Černiauskienė, Kristina

Due to resistance and the lack of treatment options, hospital-acquired Acinetobacter baumannii (A. baumannii) infections are associated with high mortality. This study aimed to analyze the characteristics of patients with infections caused by multidrug-resistant (MDR) A. baumannii and patients' clinical outcomes as well as determine the risk factors for mortality in a tertiary care teaching hospital.

Algoritmas (lot. algorismus

Background and objective: Acinetobacter baumannii (A. baumannii) is an important nosocomial pathogen that not only possesses intrinsic resistance to many classes of antibiotics, but is also capable of rapidly developing antimicrobial resistance during treatment. The aim of this study was to determine the characteristics of resistance of A. baumannii strains to β-lactams and other tested antibiotics, to evaluate the associations between the phenotypes of resistance to β-lactams and other tested antibiotics, and to evaluate the changes in antibiotic resistance of A. baumannii strains over 5 years by comparing the periods of 2016–2017 and 2020–2021. Materials and methods: A total of 233 A. baumannii strains were isolated from different clinical specimens of patients treated at the Hospital of Lithuanian University of Health Sciences in 2016–2017 (n = 130) and 2021–2022 (n = 103). All clinical cultures positive for A. baumannii were analyzed. The type of β-lactamase was detected by phenotypic methods using ESBL plus AmpC screen disk tests and the combination meropenem disk test. Results: In both periods, all A. baumannii strains were resistant to ciprofloxacin; resistance to carbapenems, piperacillin/tazobactam, gentamicin, and tobramycin was noted in more than 80% of strains. A comparison of two periods showed that the percentages of A. baumannii strains producing two or three types of β-lactamases were significantly greater in 2021–2022 than in 2016–2017 (94.2% and 5.8% vs. 17.7% and 2.3%, respectively, p < 0.001). Isolates producing two or three types of β-lactamases were more often resistant to tigecycline, tetracycline, and doxycycline than strains producing one type of β-lactamase (p < 0.001). Conclusions: The frequency of isolation of A. baumannii strains producing two different types of β-lactamases (AmpC plus KPC, AmpC plus ESBL, or ESBL plus KPC) or three types of β-lactamases (AmpC, KPC, and ESBL) and the resistance rates to ampicillin/sulbactam, tigecycline, tetracycline, and doxycycline were significantly greater in 2020–2021 as compared with 2016–2017. The production of two or three types of β-lactamases by A. baumannii strains was associated with higher resistance rates to tetracyclines.

Introduction: Acinetobacter baumannii (A. baumannii) is an important nosocomial pathogen that possesses not only intrinsic resistance to many classes of antibiotics, but also has a propensity for rapid development of antimicrobial resistance during treatment. Aims & Objectives: Aim of our study was to investigate A. baumannii strains producing different betalactamases. A total of 223 A. baumannii were isolated from different clinical samples of patients treated in 2016-2017 and 2021-2022 years in Hospital of Lithuanian University of Health Sciences. Methods: ESBL plus AmpC screen disc kit (Abtek Biologicals, UK) was used to determine the production of the Extended Spectrum β-Lactamase (ESBL) and AmpC β-lactamase. Combination meropenem disc test was used to determine the co-production of KPC and MBL carbapenem ases. For the statistical analysis were used Chi-square test and multivariate analysis; p <0.05 was considered statistically significant. Results: All isolates had a multidrug resistant profile, and all were resistant to the carbapenems but remained susceptible to colistin. Phenotypic method showed that 60.9% (n=142) of A. baumannii strains were AmpC β lactamase, 11.6% (n=27) ESBL and 76.8% (n=179) KPC β lactamase producers. 46.3% (n=108) of A. baumannii strains had AmpC plus KPC β lactamases, 2.6 % (n=6) AmpC plus ESBL, 2.6 % (n=6) ESBL plus KPC and 3.8% (n=9) AmpC plus KPC plus ESBL. All tested strains were divided into fourth groups: non-producing β - lactamase (9.9%, n=23), producing only AmpC, KPC or ESBL (34.8%, n=81), producing two different β - lactamases: AmpC plus KPC, AmpC plus ESBL or ESBL plus KPC (51.5%, n=120) and the last group: producing all β - lactamases (3.9%, n=9). We have found that all A. baumannii strains were β - lactamase producers in 2021/2022 while 17.7% (n=23) strains didn’t produce any β - lactamase in 2016/2017. In 2016-2017 only one β - lactamase producing stains were detected in 62.3% of tested strains while in 2021-2022 no one only one β - lactamase producing strains were detected. A. baumannii strains producing two different β - lactamases were more frequently identified in 2021/2022 compared to 2016-2017 (94.2% (n=97) compared to (17.7% (n=23), p<0.001). ESBL, AmpC and KPC β - lactamase producing strains were identified 5.8 % (n=6) in 2021-2022 and only 1.3 % (n=3) in 2016-2017 (p<0,001). Conclusions: Increased synthesis of β - lactamases in 2021-2022 compared to 2016-2017 years is a serious warning because β - lactamases are a major threat to the effectiveness of antibiotics that are currently available for medical uses. Audience Take Away Notes • Phenotypic methods for the detection of β - lactamases are easy and simple and can be implemented in routine diagnostic laboratories along with susceptibility testing. These data will assist the clinicians in the management and control of infections

Įvadas. Atsparumas antibiotikams yra didelė problema, kelianti susirūpinimą tiek ligoninių personalui, tiek kiekvienam visuomenės nariui. Nepaisant didėjančio antibiotikų atsparumo, A. baumannii lieka neaiškiai apibrėžtas beta laktamazių atsparumo mechanizmas. Darbo tikslas. Nustatyti iš klinikinės medžiagos išskirtų A. baumannii padermių atsparumą antibiotikams priklausomai nuo beta laktamazių sintezės bei gydymui skiriamų antibiotikų įtaką atsparių padermių išsivystymui. Darbo metodika. Iš kvėpavimo takų sekreto, šlapimo ar žaizdų sekreto išskirtos bakterijos buvo identifi kuotos Maldi biotipavimo sistema, visoms A. baumannii padermėms buvo atliktos antibiotikogramos diskų difuzijos metodu, kurios buvo įvertintos po 24 val., remiantis EUCAST standarto rekomendacijomis. Visos karbapenemams atsparios A. baumannii padermės buvo ištirtos naudojant 4 diskų metodą (cefotaksimo 30 μg, cefotaksimo 30 μg + klavulanato 10 μg, cefotaksimo 30 μg + kloksacilino 200 μg, cefotaksimo 30 μg, 200 μg kloksacilino ir 10 klavulanato) ir buvo nustatyta išplėsto spektro beta laktamazių (ESBL) bei AmpC sintezė. Statistinė analizė atlikta naudojant Microsoft Excel 2010 ir SPSS 22.0 programas. Skirtumai laikyti statistiškai reikšmingais, kai p<0,05. Rezultatai Vertindami A. baumannii atsparumo antibiotikams mechanizmą nustatėme, kad 71,4 proc. (n=40) tirtų padermių atsparumas antibiotikams buvo susijęs su beta laktamazių sinteze. Dauguma A. bamannii padermių (66,1 proc., n=37) buvo įgijusios karbapenemazes, o metalo beta laktamazės buvo nustatytos tik 5,4 proc. (n=3) atvejų. Visos padermės, kurios buvo įgijusios karbapenemazes, buvo atsparios piperacilinui / tazobaktamui, ceftazidimui bei karbapenemams. Karbapenemazes sintetinančios padermės patikimai dažniau buvo atsparios piperacilinui / tazobaktamui bei karbapenemams, palyginti su nesintetinančiomis padermėmis

Tikslas: palyginti galūnių amputacijų aukštį prieš ir po diabetinės pėdos multidisciplininės komandos (DP MDK) įkūrimo Lietuvos sveikatos mokslų universiteto Kauno klinikose (LSMUL KK). Metodai: Retrospektyvinė 2012-2016 metais atliktų apatinių galūnių amputacijų Kauno apskrityje (570 000 gyventojų, diabeto paplitimas ~ 4%) analizė. Duomenys buvo surinkti iš 6 ligoninių, įskaitant LSMUL KK, kur 2014 m. buvo įkurta diabetinės pėdos multidisciplininė komanda (DP MDK). 2014 m. duomenys nebuvo įtraukti į išsamią analizę (DP MDK įkurta 2014 m. rudenį). Amputacijos buvo suskirstytos į aukštas (virš kulkšnies) ir žemas (žemiau kulkšnies). Analizuojant duomenis buvo naudojamasi aprašomąja statistika ir (dviejų komponentų) logistine regresine analize. Bioetikos centro leidimas Nr. BEC-MF-564. Rezultatai: 2012-2016 metais atliktos 1511 apatinių galūnių amputacijų, iš jų 455 (30,11%) – cukriniu diabetu (CD) sergantiems pacientams. Dauguma amputacijų, atliktų CD sergantiems pacientams buvo aukštos (256 atvejai - 56,26%, palyginti su 199 atvejais - 43,74% žemų, p<0,05). Amputacijų dažnis buvo reikšmingai didesnis vyrų grupėje: žemos amputacijos 143 (71,86%) vyrams vs. 56 (28,14%) moterims; aukštos - 152 (59,37%) vyrams vs. 104 (40,63%) moterims (p<0,05). 90,33% amputacijų (411 atvejų) buvo atlikta pacientams sergantiems 2 tipo CD, jiems dažnesnės aukštos amputacijos (244 aukštos ir 167 žemos), o 1 tipo CD sergantiems pacientams dažnesnės žemos amputacijos (32 žemos ir 12 aukštų). Mūsų tyrime amputacijų aukščiui HbA1c reikšmė (p=0,59), kūno masės indeksas (p=0,69), CD trukmė (p=0,35), CD gydymo būdas (p=0,57) ar anksčiau atliktos amputacijos (p=0,96) įtakos neturėjo. Palyginus du laikotarpius (2012-2013 m. su 2015-2016 m.) pastebėta, kad Kauno apskrityje reikšmingai (p <0,05) padidėjo žemų amputacijų skaičius: nuo 50 (31,65%) [...].

Introduction. Acinetobacter baumannii (A. baumannii) is an important nosocomial pathogen that possesses not only intrinsic resistance to many classes of antibiotics, but also has a propensity for rapid development of antimicrobial resistance during treatment. Aim. The aim of our study was to investigate the effect of cross-re istance to aminoglycosides in A. baumannii strains producing β-lactamases. Materials and methods. All clinical cultures positive for A. baumannii were analyzed. A 4-disc detection kit (Abtek Biologicals, UK) was used to determine the production of the extended spectrum β-lactamase (ESBL) and AMPC β-lactamase: cefotaxime 30 μg (CTX 30), cefotaxime 30 μg plus clavulanate 10 μg CXV 40), cefotaxime 30 μg plus cloxacillin 200 μg (CTC 230), cefotaxime 30 μg plus cloxacillin 200 μg plus clavulanate 10 μg (CCC 240). If the zone of inhibition around CXV 40 disc was mea sured ≥5 mm larger than around CXT 30 disc, strain was determined to be an ESBL producer strain. If the zone of inhibition around CTC 230 disc was mea sured ≥5 mm larger than around CXT 30 disc, or around CCC 240 disc was measured ≥5 mm larger than around CXV 40 disc, or around CCC 240 disc was measured <5 mm larger than around CTC 230 disc, strain was determined to be an AMP-C producer strain. The study data were analyzed by the Statistical Package for Social Sites, version 20. Combination of meropenem disc, EDTA and boronic acid test was used to determine the production of the KPC carbapenemases. The interpretation of test results was based on the comparison between the inhibition zones of the four meropenem discs. In case of KPC production, an in crease of ≥5 mm of inhibition zone around the discs with boronic acid was observed. The Chi-square ( ᵪ²) criterion was used to evaluate qualitative data. The results were considered statistically significant at p<0.05. [...].

Introduction: Acinetobacter spp. are important pathogens increasingly reported as the cause of outbreaks of nosocomial infections. The aim of our study was to identify the risk factors and assess their influence on outcomes in patients with infections caused by carbapenem-resistant Acinetobacter spp. Methods: A retrospective data analysis was performed to evaluate risk factors and mortality in patients with Acinetobacter spp. infections. Methods used for the statistical analysis were the Student's t-test, Chi-square test, and multivariate analysis; p < 0.05 was considered statistically significant. Results: A total of 99 patients with an Acinetobacter spp. infection were identified. Comparing patients with carbapenem-sensitive and carbapenem-resistant Acinetobacter spp. infection, significant differences were found in the mean length of intensive care unit stay (4.17 ± 3.61 vs 7.92 ± 6.74 days, p = 0.038) and mechanical ventilation (3.25 ± 2.61 and 7.07 ± 5.79 days, p = 0.009). The previous use of carbapenems (odds ratio (OR) 10.1, 95% confidence interval (CI) 1.16-87.20) and fluoroquinolones (OR 3.6, 95% CI 1.13-11.51) was independently associated with resistance to carbapenems. Of the Acinetobacter spp. strains, 94.9% (n = 94) were resistant to piperacillin-tazobactam, 88.9% (n = 88) to ceftazidime, 85.9% (n = 85) to ciprofloxacin, 83.8% (n = 83) to gentamicin, 79.8 (n = 79) to amikacin, and 48.5% (n = 48) to cefepime. Conclusions: Intensive care unit stay before infection and source of infection in the respiratory tract were independently associated with patient mortality. Resistance to carbapenems had no impact on mortality rates. Carbapenem-resistant Acinetobacter spp. isolates had high resistance rates to other antimicrobial drugs.

Background. Acinetobacter is important nosocomial pathogen with increasing carbapenem resistance, it is alarming, because of limited choise of treatment. Purpose. To compare source of infection and resistance to antibiotics in carbapenen-resistant and carbapenen-sensitive Acinetobacter spp. strains. Methods. A retrospective data analysis was performed of patients, treated in Hospital of Lithuanian University of Jealth Sciences. Identification ans antimicrobial susceptibility of isolated Acinetobacter spp. strains were performed by Phoenix ID system (Becton Dickinson, USA), results were interpreted according to Clinical and Laboratory Standarts Institute guidelines. [...].