Incidence, course, and outcome of Clostridium difficile infection in children with hematological malignancies or undergoing hematopoietic stem cell transplantation.

Clostridium difficile infection (CDI) is one of the most common causes of nosocomial infectious diarrhea in children during anticancer therapy or undergoing hematopoietic stem cell transplantation (HSCT) in Europe. Immunosuppression in these patients is a risk factor for CDI. Malignant diseases, age, acute graft-versus-host disease (aGVHD), HLA mismatch, or use of total body irradiation may play an important role in CDI course. The aim of this study was to evaluate the incidence, course, and outcome of CDI in children treated for malignancy or undergoing HSCT. Between 2012 and 2015, a total number of 1846 patients were treated for malignancy in Polish pediatric oncological centers (PHO group) and 342 underwent transplantation (HSCT group). In PHO group, episodes of CDI occurred in 210 patients (14%). The incidence of CDI was higher in patients with hematological malignancies in comparison to that with solid tumors. Patients with acute myeloblastic leukemia had shorter time to episode of CDI than those with acute lymphoblastic leukemia. Patients over 5 years and treated for acute leukemia had more severe clinical course of disease in PHO group. In HSCT group, CDI occurred in 29 (8%) patients. The incidence of CDI was higher in patients transplanted for acute leukemia. The recurrence rate was 14.7% in PHO and 20.7% in HSCT patients. CDI incidence was highest in patients with hematological malignancies. Most of patients experienced mild CDI. Age < 5 years and diagnosis other than acute leukemia were the positive prognostic factors influencing clinical CDI course.

Prevalence of healthcare-associated infections in Polish adult intensive care units: summary data from the ECDC European Point Prevalence Survey of Hospital-associated Infections and Antimicrobial Use in Poland 2012-2014.

BACKGROUND: Infection is a major cause of morbidity and mortality in intensive care units (ICUs) worldwide. Local epidemiological studies need to be conducted to set the priorities for surveillance and prevention programmes. AIM: To investigate the epidemiology of hospital-acquired infections (HAIs) among patients admitted to Polish adult ICUs over a three-year period. METHODS: Data were collected according to the European Centre for Disease Prevention and Control (ECDC) European Union Point Prevalence Survey of Healthcare-associated Infections and Antimicrobial Use in European Acute Care Hospitals (EU-PPS HAI & AU) protocol for 39,318 patients within 160 acute care hospitals. From this initial database, data for adult ICU patients (N=945) were filtered for further analyses. FINDINGS: HAIs were present in 370 patients (39%) and 430 HAI episodes were recorded. The most common HAIs were respiratory tract infections (45%), usually caused by Enterobacteriaceae and Gram-negative non-fermenters. The majority (87%) of these infections were likely to be device associated. Out of 61 cases of bloodstream infection, 51% were catheter associated. These bloodstream infections were mainly caused by coagulase-negative staphylococci. Among 57 cases of surgical site infection, 42% were classified as organ/space, 33% were classified as deep incisional, and 25% were classified as superficial. The predominant micro-organisms were Enterobacteriaceae and Staphylococcus aureus. Out of 50 cases of urinary tract infection, 96% were device associated. CONCLUSIONS: The prevalence of HAI among Polish adult ICU patients is higher than described in similar studies, but may be partially affected by methodological differences. The proportion of device-associated infections was very high, so there is an urgent need to introduce countrywide, targeted surveillance and prevention programmes.

Risk factors for healthcare-associated infection in light of two years of experience with the ECDC point prevalence survey of healthcare-associated infection and antimicrobial use in Poland.

BACKGROUND: Healthcare-associated infection (HAI) and antimicrobial resistance are two of the most important threats in contemporary medicine. The aim of this study was to evaluate independent risk factors associated with higher prevalence of HAI in a population of patients hospitalized in acute care hospitals in Poland. METHODS: This study was conducted in accordance with the protocol of the European Centre for Disease Prevention and Control (ECDC) point prevalence survey of HAI and antimicrobial use. Data for 16,598 patients were collected from 50 hospitals. Independent risk factors assessed included: hospital size and type; consumption of alcohol hand rub; isolation capacity; number of beds per full-time-equivalent (FTE) infection control doctor/nurse; sex; age; hospitalization specialty; exposure to invasive procedures; and McCabe score. FINDINGS: The highest prevalence of HAI was observed in large and teaching hospitals (6.7% and 7.4%, respectively), in children aged less than one (13.3%) and among males (7.2%). With regard to invasive procedures, the strongest association was observed for central venous catheterization (30.2%), intubation (41.6%) and urinary catheterization (17.5%). The highest prevalence of HAI was observed among patients in intensive care units (adult 39.8%, paediatric 30.8%). The lowest prevalence of HAI was observed in hospitals with one FTE infection control nurse per <200 beds (4.1%). CONCLUSION: A high prevalence of HAI combined with high exposure to risk factors among patients in paediatric and adult ICUs should result in the introduction of an HAI prevention programme across Poland.

Synthesis of microspheres of triuranium octaoxide by simultaneous water and nitrate extraction from ascorbate-uranyl sols.

A new method for synthesis of uranium oxide microspheres (diameter <100 µm) has been developed. It is a variant of our patented Complex Sol-Gel Process, which has been used to synthesize high-quality powders of a wide variety of complex oxides. Starting uranyl-nitrate-ascorbate sols were prepared by addition of ascorbic acid to uranyl nitrate hexahydrate solution and alkalizing by aqueous ammonium hydroxide and then emulsified in 2-ethylhexanol-1 containing 1v/o SPAN-80. Drops of emulsion were firstly gelled by extraction of water by the solvent. Destruction of the microspheres during thermal treatment, owing to highly reactive components in the gels, requires modification of the gelation step by Double Extraction Process-simultaneously extraction of water and nitrates using Primene JMT, which completely eliminates these problem. Final step was calcination in air of obtained microspheres of gels to triuranium octaoxide.

Serum concentration of vitamin D and parathyroid hormone after living kidney donation.

BACKGROUND: Metabolic consequences resulting from loss of renal mass in living kidney donors remain uncertain. There is recent focus on the changes in the active form of vitamin D because it is an agent for cancer regulation. The objective of the study was to measure serum concentrations of 1,25-dihydroxycholecalciferol, parathyroid hormone and insulin-like growth factor-1 (IGF-1) in living donors after kidney donation. PATIENTS AND METHODS: Forty living kidney donors reported for follow-up visits. Their mean age was 46.14 years. They were women in 52.5% of cases. The mean observation period was 65.6 months. Serum 1,25(OH)2D3 and IGF-1 concentrations were measured by radioimmunoassay after extraction. Serum intact parathyroid hormone (PTH) was quantified using an enhanced chemiluminescence immunoassay system. RESULTS: 1,25-dihydroxycholecalciferol deficiency in 57.5% patients after nephrectomy was the most important change we noted. No correlation was observed between 1,25(OH)2D3 and PTH. A decreased serum IGF-1 concentration was observed in 17.5% of donors. However, decreases in both serum IGF-1 and 1,25(OH)2D3 concentrations were observed in 12.5% of donors. CONCLUSION: Prospective studies may be essential to determine metabolic changes after nephrectomy among living kidney donors.