[Review of the effectiveness of an empirical antibiotic therapy in suspected ventilator-associated pneumonia]. / Ocena skutecznosci rekomendowanych scheatów antybiotykoterapii emprirycznej VAP w oparciu o analize in vitro lekowraziliwosci glównych patogenów.

BACKGROUND: Ventilator-associated pneumonia (VAP) occurs in approximately 10-20% of mechanically ventilated patients, and is associated with an extremely high mortality rate (up to 70%). The purpose of the study was to determine the susceptibility spectrum of Klebsiella, Pseudomonas and Acinetobacter strains isolated from VAP patients. METHODS: We analysed 81 strains of microorganisms isolated from bronchoalveolar lavages (BAL) of VAP patients. The minimal inhibitory concentrations (MIC) of antibiotics recommended for empirical therapy were determined using an automated VITEK 2 system, and for the MIC of doripenem - the Etest assay. Results were analysed following the guidelines of the Clinical and Laboratory Standards Institute. RESULTS: For infections caused by the group of bacteria under investigation, the most successful regimen was monotherapy with carbapenems (doripenem, meropenem and imipenem). Cephalosporins (cefepim and ceftazidim) were less effective in vitro. The worst results were obtained with the combination of piperacillin/tazobactam with aminoglycosides (amikacin or gentamicin) or fluoroquinolones (ciprofloxacin). CONCLUSIONS: Antibiotic monotherapy proved to be more effective in VAP patients than combined therapy; the best results were achieved with carbapenems. Doripenem showed strong activity in vitro against P. aeruginosa and Klebsiella sp. and should be considered for empirical VAP therapy; however, carbapenems may be less effective against Acinetobacter baumannii. The wide range of bacteria, and their broad range of susceptibility to antibiotics, suggests the need for modification of current recommendations.

[Etiological factors of vascular grafts infections and their resistance to antibiotics]. / Czynniki etiologiczne zakazen przeszczepów naczyniowych i ocena ich lekoopornosci.

THE AIM: of our study was the identification of microorganisms causing vascular graft infections and the evaluation of their antimicrobial susceptibility. MATERIAL AND METHODS: 25 patients with infected vascular graft, took part in our research. In 19 patients late type of infection was recognized, in 6 the infection was qualified as early. Purulent discharge obtained from the fistula was inoculated on the bacteriological media. Antimicrobial susceptibility was assessed by disc-diffusion method. RESULTS: Staphylococcus aureus and Pseudomonas aeruginosa proved to be the most frequently isolated microorganisms. Mixed infection, caused by two distinct bacteria, occurred in 5 patients; in all cases one species belonged to Gram-positive, and the second one to Gram-negative bacteria. In 50% of patients with early type infection different species of Gram-negative rods were present, in 37,5% of them S. aureus and S. epidermidis were isolated. In late type infection Gram-negative rods were isolated from 54,5% of patients and Gram-positive bacteria from 31,5% of patients. The most frequently isolated species appeared to be Pseudomonas aeruginosa. The isolated species of bacteria varied depending on the degree of infection (according to Shilagy and Samson). CONCLUSIONS: A diversity of isolated species, the presence of mixed infections and resistance patterns typical for hospital flora among bacteria infecting vascular grafts cause that antibiotic therapy should always be based on the results of microbiological examination.

[Evaluation of invasive tests in diagnosis of Helicobacter pylori infection and their correlation with endoscopic features in children with chronic gastritis]. / Ocena wybranych testów inwazyjnych w rozpoznawaniu zakazenia Helicobacter pylori w powiazaniu z obrazem endoskopowym w przewleklym zapaleniu zoladka u dzieci.

Fifty children aged 8-17 years with histologically confirmed chronic gastritis were investigated for Helicobacter pylori (H. pylori) presence in gastric mucosa bioptates taken during endoscopy. Three invasive tests (histology, rapid urease test and culture) were done. H. pylori was stated in 26 patients (56%). In this group the positive results were as follows: histology--96.4%, urease test--82.1%, culture--60.7%. The consistency of positive results ranged from 60.7% to 78.6%, being most often for histology and urease test. In 91% of non-infected patients the endoscopic features were limited to erythematous, oedematous and exsudative changes of gastric mucosa, whereas in patients with H. pylori infection the prevalence of antral nodularity was noted in 60.7%. The probable causes of non compatible test results are discussed.