Healthcare associated bloodstream infections in Polish hospitals: prevalence, epidemiology and microbiology-summary data from the ECDC Point Prevalence Survey of Healthcare Associated Infections 2012-2015

Aggregated data from the Polish Point Prevalence Survey of Healthcare Associated Infections and Antimicrobial Use (PPS HAI&AU) collected between 2012 and 2015 were used to describe the epidemiology of healthcare associated bloodstream infections (BSI) in Polish hospitals, in order to assess the rationale for introducing a BSI surveillance programme in our country and analyse selected risk factors. Data were collected according to the ECDC PPS HAI&AU protocol. Within four years, records for 71,039 patients were collected in 36 (2012), 32 (2013), 112 (2014), and 158 (2015) hospitals; representativeness was evaluated as good in 2012-2013, and excellent from 2014. HAI was found in 4,258 of these patients; laboratory confirmed BSI, including catheter related infections (CRI), and neonatal BSI accounted for 7.7% (329 cases). A representative control group was selected during a random selection process. Out of 329 cases of BSI, 48.9% were associated with vascular access, and 70.8% of them met the criteria of (CRI). The most frequently isolated microorganisms were Staphylococci with 150 isolates (45.6%). Most of them were coagulase-negative (64.4%) that usually caused CRI. Out of 53 S. aureus isolates 24.5% were methicillin-resistant. Enterobacteriaceae were responsible for 31.3% of BSI (n = 103), 50.0% of them were resistant to third generation cephalosporins and 6 (5.8%) to carbapenems. Since little is known about the epidemiology of BSI in Poland, introduction of a countrywide surveillance programme based on incidence is justified, in order to create national prevention initiatives based on local epidemiology, as well as bundle focusing on prevention of CRI.

Identifying the Infection Control Areas Requiring Modifications in Thoracic Surgery Units: Results of a Two-Year Surveillance of Surgical Site Infections in Hospitals in Southern Poland

BACKGROUND

Surgical site infection (SSI) is considered to be a priority in infection control. The objective of this study is the analysis of results of active targeted surveillance conducted over a two-year period in the Department of Thoracic Surgery at the Pulmonology and Thoracic Surgery Center in Bystra, in southern Poland.

PATIENTS AND METHODS

The retrospective analysis was carried out on the basis of results of active monitoring of SSI in the 45-bed Department of Thoracic Surgery at the Pulmonology and Thoracic Surgery Center in Bystra between April 1, 2014 and April 30, 2016. Surgical site infections were identified based on the definitions of the European Centre for Disease Prevention and Control (ECDC) taking into account the time of symptom onset, specifically, whether the symptoms occurred within 30 d after the surgical procedure. Detection of SSI relied on daily inspection of incisions by a trained nurse, analysis of medical and nursing entries in the computer system, and analysis of all results of microbiologic tests taken in the unit and in the operating room.

RESULTS

In the study period, data were collected regarding 1,387 treatment procedures meeting the registration criteria. Forty cases of SSI were detected yielding an incidence rate of 3%. Most cases (55%) were found in the course of hospitalization and 45% were detected after the patient's discharge. The SSIs were classified as follows: superficial, 37.5%; deep infections, 7.5%; and organ/space infection, 55%. Among patients who were diagnosed with SSI, most were male (77.5%). For patients with an American Society of Anesthesiologists (ASA) score I-II the incidence rate was 2%; ASA score III or more, 3.7%. The incidence rate varied from 0.3% in clean surgical site to 6.5% in clean-contaminated site.

CONCLUSIONS

The study validated the usefulness of targeted surveillance in monitoring SSIs in patients hospitalized in thoracic surgery departments. Surgical site infection surveillance identified areas of care requiring modifications, namely, organization of post-discharge and microbiologic diagnostics of infection cases.

New insights on the phylogeny and biology of the fungal ant pathogen Aegeritella

This paper evaluates the phylogenetic position of the ectoparasitic fungus Aegeritella tuberculata Bałazy & Wiśniewski, and broadly discusses its presence on ants in southern Poland. Field work was conducted in the Silesian Beskid Mountains in 2011-2013. The fungus was found on four species of ants: Lasius niger L., Lasius brunneus Latr., Formica lemani Bondr. and Formica fusca L. The first three species have not been noted previously in the literature as hosts of Aegeritella fungi. The infection rate ranged from 1% for Formica lemani to 21% for L. brunneus. Molecular analysis based on ITS and SSU rDNA sequences revealed close relationships between Aegeritella and Trichosporon isolates. We conclude that the genus Aegeritella-inceratae sedis until now, should be placed within the fungal group Basidiomycota, Tremellomycetes, Tremellomycetidae, Tremellales, Trichosporonaceae.

Leucocoprinus lilacinogranulosus (Henn.) Locq. in Poland

The paper presents the first finding of <em>Leucocoprinus lilacinogranulosus </em>in Poland, the rare, exotic fungus, sporadically found in Europe. The species was found indoors, on soil in terrarium. A description based on the specimens from Poland as well as photographs and microcharacter drawings are presented.

[Granulomatous pneumonia as a complication of intravesical BCG immunotherapy--a case report]

BCG (Bacillus Calmette-Guerin) comprises an attenuated strain of Mycobacterium bovis and is used for vaccination against tuberculosis. An additional use of BCG is for immunotherapy of cancer in which the vaccine is administered intravesically for the treatment of superficial bladder cancer. The efficacy of immunotherapy with BCG in the prevention of recurrence is estimated at 70-99%, which is higher than for local chemotherapy. The most frequent complications of such treatment include fever and urinary bladder inflammation, while serious complications of haematogenous organ inflammation, especially inflammation of the lungs with the formation of pulmonary caseosus granulomas, are rarely seen. The authors reported a case of a 68-year-old man who was treated with intravesical BCG instillations due to a superficial bladder cancer. The patient underwent transurethral resection of bladder cancer and then periodically received intravesical BCG instillations. A few days after one instillation, systemic symptoms with a high fever appeared. Further examinations showed features of hepatitis and spread pulmonary changes. The patient underwent videothoracoscopy, and a fragment of lung parenchyma was collected. The histopathological examination revealed the presence of granulomas with central caseosus necrosis. Suspecting BCG infection, diagnostics were enhanced to include bacteriological and genetic tests for the presence of acid-resistant bacilli, which finally gave negative results. The authors diagnosed granulomatous pneumonia as a complication of intravesical BCG immunotherapy. Treatment with antituberculous drugs was initiated. After completing pharmacological treatment, radiological control was performed, which showed significant but not complete remission of pulmonary changes.

Octaviania asterosperma (hypogeous Basidiomycota). Recent data to ecology and distribution

Phylogenetic analyses place <em>Octaviania asterosperma</em> in the Boletales, with <em>Leccinum</em> being the closest relative. Results of the structural investigation of <em>O. asterosperma</em> ectomycorrhiza with <em>Fagus</em> sylvatica confirm this systematic position. In Europe the species is an ectomycorrhizal partner of broad-leaved trees, such as <em>Carpinus, Corylus, Fagus, Quercus</em> and <em>Tilia</em>. This paper aims at presenting the new data to the distribution of <em>O. asterosperma</em> in Central Europe. The description of the basidiocarps discovered in Poland in the recent years is also given, together with evidence for the parasitic relationship of <em>Sepedonium laevigatum</em> with <em>O. asterosperma</em>. We also present the information concerning all known localities of the species in Poland and its distribution map. Data on the ecologz, distribution and status <em>O. asterosperma</em> in Europe, and some structural aspects of basidiocarps and spores, are also summarized.

Emergence of Clostridium difficile infection in tuberculosis patients due to a highly rifampicin-resistant PCR ribotype 046 clone in Poland

Clostridium difficile infection (CDI) is a major cause of nosocomial diarrhea. CDI is known to develop after antibiotic administration, but anti-tuberculosis agents have rarely been implicated. We documented an outbreak caused by a highly rifampicin-resistant C. difficile strain of polymerase chain reaction (PCR) ribotype 046 in patients with active tuberculosis.

[Blood culture results in Specialistic Unit for Pulmonary Illness and Tuberculosis in Bystra in 2008-2010]

The study presents the results of analysis of blood culture examination carried out in Specialistyczny Zespół Chorób Płuc i Gruźlicy in Bystra in 2008-2010. Contamination incidence and number of blood samples taken from individual patients make it possible to assess if the procedure for taking material for microbiological examination is carried out. The analysis of positive test results allows for the evaluation of epidemiological condition of the hospital and it is also largely dependent on the specificity of a health centre. Because of a growing incidence of infections with opportunistic pathogens, the growth of coagulase-negative Staphylococcus sp., viridans streptococci and Corynebacterium sp. in blood samples requires extensive assessment of clinical state and analysis of laboratory examination in order to distinguish between infections and sample contamination.

[Epidemiologic analysis of increased frequency of isolation of multidrug-resistant Acinetobacter sp. using PFGE technique]

From November 2007 to November 2008, 25 multidrug resistant Acinetobacter baumanii/haemolyticus strains were isolated from 21 patients treated in the Pulmonary Diseases and Tuberculosis Hospital in Bystra. Seven cases were regarded as nosocomial infections. Most of the patients were hospitalized several times and/or admitted from other hospitals. The aim of this study was to find the reason for increasing colonization and infections with this microorganism. PFGE analysis showed high, exceeding 90% relationship among tested strains suggesting their clonal spread among patients in several hospitals in our region. Despite excessive search, no environmental reservoir of Acinetobacter was found, so cross-contamination via staff's hands was suspected the most likely source of this spread. Therefore, hand hygiene and contact isolation seemed the most relevant infection control measures.