonas aeruginosa (15 DTR vs. 15 non-DTR), and 60 Staphylococcus aureus (30 methicillin-susceptible, MSSA, vs. 30 methicillin-resistant, MRSA). Conclusions: Neither one of the tested methods was identified as a suitable alternative to AD. It would be beneficial to define more interpretation criteria, at least in some instances.
- Publication type
- Journal Article MeSH
- MeSH
- Anti-Bacterial Agents administration & dosage therapeutic use MeSH
- Borrelia burgdorferi Group MeSH
- Immunoassay MeSH
- Humans MeSH
- Lyme Disease * diagnosis epidemiology drug therapy MeSH
- Lyme Neuroborreliosis diagnosis drug therapy MeSH
- Polymerase Chain Reaction MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Travel MeSH
- Humans MeSH
- Immunization Programs MeSH
- Immunization Schedule MeSH
- Spleen immunology pathology MeSH
- Pregnancy drug effects MeSH
- Vaccination * methods MeSH
- Vaccines classification therapeutic use MeSH
- Check Tag
- Humans MeSH
- Pregnancy drug effects MeSH
- Publication type
- Review MeSH
Streptococcus pyogenes, group A streptococci (GAS) bacteriaemia, is a life-threatening infection with high mortality, requiring fast diagnosis together with the use of appropriate antibiotic therapy as soon as possible. Our study analysed data from 93 patients with GAS bacteraemia at the General University Hospital in Prague between January 2006 and March 2024. In the years 2016-2019 there was an increase in GAS bacteraemia. Mortality in the period 2006-2019 was 21.9%; in the period 2020-2024, the mortality increased to 41.4%, p = 0.08. At the same time, in the post-2020 period, the time from hospital admission to death was reduced from 9.5 days to 3 days. A significant predictor of worse outcome in this period was high levels of procalcitonin, >35.1 μg/L (100% sensitivity and 82.35% specificity), and lactate, >5 mmol/L (90.91% sensitivity and 91.67% specificity). Myoglobin was a significant predictor in both compared periods, the AUC was 0.771, p = 0.044, and the AUC was an even 0.889, p ≤ 0.001, respectively. All isolates of S. pyogenes were susceptible to penicillin, and resistance to clindamycin was 20.3% from 2006-2019 and 10.3% in 2020-2024. Appropriate therapy was initiated in 89.1%. and 96.6%, respectively. We hypothesise that the increase in mortality after 2020 might be due to a decrease in the immune status of the population.
- Publication type
- Journal Article MeSH
Bacterial resistance surveillance is one of the main outputs of microbiological laboratories and its results are important part of antimicrobial stewardship (AMS). In this study, the susceptibility of specific bacteria to selected antimicrobial agents was tested. The susceptibility of 90 unique isolates of pathogens of critical priority obtained from clinically valid samples of ICU patients in 2017-2021 was tested. 50% of these fulfilled difficult-to-treat resistance (DTR) criteria and 50% were susceptible to all antibiotics included in the definition. 10 Enterobacterales strains met DTR criteria, and 2 (20%) were resistant to colistin (COL), 2 (20%) to cefiderocol (FCR), 7 (70%) to imipenem/cilastatin/relebactam (I/R), 3 (30%) to ceftazidime/avibactam (CAT) and 5 (50%) to fosfomycin (FOS). For Enterobacterales we also tested aztreonam/avibactam (AZA) for which there are no breakpoints yet. The highest MIC of AZA observed was 1 mg/l, MIC range in the susceptible cohort was 0.032-0.064 mg/l and in the DTR cohort (incl. class B beta-lactamase producers) it was 0.064-1 mg/l. Two (13.3%) isolates of Pseudomonas aeruginosa (15 DTR strains) were resistant to COL, 1 (6.7%) to FCR, 13 (86.7%) to I/R, 5 (33.3%) to CAT, and 5 (33.3%) to ceftolozane/tazobactam. All isolates of Acinetobacter baumannii with DTR were susceptible to COL and FCR, and at the same time resistant to I/R and ampicillin/sulbactam. New antimicrobial agents are not 100% effective against DTR. Therefore, it is necessary to perform susceptibility testing of these antibiotics, use the data for surveillance (including local surveillance) and conform to AMS standards.
- MeSH
- Anti-Bacterial Agents * pharmacology therapeutic use MeSH
- Azabicyclo Compounds * MeSH
- Aztreonam MeSH
- Cephalosporins * MeSH
- Cefiderocol MeSH
- Gram-Negative Bacteria MeSH
- Colistin pharmacology MeSH
- Humans MeSH
- Microbial Sensitivity Tests MeSH
- Pseudomonas aeruginosa MeSH
- Retrospective Studies MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
