Molecular epidemiology and clinical significance of carbapenemase genes in carbapenem-resistant Acinetobacter baumannii isolates in southern Poland.

INTRODUCTION: A complex interplay between Acinetobacter spp., patients, and the environment has made it increasingly difficult to optimally treat patients infected with Acinetobacter spp., mainly due to rising antimicrobial resistance and challenges with surveillance. OBJECTIVES: This study evaluated carbapenem­resistant A. baumannii (CRAB) isolates to determine their resistance profiles and the presence of specific ß­lactamases to inform CRAB surveillance upon hospital admission and regional empiric antibiotic therapies. PATIENTS AND METHODS: The study was conducted at 4 hospitals in southern Poland between June and December 2022. Only health care-associated infections caused by A. baumannii were considered. A total of 82 CRAB isolates were included in the analysis. Species identification was performed by matrix­assisted laser desorption / ionization time­of­flight mass spectrometry, antimicrobial susceptibility was determined phenotypically, and polymerase chain reactions were carried out to identify the resistance genes. RESULTS: Depending on the hospital, the incidence of CRAB infections varied from 428.6 to 759.5 per 10 000 admissions in intensive care units (ICUs), and from 0.3 to 21 per 10 000 admissions in non­ICUs. CRAB antibiotic susceptibility was the highest for cefiderocol (100%), colistin (96%), tigecycline (77%), gentamicin (51%), and ampicillin / sulbactam (36%). The most prevalent blaOXA genes were blaOXA­66­1 (95%) and blaOXA­40 (71%), and additionally the extended­spectrum ß­lactamase gene blaTEM­1 (41%). CONCLUSION: An unexpectedly high incidence of CRAB infections occurred in Polish hospitals. There is a need for effective CRAB prevention and control that includes effective hospital screening, national surveillance, and improved treatment options.

Influence of Process Parameters on the Efficiency of Pervaporation Pilot ECO-001 Plant for Raw Ethanol Dehydration.

Pervaporation is a membrane-based process used for the separation of liquid mixtures. As this membrane process is governed by the differences in the sorption and diffusivities of separated components, close boiling mixtures and azeotropic mixtures can effectively be separated. The dehydration of ethanol is the most common application of hydrophilic pervaporation. The pilot scale properties of hydrophilic composite poly(vinyl alcohol) PVA membrane (PERVAPTM 2200) in contact with wet raw bioethanol are presented. The wet raw bioethanol was composed of ethanol (82.4-89.6 wt%), water (5.9-8.5 wt%), methanol (2.3-6.9 wt%), cyclohexane (0.2-2.4 wt%), higher alcohols (0.2-1.3 wt%), and acetaldehyde (0.004-0.030 wt%). All experiments were performed using a SULZER ECO-001 plant equipped with a 1.5 m2 membrane module. The efficiency of the dehydration process (i.e., membrane selectivity, permeate flux, degree of dehydration) was discussed as a function of the following parameters: the feed temperature, the feed composition, and the feed flow rate through the module. It was found that the low feed flow rate influenced the dehydration efficiency as the enthalpy of evaporation caused a high temperature drop in the module (around 25 °C at a feed flow rate equal to 5 kg h-1). The separation coefficient during pervaporation was in the range of 600-1200, depending on the feed composition. The increase in temperature augmented the permeation flux and shortened the time needed to reach the assumed level of dehydration. It was revealed that dehydration by pervaporation using ECO-001 pilot plant is an efficient process, allowing also to investigate the influence of various parameters on the process efficiency.

Impact of tooth brushing on oral bacteriota and health care-associated infections among ventilated COVID-19 patients: an intervention study.

BACKGROUND: Up to 48% of ventilated coronavirus disease 2019 (COVID-19) patients develop ventilator-associated pneumonia (VAP) during hospitalization in an ICU. Dysbiotic oral microbiota can colonize the lower respiratory tract and lead to VAP. It is recommended to introduce oral care strategies in the ICU to prevent VAP. In this study, we observed the impact of an oral hygienic protocol with tooth brushing on cultivable oral bacteriota, the incidence of HAI and patient safety among mechanically ventilated COVID-19 patients in an ICU setting. METHODS: In this prospective cohort study, we recruited 56 adult COVID-19 patients who qualified for mechanical ventilation. Patients were divided into 2 groups depending on the oral care procedure: standard and extended oral procedures with tooth brushing. Oral bacteriota samples were taken first within 36 h and after 7 days of intubation. Microorganisms were identified by MALDI/TOF mass spectrometry. bacterial health care-associated infection (HAI) cases were retrospectively analyzed by etiology. A PFGE study was performed for Klebsiella pneumoniae to check for clonal spreading of strains from oral bacteriota samples and HAI cases. RESULTS: We observed significant dysbiosis and a decrease in cultivable oral bacteriota diversity, with a high frequency of potentially pathogenic species, including Acinetobacter baumannii and K. pneumoniae. The HAI incidence rate was high (55.2/1000 patient-days), most commonly of K. pneumoniae and A. baumannii etiologies, which correlated with the presence of A. baumannii and K. pneumoniae in the oral samples. Strains isolated from VAP cases were the same as oral isolates in 8 cases. The procedure with tooth brushing led to less frequent identification of A. baumannii in oral samples (55.6% vs. 5.3%, p = 0.001); however, it did not decrease the incidence of HAIs. CONCLUSIONS: Dysbiotic oral bacteriota is an important source of respiratory pathogens. The introduction of tooth brushing in oral hygiene protocols in an ICU setting was effective in decreasing the extent of oral bacteriota dysbiosis; however, it did not reduce the risk of HAIs or mortality. TRIAL REGISTRATION: 1072.6120.333.2020.

Long-term results of surgical treatment of non-small cell lung cancer in patients over 75 years of age.

INTRODUCTION: Patients over 75 years of age, who, in addition, often have already exceeded the average life expectancy, in the Polish population on average 77.4 years, are the subject of discussion concerning the most appropriate choice of treatment. AIM: To analyse the long-term results in elderly patients over 75 years of age with lung cancer who underwent curative pulmonary resection. MATERIAL AND METHODS: 166 patients aged from 75 to 85 (mean: 77.4 ±2.3) operated on for non-small cell lung cancer (NSCLC) were included in this study. There were 128 (77%) men and 38 (23%) women. RESULTS: Lobectomy, including bilobectomy, was performed in 122 (74%) patients, pneumonectomy in 8 (5%) patients, and wedge resections or segmentectomy in the remaining 36 patients. Squamous or adenocarcinoma was diagnosed in 46% and 42% of cases respectively. Clinical stage I A was diagnosed in 36 (22%) patients, I B in 51 (31%), IIA in 30 (18%), IIB in 19 (11%) and IIIA in 30 (18%) of our cases. The early 30-day postoperative mortality was 5% whilst postoperative morbidity occurred in 47% of cases. The five-year survival rate was 30%. In statistical analysis, the TNM classification (p = 0.0490), the number of postoperative complications (p = 0.0001) and obstructive atelectasis requiring repeat bronchofibroscopic aspirations (p = 0.0137) in the early postoperative period most negatively influenced the long-term survival in the whole study group. CONCLUSIONS: Surgical resections for lung cancer in patients over 75 years of age are characterised by a relatively good long-term prognosis. Careful and strictly detailed preoperative selection, particularly of patients with pulmonary comorbidities and the earliest possible diagnosis of a lung tumour, can reduce the occurrence of these postoperative complications in elderly patients, which negatively influence long-term results.

Cutaneous allergic reactions induced by sporting activities.

This survey searched for allergic skin reactions associated with, and possibly resulting from, sporting or recreational activities. The goal was to develop profiles of the types of allergens and responses that might be expected in association with particular sports involvement. The data mainly derive from published reports of allergic-appearing skin responses occurring during and after sports participation. The majority of these are single or short series of cases. Some supplementary data from earlier reviews, and two cases from our own clinical experience, have also been incorporated. Given the scattered availability of published case material in this field, we have included most of the reports that came to our attention. We have indicated where the connection between the clinical response and the putative agent or sporting activity seems tenuous. The data are organised according to type of reaction (type I, immunoglobulin E-mediated, largely hives, angioedema and anaphylaxis; and type IV, cell-mediated, largely contact dermatitis). Some envenomations that may be amplified by allergy have also been included. In water sports, allergic sensitivity to equipment (wetsuits, masks, goggles), water per se and disinfecting agents, and various water-dwelling creatures was found. In team and other outdoor sports, most allergies related to shoes, braces/supports and other equipment, and occasionally to topical medicaments and other miscellaneous contactants. Sports participants encounter a variety of potential sensitisers. Of interest is whether a higher level of physical activity may put them at greater risk of becoming sensitised.