Issue 4, 2018
Quality management – hand hygiene – Does practice follow theory
Zakażenia XXI wieku 2018;1(4):135–141.
Quality assurance in hospitals consists in increasing the ability to meet the requirements in the area of prevention of problems related to the provision of a medical service. Part of the quality system is continuous improvement that is making the current situation the subject of the analysis, diagnosing the causes of dysfunction and proposing specificmethods of improvement and monitoring achieved results. If in the certified hospitals the basic procedure of infection prevention, which is hand hygiene, does not work as expected, it means that the quality management system has been partially implemented and requires corrective action. In the area of implementation of basic infection prevention procedures a specialist is the epidemiological nurse and solutions that she proposes should not be treated as unjustified only because they go beyond legal regulations.
The position of nitroxolin in the treatment of uncomplicated urinary tract infections in adult
Przemysław Dziewirz, Monika Lemańska
Zakażenia XXI wieku 2018;1(4):143–147.
The work involved the analysis of the sensitivity of the most frequently isolated uropathogens to nitroxiline, nitrofurantoin, cotrimoxazole and norfloxacin. The study involved 1856 strains of gram-negative bacilli (E. coli, K. pneumoniae, P. mirabilis, E. cloacae, M. morganii) isolated from patients with UTI symptoms. The highest sensitivity for ESBL negative bacteria Enterobacteriaceae was found for nitroxilineand the percentage of strains susceptible to this drug was 100% for E. coli, 94.5% for P. mirabilis, 93% for K. pneumoniae, 88% for E. cloacae and 80% for M. morganii and ESBL-positive isolates showed differential sensitivity from 46% for K. pneumoniae to 98% for E. coli. Nearly 30% of non-beta-lactamase-producing rods were resistant to cotrimoxazole and norfloxacin while for strains with enzyme the resistance was even higher 83% for cotrimoxazole and 92% for norfloxacin.
Pegasys in the treatment of HBV infections in 2018
Zakażenia XXI wieku 2018;1(4):149–151.
Successful treatment of HBV infections remains a huge challenge. The recommendations regarding HBV treatment issued in 2018 by the European Association for Liver Study (EASL) and the Polish HBV Expert Group recommend two main therapeutic strategies for HBV infections. The first one, based on immunotherapy, is in practice a 48-week interferon-α2a-based treatment, and the second one uses nucleos(t)ide analogs, most often to the end of life. According to the recommendations of EASL and PGE HBV, the treatment should start with Peg-IFN-α therapy in patients with liver disease of low or advanced stage, both in HBeAg-positive and negative patients. Proposed Peg-IFN application, in combination with analogs or in sequential treatment, was also discussed.
Postępy w leczeniu zakażeń wieloopornymi szczepami bakterii gram-dodatnich w oddziałach chorób zakaźnych
Advances in treatment of infections with multi-resistant strains of gram-positive bacteria in the departments of infectious diseases
Mirosław Jawień, Aleksander M. Garlicki
Zakażenia XXI wieku 2018;1(4):153–159
Infections with multi-resistant strains of Gram-positive bacteria are an increasing challenge in the selection of therapeutic options. This type of infection is not only a nosocomial infection, but may also be acquired de novo in out-of-hospital conditions. Infection of skin and soft tissues is mainly caused by Gram-positive bacteria with a systematic increase in the strains of methicillin-resistant or vancomycin-resistant bacteria. This unfavorable trend caused the necessity to create new groups of drugs active against this type of strains. The article discusses the principles of treatment of skin and soft tissue infections taking into account new therapeutic options in the form of the second generation of glycopeptides.
Infections with Clostridium difficile – diagnostics and treatment
in the elderly
Hanna Pituch, Dorota Wultańska
Zakażenia XXI wieku 2018;1(4):161–168
Burden for health-care systems associated with Clostridium difficile infection (C. difficile infection – CDI) has increased recently due to an increase in the incidence of CDI cases and the rising costs of medical care for a patient with CDI. CDI in particular affects older people due to numerous conditions such as: impaired immune system, disorders of the intestinal microbiome, malnutrition, increasing antibiotic consumption, and more frequent exposure to drugs other than antibiotics. Two out of three CDIs related to healthcare are found in patients who are 65 years old or older. In addition, older people are more prone to CDI recurrence (recurrence CDI – rCDI). Currently, three antibiotics as metronidazole, vancomycin and fidaxomicin and the fecal microbiota transplantation (FMT) are available to treat CDI. The paper presents epidemiology, current recommendations regarding diagnostics, treatment, prevention of C. difficile infections and management of the hospital environment in situation of CDI.
Lactobacillus rhamnosus GG – an ally in the fight against antibiotic resistance?
Zakażenia XXI wieku 2018;1(4):169–174
Antibiotic resistance of microorganisms is currently one of the most serious problems of medicine. The strategy of combating antibiotic resistance covers many areas, among which the responsible use of antibiotics and the search for new substances with antimicrobial activity is of great importance. Probiotics, defined as live microorganisms beneficial to health, can be helpful in combating antibiotic resistance. Probiotics modulate the composition of intestinal microbiota, eliminate resistant pathogens from the body and strengthen immunity, which results in lowering the risk of infections and reducing antibiotic therapy. Lactobacillus rhamnosus GG (LGG) is a probiotic strain with the most proven clinical effects in the fight against antibiotic resistance. Oral administration of LGG reduces the risk of infection, including nosocomial infections and the use of antibiotics in young children, and reduces the incidence of vancomycin-resistant enterococci in children and adults.
Treatment of acute pharyngitis
Ernest Kuchar, Monika Karlikowska-Skwarnik
Zakażenia XXI wieku 2018;1(4):175–182
Pharyngitis belongs to the most common conditions consulted by primary care physicians. The central diagnostic dilemma is the proper identification of the etiologic agent to avoid unnecessary antibiotic treatment. Careful clinical history and patient examination are usually sufficient to estimate the likelihood of bacterial infection and indications to antibiotic therapy. Due to the predominance of viral etiologic agents, local treatment, which alleviates symptoms and can act antimicrobially, is used next to the systemic antimicrobial treatment.
Zastosowanie leków z grupy echinokandyn – w szczególności kaspofunginy w prewencji i leczeniu inwazyjnych zakażeń grzybiczych w populacji dorosłych pacjentów ze schorzeniami onkohematologicznymi, w tym po przeszczepieniu krwiotwórczych komórek macierzystych
Echinocandins – in particular caspofungin for prevention and treatment of invasive fungal infections in adult patients with onco-hematological diseases including recipients of hematopoietic stem cells
Michał Górka, Martyna Maciejewska, Emilian Snarski, Wiesław W. Jędrzejczak
Zakażenia XXI wieku 2018;1(4):183–191
Fungal infections are a significant problem in the hematological care in the 21st century. Effective prevention and treatment of those infections remains still a challenge. Echinocandins provide another effective treatment option for serious fungal infections. Additionally, the cost-effectiveness of the treatment is also important and implementation of generic antifungal agents can have a significant role in improvement of pharmacoeconomic aspects of the therapy. The aim of the article is to present therapeutic indications of echinocandins (in particular caspofungin) in the prophylaxis and treatment of invasive fungal infections in the population of oncohematological patients including hematopoetic stem cell recipients. We analyzed the spectrum of action of medicines from the group of echinocandins, the differences between individual active substances and the possibility of using caspofungin in the above-mentioned patient population based on drug registration indications and guidelines of international scientific societies.
Surface disinfection in hospital-acquired infection prevention
Zakażenia XXI wieku 2018;1(4):193-197
This article is a review of current literature, which indicates the important role of proper surface disinfection in preventing hospital-acquired infections. Before 2010, it was commonly assumed that proper surface disinfection has limited importance or that it is purely a maintenance and cleaning procedure rather than form of infection control, however, since then its role has increasingly been acknowledged. Therefore, the proper choice of disinfectants and thorough surface disinfection are fundamental for modern prevention of hospital-acquired infections.
External quality control of immunology assays used in virological tests
Zakażenia XXI wieku 2018;1(4):197–202
For the last two decades there has been a dynamic development of diagnostic technologies for the detection of bacterial, viral and parasitic diseases, for monitoring of their progress and recovery period. The complexity of immunodiagnostic assays is a result of patient’s immune response to infection and the nature of the infectious agent, as well as the variety of techniques used in laboratories. Viral serological tests use standard and often simple but also automated methods. External quality assessment in addition to analytical accuracy, based on appropriate clinical cases, should determine the ability to comprehensively analyze the results of immunochemical tests and the quality of clinical interpretation. A key element of external quality control is regular internal quality control in the laboratory. Therefore, the basic task of each laboratory is to implement internal quality control procedures, in particular in the critical stages of research procedures.
Przygotowanie sali operacyjnej do zabiegów operacyjnych – propozycja ogólnego standardu sprzątania sali operacyjnej
Preparation of the operating room for surgical procedures – proposal of the general standard of cleaning the operating room
Zakażenia XXI wieku 2018;1(4):203–207
The operating room is a place where medical procedures requiring aseptic techniques are performed. In order to ensure epidemiological safety, it is crucial to properly prepare the operating room for the procedures. The aim of this article is to describe the process of preparing the operating room for the treatment with particular emphasis on the cleaning process and to develop a proposal for the general standard of cleaning the operating room.