Microbiological investigation of a hospital outbreak of invasive group A streptococcal disease in Krakow, Poland.

The present study reports the epidemiological investigations undertaken in one of Krakow's city hospitals regarding the source of infection and the routes of transmission of a group A streptococcus (Streptococcus pyogenes), using fluorescent in situ hybridization as a rapid method for detecting S. pyogenes carriage in the medical personnel involved. Four patients from the gynaecology department and two patients from the surgery department presented with clinical signs of infection. Characteristics of the S. pyogenes strains isolated from patients and from one medical staff member, including the emm gene and superantigens encoding genes, are described. All patients (four confirmed and two probable cases) survived; the operating theatre aid was identified as an S. pyogenes carrier and the source of the infections.

Adherence of bile-isolated bacteria to the bile ducts mucosa as a pathogenic factor in the development of inflammatory lesions.

Bacterial infection of the bile system appears to be an important factor in the formation of stones. In view of the hypothesis that strains of E. c. form an essential factor in infections of the bile ducts, an attempt has been made to determine the connection between infections of the bile ducts and the adherence of E. c. to the epithelium of the gallbladder. The research covered 148 patients operated electively for cholecystolithiasis (121), cholecystocholedocholithiasis (26) and recurrent lithiasis (1). In bile collected from the gallbladder in the course of the operation, E. coli strains were isolated. Cholangioscopy performed in 26 patients enabled the macroscopic evaluation and grading of inflammatory lesions of bile duct mucosa. The mucosa of the gallbladder was evaluated histologically. The adherence test was performed using homologous and heterologous strains of E. c. isolated from the bile of gallstone patients. The adherence occurred most frequently in the neck of the gallbladder (71-100%) in those patients in whom an infectious process of the bile ducts mucosa was endoscopically diagnosed. The adherence of bacteria to the epithelium of the gallbladder did not depend on the type of inflammation (acute, chronic).

[Alpha-L-fucosidase activity in patients with ductal cholelithiasis]. / Alfa-L-fukozydaza u chorych z przewodowymi postaciami kamicy zólciowej.

Alpha-L-fucosidase (ALF), AST, ALT and GGT activities were measured in blood serum of 36 patients with recurrent cholelithiasis (group I), 32 patients with ductal and/or bladder cholelithiasis (group II), 24 patients with focal changes in the liver (group III) and in 22 patients without disturbances of gastrointestinal tract (control group). A statistically significant increase in ALF activity was found in the patients with recurrent cholelithiasis as compared to the control group (p < 0.001), the patients of group II (p < 0.001) and the patients of group III (p < 0.05). The AST and ALT activities were higher both in group I and in group II than in the control group (p < 0.001 and p < 0.02 for group I and group II, respectively), whereas the mean GGT activity was significantly higher in all three patients groups as compared to the control group (p < 0.001 in all cases). On the basis of the observed differences in the activities of the enzymes studied it was postulated that the determination od ALF activity in blood serum of patients with cholelithiasis may provide the means for early diagnosis of the predisposition to recurrent stones.

[Results of prophylactic and curative antibiotic therapy in biliary surgery]. / Wyniki profilaktycznego i leczniczego stosowania antybiotykoterapii w chirurgii dróg zólciowych.

Prophylactic antibiotic regimen (gentamicin, clindamycin) was assessed in a group of 104 patients operated electively on biliary lithiasis (cholecysto- and choledocholithiasis). Antibiotic prophylaxis was performed in group of 20 patients, in 6 of them antibiotics were continued postoperatively. Intraoperatively antibiotics were given in a group of 20 patients--curative treatment. Control group consisted of 58 patients. We concluded that "one shoot" antibiotic therapy is valuable in controlling of wound infections. But the most effective method of reducing local septic complications rate combines prophylaxis with prolonged antibiotic administration.

Bacteria in bile of patients with bile duct inflammation.

Bile samples taken intraoperatively from 100 patients with three different bile system diseases were subjected to bacteriological analysis. Statistically significant differences between the types of aerobic and anaerobic bacteria present in the bile were found.