Issue 2, 2018
Integrase inhibitors – neuropsychiatric tolerability
Zakażenia XXI wieku. 2018;1(2):51–58.
Integrase strand transfer inhibitors (INSTIs) are recommended components of initial antiretroviral therapy with two nucleoside reverse transcriptase inhibitors. Overall, INSTIs are well tolerated but headache and insomnia were the most frequently reported adverse events. Currently, the data have suggested potential differences betweenclinical trials and cohort studies in “real-life”. In this paper we described the rates of frequency and reasons for discontinuation of raltegravir,elvitegravir and dolutegravir-based regimen, in a few large cohorts of HIV-infected patients. The most common reason for discontinuation was neuropsychiatric symptoms, defined as INSTIs adverse effects. Clinical manifestationsreported at drug discontinuation were insomnia, dizziness, headache,anxiety, and rare – depression, psychosis and suicidal ideas. Neuropsychiatric toxicity leading to discontinuation was more frequent with dolutegraviras compared to other INSTIs. Discontinuations due to neuropsychiatric reason are less common among patients treated with elvitegravir. Increasing age is associated with higher incidence of neuropsychiatric disorders and with increased plasma exposure to some drugs, so older age isan independent factor associated with a higher risk of discontinuation of integrase inhibitors due to adverse effects.
Liposomal amphotericin B – putative mechanism of entry into fungal cells
Beata Sulik-Tyszka, Marta Wróblewska
Zakażenia XXI wieku. 2018;1(2):59–65.
Amphotericin B is characterised by a broad spectrum of antifungal activity and continues to constitute a gold standard in the therapy of invasive fungal infections of diverse etiology. However, this drug is characterized by nephrotoxicity, which restricts its clinical use within certain groups of patients. At present three lipid formulations of amphotericin B are available, of which the liposomal form shows the lowest visceral organ toxicity. In this product amphotericin B deoxycholate is inserted in the liposomal molecules. Slow release of amphotericin B from the liposomes significantly reduces the risk of toxicity. Liposomal amphotericin B is indicated in the treatment of severe systemic and/or deep mycoses as well as in the empirical treatment of presumed fungal infection in febrile neutropenic patients if fever persists despite administration of a broad-spectrum antibiotic therapy and if laboratory tests did not reveal the bacterial or viral etiology of infection. Liposomal amphotericin B is effective in the therapy of disseminated candidiasis, aspergillosis, mucormycosis, and cryptococcal meningitis. This drug should not be used to treat the common clinically inapparent forms of fungal disease which show positive skin or serologic tests only. Another indication for the use of liposomal amphotericin B is visceral leishmaniasis (however this indication has not been registered in Poland). Newest research shows that intact liposomes enter the fungal cells thanks to the viscoelastic properties of the fungal cell wall. This mechanism enables large liposomal molecules to pass the fungal cell wall despite their size exceeding the pore size.
The role of tenofovir alafenamide (TAF) in treatment of HBV infection
Zakażenia XXI wieku 2018;1(2):67–72.
Tenofovir alafenamide (TAF) is a newly registered prodrug derivative of tenofovir diphosphate, a nucleotide analog acting by inhibiting HBV DNA transcription (by a mechanism called chain termination). Main advantages include significantly lower serum concentration of the active form of tenofovir diphosphate after oral administration, resulting from greater stability and half-life of TAF. This effect, combined with accelerated hepatocyte uptake strongly improves drug’s safety profile. Being safer with similar efficacy to currently used tenofovir fumarate, the advantage of tenofovir alafenamide is particularly significant in elderly patients or those with concomitant inflammatory or metabolic disorders (diabetes, kidney disease, osteoporosis), as well as in patients receiving many other medications potentially affecting the course of the diseases mentioned. In this study, we summarized preclinical and clinical reports on the efficacy and safety of TAF as well as its role in modern treatment of chronic hepatitis B.
Lekooporność oraz potencjał biofilmotwórczy szczepów z grupy gronkowców koagulazoujemnych izolowanych z powierzchni dotykowych oddziałów szpitalnych
Antimicrobial resistance and ability to form biofilm of coagulase-negative staphylococci isolated from touch surfaces in Polish hospital wards
Małgorzata Bulanda, Edyta Synowiec, Agnieszka Chmielarczyk, Dorota Romaniszyn, Anna Różańska
Zakażenia XXI wieku. 2018;1(2):73–78.
The study presents results from drug resistance and biofilm-forming potential testing for coagulase-negative staphylococcal strains isolated from hospital touch surfaces. Among the 46 isolates tested, representatives of the following species were identified: Staphylococcus epidermidis, Staphylococcus haemolyticus, Staphylococcus hominis, Staphylococcus warneri, Staphylococcus capitis, Staphylococcus simulans, Staphylococcus pettenkoferi, Staphylococcus saprophyticus. The majority of strains (67%) demonstrated resistance to methicillin and erythromycin, half were resistant to clindamycin, a bit less (43%) to gentamicin. Resistance of up to 40% was reported for ciprofloxacin, sulfamethoxazole/trimethoprim and mupirocin. One strain was resistant to all antibiotics studied, and 11 to all of them, except for mupirocin. As much as 26% of isolates demonstrated biofilm-forming potential. Resistant coagulase-negative staphylococci, most frequently isolated from hospital touch surfaces, may pose a threat to severely ill patients, in particular those treated in intensive care units. The results obtained confirm the necessity of implementing and complying with effective procedures for washing and disinfection of hospital surfaces.
Acute infectious diarrhea in children – what do current data show?
Anna Falszewska, Hanna Szajewska
Zakażenia XXI wieku. 2018;1(2):79–87.
Acute diarrhea is the main reason for hospitalization among children younger than 3 years of age. Rotavirus is the most frequent agent responsible for both community-acquired and nosocomial infections. Acute diarrhea does not generally require a specific diagnostic work-up because it does not influence the management. Oral rehydration (with oral rehydration solution) is the major treatment. When oral treatment is not feasible, enteral rehydration by nasogastric route should be considered, before intravenous therapy. Nutritional management is the second most important component in the management of acute diarrhea. Breastfeeding should be continued throughout rehydration. An age-appropriate diet should be started during or after rehydration. In the hospital setting, in non-breast-fed infants and young children, lactose-free feeds can be considered. The recommendations for active therapy are limited, and such a therapy should be only considered as a supportive treatment. Effective interventions include the administration of specific probiotics such as Lactobacillus rhamnosus GG and Saccharomyces boulardii, diosmectite, and racecadotril. Antibiotics should not be used routinely. Rotavirus vaccination is effective for prevention of infections caused by rotavirus.
Bielizna operacyjna jako wyrób medyczny służący ochronie pacjenta przed zakażeniami miejsca operowanego
Surgical drapes and gowns as medical products in patient protection from surgical site infections
Zakażenia XXI wieku. 2018;1(2):89–92.
Surgical drapes used to cover the operated patient and surgical coats for the team, as well as surgical instruments, implants, disposable medical equipment, have to be sterile medical products. The surgical drapes and gowns must meet the PN-EN ISO 13795 and PN-EN ISO 22610 standards and must protect patients from surgical site infections.
Safe multiple use tools and equipment
Zakażenia XXI wieku. 2018;1(2):93–99.
Operating procedures entail high risk of hospital infections. The duty of every hospital is to provide sterile tools and materials through its own sterilizer or through a sterilizer located outside the hospital. Regardless of the medical facility where the procedures are carried out (public hospital, non-public/private hospital, specialist clinics with treatment rooms, dental offices), the principles of preparing the reusable tools for re-use are the same. The quality of the tools must guarantee complete safety to all patients. Surgical instruments and reusable medical equipment must be sterile.
Implementation of IT solutions in medical equipment reprocessing technology – benefits and perspectives
Zakażenia XXI wieku. 2018;1(2):101–104.
In Poland the use of special IT systems dedicated to monitoring and keeping records of the work of central sterile services departments (CSSD) goes more than 10 years back. Introducing these systems started almost as soon as the process of implementing IT solutions in hospitals in general. Under current conditions, the maximum automation of the flow of information should be a strategic goal of each modern and well-managed hospital. Moreover, the growing demands of the National Health Fund in the area of reporting on services performed by a unit, are the factor that stimulates the development and integration of various IT systems in hospitals. From this point of view, transmitting the most important statistics to hospital IT systems in real time, facilitates day to day reporting and the calculation of CSSD operating costs.