[Prognostic useful of the new risk index for infective endocarditis]. / Rokownicze znaczenie nowego wskaznika ryzyka u chorych na infekcyjne zapalenie wsierdzia.

UNLABELLED: The aim of study was the separation of the group of patients with the high risk of death based on the risk index (I(R)) calculated with use of C-reactive protein and hemoglobin concentrations measured on the admission. MATERIAL AND METHODS: The initial group consisted 41 patients (16 women and 25 men) hospitalized between 1999 and 2005 with the recognition of the infective endocarditis based on the Duke University criteria. The IR was calculated according to the formula: I(R) = [(CRP[mg/l])/(Hgb[g/dl]-beta)] x 10, and the coefficient beta = 6 g/dl. RESULTS: The I(R) was significantly higher among deceased patients than among patients with good early prognosis (376,6 vs 79,9; p < 0,001). The risk index exceeding 100 is strongly associated with high death risk among patients with infective endocarditis. CONCLUSION: This index may also be very useful in reaching the diagnosis and the efficacy prognosing of treatment.

Bacterial infections as complications in patients within 3 months after simultaneous pancreas-kidney transplantation.

INTRODUCTION: Simultaneous pancreas-kidney transplantation (SPK) is associated with high risk of infectious complications. OBJECTIVES: The aim of the study was to evaluate the incidence of bacterial infections within 3 months after SPK transplantation. PATIENTS AND METHODS: 17 patients with type 1 diabetes at the age of 32-54 years (mean age 42.5 +/- 7.1) were retrospectively analyzed within 3 months after SPK. RESULTS: No septic complications were observed in 2 patients (12%). In the remaining 15 patients (88%), at least 1 (from 1 to 5, a total of 30) infection episode was observed during follow-up. The infections were located: only at the surgical site (1 patient--6.7%), only in the urinary tract (6 patients--40%), both at the surgical site and in the urinary tract (7 patients--46.7%), at the surgical site and in blood (1 patient--6.7%). 2 groups of microbes were predominant, namely enterococci represented by 1 species, E. faecium (13 isolates) and the so-called intestinal bacilli, Enterobacteriaceae (19 isolates). No methicillin resistant Staphylococcus aureus strains were isolated. Candida species fungi were isolated only 3 times. CONCLUSIONS: In our study only 2 types of infections were observed (urinary tract and surgical site infections) and each of them comprised nearly half of all the septic episodes recorded. Gram-negative bacilli were collected more often than Gram-positive cocci, both from the surgical site and urinary tract infections. All infections ended with full recovery.

Outbreak of Pseudomonas aeruginosa infections with PER-1 extended-spectrum beta-lactamase in Warsaw, Poland: further evidence for an international clonal complex.

Forty-one Pseudomonas aeruginosa isolates with extended-spectrum beta-lactamases (ESBLs) from a hospital in Warsaw, Poland, were analyzed. Thirty-seven isolates from several wards were collected over 9 months in 2003 and 2004. The isolates were recovered from patients with multiple types of infections, mostly respiratory tract and postoperative wound infections. All 41 isolates produced the PER-1 ESBL, originally observed in Turkey but recently also identified in several countries in Europe and the Far East. The bla(PER-1) gene resided within the Tn1213 composite transposon, which was chromosomally located. Pulsed-field gel electrophoresis and multilocus sequence typing (MLST) revealed the presence of three separate clones among the isolates. Two of these, corresponding to sequence types (STs) ST244 and ST235, were responsible for parallel outbreaks. Apart from PER-1, all the isolates produced OXA-2 oxacillinase. ST235 isolates additionally expressed a novel enzyme, OXA-74, differing by one amino acid from the OXA-17 ESBL identified originally in PER-1- and OXA-2-positive P. aeruginosa isolates from Ankara, Turkey, in 1992. These earlier Ankara isolates with PER-1, OXA-2, and OXA-17 were also classified into ST235, which is a single-locus variant of two other STs, ST227 and ST230. ST227, ST230, and ST235 all correspond to the recently described clonal complex BG11, which seems to be internationally distributed, having spread in Turkey, Greece, Italy, Hungary, Poland, Sweden, and much of Russia. It is associated with various beta-lactamases, including PER-1 and VIM metalloenzymes. This work further demonstrates the value of MLST of P. aeruginosa.

A case of candida albicans mediastinitis after heart transplantation successfully treated with caspofungin.

Reported here is a case of mediastinitis caused by candida albicans and Staphylococcus aureus following a heart transplantation that was successfully treated with caspofungin, antibiotics and mediastinal lavage. A review of the literature revealed that Candida albicans as a cause of mediastinitis has been rarely described. In the few existing reports, evolution was generally fatal, especially in immunocompromised patients, despite treatment with antifungal drugs and antibiotics.