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Usporedba dviju različitih metoda za testiranje osjetljivosti na tigeciklin u Acinetobacter baumannii
No full textTigecycline susceptibility testing (TST) presents a tremendous challenge for clinical microbiologists. Previous studies have shown that the Epsilometer test (E-test) and Vitek 2 automated system significantly overestimate the minimum inhibitory concentrations for tigecycline resistance compared to the broth microdilution method (BMM). This leads to very major errors or false susceptibility (i.e. the isolate is called susceptible when it is actually resistant). The aim of this study was to compare E-test against BMM for TST in carbapenem-resistant and carbapenem-susceptible Acinetobacter (A.) baumannii and to analyze changes in tigecycline susceptibility between two time periods (2009-2012 and 2013-2014), with BMM as the gold standard. Using the EUCAST criteria, the rate of resistance to tigecycline for the OXA-23 MBL-positive, OXA-23 MBL-negative and carbapenemase-negative strains for BMM was 54.5% (6/11), 29.4% (5/17) and 2.7% (1/37), respectively; the OXA-24/40 and OXA-58 producing organisms did not exhibit any resistance. With E-test, all OXA-23 MBL-positive organisms (11/11), 23.5% (4/17) of OXA-23 MBL-negative, and 4.1% of OXA-24/40 (3/74) strains displayed tigecycline resistance; there were no resistant strains among the OXA-58 and carbapenemase-negative isolates. Resistance emerged in the bacterial isolates from 2013 to 2014. Although tigecycline does not display cross-resistance, the highest rates of resistant A. baumannii isolates were observed among those producing VIM MBL, regardless of the testing method. These findings suggest that the commercial E-test does not provide reliable results for TST of A. baumannii. Further confirmation with the dilution method should be recommended, particularly in cases of serious infections.Testiranje osjetljivosti na tigeciklin (TST) je velik izazov za kliničke mikrobiologe. Prethodna istraživanja su pokazala da E-test i Vitek 2 daju veće vrijednosti minimalne inhibitorne koncentracije tigeciklina u odnosu na dilucijsku metodu, što uzrokuje vrlo veliku grešku (engl. very major error, što znači da je rezistentan izolat proglašen osjetljivim). Cilj istraživanja bio je usporediti dvije metode za testiranje osjetljivosti na tigeciklin (E-test i bujonska dilucijska metoda) u karbapenem osjetljvim i karbapenem rezistentnim izolatima Acinetobacter (A.) baumannii s različitim tipovima karbapenem-hidrolizirajućih oksacilinazama i analizirati promjenu u stopama osjetljivosti na tigeciklin u dva razdoblja istraživanja (2009.-2012. i 2013.-2014.). Dilucija u bujonu je bila referentna metoda. Testiranje osjetljivosti na tigeciklin je provedeno E-testom i bujonskom mikrodilucijskom metodom. Prema kriterijima EUCAST-a stopa rezistencije bila je 54,5% (6/11) za OXA-23 MBL-pozitivne sojeve, 29,4% (5/17) za OXA-23 MBL-negativne sojeve i 2,7% (1/37) za karbapenemaza-negativne sojeve uz bujonsku mikrodilucijsku metodu. OXA-24/40 i OXA-58 producirajući sojevi nisu iskazivali rezistenciju. E-testom su svi OXA-23 MBL pozitivni organizmi (11/11), 23,5% (4/17) OXA-23 MBL negativnih i 4,1% OXA-24/40 (3/74) pokazivali rezistenciju na tigeciklin. Svi OXA-58 pozitivni i karbapenemaza-negativni sojevi su bili osjetljivi na tigeciklin u E-testu. Rezistencija na tigeciklin se pojavila u razdoblju od 2013. do 2014. godine. Iako tigeciklin ne pokazuje križnu rezistenciju s drugim antibioticima najviše stope rezistencije su zapažene među VIM-pozitivnim izolatima bez obzira na metodu testiranja. Prema rezultatima našega istraživanja komercijalni E-test ne daje pouzdane rezultate TST u A. baumannii. Potrebna je potvrda dilucijskom metodom, osobito kod teških infekcija
Cephalosporinases in Proteus mirabilis isolates from long-term care facilities and the community
No full textProteus mirabilis (P. mirabilis) je sve značajniji uzročnik bolničkih i izvanbolničkih infekcija – uključujući i infekcije u domovima za starije i nemoćne osobe. Prethodna istraživanja rezistencije u P. mirabilis u Hrvatskoj su pokazala dominaciju TEM-52 beta-laktamaze proširenog-spektra (ESBL) i pojavu plazmidnih AmpC beta-laktamaza. Cilj ovog istraživanja bio je utvrditi evoluciju i dinamiku pojavljivanja cefalosporinaza u P. mirabilis u domovima umirovljenika te usporediti izolate iz domova s onima u izvanbolničkoj populaciji. Ukupno je prikupljen 41 izolat rezistentan na cefalosporine treće generacije iz dva doma za starije i nemoćne te od izvanbolničkih pacijenata u razdoblju od ožujka 2015. do rujna 2017. godine. Testiranje osjetljivosti na antibiotike provedeno je metodom dilucije u bujonu. ESBL i plazmidne AmpC beta-laktamaze su detektirane fenotipskim testovima s inhbitorima te metodom lančane reakcije polimerazom (PCR). Plazmidi su karakterizirani konjugacijom, transformacijom i replikon-tipizacijom. Svi izolati su pokazivali visoki stupanj rezistencije na amoksicilin te na cefalosporine prve, druge i treće generacije. Tri izolata su pokazivala pozitivan test dvostrukog diska i kombiniranih diskova s klavulanskom kiselinom, što je upućivalo na produkciju ESBL. Trideset-osam izolata je bilo negativno fenotipski na ESBL ali su imali pozitivan Hodgeov test i test kombiniranih diskova s fenilboroničnom kiselinom, što je upućivalo na produkciju AmpC beta-laktamaze. PCR-om su dokazane CTX-M i TEM beta-laktamaze u ESBL-pozitivnih izolata i CMY u izolata pozitivnih na AmpC. U CTX-M pozitivnim izolatima identificiran je plazmid iz IncK grupe, dok AmpC-pozitivni sojevi nisu posjedovali plazmid. Ovim istraživanjem dokazali smo perzistenciju AmpC beta-laktamaze iz CMY porodice u izolatima ove bakterijske vrste u jednom domu za starije i nemoćne osobe, ali i diseminaciju takvih izolata u drugom domu te u izvanbolničkoj populaciji. Kao i u nekim drugim istraživanja, uočen je trend skretanja beta-laktamaza od TEM varijanti prema CTX-M i CMY tipovima. Shodno tome, pravilna i brza laboratorijska identifikacija tipa cefalosporinaze postaje sve važniji preduvjet za odabir adekvatne terapije.Proteus mirabilis (P. mirabilis) is increasingly recognized as a causative agent of hospital and community acquired infections, including those in long-term care facilities (LTCFs). Previous studies on P. mirabilis from Croatia showed the predominance of TEM-52 extended spectrum beta-lactamase (ESBL) and the emergence of plasmid AmpC beta-lactamases. The aim of the present study was to investigate the evolution and dynamics of cephalosporinases in P. mirabilis from LTCFs and to compare the isolates found in the LTCFs with those from a community setting. A total of 41 isolates of P. mirabilis resistant to third-generation cephalosporins were collected from two nursing homes and from outpatients from March 2015 until September 2017. Antibiotic susceptibility testing was performed by the broth microdilution method. ESBLs and plasmid-mediated AmpC beta-lactamases were detected by phenotypic inhibitor-based tests and by polymerase chain reaction (PCR). Plasmids were characterized by utilizing conjugation and transformation experiments, as well as PCR-based replicon typing. All isolates exhibited high level of resistance to amoxicillin alone and in combination with clavulanic acid, as well as to first-, second- and third-generation cephalosporins. Three isolates tested positive in inhibitor-based test with clavulanic acid, and 38 in Hodge test and combined disk test with phenylboronic acid, indicating the production of ESBLs and plasmid-mediated AmpC beta-lactamases, respectively. Two ESBL-positive organisms yielded amplicons with primers specific for CTX-M beta-lactamase of group 1 and one for TEM. All AmpC-positive organisms were identified by PCR as CMY. CTX-M positive strains harbored IncK plasmid, whereas AmpC-positive strains were negative for known plasmid types. This study demonstrated persistence of CMY beta-lactamases in one LTCF, but also dissemination of the aforementioned resistance determinants to another nursing home and to the community setting. Akin to other studies, there was a trend of cephalosporinase dynamic switch from TEM variants to CTX-M and CMY. Therefore, accurate and swift laboratory identifi cation of cephalosporinase type is becoming pivotal for appropriate choice of treatment
Molecular Epidemiology of Cephalosporinases and Extended Spectrum β-Lactamases (ESBLs) in Proteus mirabilis Isolates From Croatia: Following the Spread of Resistance Determinants Between Long-Term Care Facilities and the Community
No full textPrevious studies on P. mirabilis strains isolated from Croatian healthcare institutions revealed the predominance of TEM-52 extended spectrum β-lactamase (ESBL), as well as the emergence of plasmid AmpC β-lactamases. Our aim was to molecularly characterize cefalosporinases in P. mirabilis isolates from long- term care facilities (LTCFs) and to compare their resistance profile and dynamics with community isolates
Erlotinib for coexisting typical bronchial carcinoid and advanced lung adenocarcinoma: does the epidermal growth factor receptor mutation status matter?
No full textAdenocarcinoma (AC) is the most common type of primary pulmonary malignancy. Lung carcinoid, however, is a rare neuroendocrine tumor. Their coexistence is extremely uncommon. We report the unique case of synchronous advanced lung AC of the right upper lobe (stage IIIB) and typical endobronchial carcinoid tumor in the contralateral lower lobe in a 49-year-old white female who had never smoked. PET-computed tomography scan revealed a fluorine-18-fluorodeoxyglucose-avid AC lesion, whereas the carcinoid tumor was fluorine-18-fluorodeoxyglucose occult. After two lines of platinum-based combination chemotherapies and radiotherapy, the AC progressed, and oral tyrosine kinase inhibitor therapy with erlotinib was initiated in third line. On erlotinib, the AC remained stable for 50 months until disease progression, whereas the carcinoid completely regressed. Molecular testing of the rebronchoscopied AC revealed an exon 19 deletion mutation in the epidermal growth factor receptor (EGFR) gene, whereas the carcinoid was retrospectively EGFR mutation negative. The patient eventually succumbed to ileus caused by intra-abdominal spread of disease, surviving a remarkable 80 months with good performance status throughout most of the follow-up period. To the best of our knowledge, this is the first reported case of synchronous primary lung cancers with different EGFR mutation status, describing an unexpected response of an EGFR-wild-type carcinoid to third-line erlotinib
Hernijacija kroz drenažni otvor kao rijetka rana -komplikacija laparoskopije
No full textPort site hernia is very rare but serious complication after laparoscopic procedures. In clinical practice drain is often placed in 10 mm or larger trocar port sites. We report a case of 61-year-old woman who underwent laparoscopy and developed small bowel herniation and incarceration in a 12 mm port site in which 24 Fr drain was inserted leaving real free space of approximately 4 mm. There are only a few case reports with the similar pathology. Priority should always be on the adequate fascial closure of port sites. Smaller trocar insertion sites (<10 mm) should be used as insertion sites for drains.U kliničkoj praksi abdominalni dren se često postavlja na mjesta insercije troakara promjera većih od 10 mm, te je pojava hernije, kao vrlo rijetke ali ozbiljne komplikacije ovih zahvata moguća. U prikazanom slučaju, na mjestu insercije troakara promjera 12 mm lijevo postavljen je dren veličine 24 Fr koji je dodatno reducirao prostor dostupan za hernijaciju na oko 4 mm. Kroz ovaj otvor ipak je došlo do hernijacije i inkarceracije tankog crijeva, što je opisano u svega nekoliko slučaja. Smatramo kako je važno odgovarajuće zatvaranje defekata fascije na mjestu postavljanja troakara i postavljanje abdominalnog drena na mjesta insercije troakara promjera manjih od 10 mm
Incidental Finding Of Hyperreactio Luteinalis during Caesarean Section in Twin Pregnancy
No full textBACKGROUND: Some benign changes of the ovaries like hyper reaction luteinalis sometimes cannot be differentiated from malignant ones without histological examination. In these cases, surgical intervention sometimes cannot be avoided. Hyperreactio luteinalis is a condition that can occur only in pregnancy. It is characterised by bilateral benign multicystic ovarian enlargement.
CASE REPORT: We present a case of misleading intraoperative findings during Cesarean section that ended with ovariectomy.
CONCLUSION: During the Caesarean section, some benign masses of the ovaries, like hyper reaction luteinalis, are difficult to differentiate from malignant disease without histological examination, requiring surgical intervention
Konzultativno-suradna psihijatrija i psihosomatska medicina, Model Kliničkog bolničkog centra Sestre milosrdnice
No full textThe aim of this paper is to demonstrate an active participation of the Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine as the first and currently the only formally founded department of that kind in Croatia. Consultation-liaison psychiatry in Sestre milosrdnice has been present for decades, from the time when psychiatry department was founded at the hospital. Nevertheless, Department as an organizational unit has been active for the last six years. It is important to emphasize the cooperation and consultation between the specialists in “somatic” medicine and psychiatrists as well as to point out a psychosomatic aspect in physical illness. Moreover, the importance of psychiatrist’s role in discovering, providing diagnosis and treating “somatic” patients with psychiatric complications must be placed in the focus, and the rest of the medical team needs to be aware that each patient has its own biological, psychological and social dimension which requires a holistic, bio-psycho-social approach regardless of the patient’s physical or mental disorder.Kroz ovaj rad prikazujemo aktivno djelovanje Odjela konzultativno-suradne psihijatrije i psihosomatske medicine kao prvog i trenutno jedinog formalno osnovanog odjela takve vrste u Republici Hrvatskoj. Aktivnosti iz područja konzultativno-suradne psihijatrije se u Kliničkoj bolnici “Sestre milosrdnice” odvijaju praktički od samog osnutka psihijatrije u bolnici, već desetljećima. Također Odjel kao zasebna organizacijska jedinica postoji unazad šest godina. U radu Odjela za konzultativno-suradnu psihijatriju i psihosomatsku medicinu istaknuli bi važnost konzultacije i suradnje između specijalista tjelesne medicine i psihijatara, te naglašavamo značajnu ulogu psihosomatskog aspekta u tjelesnoj bolesti. Također težište rada je isticanje važnosti uloge psihijatra u otkrivanju, dijagnostici i liječenju tjelesnih bolesnika s psihijatrijskim komplikacijama, a ostatku medicinskog tima ukazati da je svaki bolesnik osoba sa biološkom, psihološkom i socijalnom dimenzijom ili drugim riječima njegovanje holističkog, biopsihosocijalnog pristupa svakom bolesniku bio on samo tjelesni bolesnik ili i bolesnik s psihijatrijskim tegobama