Jirí Benes

Purpose: To present the range of diseases produced by a methicillin-resistant strain of Staphylococcus aureus (MRSA). To assess the efficacy of procedures likely to cure MRSA infections and possibly to eradicate colonization. Methods: Clinical trial studying the course of MRSA infections or colonization of in-patients, treated at the Department of Infectious Diseases of the Teaching Hospital Na Bulovce, Prague, between 1 January 2004 and 31 August 2005. The trial also took into account the results of these patients follow-up as out-patients. Results: Included in the trial were 59 patients-22 presenting MRSA infections and 37 MRSA colonization. In 14 patients we found simultaneous colonization in several anatomical sites, while in 15 patients we saw, in addition to the MRSA infection, colonization at another site. Among the infections most frequent were infections of soft tissues (11), while colonization occured chiefly in the nasal mucosa (14) and in skin defects (8). In the treatme...

The authors report a case of complicated sepsis caused by nontoxigenic Corynebacterium diphtheriae biotype gravis in a young immunocompetent female with no predisposing factors. She acquired the infection from her boyfriend, an asymptomatic carrier of nontoxigenic strain. The primary site of infection and subsequent sepsis was not identified. The occurence and importance of carriage and invasive infections caused by nontoxigenic strains of Corynebacterium diphtheriae are discused.

Incidence of Gram-positive infections caused by bacteria resistant to commonly used antibiotics has increased in the last decades. Resistant strains appeared later in the Czech Republic, however their number has been increasing and new antibiotics have to be used. The greatest increase of frequency can be seen in infections caused by methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci. Vancomycin-resistant enterococci are usually found in hematooncology patients. Curative use of vancomycin is limited due to a narrow spectrum of activity, nephrotoxicity, and limited penetration into tissues (lung) and cerebrospinal fluid. Linezolid is a good option mainly in infections of skin and soft tissues, and it has an evincible advantage over vancomycin in the treatment of nosocomial pneumonia and surgical-site infections. Oral formulations are favourable allowing switch therapy and earlier discharge from hospital.

... Characterisation of human herpes viruses and enteroviruses using a microarray technology: CLART Entherpex. Manjón N., Macias A., Benito R., Gomez J., Romero M. ... Stefani S., Monaco M., Campanile F., Cafiso V., Sanchini A., Marone P., Pantosti A. ...

No standard categorization of quinolone antibiotics into generations may be found in either Czech or world literature. The author recommends a categorization into four groups defined according to their spectrum of action and utilization: 1) preparations for the treatment of urinary tract infections; 2) systemically acting quinolones chiefly efficacious against Gram-negative bacteria; 3) so-called respiratory quinolones; and 4) quinolones with a very broad spectrum of action suitable for the treatment of very complicated infections. The author describes the chief characteristics of the most important quinolone antibiotics, including preparations either in their development stage or whose development has been prematurely interrupted because of adverse side-effects. The list includes all preparations that are or were temporarily registered in the Czech Republic.

The case history of a man referred to our department with the diagnosis of purulent meningitis; actually, he presented spondylodiscitis of the lumbar spine with the infection spreading into the spinal canal and the left psoas muscle. The disease was caused by a strain of Staphylococcus aureus, which in vitro was sensitive to penicillin. However, treatment with crystalline penicillin in combination with ciprofloxacin failed. The paper suggests a differential diagnosis permitting to distinguish a typical purulent meningitis and an abscess in the spinal canal. The authors also discuss the suitability of administering penicillin in staphylococcal sepsis caused by a sensitive strain. The authors do not recommend crystalline penicillin in the management of severe staphylococcal infections even in cases, where the isolated S. aureus strain is really sensitive to penicillin.

For the time being telithromycin is the only representative of a new group of antibiotics - ketolides - available for clinical use. Its chemical structure is derived from erythromycin, but it is better resorbed from the digestive tract and is efficacious against most macrolide-resistant strains of Streptococcus pneumoniae and Streptococcus pyogenes. Telithromycin is registered for the treatment of respiratory infections: sinusitis, acute exacerbation of chronic bronchitis, community-acquired pneumonia and streptococcal tonsillopharyngitis. The drug is well tolerated. It is less likely to induce MLS(B) resistance than macrolides with a 14- or 15-member ring.

Antibiotic resistance is an increasing community problem and is related to antibiotic use. If antibiotic use could be reduced, the tide of increasing resistance could be stemmed. e-Bug is a European project involving 18 European countries, partly funded by The Directorate-General for Health and Consumers (DG SANCO) of the European Commission. It aims to develop and disseminate across Europe a junior and senior school teaching pack and web site (hosting the lesson plans and complementary games) that teach young people about ...

Several expert systems were developed for assessment of community-acquired pneumonia (CAP) and its severity in individual patients. Scoring systems PSI, CURB-65, and CRB-65 are widely used. They were primarily designed for easier decision on need of CAP patients hospitalization. Newer scoring systems evaluate especially severity of CAP and need of intensive care. This group of systems comprise ATS/IDSA recommendations, CURXO-8O, SMART-COP, and SMRT-CO. The last one appears to be the most appropriate for common practice but more studies are necessary to confirm this opinion. Regardless of the scoring systems the authors recommend more extensive usage of pulse oxymetry in the care of CAP patients.

To recognize incidence and epidemiological characteristics of infective endocarditis (IE) in the Czech Republic. A prospective multicentre observational study on occurrence and characteristics of IE in 29 hospitals within one year. A cooperative physician in every hospital reported all cases of IE that occurred in pre-defined hospital attraction area in 12 consecutive months. A unified anonymous form was used for reporting. Only patients fulfilling the modified Duke criteria were enrolled. One hundred and thirty-four cases of IE were reported. Thus, crude incidence of IE appeared 3.4 cases/100,000/year. Vegetations were found on aortic valves in 45.5% and on mitral valves in 40.3%. The most common etiological agent was Staphylococcus aureus (29.9%). Etiology was not established in 45 cases (33.6%), mostly due to previous antibiotic treatment. The most frequent predisposing conditions were purulent infections, namely in lower extremities, and previous invasive cardiac procedures (car...

Tigecyclin represents an important contribution for treatment of difficult-to-treat infections caused by polymicrobial or resistant flora. Its characteristics destinate it for use beyond the registered indications. Authors submit two case reports documenting its promising effect in patients with complicated pulmonary infection in whom standard treatment was not successful.

Tigecycline belong to glycylcycline antibiotics. This new group of antibiotics was derived from lipophilic tetracyclines but differs from them by higher effectivity, lower affinity to bacterial resistance mechanisms, and very long half-time. Tigecycline is registered for treatment two groups of infections: skin and soft tissue infections and complicated intra-abdominal infections. Nevertheless, its therapeutic use probably can be enlarged to pneumonia, STD, infections caused by multi-resistant Helicobacter pylori, subacute and chronic infections associated with biofilm formation, and serious infections caused by intracellular pathogens (serious brucellosis, Q-fever, rickettsial infections). By contrast, tigecycline seems not appropriate for treatment sepsis and similar acute life-threatening bacterial diseases.

To assess the antibiotic therapy of and approach to treating pharyngitis/tonsillopharyngitis in primary care physicians, including the trends and rationality. In April 2005, a multicentre study was carried out as a sequel to a similar study performed in 1998. The two studies monitored how primary care physicians treated patients subsequently hospitalized in Czech departments of infectious diseases with the diagnosis of acute upper respiratory infection. Patients' data were provided by physicians from the departments of infectious diseases in standard questionnaires and processed by employees of a Prague department of infectious diseases. In 1998, 14 departments of infectious diseases participated in the study and 241 valid questionnaires were obtained from them. The 2005 study comprised 21 departments and 324 valid questionnaires. According to their final diagnosis, patients were divided into four groups: infectious mononucleosis, viral infection, bacterial infection and infecti...

Human babesiosis is an emerging zoonosis. "Babesia venatorum" has been identified in only four asplenic men and a child so far. We aimed to describe the epidemiological, clinical, and laboratory characteristics of a series of cases with…

The aim of this study was to evaluate the incidence and epidemiological characteristics of infective endocarditis (IE) in the Czech Republic. These results represent the first data on the epidemiology of IE from the post-communist countries. This was a prospective multi-centre observational study monitoring the occurrence of IE in the catchment areas of 29 hospitals during a 12-month period. The total monitored territory involved a population of 3.9 million people (37.7% of the total Czech population). Patients were included in the study if they had a diagnosis of possible or definite endocarditis according to the modified Duke criteria. One hundred and thirty-four episodes of IE in 132 patients were reported. Thus the crude incidence of IE was 3.4 cases/100,000 inhabitants/y. Vegetations were most frequently found on the aortic and mitral valves. The most frequent agent was Staphylococcus aureus (29.9%). The aetiology remained unexplained in 33.6% of cases, mainly because of previous antibiotic therapy. Surgical intervention during antibiotic therapy was performed in 36 patients (27.5%). Thirty-six patients died during hospitalization (in-hospital mortality rate 27.5%). The most common predisposing cardiac factors were remote cardiac surgery (19.4%) and degenerative valvular changes (11.9%). The most common extracardiac factors were pyogenic infections of skin and soft tissues (13.0%) and chronic haemodialysis (8.2%). Our results document the changing epidemiological characteristics of IE, namely an increasing incidence of the disease and an increasing role of Staphylococcus aureus as a major pathogen. A shift was evident in predisposing factors for IE: almost 39% of IE episodes were associated with both cardiac and extracardiac modern medical procedures.

Case fatality ratio and permanent sequelae of acute bacterial meningitis remain high in recent decades. A prospective longitudinal study of adult patients admitted with community acquired acute bacterial meningitis at a tertiary infectious diseases unit aimed to identify predictors of unfavourable outcome - death and sequelae. Anamnestic, clinical and laboratory data and clinical outcome were recorded. From 1997 to 2006, 279 adults (122F, 157M) with a median age of 51 y were admitted with acute bacterial meningitis. Predisposing condition and comorbidity were recorded in 42% and 38% of patients, respectively. Time between symptoms onset and antibiotic treatment ranged from 6 to 160 h. An aetiological agent was identified in 77% of patients: Streptococcus pneumoniae (29%) and Neisseria meningitidis (27%) were the most frequent. 55 patients (20%) died and 63 (23%) had neurological sequelae 6 months after discharge. In multivariate analysis, 7 independent predictors of unfavourable outcome were identified: internal comorbidity, time to treatment >48 h, coma, hypotension, high CSF protein, low glucose ratio, and non-meningococcal aetiology. The results suggest that acute bacterial meningitis remains associated with significant morbidity and mortality. Maintaining a high clinical suspicion and initiating appropriate diagnostic testing and therapeutic interventions promptly are essential for an optimal clinical outcome.