[Serious sepsis treatment in intensive care departments in the Czech Republic -  EPOSS Project pilot results]. / Lécba tezké sepse na pracovistích intenzivní péce v Ceské republice -  pilotní výsledky projektu EPOSS.

INTRODUCTION: Severe sepsis is still associated with significant morbidity and mortality, which is however different, as well as its management, depending on the region. What is the situation in the Czech Republic and what is the character of patients with severe sepsis is currently not known. The aim of the project is to describe the processes of care, outcome and characteristics of patients with severe sepsis admitted to the intensive care department of the Czech Republic. METHODS: This is a multicentre and observational project with retrospective enrollment of patients who meet the criteria for severe sepsis before or within 24 hours after admission to selected intensive care units (ICU EPOSS). RESULTS: 394 patients were analyzed. Median age at admission was 66 (56- 76) years, males predominated (58.9%) and the median APACHE II score on admission was 25 (19- 32). Patients were predominantly medical (56.9%) and most were secondary admitted from other ICU (53.6%). Meeting the criteria of severe sepsis was most frequently within the period (± 4 hours) of admission the EPOSS ICU (77.6%). Median total fluid intake during the first 24 hours was 6,680 (4,840- 9,450) ml. Most patients required mechanical ventilation (58.4%). Compliance with the resuscitation bundle of severe sepsis in our group was very good and was associated with lower mortality of patients. Most frequently, the EPOSS ICU length of stay (LOS) was 7 (3- 15) days and median hospital LOS was 13 (8- 28) days. Hospital mortality in our cohort was 35.8%. CONCLUSION: Introducing the project, which in its first stage obtained valuable and internationally comparable data about patients with severe sepsis admitted to the involved ICU in the Czech Republic.

R plasmids in enterobacteriaceae from the hospital environment.

R plasmids have been demonstrated in several group of strains of enterobacteriaceae from hospital environment. R + enteropathogenic strains of Escherichia coli were isolated from several items of baby-care as well as from the pre-prepared baby food in a newborn unit. Strains from environmental samples are thought to be identical with those causing nosocomial gastroenteritis of babies. From hospital waste waters of another larger country hospital we could isolate R + strains of Salmonella typhimurium and R + protei, both associated with occurence of gastrointestinal or urological hospital infections. R-factor-carrying strains of E. coli have been isolated also from surface water samples from the area surrounding the hospital monitored.

Potential producers of aflatoxin in working environment.

It has been investigated the amount of the viable germs of A. flavus in the environment of the food-stuff establishment, where peanuts and hazel nuts, almonds, crushed coconuts, tea and other food-stuffs, imported from tropical and subtropical countries, were processed and packed. In the air of the store-hall have occurred the most 3.73 x 10(2) and in the air of the working-halls, where they were manipulating with food-stuffs - the most 6.2 x 10(3) germs of A. flavus/m3. From the samples of the sedimented dust were isolated at least 0.4 x 10(1), the most 1.3 x 10(4) colonies of A. flavus/g. From 57 investigated strains produced aflatoxin B1 64.9%. The authors are discussing about a professional risk for the workers of some establishments during the manipulation with food-stuffs or feeds, which are contaminated with germs of toxinogenic moulds and with mycotoxins.