BACKGROUND: Multidrug-resistant (MDR) bacteria pose a significant challenge to the treatment of infectious diseases. Of particular concern are members of the Klebsiella pneumoniae species complex (KpSC), which are frequently associated with hospital-acquired infections and have the potential to spread outside hospitals via wastewaters. In this study, we aimed to investigate the occurrence and phylogenetic relatedness of MDR KpSC from patients with urinary tract infections (UTIs), hospital sewage, municipal wastewater treatment plants (mWWTPs) and surface waters and to evaluate the clinical relevance of the KpSC subspecies. METHODS: A total of 372 KpSC isolates resistant to third-generation cephalosporins and/or meropenem were collected from patients (n = 130), hospital sewage (n = 95), inflow (n = 54) and outflow from the mWWTPs (n = 63), river upstream (n = 13) and downstream mWWTPs (n = 17) from three cities in the Czech Republic. The isolates were characterized by antimicrobial susceptibility testing and whole-genome sequencing (Illumina). The presence of antibiotic resistance genes, plasmid replicons and virulence-associated factors was determined. A phylogenetic tree and single nucleotide polymorphism matrix were created to reveal the relatedness between isolates. RESULTS: The presence of MDR KpSC isolates (95%) was identified in all water sources and locations. Most isolates (99.7%) produced extended-spectrum beta-lactamases encoded by blaCTX-M-15. Resistance to carbapenems (5%) was observed mostly in wastewaters, but carbapenemase genes, such as blaGES-51 (n = 10), blaOXA-48 (n = 4), blaNDM-1 (n = 4) and blaKPC-3 (n = 1), were found in isolates from all tested locations and different sources except rivers. Among the 73 different sequence types (STs), phylogenetically related isolates were observed only among the ST307 lineage. Phylogenetic analysis revealed the transmission of this lineage from patients to the mWWTP and from the mWWTP to the adjacent river and the presence of the ST307 clone in the mWWTP over eight months. We confirmed the frequent abundance of K. pneumoniae (K. pneumoniae sensu stricto and K. pneumoniae subsp. ozaenae) in patients suffering from UTIs. K. variicola isolates formed only a minor proportion of UTIs, and K. quasipneumoniae was not found among UTIs isolates; however, these subspecies were frequently observed in hospital sewage communities during the first sampling period. CONCLUSION: This study provides evidence of the transmission and persistence of the ST307 lineage from UTIs isolates via mWWTPs to surface waters. Isolates from UTIs consisted mostly of K. pneumoniae. Other isolates of KpSC were observed in hospital wastewaters, which implies the impact of sources other than UTIs. This study highlights the influence of urban wastewaters on the spread of MDR KpSC to receiving environments.
- MeSH
- antibakteriální látky * farmakologie MeSH
- bakteriální proteiny genetika MeSH
- beta-laktamasy * genetika MeSH
- fylogeneze * MeSH
- infekce bakteriemi rodu Klebsiella * mikrobiologie epidemiologie MeSH
- infekce močového ústrojí mikrobiologie epidemiologie MeSH
- infekce spojené se zdravotní péčí mikrobiologie epidemiologie MeSH
- Klebsiella pneumoniae * účinky léků genetika izolace a purifikace klasifikace MeSH
- lidé MeSH
- mikrobiální testy citlivosti * MeSH
- mnohočetná bakteriální léková rezistence * MeSH
- nemocnice * MeSH
- odpadní voda * mikrobiologie MeSH
- odpadní vody mikrobiologie MeSH
- sekvenování celého genomu MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
- MeSH
- diabetes mellitus MeSH
- lidé MeSH
- nemocnice krajské * dějiny organizace a řízení MeSH
- vnitřní lékařství MeSH
- výstavba, architektura a design nemocnic MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Česká republika MeSH
- O autorovi
- Baťova krajská nemocnice (Zlín, Česko) Autorita
AIMS: Missed nursing care (MNC) significantly affects patient safety and quality of care. It is a widely used concept that has been studied in different settings, but research in paediatric care is quite limited. Therefore, this descriptive cross-sectional study aimed to report the prevalence, patterns, correlates, factors and predictors of MNC in paediatric care units in two central European countries. DESIGN: A cross-sectional comparative study. METHODS: Data collection was carried out between June and November 2021 using the MISSCARE Survey-Pediatric. The study included 441 registered nurses working in paediatric care units in the Czech Republic and Slovakia. Data were analysed using descriptive and inferential statistics in the SPSS 25.0 statistical program. RESULTS: Almost all nurses, 92.7% of nurses missed at least one nursing activity during the last shift. The most missed care activity in both countries was the promotion of neuroevolutionary development, and the most prominent reasons were labour resources. MNC was weakly but significantly correlated with nurse experience in the current position and was predicted by the country, nurse education and overtime hours (p ≤ .05). Differences in prevalence of MNC and reasons for MNC were identified based on several variables (p ≤ .05). CONCLUSION: The assessment of MNC in paediatric settings is often a neglected area, although the prevalence in this study was moderate. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nurse staff shortages, as a global problem, have many impacts on patient outcomes in the delivery of nursing care. However, there are also many factors that can reduce the prevalence of MNC. More research should focus on a closer examination of these factors that involve hospital and nurse variables. REPORTING METHOD: The study was carried out according to the STROBE checklist and the RANCARE guideline. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.
- MeSH
- dětské sestry * MeSH
- dítě MeSH
- lidé MeSH
- nemocnice MeSH
- ošetřovatelská péče * MeSH
- personál sesterský nemocniční * MeSH
- průřezové studie MeSH
- průzkumy a dotazníky MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
1. vydání 179 stran : ilustrace, tabulky ; 24 cm
Publikace se zaměřuje na dlouhodobou institucionální péči o geriatrické pacienty a to zejména na proces aktivizace. Určeno odborné veřejnosti.
- Klíčová slova
- aktivizace,
- MeSH
- činnosti denního života MeSH
- dlouhodobá péče MeSH
- domovy pro seniory MeSH
- geriatrické ošetřovatelství MeSH
- kvalita života MeSH
- nemocnice pro chronická onemocnění MeSH
- neurodegenerativní nemoci MeSH
- senioři MeSH
- stárnutí MeSH
- Check Tag
- senioři MeSH
- Publikační typ
- monografie MeSH
- Konspekt
- Geriatrie
- NLK Obory
- geriatrie
- psychologie, klinická psychologie
- MeSH
- doškolování MeSH
- kardiopulmonální resuscitace výchova MeSH
- lidé MeSH
- nemocnice fakultní MeSH
- Check Tag
- lidé MeSH
- MeSH
- dezinficiencia MeSH
- kvartérní amoniové sloučeniny MeSH
- lidé MeSH
- nemocnice fakultní MeSH
- Check Tag
- lidé MeSH
- MeSH
- kardiochirurgické výkony MeSH
- nemocnice fakultní MeSH
- výchova a vzdělávání MeSH
- Publikační typ
- zprávy MeSH
