Characterization of Salmonella enterica serotype typhimurium in the Czech Republic: phage types, antimicrobial and plasmid profiles.

In this study a collection of 547 S. Typhimurium strains isolated in the years 2000 and 2001 both of the human and non-human origin were analysed. 21 different phage types were detected, the most frequent one was DT104 (46%) followed by DT141 (28%) and DT68 (3%). Resistance to one or more antimicrobial agents was found mainly in DT104 (77.4%). S. Typhimurium isolates resistant to 5 and more antimicrobial agents were found in three phagetypes DT104 (57%), DT120 and DT155. Plasmid profiling of DT104 isolates showed 10 different profiles. Pattern A found in 30.5% of tested strains was predominant and carried serovar specific plasmid and one additional small plasmid of approx. 2.5 kb.

[Multiresistant Salmonella enterica subspecies enterica serovar Typhimurium DT104 in the Czech republic 2000-2001]. / Multirezistentní Salmonella enterica subspecies enterica serovar Typhimurium DT104 v Ceské republice v letech 2000 a 2001.

Salmonelloses belong to the most important alimentary diseases. From 1989 the main source of infection is S. Enteritidis (95% and more). The ratio of S. Typhimurium in the etiology declined gradually since 1994 from 3% in 1993 to 1.9% in 2001. The number of detected multiresistant strains STM DT104 is so far low in the Czech Republic. In 2000 laboratory tests confirmed 53 and in 2001 a total of 63 strains. Analysis of these strains revealed: 1. the proportion of multiresistant strains STM DT104 of the total number of isolated STM strains increased from 7% in 2000 to 11.5% in 2001, 2. the territory in the CR where these multiresistant strains were found expanded, 3. the relationship of proportions of the most frequently detected STM phagotypes in the human population changes: in 2000 this ratio was balanced, in 2001 the ratio of phagotype DT104 is roughly three times higher than of DT 141, 4. analysis of all STM strains from the environment and animals indicates that the frequency of STM DT104 is 73%. Almost 90% of these strains are multiresistant (resistant to one or several antimicrobial substances). The highest number was found in calves, piglets but also in poultry. With regard to the results of the submitted work it is important to concentrate attention on detection and further laboratory examination of STM strains in the human and animal population.

The 2001 serological survey in the Czech Republic--viral hepatitis.

Within serological surveys 2001, prevalence of markers of hepatitis viruses A (anti-HAV), B (anti-HBc, HBsAg, anti-HBs) and for the first time also C (anti-HCV) was investigated. Sera were collected in 2001 and tested by respective kits AxSYM, Abbott. HAV: 2,623 sera were tested for the presence of anti-HAV antibodies. Comparison with serological surveys of 1984 and 1996 revealed again shifts of the age prevalence curve for anti-HAV antibodies towards higher age groups corresponding to time intervals between epidemiological surveys. High prevalence rates of anti-HAV antibodies (more than 20%) were only found for the population age groups who lived in the period of high incidence of VHA, i.e. up to 1965. The prevalence of anti-HAV antibodies increased by about 5-10% in the population under 20 years of age, the increase being significant and assumingly attributable to vaccination against VHA, and remained the same as in 1996 in the age group 20-29 years. HBV: 2,568 sera were tested for the presence of anti-HBc antibodies and 76 reactive specimens were further tested for the presence of HBsAg and anti-HBs antibodies. The prevalence of anti-HBc antibodies continuously increases with age. The total prevalence of anti-HBc antibodies calculated for the Czech population is 5.59% compared to 6.95% recorded in 1996. The calculated prevalence rate of HBsAg is 0.56% and that of anti-HBs antibodies is 3.99% for the non-vaccinee population. HCV: The prevalence rate of anti-HCV antibodies was 0.2% with 6 out of 2,950 sera testing positive. Age dependence could not be assessed because of the small number of positive persons. HCV infection is known to afflict high-risk groups, likely to escape a general serological survey, rather than the normal population.

[Incidence of S. typhimurium in the Czech Republic 1999-2001]. / Výskyt S. typhimurium v CR v letech 1999-2001.

The ratio of serovars of S. Typhimurium among notified cases of salmonelloses in 1999-2001 did not exceed 3% and so far has a slightly declining trend. On a long-term basis the highest morbidity rate caused by this agent is reported in the South Moravian region. The age distribution and specific morbidity is highest in 1-4-year-old children, the seasonal incidence is highest, in the summer months. The most frequently suspected vehicles are eggs, poultry and meat products, in 1999 for the first time as a vehicle a grilled piglet was reported, in a total of three epidemics. Epidemiological analysis of salmonelloses caused by S. Typhimurium revealed that in the CR individual characteristics do not differ from those caused by S. Enteritidis and that the epidemiological situation as regards this serovar is, so far quiescent.

[Salmonelloses in the Czech Republic 1989-1998]. / Salmonelózy v Ceské republice v letech 1989-1998.

In the Czech Republic in 1989 a triple increase of the incidence of salmonelloses was recorded: 34,435 cases. Since that year the morbidity trend varies between 400 and 500 cases per 100,000 population. The dominating agent (95% and more) is Salmonella Enteritidis PT8. The epidemic incidence was recorded on the whole territory of the Czech Republic mainly in Moravia and in the East Bohemian region. The specific morbidity is highest in 0 and 1-4 year-old children. The seasonal incidence has two peaks with the exception of 1997. During the period between 1989 and 1996 there was a significant increase of epidemics of salmonellosis in conjunction with food production incl. private confectionery shops, restaurants and the sale of foods in the streets. The most important vehicle are eggs and egg products, in particular confectionery. Salmonella Typhimurium DT104 is found only rarely in the Czech Republic. The first epidemic (15 cases) developed in 1998.

[Properties of Salmonella isolates in the Czech Republic]. / Vlastnosti salmonelových izolátu v Ceské republice.

Based on a grant project "Use and importance of epidemiological markers in Salmonella enteritidis and Salmonella typhimurium in the spread of salmonelloses in children under two years of age" implemented in 1995 to 1997, the authors investigated epidemiological markers in 1,186 salmonella isolates; the strains were isolated from faeces of 838 sick children, from 266 faeces of their contacts, from 49 specimens of incriminated foods and from 33 smears from the children's environment. Of 1,186 Salmonella isolates 999 were strains of S. enteritidis, 39 strains of S. typhimurium and 148 strains were not identified. The markers of Salmonella isolates were investigated from the aspect of biotyping--98% S. enteritidis were formed by the biovar Jena. 2% by biovar Essen; sensitivity to antibiotics--94.5% Salmonella strains were sensitive to 12 selected antibiotics, 2.9% were resistant and in 2.6% the resistance was in the intermediate zone; phagotyping--in 808 strains of S. enteritidis PT 8--88% predominated, in S. typhimurium DT 104 and DT 141; assessment of plasmid profiles--in strains of S. enteritidis plasmid 55 kb predominated, in three strains of S. typhimurium a plasmid size 95 kb; virulence--was compared in 43 strains isolated from hospitalized children with a severe clinical course with 39 strains from children treated at home. In vitro tests revealed that hospitalization of affected children was associated with virulence of the strains (SE phagotype 8) and not with age. The presented results are discussed with regard to the epidemiological situation in the Czech Republic and in the world.

[Salmonellosis in children under 2 years of age]. / Salmonelózy u detí do dvou let veku.

The authors pay attention to the mode of transmission of salmonelloses in children under two years of age, where the highest specific morbidity was recorded. Using phenotypic (biochemical properties, sensitivity to antibiotics, phagotype) and genotypic properties (presence of plasmids) they examine five sporadic and seven epidemic incidences of salmonelloses in young children. The most frequent agent is Salmonella enteritidis, phagotype 8, plasmid 55 kb. Strains of S. enteritidis are isolated from the faeces of affected children, their family contacts, from food and the sick child's environment. Alimentary transmission by the incriminated food was detected from epidemic incidence where the vehicle were confectionery products contaminated by S. enteritidis. In sporadic cases in families also direct and indirect contact may have participated in the transmission of infection.

[Incidence of sepsis in the Czech Republic. Analysis of mortality in 1993]. / Výskyt sepsí Ceské Republice. (Analýza úmrtí na sepsi v roce 1993).

Sepsis holds the second place on the list of deaths from infectious diseases. Epidemiological data on the morbidity from sepsis are inadequate. The basis of the submitted paper are data from the Czech Statistical Office on subjects who died of sepsis, death certificates and health records. The analysis of assembled data pertains to 85 subjects who died from sepsis in 1993 and is concerned with the age distribution of the deceased, the distribution by gender, type of hospital department, where death occurred, and the diagnosis made on admission. A group of 32 subjects who developed a septic focus during hospitalization (group of nosocomial sepses) was investigated further: 10 developed a decubital sepsis (31%), 3 a diabetic sepsis and 5 urosepsis. As to risk factors, in addition to ATB therapy the following dominated: repeated hospitalizations, the development of infectious decubiti, infusions and venous and urinary catheters. A haemoculture was examined in 9 (28%), 4 times Gram-positive cocci were detected, 5 times Gram-negative rods. Antibiotics were prescribed to two-thirds of the affected patients: gentamicin in 35%, ampicillin in 34%, PNC in 13%, cefotaxime in 12% of the affected subjects.

Lucilia sericata (Diptera: Calliphoridae) causing hospital-acquired myiasis of a traumatic wound.

A case of traumatic nosocomial myiasis caused by the green bottle fly Lucilia sericata (Meigen, 1826) occurred in a patient hospitalized following a serious road traffic accident. The patient had suffered extensive polytrauma particularly in the facial area of the skull. A total of 50 larvae was discovered in the oral cavity, nose, paranasal sinuses and enucleated eye-socket. Projected timing indicated that the eggs were laid while the patient was hospitalized. The development of myiasis was facilitated by the mental and physical debility and dependency of the patient, numerous and deep facial necrotic wounds and a lengthy period of hot weather which led to prolonged open window ventilation of his room.

[Salmonellosis in the Czech Republic 1989-1993]. / Salmonelózy v Ceské republice v letech 1989-1993.

The authors discuss the incidence of salmonelloses in the Czech Republic and analyze changes which developed during the period from 1989 to 1993. In 1989 a steep rise of cases of salmonellosis was recorded; 34,435 cases were notified which, as compared with the previous period, is a threefold rise of the incidence. This trend persists already for five years. So far the largest number of notified cases (43,558) was recorded in 1992. The death rate and case fatality rate from salmonellosis has been low for some years: the number of deaths is approximately 20-25 people per year. The salmonellosis epidemic in 1989-1993 spread to all regions of the Czech Republic. The most heavily affected regions are the South Moravian, North Moravian, East Bohemian and West Bohemian region. As to age distribution, it was revealed that the highest values of specific morbidity are in children in their first year of life and in 1-4-year-olds and that the greatest increment in 1989-1993 was notified in 1-4-year-old and in 5-9-year-old children. The dominating aetiological agent was Salmonella enteritidis, probably phagotype 8. Its ratio in the isolation of Salmonella strains is 87%. The largest number of epidemics in 1989-1991 was notified in communities with a communal catering type (workers canteens, catering for nursery schools and schools) and in communities where half the epidemics developed during family festivities (weddings, graduation, funerals, birthdays, pig-slaughtering feasts etc.). During the last two years the number of epidemics which develop in workshops producing foods and in private confectionaries is rising.(ABSTRACT TRUNCATED AT 250 WORDS)

[Salmonellosis in the Czech Republic]. / Salmonelózy v Ceské Republice.

The submitted paper analyzes the treble increase of the annual incidence of salmonelloses in the Czech Republic in 1989-1991. It deals with the seasonal distribution of notified morbidity (it is highest in August, September, October), the age distribution (it is highest in 0-4-year-old children) and the geographical distribution (the most affected areas are the eastern Bohemian, southern Moravian and northern Moravian regions). The authors emphasize the high ratio of S. enteritidis in this rise (the ratio of S. E. increased from 55% in 1988 to 84% in 1991). They analyze the notified mass incidence of salmonelloses, where one third is accounted for by catering establishments of the so-called closed type; in 1989-1991 the highest ratio of salmonelloses was in works canteens. The authors confirm that the epidemic rise of salmonelloses in 1989-1991 is associated with the consumption of contaminated eggs, similarly as in other parts of the world. The most frequent vehicle of infection revealed in the Czech Republic are eggs, their products, in 1991 in particular confectionery and fancy cakes.

[Use of markers of hospital strains in studying the occurrence of nosocomial infections]. / Vyuzití markeru nemocnicních kmenu pri sledování výskytu nozokomiálních nákaz.

The submitted paper deals with one of the possible aspects of the investigation of nosocomial infections, i.e. investigations of the properties of hospital strains, their importance and possible use. The incidence of bacterial hospital strains was investigated in a surgical department of a district hospital of the North Bohemian region in October 1990; at the time of the survey 29 nosocomial infections (36.1%) were revealed by the prevalence method. Bacterial hospital strains were isolated from patients with a nosocomial infection, from the attending staff and the hospital environment. The following markers were investigated: biotyping, phagotyping, serotyping, toxin production, sensitivity to antimicrobial substances and sensitivity to disinfectants. Based on results of marking of hospital strains 7 incidences with a possible epidemiological association were detected where the hospital strain of equal or very similar properties dominated. The results of the investigation confirmed the important participation of the attending staff in the spread of nosocomial infections, in particular via contaminated hands, and drew attention to shortcomings as regards adherence to the hygienic and epidemiological regime in the investigated department.

[Bacterial contamination of arthropods in a health facility]. / Bakteriální kontaminace clenovcu ve zdravotnickém zarízení.

At 55 sites of a health institution in July and September 1990 a total of 161 specimens of arthropods were detected, 30 outdoors and 131 on the premises of the health institution. On their bodies 116 bacterial strains were isolated, mostly Gram-negative rods (more than 85%), in particular spp. Enterobacter, Acinetobacter, Klebsiella, Citrobacter and Pseudomonas. Gram-positive cocci accounted for cca 12%, in particular strains of S. haemolyticus and S. hominis. The greatest number of strains was detected on bodies of cockroaches, flies, Chironomus and Tenebrio. In about one third of strains the diffuse disk test revealed resistance to more than three antibiotics. The investigation was supplemented by microbiological examination of strains from a hospital environment (45 smears) and strains from biological material (82 specimens), from patients with nosocomial infections.

Epidemiological role of arthropods detectable in health facilities.

A total of 161 arthropod specimens were collected from 55 sites in a health care facility during July and September 1990. Of the 116 bacterial isolates obtained from their body surfaces 6% were from parasites (mosquitoes), 59% from eusynanthropic arthropods (Tenebrionid beetles, flies, German cockroaches, wasps), 16% from hemisynanthropic arthropods (ants, spiders) and 19% from occasionally encountered insects (non-biting midges, moths, beetles). Most (88%) of the isolated bacteria were Gram-negative rods of the species E. coli, Enterobacter, Klebsiella, Citrobacter, Proteus, Serratia, Pseudomonas and Acinetobacter. Gram-positive cocci accounted for 13% of isolates and were primarily represented by coagulase-negative staphylococci. The highest isolation rates were from body surfaces of flies, German cockroaches, non-biting midges (Chironomids) and Tenebrionid beetles. About one third of all isolates were resistant to more than three antimicrobials using a standard disc diffusion assay. The presence of multiple resistance to antibiotics was observed in two thirds of Enterobacter isolates, namely those of Enterobacter cloacae from the body surface of Germany cockroaches, in 13% of Citrobacter spp and in 8% of Klebsiella spp as well as Acinetobacter calcoaceticus strains. Strains of Morganella and Hafnia species were very infrequent but all of them shared resistance to the antibiotics tested. In contrast, strains of Serratia spp were relatively antibiotic-sensitive. The group of isolated Gram-positive organisms was represented by two strains of Staphylococcus hominis and one strain of Enterococcus sp, all of them were multiply-resistant to antimicrobials.

Arthropods in a hospital and their potential significance in the epidemiology of hospital infections.

Synanthropic and other arthropods were collected and examined for microbes in the summer seasons of 1988 and 1990. The collection was performed in a Prague hospital with departments situated in separate buildings, each surrounded by a park. In 1988, the most attention was given to flies (35 species collected) found outside between the buildings. In 1990, all arthropods found inside the buildings (particularly in the departments of dermatology and urology) were studied. A total of 30 taxons were identified. The microbes found on the bodies of arthropods were isolated in both seasons. In 1990, the hospital environment and biological material from patients (urine, pus) were also examined for the presence of microbes. Altogether 108 strains (21 species) and 116 strains (25 species) were isolated from the arthropods' bodies in 1988 and 1990, respectively. The ecological characterization of the arthropods and results of microbiological studies show that synanthropic arthropods play a significant role in the epidemiology of hospital infections.

[Panophthalmitis as a nosocomial infection]. / Panophtalmitida jako nosokomiální nákaza.

The submitted paper deals with an epidemic of severe postoperative panophthalmitis, its development, course, causes and sequelae incl. epidemiological characteristics. The disease developed in four patients 40 hours after operation of cataract. Despite treatment all four patients developed septicaemia and therefore the affected eyeballs were eviscerated. From smears of the conjunctival sac of the affected patients and from the contents of the eviscerated eyeball Proteus mirabilis and Enterobacter cloaceae were cultivated. The authors draw attention to the epidemiological association with the eye lotion BSS which was used from which Proteus mirabilis and E. coli were cultivated and with the Ringer solution from which Enterobacter cloaceae and Klebsiella pneumoniae were cultivated. An epidemiological analysis of the epidemic was made and provisions were defined to rule out its recurrence.

[Epidemic occurrence of alimentary bacterial infections in the Czech Republic 1979-1989]. / Epidemický výskyt alimentárních nákaz bakteriálního puvodu v Ceské Republice v letech 1979-1989.

The authors analyze the epidemic incidence of alimentary infections of bacterial origin in two periods: 1979-1983 and 1984-1988 and 1989 resp., where in each period the number of notified epidemics of different infections equals 100%. During the period 1984-1988 as compared with 1979-1983, there was a decline in the number of epidemics of salmonelloses in health institutions from 42% to 14%, whereby almost half these epidemics were caused by Salmonella agona spread via dried milk. Conversely there was an increase in the number of epidemics of salmonelloses in communities from 14% to 23% and in works canteens from 9% to 14%. In 68% of the latter Salmonella enteritidis dominated. In 1989 there was a potent increase epidemics of salmonelloses. In 86% of the notified epidemics Salmonella enteritidis was the aetiological agent. A quarter of these epidemics developed in works canteens and half the affected subjects were ill. The transmission occurred via poultry meat and egg products. The annual incidence of bacillary dysentery after 1985 has a declining trend, the epidemics persist in nursery schools, summer camps for children and are increasing in institutes for social care. The number of alimentary intoxications is rising in recent years, in particular in school and works canteens. The number of 008 epidemics in 1984-1988 declined in health institutions from 52% to 20%. 17% of the epidemics developed in schools and camps for children.

Prevalence of nosocomial infections in general surgery, orthopedic surgery and urological departments in the Czech Republic.

Two prevalence studies of Nosocomial Infections carried out in 1987 (based on 4479 patients in 64 general surgery departments and 1603 patients in 29 orthopedic surgery departments) and in 1988 (based on 1263 patients in 32 urological departments) are summarized. The prevalence rate of nosocomial infections (NI) in general surgery departments was 14.0%, in orthopedic surgery departments 8.0% and in urological departments 20.9%. The highest degree of risk of acquiring NI was run by patients above 60 years of age in urological and general surgery departments. Surgical wound infections in departments of general surgery accounted for 60%, in orthopedic surgery departments for 47% and in urological departments for 37% of all NI. The prevalence of wound infections amongst general surgical patients was 8.4%, amongst orthopedic surgical patients 3.8% and in urological patients 7.7%. The prevalence of urinary tract infections in general surgery departments was 14.4%, in orthopedic surgery departments 18.6% and in urological departments 51.6%. The problems discussed include the role of intrinsic and in-hospital risk factors and the involvement of pathogens responsible for the onset of NI.

[Botulism in the Czech Republic]. / Botulismus v Ceské republice.

In a retrospective study the authors analyzed 76 cases of botulism reported in 1961-1989 in the Czech Republic. The analysis of descriptive data pertained to the annual incidence of botulism with a maximum of cases in 1966, 1973 and 1984 (11, 7 and 6 cases); geographical distribution with a maximum incidence in the South and Central Bohemian region (100,000 population); age distribution with a predominance in subjects above 15 years. The dominating vehicle of botulism was in 61% of the notified cases a home-prepared food; usually a galantine, aspic, liver paste, pork with vegetables, and smoked pork. In 1966 and 1973 a processed food predominated as vehicle: pickled herring and tomato, red peppers and sausage. The results of the retrospective study were compared in the discussion with the problem of botulism in other countries. The authors discuss the danger of undetected botulism and the necessity of an anti-botulin serum (Bossea).