Antibiotic consumption in laboratory confirmed vs. non-confirmed bloodstream infections among very low birth weight neonates in Poland.

BACKGROUND: Newborns are a population in which antibiotic consumption is extremely high. Targeted antibiotic therapy should help to reduce antibiotics consumption. The aim of this study was an assessment of antibiotic usage in bloodstream infections treatment in the Polish Neonatology Surveillance Network (PNSN) and determining the possibility of applying this kind of data in infection control, especially for the evaluation of standard methods of microbiological diagnostics. METHODS: Data were collected between 01.01.2009 and 31.12.2013 in five teaching NICUs from the PNSN. The duration of treatment in days (DOT) and the defined daily doses (DDD) were used for the assessment of antibiotics consumption. RESULTS: The median DOT for a single case of BSI amounted to 8.0 days; whereas the median consumption expressed in DDD was 0.130. In the case of laboratory confirmed BSI, median DOT was 8 days, and consumption-0.120 DDD. Median length of therapy was shorter for unconfirmed cases: 7 days, while the consumption of antibiotics was higher-0.140 DDD (p < 0.0001). High consumption of glycopeptides expressed in DOTs was observed in studied population, taking into account etiology of infection. CONCLUSIONS: Even application of classical methods of microbiological diagnostics significantly reduces the consumption of antibiotics expressed by DDD. However, the high consumption of glycopeptides indicates the necessity of applying rapid diagnostic assays. Nevertheless, the assessment of antibiotic consumption in neonatal units represents a methodological challenge and requires the use of different measurement tools.

Infections and risk-adjusted length of stay and hospital mortality in Polish Neonatology Intensive Care Units.

BACKGROUND: The objectives of this study were to analyze the impact of infections on prolonging hospital stay with consideration of underlying risk factors and determining the mortality rates and its association with infections. METHODS: An electronic database developed from a continuous prospective targeted infection surveillance program was used in the study. Data were collected from 2009 to 2012 in five Polish tertiary academic neonatal intensive care units (NICUs). The length of stay (LOS) of 2,003 very low birth weight (VLBW) neonates was calculated as the sum of the number of days since birth until death or until reaching a weight of 1,800g. RESULTS: The median LOS for neonates with infections was twice as high as for neonates without infection. LOS was significantly affected by the overall general condition of the neonate, as expressed by both gestational age and birth weight as well as by the Clinical Risk Index for Babies (CRIB) score; another independent factor was presence of at least one infection. Risk of in-hospital mortality was significantly increased by male sex and vaginal birth and was lower among breastfed neonates. Deaths were significantly more frequent in neonates without infection. CONCLUSIONS: The general condition of VLBW infants statistically increase both their risk of mortality and LOS; this is in contrast to the presence of infection, which significantly prolonged LOS only.

Overview of pleiotropic effects of platelet P2Y12 receptor inhibitors.

Dual antiplatelet therapy consisting of one of the P2Y12 receptor inhibitors in conjunction with aspirin is the mainstay of treatment for patients with acute coronary syndromes (ACS) and those undergoing percutaneous coronary interventions (PCI). In recent years, multiple extra-platelet features of P2Y12 receptor antagonists have been reported in numerous clinical trials. The aim of this review is to summarise reported pleiotropic effects of clopidogrel, prasugrel, ticagrelor and other P2Y12 receptor blockers. We included observations made both in human and in animal models, together with proposed mechanisms of action for described features. If confirmed in randomised studies and properly applied to everyday practice, the observed extra-platelet actions could enable us to improve efficacy of ACS and post-PCI treatment, as well as to confine mortality and occurrence rate of cardiovascular events.

Infection control: point prevalence study versus incidence study in Polish long-term care facilities in 2009-2010 in the Malopolska Region.

OBJECTIVE: The objective of this study was to evaluate the epidemiology of infection in Polish long-term care facilities (LTCFs) and to analyse the capabilities and legitimacy of implementing continuous targeted surveillance. METHODS: The study investigated the relationship between the presence of infection and health status, tested using a point prevalence study (PPS) and incidence study. A 1-day PPS was carried out in October 2009, with prospective continuous surveillance between December 2009 and November 2010. Infections were defined according to McGeer's criteria. RESULTS: The surveillance encompassed 193 people. The prevalence was 14.0 % in residential homes (RHs) and 18.7 % in the nursing home (NH). Various types of infections (in the PPS) were observed significantly more frequently in patients with asthma, wounds, atherosclerosis of lower extremities, tracheotomy tubes and conditions in patients hospitalised in intensive care units (ICUs) up to 1 year before the PPS day. The incidence rate was 2.7/1,000 patient days (pds). CONCLUSIONS: The factors determined to be important for the risk of infection (in the continuous study) include the general status of patients, expressed using Barthel, abbreviated mental and Katz scales, as well as limited physical activity, stool incontinence and urinary catheterisation. In the PPS study, only a slight relationship was shown between the general status of residents and the risk of infection. None of the general status scales used clinically were shown to be helpful in estimating that risk, similarly to the five-point physical activity scale. Prospective continuous surveillance shows a possibility of limiting the range of infection control in the LTCFs within targeted surveillance in a population of patients that requires intensive nursing procedures. As a marker, one could point to the low score in the Barthel or Katz scales or low physical activity/bedridden persons.

Molecular characterization of capsular polysaccharides and surface protein genes in relation to genetic similarity of group B streptococci isolated from Polish pregnant women.

Serotyping, subtyping and genotyping are important tools for epidemiological studies of group B streptococci (GBS). We investigated the genotype distribution of 353 GBS isolates originating from vaginal or rectal carriage to identify capsular serotypes and subtypes based on the surface protein genes of the alpha-like protein (Alp) family. GBS were recovered from 30% of 1176 pregnant women during the period 2007-2009, with a predominance of capsular genotypes III (35%), Ia (20%), V (17%), II (15%), Ib (8%) and IV (5%). The most common Alp gene was epsilon (26%), followed by rib (22%), alp2 (21%), bca (17%) and alp3 (14%). Several protein genes were significantly associated (G(2)=249·635, P<0·0001) with particular serotypes: epsilon with Ia, Ib, IV; bca with Ib, II; rib with II, III; alp3 with V; alp2 with III. High genetic diversity within GBS strains was observed using DNA macrorestriction. Serotypes Ib, II and III demonstrated the greatest genetic heterogeneity and serotype V the lowest heterogeneity (relative frequency coefficient ≥0·03 vs. -0·46, respectively). Macrolide-resistant strains with serotype V and alp3 gene, showed higher uniformity in genetic profile. The distribution of serotypes and surface proteins of GBS strains are necessary data to inform the design and formulation of new GBS vaccines for use in Poland and other countries.

Association of the physical activity with leptin blood serum level, body mass indices and obesity in schoolgirls.

Decreased physical activity is undoubtedly significantly associated with obesity. Similarly, the proper hormones secretion, the proper weight and body development. The aim of this study was to investigate the relationship between body mass composition and leptin concentration in relation to the degree of physical activity expressed in MET-h/week (metabolic equivalent per week). The study included 59 girls, aged 9-16 years (12.55±1.67) and divided into two groups: 1) PA: a physically active group of 29 girls and 2) PI: a group of 30 physically inactive girls. In all, physical activity was assessed using modified questionnaire concerning "activity for adolescents" and expressed in MET-h/week. Serum blood leptin concentrations in fasting girls were determined by RIA. Anthropometric parameters were measured and fatness indices calculated (BMI, SF, WHtR). Body composition (%BF, FM, FFM) was assessed using bioelectrical impedance analysis method (BIA). Statistical analysis showed significant differences between groups of PA and PI concerning values of BMI, WHtR, %BF, WC and MET-h/week as well as in leptin concentrations. In both groups of girls negative correlations between physical activity measured in MET and leptin concentrations and in WHtR were observed. The concentration of leptin was directly proportional to the degree of body fat and to the body composition expressed by BMI, WHtR, log SF, WC and %BF, FM and FFM, respectively. Increased physical activity was associated with lower body fat ratios and WHtR, BMI, WC, %BF, but did not affect significantly the changes in the values of log SF, FM and FFM. Higher values of BMI, WHtR and WC can provide not only a greater risk of obesity in general, but also cause excessive accumulation of fat in the central part of the body (abdominal obesity).

Importance of luminal and mucosal zinc in the mechanism of experimental gastric ulcer healing.

Zinc has been reported to exert a gastroprotective action against various experimental gastric lesions suggesting that this trace element is involved in the integrity of the gastric mucosa. Compounds containing zinc, such as polaprezinc, were developed in Japan and used as an antiulcer drugs in the treatment of human peptic ulcer disease. However, the precise mechanism of Zn(2+) containing compounds and their effects on mucosal integrity, gastroprotection and ulcer healing remain unclear. We have determined the efficacy of zinc hydroaspartate, a compound containing Zn(2+), in the mechanism of gastric secretion and ulcer healing in rats with chronic gastric ulcers induced by acetic acid (initial ulcer area = 28 mm(2)). Rats with gastric ulcers were randomized into two groups: A) with gastric fistulas (GF) and B) without gastric fistulas and received a daily treatment with zinc hydroaspartate (32-130 mg/kg-d i.g.) for 3, 7 and 14 days. At the termination of each treatment, the area of gastric ulcers were examined by planimetry, the gastric blood flow (GBF) at ulcer margin was assessed by laser Doppler flowmetry and H(2)-gas clearance methods. The venous blood was withdrawn for a measurement of plasma gastrin levels by radioimmunoassay (RIA). The concentration of Zn(2+) in the gastric juice and mucosa at the ulcer margin were determined by differential pulse anodic stripping voltammetry (DPASV) and flame atomic absorption spectrometry (FAAS) methods and the gastric biopsy samples were taken for histopathological assessment of the quality of ulcer healing. The ulcers healed gradually, with the ulcer area in the vehicle control rats being diminished by 15%, 48% and 78% upon ulcer induction at 3, 7 and 14 days, respectively. Zinc hydroaspartate dose-dependently inhibited the area of gastric ulcer, the dose reducing this area by 50% (ID(50)) being about 60 mg/kg-d. The mucosal concentration of Zn(2+) significantly was unchanged from the baseline immediately after ulcer induction (day 0) and at day 3 but then it rose significantly at day 7 after ulcer induction. Treatment with zinc hydroaspartate (65 mg/kg-d i.g.), which significantly raised the gastric luminal and mucosal levels of Zn(2+), significantly accelerated ulcer healing at day 7 upon ulcer induction. The GBF, which reached a significantly higher value at the ulcer margin than the ulcer bed, was significantly increased in rats treated with zinc hydroaspartate compared with vehicle-controls. The gastric acid output was significantly inhibited in GF rats with gastric ulcer at day 3 then restored at day 14 followed by a significant rise in the plasma gastrin levels. Treatment with zinc hydroaspartate significantly inhibited gastric secretion and also significantly raised the plasma gastrin level when compared to vehicle-control rats. We concluded that 1) trace micronutrients such as Zn(2+) could be successfully measured in the gastric juice and gastric mucosa during ulcer healing; 2) compounds chelating of Zn(2+) can exert a beneficial influence on the ulcer healing via Zn(2+) mediated increase in gastric microcirculation, antisecretory activity and gastrin release, which may enhance the cell proliferation and differentiation during ulcer healing, ultimately exerting a trophic action on the ulcerated gastric mucosa.

A role of hydrogen peroxide producing commensal bacteria present in colon of adolescents with inflammatory bowel disease in perpetuation of the inflammatory process.

Bacteria in the gut play a central role in the initiation and progress of inflammatory bowel disease (IBD). This study was prepared to elucidate the role in the inflammatory process of the bacterial species which are able to produce hydrogen peroxide, present in samples taken from colon lesions in adolescents with inflammatory bowel disease. Fifty eight adolescents were enrolled into the study from January 2004 to October 2006 in Cracow, Poland. Biopsies and stool samples were collected. Bacteriological examinations and measurements of hydrogen peroxide production by enterococci, streptococci and lactobacilli were performed. For the first time it has been shown here that HP producing bacteria may contribute to increased amounts of hydrogen peroxide in the inflamed mucosa of Crohn's disease and ulcerative colitis patients. Moreover, we have been able to demonstrate an increase of total populations of aerobic bacteria but not anaerobes in the studied samples of mucosa of adolescents with inflammatory bowel disease which is an indirect evidence of higher oxygen tension present in inflamed tissues in IBD. We have also been able to demonstrate the direct relationship between presence of blood in stools of IBD adolescents and increased populations of Enterobacteriaceae but not streptococci in samples of colon mucosa. It is, therefore, possible that different products of Enterobacteriaceae and especially their lipopolysaccharides may also contribute to perpetuation of the chronic colon inflammation.

Liquid chromatographic/mass spectrometric procedure for measurement of NAD catabolites in human and rat plasma and urine.

Monitoring level of the metabolites of the coenzyme NAD such as nicotinamide and its oxidized and methylated derivatives is important due to therapeutic applications of these compounds and monitoring of oxidative stress. We evaluated feasibility of using HPLC with electrospray ion-trap mass detection for single run separation and quantitation of all the NAD metabolites. We achieved good separation and retention of all the metabolites of interest using reversed-phase with ion-pairing. Single ion monitoring or tandem MS were used for detection and quantitation of the specific compounds with good linearity. The method was able to detect all the physiological metabolites in plasma samples of rats and humans or in urine. However, full validation is necessary before this method could be routinely applied.