Four years of monitoring antibiotic resistance in microorganisms from bacteremic patients.

From the second semester of 2002 to the end of the first semester of 2005, a total of 2544 bacterial strains were isolated from the blood stream of patients with clinical sepsis and bacteremia hospitalized in six University Hospitals in the Slovak Republic. Almost 30% of strains were coagulase-negative staphylococci (CONS), about 14% were Staphylococcus aureus and, of the Gram-negative bacteria, up to 9% were Klebsiella pneumoniae. All CONS, S. aureus and Enterococcus spp. strains were found to be still susceptible to vancomycin, but the resistance of CONS and/or S. aureus to macrolides and fluoroquinolones dramatically increased during the period of this study. Among Gram-negative bacteria, increasing levels of resistance to higher generation cephalosporins, to fluoroquinolones resistance in Pseudomonas aeruginosa and Acinetobacter spp. to meropenem was recorded, which is alarming. The results were periodically submitted to cooperating hospitals with proposals for rationalizing the prophylactic and general use of indicated antibiotics as well as for improving hospital hygiene measures and anti-epidemic practices.

Monitoring of antibiotic resistance in bacterial isolates from bacteremic patients.

The aim of the study was to monitor the prevalence of pathogens and development of resistance in bacteria isolated from bacteremic patients. Five University Clinics and/or Regional Hospitals in the Slovak Republic participated in the study and a total of 421 isolates were collected in the second half of the year 2002. The most prevalent organisms were coagulase-negative staphylococci (CONS) (19%), Staphylococcus aureus (18.3%), among Gram-negative bacteria Escherichia coli (13.3%), Klebsiella pneumoniae (11.4%) and Pseudomonas aeruginosa (7.8%) followed by enterococci, Acinetobacter baumannii and Enterobacter sp. All CONS and S. aureus were susceptible to vancomycin; resistance to oxacillin was observed for 55% of the CONS and only for 4% of S. aureus isolates. A higher prevalence of resistance to erythromycin, clindamycin, gentamicin and ofloxacin was found in CONS in comparison to S. aureus. Enterococcus sp. isolates were fully susceptible to vancomycin and teicoplanin. Gentamicin, amoxicillin/clavulanate, third generation cephalosporins and ciprofloxacin showed good activity against E. coli. Although 17% of K. pneumoniae isolates were resistant to ciprofloxacin, it was the most effective drug against K. pneumoniae; the prevalence of resistance to other antibiotics was rather higher. Gentamicin and ciprofloxacin were the most active against Enterobacter sp. isolates and ceftazidime and meropenem against P. aeruginosa.

[Acute renal insufficiency after the administration of tetracycline and gentamycin]. / Akútna renálna insuficiencia po podávaní tetracyklínu a gentamicínu.

The clinical course of eight case reports of patients with acute renal failure after administration of nephrotoxic antibiotics--specially of tetracycline and gentamycin--is demonstrated. All patients were suffering on preexisting nephropathy, many of them in stage of chronic renal failure according to various etiopathogenesis. As concomitant factor inducing acute renal failure together with antibiotics are: elderly, hepatopathy, surgical interventions, administration of other nephrotoxic drugs. In 6 patients, where acute renal failure induced by nonreducted doses of antibiotics appeared, the treatment was successful, in five cases due to short term haemodialysis, once conservatively with diuretics and volume diuresis. Two patients died before the therapeutic measures and dialysis could be performed. Algorithms in diagnosis and treatment of chronic renal failure--patients where antibiotic treatment is necessary are discussed.

Are results of immunosuppressive therapy influenced by immunogenetic markers?

A group of 157 children, 4-15 years old, suffering from various forms of glomerulonephritis were investigated. Associations between the HLA system and the clinical, morphological and therapeutic responses were looked for. The study revealed the following associations: chronic GN to B15 and B18; Schönlein-Henoch GN to B27, Bw35 and Bw40; focal GN to B18; mesangioproliferative GN to B27; susceptibility to corticosteroids to B18; resistance to corticosteroids to B15.