Publications by authors named "Rafał Gierczyński"

62 Publications

Patients with epilepsy as drivers in Poland.

Med Pr 2021 Mar 30. Epub 2021 Mar 30.

Nofer Institute of Occupational Medicine, Łódź, Poland (Department of Occupational Diseases and Environmental Health).

Background: Drivers suffering from epilepsy are commonly regarded as a threat to road safety. However, inability to use their own means of transport very often implies specific professional effects and lowers the quality of life. The aim of this study was to analyze the driving status of patients with epilepsy in Poland.

Material And Methods: The prospective study was performed using an independent questionnaire developed by the authors, consisting of 4 parts: 1) socio-demographic information, 2) clinical information, 3) driving information, and 4) opinions about patients with epilepsy as drivers. The study was conducted in November 2018-September 2019. A total of 188 patients completed this study.

Results: More than one-quarter of the patients have a driving license. Among them, 35 individuals (accounting for 18.62% of the whole study group) said that they had received their driving license after the diagnosis of epilepsy. In 10 cases (5.32%), seizures occurred while the patients were driving and in 72 cases (38.30%) while they were traveling as passengers. Among all socio-clinical factors, having a driving license was conditioned by the marital status (p = 0.008) and education (p = 0.007). Other factors did not affect having a driving license or the time of obtaining the license (p > 0.05 for all cases). A relationship was observed between the occurrence of side effects of antiepileptic drugs and the occurrence of seizures while traveling as a car passenger (p = 0.001). Other factors did not affect the occurrence of epileptic seizures while traveling by car, either as a driver or a passenger (p > 0.05).

Conclusions: A significant proportion of the respondents were of the opinion that patients with epilepsy should not be allowed to obtain a driving license, which is probably related to concerns about the occurrence of epileptic seizures while driving. It is necessary to conduct a nationwide educational and information campaign on epilepsy in various aspects. Med Pr. 2021;72(4).
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http://dx.doi.org/10.13075/mp.5893.01079DOI Listing
March 2021

The first SARS-CoV-2 genetic variants of concern (VOC) in Poland: The concept of a comprehensive approach to monitoring and surveillance of emerging variants.

Adv Med Sci 2021 Mar 30;66(2):237-245. Epub 2021 Mar 30.

Academic Center for Pathomorphological and Genetic-Molecular Diagnostics, Bialystok, Poland; Department of Medical Pathomorphology, Medical University of Bialystok, Bialystok, Poland. Electronic address:

Purpose: We analyzed the SARS-CoV-2 genome using our integrated genome analysis system and present the concept of a comprehensive approach to monitoring and surveillance of emerging variants.

Material/methods: A total of 69 SARS-CoV-2 positive samples (with Ct value ​≤ ​28) were tested. Samples included in this study were selected from 7 areas of eastern Poland. All samples were sequenced on an Illumina MiSeq platform using a 300-cycle MiSeq Reagent Kit v2. BWA was used for reads mapping on the reference SARS-CoV-2 sequence. SAMTools were used for post-processing of reads to genome assembly. Pango lineage and Nexstrain were used to identify variants and amino acid mutations. Statistical analysis was performed with R 4.0.2.

Results: This study shows the first confirmed case of SARS-CoV-2 in Poland with the lineage B.1.351 (known as 501Y.V2 South African variant), as well as another 18 cases with epidemiologically relevant lineage B.1.1.7, known as British variant. Supplementary analysis of SARS-CoV-2 sequences deposited in GISAID shows that the share of a new variant can change rapidly within one month. In addition, we show a complete, integrated concept of a networked system for analyzing the variability of the SARS-CoV-2 genome, which, used in the present study, generated data and a variant report within 6 days.

Conclusion: The analyzed viral genomes showed considerable variability with simultaneous clear distinction of local clusters of genomes showing high similarity. Implementing real-time monitoring of new SARS-CoV-2 variants in Poland is urgently needed, and our developed system is available to be implemented on a large scale.
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http://dx.doi.org/10.1016/j.advms.2021.03.005DOI Listing
March 2021

Evaluation of PCL rapid point of care antigen test for detection of SARS-CoV-2 in nasopharyngeal swabs.

J Med Virol 2021 04 6;93(4):1920-1922. Epub 2021 Jan 6.

The Heart Institute, Cincinnati Children's Hospital Medical Center, Ohio, USA.

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http://dx.doi.org/10.1002/jmv.26765DOI Listing
April 2021

[Health protection of employees against SARS-CoV-2 coronavirus infection causing the COVID-19 disease - the current state of knowledge and recommendations].

Med Pr 2021 Feb 2;72(1):69-87. Epub 2020 Dec 2.

Instytut Medycyny Pracy im. prof. J. Nofera / Nofer Institute of Occupational Medicine, Łódź, Poland (Klinika Chorób Zawodowych i Zdrowia Środowiskowego / Clinic of Occupational Diseases and Environmental Health).

The COVID-19 pandemic, despite the restrictions and preventive measures applied, has rapidly spread and reached Poland. The adaptation to the dynamically changing epidemiological situation requires a prompt implementation of effective preventive measures. The aim of the publication is to provide current knowledge to all persons involved in the preventive care system, i.e., employees, employers and professionals of occupational medicine, about the epidemiological situation related to SARS‑CoV- 2, as well as recommendations and possible solutions. In order to analyze these issues, a review of literature was conducted based on medical research databases: PubMed, SCOPUS, and the Web of Science Core Collection. The literature was supplemented with studies found on websites of the Ministry of Health and the World Health Organization. Data on the cases of and deaths due to COVID-19 come from reports provided by the Ministry of Health, data published on the websites of the European Center for Disease Prevention and Control, and ourworldindata.org. By the time of submitting the publication, 34 154 cases and 1444 deaths due to coronavirus had been recorded in Poland. Data from published studies suggest that the virus is mainly transmitted via droplets or through contact with contaminated objects and surfaces. Therefore, in the absence of an effective vaccine, preventive actions are based mainly on strategies that minimize the risk of pathogen transmission. In addition to discussing the current epidemiological situation, diagnostic procedures, risk groups and COVID-19 characteristics, the paper presents recommendations and proposed solutions for employers and employees regarding the prevention of SARS‑CoV- 2, along with currently applicable laws and recommendations on employee prophylactic examinations during the pandemic. Subsequently, COVID-19 was discussed in the aspect of an occupational disease and other health threats related to the pandemics. The epidemiological situation regarding coronavirus indicates the need to take immediate and effective actions to minimize infection transmission among employees, and to develop procedures for a quick and effective ability to locate the COVID-19 outbreaks in workplaces. Med Pr. 2021;72(1):69-87.
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http://dx.doi.org/10.13075/mp.5893.01042DOI Listing
February 2021

Draft genome sequence of an Escherichia coli ST410 isolate co-harbouring bla, bla, bla, aac(3)-IIa and aac(6')-Ib-cr genes with gyrA and parC mutations isolated from a paediatric patient in Poland.

J Glob Antimicrob Resist 2019 03 12;16:120-122. Epub 2018 Dec 12.

Department of Bacteriology and Biocontamination Control, National Institute of Public Health-National Institute of Hygiene, 24 Chocimska Str., 00-791 Warsaw, Poland.

Objectives: Escherichia coli is one of the major causative agents of nosocomial infections. Here we report the first draft genome sequence of an E. coli strain (no. 158) isolated in Poland carrying bla, bla, bla, aac(3)-IIa and aac(6')-Ib-cr genes together with mutations in the gyrA and parC genes.

Methods: Total DNA was sequenced using an Illumina NextSeq 500 platform. The draft genome of E. coli strain 158 was assembled using SPAdes 3.9 assembler. Contigs were annotated using the Prokka v.1.12 algorithm. Species confirmation, multilocus sequence typing (MLST), serotyping, molecular virulence and resistance traits, and plasmid replicons were analysed using appropriate bioinformatics tools available at the Centre for Genomic Epidemiology website. Additional in silico analyses were also conducted.

Result: The genome size was estimated at 4883487bp, with 4601 predicted coding sequences. The presence of bla, bla, bla, aac(3)-IIa and aac(6')-Ib-cr genes was detected in addition to other antimicrobial resistance genes as well as mutations in the gyrA (Ser83Leu and Asp87Asn) and parC (Ser80Ile) genes. The investigated strain E. coli 158 belongs to ST410.

Conclusion: To our knowledge, this is the first draft genome of an E. coli strain co-harbouring bla, bla, bla, aac(3)-IIa and aac(6')-Ib-cr genes with mutations in gyrA and parC reported in Poland. The reported genome sequence contains valuable information on genetic features of antimicrobial resistance mechanisms of E. coli in Poland.
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http://dx.doi.org/10.1016/j.jgar.2018.11.024DOI Listing
March 2019

Emergence of Enterobacteriaceae co-producing CTX-M-15, ArmA and PMQR in Poland.

Adv Clin Exp Med 2019 Feb;28(2):249-254

Department of Bacteriology, National Institute of Public Health-National Institute of Hygiene, Warszawa, Poland.

Background: Plasmid-mediated extended-spectrum β-lactamases (ESBLs), 16S rRNA methylases and quinolone resistance mechanisms (PMQRs) are well-known agents conferring resistance to more than 1 antimicrobial in its group. The accumulation of these agents poses, therefore, a serious risk to public health.

Objectives: The objective of this study was to investigate the presence of common ß-lactamases and 16S rRNA methylases in Qnr-producing Enterobacteriaceae and their genetic relatedness.

Material And Methods: We examined 18 Qnr-producing isolates (Klebsiella pneumoniae n = 8, Enterobacter cloacae n = 6 and Escherichia coli n = 4) selected from a collection of 215 ciprofloxacin-resistant strains obtained from patients in a 1030-bed tertiary hospital from 1 March to 31 August 2010. The antibiotics minimum inhibitory concentration (MIC) was determined by E-test. The detection of common ß-lactamases, 16S rRNA methyltransferases and PMQR genes was performed by polymerase chain reaction (PCR) and sequencing. Genetic relatedness was assessed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST).

Results: All the isolates tested were susceptible to carbapenems and colistin, while 16 were multidrug-resistant. Thirteen, 2 and 2 isolates carried qnrB1, qnrA1 and qnrS1, respectively. Ten of 13 qnrB1-positive Enterobacteriaceae also carried genes encoding for aac(6')-Ib-cr and at least 1 ESBL. The blaCTX-M-15 gene was the most common ESBL. The most prevalent combination of genes was qnrB1+aac(6')-Ib-cr+blaTEM-1+blaCTX-M-15. Two isolates of K. pneumoniae and E. cloacae were found to bear multiple extended range resistance traits: ArmA, CTX-M-15, QnrB1, and AAC (6')-Ib-cr. The PFGE showed that most of the isolates exhibited individual DNA patterns, whilst MLST assigned K. pneumoniae (n = 8) to 5 sequence types (STs) (ST15, ST323, ST336, ST147, and ST525), E. coli (n = 4) to 2 (ST131 and ST1431) and E. cloacae (n = 5) to 4 (ST90, ST89, ST133, and the novel ST407).

Conclusions: Our findings reveal the accumulation of resistance traits and their important role in spreading of multiresistant bacteria among hospitalized patients.
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http://dx.doi.org/10.17219/acem/94165DOI Listing
February 2019

Factors associated with hepatitis C prevalence differ by the stage of liver fibrosis: A cross-sectional study in the general population in Poland, 2012-2016.

PLoS One 2017 20;12(9):e0185055. Epub 2017 Sep 20.

Department of Epidemiology, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland.

Background & Aims: There is a considerable burden of hepatitis C in Europe related to the lack of prompt diagnosis. We aimed to estimate the prevalence and related risk factors of HCV infections by the stages of liver fibrosis, using non-invasive methods, to understand testing needs in Poland.

Methods: A cross-sectional study was conducted in 2012-2016 adopting a stratified random sampling of primary health care units followed by systematic sampling of patients within each unit. Study participants filled a questionnaire and donated blood for laboratory HCV testing. Additionally, the results of liver function tests and platelet count were collected to calculate APRI and FIB-4 scores. Cases were classified according to the level of fibrosis: 'significant fibrosis' (APRI≥0.7 or FIB4≥1.45) and 'no significant fibrosis' (APRI<0.7 and FIB4<1.45).

Results: Of 21 875 study participants, 102 were HCV-RNA positive. Prevalence of HCV infections and significant fibrosis was estimated at 0.47% (95% CI 0.38% - 0.57%) and 0.12% (0.08% - 0.17%), respectively. Cases with significant fibrosis accounted for 51.6% (33.4%-69.9%) in men and 34.4% (17.3%-51.4%) in women. There was no correlation between the HCV prevalence and age. Blood transfusion prior to 1992 strongly predicted significant fibrosis as did the history of injecting drug use (IDU) and ever having an HCV-infected sexual partner in men and caesarean sections in women. Factors associated with HCV infection without significant fibrosis were tattooing in men and younger age in women. We acknowledge limited possibility to study the associations between IDU and ever having HCV-infected sexual partner, given small sample sizes for these exposures.

Conclusions: As no clear birth cohort affected by HCV could be identified, risk factor-based screening in the general population should be considered, taking into account the association between the increased risk of liver fibrosis and the history of transfusion prior to 1992 and caesarean sections.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0185055PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5607182PMC
October 2017

Distribution of carbapenem resistance mechanisms in Pseudomonas aeruginosa isolates among hospitalised children in Poland: Characterisation of two novel insertion sequences disrupting the oprD gene.

J Glob Antimicrob Resist 2016 12 8;7:119-125. Epub 2016 Oct 8.

Children's Memorial Health Institute, 20 Dzieci Polskich Str., 04-730 Warsaw, Poland.

This study aimed to analyse the distribution of carbapenem resistance mechanisms among Pseudomonas aeruginosa clinical isolates. Fifty-five P. aeruginosa isolates, resistant both to imipenem and meropenem, from children hospitalised in 2009-2010 were studied. All strains were genotyped by pulsed-field gel electrophoresis (PFGE). Mutations in the oprD gene and the occurrence of insertion sequences (ISs) were determined by DNA sequencing. Mex efflux systems were determined by analysis using the efflux pump inhibitor Phe-Arg β-naphthylamide. Metallo-β-lactamase (MBL) production was determined with Etest MBL strips and PCR for bla and bla. PFGE show high genetic diversity among the isolates. Mutations inactivating the oprD gene were detected in 44 strains (80%). Frameshift mutations detected in 20 isolates were the most common cause of inactivation of the oprD gene. Point mutations leading to premature stop codons were found in 12 isolates, and various substitutions were found in 6 isolates. Disruption of the coding sequence of oprD by ISs was found in six isolates. Two novel ISs (ISPa51 and ISPa52) were detected. Increased activity of different Mex systems was observed in 27 isolates (49%). Ten isolates simultaneously overexpressed two (n=3) or three (n=7) types of Mex efflux system. Seven (13%) P. aeruginosa strains were found to have minimum inhibitory concentrations (MICs) of >64mg/L both for imipenem and meropenem (two VIM-4, four VIM-2 and one IMP-1). These results show a significant diversity of P. aeruginosa strategies for resistance development. Noteworthy, a variety of ISs were found to disrupt the oprD gene.
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http://dx.doi.org/10.1016/j.jgar.2016.08.007DOI Listing
December 2016

Distribution of 16S rRNA Methylases Among Different Species of Aminoglycoside-Resistant Enterobacteriaceae in a Tertiary Care Hospital in Poland.

Adv Clin Exp Med 2016 May-Jun;25(3):539-44

Department of Bacteriology, National Institute of Public Health-National Institute of Hygiene, Warszawa, Poland.

Background: Aminoglycosides are a group of antimicrobial agents still the most commonly used in the treatment of life-threatening bacterial infections in human and animals. The emergence and spread of 16S rRNA methylases, which confer high-level resistance to the majority of clinically relevant aminoglycosides, constitute a major public health concern.

Objectives: Our goal was to evaluate the distribution of 16S rRNA methylases among different species of Enterobacteriaceae during a five month-long survey in a tertiary hospital in Warszawa, Poland.

Material And Methods: In the survey, a total of 1770 non-duplicate clinical isolates were collected from all hospital wards in a tertiary hospital in Warszawa, Poland. The survey was conducted between 19 April and 19 September 2010. The ability to produce 16S rRNA methylase was examined by determining MICs for gentamicin, kanamycin, amikacin by means of the agar dilution method. The isolates resistant to high concentration of aminoglycosides were PCR tested for genes: armA, rmtA, rmtB and rmtC. PCR products were subjected to DNA sequencing by the Sanger method. The genetic similarity of the ArmA-producing isolates was analysed by pulsed-filed gel electrophoresis (PFGE).

Results: ArmA was the only 16S rRNA methylase detected in 20 of 1770 tested isolates. The overall prevalence rate of ArmA was 1.13%. In K. pneumoniae (n = 742), P. mirabilis (n = 130), and E. cloacae (n = 253) collected in the survey, the prevalence of ArmA was 0.4%, 0.8% and 5.9%, respectively. The PFGE revealed both horizontal and clonal spread of the armA gene in the hospital.

Conclusions: The prevalence of 16S rRNA methylase ArmA reported in this study is significantly higher than observed in other countries in Europe.
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http://dx.doi.org/10.17219/acem/34150DOI Listing
December 2016

Characterisation of Yersinia Secretion Apparatus--Pathogenicity Island (Ysa-PI) of Yersinia enterocolitica 1B/O8 in Poland: an Idle Ysa is a Specific Hallmark of the Epidemic Sensu Stricto Strain.

Pol J Microbiol 2015 ;64(2):171-4

Yersinia secretion apparatus (Ysa), the chromosomal type three secretion system (T3SS) is considered to contribute to virulence of high-pathogenicity Yersina enterocolitica biovar 1B. DNA-sequence of Ysa pathogenicity island was determined for clinical isolate DM0110 of Y enterocolitica 1B/08 with origin in Poland. We found a premature stop-codon in the regulatory gene ysrR (mutation at position 269). Altered ysrR was detected in all tested 78 isolates of Y enterocolitica 1B/O8 collected from clinical samples in Poland from 2004 to 2013. Since aberrations in YsrR are considered to inactivate Ysa, our findings may suggest Ysa is not indispensable for Y enterocolitica 1B/O8 to infect humans.
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October 2015

Development and evaluation of a latex agglutination test for the rapid serodiagnosis of tularemia.

J Microbiol Methods 2015 May 26;112:1-2. Epub 2015 Feb 26.

Department of Bacteriology, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland.

A latex agglutination test (LAT) was developed for a rapid detection of antibodies against Francisella tularensis. The assay is performed by mixing serum with antigen-coated latex beads and read within 5 min. Developed LAT has been proved to be a specific, sensitive, fast, easy-to-perform and cost-efficient tool for the routine diagnosis of tularemia.
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http://dx.doi.org/10.1016/j.mimet.2015.02.012DOI Listing
May 2015

Probable Interspecies Transfer of the bla(VIM-4) Gene between Enterobacter cloacae and Klebsiella pneumoniae in a Single Infant Patient.

Pol J Microbiol 2015 ;64(4):387-9

We report the interspecies transfer of the bla(VLM-4) gene in MBL-producing Enterobacter cloacae and Klebsiella pneumoniae isolates from a newborn patient who had received meropenem therapy. We show evidence that gene bla(VIM-4) was transmitted as a part of the class-1 integron on a ca. -90 kb conjugative plasmid. High homology of nucleotide sequence was observed between the integron found in VIM-4 producing E. cloacae and K. pneumoniae strains tested and class-1 integrons previously reporteded in Pseudomonas aeruginosa from Hungary and Poland. This finding may suggest P. aeruginosa as a potential source of acquired VIM-4 in Enterobacteriaceae.
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http://dx.doi.org/10.5604/17331331.1185239DOI Listing
May 2016

Co-existence of plasmid-mediated quinolone resistance determinants and mutations in gyrA and parC among fluoroquinolone-resistant clinical Enterobacteriaceae isolated in a tertiary hospital in Warsaw, Poland.

Int J Antimicrob Agents 2015 Mar 13;45(3):238-43. Epub 2014 Nov 13.

Department of Bacteriology, National Institute of Public Health - National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland.

Plasmid-mediated quinolone resistance (PMQR) determinants and the distribution of mutations in the quinolone resistance-determining regions (QRDRs) of gyrA and parC were investigated in 215 ciprofloxacin-resistant (MIC>1mg/L) clinical Enterobacteriaceae collected during a 6-month prospective study in a tertiary hospital in Warsaw, Poland. PMQR determinants were present in 49 isolates (22.8%), among which aac(6')-Ib-cr and qnrB1 predominated (85.7% and 26.5%, respectively). Mutations in gyrA and parC QRDRs were detected among 89.8% of isolates (MIC≥4mg/L). Changes in Ser-83, Ala-84 and Asp-87 in GyrA and Ser-80 and Glu-84 in ParC were detected. Five isolates with ciprofloxacin MICs in the range 1.5-16 mg/L were found to have unaltered QRDRs, with PMQR as the only fluoroquinolone (FQ) resistance trait detected. The remaining 44 PMQR-positive isolates were found to carry altered QRDRs. Three substitutions (two in GyrA and one in ParC) were detected in 23 isolates, whilst 8 isolates carried four mutations (two in GyrA and two in ParC). One isolate of Klebsiella pneumoniae with two amino acid substitutions in the ParC QRDR in the presence of aac(6')-Ib-cr and qnrB1 had a ciprofloxacin MIC of 16mg/L. The results presented here show that FQ resistance in these clinical Enterobacteriaceae is a complex interplay between PMQR determinants and mutations in gyrA and parC rather than a single stepwise accumulation of mutations in the gyrase and topoisomerase subunits. In addition, these results show the role of PMQR determinants in promoting QRDR mutations and the acquisition of high-level FQ resistance in clinical settings.
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http://dx.doi.org/10.1016/j.ijantimicag.2014.09.019DOI Listing
March 2015

[Development of molecular PCR-RFLP test for identification of the epidemic strain of Y. enterocolitica bioserotype 1B/O8 circulating in Poland since 2004].

Med Dosw Mikrobiol 2014 ;66(2):89-98

Introduction: Highly pathogenic Y. enterocolitica bioserotype 1B/O8 is considered to be an important etiological agent of yersiniosis in Poland. Infections caused by Y. enterocolitica 1B/O8 became an important public health problem in Poland, especially because of their high potential of virulence and the unknown source of the bacteria. Y. enterocolitica 1B/O8 isolates recovered in Poland are genetically highly related and constitute single epidemic sensu stricto strain. The aim of the present study was to develop a time- and money-effective molecular assay for rapid identification of pathogenic Y. enterocolitica 1B/O8 isolates belonging to the epidemic strain.

Methods: In the first stage we performed a multiplex-PCR for four genetic markers: ail, ystA, irp1 and 16S rDNA sequence. In the next stage we designed a duplex-PCR-RFLP assay with BtsI endonuclease to detect/identify specific variant of an ysrR gene that is characteristic for epidemic strain of Y. enterocolitica 1B/O8 strain. The assay was tested against a panel of a consisted of a variety Yersinia enterocolitica and Y. pseudotuberculosis strains.

Results: All the tested Y. enterocolitica 1B/O8 strains were positive for all the genetic markers in multiplex-PCR assay what distinguished them from other tested Yersinia strains. In duplex-PCR-RFLP test all tested isolates of the epidemic strain were negative for ysrR digestion with BtsI endonuclease, while all tested reference strains of Y. enterocolitica 1B/O8 were positive.

Conclusions: The assay developed in this study was two-stage/two-step molecular test efficiently distinguishing wild-type and the epidemic Y. enterocolitica 1B/O8 strain. Such test can be a useful screening tool for clinical, veterinary and food diagnostics, as well as for the purposes of epidemiological investigation.
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November 2014

Screening for anthrax occurrence in soil of flooded rural areas in Poland after rainfalls in spring 2010.

Ann Agric Environ Med 2014 ;21(3):460-3

National Institute of Public Health - National Institute of Hygiene, Department of Bacteriology, Warsaw, Poland.

Introduction And Objective: Anthrax spores remain viable and infectious in soil for decades. Flood water can percolate towards the surface the spores buried in soil. Moreover, the flood water might transport spores to areas previously unaffected. After the water recedes the spores located on the surface of the ground can be consumed by grazing animals and cause outbreaks of anthrax.

Materials And Method: Soil samples were collected in areas of Poland most affected by floods in 2010 (Lubelskie, Świętokrzyskie, Podkarpackie and Mazowieckie provinces). After heating with the aim to kill vegetative forms of bacteria, the samples were cultured on PLET agar and the resulted colonies were investigated in terms of motility and presence of anthrax specific chromosomal (SG-749, plcR) and plasmid markers (capB, pagA).

Results: In total, 424 spore-forming, aerobically growing isolates were collected from the tested soil samples. Eighty-nine of them were non-motile. All the isolates were negative in PCR for anthrax specific chromosomal and plasmid markers.

Conclusions: Spores of B. anthracis that could be related to risk of anthrax outbreaks were not detected in soil samples tested in this study. The negative results presented may not be proof that Poland is country free of anthrax. The results, however, may suggest a relatively low risk of anthrax outbreaks being triggered in the sampled areas.
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http://dx.doi.org/10.5604/12321966.1120584DOI Listing
June 2015

[Occurrence and characterisation of aac(6')-Ib-cr gene encoding fluoroquinolone-modifying enzyme in clinical ciprofloxacin-resistant Enterobacteriaceae strains isolated in Poland].

Med Dosw Mikrobiol 2013 ;65(1):39-46

Zakład Bakteriologii Narodowego Instytutu Zdrowia Publicznego - Państwowego Zakładu Higieny, Warszawa.

Introduction: The aac(6')-Ib-cr gene encodes a variant of aminoglycoside acetyltransferase that confers reduced susceptibility to hydrophilic fluoroquinolones such as ciprofloxacin and norfloxacin. AAC(6')-Ib-cr has two amino acid changes, Trp 102Arg and Asp179Tyr, which together are necessery and sufficient for the enzyme's ability to reduce the activity of fluoroquinolones, including ciprofloxacin and norfloxacin. The aim of this study was to evaluate the prevelance of aac(6')-Ib-cr determinant among 15 Enterobacteriaceae isolates randomly chosen from 215 fluorochinolone resistant strains recovered during the 6 months of 2010.

Methods: The aac(6')-Ib was detected by PCR. The presence of aac(6')-Ib-cr gene variant was futher identified by digestion with BseGI (BtsCI) and sequencing.

Results: 11/15 of the resistant (MIC CIP 2-1024 microg/ml) Enterobacteriaceae strains carried aac(6')-Ib-cr variant.

Conclusion: This is the first study identifying the variant of aminoglycoside acetyltransferase determinant in Poland. Our results demonstrate that this enzym may be even more widespread than Qnr determinants among fluoroquinolone resistant Enterobacteriaceae in Poland.
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December 2013

[Prevalence of qnr genes in clinical Enterobacteriaceae non-susceptible to fluoroquinolone in Poland].

Med Dosw Mikrobiol 2012 ;64(3):211-9

Zakład Bakteriologii Narodowego Instytutu Zdrowia Publicznego--Państwowego Zakładu Higieny.

Introduction: Fluoroquinolone are broad-spectrum antimicrobial agents extensively used by physicians. This widespread use has been associated with increased level ofquinolone resistance strains, particularly in Enterobacteriaceae. Plasmid-mediated quinolone resistance (PMQR) including Qnr determinants with the potential for horizontal transfer confer to quinolone resistance. Plasmid harboring qnr genes may also encode extended-spectrum beta-lactamases (ESBLs) such as CTX-M, SHV and TEM type. The prevalence ofplasmid-mediated quinolone resistance (PMQR) determinants like qnrA, qnrB and qnrS was investigated in a collection of 215 Enterobacteriaceae strains with reduced susceptibility to fluoroquinolone.

Methods: The isolates (n=215) were collected from 1 March to 31 September, 2010 in a regular hospital in Warsaw, Poland. The resistance to nalidixic acid, norfloxacin and ciprofloxacin was determinated by twofold agar dilution method, while MICs of moxifloxacin were examined by using E-test. The prevalence of qnrA, qnrB, qnrS, blaCTX-M, blaSHV and blaiTEM was evaluated by PCR. All PCR-products for qnr were sequenced. The epidemiological relationship between positive isolates was studied by PFGE method.

Results: Eighteen isolates (8,3%) carried the qnr gene encoding the QnrA, QnrB or QnrS. The coexistence of both qnrA and qnrS genes was noted in one isolate of E. coli. The qnrB gene was the most common qnr type found. All the Qnr-producing strains were simultaneously resistant to naldixic acid and different - level non-susceptible fluoroquinolone (MIC CIP 1.5-1024 microg/ml). Most of qnr-positive strains (88.9%) were extended-spectrum beta-lactamase (ESBL) producers of CTX-M and TEM types predominantly.

Conclusions: The present study highlights the wide spread of Qnr-like determinants in clinical Enterobacteriaceae non-susceptible to fluoroquinolone in Poland, with an association with the ESBL.
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January 2013

[Electrophoretic and immunological analysis of native proteins secreted in vitro under conditions inducing Ysa (Yersinia secretion apparatus) by clinical isolates of Yersinia enterocolitica 1B/O8 in Poland].

Med Dosw Mikrobiol 2013 ;65(4):245-54

Introduction: The high pathogenicity Yersinia enterocolitica 1B/O8 produce variety of virulence factors including chromosomal T3SS known as Ysa-Ysp system that is considered to act at the early stage of infection. The aim of the study was to examine the ability to produce Ysa-Ysp proteins in vitro by human clinical isolates of the epidemic Y. enterocolitica 1B/O8 strains in native conditions and immunological characterization of expressed proteins.

Methods: Seven Y. enterocolitica 1B/O8 isolates with known epidemiological link and the reference high pathogenicity strain WA-314 and six strains from the Institute Pasteur (France) were examined for production of Ysa-Ysp proteins according with procedure described by Matsumoto and Young (Mol. Microbiol., 2006, 59:689-76). All the isolates and strains were characterized by SDS-PAGE to determined Ysa-Ysp proteins profile. The immunological characterization was performed by using western-immunobloting method using sera from two immunized rabbits and from two patients with bacteriology confirmed Y. enterocolitica 1B/O8 infection.

Results: The reference strain WA-314 yielded typical Ysa-Ysp proteins profile. In contrast all the tested Y. enterocolitica 1B/O8 human isolates yielded the same SDS--PAGE profile that was apparently distinct from profile of Ysa-Ysp proteins of reference strain WA-314.

Conclusions: The Y. enterocolitica 1B/O8 isolates of the epidemic strain circulating in Poland were found to be unable to produce Ysa-Ysp proteins in vitro under conditions sufficient to stimulate expression of the Ysa-Ysp proteins in the reference strain WA-314 and strains from the Institute Pasteur (France). Our results may suggest that the ability to produce Ysa--Ysp proteins in concentrations sufficient to induce production of specific antibodies is not indispensible for Y. enterocolitica 1B/O8 infection in humans. The western-immunoblotting analysis of human serum samples showed that the antibodies were not induced by Ysa and Ysp proteins during infection caused by the epidemic strain of Y. enterocolitica 1B/O8 circulating in Poland. Similar, negative result was found with serum of a rabbit immunized intravenously by the reference strain WA-314. The project was funded by the National Science Centre in Cracov, Poland, grant N N401 076039.
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May 2014

[Detection and identification of highly pathogenic bacteria within the framework of the EQADeBa project--Part II: samples containing inactivated pathogens].

Przegl Epidemiol 2012 ;66(3):389-93

Zakład Bakteriologii Narodowego Instytutu Zdrowia Publicznego--Państwowego Zakładu Higieny w Warszawie.

The Aim: The aim of the studies was analysis of methods applied and results of detection and identification of Bacillus anthracis, Yersinia pestis, Francisella tularensis, Brucella sp., Bulkholderia mallei and B. pseudomallei in inactivated samples obtained within the framework of the third external quality assessment exercise (EQAE) in the project ,,Establishment of Quality Assurances for Detection of Highly Pathogenic Bacteria of Potential Bioterrorism Risk (EQADeBa)".

Material And Methods: Fifteen samples in the form of water, calf serum and milk spiked with bacteria mentioned above were investigated. Detection and identification of highly pathogenic bacteria were carried out using a PCR technique. RESULTS. Y. pestis, F. tularensis ssp. holarctica, B. anthracis, B. mallei and B. pseudomallei were detected in the investigated samples. The most problematic were samples of milk, probably because of presence of PCR inhibitors such as milk proteins and calcium ions and a low number of bacterial cells contained in the samples. CONCLUSIONS. Inactivation of samples spiked with highly pathogenic microorganisms ensure safety of labora- tory workers, but investigation of such samples needs very precise selection and validation diagnostics methods due to possibility of obtaining false negative results. Results of the third international external quality assessment exercise have confirmed competences of laboratory of Department of Bacteriology NIZP-PZH in the area of detection and identification highly pathogenic bacteria covered by the EQAE.
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January 2013

[Phylogeny, pathogenicity and genetic diversity of Yersinia enterocolitica].

Med Dosw Mikrobiol 2012 ;64(2):159-81

Zakład Bakteriologii, Narodowy Instytut Zdrowia Publicznego - Państwowy Zakład Higieny.

The past decade has witnessed a significant expansion of knowledge in field of Y. enterocolitica pathogenicity and virulence. In this period, a change of high-pathogenicity Y. enterocolitica bioserotype 1B/O8 geographical distribution has been observed. In 2003, Y. enterocolitica 1B/O8, major representative ofAmerican lineage, emerged in Europe, where it prevails in Poland. Complete genomes of major pathogenic bioserotypes have been made available, triggering substantial advances in genotyping and phylogeny of Y. enterocolitica. This study attempts to bring together the novelty in field of Y. enterocolitica pathogenicity and molecular epidemiology to rise the interest in the field, and to encourage further studies to better understand epidemiology ofyersiniosis in Poland.
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November 2012

[Rapid identification of Yersinia enterocolitica by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS)].

Med Dosw Mikrobiol 2012 ;64(2):123-8

Zakład Bakteriologii, Narodowego Instytutu Zdrowia Publicznego - Państwowego Zakładu Higieny.

Introduction: Yersinia enterocolitica includes both human pathogenic and non-pathogenic strains. The pathogenic strains belong to two evolutionary lineages: European and American, of mild- and high- pthogenicity, respectively. Y. enterocolitica European bioserotypes 4/O3 and 2/O9 are one of the major etiological agents of human yersiniosis worldwide. American lineage Y. enterocolitica bioserotype 1B/O8 has recently emerged in Europe. Since 2004 this high-pathogenicity bioserotype is increasingly isolated from humans in Poland. The rapid and accurate identification of pathogenic Y. enterocolitica strains is essential for diagnostic purposes. The aim of this study was to assess the usefulness of commercially available MALDI-TOF mass spectroscopy for Y. enterocolitica identification and subtyping.

Methods: A total of 33 strains of Y. enterocolitica belonging to bioserotype: 1B/O8 (n=2), 4/O3 (n=25) and 2/O9 (n=6) isolated from clinical specimens in Poland and 10 reference Y. enterocolitica 1B/O8 strains (Institute Pasteur, France) were used in this study. The identification of the Y. enterocolitica strains by MALDI-TOF MS was performed on MALDI Biotyper system (Bruker Daltonics, USA) with flexControl 3.0 software (Bruker Daltonics) according with the manufacturer's instruction.

Results: All of the tested Y. enterocolitica strains were correctly identified at the species level. However, American and European strains were not differentiated.

Conclusions: Our data indicate that MALDI-TOF MS can be used as a first-line method for rapid identification of Y. enterocolitica strains at the species level in clinical microbiology laboratories.
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November 2012

[Characteristic of fluoroquinolone resistant clinical isolates of K. pneumoniae, P. mirabilis and E. coli producing ESBL and AmpC beta-lactamases].

Med Dosw Mikrobiol 2012 ;64(4):285-95

Zakład Bakteriologii Narodowego Instytutu Zdrowia Publicznego - Państwowego Zakładu Higieny w Warszawie.

Introduction: Extended-spectrum beta-lactamases (ESBLs) are the predominant mechanism for acquired antibiotic resistance in Enterobacteriaceae. During the past few years, increasing occurrence of plasmid-mediated AmpC beta-lactamases (pAmpCs) particularly in K. pneumonia, P. mirabilis and E. coli was reported. Therefore, the aim of our study was to analyse of the diversity of plasmid-mediated beta-lactamases such as pAmpCs and ESBLs among clinical K. pneumonia, P. mirabilis and E. coli strains in Poland.

Methods: A total of 19 clinical Enterobacteriaceae strains (E. coli, n = 9; K. pneumoniae, n = 7; P. mirabilis, n = 3) resistant to third-generation cephalosporin were selected from collection of fluoroquinolone resistant isolates recovered during a 6-months period in regular hospital in Warsaw, Poland. ESBLs and AmpCs were detected by using phenotypic methods: double-disc tests (DDSTs), MAST ID D68C test, sensitivity to cefoxitin, disk potentiation test (DPT) and Tris-EDTA test. Polymerase chain reaction (PCR) amplification of the bla(AmpC), bla(CTM-M), bla(TEM), and bla(SHV), genes. PCR-products for these genes were sequenced. To determine the possible clonality of the tested isolates PFGE with the XbaI was performed.

Results: Nine of 19 fluoroquinolone-resistant strains tested produced extended-spectrum beta-lactamases of TEM, SHV and CTX-M families. These ESBLs were most commonly detected in E. coli. AmpC beta-lactamases were produced by 6 tested strains, including 3 isolates of P. mirabilis. The AmpC found in our study belonged to CMY and DHA families, Furthermore, 4 isolates of K. pneumoniae were found to co-produce both ESBL and AmpC beta-lactamases. XbaI-PFGE profiles pointed significant differences of tested strains.

Conclusion: Horizontal transfer of genes encoding for acquired beta-lactamases such ESBL and AmpC seem to play primary role in dissemination of these resistance traits among fluoroquinolone-resistant clinical strains of Enterobacteriaceae in Poland.
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April 2013

[Detection and identification of highly pathogenic bacteria within the framework of the EQADeBa project--Part I: Samples containing living pathogens].

Przegl Epidemiol 2011 ;65(3):401-7

Załkad Bakteriologii Narodowego Instytutu Zdrowia Publicznego - Państwowego Zakładu Higieny, Warszawa.

Bacillus anthracis, Yersinia pestis, Francisella tularensis, Brucella sp., Bulkholderia mallei are B. pseudomallei are highly pathogenic bacteria of potential bioterrorism risk. To support the early warning and rapid response capacity to ensure an effective reaction to bioterrorist attacks the international project "Establishment of Quality Assurances for Detection of Highly Pathogenic Bacteria of Potential Bioterrorism Risk" (EQADeBa) has been established. The aim of the project was establishment the network of European laboratories that possess a suitable infrastructure and experts and laboratory workers trained in detection and identification of the highly pathogenic bacteria. This work presents methods used in investigation of samples containing living pathogens and results obtained in Department of Bacteriology NIZP-PZH in the third international test organized within the framework of the EQADeBa. The test evaluated competence of laboratories in detection and identification of pathogens mentioned above. In the work methods used in other laboratories were discussed and the results were compared. Results of the test confirmed competence of NIZP-PZH in detection and identification of highly pathogenic bacteria covered by EQADeBa project.
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January 2012

Molecular epidemiology of a household outbreak of Shiga-toxin-producing Escherichia coli in Poland due to secondary transmission of STEC O104:H4 from Germany.

J Med Microbiol 2012 Apr 1;61(Pt 4):552-558. Epub 2011 Dec 1.

Department of Bacteriology, National Institute of Public Health - Public Institute of Hygiene, 24 Chocimska Street, 00-791 Warsaw, Poland.

We characterized two STEC O104 : H4 clinical isolates collected in Poland from a 7-year-old boy with haemolytic uraemic syndrome (HUS) and his nanny. This household outbreak began on 29 May 2011. Because of its time-frame, the outbreak was assumed to be part of the international STEC O104 : H4 outbreak that arose in Germany in May 2011. The two Polish isolates were Shiga-toxin-producing Escherichia coli (stx2 lpf) with enteroaggregative E. coli pathotype (aggR aap aggA), thereby sharing the unique virulence properties of the epidemic STEC O104 : H4 strain from the international outbreak. The Polish isolates were multi-drug resistant and carried bla(TEM), strA, strB, tetA, sul1 and sul2 markers together with the bla(CTX-M-15) gene for CTX-M-15 extended-spectrum β-lactamase. PFGE patterns and plasmid profiles of the Polish isolates and the epidemic STEC O104 : H4 strain corresponded closely. This finding suggested an epidemiological link between the Polish STEC O104 : H4 isolates and the international outbreak. Retrospective serological investigations proved person-to-person transmission of the epidemic STEC O104 : H4 strain from a father who had visited Dortmund, Germany, to his 7-year-old son in Giżycko, Poland. To the best of our knowledge, this is the first report of household transmission of Shiga-toxin-producing E. coli in Poland.
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http://dx.doi.org/10.1099/jmm.0.039289-0DOI Listing
April 2012

Plasmid-borne 16S rRNA methylase ArmA in aminoglycoside-resistant Klebsiella pneumoniae in Poland.

J Med Microbiol 2011 Sep 20;60(Pt 9):1306-1311. Epub 2011 Jan 20.

Department of Bacteriology, National Institute of Public Health - National Institute of Hygiene, Chocimska 24, 00-791 Warsaw, Poland.

We characterized 17 clinical isolates of Klebsiella pneumoniae producing 16S rRNA methylase ArmA. The isolates originated in Poland from 2002 to May 2010 and encompassed four XbaI-PFGE clusters. All the isolates were resistant to amikacin, gentamicin and kanamycin (MIC range: 256-1024 mg l(-1)) and carried the armA gene on a large plasmid of approximately 90 or 130 kb in 15 and 2 isolates, respectively. The armA gene was found in a ~10 kb ClaI restriction fragment of the large plasmid and was flanked by the same elements as in Tn1548. All the isolates carried the bla(CTX-M) gene for a CTX-M-type extended-spectrum β-lactamase. Our results show that ArmA has disseminated horizontally among K. pneumoniae isolates in Poland on the ~90 kb plasmid of the pCTX-M3 family.
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http://dx.doi.org/10.1099/jmm.0.024026-0DOI Listing
September 2011

[Occurrence of 16s rRNA methylase ArmA producing Enterobacteriaceae in a general hospital in Warsaw, Poland].

Med Dosw Mikrobiol 2010 ;62(3):201-9

Zakład Bakteriologii Narodowego Instytutu Zdrowia Publicznego-Państwowego Zakładu Higieny.

Resistance to gentamicin, amikacin and kanamycin was screened in 270 clinical isolates of Enterobacteriaceae originated from April 19 to May 19, 2010 in a regular hospital in Warsaw, Poland. Most of the isolated bacteria were considered pathogenic. Nineteen isolates (7%) were simultaneously resistant to two or three of the tested aminoglycosides. MICs of the three aminoglycosides ranged form 128 to 1024 mcg/ml for six isolates. These isolates were suspected to produce 16S rRNA methylase. Genes encoding for three methylases reported in Europe: ArmA, RmtB and RmtC were searched by PCR. The armA gene was detected in all of the six isolates. This group encompassed Enterobacter cloacae (n=4), Klebsiella pneumoniae (n=1) and Proteus mirabilis (n=1). Five isolates of this group carried the bla(CAX-M) gene for CTX-M type ESBL. The remaining isolate E. cloacae DM0340 was ESBL negative and lacked bla(CRX-M) that may suggest an altered genetic environment of the armA gene in this isolate. Our results showed that 2.2% of the tested isolates produced 16S rRNA methylase ArmA. This finding may argue for a high incidence of ArmA producing Enterobacteriaceae in Poland when compared to reports from other European countries.
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January 2011

Emergence of Klebsiella pneumoniae coproducing KPC-2 and 16S rRNA methylase ArmA in Poland.

Antimicrob Agents Chemother 2011 Jan 18;55(1):443-6. Epub 2010 Oct 18.

Department of Bacteriology, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland.

A Klebsiella pneumoniae epidemic strain that coproduced carbapenemase KPC-2 (K. pneumoniae carbapenemase 2) and 16S rRNA methylase ArmA has emerged in Poland. Four nonduplicate isolates from patients in a hospital in Warsaw, Poland, were found to carry the bla(KPC-2) and armA genes on ca. 50-kb and 90-kb plasmids, respectively. Tn4401 with a 100-bp deletion in the variable region was detected in all the isolates. XbaI pulsed-field gel electrophoresis (PFGE) revealed 93.2% similarity of the isolates. All the isolates were resistant to carbapenems and 4,6-disubstituted 2-deoxystreptamines.
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http://dx.doi.org/10.1128/AAC.00386-10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3019640PMC
January 2011

[Aminoglycoside resistance in Enterobacteriaceae originated in a gynecology-obstetrical hospital: a survey for 16s rRNA methylases: ArmA, RmtB and RmtC].

Med Dosw Mikrobiol 2010 ;62(2):97-107

Zakład Bakteriologii Narodowego Instytutu Zdrowia Publicznego--Państwowego Zakładu Higieny.

We examined the resistance of 2359 clinical isolates of Enterobacteriaceae to gentamicin, amikacin, netilmicin and neomycin by the disc-diffusion assay. The isolates originated from female-patients and newborn infants in a gynecology-obstetrical hospital in Warsaw, Poland. Isolates from adults predominated. Most of the isolated bacteria were considered non-pathogenic, colonization flora. The majority (above 95%) of the isolates were sensitive to all of the tested aminoglycosides. Forty five (1,90%) isolates were resistant to one or more agents. In this group, E. coli was prevalent (73,33%). As little as 14 isolates had no growth inhibition around the gentamicin disc (10 mcg) (contact-growth). MICs of seven isolates ranged from 256 to 1024 (mcg/ml) of the tested agents. One isolate had MIC 1024 for amikacin and kanamycin. All the contact-growth isolates were examined for genes encoding for TEM, SHV and CTX-M beta-lactamases, and genes armA, rmtB and rmtC for 16S rRNA methylases reported in Europe. All of them produced TEM enzyme while SHV and CTX-M was expressed by one and two isolates respectively. None of the tested 16S rRNA methylases was detected. Our results show the low carriage of the aminoglycoside-resistant Enterobacteriaceae in healthy pregnant-women and most probably their sexual partners. Our findings may argue that production of the 16S rRNA methylases is still limited to patients with a long-term antibiotic-therapy in regular hospitals rather than to non-hospitalized population in Poland.
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December 2010

[Dissemination of the KPC carbapenemase producing Klebsiella pneumoniae in a hospital in Warsaw, Poland].

Med Dosw Mikrobiol 2010 ;62(1):9-20

Zakład Bakteriologii, Narodowego Instytutu Zdrowia Publicznego-Państwowego Zakładu Higieny.

Within the last decade, human infections caused by enterobacteria which produce the Klebsiella pneumoniae carbapenemase (KPC) became a serious therapeutic and epidemiological problem worldwide. The KPC producing strains of K. pneumoniae broadly disseminated in the USA then spread to Europe. Recently, the KPC-2 was found in Poland. In the presented study we tested 11 ertapenem resistant isolates of K. pneumoniae. The isolates were obtained from 10 patients of a regular hospital (RH) and from one patient of a palliative care hospital (PH) in Warsaw, Poland. Expression of the KPC was confirmed in all the tested isolates by the positive result of phenotypic test with boronic acid. All the isolates were also shown to harbour the bla(KPC) gene by PCR with primers targeting the core 372 bp fragment of the gene, and all but two were resistant to imipenem and meropenem as determined by the disc-diffusion method. The DNA sequence analysis of the complete bla(KPC) gene from representative isolate DM0269 revealed variant 2 of KPC (KPC-2). Tested isolates were subjected to genotyping by the PFGE with XbaI. Dendrogram based on the PFGE profiles was composed of two main branches with 82,3% of similarity. Branch A encompassed 9 isolates (93,2%), including the one from the PH-patient, while the two remaining isolates (86,5%) were located in branch B. Five isolates of the branch A were indistinguishable by the PFGE. The high genetic similarity of the branch A isolates strongly suggests the intra-hospital dissemination of epidemic K. pneumoniae KPC+ sensu stricto strain. Most probably, the strain was also transferred to the palliative care hospital. In contrast, the branch B isolates appear to belong to the distinct sensu stricto strain, that has acquired the bla(KPC) gene via horizontal transfer. This is the first report on the intra-hospital dissemination of the KPC producing K. pneumoniae in Poland. It is noteworthy, all the tested strains were also resistant to cefotaxime, ceftazidime, aztreonam, ciprofloxacin and sulphonamides, but sensitive to colistin.
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November 2010

Carriage of genes for various extended-spectrum beta-lactamases: a novel resistance strategy of Klebsiella pneumoniae in Poland.

Int J Antimicrob Agents 2010 Apr;35(4):392-5

Department of Clinical Microbiology and Immunology, Children's Memorial Health Institute, Al. Dzieci Polskich 20, 04-730 Warsaw, Poland.

Among 110 randomly sampled strains from a collection of 247 extended-spectrum beta-lactamase (ESBL)-producing clinical isolates of Klebsiella pneumoniae collected from hospitalised children in three paediatric hospitals in Poland, 64 strains (58.2%) with multiple ESBLs were found, including five non-clonal strains (4.5%) harbouring bla genes for ESBLs of three families (CTX-M, SHV and TEM). This is the first report of the emergence of triple ESBL-producing K. pneumoniae in Poland. In addition, K. pneumoniae strains harbouring bla genes for TEM-130 and TEM-132 ESBLs were detected in Poland for the first time. Epidemiological analysis of the multiple ESBL-producing K. pneumoniae isolates by pulsed-field gel electrophoresis (PFGE) revealed a relatively high genetic diversity between isolates producing the same combination of enzymes. Clonally related strains were uncommon.
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http://dx.doi.org/10.1016/j.ijantimicag.2009.12.010DOI Listing
April 2010