High risk of intestinal colonization with ESBL-producing Escherichia coli among soldiers of military contingents in specific geographic regions.

One-hundred Polish soldiers of a contingent in Afghanistan in 2019 were screened for Enterobacterales resistant to newer-generation ß-lactams at their departure and return. Seventeen percent were colonized in the gut at the departure, whereas 70% acquired carriage in Afghanistan. The commonest organisms were extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli (ESBL-Ec; 96.6%). All isolates were sequenced and were clonally diverse overall, even within the same sequence type, indicating that independent acquisitions mainly. ESBL-Ec were often multi-drug-resistant. Soldiers stationing in certain regions are at high risk of acquiring resistant bacteria that may cause endogenous infection, be transmitted to vulnerable individuals, and spread resistance genes.

The Prevalence of Intestinal Parasitic Infections Among Kosovar and Serbian School-children in Kosovo.

The aim of this study was to estimate the prevalence and distribution of species of intestinal parasites in the Balkans on the example of Kosovar and Serbian residents from the region of Gnjilane ineastern Kosovo,where the epidemiology of intestinal parasitic infections remains unknown. Parasitological examination of stools pecimens was performed in 2017 and 2018. Stool samples were collected from asymptomatic school-children aged 6-17 years: 530 Kosovars from the municipality of Kaçanik and310 Serbs from the municipalities of Kamenica and Strpce. Each patient provided two stool samples collected every second day,fixed in SAF preservative and 70 % spiritus vini, transported to the Department of Epidemiology and Tropical Medicine at the Military Institute of Medicine in Poland,and tested by light microscopy using three diagnostic methods: directs mearin Lugol's solution,decantation in distilled water, and Fülleborn's flotation. A total of 101 Kosovar children (19.1 % of the study group)were found to be infected with intestinal parasites: nematodes (n=20), cestodes (n=2), trematodes (n=2), and protozoa (n=79). Only 13 Serbian children (4.2 %) were found to beinfected with nematodes (n=4),cestodes (n=3),and protozoa (n=6). Giardia intestinalis was themost prevalent intestinal parasite in both groups (14,9 % vs. 1.9 % children). The prevalence ofasymptomatic parasitic infections was significantly higher in Kosovars in comparison to the Serbsliving in the same region of eastern Kosovo. This fact shows that there may be significant differencesin the quality of health care and sanitation as well as feed hygiene between these two communities.

Bacteriological Assessment of Pneumonia Caused by Gram-Negative Bacteria in Patients Hospitalized in Intensive Care Unit.

The article presents the results of 11-year study (2005-2015) of Gram-negative bacteria responsible for pneumonia in 2033 mechanically ventilated patients hospitalized in Intensive Care Unit. Of 8796 biological samples, consisting mainly of bronchial aspirate (97.9 %), 2056 bacterial strains were isolated and subjected to identification. VITEK 2 was used to determine drug susceptibility (classified according to the EUCAST criteria). ESBL, MBL and KPC-producing strains were identified by means of phenotypic methods using appropriate discs. The findings were that the predominant bacteria responsible for infections consisted of Enterobacteriaceae (42.0 %), Acinetobacter baumannii (37.2 %), Pseudomonas aeruginosa (16.1 %), and Stenotrophomonas maltophila (4.7 %). We observed a rise in the number of bacteria causing pneumonia throughout the study period, especially in S. maltophila and Enterobacteriaceae ESBL (+). Gram-negative bacilli were 100 % susceptible to colistin, apart from naturally resistant strains such as Proteus mirabilis, Serratia marcescens, whereas Enterobacteriaceae ESBL (+) were susceptible to imipenem and meropenem. Acinetobacter baumannii strains exhibited the lowest drug susceptibility. In conclusion, we report an increase in the prevalence of pneumonia associated with Gram-negative bacteria in mechanically ventilated intensive care patients. Colistin remains the most effective drug against the majority of Gram-negative bacteria. Therapeutic problems are common in the course of treatment of Acinetobacter baumannii infections.

Prevalence of Neisseria meningitidis Carriage with Identification of Serogroups and Genogroups in Professional Soldiers.

The article presents the prevalence of Neisseria meningitidis carriage with the identification of sero- and genogroups in professional soldiers serving in the Polish Armed Forces. A total of 1246 soldiers from the 10th Armored Cavalry Brigade in Swietoszów, Poland were examined in the period January-February 2016. Microbiological tests were performed using standard methods (culture, incubation, microscopy, biochemical, and automated identification with VITEK cards). Neisseria meningitidis isolates from carriers were subjected to a slide agglutination test for the identification of serogroups, next bacterial DNA was isolated and genogroups were identified based on the results of PCR. Of the 1246 soldiers tested, 65 were found to be carriers of N. meningitidis. Serogroups of 36 isolates and genogroups of 56 meningococcal isolates were determined. The genogrouping identified the isolates as belonging to group B (n = 34; 52.3 %), E29 (n = 8; 12.3 %), C (n = 6; 9.2 %), Y (n = 6; 9.2 %), and W (n = 2; 3.1 %). The primers which were used did not make it possible to determine the genogroup of nine isolates. In conclusion, the overall carrier rate of N. meningitidis amounted to 5.2 %, with the serogroup B being predominant, which is similar to that reported in the general population in Poland and Central Europe.

Implementation of Hospital's Antibiotic Policy Decreases Antimicrobial Use in the General Pediatric Ward.

Hospitalized children are often treated with antibiotics. However, 30-75% of antibiotic treatment in pediatric hospitals is administrated incorrectly or unreasonably. Implementation of Hospital's Antibiotic Policy (HAP) should improve antibiotic consumption patterns in pediatric wards. The objective of this study was to determine the effectiveness of HAP by assessing antibiotic consumption in the General Pediatric Ward of an academic hospital in the city of Warsaw, Poland before and after this policy was introduced in the years 2012 and 2013, respectively. Antibiotic use was calculated in daily-defined doses (DDDs) per 100 patient-days and DDDs per 100 admissions. Antibiotics were ranked by the volume of DDDs and the number of antibiotics which accounted for 90% and 100% of the total volume: DU90% and DU100% (where DU stands for drug use). The total antibiotic consumption and significantly decreased after the implementation of HAP; DDDs were 2,177.5 before and 1,335.4 after implementation of HAP. The number of DDDs/100 patient-days was also lower; 36.3 vs. 24.9 before and after HAP, respectively. After implementation of HAP a decreased use of ceftriaxone and cefuroxime was observed. The most commonly used antibiotic was amoxicillin with clavulanic acid. The DU100% rates remained the same (8 antibiotics) and DU90% increased (from 3 in 2012 to 5 in 2013). We conclude that implementation of HAP resulted a decreased consumption of antibiotics in the General Pediatric Ward, despite the hardly changed number of children treated with antibiotics.

Stagnating Low Influenza Vaccine Coverage Rates in the Polish Elderly Population in 2008-2013.

Although annual vaccination is the most effective way of preventing the disease and its severe outcomes, influenza vaccine coverage rates have always been at suboptimal levels in Poland. A retrospective analysis was conducted on influenza vaccine coverage rates among patients older than 65 years at local and national levels. Influenza vaccine coverage rates among the elderly in the capital city of Warsaw ranged from 20.5% in 2013 to 31.5% in 2010 and these rates were higher than those reported at the national level (from 7.6% in 2012 to 11.3% in 2009). At a local level the proportion of vaccines given to the elderly compared to all vaccinated individuals varied from 40 to 52% which was comparable to the proportions reported at the national level (37-48.5%). 69% of the elderly were only vaccinated once during the observation period, and only 0.5% of them repeated the vaccination in each subsequent year. The chance of being vaccinated against influenza more than once was statistically higher among women than men (OR 4.9; 95% CI 4.2-5.8). Influenza vaccine coverage rates are low at both local and national levels and ought to be improved in Poland in future.

Effectiveness of immunoprophylaxis in suppressing carriage of Neisseria meningitidis in the military environment.

Neisseria meningitidis, etiological factor of invasive meningococcal disease, is a human commensal that colonizes the nasopharynx. Colonization is usually asymptomatic, but it is a prerequisite for disease. Asymptomatic carriers are the major source of infection. In the present study, a survey of N. meningitidis carriage was conducted between January and March 2013 in a military unit in Poland. Single-time throat culture samples were collected from professional 559 soldiers (302 unvaccinated vs. 257 vaccinated individuals with the quadrivalent conjugate vaccine ACYW-135). Bacterial identification was performed with classic microbiological methods (culture, incubation, identification). Non-culture method (PCR) was used for confirmation of detected strains of N. meningitidis and determination of serogroups. We found 29 carriers in the group of unvaccinated soldiers (9.6 % of examined individuals) whereas among vaccinated soldiers only 3 persons were carriers of N. meningitidis (1.2 %). The most frequently identified serogroups among the carriers serving in the same military facility were serogroup B (28 %), followed by Y (25 %), and C (22 %). In conclusion, the initiation of mass vaccination with the quadrivalent conjugate vaccine ACYW-135 in the military environment seems an effective method of suppressing N. meningitidis carriage.

Etiological factors causing lower respiratory tract infections isolated from hospitalized patients.

Lower respiratory tract infections (LRTI) account for 20-30 % of all hospital-acquired contagions. They are characterized by high mortality of hospitalized patients. The most serious form of LRTI is pneumonia, and the most common etiological factors in such cases are bacteria. The article gives the analysis of bacterial flora samples obtained from lower respiratory tract of hospitalized patients. In vitro susceptibility of pathogens to selected antibiotics has also been assessed. We carried out a retrospective analysis of 1,171 bacterial strains isolated from 1,171 patients treated in clinics of the Military Institute of Medicine in Warsaw, Poland. In most cases the samples were collected from an endotracheal or tracheostomic tube (71.5 %) and from bronchoalveolar lavage (21.7 %). The most commonly isolated pathogens included Acinetobacter baumannii (35.8 %), Staphylococcus aureus (27.6 %), Klebsiella pneumoniae (19.4 %), and Pseudomonas aeruginosa (16.2 %). Multidrug-resistant gram-negative bacteria exhibited 100 % susceptibility to colistin only. Klebsiella pneumoniae ESBL+ and Acinetobacter baumannii were most susceptible to carbapenems, while Pseudomonas aeruginosa strains to ceftazidime. Methicillin-resistant Staphylococcus aureus were 100 % susceptible to vancomycin, linezolid, and tigecycline. In conclusion, identifying the etiological factors causing infections of the lower respiratory tract and determining their drug-susceptibility is of key importance in empirical treatment.

In vitro sensitivity of Acinetobacter baumannii and Pseudomonas aeruginosa to carbapenems among intensive care unit patients.

Acinetobacter baumannii and Pseudomonas aeruginosa pathogens are the most common causes of fatal pneumonia among patients treated in Intensive Care Units (ICU). Carbapenems remain a group of antibiotics characterized by the highest effectiveness in treatment of heavy infections of the lower respiratory tract. This study compared in vitro sensitivity of A. baumannii and P. aeruginosa to three carbapenems: imipenem, meropenem and doripenem. The material was collected from 71 patients treated in the ICU from April 2009 to January 2010. Bronchial tree was the predominant source of samples. Fifty-four strains of A. baumannii and 17 strains of P. aeruginosa were analyzed. Sensitivity to carbapenems was interpreted in line with Clinical and Laboratory Standard Institute (CLSI) and European Committee for Antimicrobial Susceptibility Testing (EUCAST) criteria (imipenem and meropenem) or in compliance with the Food and Drug Administration (FDA) and CLSI guidelines (doripenem). We found that A. baumannii was significantly more often sensitive to imipenem than to doripenem and meropenem, but only according to the CLSI and FDA and not EUCAST criteria. The sensitivity of P. aeruginosa was higher to imipenem than to doripenem and meropenem, according to both CLSI and EUCAST criteria (64.7 %). We conclude that the EUCAST criteria demonstrate a higher rigor than those of CLSI and FDA in the determination of carbapenems sensitivity. Imipenem appears more effective than doripenem and meropenem in treatment of A. baumannii and P. aeruginosa infections.

Prevalence of acute respiratory tract diseases among soldiers deployed for military operations in Iraq and Afghanistan.

Respiratory diseases are one of the most common health problems among service personnel assigned to contemporary military operations which are conducted in areas characterized by adverse environmental conditions. This article reviews the results of the studies into the prevalence of acute respiratory tract diseases among soldiers of the Polish Military Contingent deployed to Iraq and Afghanistan. The article also discusses a number of factors which increase the prevalence of diseases diagnosed in the population of soldiers on a military mission in different climatic and sanitary conditions. Retrospective analysis was based on medical records of Polish troops treated on an outpatient basis in Iraq in 2003-2004 (n = 871) and in Afghanistan in 2003-2005 (n = 400), 2009 (n = 2,300), and 2010 (n = 2,500). The intensity rates were calculated and were then used to calculate the prevalence of diseases per 100 persons in a given population of the military personnel. We found that acute respiratory tract diseases were one of the most common health problems treated in outpatient medical facilities in all four study populations. The incidence rate was 45.6 cases in Iraq in 2003-2004, and in Afghanistan it amounted to 61.8 in 2003-2005, 45.3 in 2009, and 54.8-100 persons in 2010. In conclusion, the prevalence of respiratory diseases was closely related to the environmental factors, such as sand and dust storms, extreme temperature changes, unsatisfactory sanitary conditions, and common disregard of basic principles concerning disease prevention.

In vitro susceptibility of Staphylococci and Enterococci to vancomycin and teicoplanin.

Hospital-acquired infections (HAIs) pose a worldwide problem. They primarily concern intensive care, hematology-oncology, and surgical units. Coagulase-positive and coagulase-negative Staphylococci, especially their subgroups possessing the ability to develop resistance to methicillin, and Enterococci have a particular role in the etiology of HAIs. The aim of this study was to determine the therapeutic minimal inhibitory concentration (MIC) values for vancomycin and teicoplanin, two of the most commonly administered antibiotics in the treatment of infections caused by Staphylococci resistant to methicillin, and infections caused by Enterococci. The material analyzed included 200 bacterial strains collected from patients treated in the Intensive Care Unit, the Musculoskeletal Infections Unit, and Surgical Clinics of the Military Institute of Medicine in Warsaw, Poland. The study was conducted in accord with the European Committee for Antimicrobial Susceptibility Testing (EUCAST) criteria by means of the Etest® gradient strips. We demonstrate a full susceptibility of Staphylococci MSSA (methicillin susceptible Staphylococcus aureus), Staphylococci MRSA (methicillin resistant Staphylococcus aureus), and Enterococci to both antibiotics. Coagulase-negative Staphylococci had a higher sensitivity to vancomycin. Teicoplanin had a lower MIC than vancomycin against the analyzed strains of Enterococci. As regards the coagulase-negative Staphylococci, vancomycin had a lower MIC than teicoplanin. In conclusion, the study confirmed current recommendations on the use of vancomycin and teicoplanin in the treatment of infections caused by gram-positive bacteria, emphasizing the need for the determination of MIC values.

Lung function in divers.

Correct lung function is indispensible to perform work underwater. Thus, spirometric tests of lung function remain an important element in the process of selecting candidates for professional diving. Studies conducted in the population of divers identified the phenomenon called 'large lungs', which is often associated with spirometric indices characteristic of obstructive impairment of lung function. This study investigated selected parameters of lung function in the population of divers and candidates for professional divers. Fifty two male subjects were examined as part of the selection process. Basic spirometric tests: forced expiratory volume in 1 s (FEV1; dm(3)), forced vital capacity (FVC; dm(3)), forced expiratory flow in the range 25-75 % of FVC (FEF25-75; dm(3) s(-1)), and FEV1/FVC (%) were compared with compared with the predicted reference values estimated by the European Coal and Steel Community. The results demonstrate differences in FVC and FEF25-75 in divers, which may correspond to functional hyperinflation. The effects of 'large lungs' observed in divers, if persisting for an extended period of time, may lead to lung ventilation impairment of the obstructive type.

Decreased levels of PAI-1 and alpha 2-antiplasmin contribute to enhanced fibrinolytic activity in divers.

BACKGROUND: There are a number of reported cases of decompression sickness (DCS) with haemorrhages. These cases have not been sufficiently investigated and thus bleeding complications could not be directly correlated to the enhanced fibrinolysis. OBJECTIVES: The effect of hyperbaric exposition and decompression on the main components of fibrinolytic system has been measured. METHODS: Two groups of 25 male divers each were subjected to hyperbaric exposures to the pressure of either 400 kPa - group I - or 700 kPa - group II followed by a staged decompression. The divers were monitored for clinical symptoms of DCS and checked for Doppler-detected venous gas bubbles. Venous blood was drawn from divers before exposition and 15 min after decompression. The concentrations and activities of t-PA and PAI-1 as well as concentrations of PAP and alpha2-antiplasmin and activity of factor XIIa were measured. RESULTS: In all groups of divers no cases of DCS as well as detectable gas bubbles were noted. We observed elevated concentration of PAP, decreased concentration of alpha2-AP, decreased PAI-1 concentration and activity. There were no significant changes in factor XIIa activity as well as of t-PA concentration and activity. CONCLUSIONS: Hyperbaric exposition and decompression induce activation of fibrinolysis, even in the absence of detectable gas bubbles. Fibrinolytic activity increases mainly due to decrease of PAI-1 concentration and activity. Further clinical trials are necessary for the estimation of the importance of activation of fibrinolysis with decreased level of PAI-1 and alpha2-AP as a possible risk factor for bleeding in divers.