The incidence of Borrelia burgdorferi, Anaplasma phagocytophilum and Babesia microti coinfections among foresters and farmers in eastern Poland.

BACKGROUND & OBJECTIVES: Lyme borreliosis is the most common tick-borne disease in Europe and the USA. However, a great variety of pathogens are transmitted by ticks, which results in mixed infections, with Lyme borreliosis. The aim of the present study was to show the incidence of Borrelia burgdorferi, Anaplasma phagocytophilum, and Babesia microti coinfections among the population of foresters and farmers, as these people, due to their profession, are particularly exposed to tick contact. METHODS: The study was carried out in eastern Poland (the northern part of the Lublin Province) in 2013. The study was performed in a group of 93 individuals occupationally exposed to tick bites (foresters and farmers), whose blood serum showed the presence of IgG anti-B. burgdorferi antibodies. Blood serum in this group were evaluated for IgG anti-A. phagocytophilum and IgG anti-B. microti antibodies by means of IFA IgG indirect immunofluorescence tests. Information related to age, sex, number of tick bite episodes, presence of various symptoms related to the tick bites, and antibiotic therapy applied as treatment for diagnosed Lyme borreliosis were obtained from the subjects through a structured questionnaire. The results were analyzed in Statistica v. 7.1 statistical analysis software. RESULTS: The presence of IgG antibodies against the analyzed pathogens revealed B. burgdorferi and A. phagocytophilum coinfection in 26 (28%) of the examined subjects and B. burgdorferi and B. microti coinfection in one person (1.1%). No coinfection with all the three pathogens was observed in any individual. The co-occurrence of headache plus bone, joint and muscle pain was noted significantly more often among individuals diagnosed with B. burgdorferi and A. phagocytophilum coinfection. INTERPRETATION & CONCLUSION: Foresters and farmers are exposed to B. burgdorferi and A. phagocytophilum coinfection in the study area. Therefore, it is probable that these pathogens may severely interfere with the clinical course of Lyme borreliosis.

[Acquired perforating dermatosis in the patient with chronic kidney disease ­ case report and literature review].

Acquired perforating dermatosis (APD) represents a heterogenous group of skin disorders characterized histopathologically by transepithelial elimination (TEE) of dermal structures. APD is manifested clinically as multi-localized, papulo-nodular skin lesions accompanied by a refractory pruritus. APD typically coexists with long-term disorders, most often diabetic kidney disease (DKD). The paper presents a case of a 56-year-old male patient with chronic kidney disease (CKD) and concomitant acquired reactive perforating collagenosis (ARPC), which is a subtype of APD. Etiological theories of ARPC as well as current diagnostic and treatment principles in dermatosis were described. On the basis of the presented case report and the literature review attention was paid to diagnostic difficulties associated with APD. The assumption was made that APD can be an underdiagnosed disease and thus it is not treated correctly. According to the authors' opinion, this is an important circumstance to popularize the knowledge about APD.

Concurrent peritonsillar abscess and poststreptococcal reactive arthritis complicating acute streptococcal tonsillitis in a young healthy adult: a case report.

BACKGROUND: Streptococcus pyogenes is responsible for 5-15% and 20-30% of acute pharyngitis/tonsillitis in adults and children, respectively. It not only causes acute illness but also can give rise to local suppurative complications such as peritonsillar abscess as well as trigger the postinfectious syndromes of glomerulonephritis, acute rheumatic fever and poststreptococcal reactive arthritis. Here, we report a case of a young healthy adult in whom both peritonsillar abscess and poststreptococcal reactive arthritis developed as a complication of acute streptococcal tonsillitis. To the best of our knowledge, such a coincidence of poststreptococcal sequelae has not been reported previously. CASE PRESENTATION: A 32-year-old previously healthy woman was diagnosed with acute tonsillitis by her family doctor and treated empirically with amoxicillin/clavulanic acid (875/125 mg) twice daily for 5 days. Four days after completing antibiotic therapy, peritonsillar abscess of left tonsil developed. Needle aspiration followed by incision and drainage were performed by otolaryngologist at the Emergency Department. Next, the patient was discharged home on a 10-day course of cefuroxime and metronidazole. The symptoms of peritonsillar abscess were subsiding during treatment, however on the last day of antibiotic therapy, swelling and pain of the left ankle appeared. Five days later the patient was consulted by rheumatologist. Cultures of throat swabs and abscess aspirate collected 2 weeks before revealed the presence of Streptococcus pyogenes. Antistreptolysin O (ASO) titer was evaluated and proved to be 412 IU/ml (normal 0-200 IU/ml). The level of C-reactive protein was 13,0 mg/L (normal <5,0 mg/L). There was no known cardiac involvement. Poststreptococcal reactive arthritis was diagnosed. Left ankle arthralgia persisted for about 5-6 weeks. Six months after the presentation at the Emergency Department, the patient was well, with ASO titer reaching 262 IU/ml. CONCLUSIONS: Clinicians should be aware that appropriate choice of antibiotic, proper dose as well as duration of therapy of acute GAS pharyngitis/tonsillitis are crucial to prevent poststreptococcal sequelae.

Investigation of the Actual Causes of Hip Joint Implant Loosening Classified as Aseptic--Analysis of Microbiological Culture Results and Levels of Inflammatory Markers.

Loosening of the hip joint prosthesis is considered as one of the most significant postoperative complications in recent years. The laboratory diagnostic procedure used to differentiate periprosthetic infection from aseptic loosening is very difficult because of the biofilm which microorganisms form on the implant surface. The purpose of this research was to evaluate the level of concordance between clinical classification of implant loosening among 50 patients subjected to reimplantation procedure and laboratory investigation of PJI including microbiological culture results and the levels of inflammatory markers assessed in the patients' synovial fluid samples, serum, and full blood. The synovial fluid was collected for leukocyte count, differential cell count, and culture on standard media. The levels of systemic inflammation markers such as the ESR and CRP concentration were determined in serum and full blood. Tissue samples were collected for microbiological studies. Components from endoprostheses were exposed to ultrasound in a process called sonication. Among the parameters measured in serum and full blood the levels of ESR and CRP were higher in the septic group of patients. Cytologic analysis of synovial fluid was in correlation with microbiologic identification. The most frequent isolated bacteria was Staphylococcus epidermidis. Culture results from materials such as synovial fluid, sonicate and tissues are crucial to establish the infectious aetiology of the loosening. Microscopic analysis of synovial fluid represents a simple, rapid and accurate method for differentiating PJI from aseptic failure. Sonication increases detection of the infectious process, and culture results are in correlation with the cytologic analysis of synovial fluid.

Analysis of nanomechanical properties of Borrelia burgdorferi spirochetes under the influence of lytic factors in an in vitro model using atomic force microscopy.

BACKGROUND: Atomic force microscopy (AFM) is an experimental technique which recently has been used in biology, microbiology, and medicine to investigate the topography of surfaces and in the evaluation of mechanical properties of cells. The aim of this study was to evaluate the influence of the complement system and specific anti-Borrelia antibodies in in vitro conditions on the modification of nanomechanical features of B. burgdorferi B31 cells. MATERIAL AND METHODS: In order to assess the influence of the complement system and anti-Borrelia antibodies on B. burgdorferi s.s. B31 spirochetes, the bacteria were incubated together with plasma of identified status. The samples were applied on the surface of mica disks. Young's modulus and adhesive forces were analyzed with a NanoScope V, MultiMode 8 AFM microscope (Bruker) by the PeakForce QNM technique in air using NanoScope Analysis 1.40 software (Bruker). RESULTS/CONCLUSION: The average value of flexibility of spirochetes' surface expressed by Young's modulus was 10185.32 MPa, whereas the adhesion force was 3.68 nN. AFM is a modern tool with a broad spectrum of observational and measurement abilities. Young's modulus and the adhesion force can be treated as parameters in the evaluation of intensity and changes which take place in pathogenic microorganisms under the influence of various lytic factors. The visualization of the changes in association with nanomechanical features provides a realistic portrayal of the lytic abilities of the elements of the innate and adaptive human immune system.

[Monoinfections caused by Borrelia burgdorferi and Borrelia burgdorferi / Anaplasma phagocytophilum co-infections in forestry workers and farmers]. / Monoinfekcja Borrelia burgdorferi i wspólzakazenia Borrelia burgdorferi / Anaplasma phagocytophilum u pracowników lesnictwa i rolników.

BACKGROUND: The presence of co-infections induced by tick-borne pathogens in humans is an important epidemiological phenomenon. This issue has attracted growing attention of doctors and people working under conditions of an increased risk of being exposed to tick bites. MATERIAL AND METHODS: The research group consisted of 93 individuals with current anti-immunoglobulin M/G (IgM/ IgG) Borrelia burgdorferi or IgG anti-Anaplasma phagocytophilum. The respondents were identified during the screening survey in a group of farmers and foresters occupationally exposed to tick bites. The aim of the work was to analyse the frequency of antibodies to specific antigens of B. burgdorferi and the levels of cytokines in forestry workers and farmers with B. burgdorferi monoinfections and B. burgdorferi / A. phagocytophilum co-infections. Statistical analysis was performed using the Chi2, Mann-Whitney U and Kruskal-Wallis tests. RESULTS: There is a stronger generation of IgG antibodies to B. burgdorferi antigens in patients with B. burgdorferi / A. phagocytophilum co-infections, such as variable major protein-like sequence expressed (VlsE) (p < 0.05), p19 (p < 0.02), p17 (p < 0.05) and complement regulator-acquiring surface protein 3 (CRASP3) (p < 0.02) compared to persons with B. burgdorferi monoinfections. The discrepancies in the synthesis of cytokines interleukin 6 (IL-6), IL-10, and tumor necrosis factor α (TNF-α) have not been found in persons with B. burgdorferi monoinfections and B. burgdorferi / A. phagocytophilum co-infection. CONCLUSIONS: The immune response directed against B. burgdorferi is stronger in patients co-infected with B. burgdorferi and A. phagocytophilum than in those with monoinfection.

[Sternal wound complications after cardiac surgery--a case report]. / Powiklania w gojeniu rany mostka po operacji kardiochirurgicznej--opis przypadku.

The authors presents case report of a 59-years-old man with triple vessel coronary artery disease, hypertension after myocardial infarction of the inferior wall with sternal wound complcations after coronary bypass grafting (CABG). On the fourth postoperative day the patient developed sternal dehiscence with wound infection. Infection was caused by Staphylococcus haemolyticus--coagulase-negative methicillin-resistant strain, MRCNS. An antimicrobial therapy and negative pressure wound therapy were used for complete wound healing.

Infectious prosthetic hip joint loosening: bacterial species involved in its aetiology and their antibiotic resistance profiles against antibiotics recommended for the therapy of implant-associated infections.

Reliable microbiological diagnosis along with surgery and prolonged antibiotic therapy are key elements in the management of prosthetic-joint infections (PJIs). The purpose of this study was to characterize antibiotic resistance profiles of bacteria involved in the aetiology of PJIs. A total of 33 bacterial isolates cultured from 31 patients undergoing exchange of total hip prostheses were analyzed. The diagnostic approach toward isolation of prosthesis- associated microorganisms included sonication of retrieved implants and conventional cultures of periprosthetic tissues and synovial fluid. The in vitro resistance profiles of bacterial isolates were determined in relation to antibiotics recommended for the therapy of PJIs using the disc diffusion method, E-tests(®) and broth microdilution system. Coagulase-negative staphylococci (CNS) were predominant microorganisms followed by Staphylococcus aureus, Enterobacter cloacae, Streptococcus mitis, and Propionibacterium acnes. Twenty out of 30 and 12 out of 30 staphylococcal isolates were methicillin- and multi-drug resistant, respectively. Only two isolates were rifampicinresistant. All staphylococci were susceptible to glycopeptides and linezolid. This paper stresses the pathogenic role of staphylococci in patients suffering from implant loosening and reports high methicillin- and multidrug-resistance rates in these bacteria. Hence, antimicrobial susceptibility tests of individual bacterial isolates must always be performed to guide selection of the optimal therapeutic option.

Sonication as a diagnostic approach used to investigate the infectious etiology of prosthetic hip joint loosening.

The purpose of the study was to evaluate the usefulness of sonication for the diagnosis of prosthetic joint infections (PJIs) by its comparison with periprosthetic tissues (PTs) and synovial fluid (SV-F) cultures. The study groups included 54 patients undergoing exchange of total hip prostheses for so called "aseptic" loosening occurring without clinical manifestations of an accompanying PJI and 22 patients who developed a sinus tract communicating with the prosthesis which was indicative of an ongoing infectious process. Significant positive culture results were obtained among 10 (18.5%) patients with "aseptic" implant failure and in 18 (81.8%) patients who developed a sinus tract. Sonicate-fluid (S-F) yielded bacterial growth in all culture-positive patients with "aseptic" loosening vs. 15 patients with presumed PJIs. There was a concordance in terms of bacterial species isolated from S-F and conventional cultures from individual patients. Coagulase-negative staphylococci were isolated most frequently. Sensitivity of sonication (75%) exceeded that estimated for PTs (69%) and SV-F (45%) cultures. We conclude that identification of causative agents of PJIs which is critical to further therapeutic decisions is aided by the combination of sonication and conventional culture.

[Risk of occupational infections caused by Borrelia burgdorferi among forestry workers and farmers]. / Ryzyko zakazen zawodowych Borrelia burgdorferi u pracowników lesnictwa i rolników.

BACKGROUND: The aim of the work was to analyze the incidence of infection with Borrelia burgdorferi in forestry workers and farmers, major groups occupationally exposed to tick bites. MATERIAL AND METHODS: The study group included 275 workers (171 foresters and 104 farmers). The control group consisted of 45 people, who have not been occupationally exposed to tick bites. The screening Elisa and Wb tests for the presence of anti-Borrelia IgM/IgG antibodies were performed in all subjects of the study and control groups. Statistical analysis was performed using the Chi2 test. RESULTS: The positive results denoting the presence of anti-Borrelia IgM/IgG antibodies were found in 55% of farmers and 28% of foresters occupationally exposed to Lyme borreliosis and coming from the area of South Podlasie Lowland and Lublin Polesie. The differences between the forestry workers and the control group (p < or = 0.00001) and between farmers and the control group (p < or = 0.001) were statistically significant. The species, such as B. spielmanii and B. bavariensis, which have not yet been reported in Poland, are significant etiologic agents of Lyme disease. CONCLUSION: The risk of occupational exposure to the B. burgdorferi infection is high for foresters and farmers, and the infection with spirochetes is frequently confirmed on the basis of positive results of the Wb test. The presence of specific antibodies against protein antigens of B. spielmanii and B. bavariensis suggest that these bacteria can cause Lyme disease both independently and in participation with other Borrelia species, which influences the development of the clinical manifestations of infection.

[Preliminary results of research on a new marker of idiopathic membranous nephropathy: anti-PLA2R]. / Wyniki wstepne badan nad nowym markerem idiopatycznej nefropatii bloniastej: anty-PLA2R).

UNLABELLED: Idiopathic membranous nephropathy (IMN) is a chronic glomerular disease. It is result of new discovery that the production of anti-PLA2R autoantibodies, reacting with phospholipase A2 receptor on the surface of podocytes. Specific antibodies occur in IMN patients blood in exacerbated of disease, and disappear during remission. It suggest that analyse of these parameter can prove quick diagnosis to recognize and monitoring treatment process. The aim of our work was to determine anti-PLA2R in patients with suspected IMN and persons during/after treatment in order to monitor the effectiveness of therapy. MATERIAL AND METHODS: The study group consisted of 22 patients. Patients were divided into two groups: Group A--patients with symptomatic nephrotic syndrome in the course of membranous nephropathy; Group B--patients diagnosed with IMN who monitored the effectiveness of therapy. We collected the serum samples for all patients and determined of anti-PLA2R autoantibodies by indirect immunofluorescence test. RESULTS: Antibodies were detected in 12 patients (54.54%): diagnosed (n = 5) and monitor (n = 7). All of patients with exacerbated disease process in monitored group had positive test results. CONCLUSIONS: Our data suggest that anti-PLA2R is a sensitive diagnostic method and good for monitoring of disease activity, but nevertheless a need for further research on a larger group of patients to confirm that the test is a reliable source of diagnostic information.

[Significance of circulating immune complexes (CIC) in the diagnosis of infections with Borrelia burgdorferi]. / Znaczenie krazacych kompleksów immunologicznych (CIC) w diagnostyce zakazen Borrelia burgdorferi.

INTRODUCTION: The infection caused by Borrelia burgdorferi initiates a number of reactions in the human immunological system and particular behaviors of the infectious factor. The aim of work was to analyze the level of circulating immune complexes (CIC) due to infection with Borrelia burgdorferi in persons professionally exposed to tick bites. MATERIAL AND METHODS: The group of tested consisted of 275 persons, who are professionally exposed to tick bites, including 171 foresters and 104agriculturists. The controlled group consisted of 45 people, living permanently ortemporarily in Biata Podlaska, city in the South Podlasie Lowland, who have not been exposed professionally on tick bites.The screening test ELISA (Euroimmun) has been carried among all persons from the tested group towards the presence ofantibodies IgM/IgG anty-Borrelia. Among those who met positive or delimited results from screening test Elisa, another test of Western blot (Wb, Euroimmun, Virotech GmbH) has been carried in order to confirm the infection. The serum which has been taken from a group of persons being professionally exposed to infection of B. burgdorferi and persons from a controlled group, has been tested in terms of estimating levels of circulating immune complexes CIC C1q (Elisa, DRG). RESULTS AND CONCLUSION: The circulating immune complexes (CIC) are increasingly generated at persons with present IgM and/or IgG anty-Borrelia but their existence accompanied by the presence of strongly expressed humoral response does not affect the diagnostic effectiveness of infections with B. burgdorferi.

Evaluation of high-mobility group box 1 protein concentration in serum of patients with M. tuberculosis infection.

Infection with Mycobacterium tuberculosis is accompanied by an intense inflammatory response. Recently, a new mediator of inflammation, HMGB1 protein has been identified that contributes to acute lung injury. However, its role in the systemic inflammatory response in tuberculosis has not been thoroughly investigated. We investigated the systemic levels of HMGB1 and TNF-α in patients with active and latent lung tuberculosis as a prognostic marker of disease activity. The study was performed to 70 patients with confirmed Mycobacterium tuberculosis infection and other than tuberculosis lung diseases and in 20 healthy persons. Serum HMGB1 and TNF-α concentrations were measured by ELISA. The highest concentration of HMGB1 was detected in the bloodstream of people with Mtb infection (latent and active). Its concentration increased significantly in sera of patients with active tuberculosis (47.5 ng/ml), compared to patients with other lung diseases (36.87 ng/ml). TNF-α had significantly higher concentration in a patients group compared to healthy controls, with the highest concentration in the LTBI group of patients (0.136 ng/ml). We observed a strong positive correlation between TNF-α and HMGB1 concentrations in patients with tuberculosis infections. We conclude that HMGB1 is secreted during active and latent tuberculosis in the highest amounts compared to other lung diseases.

Assessment of cytokine release after in vitro stimulation of whole blood with legionella pneumophila in immunocompromised patients.

This study we examined ex vivo potential of the immune response after stimulation of whole blood with L. pneumophila SG 1, SG 2-14 and L. pneumophila standard strain ATCC 33152 in immunocompromised patients, such as: hemodialysis patients and patients after renal transplantation. The levels of TNF-α and IFN-γ in supernatants were measured with the use of commercial ELISA kits. The synthesis of TNF-α and IFN-γ after stimulation with L. pneumophila were analyzed in two aspects: differentiated stimulatory activity in relation to SG 1, SG 2-14 and ATCC 33152 L. pneumophila and differentiated response of the hemodialysis patients and patients after renal transplantation in relation to the control group. The positive and negative results of anti-L. pneumophila antibodies of two groups of our patients were found for the analysis of the stimulatory activity of L.pneumophila as a primary or secondary response. In patients with immunosuppression the response in the secretion of cytokines (TNF-α and IFN-γ) was reduced after stimulation of L. pneumophila SG 1 but in varying degrees after stimulation of L. pneumophila SG 2-14, which indicates that the risk of the infection is varied.

[The hazards of hospitals and selected public buildings of Legionella pneumophila]. / Zagrozenia szpitali oraz wybranych obiektów uzytecznosci publicznej bakteriami Legionella pneumophila.

UNLABELLED: The registered infection and outbreaks of epidemic tend to monitor potential reservoirs of Legionella infection. According to the Act of 29 March 2007 on the requirements for the quality of water intended for human consumption are required to test for the presence and number of Legionella in the water system of hospitals. In case of detection of L. pneumophila serogroup 1 (SG 1) or increased above normal number other serogroups of bacteria it is necessary to eradicate these bacteria from the water system. The aim of this study was to assess the degree of contamination of the water supply system of selected public buildings and analyze the effectiveness of disinfection methods for the elimination of L. pneumophila in hot water systems. MATERIAL AND METHODS: The materials for this study were hot and cold water samples which were collected from the water supply system of 23 different objects. Enumeration of Legionella bacteria in water samples was determined by membrane filtration (FM) and/or by surface inoculation methods according to the standards: PN-ISO 11731: 2002: "The quality of the water. Detection and enumeration of Legionella" and PN-EN ISO 11731-2: 2008: "Water quality--Detection and enumeration of Legionella--Part 2: Methodology of membrane filtration for water with a small number of bacteria". RESULTS: L. pneumophila was present in 164 samples of hot water, which accounted for 76.99%. In all tested water samples L. pneumophila SG 2-14 strains were detected. The most virulent strain--L. pneumophila SG 1 was not detected. In examined 23 objects in 12 of L. pneumophila exceed acceptable levels > 100 CFU/100 ml. CONCLUSIONS: The presence of L. pneumophila SG 2-14 demonstrated in all examined objects, indicating the risk of infection, and the need for permanent monitoring of the water system supply. The thermal disinfection is the most common, inexpensive, and effective method of control of L. pneumophila used in examined objects, but does not eliminate bacterial biofilm. Disinfection using the filters stopped of L. pneumophila, and was the method of complementary thermal disinfection. Chlorine dioxide is a very effective biocide for large numbers of L. pneumophila in water systems.

The effects of cooperation between orthopaedic surgeons and microbiologists on the effectiveness of diagnosis and treatment of septic hip joint loosening.

BACKGROUND: The objective of this study is to compare the results of microbiological examinations of two types of materials: specimens collected intraoperationally upon removal of prostheses following septic loosening and cultures from sonicated implants. The study was the effect of collaboration between the Clinic of Orthopedics of A. Gruca Hospital in Otwock and the Department of Microbiology in Lublin. MATERIAL AND METHODS: The study population consisted of 24 patients aged 39 to 84 years, average of 68 years, undergoing surgeries at the Department of Bone and Joint Inflammation, Clinic of Orthopedics of A. Gruca Hospital in Otwock in years 2010-2011. All patients were qualified for surgical treatment consisting of removal of hip prosthesis due to inflammation. Sixty percent of the group were women, while the remaining forty percent were men. The methodology of the study was based on intraoperational collection of material for microbiological examinations at the Department of Microbiology of A. Gruca Hospital. The study material was collected from 3 locations: femoral shank, hip acetabulum and gluteal muscle. Explanted implants were placed in sterile containers, frozen at -20°C and transported to the Department of Microbiology in Lublin. There, the implants were sonicated. RESULTS: The obtained results were consistent in both groups in 37% of cases. In 9 patients (37%), standard cultures were negative while the cultures of sonicated material were positive. In 16 patients (67%), the spectrum of perioperative and sequential antibiotic therapy included flora cultured by standard methods as well as flora obtained from sonicated implant cultures. In the remaining patients, cultures obtained from sonicated material were resistant to antibiotics used. CONCLUSIONS: Cultures of sonicated implant materials increase the chance for identification of microbes responsible for inflammation. Limitations of the method include the requirement to either examine the implant shortly after removal or freeze the implant in order to prevent secondary infections of the material.

[Microbiological causes of antibiotic therapy failure in respiratory tract infections]. / Mikrobiologiczne przyczyny niepowodzen w antybiotykoterapii zakazen ukladu oddechowego.

This article reviews the most important aspects of antibiotic treatment failure in respiratory tract infection which may occur with empirical as well as under target antibiotic therapy. Potential risk factors leading or predisposing to treatment failure exist in hospital acquired infections which cover polymicrobial aetiology with high multidrug resistance bacteria, changed conditions of pharmacokinetic and pharmacodynamic (PK/PD) parameters of antibiotics, bioavailability, drug interactions and inactivation. Microbial determinants of treatment failure includes bacterial physiology in laboratory cultures and inside the host, inadequate drug choice, lack of knowledge of PK/PD parameters with insufficient antibiotic level in target tissue. Differences between microbial in vitro tests and clinical outcome can be caused by varied CFU concentration, growing phase, nutritional, pH and redox conditions. Many factors of treatment failure are focused on bacterial biofilm structure and phenomenon of small-colony variants (SCVs) which both display reduced susceptibility to antimicrobial agents protected by matrix feature, enhanced production of PIA and by slow multiplication of biofilm forming cells.

[Utility of clinical differentiation and microbiological examination for appropriate antibiotic therapy of acute pharyngotonsillitis in children]. / Ocena przydatnosci parametrów klinicznych oraz badania mikrobiologicznego do optymalizacji antybiotykoterapii ostrego zapalenia gardia i migdalków podniebiennych u dzieci.

UNLABELLED: The differentiation between streptococcal pharyngotonsillitis and that of viral etiology is crucial, since it allows to discriminate patients who need to be treated with the use of antibiotics from those who only need symptomatic treatment. For that purpose, Centor/Mclssac's scale, based on the clinical examination and a history of a patient, is suggested by "Polish Recommendations for the diagnosis and treatment of community-acquired respiratory tract infections 2010". In patients who have obtained two or more points according to this scale, a definitive diagnosis of streptococcal pharyngotonsillitis depends on the identification of the bacterium, which can be performed by throat swab culture or by rapid antigen detection test. The aim of the study was to evaluate utility of clinical differentiation, rapid antigen detection test and throat swab culture for appropriate antibiotic therapy of acute pharyngotonsillitis in children. To the best of our knowledge, this is the first survey of this type carried out in Poland. MATERIAL AND METHODS: 42 children in the age of 3-14 years with acute pharyngotonsillitis who obtained at least two points in Centor/ Mclssac's scale took part in our study. Two throat swabs were obtained from every child, one of them was used to perform rapid test, and the second one was cultured on Columbia blood agar. Grey-white colonies with beta-hemolysis were classified to the groups A, B, C, D, F and G according to Lancefield with the use of bacitracin discs and latex agglutination test. RESULTS: 50% of children obtained 4 points and 40.5% of them received 5 points in Centor/Mclssac's scale. QuickView+ Strep A test turned up to be consistent with culture in 97.6% of cases. On the grounds of rapid test and culture results patients were subdivided into 3 groups: I--infected with S. pyogenes (50.0%), II--infected with other groups of beta-hemolytic streptococci (9.5%), III--infected with viruses (40.5%). CONCLUSIONS: It is impossible to recognize streptococcal pharyngitis only on clinical grounds, the diagnosis must be confirmed by laboratory methods. In children with high risk of streptococcal pharyngitis QuickView+Strep A test possesses diagnostic value comparable to culture in the detection of S. pyogenes, however negative rapid test results in such patients should be confirmed by culture. Antibiotic therapy should be initiated on the base of microbiological examination.

[The characteristics of Gram-positive bacteria isolated from skin lesions observed in ambulatory patients and the assessment of their susceptibility to antimicrobial drugs]. / Charakterystyka bakterii Gram-dodatnich wyizolowanych od pacjentów ambulatoryjnych ze zmian skórnych oraz ocena ich lekowrazliwosci.

The bacterial skin and soft-tissue infections occur commonly and are characterized by more or less intensified changes within skin and subcutaneous tissue. The bacterial skin infections give rise to significant therapeutic problems associated with increasing resistance etiological agents of these infections to antibiotics and chemotherapeutics. The aim of this study was to assess the distribution of various Gram-positive microorganisms in skin lesion observed in ambulatory patients in a period from June 2005 to December 2006. There were 116 bacterial strains isolated and identified from clinical samples: Staphylococcus aureus, coagulase - negative staphylococi (S.epidermidis, S. xylosus, S.capitis, S.saccharolyticus), Propionobacterium acnes, Streptococcus spp. (S.agalactiae, S.pyogenes) i Corynebacterium spp. (C. striatum, C. amycolatum, C. aquaticum). In the further part of this study we analyzed a profile of their susceptibility to antibiotics and chemotherapeutics in relation to drugs recommended for the empirical therapy. The resultant resistance patterns among the examined bacterial isolates are indicative of certain divergence between recommended empirical antibiotic therapy and actual antimicrobial susceptibility of many etiologic factors of skin and soft-tissue infections.

[Perioperative antibiotic prophylaxis in surgery]. / Okolooperacyjna profilaktyka antybiotykowa (OPA) w chirurgii.

Surgical site infections - SSI belong to one of the most frequent and serious post-operative complications occurring in patients. They lead to extended hospitalization period, to increase of treatment costs, morbidity and mortality among patients. The surgical antibiotic prophylaxis is one of the most significant procedures which goal is to reduce infectious complications and to complement surgical effects. Proper surgical antibiotic prophylaxis should be distinguished by: appropriate time of application and administration adequate to the kind of treatment and quality of the drug, proper selection of the antibiotic which considers microbiological as well as pharmacological conditions which has established clinical effectiveness.