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Detection of methicillin - resistant Staphylococcus aureus (MRSA) in Hospital České Budějovice, a. s. and in University Hospital Hradec Králové
Polenová, Lucie ; Paterová, Pavla (advisor) ; Hobzová, Lenka (referee)
Charles University in Prague, Faculty of Pharmacy in Hradec Králové Department of Biological and Medical Sciences Student: Bc. Lucie Polenová Supervisor: MUDr. Pavla Paterová Title of diploma thesis: Detection of methicillin - resistant Staphylococcus aureus (MRSA) in Hospital České Budějovice, a. s. and in University Hospital Hradec Králové The resistance of microbes to antibiotics belongs to worldwide health problems. Infections, which are caused by methicillin-resistant Staphylococcus aureus (MRSA), occur mainly in hospitals. It is because of incorrect and excesive consumption of antibiotics. Insufficient observance of hygienic-epidemiological measures helps to spread resistant strains. Background: The aim of the study was to determine the incidence of MRSA strains in two Czech hospitals - in Hospital České Budějovice, a.s. and in University Hospital Hradec Králové. To compare results with figures in the previous years and sort isolated strains by different characteristics in both hospitals. Methods: Results of the study are based on retrospective data analysis from electronic database. All data from hospitalized patients or outpatients during 1.1.2015 - 31.12.2015 with isolation of MRSA were counted. Processing and cultivation of isolates were made by standard microbiology measures. Strains,...
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Monitoring and detection of Escherichia coli and Klebsiella pneumoniae strains with Extended Spectrum Beta-Lactamase (ESBL) production in Hospital Prachatice, a. s. in 2014-2018.
TVRDKOVÁ, Pavla
The ever increasing resistance of bacteria is a grave issue world-wide. Some bacteria are resistant naturally but for other resistance is acquired. As a result, we can encounter bacterium that would formerly be quite easily killed by administering antibiotics but, in the course of time, as a result of, for example, communication between various bacteria species and strains in the form of various mutations and, frequently, after the administration of incorrect antibiotic and the effects of selective antibiotic pressure, the same bacterium becomes resistant to antibiotics. One of the types of such acquired resistance is the production of broad-spectrum beta-lactamases ESBL. The objective of this thesis is to establish the representation and development of ESBL production in Escherichia coli strains and Klebsiella pneumoniae strains as these make the most frequent producers of these broad-spectrum beta-lactamases, in certain hospital departments and in various types of clinical materials over the period of 5 years. In addition, the thesis focuses on the development of antibiotic resistance, accordingly, over the 5 year period. Data gathering and utilization of methods took place at the Medical Microbiology Department of the Prachatice Hospital (Nemocnice Prachatice, a.s.). To identify microbes to a more precise level, the commercial set ENTEROtest 24 N and INDOL test were used. The disk diffusion method and method for determining the minimum inhibitory concentration were used to determine sensitivity to antimicrobial agents. The commercial set MASTDISC AmpC and ESBL (D68C) were used to detect ESBL. The outcomes indicated that the number of Escherichia coli strains producing ESBL and Klebsiella pneumoniae strains producing ESBL grew almost each year (with the exception of 2016). The outcomes also indicated that the greatest number of ESBL producers were found with Klebsiella pneumoniae strains. Furthermore, the ESBL producers were grouped depending on hospital departments in which most frequent occurrences were found; the most frequent ESBL occurrence of both producers was found in the department of internal medicine. Additionally, the ESBL producers were grouped based on capture in various types of clinical materials; the greatest quantities of both microbes were found in urine. Based on these findings, the development of antibiotic resistance for both microbes over the period of 5 years was analyzed on samples of urine. When monitoring antibiotic resistance development, no considerable growths in bacterial strains resistant to individual anti-microbial agents was found over the 5 year period. Only for 3rd generation cephalosporins, there was a certain growth in resistance detected almost every year for both microbes. Namely, Escherichia coli isolates showed a growth from 6 % to 9 % and Klebsiella pneumoniae isolates showed a growth from 29 % to 33 % in the percentual quantity of strains resistant to these antibiotics.
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Occurrence of ESBL strains in Hospital Pisek, Inc.
KOTHÁNKOVÁ, Michaela
Resistance to ATB is becoming a big problem all round the world. Bacterial resistance occurs naturally or is obtained by gene mutations where genetic information is transmitted between genera or species. These strains are then resistant to antibiotics that are otherwise effective. The biggest problem is that in these cases the treatment is prolonged, the mortality and morbidity of the patients increases and the costs of the treatment as well. The initial theoretical part is devoted to the characteristics and types of effects of antimicrobial agents, beta-lactam antibiotics, antibiotic resistence, where resistance transfer process, multiresistance and resistance mechanisms are described. Further, this part is dedicated to beta-lactamases and their classification, broad-spectrum beta-lactamases (ESBL) and their producers, especially the genus Klebsiella, the genus Escherichia, the genus Enterobacter and the genus Proteus. The last chapter of this part is focused on the impact of resistance to therapy and treatment options. A methodical part of this work was performed at the Department of Clinical Microbiology of Písek Hospital, Inc., where the detection of ESBL positive strains of the genus Klebsiella, Escherichia, Enterobacter and Proteus was observed during one year (January-December 2016). This part focuses on microbes of the mentioned genera and their antibiotic susceptibility. For susceptibility testing, this is a disk diffusion test based on the inhibition zone and a bouillon microdilution method, which is based on minimum inhibitory concentration. Further, this part also deals with an ESBL production test where a screening test using Brilliance ESBL agar chromogenic soil and method of detection ESBL and AmpC production (known as the MAST test) are described. The last chapter of this part is dedicated to quality control. In the practical part of the thesis, we can compare the incidence of bacteria genus Klebsiella, genus Escherichia, genus Enterobacter, genus Proteus and their production of ESBL. Further, this part is focused on the distribution of isolates with ESBL production according to the type of hospital department, the highest incidence was found in the department of aftercare and department of social beds. This section also describes the distribution of ESBL-producing isolates according to the type of clinical material, where there was a huge catch in the urine. It was also compared the number of ESBL producers in the hospital and the community where it was found 85% incidence in the hospital, which was expected.
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Detection of methicillin - resistant Staphylococcus aureus (MRSA) in Hospital České Budějovice, a. s. and in University Hospital Hradec Králové
Polenová, Lucie ; Paterová, Pavla (advisor) ; Hobzová, Lenka (referee)
Charles University in Prague, Faculty of Pharmacy in Hradec Králové Department of Biological and Medical Sciences Student: Bc. Lucie Polenová Supervisor: MUDr. Pavla Paterová Title of diploma thesis: Detection of methicillin - resistant Staphylococcus aureus (MRSA) in Hospital České Budějovice, a. s. and in University Hospital Hradec Králové The resistance of microbes to antibiotics belongs to worldwide health problems. Infections, which are caused by methicillin-resistant Staphylococcus aureus (MRSA), occur mainly in hospitals. It is because of incorrect and excesive consumption of antibiotics. Insufficient observance of hygienic-epidemiological measures helps to spread resistant strains. Background: The aim of the study was to determine the incidence of MRSA strains in two Czech hospitals - in Hospital České Budějovice, a.s. and in University Hospital Hradec Králové. To compare results with figures in the previous years and sort isolated strains by different characteristics in both hospitals. Methods: Results of the study are based on retrospective data analysis from electronic database. All data from hospitalized patients or outpatients during 1.1.2015 - 31.12.2015 with isolation of MRSA were counted. Processing and cultivation of isolates were made by standard microbiology measures. Strains,...
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Detection of extended-spectrum beta-lactamase (ESBL) producers in community and in a hospital
POLENOVÁ, Lucie
The incidence of bacteria resistant to available antibiotics has become an important problem. Statistics show the rising number of resistant bacteria worldwide. Bacteria have ability to be resistant naturally or they develop from point mutation of genes and relay it between species or kinds. The study was made because of significance and relevance of this problem. In theoretical part the study is focused on the functional parts of bacterial cell, which participate in mechanisms of resistance. Beta - lactam antibiotics are described in more detail. The research took place in Hospital České Budějovice, a. s. during 2013. The study aimed to determine the frequency of ESBL positive producers in this hospital and to compare with frequency in community, and to identify units with highest frequency of ESBL producers. Pathogens are isolated from clinical material, being delivered to bacteriology lab in Hospital České Budějovice, a. s. Resistant samples were examined with double disc synergy test (DDST) and quantitative method based on principle of minimal inhibition concentration in combination with chromogenic agar. The prevalence rate of ESBL producers is average to low in Hospital České Budějovice, a. s. During 2013, 12, 347 isolates were identified, ESBL production was identified in 226 isolates. Escherichia coli (183 isolates), Klebsiella pneumoniae (16 isolates), and Enterobacter cloacae (15 isolates) were the most prevalent species. The number of ESBL producers was lower compared to 2012, 2011, and 2010.
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Surveillance of bacterial strains producing broad-spectrum beta-lactamase.
VLASOVÁ, Martina
In the first part of my thesis I focus on mapping problems associated with antibiotic therapy and subsequent development of antibiotic resistance. Tracking resistance is based primarily on data collection and evaluation of the results set sensitivity from around the world. Antibiotic resistance is a natural phenomenon that can be observed in the evolution of microbes as one of the mechanisms of adaptation to new conditions in the environment. For this work I have chosen the following research questions. Do the incidence of ESBL strains in the České Budějovice Hospital a.s. increase over time? Are these values comparable to those achieved in another region, namely in Moravian hospitals the University Hospital of Olomouc, Ostrava University Hospital and Regional University Hospital of T. Bata in Zlin? The data collection I made in collaboration with the laboratory technicians and doctors at Hospital?s Bacteriology Laboratory in České Budějovice. Bacteries tested for the detection of ESBL production originated from biological materials, witch came from patients of hospital in České Budějovice. The first objective was to compare the results achieved in the České Budějovice Hospital in the period of 2007 to 2012. If we look at the total number of ESBL strains that have been isolated since 2007, values have upward trend. While in 2007 there were only 64 strains a year later, the number more than doubled. In 2010, the value soared to 281 tribes and in the year 2012, the number was 321 tribes. The incidence of ESBL strains in 2007 increased about five times. In the long term we can say the numbers have increasing tendency and the range of each species in the production of ESBL has significantly changed. In 2007, it was K. pneumoniae strains that dominated the statistics, but over time the strains of E. coli came forefront. Values of 2012 suggest that the presence of ESBL strains of K. pneumoniae is again almost equal to the number of E. coli strains. The second objective was to compare the results of the 2012 with study of the Prevalence of ESBL-positive Enterobacteriaceae in large Moravian hospitals. In the general overview of ESBL producers values in Hospital České Budějovice (5.23%) are comparable to those in Ostrava (4.9%) and in Zlín (4.3%). Number of strains in the Hospital in Olomouc (11.8%) is about twice as high as the numbers in České Budějovice. In this comparison the České Budějovice Hospital is one of the hospitals with a lower incidence of ESBL producers. The České Budějovice Hospital is below the national average, which originate from an elaborate system of care for patients with colonization or infection with ESBL strains, and from therapy control system using antibiotic center. These results may serve to the Hospital in České Budějovice for statistical purposes, and also for proposals for improving patient care. In the discussion, I pointed out the danger of the spread of resistant strains of bacteria in the community and also the associated risks that mentioned bacteria mean for patients injured in mass accidents or disasters. In these cases, number of infections including ESBL producers can penetrate through open wounds into the affected body. Unlike conventional sensitive bacteria those strains are resistant to commonly used antibiotics and thereby endanger the lives of people affected by the accident.
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Nursing care of a patient with multi-resistant strains
ZAJÍCOVÁ, Lucie
Occurrence of bacterial resistance appeared already five years after the antibiotics had been introduced in practice. Currently the occurrence of resistant or multiresistant strains is increasing. It is therefore highly important to adhere to barrier nursing techniques for clients colonized or infected with multiresistant strains. The risk of transmission of infection between patients and also between the medical staff is thus minimized. However, many of the nursing staff have not fully realized the importance of adhering to the barrier nursing care. A quantitative research by means of anonymous questionnaires was applied to collect the data. The research survey was carried out in the specialized departments of Nemocnice České Budějovice a.s. (The Hospital of České Budějovice). The following information was checked: identification data, the awareness of the nursing staff concerning the barrier care and the possibilities of the nursing staff to adhere to this care in practice when nursing clients suffering from multiresistant strains. 139 questionnaires have been distributed from which 110 (100%) have been included in the research. In the bachelor thesis the awareness of the nursing staff concerning the barrier nursing care and the possibility to adhere effectively to this kind of care for nursing clients suffering from multiresistant strains has been investigated, which was also stated in the aims of the paper (there were three of them), which were confirmed by the results of the research. Three hypotheses were set. The first one was to prove that the nursing staff adhere to the barrier nursing care for patients suffering from multiresistant strains, which was confirmed. The second one was to prove, that the nursing staff have enough aids to adhere to barrier care for patients suffering from multiresistant strains. This hypothesis was also confirmed. The third one was to prove that the nursing staff are acquainted with principles of barrier nursing technique as prevention of transmission of multiresistant strains, which was also confirmed. In general it can be stated that although the nursing staff are over strained in their work physically and psychically due to evident lack of nursing staff in all departments, the awareness and adherence to barrier nursing care and thus the minimizing the risk of transmission of resistant or multiresistant strains is evident. The research has shown that in spite of problems the nursing staff is to handle daily, the adherence to barrier nursing technique is important for them. The awareness in this field is on a very satisfactory level, as well as material equipment and aids necessary to adherence to barrier care. There is also a tendency from the part of the superiors to inform on topical subjects in nursing care for clients suffering from multiresitant strains in regular seminars organized within the hospital. The adherence to barrier nursing care is an essential part of care for clients suffering from multiresistant strains. The results of the paper shall be used to inform medical staff on this issue to make a positive impact on opinions of medical staff on adhering to barrier nursing care to prevent transmission of multiresistant strains.
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