[Elevated blood glucose level as a risk factor of hospital-acquired pneumonia among patients treated in the intensiv care unit (ICU)]. / Podwyiszone stezenie glukozy jako czynnik ryzyka szpitalnego zapalenia pluc u chorych w oddziale intensywnej terapii.

Hospital acquired-pneumonia is the most frequently occurring hospital-acquired infection in intensive care units (ICU). The study group consisted of 233 patients treated over 12 months in the ICU of the 1st Department of General Surgery and Gastroenterological Surgery Clinics, University Hospital in Krakow. Patients were divided in two groups: experimental--consisting of 92 patients with hospital-acquired pneumonia, and control--consisting of 141 patients without the disease. The following risk factors of hospital-acquired pneumonia risk were analysed for both groups: length of stay in the ICU, duration of mechanical ventilation, kind of treatment applied, presence of a gastrointestinal tube, blood glucose levels. Significantly more patients with hospital-acquired pneumonia than controls had blood glucose level above 6 mmol/l (OR = 2.23). Monitoring and maintainment of glucose level within the normal ranges is an important element of successful treatment. In fact, glucose level is the only risk factor that can be easily modified compared with other analyzed factors.

[Etiological bacterial factors of respiratory system infections in the Intensive Care Unit Surgery Clinic]. / Bakteryjne czynniki etiologiczne zakazen ukladu oddechowego w Oddziale Intensywnej Terapii Kliniki Chirurgicznej.

Pneumonia is the most frequently occurring hospital-acquired infection in Intensive Care Units (ICU). The frequency of bacteriological pathogenic factors in the surgical ICU and efficiency of empiric antibiotic therapy used in ICU was assessed. The study included 239 ICU patients in the I Department of General Surgery and Gastroenterological Surgery Clinics of Jagiellonian University Hospital in 2006 year. The bronchoscope materials were worked out with the application of qualitative and quantitative diagnostic methods. Identification of bacteria strains was based on the qualification of their biochemical characteristics based on commercially available tests (bio-Merieux): ID 32E and ID 32GN for rod-shaped (bacilli) bacteria and tests ID 32 STAPH and api 20 STREP that were applied to identify spherical (cocci) bacteria. Sensitivity to medicines was marked in the automatic system VITEK 2 (bio-Merieux). The ability to produce extended spectrum beta-lactamases (ESBL) was marked with double disc test (DDT). The immunity to meticiline was marked with diffusion-disc test and with E test method (AB BIODISK). The most frequently isolated gram-negative bacteria (92.3%). Klebsiella pneumoniae, Serratia marcescens constituted the largest percentage of bacteria strains resistant to many antibiotics. Change of antibiotic used was necessary in 24.3% of patients.

The impact of immunostimulating nutrition on infectious complications after upper gastrointestinal surgery: a prospective, randomized, clinical trial.

BACKGROUND AND AIM: Immunomodulating nutrition is supposed to reduce the number of complications and lengthen of hospital stay during the postoperative period in patients after major gastrointestinal surgery. The aim of the study was to assess the clinical effect of immunostimulatory enteral and parenteral nutrition in patients undergoing resection for gastrointestinal cancer in the group of well-nourished patients. MATERIAL AND METHODS: Between June 1, 2001, and December 31, 2005, a group of 214 well-nourished patients was initially assessed (150 men, 64 women, mean age 61.2 years) to participate in the study. Nine patients were subsequently excluded and the remaining 205 subjects were randomly assigned in a 2 x 2 factorial design into 4 study groups, ie, standard enteral nutrition (n = 53), immunomodulating enteral nutrition (n = 52), standard parenteral nutrition (n = 49), and immunomodulating enteral nutrition (n = 51). The study was designed to test the hypothesis that immunonutrition and enteral nutrition would reduce the incidence of infectious complications after upper gastrointestinal surgery; the secondary objective of the study was to evaluate the effect of nutritional intervention on overall morbidity and mortality rates, and hospital stay. The study was registered in the Clinical Trials Database-number NCT 00558155. RESULTS: The overall morbidity rate was 33% and the incidence of individual complications was comparable between all groups. Infectious complications occurred in 26 of 102 patients given standard diets and in 22 of 103 patients receiving immunomodulatory formulas (odds ratio 0.81; 95% CI, 0.43-1.50). There were no significant differences between infectious complications in patients using parenteral nutrition (22 of 100 patients) and parenteral formulas (26 of 105, odds ratio 1.14; 95% CI, 0.61-2.14). Neither immunostimulating formulas nor enteral feeding significantly affected secondary outcome measures, including overall morbidity and mortality rates, and hospital stay. CONCLUSIONS: Our study failed to demonstrate any clear advantage of routine postoperative immunonutrition in patients undergoing elective upper gastrointestinal surgery. Both enteral and parenteral treatment options showed similar efficacy, tolerance, and effects on protein synthesis. Parenteral nutrition composed according to contemporary rules showed similar efficiency to enteral nutrition. However, because of its cost-efficiency, enteral therapy should be considered as the treatment of choice in all patients requiring nutritional therapy.

Clinical presentation of extraintestinal infections caused by non-typhoid Salmonella serotypes among patients at the University Hospital in Cracow during an 7-year period.

The most characteristic finding in non-typhoid salmonella (NTS) infection is acute food related outbreaks of gastroenteritis, which is usually benign and self-limiting. However, more serious extraintestinal findings, such as bacteraemia and focal infections localized to any organ may appear. The objective of this paper is to describe the most important characteristic of the extraintestinal infections due to NTS serotypes observed in University Hospital, in Cracow between January 2000 and December 2006. To do so, we reviewed the clinical presentations, risk groups, complications and outcomes of in-patients, in which extraintestinal non-typhoid Salmonella serotypes were isolated, applying a clinomicrobiological protocol. Out of 30 patients with either bacteraemias (n = 22) or focal salmonella infections (n = 8), 12 had malignancies, 17 had immune dysfunction state, 9 had gastrointestinal disorders and 8 had chronic heart, pulmonary or kidney disease. Four of these patients (13%) who had hematological malignancies (2), renal transplantation (1) and pulmonary disease (1) died. Regarding the clinical picture, primary bacteraemia and focal infections occurred with similar frequency (33.3% and 26.7%, respectively); the remaining were bacteraemias secondary to gastroenteritis. The incidence rate (mean 0.30/1000 hospital admission/year) increased steadily from 0.19/1000 to 0.32/1000 hospital admission during the study period. From 30 Salmonella isolates from extraintestinal samples collected, only four isolates were resistant to ampicillin, ciprofloxacin or trimethoprim-sulfamethoxazole. This finding indicate that multidrug resistance does not represent a serious problem among NTS serotypes collected from the our medical center as monitored over a period of 7 years. Given this presentation, clinicians need to have a high index of suspicion and to consider preemptive therapy, especially in elderly patients who are likely to develop severe immunosuppression following interventions.

Standard and immunomodulating enteral nutrition in patients after extended gastrointestinal surgery--a prospective, randomized, controlled clinical trial.

BACKGROUND & AIM: The immunomodulating enteral diets are intended to reduce the incidence of postoperative complications in surgical patients. The aim of the study was to assess the clinical effect of such nutrition. MATERIALS AND METHODS: Between June 2004 and September 2007 196 well-nourished patients undergoing resection for pancreatic and gastric cancer were randomized in double-blind manner to receive postoperative enteral nutrition with immunostimulating diet (IMEN group) or standard oligopeptic diet (SEN group). Outcome measures were: number and type of complications, length of hospital stay, mortality, treatment tolerance, liver and kidney function. RESULTS: One hundred and ninety six patients were initially enrolled, finally 183 patients (91 SEN, 92 IMEN group; 69 F, 114 M, median age 61.2) were analyzed. Median postoperative hospital stay was 12.4 days (SD 5.9) in SEN and 12.9 days (SD 8.0) in IMEN group (p=0.42). Complications were observed in 21 patients (23.1%) in SEN and 23 (25.2%) in IMEN group (p>0.05). Four (4.4%) patients in SEN group and 4 (4.4%) in IMEN had surgical complications (p>0.05). There were no differences in liver and kidney function, visceral protein turnover and treatment tolerance. CONCLUSION: Results of our study showed no benefit of immunomodulating enteral nutrition over standard enteral nutrition in patients after major gastrointestinal surgery. The Trial was registered in Clinical Trials Database--number: NCT00576940.

[Age as a prognostic factor in colorectal cancer treatment]. / Wiek jako czynnik rokowniczy u chorych z rakiem jelita grubego.

Aging of the population leads to increasing the numbers of patients requiring surgical interventions. Though highest incidence of colorectal cancer occurs in the age range between 60-70 years, the incidence of colorectal cancer in the age group below 40 years has been also increasing. In this age group the course of the disease and prognosis are different than in the patients over 60 years of age. The authors are analysing data from the study protocols of 1332 patients operated for colorectal cancer at our Department of Surgery between 1984-2000. The results obtained in 3 age groups were compared: group I--patients < or = 40 years (n = 56), group II patients between 41-70 years (n = 944), group III > 70 years (n = 332). No significant differences related to the stage of the disease and the number of asymptomatic patients were observed between groups. The patients below 40 years had more lesions of multiple type, and the number of emergency procedures was lower. The number of resective procedures was the highest in this group similarly as the rates of recurrent disease, either local or systemic. The patterns of five-year survival in the age group below 40 years and over 70 were similar. Colorectal cancer in the patients below 40 years of age has poor prognosis, however long-term survivals are similar as in the patients over 70 years. Due to the lack of concomitant diseases in the patients with colorectal cancer below 40 years, prognosis in this group is the worst.