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INTRODUCTION: Chronic rhinosinusitis (CRS) is one of the commonest chronic diseases. It is a systemic disease caused by many factors, including bacterial infections. There are two main types of CRS phenotypes: with polyps (CRSwNP) and without polyps (CRSsNP). AIM: Analysis of sinus mucosal microbiome in patients with CRS depending on the phenotype. Investigating a possible link between the type of bacterial flora and the coexistence of diseases present in the CRS (asthma, allergy or hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) as well as the number of performed operations. MATERIAL AND METHODS: The authors conducted a retrospective study of the bacterial flora of the nasal cavity in patients with CRS operated endoscopically from March 2016 to June 2017. The study consisted od 222 women and 248 men. On the basis of an endoscopic examination, patients were qualified for the phenotype with or without polyps. Based on the medical interview patients were divided into group with asthma, allergy, NSAID hypersensitivity, first and repeated operations. The statistical analysis was made. RESULTS: There is no statistically significant relationship (p = 0.8519) between the CRS penotypes. In the group with CRSsNP, a statistically significant relationship was found between the observed flora and the coexistence of asthma (p = 0.0409), a trend towards significance was also noticed in the case of allergy (p = 0.0947). There was no relationship between the flora and NSAID hypersensitivity (p = 0.7356). In the group of CRSwNP patients, no statistically significant relationship was found between the observed bacterial flora and the presence of asthma (p = 0.7393), hypersensitivity to drugs (p = 0.1509) or allergy (p = 0.7427). There is no statistical significance between the occurrence of particular flora and the multiplicity of operations in both the CRSwNP (p = 0.4609) and CRSsNP phenotypes (p = 0.2469). CONCLUSIONS: Gram-positive cocci were equally common in CRSwNP and CRSsNP. In the CRSsNP, there was a correlation between the coexistence of asthma and allergy, and the presence of Gram-positive cocci. There was no statistical significance between the occurrence of particular flora and the multiplicity of operations in both CRS phenotypes.
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Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an important bacterium of nosocomial infections. In this study, CRKP strains, which were mainly isolated from fecal samples of 14 patients in three wards of the hospital in the Silesia Voivodship, rapidly increased from February to August 2018. Therefore, we conducted microbiological and molecular studies of the CRKP isolates analyzed. Colonized patients had critical underlying diseases and comorbidities; one developed bloodstream infection, and five died (33.3%). Antibiotic susceptibilities were determined by the E-test method. A disc synergy test confirmed carbapenemase production. CTX-Mplex PCR evaluated the presence of resistance genes bla CTX-M-type, bla CTX-M-1, bla CTX-M-9, and the genes bla SHV, bla TEM, bla KPC-2, bla NDM-1, bla OXA-48, bla IMP, and bla VIM-1 was detected with the PCR method. Clonality was evaluated by Multi Locus Sequence Typing (MLST) and Pulsed Field Gel Electrophoresis (PFGE). Six (40%) strains were of XDR (Extensively Drug-Resistant) phenotype, and nine (60%) of the isolates exhibited MDR (Multidrug-Resistant) phenotype. The range of carbapenem minimal inhibitory concentrations (MICs, µg/mL) was as follows doripenem (16 to >32), ertapenem (> 32), imipenem (4 to > 32), and meropenem (> 32). PCR and sequencing confirmed the bla CTX-M-15, bla KPC-2, bla OXA-48, and bla VIM-1 genes in all strains. The isolates formed one large PFGE cluster (clone A). MLST assigned them to the emerging high-risk clone of ST147 (CC147) pandemic lineage harboring the bla OXA-48 gene. This study showed that the K. pneumoniae isolates detected in the multi-profile medical centre in Katowice represented a single strain of the microorganism spreading in the hospital environment.