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.

[Effective treatment of recurrent infective endocarditis. Is it always in compliance with the guidelines?]. / Skuteczne leczenie nawracajacego infekcyjnego zapalenia wsierdzia. Czy zawsze zgodnie ze standardami?

We present a case of recurrent infective endocarditis (IE) in a 36-year-old man, localised on native congenital bicuspid aortic valve and an acquired membranous ventricular septal defect with vegetations extending to the right ventricle. Patient was successfully treated with standard therapy for IE due to staphylococci MSSA followed by aortic valve replacement and closure of ventricular septal defect.

[Diagnostic significance of tuberculin skin test in BCG vaccinated population]. / Znaczenie diagnostyczne próby tuberkulinowej w populacji szczepionej BCG.

UNLABELLED: There is some data on the influence of the BCG vaccination on the TST (tuberculin skin test) but most of them are focused on the population vaccinated only one time. The aim of the study was to describe the relation between vaccination scheme and TST in polish population. MATERIAL AND METHODS: TST was performed in 114 patient with active, culture confirmed tuberculosis and 100 medical student at the beginning of the study as a control group. RESULTS: In our investigation there was no statistically important differences of the TST size between Tb patients and control group. CONCLUSION: In polish population it is not possible to estimate the cutoff value of TST size that could be used to differentiate between TB infection and reaction to vaccination.

Hospital antibiotic management in Poland--results of the ABS maturity survey of the ABS International group.

BACKGROUND: The increasing incidence of antibiotic resistance is a serious worldwide problem, as underlined by European Union documents. The project ABS International has been appointed to identify strengths and weaknesses of hospitals with regard to issues related to antibiotic policy. METHODS: The questionnaire "ABS hospital mature" was developed within the study to analyze the ABS-related maturities in nine member states of the EU. Several fields of antibiotic strategy in hospitals were explored. In Poland the questionnaire was sent to over 100 hospitals and the responses were delivered to the National Medicines Institute (the project representative in Poland) via the internet. MAIN FINDINGS: The hospitals involved represented three referral levels according to services provided. Within the hospital, the questionnaire was filled out by a microbiologist or an infectious disease specialist. Within the examined fields there were no serious differences between the referral levels. Microbial diagnostics obtained the highest score, whereas "antibiotic-related relationships" and "antibiotic-related personnel development" ranked lowest. Maturity in the field of the antibiotic strategy differs among Polish hospitals. The highest score in the general assessment was assigned to hospitals at secondary referral level. Knowledge on issues of antibiotic resistance and microbiological services and procedures obtained the highest score but its implementation was not sufficient. CONCLUSIONS: Results suggest a need to increase the number of specialists in antibiotic usage and policy, and to improve collaboration within and between hospitals.

Use of ECDC PPS HAI&AU data to evaluate adherence to national guidelines for antimicrobial treatment of community-­acquired pneumonia

INTRODUCTION    Point prevalence surveys are widely described as a useful tool for evaluating antimicrobial policy and adherence to guidelines. OBJECTIVES    We aimed to investigate if data from the European Centre for Disease Prevention and Control (ECDC) point prevalence survey of healthcare­associated infections and antimicrobial use (PPS HAI&AU) canbe used to evaluate adherence to national guidelines for the treatment of community­acquired pneumonia (CAP) and to analyze the quality of treatment regimens. PATIENTS AND METHODS    Data for 72 698 patients were collected in Poland between the years 2012 and 2015 according to the ECDC Protocol v.4.2. CAP was an indication for antimicrobial treatment in 3608patients. Patients hospitalized longer than 48 hours were excluded. A total of 667 patients met the inclusion criteria, and 79 regimens were recorded and evaluated as concordant or discordant with the guidelines. Afterwards, 7 experts scored the regimens from 1 to 5. The averages were calculated, and the results below 3.0 were considered as not optimal and those of 3.0 or higher-as optimal. Coherence of the experts' scores was evaluated. RESULTS    Of all patients, 153 (22.8%) were treated exactly according to the guidelines. Nineteen regimens (24.0%) were optimal but discordant with the guidelines; they were administered to 346 patients (51.9%). The remaining 50 regimens (63.3%) were evaluated as discordant and not optimal and were used in 169 patients(25.3%). The correlation results of the experts' scores were significant. CONCLUSIONS    ECDC PPS HAI&AU data can be efficiently used to assess adherence to guidelines. Despite low adherence (22.8%), almost 75% of patients received optimal antimicrobial treatments. Actions promoting the guidelines and time­series studies analyzing improvement of adherence should be considered.

New selective and differential chromogenic agar medium, chromID VRE, for screening vancomycin-resistant Enterococcus species.

This study aimed to evaluate the usefulness of a novel differential culture medium, chromID VRE agar, for the isolation of VRE in a clinical laboratory. It was shown that ChromID VRE agar may be useful for rapid and selective isolation of VRE especially after inclusion of broth enrichment step.

The effect of an antibiotic policy on the control of vancomycin-resistant enterococci outbreak and on the resistance patterns of bacteria isolated from the blood of patients in a hematology unit.

INTRODUCTION: Antibiotic resistance has become one of the main medical problems worldwide. This is mainly due to an overuse and misuse of antibiotics. OBJECTIVES: The aim of the study was to assess the effect of an antibiotic policy and enhanced infection control on the occurrence of epidemic strains of vancomycin-resistant enterococci (VRE) and resistance patterns of bacteria isolated from the blood of patients hospitalized in two departments of a hematology center in Poland. PATIENTS AND METHODS: Antibiotic use was calculated in daily defined doses (DDD) per 100 patient-days during the two 5-month periods, before and after the introduction of the policy. Infection control measures included a 1-week screening for VRE rectal carriage and contact isolation. RESULTS: Antibiotic consumption decreased from 82.1 to 57.3 DDD per 100 patient-days, mainly because of a decrease in the use of co-trimoxazole, other antimicrobials active against anaerobes, and cephalosporins. A significant change in antibiotic resistance patterns was observed and in vitro efficacy of antibiotics against bacteria isolated from the blood increased remarkably. We managed to eradicate the outbreak of VRE. CONCLUSIONS: The introduction of antibiotic policy and enhanced infection control measures may prove efficacious in VRE control.