Fecal Microbiota Transplantation in Patients With Blood Disorders Inhibits Gut Colonization With Antibiotic-Resistant Bacteria: Results of a Prospective, Single-Center Study.

Background: Patients with blood disorders colonized with antibiotic-resistant bacteria (ARB) are prone to systemic infections that are difficult to treat. Reintroduction of commensal bacteria in a murine model of enterococcal colonization of the gut can lead to eradication of enterococci. We hypothesized that fecal microbiota transplantation (FMT) could be used to eradicate ARB in humans. Methods: Participants colonized with ARB were treated with intraduodenal FMT according to a prospective protocol (NCT02461199). The primary endpoint was complete ARB decolonization at 1 month after FMT. Secondary endpoints included safety assessment and partial ARB decolonization. Microbiome sequencing was performed to investigate the influence of microbial composition of the transplanted material on the outcome of FMT. Results: Twenty-five FMTs were performed in 20 participants (including 40% who had neutropenia) who were colonized by a median of 2 (range, 1-4) strains of ARB. The primary endpoint was reached in 15/25 (60%) of the FMTs and more frequently in cases in which there was no periprocedural use of antibiotics (79% vs 36%, P < .05). Among participants, 15/20 (75%) experienced complete ARB decolonization. There were no severe adverse events, and partial ARB decolonization was observed in 20/25 (80%) of the FMTs. The microbiota composition analysis revealed higher abundance of Barnesiella spp., Bacteroides, and Butyricimonas and greater bacterial richness in the fecal material, resulting in eradication of Klebsiella pneumoniae compared with nonresponders. Conclusions: FMT in patients with blood disorders is safe and promotes eradication of ARB from the gastrointestinal tract. Clinical Trials Registration: NCT02461199.

An isolated outbreak of influenza A H1N1 in a haematological department during post-pandemic period.

INTRODUCTION AND OBJECTIVE: Influenza A H1N1 virus strain was associated with the pandemic outbreak of febrile respiratory infections worldwide in 2009, however in August 2010, the WHO announced that the world had entered the postpandemic period. It offered specific recommendations for this period, including the identification of clusters of severe respiratory disorders and deaths. Here we report the fulminant course of influenza AH1N1 infection in the postpandemic period in a group of patients in a single hematology department. We make an attempt to identify potential risk factors and the mode of spreading, and to provide recommendations for best practice. MATERIAL AND METHODS: We conducted a retrospective analysis of a cluster of patients diagnosed with or suspected of influenza A H1N1 infection in the period from December 2010 to March 2011. RESULTS: Fourteen patients with hematological disorders unexpectedly developed acute respiratory failure ARDS (Acute Respiratory Distress Syndrome). Of them, nine tested positive for influenza A H1N1 in a screening test and eight in confirmatory polymerase chain reaction. The infection was fatal in nine patients, despite artificial ventilation in eight and oseltamivir administration in 11. Ten were in reverse isolation according to CDC. No similar cases occurred in the whole hospital concurrently, or in the hematology wards at any other time. CONCLUSIONS: The occurrence of A H1N1 epidemics in a hematological ward in the post-pandemic period highlights the importance of awareness of this complication, prompt testing and antiviral treatment. Furthermore, it confirms the importance of vaccinating patients and personnel against influenza as a prophylactic measure.

[The use of molecular methods in the diagnosis of Clostridium difficile infections]. / Zastosowanie metod molekularnych w diagnostyce zakazen Clostridium difficile.

INTRODUCTION: The aim of this study was to use molecular methods to identify selected strains of C. difficile isolated from patients hospitalized at Independent Public Central Teaching Hospital [SP CSK] between 2008 and 2011 in order to demonstrate their toxicgenic character and to determine their epidemic potential, including the incidence of a suspected C. difficile strain 027/NAP1/B1. MATERIAL AND METHODS: Originally evaluated material consisted of freshly collected stool samples from patients who had developed diarrhea. Stool samples were assessed for toxins A and B via an immunoenzymatic method and for the presence of C. difficile via the first culture method. The isolated strains were stored on MICROBANK mediums, at -70 degrees C. From this sample collection, 48 strains isolated in 2008 and 28 strains isolated in 2011 were selected for molecular analysis. RESULTS: Among the C. difficile isolates that underwent molecular analysis there were 6 strains 027/NAP1/BI out of the 48 evaluated strains isolated in 2008, which constituted 12.5% and 24 strains 027/NAP1/BI out of the 28 strains isolated in 2011, which constituted 85.7%. CONCLUSIONS: Identification of a possible hyperepidemic strain of C. difficile is crucial for undertaking any anti-epidemic activities in health care facilities, where such activities are more and more common and are responsible for nosocomial foci of infection.

An analysis of risk factors of Clostridiumdifficile infection in patients hospitalized in the teaching hospital in 2008.

UNLABELLED: The last decade saw an increase in the incidence of Clostridium difficile infections.Approximately 80% of these infections occur in hospitalized patients. There are ongoing studies on the increase in the incidence of infections with this microorganism. OBJECTIVE: The objective of this study was to assess the risk factors of C. dicfficile infections in patients hospitalized in the teaching hospital in Warsaw in 2008. MATERIAL AND METHODS: A case-control study was conducted to achieve this objective. The study group comprised 266 patients. Patients in the study group were assessed for the following factors: sex; age; place of residence; hospitalizations; the use of proton pump inhibitors (IPP), various antibiotics, probiotics; hospital stay conditions, and the patient's condition. RESULTS: The statistical analysis showed that out of the assessed risk factors, hospitalization within the 3 months preceding hospital admission (OR 5.02; P<0.003) and antibiotic therapy (OR 4.85; P<0.003) were associated with the highest risk of C. difficile infection. Hospital stay conditions, including a stay in a multi-bed room (OR 1.64; P=0.05) or in a room without an en suite toilet (OR 1.59; P=0.01), were also shown to play a role. The risk of a C. difficile infection was also increased in the case of "bed-ridden" patients requiring the assistance of hospital staff for their daily hygiene (OR 1.69; P=0.01). CONCLUSIONS: This study demonstrated that hospitalization itself, including the frequency and conditions of hospital stay, as well as receiving antibiotic therapy were significant risk factors of C. difficile infections in patients hospitalized at the SP CSK. Therefore, our analysis showed that C. difficile infections are mostly nosocomial.

The association between paracetamol use and the risk of asthma, rhinitis and eczema in the Polish population.

INTRODUCTION: A growing number of epidemiological studies suggest that paracetamol, which is commonly used in children, may be a risk factor for asthma, allergic rhinitis, and atopic eczema. OBJECTIVE: The aim of this study was to determine and characterize the correlation between paracetamol use and asthma, allergic rhinitis, and atopic eczema symptoms in the Polish population. MATERIAL AND METHODS: The study is part of the ECAP project involving the use of the ISAAC and ECRHS questionnaires. Completed questionnaires of 18,617 subjects, including 10,011 (53.8%) females, were analyzed. Children aged 6-7 (n=4,510), adolescents aged 13-14 (n=4,721), and adults aged 20-44 (n=9,386) constituted 24.2%, 25.4%, and 50.4% of respondents, respectively. Study subjects lived in 8 major urban centres and one rural area. The frequency of paracetamol use during the previous 12 months and symptoms of asthma, allergic rhinitis, and atopic eczema during that period were analyzed. RESULTS: The use of paracetamol was associated with a significant dose-dependent increase in the risk of asthma symptoms in all evaluated age groups. This was demonstrated via odds ratios (OR) for developing asthma symptoms, including wheezing or whistling in the chest in 6-7-year-olds and exercise-induced shortness of breath in 13-14-year-olds and adults, depending on the frequency of paracetamol use in the previous 12 months, compared to no paracetamol intake during that period. CONCLUSIONS: The use of paracetamol in the last 12 months was associated with a significant dose-dependent increase in the risk of rhinitis and skin allergy symptoms, as demonstrated by the odds ratio. Therefore, frequent paracetamol use may be a risk factor for symptoms of asthma, rhinitis, and skin allergy in the Polish population.

The Effect of Preventive Immunization on the Incidence of Allergic Conditions.

The purpose of this study was to assess the effect of preventive immunization on the incidence of allergies in Poland. 18,617 (53.8% female, 24.2% 6-7 years old, 25.4% 13-14 years old, 50.4% 20-44 years old) were selected by stratified cluster sampling method in 8 cities and 1 rural area. 4783 of whom underwent objective outpatient screening assessments. Study subjects were evaluated for any association between preventive immunization against rubella, measles, typhoid fever, smallpox and incidence of atopic dermatitis, allergic rhinitis, and asthma. There was no increased risk of allergy incidence in the majority of vaccinated subjects against rubella, measles, typhoid fever, or smallpox (OR from 0.42 (p<0.0001) to 1.34 (p<0.0001) with 95% CI from 0.27-0.65 to 1.19-1.50). Slightly increased risk of asthma was after vaccination against typhoid (OR=1.27; p<0.0001) and smallpox (OR=1.21; p=0.02). The risk of atopic dermatitis (AD) was also evaluated following vaccination against rubella (OR=1.34; p<0.0001), typhoid (OR=1.13; p=0.005), varicella (OR=1.18; p=0.003); rhinitis and AR following vaccination against measles (respectively OR=1.22; p<0.0005 and OR =1.21; p=0.0002). No higher risk of allergic diseases was demonstrated in vaccinated individuals diagnosed by doctor in an outpatient setting. These data do not demonstrate a causal relationship between vaccinations and allergic conditions.

[Immunity of children aged 6-8 against pertussis, tetanus and diphtheria]. / Stan uodpornienia dzieci w wieku 6-8 lat przeciw krztuscowi, tezcowi i blonicy.

Vaccination against pertussis has been performed since 1960. Whole cell pertussis vaccine produced by Plant of Sera and Vaccines Biomed S.A. in Kraków, has been used. After vaccination has been introduced, epidemiological situation of pertussis in Poland improved, but in 90's the decrease of immunity was observed. The aim of this work was to determine pertussis immunity of children after several years from the last dose of pertussis vaccine. For comparison purposes immunity against tetanus and diphtheria was tested. Protective antibody levels were detected in 70%, 58%, and 45% children aged 6, 7, and 8, respectively. It shows that decrease of immunity may cause increasing number of pertussis in children above 5. Taking into consideration our results, it seems necessary to introduce additional dose of pertussis vaccine among children aged 5 years. The level of tetanus and diphtheria antibodies was high in all tested groups.

Sequence variation in pertussis S1 subunit toxin and pertussis genes in Bordetella pertussis strains used for the whole-cell pertussis vaccine produced in Poland since 1960: efficiency of the DTwP vaccine-induced immunity against currently circulating B. pertussis isolates.

The present study indicates that the appearance of the B. pertussis harbouring prn2 gene allele variant (not found among clinical isolates before 1990s) may have been induced by long-term vaccination in Poland with DTP-composed vaccine strains presenting exclusively prn1. However, ptxS1A allele of pertussis toxin subunit S1 encoding gene, predominant in the currently isolated B. pertussis strains, has been found in vaccine strains used for whole-cell pertussis component (wP) production of DTP vaccine in 1960-1978. This outrules the possibility that the appearance of ptxSIA allele might be related to vaccine pressure driven by non-ptxS1A vaccine strains used for long-term immunization with wP. Intranasal challenge animal model testing the efficiency of the clearance of B. pertussis strains harbouring different ptxS1/prn allele gene combinations revealed that currently produced DTwP vaccine may not contain adequate B. pertussis vaccine strains, since isolates with gene variants different from those observed in vaccine strains were eliminated from the lungs of the immunized animals with lower efficiency.