Fecal Microbiota Transplantation Inhibits Multidrug-Resistant Gut Pathogens: Preliminary Report Performed in an Immunocompromised Host

Colonization of the gastrointestinal tract with multidrug-resistant (MDR) bacteria is a consequence of gut dysbiosis. We describe the successful utilization of fecal microbiota transplantation to inhibit Klebsiella pneumoniae MBL⁺ and Escherichia coli ESBL⁺ gut colonization in the immunocompromised host as a novel tool in the battle against MDR microorganisms.

ClinicalTrials.gov identifier NCT02461199.

Rotavirus vaccination in central Europe

Each year, rotavirus (RV) infection is the leading cause of acute gastroenteritis requiring hospitalisation and of nosocomially transmitted diseases in children younger than 5 years across Central European Vaccination Awareness Group (CEVAG) countries; however, inadequate surveillance systems and lack of routine RV testing still exist in most CEVAG countries, making it difficult to accurately assess the present burden of acute RV gastroenteritis in the younger population. Furthermore, routine immunisation of infants with RV vaccines has not been implemented, and no official and uniform recommendations exist in most of the countries in these territories. The present study provides CEVAG country-specific estimates of the disease burden of RV gastroenteritis among the youngest population and presents evidence-based advice on the use of RV vaccines in the region, while providing a framework for vaccination at the national level.

[Paediatric Expert Group on the Immunization Programme. Activities focusing on effective immunization in Poland]

The Paediatric Expert Group on the Immunization Programme was established in January 2007. It is an independent advisory body to the Minister of Health. The Expert Group consists of paediatricians from various sub-specialities. Most of them are members of the Polish Society of Vaccinology (Table I). The Group started their activities informally in 2005. The first project concerned changes in immunization against tuberculosis and prophylaxis of measles, mumps and rubella. The project was fully implemented in 2006. The changes initiated three years ago, gradually implemented in the Immunization Programme are a result of wide cooperation with the Ministry of Health, Department of Health Policy Chief Sanitory Inspector, as well as the Institute of Tuberculosis and Pulmonary Diseases. The aim of the Paediatric Expert Group on the Immunization Programme is to present a unified policy in matters related to vaccination, leading to rapid changes in the prophylaxis of infective diseases which are still a threat to the life and health of children.

Clonal diversity and resistance mechanisms in tetracycline-nonsusceptible Streptococcus pneumoniae isolates in Poland

The frequency of tetracycline resistance in Streptococcus pneumoniae isolates in Poland is one of the highest in Europe. The aim of this study was to analyze the clonal diversity and resistance determinants of tetracycline-nonsusceptible S. pneumoniae isolates identified in Poland and to investigate the effect of tetracycline resistance on their susceptibilities to tigecycline, doxycycline, and minocycline. We have analyzed 866 pneumococcal isolates collected from 1998 to 2003 from patients with respiratory tract diseases, and 242 of these (27.9%) were found to be resistant to tetracycline. All of the resistant isolates were characterized by testing of their susceptibilities to other antimicrobials, serotyping, pulsed-field gel electrophoresis (PFGE), and identification of tetracycline resistance genes and transposons. Selected isolates representing the main PFGE types were analyzed by multilocus sequence typing. Among the isolates investigated, 27 serotypes and 146 various PFGE patterns, grouped into 90 types, were discerned. The most common PFGE type, corresponding to serotype 19F and sequence type 423, was represented by 22.3% of all of the tetracycline-resistant isolates. The tet(M) gene was the sole resistance gene in the group of isolates studied, and in over 96% of the isolates, the Tn916 family of tet(M)-containing conjugative transposons was detected. Several isolates contained specific variants of the transposons, the Tn1545-like, Tn3872-like, or Tn2009-like element. The correlation between the MICs of tetracycline, doxycycline, and minocycline was revealed, whereas no cross-resistance to tetracycline and tigecycline was observed.

[Self-medication with antibiotics in Poland]

Antibiotic resistance, the important public health threat, depends on antibiotic overuse/misuse. Self-medication with antibiotics is of serious medical concern. The aim of the study, as a part of SAR project (Self-medication with antibiotic in Europe) was to survey the incidence of this phenomenon.

MATERIAL AND METHODS

In Poland among 938 respondents of the questionnaire 27% adults were treated with antibiotics at least once a year, 13% of the therapies were undertaken without medical consultation. The most frequently prescribed antibiotic was amoxicillin, the most often self-ordered--fusafungine.

RESULTS

The main self-medicated symptoms were sore throat and common cold. The duration of self-ordered therapy was less then 5 days. The sources of antibiotics used for self-medication were leftovers and those given by friends or family.

CONCLUSION

The results of the study confirmed that antibiotic self-medication is relatively frequent problem in Poland and interventions are required in order to reduce the frequency of antibiotics misuse.

[Prevalence of antibodies against Anaplasma phagocytophilum, Babesia microti i Borrelia burgdorferi in adults in North-Eastern Poland]

THE AIM

of the study was to evaluate the seroprevalance of antibodies against Anaplasma phagocytophilum and Babesia Microti in healthy north-eastern Poland, adult population.

MATERIAL AND METHODS

The study was conducted in a group of 142 healthy adults (mean age 19-22), bitten by ticks within last 2 years. The control group consisted of 50 adults from central Poland (nonendemic area). The antibody levels for A. phagocytophilum (IgG/Ap-Ab) and B. microti (IgM/Bm-Ab) were evaluated in two series of samples from the same persons (interval 5-6 months) by immunoenzymatic tests (Borrelia Biomedica, Austria), immunofluorescence test (Human Granulotic Ehrlichiosis IFA IgG and Babesia microti IFA IgG from MRL Diagnostics).

RESULTS

Positive results for A. phagocytophilum were defined as titres > or =1:256 and for B. microti > or =1:64 and B. burgdorferi > or = 11 BBU/ml. Positive results for IgG B. burgdorferi during the first collection were revealed in 16% (n=24/142) of individuals from endemic area and in 4% (n=2/50) of the control group, which was statistically relevant (p<0,05). IgG A. phagocytophilum antibodies were present in 3,5% (n=5/142) of individuals from the endemic area, but for IgG B. microti antibodies (IgG/Bm-Ab) no positive results were found. No IgG antibodies against A. phagocytophilum and B.microti, were found in individuals from non-endemic area. During the second collection, in individuals from the endemic area, the antibodies against B. burgdorferi were found in 9,8% (n=14/142), IgG A. phagocytophilum antibodies (IgG/Ap-Ab) in 4,9% (n=7/142) and against B. microti (IgG/ Bm-Ab) in 1,4% (n=2/142). The antibodies against B. Burgdorferi were found in 2% (n=1/150) of the control group during the second collection, and no IgG against A. phagocytophilum and B. microti were found.

CONCLUSION

[corrected] Evaluating the seroprevalance of the studied antibodies in both collections, a conclusion was drawn that there was no significant increase of antibodies levels directly after the highest exposition to tick bites. None of individuals showed 4-fold antibody level increase between the first and second collection. The seroconversion for IgG/Bm-Ab antibodies was present in 1,4% (n=2/142) of individuals, in those 2 cases a 2-fold antibodies level increase was observed. As far as IgG/Ap-Ab antibodies are concerned the seroconversion was observed in 2,1% (n-3/142), but only one case shown a 3-fold antibodies level increase. No seroconversion of B. burgdorferi antibodies were found in the second collection.

[Chlamydia pneumoniae infection in patients with advanced carotid atherosclerosis]

Despite the growing number of scientific reports showing different markers of infection caused by Chlamydia pneumoniae in patients with advanced atherosclerosis, there is still no clear confirmation of a pathogenetic link between this infection and atherogenesis. The aim of the present study was to investigate the presence C. pneumoniae DNA in peripheral blood mononuclear cells and carotid endarterectomy samples obtained from patients with advanced atherosclerosis according to the presence specific antibodies against C. pneumoniae in serum. The levels of IgG, IgM and IgA antibodies to C. pneumoniae were determined by enzyme immunoassay (EIA) in sera of 36 patients with advanced atherosclerosis undergoing carotid endarterectomy. The presence of C. pneumoniae DNA in the carotid samples and in peripheral blood mononuclear cells was investigated by a nested polymerase chain reaction (PCR). We have not confirm the presence of C. pneumoniae DNA either in the carotid endarterectomy samples or in peripheral blood mononuclear cells, both in patients having the specific antibodies against C. pneumoniae and in seronegative patients. In the studied group of patients with advanced carotid atherosclerosis there was no correlation between the presence of specific antibodies against C. pneumoniae and the presence of C. pneumoniae DNA in endarterectomy samples and peripheral blood mononuclear cells.

The antibodies against Bordetella pertussis in sera of patients with Parkinson's disease and other non-neurological diseases

OBJECTIVES

It has been reported that the prevalance of parkinsonism might be associated with exposure to whooping cough.

METHODS

Examination of levels of antibodies against Bordetella pertussis in serum using enzyme-linked immunosorbent assay (ELISA) tests [presence of IgG antibodies against filamentous hemagglutinin and pertussis toxin (PT)] were performed in 81 persons (including 45 patients with controls) (age-matched groups).

RESULTS

Positive results were found in patients with Parkinson's disease (PD), patients with other non-inflammatory diseases, and controls (about 40-45% in each group). A detailed examination of separate responses (IgG and IgA antibodies against PT, and a whole cell immune response) and of the serum level of immunoglobulins IgG, IgA and IgM was also performed.

CONCLUSION

Our results demonstrate numerous cases of whooping cough serum antibodies among the adult population (also among PD patients). The results of our research, i.e. a common occurrence of Bordetella pertussis infection do not provide evidence of relationship between PD and the above-mentioned infection.

[Anthrax as a bioweapon]

The risk of biological and chemical terrorism is growing according to availability of modern biotechnologies and financial resources. The most potent biological weapon mentioned in the last decade is anthrax. The number of naturally acquired infections in humans is constantly reduced, however endemic areas are located in South and Middle Americas, South Europe, Asia and Africa. In any case of infection laboratory confirmation is indicated. Primary basic testing is available in all microbiology laboratories. In the current situation the medical and epidemiological infrastructure and microbiology diagnostics must be prepared for early and rapid coordinated action in order to detect and respond to biological and chemical attacks.

[Modern possibilities of bioterrorism diagnosis]

One of the most important components of early detecting and response to biological attack are microbiological diagnostic methods. In order to provide the effectiveness of diagnosis continuous training in detection of potentially dangerous bioterrorist agents is needed. Basic information about selected microbiological agents most dangerous for public health, belonging to A and B CDC categories are presented in the article. The most potent biological weapon mentioned in the last decade is anthrax. Other potential bioterrorist agents discussed in this article are Francisella tularensis, Yersinia pestis, Brucella species and Coxiella burnetii.

Hospital infection control in Poland

During the last 10 years, as in other areas of the public sector in Poland, the healthcare system has undergone important changes presenting a challenge for medical staff and healthcare managers alike. Since 1997, the Polish Government has undertaken important healthcare reforms. New regulations have introduced decentralization of management and a financing system for hospitals. These changes have provided favourable conditions in which to implement an infection control system for hospitals. The most important recent initiatives are training courses and workshops for hospital staff organized in co-operation with microbiologists and epidemiologists as well as preparation of recommendations and guidelines for hospitals. Several non-governmental organizations have been set up to improve hospital hygiene, infection control and monitoring of antimicrobial resistance.

[Tubulointerstitial nephritis related to immunotherapy and immunostimulation: a report of two cases]

Two cases of tubulointerstitial nephritis (TIN) with renal failure related to immunotherapy (case 1) and immunostimulation (case 2) have been described. Case 1: 18 years old male patient with hay fever was admitted because of rapid increase of serum creatinine from 1.1 mg/dl to 5.5 mg/dl, fever, weight loss and anemia which developed during 6 months after second course of immunotherapy. Case 2: 12 years old boy was admitted because of fever, weight loss and rapid progression to renal failure after treatment of pharyngitis with antibiotics and immunostimulant drug. In both patients renal biopsy was performed and TIN with huge lymphocytes T infiltrates was diagnosed. After 6 months treatment with corticosteroids renal function turned back to previous levels in both patients. Pathogenesis and treatment of TIN is discussed.

National and local antibiotic policies in Central and Eastern Europe

To assess the antibiotic policies of Central European countries, we performed an overview of antibiotic stewardship, prescription habits and antibiotic prescription regulatory procedures. Since most Central European countries have had centralized health care and drug policies, the situation 10 years after decentralization is surprising. Only 3 of 10 Central European countries have some regulation of prescription of antibiotics, only 4 restrict some antibiotics, only 5 have hospital and only 3 national antibiotic policies. In all but 3 countries physicians can prescribe quinolones and/or 3rd generation oral cephalosporins as first-line antibiotics. Information on local and national antibiotic policies in Central and Eastern European countries is given including prescription guidelines for antibiotic use in community and hospital.

Comparison of four serological methods for the detection of diphtheria anti-toxin antibody

The aim of this study was to compare four serological methods for the detection of Corynebacterium diphtheriae IgG anti-toxin antibodies (IgG-DTAb) in human serum. One hundred serum samples were evaluated for C. diphtheriae IgG-DTAb by four different methods: passive haemagglutination (PHA), latex agglutination test (LA), toxoid enzyme-linked immunosorbent assay (Toxoid-ELISA), and toxin-binding inhibition enzyme-linked immunosorbent assay (ToBI-ELISA). As the external standardisation the neutralisation test for C. diphtheriae toxin in Vero cells (TN Vero) was used. For internal standardisation of IgG-DTAb titres, the WHO standard serum of human diphtheria antitoxin was used. The study revealed a poor correlation between the reference test and the PHA (r=0.34 Pearson's correlation coefficient), an acceptable correlation for the LA (r=0.74), a good correlation for the Toxoid-ELISA (r=0.81) and a very good correlation for ToBI-ELISA (r=0.93). The sensitivity measurements of PHA, LA, Toxoid-ELISA and ToBI-ELISA tests, were 14, 100, 94, 96% respectively and the corresponding specificity characteristics were 86, 76, 94, 90 respectively. Of the four evaluated methods, the ToBI-ELISA could be recommended for scientific and precise laboratory assays of diphtheria antibody levels in humans. For screening purposes the Toxoid-ELISA could be used, but the accuracy of antibody titres below 0.1 IU/ml, considered as the limits of protection, is questionable. Both tests offer very useful alternatives to the in vitro diphtheria toxin neutralisation test in Vero cells. Because of their unsatisfactory correlation and sensitivity as compared to the reference method, PHA and LA should be avoided and replaced by one of the two enzyme immunoassays.

[Immunity against diphtheria and tetanus in the adult Polish population]

The aim of the study was to evaluate immunity against diphtheria and tetanus in healthy adult population in Poland. For determination of antitoxin IgG antibody, toxoid enzyme-linked immunosorbent assay (Toxoid-ELISA) was used. Serum samples were obtained from different regions of Poland and titrated for diphtheria (n = 2442) and tetanus (n = 827) IgG antitoxin. For calibration of anti-toxins determination, the WHO standard of human diphtheria and tetanus antitoxin was used. About 32% (n = 787) of persons were non-protected against diphtheria (IgG-DTAb < 0.1 IU/ml) and 24% (n = 195) against tetanus (IgG-TTAb < 0.1 IU/ml). In 63% (n = 1528) individuals basic protection for diphtheria and 48% (n = 402) for tetanus (0.1-1.0 IU/ml IgG-DTAb and IgG-TTAb) were observed. Only 5% (n = 127) were fully protected for diphtheria and 28% (n = 230) for tetanus (IgG-DTAb and IgG-TTAb > 1.0 IU/ml). In adults between 30-64 years of age, not vaccinated at least during last 10 years, 43% of persons were non-protected. The study showed insufficient immunity against diphtheria in adults. We indicate booster immunisation for selected group of persons.

Outbreak of ceftazidime-resistant Klebsiella pneumoniae in a pediatric hospital in Warsaw, Poland: clonal spread of the TEM-47 extended-spectrum beta-lactamase (ESBL)-producing strain and transfer of a plasmid carrying the SHV-5-like ESBL-encoding gene

In 1996 a large, 300-bed pediatric hospital in Warsaw, Poland, started a program of monitoring infections caused by extended-spectrum beta-lactamase (ESBL)-producing microorganisms. Over the first 3-month period eight Klebsiella pneumoniae isolates were identified as being resistant to ceftazidime. Six of these were found to produce the TEM-47 ESBL, which we first described in a K. pneumoniae strain recovered a year before in a pediatric hospital in Lódź, Poland, which is 140 km from Warsaw. Typing results revealed a very close relatedness among all these isolates, which suggested that the clonal outbreak in Warsaw was caused by a strain possibly imported from Lódź. The remaining two isolates expressed the SHV-5-like ESBL, which resulted from the horizontal transfer of a plasmid carrying the blaSHV gene between nonrelated strains. The data presented here exemplify the complexity of the epidemiological situation concerning ESBL producers typical for large Polish hospitals, in which no ESBL-monitoring programs were in place prior to 1995.

[Long-term efficacy of hepatitis B vaccine in children with chronic renal failure]

The aim of the study was to determine the duration of post vaccination immunity and antibody persistence in children in different stages of chronic renal failure. The study was performed in 25 children and time of observation was 12-36 months. After completing vaccination seroprotection rate was 92% in non-dialysed children and 77% in dialysed. After 36 months of observation seroprotection was found in 90% of patients, none of them was infected by HBV. We conclude that in case of decrease in antibody titer below 100 mIU/ml the booster dose of vaccine is indicated.

[The influence of hepatitis B vaccine dose on direct results of hepatitis B vaccination in children with nephrotic syndrome]

In the first phase of the study on the efficacy of vaccination against hepatitis B with a double dose of the vaccine in children with steroid-sensitive nephrotic syndrome (NS), the best results were obtained in the group of patients in remission of NS. The aim of the present study was to compare the efficacy of standard and double doses of the vaccine in patients in remission. After excluding HBV infection, recombinant hepatitis B vaccine was administered i.m. according to the 0, 1, 2 month protocol in a standard dose in group I and a double dose in group II. In both groups the seroprotection rate was similar (I group-96%, II group-93%), however the anti-HBs antibody level was significantly higher in group II during a 3 month observation period.