1,720,991 research outputs found
Antimicrobial resistance in gram-negative bacteria
No full textZabrinjavajuće povećanje proširenosti višestruko rezistentnih bakterija povezano s nedostatkom
novih i djelotvornih antibiotika prijetnja je globalnom zdravlju. Čimbenici koji najviše pridonose
nastanku antimikrobne rezistencije su: manjak dostupnosti dijagnostičkih metoda, pretjerano
propisivanje antibiotika ili propisivanje neadekvatnih antimikrobnih lijekova, pretjerano korištenje
antibiotika u agrikulturi, nesrazmjer između pronalaska novih antibiotika i brzine pojave i širenja
rezistencije, izostanak programa nadzora nad antibioticima te izostanak programa za kontrolu
infekcija. Najvažnije skupine antibiotika za liječenje rezistentnih gram-negativnih infekcija su
karbapenemi, fluorokinoloni, aminoglikozidi i polimiksini. Mehanizmi rezistencije na antibiotike
su: enzimatska razgradnja lijeka, promjena ciljnog mjesta vezanja antibiotika, promjena
propusnosti stanične stijenke i pojačano izbacivanje antibiotika. Neki od najvažnijih gram-negativnih uzročnika koji uzrokuju teške infekcije zbog rastuće višestruke rezistencije su
enterobakterije, acinetobakter i pseudomonas. Zabrinjavajuća proširenost bakterijskih sojeva koji
produciraju karbapenemaze sve više smanjuje djelotvornost širokospektralnih karbapenema.
Razvoj novih antibiotika dugotrajan je proces, a novi se antibiotici pojavljuju rijetko. Jedan od
najvažnijih koraka u borbi protiv rezistencije je primjena brze i jeftine dijagnostike koja bi
omogućila ciljanu antibiotsku terapiju i smanjila pretjeranu i nepravilnu upotrebu antibiotika.
Edukacija medicinskog osoblja i kontrola nad propisivanjem antibiotika mogu dodatno utjecati na
usporavanje rastućeg problema rezistencije.The worrying increase in the spread of multidrug resistant bacteria combined with the lack of new
and effective antibiotics, poses a threat to global health. The factors that contribute most to the
emergence of antimicrobial resistance are: limited availability of diagnostic methods, misuse and
overuse of antibiotics, overuse of antibiotics in agriculture, mismatch between the discovery of
new antibiotics and the speed of emergence and spread of antibiotic resistance, lack of antibiotic
control programs and poor infection prevention and control. The main antibiotic groups used to
treat resistant Gram-negative infections are carbapenems, fluoroquinolones, aminoglycosides and
polymyxins. The mechanisms of antimicrobial resistance fall into four main categories: enzymatic
degradation of antibacterial agents, alteration of a drug target, limiting uptake of a drug and active
drug efflux. Some of the most important Gram-negative pathogens causing serious infections due
to increasing multidrug resistance are Enterobacterales, Acinetobacter spp. and Pseudomonas spp.
The worrying prevalence of carbapenemase-producing bacterial strains is increasingly reducing the
efficacy of broad-spectrum carbapenems. The development of new antibiotics is a long-term
process, and new antibiotics rarely appear. One of the most important steps in the fight against
resistance is the use of faster and cheaper diagnostics that would allow directed antibiotic therapy
and reduce the excessive and inappropriate use of antibiotics. Education of the healthcare workers
and control over the prescription of antibiotics can help control the growing problem of resistance
MIDWIVES' KNOWLEDGE REGARDING INFLUENZA VACCINATION DURING PREGNANCY
No full textPrimalje trebaju biti pouzdan i pravovremen izvor informacija o cijepljenju protiv gripe tijekom trudnoće s obzirom na to da rade u izravnom doticaju s trudnicama koje su rizična skupina za obolijevanje i prioritetna skupina za cijepljenje protiv gripe. Dok se u nekim zemljama preporučuje rutinski svim trudnicama ponuditi sezonsko cjepivo protiv gripe, u RH to nije slučaj.
Ciljevi ovog istraživanja su saznati koliko primalje u RH znaju o cijepljenju protiv gripe tijekom trudnoće, pružaju li trudnicama informacije i postoji li povezanost njihovih znanja prema sociodemografskim karakteristikama.
Istraživanjem je obuhvaćeno 82 primalje RH svih stupnjeva obrazovanja. Učinjena je presječna studija online anketnim upitnikom.
Sveukupna znanja primalja o cijepljenju protiv gripe tijekom trudnoće su ograničena. Da je cijepljenje protiv gripe u trudnoći učinkovito smatra 43 %, a da je sigurno samo 28 % ispitanika. 30 % ispitanika zna da trudnice mogu koristiti inaktivirano cjepivo i samo 21 % ispitanika zna da ga mogu primiti u bilo kojem tromjesečju. Čak 93 % primalja uključenih u istraživanje navelo je da ne pružaju trudnicama informacije o cijepljenju protiv gripe tijekom trudnoće. Svega je 18 % ispitanika primilo sezonsko cjepivo protiv gripe. Rezultati pokazuju da postoji razlika znanja prema sociodemografskim karakteristikama ispitanika kao što su spol, stupanj obrazovanja, radni staž i procijepljenost ispitanika.
Primalje imaju ključnu ulogu u prevenciji komplikacija gripe informiranjem trudnica o važnostima cijepljenja protiv gripe. Kako bi se ova važna uloga ispunjavala same primalje moraju biti educirane o cijepljenju protiv gripe tijekom trudnoće te svoja znanja prenositi trudnicama u svakodnevnoj praksi.Midwives should provide reliable and valid information on influenza vaccination during pregnancy, considering they work directly with pregnant women, who are in the risk group, and in the priority group. Whereas in some countries it is routinely recommended to offer a seasonal flu vaccine to all pregnant women, in Croatia this is not the case.
The goals of this research are to find out how much midwives know about influenza vaccination during pregnancy, whether they provide pregnant women with information, and whether there is a link between their knowledge and sociodemographic characteristics.
The research involves 82 midwives of all levels of education in Croatia. A cross-sectional study was conducted using an online questionnaire.
The overall knowledge of midwives on influenza vaccination during pregnancy is limited. 43% of respondents think that influenza vaccination during pregnancy is efficient, and 28% of them claim that it is safe. 30% of respondents know that pregnant women can get the inactivated vaccine, and only 21% of respondents know that they can get it in any trimester. 93% of midwives involved with the research claimed they don't provide pregnant women any information on influenza vaccination during pregnancy. The results show that there is a difference according to sociodemographic characteristics of respondents such as gender, level of education, years of service, vaccination of participants against influenza during the 2020/2021 season.
Midwives play an important role in preventing complications of influenza by informing pregnant women on the importance of influenza vaccination. To fulfill this important role, midwives themselves need to be educated on influenza vaccination during pregnancy and provide pregnant women with information in their everyday work
Lyme borreliosis: pathogenesis and diagnosis
No full textBorrelia burgdorferi uzročnik je lajmske bolesti (LB) te pripada koljenu spiroheta. Visoko je invazivna bakterija prilagođena krpeljima i sisavcima. Patogeneza LB nije u potpunosti razjašnjena, ali ovisi o pokretljivost i citotoksičnost bakterije, antigenskoj varijabilnosti i imunološkom odgovoru domaćina. Klinička slika LB se dijeli na rani lokalizirani stadij, rani diseminirani stadij te kasni stadij. Erythema migrans (EM), ujedno i patognomoničan znak LB, je najčešća manifestacija u ranom stadiju bolesti, dok se u kasnijim stadijima javljaju neurološki simptomi, srčane manifestacije i artritis. Dijagnostika lajmske bolesti (LB) uključuje različite mikrobiološke metode u otkrivanju uzročnika, a dijeli se na izravne i neizravne metode. Izravne metode uključuju kultivaciju, mikroskopiju i PCR, dok su neizravne metode utemeljene na serološkom testiranju. PCR je brza dijagnostička metoda, ali ne može razlikovati akutnu od kronične infekcije. Serološki testovi detektiraju protutijela IgM i IgG u krvi, likvoru i sinovijalnoj tekućini. Serološka dijagnostika se provodi u dva koraka. Nakon primjene osjetljivih probirnih (EIA, IFA, CLIA i dr.) testova, reaktivni se rezultati potvrđuju potvrdnim visokospecifičnim imunoblot/Western blot testom. Serološki testovi imaju zadovoljavajuću osjetljivost i specifičnost, no interpretacija ovisi o kvaliteti testova i kliničkim podacima. U dijagnostici LB kombinira se klinička slika s laboratorijskim testovima te integracija različitih metoda osigurava pravodobno postavljanje dijagnoze i pravovremeno liječenje. Liječenje lajmske bolesti ovisi o stadiju bolesti. U ranim stadijima, koriste se oralni antibiotici tijekom 10-14 dana, dok se neurološke i reumatske manifestacije liječe primjenom parenteralnih antibiotika tijekom 2-4 tjedna.Borrelia burgdorferi is the causative agent of Lyme disease (LB) and belongs to the spirochete phylum. It is a highly invasive bacterium, adapted to ticks and mammals. The pathogenesis of LB is not fully understood but depends on the bacterium's motility, its cytotoxicity, its antigenic variability, and the host immune response. The clinical presentation of LB is divided into early localized, early disseminated, and late stages. Erythema migrans (EM), which is also a pathognomonic sign of LB, is the most common manifestation in the early stage, while neurological symptoms, cardiac manifestations, and arthritis occur in later stages. Diagnosis of LB involves various microbiological methods to detect the causative agent, categorized as direct and indirect methods. Direct methods include cultivation, microscopy, and PCR, while indirect methods are based on serological testing. PCR is a rapid detection method but cannot differentiate between acute and chronic infections. Serological tests detect antibodies (IgM and IgG) in blood, cerebrospinal fluid, and synovial fluid. A two-step testing process for LB is currently recommends. The most commonly screening tests are EIA, IFA and CLIA followed by confirmatory immunoblot/Western Blot test. Serological tests have satisfactory sensitivity and specificity, but interpretation depends on the test quality and clinical data. LB diagnosis combines clinical presentation with laboratory tests, and integration of different methods ensures timely diagnosis and treatment. Treatment of LB depends on the disease stage. In early stages, oral antibiotics are used for 10-14 days, while neurologic and rheumatic manifestations are treated with parenteral antibiotics for 2-4 weeks
Antimicrobial resistance in gram-negative bacteria
No full textZabrinjavajuće povećanje proširenosti višestruko rezistentnih bakterija povezano s nedostatkom
novih i djelotvornih antibiotika prijetnja je globalnom zdravlju. Čimbenici koji najviše pridonose
nastanku antimikrobne rezistencije su: manjak dostupnosti dijagnostičkih metoda, pretjerano
propisivanje antibiotika ili propisivanje neadekvatnih antimikrobnih lijekova, pretjerano korištenje
antibiotika u agrikulturi, nesrazmjer između pronalaska novih antibiotika i brzine pojave i širenja
rezistencije, izostanak programa nadzora nad antibioticima te izostanak programa za kontrolu
infekcija. Najvažnije skupine antibiotika za liječenje rezistentnih gram-negativnih infekcija su
karbapenemi, fluorokinoloni, aminoglikozidi i polimiksini. Mehanizmi rezistencije na antibiotike
su: enzimatska razgradnja lijeka, promjena ciljnog mjesta vezanja antibiotika, promjena
propusnosti stanične stijenke i pojačano izbacivanje antibiotika. Neki od najvažnijih gram-negativnih uzročnika koji uzrokuju teške infekcije zbog rastuće višestruke rezistencije su
enterobakterije, acinetobakter i pseudomonas. Zabrinjavajuća proširenost bakterijskih sojeva koji
produciraju karbapenemaze sve više smanjuje djelotvornost širokospektralnih karbapenema.
Razvoj novih antibiotika dugotrajan je proces, a novi se antibiotici pojavljuju rijetko. Jedan od
najvažnijih koraka u borbi protiv rezistencije je primjena brze i jeftine dijagnostike koja bi
omogućila ciljanu antibiotsku terapiju i smanjila pretjeranu i nepravilnu upotrebu antibiotika.
Edukacija medicinskog osoblja i kontrola nad propisivanjem antibiotika mogu dodatno utjecati na
usporavanje rastućeg problema rezistencije.The worrying increase in the spread of multidrug resistant bacteria combined with the lack of new
and effective antibiotics, poses a threat to global health. The factors that contribute most to the
emergence of antimicrobial resistance are: limited availability of diagnostic methods, misuse and
overuse of antibiotics, overuse of antibiotics in agriculture, mismatch between the discovery of
new antibiotics and the speed of emergence and spread of antibiotic resistance, lack of antibiotic
control programs and poor infection prevention and control. The main antibiotic groups used to
treat resistant Gram-negative infections are carbapenems, fluoroquinolones, aminoglycosides and
polymyxins. The mechanisms of antimicrobial resistance fall into four main categories: enzymatic
degradation of antibacterial agents, alteration of a drug target, limiting uptake of a drug and active
drug efflux. Some of the most important Gram-negative pathogens causing serious infections due
to increasing multidrug resistance are Enterobacterales, Acinetobacter spp. and Pseudomonas spp.
The worrying prevalence of carbapenemase-producing bacterial strains is increasingly reducing the
efficacy of broad-spectrum carbapenems. The development of new antibiotics is a long-term
process, and new antibiotics rarely appear. One of the most important steps in the fight against
resistance is the use of faster and cheaper diagnostics that would allow directed antibiotic therapy
and reduce the excessive and inappropriate use of antibiotics. Education of the healthcare workers
and control over the prescription of antibiotics can help control the growing problem of resistance
DETECTION OF EPSTEIN-BARR VIRUS SPECIFIC ANTIBODIES BY DIFFERENT IMMUNOASSAYS
No full textEpstein-Barrov virus (EBV) je jedan od najučestalijih uzročnika virusnih infekcija u ljudi. Specifična EBV-protutijela se mogu detektirati različitim serološkim postupcima u serumu zaraženih osoba metodama kao što su enzimski imunotest (EIA, engl. enzyme immunoassay), kemiluminiscentni imunotest (CLIA, engl. chemiluminescent immunoassay) i dr. Za definiranje faze infekcije najčešće se koriste testovi za određivanje IgM i IgG protutijela na antigen virusne kapside (VCA) EBV-a te IgG protutijela na EBV nuklearni antigen-1 (EBNA-1). U serumu bolesnika s akutnom primarnom infekcijom obično su prisutna IgM protutijela na VCA ili IgG i IgM protutijela na VCA, a izostaju IgG protutijela na EBNA-1. U osoba koje su preboljele infekciju prisutna su IgG protutijela na VCA uz EBNA-1 IgG, a izostaju IgM protutijela na VCA. IgM protutijela protiv VCA antigena prisutna su nekoliko mjeseci, dok su IgG protutijela protiv VCA i EBNA prisutna godinama.
Cilj istraživanja je usporediti rezultate dobivene korištenjem komercijalnih Enzygnost anti-EBV IgG i IgM testova EIA metodom na analizatoru BEP® 2000 System (Siemens, Njemačka), te Abbot Architect anti-EBV IgG i IgM testova kemiluminiscentnom metodom (CMIA, engl. chemiluminescent microparticle immuno assay) na analizatoru Architect i1000SR (Abbott, SAD) s referentnom metodom. U radu su korišteni arhivirani uzorci seruma koji su prethodno testirani u sklopu rutinske dijagnostike EBV infekcije u Kliničkom laboratoriju za kliničku mikrobiologiju KBC Rijeka. Serumi su prethodno analizirani Vircell ELISA metodom korištenjem kitova EBV VCA ELISA IgG, EBV VCA ELISA IgM i EBNA ELISA IgG (proizvođač Vircell, Granada, Španjolska), a dobiveni serološki profili potvrđeni su CLIA metodom istog proizvođača na ThunderBolt uređaju. Navedene metode su uzete kao referentne metode testiranja.
Visoka osjetljivost i specifičnost Enzygnost i Abbott komercijalnih seroloških EBV testova, te velika podudarnost rezultata dobivenih s obje korištene metode s referentnom metodom ukazuju na pouzdanost ovih komercijalnih testova u kliničkoj dijagnostičkoj primjeni. Dodatno, upotreba trećeg markera ENBA-1 IgG (Abbott Architect EBV test) omogućava bolju diskriminaciju primarne i prošle infekcije te pridonosi većoj pouzdanosti dobivenih rezultata.Epstein-Barr virus (EBV) is one of the most common causes of of viral infections in humans. Specific EBV antibodies can be detected by different serological procedures in serum of infected individuals with the help of methods such as enzyme-immunoassay (EIA), chemiluminescent immunoassay (CLIA) and others. For infection stage determination, tests for detection of IgM and IgG antibodies to EBV Viral Capsid Antigen (VCA) and IgG antibodies to Epstein-Barr Nuclear Antigen-1 (EBNA-1) are commonly used. VCA IgG and VCA IgM antibodies in the absence of EBNA-1 IgG antibodies are typically found in serum of patients with acute primary infections. Past infections are characterized by the presence of VCA IgG and EBNA-1 IgG antibodies in the absence of VCA IgM antibodies. VCA IgM antibodies persist for months, while VCA IgG and EBNA IgG antibodies persist for years.
The aim of the study is to compare results of commercially available Enzygnost Anti-EBV IgG and IgM assays by EIA method on BEP® 2000 System (Siemens, Germany), and results of Abbott Architect Anti-EBV IgG and IgM assays by chemiluminescent microparticle immunoassay (CMIA) method on Architect i1000SR analyzer (Abbott, USA), with a reference method. In this study, archived serum samples were used that were previously tested as part of routine diagnostics of EBV infections at Clinical Department for Clinical Microbiology of Clinical Hospital Centre Rijeka. The serum samples were previously tested by Vircell ELISA method using EBV VCA ELISA IgG, EBV VCA ELISA IgM and EBNA ELISA IgG kits (manufacturer Vircell, Granada, Spain), and resulting serological profiles were confirmed by CLIA method by the same manufacturer on ThunderBolt analyzer. The above methods were used as reference testing methods.
High sensitivity and specificity of commercially available Enzygnost and Abbott serological EBV assays, as well as high rate of result agreement of the two methods with the reference method indicate the reliability of these assays in clinical diganostics. Additionally, the use of a third marker, ENBA-1 IgG (Abbott Architect EBV assay), provides better discrimination of primary and past infection and contributes to better reliability of obtained results
Antimicrobial resistance in gram-negative bacteria
No full textZabrinjavajuće povećanje proširenosti višestruko rezistentnih bakterija povezano s nedostatkom
novih i djelotvornih antibiotika prijetnja je globalnom zdravlju. Čimbenici koji najviše pridonose
nastanku antimikrobne rezistencije su: manjak dostupnosti dijagnostičkih metoda, pretjerano
propisivanje antibiotika ili propisivanje neadekvatnih antimikrobnih lijekova, pretjerano korištenje
antibiotika u agrikulturi, nesrazmjer između pronalaska novih antibiotika i brzine pojave i širenja
rezistencije, izostanak programa nadzora nad antibioticima te izostanak programa za kontrolu
infekcija. Najvažnije skupine antibiotika za liječenje rezistentnih gram-negativnih infekcija su
karbapenemi, fluorokinoloni, aminoglikozidi i polimiksini. Mehanizmi rezistencije na antibiotike
su: enzimatska razgradnja lijeka, promjena ciljnog mjesta vezanja antibiotika, promjena
propusnosti stanične stijenke i pojačano izbacivanje antibiotika. Neki od najvažnijih gram-negativnih uzročnika koji uzrokuju teške infekcije zbog rastuće višestruke rezistencije su
enterobakterije, acinetobakter i pseudomonas. Zabrinjavajuća proširenost bakterijskih sojeva koji
produciraju karbapenemaze sve više smanjuje djelotvornost širokospektralnih karbapenema.
Razvoj novih antibiotika dugotrajan je proces, a novi se antibiotici pojavljuju rijetko. Jedan od
najvažnijih koraka u borbi protiv rezistencije je primjena brze i jeftine dijagnostike koja bi
omogućila ciljanu antibiotsku terapiju i smanjila pretjeranu i nepravilnu upotrebu antibiotika.
Edukacija medicinskog osoblja i kontrola nad propisivanjem antibiotika mogu dodatno utjecati na
usporavanje rastućeg problema rezistencije.The worrying increase in the spread of multidrug resistant bacteria combined with the lack of new
and effective antibiotics, poses a threat to global health. The factors that contribute most to the
emergence of antimicrobial resistance are: limited availability of diagnostic methods, misuse and
overuse of antibiotics, overuse of antibiotics in agriculture, mismatch between the discovery of
new antibiotics and the speed of emergence and spread of antibiotic resistance, lack of antibiotic
control programs and poor infection prevention and control. The main antibiotic groups used to
treat resistant Gram-negative infections are carbapenems, fluoroquinolones, aminoglycosides and
polymyxins. The mechanisms of antimicrobial resistance fall into four main categories: enzymatic
degradation of antibacterial agents, alteration of a drug target, limiting uptake of a drug and active
drug efflux. Some of the most important Gram-negative pathogens causing serious infections due
to increasing multidrug resistance are Enterobacterales, Acinetobacter spp. and Pseudomonas spp.
The worrying prevalence of carbapenemase-producing bacterial strains is increasingly reducing the
efficacy of broad-spectrum carbapenems. The development of new antibiotics is a long-term
process, and new antibiotics rarely appear. One of the most important steps in the fight against
resistance is the use of faster and cheaper diagnostics that would allow directed antibiotic therapy
and reduce the excessive and inappropriate use of antibiotics. Education of the healthcare workers
and control over the prescription of antibiotics can help control the growing problem of resistance
Streptococcus pneumoniae - microbiology and pathogenesis of infection
No full textInfekcije uzrokovane bakterijom S. pneumoniae predstavljaju prijetnju ljudskom zdravlju.
Polisaharidna kapsula pneumokoka je glavni čimbenik virulencije, omogućavajući bakteriji
izbjegavanje imunološkog odgovora. Do sada je opisano više od 100 različitih kapsularnih
serotipova. Kapsula utječe na sposobnost pojedinog soja da uzrokuje bolest. Iako pneumokoki
uzrokuju teške invazivne infekcije s ponekad smrtonosnim ishodom, često samo koloniziraju
sluznice gornjih dišnih putova zdrave djece, odakle se mogu proširiti na osjetljive osobe putem
respiratornih kapljica. Pneumokoki najčešće uzrokuju infekcije gornjih dišnih putova, poput
otitisa i sinusitisa, te teže bolesti, uključujući upalu pluća (s ili bez bakterijemije) i meningitis.
Uvođenje pneumokoknih konjugiranih cjepiva u program cijepljenja djece u mnogim zemljama
dovelo je do značajnog smanjenja teških invazivnih pneumokoknih bolesti kod djece. Međutim,
u necijepljenoj populaciji starijih osoba se povećao broj invazivnih infekcija uzrokovanih
serotipovima koji nisu uključeni u cijepiva. Rastuća otpornost pneumokoka na antibiotike,
osobito na penicilin, dodatno ugrožava učinkovito liječenje.Infections caused by S. pneumoniae pose a serious threat to human health. The polysaccharide
capsule is a major virulence factor, mediating pneumococcal evasion of immune responses. To
date, more than 100 different capsular serotypes have been identified. The capsule influences a
strain’s ability to cause disease. Although these bacteria can cause severe invasive infections
with potentially lethal outcome, they are also common colonizers of the upper respiratory tract
in healthy children, from where they may spread to susceptible persons via respiratory droplets.
Pneumococci most commonly cause mild respiratory tract infections, such as otitis media and
sinusitis, but can also lead to more serious diseases, including pneumonia (with or without
bacteremia) and meningitis. The introduction of pneumococcal conjugate vaccines into
childhood immunization programs in many countries has led to a significant reduction in severe
invasive pneumococcal disease in children. However, infections caused by non-vaccine
serotypes have increased, resulting in invasive pneumococcal disease in unvaccinated
populations, such as older adults. Additionally, emerging resistance to penicillin threatens the
effectiveness of current therapies
Lyme borreliosis: pathogenesis and diagnosis
No full textBorrelia burgdorferi uzročnik je lajmske bolesti (LB) te pripada koljenu spiroheta. Visoko je invazivna bakterija prilagođena krpeljima i sisavcima. Patogeneza LB nije u potpunosti razjašnjena, ali ovisi o pokretljivost i citotoksičnost bakterije, antigenskoj varijabilnosti i imunološkom odgovoru domaćina. Klinička slika LB se dijeli na rani lokalizirani stadij, rani diseminirani stadij te kasni stadij. Erythema migrans (EM), ujedno i patognomoničan znak LB, je najčešća manifestacija u ranom stadiju bolesti, dok se u kasnijim stadijima javljaju neurološki simptomi, srčane manifestacije i artritis. Dijagnostika lajmske bolesti (LB) uključuje različite mikrobiološke metode u otkrivanju uzročnika, a dijeli se na izravne i neizravne metode. Izravne metode uključuju kultivaciju, mikroskopiju i PCR, dok su neizravne metode utemeljene na serološkom testiranju. PCR je brza dijagnostička metoda, ali ne može razlikovati akutnu od kronične infekcije. Serološki testovi detektiraju protutijela IgM i IgG u krvi, likvoru i sinovijalnoj tekućini. Serološka dijagnostika se provodi u dva koraka. Nakon primjene osjetljivih probirnih (EIA, IFA, CLIA i dr.) testova, reaktivni se rezultati potvrđuju potvrdnim visokospecifičnim imunoblot/Western blot testom. Serološki testovi imaju zadovoljavajuću osjetljivost i specifičnost, no interpretacija ovisi o kvaliteti testova i kliničkim podacima. U dijagnostici LB kombinira se klinička slika s laboratorijskim testovima te integracija različitih metoda osigurava pravodobno postavljanje dijagnoze i pravovremeno liječenje. Liječenje lajmske bolesti ovisi o stadiju bolesti. U ranim stadijima, koriste se oralni antibiotici tijekom 10-14 dana, dok se neurološke i reumatske manifestacije liječe primjenom parenteralnih antibiotika tijekom 2-4 tjedna.Borrelia burgdorferi is the causative agent of Lyme disease (LB) and belongs to the spirochete phylum. It is a highly invasive bacterium, adapted to ticks and mammals. The pathogenesis of LB is not fully understood but depends on the bacterium's motility, its cytotoxicity, its antigenic variability, and the host immune response. The clinical presentation of LB is divided into early localized, early disseminated, and late stages. Erythema migrans (EM), which is also a pathognomonic sign of LB, is the most common manifestation in the early stage, while neurological symptoms, cardiac manifestations, and arthritis occur in later stages. Diagnosis of LB involves various microbiological methods to detect the causative agent, categorized as direct and indirect methods. Direct methods include cultivation, microscopy, and PCR, while indirect methods are based on serological testing. PCR is a rapid detection method but cannot differentiate between acute and chronic infections. Serological tests detect antibodies (IgM and IgG) in blood, cerebrospinal fluid, and synovial fluid. A two-step testing process for LB is currently recommends. The most commonly screening tests are EIA, IFA and CLIA followed by confirmatory immunoblot/Western Blot test. Serological tests have satisfactory sensitivity and specificity, but interpretation depends on the test quality and clinical data. LB diagnosis combines clinical presentation with laboratory tests, and integration of different methods ensures timely diagnosis and treatment. Treatment of LB depends on the disease stage. In early stages, oral antibiotics are used for 10-14 days, while neurologic and rheumatic manifestations are treated with parenteral antibiotics for 2-4 weeks
IMPACT OF COVID-19 INFECTION ON COURSE OF PREGNANCY
No full textCOVID-19 je infekcija uzrokovana novim koronavirusom nazvanim SARS-CoV-2. Virus
se kod ljudi prvi put pojavio u prosincu 2019. god. u Wuhanu, u kineskoj provinciji Hubei te se
vrlo brzo proširio svijetom predstavljajući veliki izazov zdravstvenim institucijama. Svjetska
zdravstvena organizacija (SZO) je 11. ožujka 2020. god. službeno proglasila globalnu pandemiju.
Prvi slučaj bolesti u Republici Hrvatskoj dijagnosticiran je krajem veljače 2020. god., a do rujna
2021. god. inficirano je oko 372 000 ljudi od kojih je preko 8 300 umrlo. Budući da se radi o
novootkrivenom virusu još je uvijek puno nepoznanica o bolesti koju uzrokuje, kako u općoj
populaciji tako i u trudnica. Dosadašnja saznanja ukazuju da je klinički tijek bolesti u trudnica
sličan onome u općoj populaciji, a vrlo rijetko COVID-19 pozitivne trudnice imaju tešku kliničku
sliku bolesti. Zabilježen je vrlo mali rizik za vertikalni prijenos infekcije s majke na plod. S
obzirom da je riječ o novom virusu, zbog predostrožnosti trudnice se uključuju u skupinu
umjerenog rizika. Cilj ovog rada je istražiti utjecaj COVID-19 infekcije na tijek i ishod trudnoće.
Ovom retrospektivnom kohortnom studijom obuhvaćeno je 30 COVID-19 inficiranih
trudnica te jednak broj neinficiranih trudnica.COVID-19 is a disease caused by a new corona virus called SARS-CoV-2. The virus spread very
quickly around the world and presented a major challenge to all healthcare institutions. The virus
appeared in humans in December 2019 in Wuhan, in the Chinese province of Hubei. World Health
Organization (WHO) March 11, 2020 declared a global pandemic (2). The first case in the Republic
of Croatia was diagnosed at the end of February 2020, and by Septembre 2021, about 372 000
people were infected, out of whom over 8 300 died. As this is a newly discovered virus, as well as
the disease it causes, great efforts are still being made to find an effective drug / vaccine. There is
still a lot of information missing about COVID-19 and pregnancy. For now, the clinical course of
the disease in pregnant women is known to be similar to that in the general population. The poor
outcome of the virus in the course and outcome of pregnancy has not yet been proven, and there is
no conclusive evidence of vertical transmission through breast milk.
In this retrospective cohort study 30 infected pregnant women with COVID-19 and an equal
number of uninfected pregnant women were included. The aim of this study was to investigate the
impact of COVID-19 infection on course and outcome of pregnanc
KLEBSIELLA PNEUMONIAE- REZISTENCIJA NA ANTIBIOTIKE
No full textK. pneumoniae je gram-negativna, nesporogena, nepokretna štapićasta bakterija, pripadnik, obitelji Enterobacteriaceae. Široko je rasprostranjena u okolišu, a probavni sustav čovjeka služi joj kao primarni rezervoar. Većinom uzrokuje oportunističke infekcije povezane sa zdravstvenom skrbi. Novorođenčad, starije osobe i imunokompromitirani bolesnici predstavljaju najrizičnije skupine. Zabrinjavajuća pojava hv sojeva te novih MDR klonova rezultirala je pojavom infekcija među prethodno zdravim osobama . K. pneumoniae posjeduje tri glavna mehanizma rezistencije na β-lakatame: proizvodnja enzima, prekomjerna ekspresija efluksnih pumpi i modifikacija porina. Sojevi koji proizvode karbapenemaze trenutno su jedan od najvažnijih bolničkih patogena zbog različitih fenotipova rezistencije i globalne proširenosti. Otporni su na većinu β-laktamskih antibiotika, kinolone i na većinu aminoglikozida. Terapijske mogućnosti su ograničene na rezervne antibiotike: ceftazidim-avibaktam i novije kombinacije s inhibitorima β-laktamaza, fosfomicin, kolistin, tigeciklin i odabrane aminoglikozide te nove antibiotike kao što su plazomicin, eravaciklin i cefiderokol. Zabrinjavajući je i porast kolistin-karbapenem rezistente K. pneumoniae koji predstavlja javnozdravstvenu prijetnju jer rezistencija na kolistin dodatno smanjuje terapijske mogućnosti. Također, bilježi se i zabrinjavajuća pojava rezistencije na nove kombinacije β-laktama s inhibitorom β-laktamaze kao što je ceftazidim/avibaktam. Mjere kontrole i prevencije infekcija uz racionalnu primjenu i upravljanje antibioticama ključne su za sprječavanje širenja rezistencije i produljenje vremena djelotvornosti novih antibiotika.K. pneumoniae is a Gram-negative, nonsporogenic, immotile, rod-shaped bacterium that belongs to the Enterobacteriaceae family. It is widely distributed in the environment, the human digestive tract serves as its primary reservoir. Most infections caused by K. pneumoniae are opportunistic, healthcare-associated infections. The groups most at risk are infants, the elderly, and immunocompromised patients. However, a significant increase in hv strains and the emergence of new MDR clones have led to the emergence of infections in previously healthy individuals. K. pneumoniae has three main mechanisms of β-lactam resistance: enzyme production, efflux pump overexpression, and porin modification. Carbapenemase-producing strains are currently one of the most important nosocomial pathogens because they exhibit different resistance phenotypes and spread worldwide. They are resistant to most β-lactam antibiotics, quinolones, and most aminoglycosides. Therapeutic options are limited to reserve antibiotics: ceftazidime-avibactam and newer combinations with β-lactamase inhibitors, fosfomycin, colistin, tigecycline, selected aminoglycosides, as well as newer options such as plasomycin, eravacycline, and cefiderocol. The increase in colistin-carbapenem-resistant K. pneumoniae poses a serious public health threat, as resistance to colistin further limits therapeutic options. Also of concern is the emergence of resistance to new combinations of antibiotics with a β-lactamase inhibitor such as ceftazidime/avibactam. Appropriate infection control and antimicrobial stewardship programme are key to preventing the spread of resistance and extending the period during which new antibiotics are effective
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