Candidaemia in polish hospitals - a multicentre survey.

Significant changes in the frequency of candidaemia and the distribution of causative species have been noted worldwide in the last two decades. In this study, we present the results of the first multicentre survey of fungaemia in Polish hospitals. A total of 302 candidaemia episodes in 294 patients were identified in 20 hospitals during a 2-year period. The highest number of infections was found in intensive care (30.8%) and surgical (29.5%) units, followed by haematological (15.9%), 'others' (19.2%) and neonatological (4.6%) units. Candida albicans was isolated from 50.96% of episodes; its prevalence was higher in intensive care unit and neonatology (61.22% and 73.33%, respectively), and significantly lower in haematology (22%; P < 0.001). The frequency of C. krusei and C. tropicalis was significantly higher (24% and 18%) in haematology (P < 0.02); whereas, the distribution of C. glabrata (14.1%) and C. parapsilosis (13.1%) did not possess statistically significant differences between compared departments. Obtained data indicates that species distribution of Candida blood isolates in Polish hospitals reflects worldwide trends, particularly a decrease in the prevalence of infections due to C. albicans.

Epidemiological Analysis of Extended-Spectrum ß-Lactamase-Producing Klebsiella pneumoniae Outbreak in a Neonatal Clinic in Poland.

Klebsiella pneumoniae is one of the most common etiological agents isolated from epidemic outbreaks in neonatal wards. We describe how an extended-spectrum ß-lactamase-producing K. pneumoniae (ESBL-KP) outbreak in a neonatal ward was extinguished. During the outbreak, which lasted over two months, 26 neonates were tested for K. pneumoniae, and 42 environmental swabs were taken. Drug susceptibility was determined for the isolated strains, and their virulence and phylogenetic similarity were checked. ESBL-KP colonization was confirmed in 18 neonates, and six were also confirmed to be infected. All strains isolated from patients represented one clonal type, K. pneumoniae. One strain isolated from an environmental source was determined to be a unique pulsed-field gel electrophoresis pattern. Gestational age and Apgar score were assessed as statistically significant for neonates with ESBL-KP infection. The epidemiological measures taken have been successful, and no further cases appeared. Immediate tightening of hospital hygiene rules, screening of all hospitalized neonates, and cohorting ESBL-KP-positive patients proved effective in controlling and ending the outbreak. The lack of ESBL-KP in the environment suggests that the outbreak was transmitted by colonized hospital staff. This theory could be confirmed by introducing mandatory screening for medical personnel.

Analysis of the prevalence of colistin resistance among clinical strains of Klebsiella pneumoniae.

INTRODUCTION AND OBJECTIVE: Klebsiella pneumoniae is an essential component of the human gut microflora. However, it can pose a threat by causing opportunistic infections, especially in hospitalised or immunocompromised patients. It is a serious problem for health medicine, primarily because of increasing resistance to previously used antibiotics. Infections with multidrug-resistant strains are difficult to treat, creating a challenge for clinicians. Also of growing concern is the increasing resistance to the drug of last resort - colistin (CL). The aim of the study is to determine the prevalence of resistance to CL among clinical K. pneumoniae strains. MATERIAL AND METHODS: The study was conducted on 200 clinical strains of K. pneumoniae. Drug susceptibility, production of resistance mechanisms, and determination of the minimum inhibitory concentration of CL were evaluated. RESULTS: Of all isolates, 73.0% produced carbapenemases, while the remainder produced an extended substrate spectrum - ß-lactamases (ESBLs). All strains showed a diverse antibiotic resistance profile. Resistance to CL was noted among 14.5% of carbapenemase-producing strains, particularly MBL and OXA-48. ESBL-positive strains showed full susceptibility to CL. CONCLUSIONS: Although a low rate of CL resistance was observed, this was true for strains simultaneously producing carbapenemases. Such strains should be under special epidemiological surveillance due to their potential to cause epidemic outbreaks. Monitoring the prevalence of clinical CL-resistant strains would allow for more effective counteraction against pathogens in various fields, including medicine, agriculture, veterinary medicine and industry.