The screening of methicillin-resistant staphylococcus aureus in vascular surgery patients: a comparison of molecular testing and broth-enriched culture.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a major global health care-associated pathogen. This study sought to examine the prevalence of MRSA in patients who were admitted to a vascular surgery ward during a 3-month period. METHODS: MRSA screening was accomplished through the acquisition of nasal, throat and perineal swabs. These swabs were placed in tryptic soy broth that had been supplemented with 6.5% NaCl and incubated for 24 h. The resulting isolates were subcultured on agar plates containing 5% sheep blood. The BD GeneOhm MRSA assay for screening swabs was performed in accordance with the manufacturer's instructions. RESULTS: A total of 58 patients were included in the study and swabs from 232 sites were obtained during the sampling period. MRSA was detected in 33 samples of 12 patients during the study period; thus, there was a 20.6% prevalence of patients who were recognized as MRSA carriers. There were discrepancies between the results of classical bacteriological screening and molecular MRSA detection methods in 8 of the patients. CONCLUSIONS: Nasal, throat and perineal MRSA screening can detect the carriage of this pathogen and allow for the timely use of appropriate infection control measures. The choice of screening techniques poses a challenge; it has been demonstrated that molecular detection methods should be performed with great sensitivity, specificity and, most importantly, speed. The cost of the PCR screening method is the only disadvantage of this approach.

[Diagnostic approach and therapy for cytomegalovirus (CMV) infection following allogeneic stem cell transplantation]. / Dijagnosticki pristup, pracenje i lijecenje citomegalovirusne (CMV) infekcije nakon alogene transplantacije krvotvornih maticnih stanica.

In spite of improvements in diagnostics and prevention of CMV disease in recent decades, CMV infection still remains major concern in terms of diagnosis and therapy in recipients of allogeneic stem cells. Besides considerable morbidity with direct effects of CMV infection (hepatitis, gastrointestinal disease, pneumonia, retinitis), there are also indirect effects such as increased susceptibility to opportunistic infections and an increased risk of graft rejection and transplant-related mortality. Also, myelosuppression, nephrotoxicity and emergence of drug-resistant CMV strains may limit the use of antiviral agents for the control of CMV infection. The aim of this paper is to show the problems associated with CMV infection in recipients of allogeneic stem cells with special emphasis on diagnostic procedures and treatment or prophylaxis of CMV disease.

[Role of yeasts in diabetic foot ulcer infection]. / Uloga kvasaca u infekciji rane dijabetickog stopala.

AIMS: The aim was to assess the incidence of isolation of individual fungal species and interpret the meaning of fungal isolates from foot ulcers of 509 diabetic outpatients using mycologic and histopathologic methods. Another aim was to explore risk factors for the development of fungal infections in foot ulcer. METHODS: Fungus isolation was made on selective media and their identification by standard mycologic methods. Histopathologic diagnosis of fungal ulcer infections was made on PAS-stained histopathologic preparations and imprint preparations (PAS and Papanicolaou staining) of foot wound biopsy specimens. RESULTS: Fungal and mixed foot ulcer infections were found in 14.9% of diabetic patients. In 33.8% of patients, these infections were confirmed by a finding of fungal elements in histopathologic preparations of ulcer biopsy specimens, as follows: in 16.9% of patients, by finding fungal elements in imprint preparations of ulcer biopsy specimens and by isolation fungus from the swab of the same ulcer; in 2.3% by fungus isolation from ulcer biopsy specimens; in 36.9% by fungus isolation from ulcer swabs in pure culture and/or in a large number of colonies and/or from several ulcers on the foot of the same patient. More than 89% of patients had a single foot ulcer with fungal or mixed infection, big toe and the plantar-metatarsal region in one foot or both feet being the most common sites of ulcer. Fifteen species from the genera Candida, Cryptococcus, Trichosporon and Rhodotorula were the causative agents of fungal and mixed foot ulcer infections. C. parapsilosis (in 61.5% of patients), and C. albicans and C. tropicalis (in 10.8% of patients each) were the most common causes of these infections. The presence of yeasts and/or dermatophytes in the toe web of the same or other foot, or of both feet, did not influence the incidence of fungal and mixed foot ulcer infections. Patient sex and age, type and length of diabetes, or clinical picture of diabetic foot did not affect it either. In IDDM patients, the risk factor for the development of fungal and mixed foot ulcer infections was ulcer infection lasting for more than 13 weeks, whereas in NIDDM patients the length of ulcer infection did not contribute to the incidence of fungal and mixed foot ulcer infection. DISCUSSION: Our results and other reports suggest that Candida species are the most common fungal isolates (between 93.2% and 100% of all fungal isolates) from diabetic foot ulcer, with C. parapsilosis being the most common causative agent of fungal and mixed infection. From diabetic foot ulcer, bacterial isolation was 5 times as common as that of yeasts (327 vs. 65 patients). Nevertheless, this investigation showed fungal isolates, originating not only from a primarily sterile ulcer sample (biopsy specimen) but also from foot ulcer swabs to be the causative agents (not ulcer colonizers or contaminants) of the foot ulcer infection. The pathogen c effect of yeasts in foot ulcer is indicated by the severity of clinical finding, chronic course of infection, and infection progression despite antibiotic therapy. Equally indicative are microbiologic diagnostic parameters (isolation in pure culture, and/or isolation in a large number of colonies, and/or isolation from several ulcers in the foot of the same patient). CONCLUSIONS: In diabetic patients at highest risk of developing fungal and mixed foot ulcer infections (IDDM patients with ulcer infection persisting for more than 13 weeks, and NIDDM patients with the clinical picture of deep ulcer and abscess in the plantar region, irrespective of the duration of ulcer infection), routine bacteriologic diagnosis should be supplemented with targeted mycologic and histopathologic methods.

Differentiation between Candida species isolated from diabetic foot by fatty acid methyl ester analysis using gas chromatography.

Gas chromatography (GC) was used to differentiate 100 isolates of Candida species (Candida parapsilosis, Candida albicans, Candida tropicalis, Candida famata and Candida glabrata) from 22 of 509 diabetic patients in whom the same species had been isolated from ulcer and interdigital spaces of the same and/or the other foot. All clinical isolates were identified by quantitative differences in the composition of six cell fatty acids (CFA). The values of the coefficients of variability (CV) of CFA show that the isolates from foot ulcers and interdigital spaces of the same diabetic patient probably belong to different chemotypes of the same Candida species.

[Risk factors for invasive fungal infections during intensive chemotherapy of acute leukemia--retrospective study]. / Cimbenici rizika invazivnih gljivicnih infekcija tijekom intenzivne terapije akutnih leukemija--retrospektivna studija.

AIM: The incidence, outcome and risk factors for developing invasive fungal infection were retrospectively analyzed in 150 patients with acute leukemia during intensive cytostatic therapy. PATIENTS AND METHODS: Patients with and without the diagnosis of fungal infection were compared according to age, sex, diagnosis, stage of disease, type of therapy, antimicrobial prophylaxis, duration of febrile episodes, duration of antimicrobial therapy, duration of antifungal therapy, chest x-ray findings, results of surveillance cultures for fungal species isolation, clinical diagnosis at discharge from hospital, and autopsy findings. Clinical findings in patients with confirmed fungal infection on autopsy were analyzed separately. RESULTS: The incidence of fungal infection according to clinical diagnosis was 38.5%. The incidence among patients who died during therapy at autopsy was 78.5%. The incidence of Candida and Aspergillus infections at autopsy was 40% and 60%, respectively. Specific incidence could not be determined during life. The mortality was 59% in the group of patients with fungal infection, and 43% in the group of patients without fungal infection. During the study, an increase in the rate of fungal infection as well as a trend to prolonged survival of these patients were observed. On multivariate analysis, independent risk factors associated with a greater incidence of fungal infection were duration of hospitalization (p=0.04), duration of granulocytopenia with granulocyte count less than 0.5x10(9)/L (p=0.05), number of febrile episodes (p=0.01), duration of febrile episode (p=0.001), intestinal decontamination (p=0.02), duration of antibiotic therapy (p=0.01), positive chest x-ray finding (p=0.001), and year of therapy (p=0.02). On univariate analysis, a greater incidence of fungal infections was also associated with younger age, acute lymphatic leukemia, newly diagnosed disease and second relapse of the disease. The occurrence of fungal infections showed no correlation with the type of therapy, number of chemotherapy cycles, type of fungal species isolated from particular locations and frequency of colonization at particular locations. However, the number of colonized locations and number of fungal species was two to three times greater in patients with than in those without fungal infection. CONCLUSIONS: Fungal infections are becoming an increasing problem during intensive therapy of acute leukemia and contribute to poor therapy outcome. The diagnosis of fungal infection during life is extremely difficult and frequently late. There is the need of a more precise diagnostic test that would provide earlier diagnosis. The knowledge of risk factors is helpful in the diagnosis and therapy of fungal infections. The suspicion of fungal infection in patients at risk justifies the introduction of antifungal therapy and contributes to better therapeutic outcome.

[Guidelines for antimicrobial treatment and prophylaxis of urinary tract infections]. / Smjernice antimikrobnog lijecenja i profilakse infekcija mokracnog sustava.

Recommendations for antimicrobial treatment and prophylaxis of urinary tract infections (UTI) have been made according to the results of investigation of resistance of the most frequent causative agents of UTI to antimicrobial drugs. This investigation has been conducted for the past seven years by the Committee for monitoring bacterial resistance to antibiotics in the Republic of Croatia, with consensus of eight professional societies of the Croatian Medical Association. Uncomplicated cystitis is treated 1, 3, or 7 days, complicated 7 days, pyelonephritis 10-14 days, and complicated UTI 7 to 14 days, rarely longer. For the treatment of cystitis fluorokinolons, nitrofurantoin, betalactam antibiotics, and in the fields of lower resistance trimethoprim/sulfamethoxazol are being used. Single treatment with fluorokinolons is administered to otherwise healthy young women with normal urinary tract in whom cystitis symptoms have been present for less than 7 days. Empiric antimicrobial treatment of pyelonephritis, recurrent and all complicated UTI must be reviewed after urine culture finding is obtained. In the treatment of bacterial prostatitis and febrile UTI in males, the drug of first choice is ciprofloxacin. Asymptomatic bacteriuria (AB) is treated in pregnant women, newborns, preschool children with urinary tract abnormalities, before invasive urologic and gynecologic procedures, in kidney transplant recipients, and in the first days of short term urinary bladder catheterization. Recommendations for the treatment of AB in patients with diabetes mellitus have been controversial in the past two years. Antimicrobial prophylaxis is administered mostly one hour prior to the diagnostic or therapeutic invasive urological procedure, using selected antimicrobial agents.

[Helicobacter pylori--introduction and review of research]. / Helicobacter pylori--uvod i pregled istrazivanja.

The discovery of Helicobacter pylori has revolutionized the pathophysiological and clinical approach to gastric and duodenal ulcer. Since the first paper identifying H. pylori was published only 17 years ago, it has been found out that this bacterium causes probably the commonest human infection. Numerous papers published so far have confirmed causal relationship between H. pylori infection and gastritis, duodenal ulcer, gastric ulcer and gastric cancer. If any recent achievement in the world of medicine is to be called revolutionary, then it is the discovery of the role of a spiral bacterium in the etiopathogenesis of gastritis, gastric ulcer, duodenal ulcer and gastric cancer. The discovery of the role of Helicobacter pylori has entirely changed our views and approach to the treatment of patients with stomach disorders. Not only do these discoveries change our actions, but above all our way of thinking. Almost routine diagnostics and treatment of gastritis, gastric ulcer or cancer has been replaced by studies in epidemiology, isolation and eradication of a single bacterium.

[Epidemiology of Helicobacter pylori infection]. / Epidemiologija infekcije Helicobacterom pylori.

About 50% of adults in the developed and 80-90% in the developing countries are estimated to be infected by Helicobacter pylori. Being 68% nationally, this rate is higher in the northern continental parts of Croatia, which also have higher gastric cancer rates. Low socio-economic status, poor living conditions in childhood (the age when Helicobacter pylori is typically acquired), and exposure to the stomach content of an infected person are risk factors for Helicobacter pylori. Most of the infected are symptomless, with 10 to 20% subsequently developing the disease, and this mainly from peptic ulcer, asymptomatic chronic gastritis and chronic dyspepsia. Less than 5/10,000 become affected with adenocarcinoma, MALT lymphoma or primary non-Hodgkin's gastric lymphoma. Helicobacter pylori is under intensive study for possible association with other diseases. As transmission route of the infection is still unclear, any mechanism allowing the bacteria entry into a non-infected individual's stomach is probably a possibility. In addition to improved socio-economic status, eradication or vaccination may be contributors to the reduction in the number of the infected.

[Diagnosis of Helicobacter pylori infection]. / Dijagnostika infekcije Helicobacterom pylori.

The diagnostics of Helicobacter pylori infection is now one of the most important aspects of the diagnosis of various gastroduodenal diseases. New data have shown that Helicobacter pylori is a causative agent of peptic ulcer disease and an important factor in cancer development. Numerous diagnostic tests are now available. They can be divided into two groups: invasive and noninvasive tests. All invasive test methods are based on endoscopic examination during which biopsy specimens are obtained for direct (histological analysis, isolation) or indirect (urease test) diagnosis of Helicobacter pylori infection. Noninasive methods reveal the presence of Helicobacter pylori by measuring the activity of urease (urea breath test), then by confirming the presence of antibodies in the serum or saliva of the infected person or by confirming the presence of Helicobacter pylori antigens in the feces.