INTRODUCTION AND PURPOSE: Mycobacterium (M.) chelonae is responsible for a half of relatively rare nontuberculous mycobacteria (NTM) keratitis. We report a case of M. chelonae keratitis in a woman following sclerocorneal suture extraction after cataract surgery. RESULTS: A 70-year-old woman presented with a red eye and corneal infiltration of her left eye six weeks following sclerocorneal suture extraction after an elective cataract surgery in another institute. She complained of a sharp, cutting pain and photophobia. Since initial corneal scrapes and conjunctival swabs proved no pathogen using culture and PCR methods, non-specific antibiotics and antifungal agents were administered. As keratitis was complicated by an inflammation in the anterior chamber and vitreous, samples of the vitreous fluid were sent for microbiologic examination. DNA of Epstein-Barr virus (EBV) was repeatedly detected. Since the intrastromal abscess had formed, corneal re-scrapings were performed and M. chelonae was detected using culture, MALDI-TOF MS and PCR methods. Therapy was changed to a combination of oral and topical clarithromycin, intravitreal, topical and intracameral amikacin, and oral and topical moxifloxacin. The successful therapy led to stabilization. The optical penetrating keratoplasty was performed and no signs of the infection recurrence were found. CONCLUSIONS: The diagnosis of nontuberculous mycobacterial keratitis is difficult and often delayed. An aggressive and prolonged antimicrobial therapy should include systemic and topical antibiotics. Surgical intervention in the form of corneal transplantation may be required in the active and nonresponsive infection. In the presented case this was necessary for visual rehabilitation due to scarring.

• Klíčová slova
• Antibiotic therapy, keratoplasty, Keratitis, Mycobacterium chelonae,
• MeSH
• amikacin terapeutické užití   MeSH
• antibakteriální látky * terapeutické užití   MeSH
• atypické mykobakteriální infekce * diagnóza   farmakoterapie   mikrobiologie   chirurgie   MeSH
• fluorochinolony terapeutické užití   MeSH
• keratitida * diagnóza   farmakoterapie   mikrobiologie   chirurgie   MeSH
• klarithromycin terapeutické užití   MeSH
• lidé MeSH
• moxifloxacin * terapeutické užití   MeSH
• Mycobacterium chelonae * izolace a purifikace   MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• přehledy MeSH
• Geografické názvy
• Evropa MeSH
• Názvy látek
• amikacin MeSH
• antibakteriální látky * MeSH
• fluorochinolony MeSH
• klarithromycin MeSH
• moxifloxacin * MeSH

OBJECTIVES: Fluoroquinolone (FQ) prophylaxis was recommended in 2005 by European Conference on Infections in Leukemia (ECIL) for patients with prolonged neutropenia. In consideration of a worldwide increase in antibiotic resistance, the issue of FQ prophylaxis during neutropenia was re-evaluated. METHODS: Literature review of randomised controlled trials (RCT) and observational studies published in years 2006-2014 was performed. Their results were analysed in meta-analysis. Meta-regression model was applied to evaluate whether the rates of FQ resistance in community and hospital settings influenced the efficacy of FQ prophylaxis. The impact of FQ prophylaxis on colonisation and infection with resistant bacteria was reviewed. RESULTS: Two RCTs and 12 observational studies were identified. FQ prophylaxis did not have effect on mortality (pooled OR 1.01, 95%CI 0.73-1.41), but was associated with lower rate of bloodstream infections (BSI) (pooled OR 0.57, 95%CI 0.43-0.74) and episodes of fever during neutropenia (pooled OR 0.32, 95%CI 0.20-0.50). No effect of the background rate of FQ resistance on the efficacy of FQ prophylaxis was observed. In few studies, FQ prophylaxis resulted in an increased colonisation or infection with FQ- or multi-drug resistant strains. CONCLUSIONS: The possible benefits of FQ prophylaxis on BSI rate, but not on overall mortality, should be weighed against its impact in terms of toxicity and changes in local ecology in single centres.

• Klíčová slova
• Ciprofloxacin, Febrile neutropenia, Infection, Levofloxacin, Multidrug resistance (MDR), Neutropenic, Prevention, Quinolone,
• MeSH
• antibakteriální látky terapeutické užití   MeSH
• antibiotická profylaxe * MeSH
• fluorochinolony terapeutické užití   MeSH
• hematologické nádory komplikace   mortalita   MeSH
• infekce komplikace   mortalita   MeSH
• kontrola infekce * MeSH
• lidé MeSH
• neutropenie komplikace   prevence a kontrola   MeSH
• směrnice jako téma * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• práce podpořená grantem MeSH
• systematický přehled MeSH
• Názvy látek
• antibakteriální látky MeSH
• fluorochinolony MeSH

The aim of the study was to provide an update on the epidemiology of C. difficile infection (CDI) in a representative number of hospitals within the Czech Republic in 2015. In 2015, twenty-eight Czech hospitals were invited to participate in a CDI study. Laboratories sent the first 20 consecutive C. difficile isolates for characterization by capillary-electrophoresis (CE) ribotyping and the presence of toxin genes and collected patient data on previous hospitalization, antibiotic treatment, the number of CDI episodes and the course of CDI. The mean incidence of CDI was 5.2 [95% CI 4.2-6.2] cases per 10,000 patient-bed days in 27 hospitals in 2015. Of 490 C. difficile isolates, the prevalent PCR ribotypes (RTs) were 001 (n = 164, 33.5%) and 176 (n = 125, 25.5%) followed by 014 (n = 37, 7.6%), 012 (n = 17, 3.5%), 020 (n = 16, 3.3%), 017 (n = 14, 2.9%) and 002 (n = 11, 2.2%). A severe course of CDI was reported in 104 cases (21.2%) with significant association with RT001 infection (p = 0.03). CDI recurrence was 10.8% (n = 53). The previous use of fluoroquinolones was associated with RTs 001 and 176 CDIs (p = 0.046 and p = 0.041). We observed a persistence of RTs 001 and 176 CDIs in the Czech Republic that was associated with the previous use of fluoroquinolones. This highlights the need for a reduction in fluoroquinolone use in Czech hospital settings.

• Klíčová slova
• CDI surveillance, Capillary electrophoresis ribotyping, Clostridium difficile, Clostridium difficile infection, Fluoroquinolones, Toxin genes,
• MeSH
• antibakteriální látky terapeutické užití   MeSH
• bakteriální léková rezistence fyziologie   MeSH
• Clostridioides difficile klasifikace   genetika   izolace a purifikace   MeSH
• fluorochinolony terapeutické užití   MeSH
• infekce spojené se zdravotní péčí epidemiologie   mikrobiologie   MeSH
• lidé MeSH
• nemocnice MeSH
• pseudomembranózní enterokolitida farmakoterapie   epidemiologie   mikrobiologie   MeSH
• ribotypizace MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH
• Názvy látek
• antibakteriální látky MeSH
• fluorochinolony MeSH

BACKGROUND: Increasing bacterial resistance to antibiotics is one of the most serious problems in current medicine. An important factor contributing to the growing prevalence of multiresistant bacteria is application of antibiotics. This study aimed at analyzing the development of resistance of Enterobacteriaceae to selected beta-lactam, fluoroquinolone and aminoglycoside antibiotics in the University Hospital Olomouc and assessing the effect of selection pressure of these antibiotics. METHODS: For the period between 1 January 2000 and 31 December 2011, resistance of Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae and Proteus mirabilis to third- and fourth-generation cephalosporins, meropenem, piperacillin/tazobactam, fluoroquinolones and aminoglycosides was retrospectively studied. For the assessment of selection pressure of antibiotics, a parameter of defined daily dose in absolute annual consumption (DDDatb) based on the ATC/DDD classification and in relative annual consumption (RDDDatb) as the number of defined daily doses per 100 bed-days was used. The relationship between frequency of strains resistant to a particular antibiotic and antibiotic consumption was assessed by linear regression analysis using Spearman's correlation. The level of statistical significance was set at p < 0.05. RESULTS: A total of 113,027 isolates from the Enterobacteriaceae family were analyzed. There was a significant effect of selection pressure of the primary antibiotic in the following cases: piperacillin/tazobactam in Klebsiella pneumoniae, gentamicin in Klebsiella pneumoniae and Escherichia coli and amikacin in Escherichia coli and Enterobacter cloacae. Also, there was significant correlation between resistance to ceftazidime and consumption of piperacillin/tazobactam in Klebsiella pneumoniae and Escherichia coli. No relationship was found between consumption of third- and fourth-generation cephalosporins and resistance to ceftazidime or between fluoroquinolone consumption and resistance to ciprofloxacin. CONCLUSION: The study showed the effects of both direct and indirect selection pressure on increasing resistance to gentamicin, amikacin, piperacillin/tazobactam and ceftazidime. Given the fact that no correlation was found between resistance to fluoroquinolones and consumption of either primary or secondary antibiotics, we assume that the increasing resistance to fluoroquinolones is probably due to circulation of resistance genes in the bacterial population and that this resistance was not affected by reduced use of these antibiotics.

• MeSH
• aminoglykosidy terapeutické užití   MeSH
• antibakteriální látky terapeutické užití   MeSH
• beta-laktamy terapeutické užití   MeSH
• Enterobacter cloacae účinky léků   izolace a purifikace   fyziologie   MeSH
• enterobakteriální infekce farmakoterapie   mikrobiologie   MeSH
• Escherichia coli účinky léků   izolace a purifikace   fyziologie   MeSH
• fluorochinolony terapeutické užití   MeSH
• Klebsiella pneumoniae účinky léků   izolace a purifikace   fyziologie   MeSH
• lidé MeSH
• lineární modely MeSH
• mikrobiální testy citlivosti MeSH
• mnohočetná bakteriální léková rezistence účinky léků   MeSH
• Proteus mirabilis účinky léků   izolace a purifikace   fyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• aminoglykosidy MeSH
• antibakteriální látky MeSH
• beta-laktamy MeSH
• fluorochinolony MeSH

BACKGROUND: The main mechanisms causing high-level resistance to fluoroquinolones (FQ) are encoded chromosomally; that includes mutations in genes coding DNA-gyrase, but overexpression of efflux pumps contributes to increased minimum inhibitory concentration (MIC) of FQ as well. However, genes responsible for FQ-resistance may be harboured in transferable/conjugative plasmids. For some time, there was an assumption that resistance to FQ cannot be transferable in conjugation due to their synthetic origin, until 1998, when plasmid-mediated resistance transmission in Klebsiella pneumoniae was proved. We aimed to detect the occurrence of transferable FQ-resistance among Gram- negative bacteria isolated from patients in Czech and Slovak hospitals. METHODS: In this study, we tested 236 clinical isolates of Gram-negative bacteria for transferable resistance. Among relevant isolates we performed PCR detection of transferable fluoroquinolone genes (qnr). RESULTS: We have observed transfer of determinants of cephalosporin-resistance, aminoglycoside resistance as well as FQ-resistance (in 10 cases; 4.24%) not only intra-species but inter-species too. The presence of qnr gene was detected in two isolates of forty tested (5%). We have also observed that determinants of cephalosporin-resistance and aminoglycoside-resistance were linked to those of FQ-resistance and were transferred en block in conjugation. CONCLUSION: We have proved that resistance to fluoroquinolones can be transferred horizontally via conjugation among Gram-negative bacteria of different species and is associated with resistance to other antibiotics.

• MeSH
• antibakteriální látky farmakologie   terapeutické užití   MeSH
• Enterobacteriaceae účinky léků   izolace a purifikace   MeSH
• fluorochinolony farmakologie   terapeutické užití   MeSH
• lidé MeSH
• mnohočetná bakteriální léková rezistence účinky léků   genetika   MeSH
• polymerázová řetězová reakce MeSH
• Pseudomonas aeruginosa účinky léků   izolace a purifikace   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH
• Slovenská republika MeSH
• Názvy látek
• antibakteriální látky MeSH
• fluorochinolony MeSH

The aim of this study was to evaluate the dependence of Escherichia coli resistance to fluoroquinolones on their use in the outpatients and inpatients in the Hradec Kralove region of the Czech Republic. Data on inpatient fluoroquinolones use were obtained from the database of the Charles University Teaching Hospital Pharmacy and expressed as defined daily dose per 100 beds - days (DBD). Data on outpatient prescriptions were obtained from the database of the General Health Insurance Company and expressed in defined daily doses per 1000 clients per day (DID). Escherichia coli strains were isolated from samples of urine of both community and hospitalized patients suffering from acute bacterial urinary tract infection, examined using aerobic cultivation, and determined by standard biochemical procedures. The utilization of fluoroquinolones in inpatients has significantly (p < 0.01) increased from 2.73 DBD in 2001 to 4.89 DBD in 2006. In outpatients, fluoroquinolone utilization has also increased significantly from 0.29 DID to 1.15 DID (p < 0.01). In the same period, 11,856 Escherichia coli strains were isolated from inpatients and outpatients with urinary tract infection and tested for the susceptibility to fluoroquinolones. Resistance increased significantly (p < 0.01), both in the hospital (from 2% to 10%) and in the community (from 1% to 11%). The development of Escherichia coli resistance to fluoroquinolones correlates significantly with their utilization both in hospital (r = 0.996, p = 0.005) and in the community (r = 0.878, p = 0.029). Results of this study shows the impact of fluoroquinolone utilization on Escherichia coli resistance, and support the need of controlled use of these effective antibiotics.

• MeSH
• akutní nemoc MeSH
• antibakteriální látky farmakologie   terapeutické užití   MeSH
• bakteriální léková rezistence MeSH
• Escherichia coli účinky léků   MeSH
• fluorochinolony farmakologie   terapeutické užití   MeSH
• hematologie MeSH
• infekce močového ústrojí mikrobiologie   MeSH
• infekce vyvolané Escherichia coli farmakoterapie   mikrobiologie   MeSH
• infekce získané v komunitě mikrobiologie   MeSH
• lidé MeSH
• mikrobiální testy citlivosti MeSH
• nemocnice fakultní MeSH
• nemocniční oddělení MeSH
• pacienti ambulantní MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• sentinelová surveillance MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• antibakteriální látky MeSH
• fluorochinolony MeSH

OBJECTIVES: The aim of this study was to evaluate the dependence of Escherichia coli resistance to fluoroquinolones on their use in the outpatients and inpatients in the Olomouc region of the Czech Republic. METHODS: Data on inpatient antibiotic use were obtained from the database of the Department of Pharmacology and expressed as defined daily dose per 100 bed-days (DBD). Data on outpatient prescriptions were obtained from the database of General Health Insurance Company and expressed in defined daily doses per 1000 clients per day (DID). Escherichia coli strains were isolated from samples of urine of both community and hospitalized patients suffering from acute bacterial urinary tract infection, examined using aerobic cultivation, and determined by standard biochemical procedures. RESULTS: The utilization of fluoroquinolones in inpatients has significantly (p < 0.01) increased from 2.52 DBD in 1997 to 4.29 DBD in 2002. In outpatients, fluoroquinolone utilization has also increased significantly from 0.14 to 0.95 DID (p < 0.01). In the same period, 9192 E. coli strains were isolated from inpatients and outpatients suffering by urinary tract infections and tested for the susceptibility to fluoroquinolones. Resistance increased significantly (p < 0.01) both in the hospital (from 2 to 9%) and in the community (from 1 to 10%). The development of E. coli resistance to fluoroquinolones correlates significantly with their utilization both in the hospital (r = 0.944, p = 0.005) and in the community (r = 0.859, p = 0.029). CONCLUSIONS: Results of this study shows the impact of fluoroquinolone utilization on E. coli resistance and support the need of controlled use of these effective antibiotics.

• MeSH
• antiinfekční látky močové terapeutické užití   MeSH
• bakteriální léková rezistence účinky léků   MeSH
• Escherichia coli účinky léků   izolace a purifikace   MeSH
• fluorochinolony terapeutické užití   MeSH
• infekce močového ústrojí farmakoterapie   mikrobiologie   MeSH
• infekce vyvolané Escherichia coli farmakoterapie   mikrobiologie   MeSH
• lidé MeSH
• nemocnice fakultní MeSH
• pacienti ambulantní MeSH
• pacienti hospitalizovaní MeSH
• retrospektivní studie MeSH
• spotřeba léčiv MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH
• Názvy látek
• antiinfekční látky močové MeSH
• fluorochinolony MeSH

Microsporidia are a cause of emerging and opportunistic infections in humans and animals. Although two drugs are currently being used to treat microsporidiosis, concerns exist that albendazole is only selective for inhibiting some species of microsporidia that infect mammals, and fumagillin appears to have been found to be toxic. During a limited sequence survey of the Vittaforma corneae genome, a partial gene encoding for the ParC topoisomerase IV subunit was identified. The purpose of this set of studies was to determine if fluoroquinolones, which target topoisomerase IV, exert activity against Encephalitozoon intestinalis and V. corneae in vitro, and whether these compounds could prolong survival of V. corneae-infected athymic mice. Fifteen fluoroquinolones were tested. Of these, norfloxacin and ofloxacin inhibited E. intestinalis replication by more than 70% compared with non-treated control cultures, while gatifloxacin, lomefloxacin, moxifloxacin, and nalidixic acid (sodium salt) inhibited both E. intestinalis and V. corneae by at least 60% at concentrations not toxic to the host cells. These drugs were tested in vivo also, where gatifloxacin, lomefloxacin, norfloxacin, and ofloxacin prolonged survival of V. corneae-infected athymic mice (P < 0.05), whereas moxifloxacin and nalidixic acid failed to prolong survival. Therefore, these results support continued studies for evaluating the efficacy of the fluoroquinolones for treating microsporidiosis and for characterizing the target(s) of these fluoroquinolones in the microsporidia.

• MeSH
• analýza přežití MeSH
• Apansporoblastina účinky léků   MeSH
• buněčné linie MeSH
• DNA-topoisomerasa IV metabolismus   MeSH
• fluorochinolony metabolismus   terapeutické užití   toxicita   MeSH
• králíci MeSH
• lineární modely MeSH
• mikrobiální testy citlivosti MeSH
• mikrosporidióza farmakoterapie   MeSH
• myši nahé MeSH
• myši MeSH
• zvířata MeSH
• Check Tag
• králíci MeSH
• myši MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• Research Support, N.I.H., Extramural MeSH
• Research Support, U.S. Gov't, P.H.S. MeSH
• srovnávací studie MeSH
• Názvy látek
• DNA-topoisomerasa IV MeSH
• fluorochinolony MeSH