Infections of the 21st century (Zakażenia XXI wieku)

Issue 5, 2018

Mikrobiologiczna kontrola higieny rąk jako ważny element multimodalnej strategii prewencji zakażeń związanych z opieką zdrowotną

Hand hygiene microbiological control as an important part
of multimodal approach for HAI prevention

Irina Niecwietajewa, Wioletta Pracz, Małgorzata Giemza, Joanna Jakubiak, Maria Szymańczak, Wojciech Marusza

Zakażenia XXI wieku 2018;1(5):209–215.

Background. Healthcare-associated infections (HAIs) constitute a major threat to patient safety worldwide. HAIs are mainly transmitted by healthcare workers (HCWs), and compliance with hand hygiene (HH) practices among HCWs remains unsatisfactory. Therefore, a multimodal strategy ought to be introduced, of which raising HCW awareness via personalised training program is a component. Methods. This study was conducted in 7 treatment wards of 2 hospitals in Warsaw in the first half of 2018. It encompassed 3 phases: pre-intervention (3 months), intervention (20 days), and post-intervention (2 months). A total of 106 HCWs, including physicians, nurses, and auxiliary staff, were included in the HH audit. The intervention comprised conducting microbiological HH control and holding individual and group training sessions based on the obtained results. The audit in pre- and post-intervention phases concerned indicators of hand disinfectant use and of adherence to ‘Bare Below the Elbows’ policy. Results. Smear-slide samples from the hands of 106 HCWs were collected. No microbial growth was discerned in 18.9% of cases. The most frequently isolated strain was Bacillus spp. – 30.2% of all cultures, Methicillin-sensitive coagulase-negative staphylococci – 16.5%, Methicillin-resistant coagulase-negative staphylococci – 10.8%, Methicillin-sensitive staphylococci aurei – 2.9%. A positive impact of HCW training on measures of hospital HH was discerned. Conclusions. Personalised and group training founded on the application of microbiological HH control method among HCWs may feature as a component of a multimodal HAI control strategy.

Etiologia zakażeń szpitalnych rejestrowanych w Szpitalu Uniwersyteckim nr 2 w Bydgoszczy w latach 2015–2017

Etiology of hospital infections registered in University Hospital No. 2 in Bydgoszcz in 2015–2017

Arkadiusz Kuziemski, Krystyna Frankowska, Ewa Gonia

Zakażenia XXI wieku 2018;1(5):217–221.

Aim. The aim of the study was to analyze the etiology of hospital infections registered in the years 2015–2017 in University Hospital No. 2 in Bydgoszcz. The study covered the records of hospital infections from 2015–2017. In total, 2591 cases of hospital infections were registered. Infections were divided into alarm-induced microorganisms (Ordinance of the Minister of Health of 23.12.2011) and others. In addition, microbiological maps of the hospital from 2015-2017 were analyzed. Material and methods. In 2015, out of 770 hospital infections 212 were caused by alarm microorganisms. In 2016, out of 1001 hospital infections, 272 were caused by alarm microorganisms. The percentage of alarm microorganisms in both analyzed years was 27%. In 2017, out of 820 hospital infections 268 (32.68%) were caused by alarm microorganisms. Results. Microbiological maps have shown increased isolation of Enterobacteriaceae strains with ESBL resistance from 251 in 2015 to 419 in 2016. Among hospital infections in 2015, 126 (59.43%) were of this aetiology, 172 (63%) in 2016 and 153 in 2017. Conclusions. 1. Comparing year to year, the percentage of alarm microorganisms in hospital infections remains at the same level. 2. Dominance among hospital infections (approximately 60% year-on-year) of the Enterobacteriaceae strains with ESBL resistance is coincident with the results of microbiological mapping (isolates from clinically relevant materials without repetition).

Czy to możliwe, że w Polsce nie ma mukormykoz u pacjentów hematologicznych? Propozycja algorytmu postępowania diagnostyczno-terapeutycznego w kierunku mukormykoz: Skala EQUAL Mucormycosis Score 2018

Is it possible that mucormycosis does not occur in Polish patients with blood disorders? Proposed algorithm for diagnosis and management of mucormycosis: EQUAL Mucormycosis Score 2018

Jan Styczyński

Zakażenia XXI wieku 2018;1(5):223–230.

Invasive mucormycosis (IM) is a serious threat to immunocompromised and critical care patients. Recent detailed guidelines and treatment algorithms lead microbiologists and clinicians in diagnostics and treatment of invasive mucormycosis. Currently, there is no tool available that allows to measure guideline adherence. To develop such a tool, Excellence Center for Medical Mycology (ECMM, University of Cologne, Germany) reviewed current guidelines provided by 5 scientific societies (European Society for Clinical Microbiology and Infectious Diseases, European Confederation of Medical Mycology, Infectious Diseases Society of America (IDSA), Infectious Diseases Working Party of the German Society for Hematology and Medical Oncology, and European Conference on Infections in Leukemia (ECIL) and selected the strongest recommendations for management as key components for our scoring tool. ECMM integrated diagnostic measures (chest computed tomography, bronchoalveolar lavage with galactomannan, fungal culture, fungal polymerase chain reaction analysis, species identification, susceptibility testing, histology with silver stain, Periodic acid–Schiff staining, and molecular diagnostics), treatment (antifungal choice and therapeutic drug monitoring), and follow-up computed tomography. The EQUAL Mucormycosis Score 2018 aggregates and weighs the components and provides a tool to support antifungal stewardship and to quantify guideline adherence. The paper presents current state of knowledge of IM in the area of hematology and transplantology with respect to real-life Polish conditions. Polish version of EQUAL Mucormycosis Score 2018 is announced.

Terapia deeskalacyjna inwazyjnych zakażeń grzybiczych

De-escalation therapy of invasive fungal infections

Beata Sulik-Tyszka, Danuta Bieńko, Olga Saran, Marta Wróblewska

Zakażenia XXI wieku 2018;1(5):231–235.

Available guidelines issued by IDSA (Infectious Diseases Society of America) and ESCMID (European Society of Clinical Microbiology and Infectious Diseases), as well as European mycological societies, recommend the use of polyenes, azoles and echinocandins in the therapy of invasive fungal infections (IFI). Amphotericin B is characterised by fungicidal activity both against yeast-like fungi, as well as moulds. Azoles – voriconazole and posaconazole – are recommended for the therapy of IFI caused by Aspergillus and Fusarium due to their fungicidal activity, while these agents are fungistatic against yeast-like fungi of the genus Candida. Fluconazole is indicated in the therapy of IFI caused by Candida, except for Candida krusei (natural resistance of this species to this agent), Candida glabrata (naturally decreased susceptibility of this species to azoles) and Candida auris. Echinocandins are fungicidal against Candida spp. and due to their high clinical efficacy these agents are recommended for the therapy of infections of this etiology. No guidelines of high strength have been issued so far regarding de-escalation therapy. According to the IDSA recommendations, such treatment may be implemented after 3-5 days of empiric therapy of IFI using echinocandins or lipid formulation of amphotericin B. Azoles may be used in such a therapy if the patient is haemodynamically stable and the causative strain of Candida is susceptible in vitro to this group of agents. According to the European recommendations of ESCMID, de-escalation therapy may be implemented only after 10 days of intravenous empiric therapy of IFI.

Antybiotykoterapia u pacjentów hospitalizowanych na oddziale intensywnej terapii

Antibiotic therapy in patients hospitalized in the intensive care units

Justyna Sysiak-Sławecka, Mariusz Jednakiewicz, Elżbieta Rypulak, Mirosław Czuczwar

Zakażenia XXI wieku 2018;1(5):237–244.

Despite a significant improvement in the quality of care in patients with sepsis or septic shock, the mortality rates are still high and often exceed 50%. It has been recently postulated that suboptimal dosing of antimicrobials might be one of the major contributors to unfavorable outcomes in the intensive care unit. Standard dosing of antimicrobials results in achieving target drug concentrations in mild-to-moderately ill patients, but in critically ill patients the pathophysiological changes may influence drug pharmacokinetics (PK) and consequently affect required dosing. Changes in PK of patients with sepsis or septic shock include changes in clearance caused by increased cardiac output or organ failure and shifts in the volume of distribution as a result of increased vascular permeability or altered protein binding. Changes in physiology that alter PK can also be caused by medical interventions such as mechanical ventilation, continuous renal replacement therapy (CRRT), extracorporeal membrane oxygenation (ECMO), etc. Individualized dosing of antimicrobials based on patient’s characteristics is important for safety and efficacy of the therapy, but the main issue for a clinician is to determine and obtain PK target for the pathogen, which is based on the minimal inhibitory concentration and the relationship between the PK and pharmacodynamic properties of antibacterial agents.

Algorytmy postępowania w ostrej biegunce infekcyjnej

Algorithms for the management of acute infectious diarrhea

Tomasz Mach, Katarzyna Szczeklik

Zakażenia XXI wieku 2018;1(5):245–252.

Gastrointestinal infections lead to many acute and chronic diseases, with acute diarrhea being the most common manifestation. This article reviews an evidence-based approach to acute infectious diarrhea evaluation with a focus on clinical approach and treatment of the most common causes in our country. Acute diarrhea caused by viral and bacterial factors is extremely common and particularly dangerous in the group of small children and in elderly people with other diseases. This is one of the most common causes of death in children in the world. The disease occurs mainly in poor countries with a low standard of living, but also in developed countries. The risk factors for the development of this disease, both regarding the microorganism and the individual infected, are given. Due to the most common viral etiology, microbiological diagnosis is reserved for specific situations and concerns: patients with bloody diarrhea, abdominal colic, fever, sepsis, with significant dehydration, suspected nosocomial diarrhea, when the diarrhea prolongs for more than two weeks, accompanied by extraintestinal symptoms, in the epidemiological investigation. The principles of treatment are presented and include mainly rehydration with oral rehydration fluids containing sodium, potassium, chloride and glucose salts with anappropriate osmolarity. Clinical criteria for assessing the severity of diarrhea and the principles of fluid therapy by oral and intravenous route are given. The indications for inpatient treatment of patients with acute diarrhea were discussed. Attention is paid to nutritional treatment, principles of pharmacotherapy, including indications for antibiotic therapy in acute gastro-enteritis.

Profilaktyka i strategia zapobiegania zakażeniom długotrwałego dostępu naczyniowego

The strategy of long-term central venous access infection prophylaxis

Maciej Sadowski

Zakażenia XXI wieku 2018;1(5):253–258.

Central venous access infections and their complications are usually of rapid course and result in high mortality. Their treatment is a source of high costs. Central venous line infection complications may even cause failure of the whole therapy despite successful infection treatment. Patient and doctor preoperative preparation, safe central venous line insertion and correct venous line use by well-trained staff only a revital in the infection prophylaxis strategy.

Rola znakowania i ewidencji narzędzi chirurgicznych w centralnej sterylizatorni

The role of marking and recording of surgical instruments
in a central sterilizer

Dorota Kudzia-Karwowska

Zakażenia XXI wieku 2018;1(5):259–261.

A central sterilizer is a unit that absolutely should be in the structure of the institution providing surgical medical procedures. Performing procedures of decontamination of medical devices including surgical instruments requires from people who deal with contaminated equipment appropriate professional knowledge, experience in this field as well as access to the latest decontamination technologies. Every medical device that is subject to reprocessing should have a documented individual way of reprocessing from the moment of applying the patient to the central sterilizer, performing a specific washing-disinfection process, using a sterile barrier, choosing the method of sterilization and re-use in the patient

Minimalizacja zakażeń płucnych w oddziale intensywnej terapii, rola kompleksowej higieny jamy ustnej w profilaktyce VAP

Minimizing pulmonary infections in the intensive a care unit,
the role of complex hygiene of the oral cavity in VAP prophylaxis

Bogumiła Snopek-Abramowicz

Zakażenia XXI wieku 2018;1(5):263–269.

Minimizing pulmonary infections in the intensive care unit is one of the most important components of the therapeutic team’s work: doctors, nurses, physiotherapists, psychologists, consultants. At present, nosocomial infections are perceived as adverse effects of the use of medical procedures. The specificity of the intensive a care unit, including the need for invasive procedures, increases the risk of nosocomial infections. Hospital-acquired pneumonia is common in critically ill patients treated in intensive a care units (ICU). The severe health condition of patients treated in ICU is the cause of high mortality, and an additional factor that increases the value of this indicator may be nosocomial infection. Hospital pulmonary inflammation is common in patients in whom mechanical ventilation is a form of treatment of respiratory failure in life-threatening situations. It is also a situation that exposes the patient to the development of a ventilator-associated pneumonia. The problem of prophylaxis of pulmonary infections in ICUs deserves attention because the treatment of pneumonia is very difficult and connected with high mortality. Moreover, treatment of this type of infection is a huge cost [1, 2]. There are many ways to minimize this type of infection, while the simplest way in the broadly-understood prophylaxis is comprehensive oral hygiene. What is more, one should not forget about continuing education and practical exercises that raise awareness of the problem of infections among medical personnel of all levels. The aim of this document is to draw attention to practical recommendations in a concise form to facilitate the provision and prioritization of ventilator-associated pneumonia (VAP) prevention strategies among those involved in the care of patients in intensive care units.

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