Urinary tract infections caused by Pseudomonas aeruginosa among children in Southern Poland: Virulence factors and antibiotic resistance.

OBJECTIVE: The aim of this study was to analyze antibiotic resistance and virulence patterns in Pseudomonas aeruginosa (PAR) isolates from urinary tract infections among children in Southern Poland. MATERIALS AND METHODS: This study comprised consecutive, non-repetitive PAR isolates sent from two collaborative laboratories. The study group consisted of children aged up to 17 years from Southern Poland with culture-proven PAR UTIs. Relevant information about patients with UTIs, such as age, sex, and type of infection (polymicrobial or monomicrobial), was collected. Isolates were screened for major virulence factors found in uropathogenic PAR strains. Multidrug-resistant (MDR) strains were defined as strains not susceptible to one antimicrobial in at least three different antimicrobial classes. Extensively drug resistant (XDR) strains were defined as strains susceptible to no more than two antimicrobial classes. RESULTS: The total prevalence of PAR UTIs was 2.1%, and in children <5 years of age it was 3.0%. A total of 26 isolates was tested: 21 from outpatients and five from inpatients. Most infections (80.8%) occurred in children ≤ 4 years of age. The most prevalent virulence gene was exoY (96.2%). The prevalence of other effector proteins was 88.5% for exoT, 92.3% for exoS, and 19.2% for exoU. The gene for LasB was present in 80.8% of isolates; the gene for AprA in 61.5%; the gene for PilA in 19.2%; and the gene for PilB was not detected. The PAR isolates were generally susceptible to beta-lactam and aminoglycoside antimicrobials. All isolates were also susceptible to colistin. A large proportion of isolates were resistant to carbapenems and fluoroquinolones (Fig. 1). No significant differences were found in antimicrobial resistance between males and females or inpatients and outpatients (p > 0.05 for all tested antimicrobials), or in antimicrobial resistance between younger (≤ 5 years old, n = 21) and older (> 5 years old, n = 5) children (p > 0.05 for all tested antimicrobials). Two isolates were classified as XDR and none as MDR. The EDTA test yielded one MBL-positive isolate (3.8%), from a 17-year-old patient in home care. No isolates with genes for the KPC, IMP, or VIM were identified. CONCLUSION: As data on UTIs in children with Pseudomonas etiology are scarce, this paper provides useful information for clinicians and allows for comparison between Poland and other countries. Our findings have important implications for clinicians treating UTIs empirically, because the success of empiric treatment is based on knowledge of pathogen antimicrobial susceptibility patterns.

Internal morphology of the nonsyndromic prematurely fused sagittal suture in the human skull--A preliminary micro-CT study.

Although nonsyndromic craniosynostosis (NSC) of the sagittal suture is a well-known type of craniosynostosis, little is currently known about the internal morphology of this prematurely fused suture in modern humans. Recently, micro-computed tomography (micro-CT) has been applied as a new tool for the quantitative evaluation of cranial suture morphology. However, so far there are only a small number of reports concerning studies of the internal morphology of prematurely fused sagittal suture in humans using micro-CT. The primary aim of this study was to examine the internal morphology of a completely obliterated sagittal suture in NSC. Two modern human skulls were used in this study: a skull of a child (aged 10 ± 2.5 years) displaying NSC of the sagittal suture and a skull of an adult showing non-prematurely completely obliterated sagittal suture. Quantitative variables of the sagittal sutures were assessed using method proposed by the authors. Porosity, and relative thickness of three bone layers in two examined skulls (inner cortical, diploë and outer cortical) were analysed using micro-CT in three equal sections of the sagittal suture. In the case of the prematurely fused suture, there were statistically significant differences mainly in the mean values of the porosity, thickness and relative thickness of the diploë between the anterior part and the two other parts (central and posterior) of this suture. Significant differences were also observed in some of the analysed variables between the sections of the sagittal suture of the skull with NSC and the normal skull.

[Registration of hospital infections: effects of 5 years observation of peritonitis]. / Ocena efektów rejestracji zakazen szpitalnych w 5-letnim okresie obserwacji przypadków zapalenia otrzewnej.

In connection with a great availability of antibiotics, many negative side effects have been observed. A registration program of hospital infections' occurrence and drug-sensitiveness has been conducted for five years in all wards of Mining Hospital in Sosnowiec. This paper presents our first data and conclusions after examinations of the biological materials coming from patients suffering from different kinds of the peritonitis.

Cerebrospinal meningitis with the presence of Acinetobacter spp.

The study was conducted on 16 strains of Acinetobacter sp. which were isolated from cerebrospinal fluid. The diagnostic material was analysed with the use of automatic BacT/Alert system (Organon Teknika). The analysis was performed in the Department of Microbiology, Medical University in Bydgoszcz. API 20NE system (bioMérieux) enabled the identification of 14 strains (87.5%) as A. baumannii, 1 strain as A. haemolyticus and 1 strain as A. lwoffii. The micro-organisms were isolated from patients whose age ranged between 4 and 66 years. These patients were treated in the departments of Neurosurgery (75.0%), Neurology (18.8%) and Intensive Therapy (6.2%). The infection of cerebrospinal fluid was caused by injury and subsequent exposure to the bacteria present in external environment. Antibiotic-sensitivity of these micro-organisms was evaluated with the help of disc-diffusion method, observing standardisation conditions outlined by NCCLS. All the strains proved sensitive to carbapenems, 15 strains were sensitive to netilmicin, 7 strains--to tobramycin and 7 strains--to amikacin. All the strains displayed multiple resistance. The only exception was A. haemolyticus. The use of two-discs allowed for the detection of ESBLs in 7 A. baumannii strains. Positive results were most frequently obtained after the combination of sublactam and aztreonam. Due to microscopic resemblance between Acinetobacter spp., and bacteria of Neisseria, Moraxella and Haemophilus genus, microbiological diagnostics should not be restricted to microscopic assessment of cerebrospinal fluid and quick serological tests evaluating the antigens of the most frequent aetiological factors. Considering multiple resistance of Acinetobacter spp. to antibiotics, the treatment should be based on sensitivity tests and the ability of a given antibiotic to penetrate into cerebrospinal fluid. In our opinion, both reasonable antibiotic policy as well as observing the principles of hygiene and monitoring infections play equally important roles in the prevention of infections with Acinetobacter spp. Such combined measures may help to prevent the spreading of multiple resistant strains in hospital environment.

[Occurrence and susceptibility of hospital strains producing enzymes with a wide spectrum of substrate profiles]. / Wystepowanie i lekowrazliwosc szczepów szpitalnych wytwarzajacych enzymy o rozszerzonym profilu substratowym.

In connection with more and more frequent occurrence of extended spectrum beta-lactamases an effort has been made to detect their presence in the biological materials coming from the patients of different wards of Mining Hospital in Sosnowiec from January to September 1995. Among 38 diagnostic materials, from which the strains in question were isolated, the following materials have been examined: bronchial lavage (52.6%), surgical wounds (18.4%), urines (15.8%) and others (13.2%). The examined diagnostic materials came from Intensive Care Unit (87.0%), Casualty and Orthopaedic Surgery Clinic (5.0%) and General Surgery Clinic (3.0%). The most frequently isolated microorganisms were Klebsiella pneumoniae. (47.4%), Serratia marcescens (36.8%), Enterobacter cloacae (10.5%) and others (5.3%). Half of the examined strains constituted those producing extended spectrum beta-lactamases and probably possessing an extra resistance mechanism: (Serratia marcescens--74%, Enterobacter cloacae--21%, Enterobacter aerogenes--5.0%) and 50% were those producing extended--spectrum beta-lactamases. (Klebsiella pneumoniae--95%, Escherichia coli--5%). Susceptibility of the examined strains to anti-microbial antibiotics was diverse. Full susceptibility of the analysed strains has been observed exclusively in case of Karbapenems (Imipenem, Meropenem and Cefamycyn). In case of beta-lactamase with beta-lactamase inhibitor combinations susceptibility was diverse and dependent on the species of the examined microorganism.

[Isolation of Helicobacter pylori from gastric mucosa depending on the growth medium used]. / Izolacja Helicobacter pylori z blony sluzowej zoladka w zaleznosci od stosowanego podloza wzrostowego.

The usefulness of selective media in increasing the percentage of isolated Helicobacter pylori as well as the occurrence of H. pylori infection in upper gastro-intestinal tract disorders were evaluated. It was shown that the frequency of H. pylori isolation was significantly higher when selective media (Columbia agar with supplementation according to Skirrow-Campylobacter Selective Supplement SR 69 and Columbia agar with Helicobacter pylori Selective Supplement SR 147,Oxoid) were used instead of non-selective media (Columbia agar). Upper gastrointestinal endoscopy performed in 125 patients demonstrated that H. pylori infection was rather frequent (50%) and dependent on the type of pathology. It was almost always accompanied by histological features of chronic inflammation of mucosa. In patients with gastric bile reflux the frequency of H. pylori infection was about 19%.

[Strains of Pseudomonas aeruginosa isolated from patients in surgical and non-surgical wards and their serotypes according to HABS schema]. / Szczepy Pseudomonas aeruginosa izolowane od pacjentów oddzialów zabiegowych i niezabiegowych oraz ich serotypy wedlug schematu Habsa.

The purpose of this research was to determine serological types of Pseudomonas aeruginosa according to Habs and their susceptibility to various antibiotics. The material consisted of 316 strains of Pseudomonas aeruginosa isolated in the period from November 1, 1988 to March 30, 1990. Among 259 strains isolated from patients treated in operative wards, the immunotype P 16 (28.18%) was most frequent. Among 57 strains isolated from patients treated in non-operative wards, the immunotype P 16 (36.84%) was also most frequent. The majority of isolated strains were resistant to a number of applied antimicrobial drugs. Such antibiotics as netilmicin, imipenem, amikacin, ceftazidime, carbenicillin and timentin proved to be most effective.

[Phage and serological types of bacteria infecting patients in anesthesiology and intensive therapy (1988-1990)]. / Typy fagowe i serologiczne bakterii w zakazeniach u chorych w oddziale anestezjologii i intensywnej terapii (1988-1990).

1736 of biological materials, being taken from 264 patients, were investigated since 1988 to 1990. 1410 kinds of microorganisms were cultured from 999 biological materials, in which the growth of bacterial flora was noticed. Following species were isolated most frequently: Pseudomonas aeruginosa 15.39%, Proteus mirabilis 12.91%, Klebsiella pneumoniae 10.43% and Staphylococcus aureus 10.43%. The most frequent serological type according to Fisher's scheme was Pseudomonas aeruginosa--immunotype T 3.7 and according to Habs scheme--immunotype P 16. Strains of Staphylococcus aureus were most frequently sensitive to phages the group II. In case of Klebsiella sp. bacilli, the most predominant strains were not typed either by basic or extended phage sets.

[Epidemiologic investigation of infection with Klebsiella using phage typing as a method]. / Epidemiologiczne badania zakazen paleczkami Klebsiella z uzyciem lizotypii jako metody.

In epidemiological investigations of infections with Klebsiella carried on by us for many years, a lysotyping method was used with a success. The results which are now being presented deal with 638 strains of Klebsiella pneumoniae and Klebsiella oxytoca originating from patients treated in hospitals in Wroclaw, Kraków, Gdansk and Sosnowiec during the years 1986-1992. Susceptibility of strains to the standard set of 14 phages used since ten years decreased significantly, when compared with previously typed strains of Klebsiella. Out of 312 susceptible strains of Klebsiella, majority (302) represented 47 phage types described previously. Sporadic appearance of new phage types was observed. Some phagotypes (37, 47, 112, 117, 119, 142, 153 and 157) were represented most frequently and concerned 55% of susceptible strains. High repeatability of phage types in consecutive groups of typed strains suggests a need for continuation of this method for typing Klebsiella. Decreased susceptibility of strains to standard set of phages requires introduction of new typing bacteriophages.

[Etiologic bacterial factors of infections in patients treated at the clinical anesthesiology ward and with intensive therapy]. / Bakteryjne czynniki etiologiczne zakazen u chorych leczonych w Klinicznym Oddziale Anestezjologii i intensywnej Terapii.

Bacteriological investigations were carried on 264 patients treated in 1988-1990. 1736 samples of biological materials were taken and it amounts to 6-7 samples from each patient. Most frequently isolated microorganisms were: Pseudomonas aeruginosa (15%), Proteus mirabilis (13%), Klebsiella pneumoniae (10%) and Staphylococcus aureus (10%). Serological typing of Pseudomonas aeruginosa was performed according to Habs and domination of immunotype P16 (30%) was detected. Majority of isolated Klebsiella pneumoniae were not typable with basic and broadened phage set. One strain was susceptible to phages KI12 and KI27. This phage type was not isolated in Poland before. Staphylococci were most frequently susceptible to group II phages (29%), additional phages (19%) and 15% were not typable with the phage set used. Isolated bacteria were in majority resistant to numerous antibiotics.

[Bacteriologic examinations of patients with burns]. / Badania bakteriologiczne u chorych z ranami oparzeniowymi.

Bacteriological studies were performed on 189 patients treated during 1985-1989. 800 samples were tested which were taken from various sites of burn wound (3-5 smears from a patient). Surface of burn amounted to 15-86% and degree of burn was IIb/III. In 772 samples, 2073 bacterial strains were found. Most frequent were Pseudomonas aeruginosa (31%) and Staphylococcus aureus (29%). Remaining strains consisted chiefly of Proteus mirabilis, Pseudomonas cepacia, Klebsiella pneumoniae, Escherichia coli and Acinetobacter calcoaceticus. Serological typing of Pseudomonas aeruginosa carried according to Fisher demonstrated dominance of immunotype T3.7 (43%). Staphylococcal strains were most frequently sensitive to group III phages and/or supplementary phages.