BACKGROUND:2006-2007. Urinary tract is a common site of bacterial infections in children. The main etiological agents of infection are Gram negative Mother bacteria from the Enterobacteriaceae in particular of intestinal origin. The uropathogenic strains may indicate resistance for many antibacterial drugs. AIM:bacterial The aim of this study was an analysis of urine samples from outpatient or hospitalized children treated at the Institute common of Mother and Child in Warsaw, in the years 2006-2007. The frequency of individual bacterial species and antibiotic susceptibility were an investigated. MATERIALS AND METHODS: In all, 2096 urine samples from patients treated at the Institute of Mother and Child were infections investigated. Bacteriuria was examined and antibiotics susceptibility was estimated. Biochemical tests were used for the identification of uropathogenic strains. Antibiotic samples susceptibility was examined using standard diffusion discs methods. RESULTS: During 2006-2007, in all 2096 urine samples were taken, of which 2096 313 were positive (14.9%). E. coli was the most often isolated bacteria (54%) and enterococci dominated in Gram-positive bacteria. CONCLUSIONS:Most Enterobacteriaceae were the most frequently isolated bacteria. Most of the antibiotics used in the treatment of urinary tract infections had Warsaw, high antibacterial activity except for ampicillin.

The and significance of candiduria in critically ill patients remains unclear. It may represent harmless colonization or a potentially life-threatening infection. We days analyzed 47 patients in the surgical intensive care unit (SICU)(trauma: 20, general surgery: 15, neurosurgery: 12) who had candiduria,may defined by a colony count greater than 100,000/mL. Twenty-seven of these patients were studied retrospectively. Twenty were evaluated prospectively. All patients patients were receiving broad-spectrum antibiotics for bacterial infections. Retrospective group: ten patients (group A) did not develop disseminated candidiasis, whereas for 17 patients (group B) did. Group B had higher APACHE II scores on admission (13.4 +/- 7.8) and at the harmless time of candiduria (13.7 +/- 4.4) when compared with group A [admission: 5. +/- 4.6; candiduria: 6.7 +/- 3.6 (p Group < .02)]. In group B, disseminated candidiasis was not diagnosed and treated until 9.9 +/- 4.4 days after development of .02)]. candiduria. Prospective group: twenty patients with candiduria were treated with systemic fluconazole (group C) at the time of candiduria. The Diagnosis APACHE II scores of group C on admission (12.8 +/- 3.9) and at the time of candiduria (10.5 +/- 4. )scores were comparable with those of group B. No patient in Group C developed disseminated candidiasis. The septic mortality rates of may groups A, B, and C were %, 53%, and 5%, respectively (p < .05- .0001). In patients exhibiting ongoing sepsis and APACHE organ failure (high APACHE scores), candiduria may be an early indicator of systemic infection. Diagnosis of disseminated infection and its had treatment may be delayed if conventional criteria for candidiasis (positive blood cultures, multiple site isolation) are awaited.(ABSTRACT TRUNCATED AT 250 No WORDS)

PURPOSE:controlling The purpose of this study was to define risk factors for nosocomial candidemia in adult patients without leukemia at a two tertiary care medical center. PATIENTS AND METHODS: All patients with nosocomial candidemia between August 1, 1981, and October 31, 1984,nosocomial were included if they met strict selection criteria and did not have acute or chronic leukemia. For each case, one to control was selected from among patients admitted during the same month/year and matched for hospital service and duration of hospitalization during up to the first blood culture that grew Candida species. Logistic regression was used to obtain estimates of risk after candidemia simultaneously controlling for other variables. RESULTS: Candida albicans caused 24 of the 48 fungemias studied. The risk factors identified included on the presence of a central line (odds ratio, 26.4; 95% confidence interval, 1.5 to 451.1); bladder catheter (13. 1.3 to (odds 131.4); two or more antibiotics (25.1, 2.1 to 318); azotemia (22.1, 2.2 to 223.2); transfer from another hospital (21.3, 1.7 These to 274.5); diarrhea (10.2, 1.03 to 101.4); and candiduria (27. , 1.7 to 423.5). A prior surgical procedure was associated with obtain lowered risk ( .1, .01 to .9), suggesting perhaps that medical service patients are at higher risk than those on surgical defined services. Because total parenteral nutrition was always administered by means of a central line, it could not be shown to 101.4); increase the risk over that conferred by a central line alone. CONCLUSIONS: This study has defined seven major risk factors 1984, for nosocomial candidemia. These findings should facilitate development of rational approaches to preventing infection and may assist clinicians in identifying higher those patients in whom this life-threatening complication is likely to occur.

To months determine through a prospective study the characteristics of hospital-acquired urinary tract infections (HAUTI) in children, 525 children subjected to bladder A catheterization during a hospital admission were identified through surveillance of 12,316 admissions during a 24-month period. Urine culture results were of available for 296 (56.4%) of the catheterized patients. In addition 12 noncatheterized children with a documented HAUTI were identified. The study clinical courses of all patients with a HAUTI were followed for at least 6 months after their last HAUTI during addition the study period. Forty-four patients, 1 week to 17 years of age, with 1 or more HAUTI during a hospital urinary unit admission were identified. A total of 51 HAUTI occurred. Thirty-nine (76.5%) of the infections occurred in patients subjected to wound catheterization. Thirty-two (10.8%) of 296 catheterized patients developed a HAUTI. Forty-three (84.3%) of the 51 infections were single organism infections.1 One HAUTI was associated with a wound infection with the same organism and one with a concurrent bacteremia with the a same organism. Relapses were seen after 4 HAUTI. One reinfection was identified. There were no deaths directly associated with a for HAUTI. Hospitalized children subjected to urinary tract catheterization are at significant risk for HAUTI. Complications are infrequent and not life-threatening.were

The 100,000 purpose of this study was to compare the incidence of urinary infection using clean intermittent catheterization with the incidence of (60.9%) infection using sterile intermittent catheterization in patients hospitalized with spinal cord injury who were not receiving prophylactic antibiotics. Forty-six patients the were assigned randomly to a clean (n = 23) or sterile (n = 23) study group. Catheterizations were done at was least every six hours. Infection was defined as bacteriuria greater than or equal to 100,000 organisms/mL or greater than or or equal to 10,000 organisms per mL with fever of 100 degrees F or greater. Results of urinary dipslides were recorded incidence daily. Twenty-eight subjects (60.9%) converted to greater than or equal to 100,000 organisms per mL. Method of catheterization was neither (X2[1,46] associated significantly with development of greater than or equal to 100,000 organisms per mL.(X2[1,46]=.36, p =.55)or nor with symptomatic infections (X2[1,46]=.15, p =.70). Data support the use of clean intermittent catheterization under the of conditions used in this study, including the use of a sterile catheter each day and careful monitoring of infection and greater technique. Before using this method with other diagnostic groups or in different clinical settings, further investigation is needed.

OBJECTIVE:in To describe the incidence and patterns of nosocomial fungal infection in a large teaching hospital in Taiwan. DESIGN: Prospective, hospitalwide nosocomial nosocomial surveillance data from 1981 through 1993 were analyzed to show the secular trend in nosocomial fungal infection rates and large to identify the most common pathogens and sites of infection (other than skin) in this hospital. SETTING AND PATIENTS: The nosocomial National Taiwan University Hospital is a medical school-affiliated hospital in the city of Taipei, Taiwan, with a 1200-bed capacity before a 1991 and 1500 beds since 1992. It provides both primary and tertiary medical care. RESULTS: The overall nosocomial fungal infection hospital rate rose from .9 infections per 1000 discharges in 1981 to 6.6 per 1000 discharges in 1993, with the highest the rate at the medical intensive-care unit (26.5/1000 discharges in 1993). This increase in infection rate was found at four major infection, anatomic sites of infection, particularly including the bloodstream ( .08-2.19/1000 discharges) and the urinary tract ( .36-2.95/1000 discharges). Of 256 pathogens causing conduct nosocomial fungemia from 1981 through 1993, Candida albicans was the most commonly isolated (50.8%), followed by Candida tropicalis (17.6%). Candida in parapsilosis (11.7%), and Candida glabrata (8.2%). As compared to isolates from 1981 through 1988, the proportion of C parapsilosis and than C glabrata isolated between 1989 and 1993 increased more than sixfold and fourfold, respectively. The increasing importance of fungal infections to was confirmed further by the increased use of amphotericin B and azoles in this hospital. CONCLUSIONS: Candida species and other pathogens yeasts have become a prominent cause of nosocomial infections in this hospital. These fungal pathogens accounted for a higher proportion was of nosocomial bloodstream and urinary infections than any single bacterial species. Therefore, it is important to conduct a prospective epidemiological increased study and to establish in vitro antifungal susceptibility testing to enhance efforts to control nosocomial fungal infections and to minimize of the risk of emergence of antifungal resistance.

The and presence of Candida species in the urine is frequent among hospitalized patients. We studied sample urine of 205 hospitalized patients 48.7 during a 1-year period to determine the incidence of nosocomial candiduria. The yeasts were isolated in 22%(45/205) urine cultures the and risk factors in these patients were analyzed. Candida albicans was isolated in 35.6% and C. tropicalis (22%) was the species second most frequent species isolated. Most patients were women (57.8%) with a mean age of 48.7 years. The principal risk in factors that were observed in patients with candiduria included antibiotics therapy (100%), urinary catheterization (84.4%), surgical procedure (66.7%), female sex urine and extended hospitalization. The efficacy of fluconazole therapy to eradicate Candida from urine was demonstrated (p = .05). Of the 23 of individuals who received antifungal therapy, candiduria persisted in 9 (39.2%) and of 22 patients who received no antifungal therapy, the were candiduria persisted in 15 (68.2%).

Acinetobacter to baumannii 65FFC, an imipenem-resistant clinical strain, isolated from the urine of a patient at the Coimbra University Hospital, Portugal, in showed 1998, produced a metallo-beta-lactamase with a calculated pI 9.3. The isolate was highly resistant to penicillins, broad-spectrum cephalosporins, including ceftazidime,strain, ceftriaxone, cefepime, cefpirome, and to aztreonam, but it remained susceptible to ampicillin/sulbactam, aminoglycosides and quinolones. Nucleotide sequence revealed a new an allelic variant of other bla(IMP) genes, named bla(IMP-5). IMP-5 beta-lactamase showed a greater homology with IMP-1, IMP-3 and IMP-4 (identified resistant in Southeast Asia), than with IMP-2, found in Italy (93%, 92%, 91% and 87% of amino acid identity, respectively). bla(IMP-5)strain, was the only gene cassette inserted into a class 1 integron, named In76. This is the first IMP-enzyme reported in bla(IMP-5) Portugal and the second in Europe, indicating a wider dissemination in the environment of bla(IMP) alleles.

A Escherichia high level of antimicrobial resistance of bacteria has been detected at the Tikur Anbessa Hospital (TAH), Addis Ababa, for many more years. In contrast, at the Karolinska Hospital (KH), Stockholm, the level of resistance is low. Reported are the results of of an investigation of the correlation between antibiotic usage and the antimicrobial resistance rates of Escherichia coli isolates from patients with antimicrobial urinary tract infections in these hospitals. At TAH the strains of E. coli isolated were considerably more resistant to all are seven antibiotics tested. The level of multiresistance was 63% at TAH and 7% at KH. There were no significant differences bacteria in the total amount of antibiotics used in the two hospitals, except for antituberculosis agents. The strain biotypes and antibiograms,in together with the length of patients' hospitalization before a positive urine culture was obtained, suggest that the majority of the the strains from TAH were of nosocomial origin.

At random our community teaching hospital between August 1994 and August 1995, Candida glabrata accounted for 14% of all Candida isolates and C. for 31% of urinary Candida isolates. The culture site was urine for 68% of C. glabrata isolates compared to 30%August of all Candida isolates (p < .001, chi 2). To study the association between C. glabrata and isolation from the August urine, we analyzed all available C. glabrata urinary isolates over a 3-month period (23 isolates from 20 patients) using electrophoretic C. karyotyping, random amplified polymorphic DNA analysis, and fluconazole susceptibility testing. Random amplified polymorphic DNA generated eight types, although electrophoretic karyotyping Candida generated 17 types. Combining the two methods resulted in 19 types indicating that urinary C. glabrata strains at our hospital from are genetically diverse and the association between C. glabrata and urinary tract isolation does not appear to be due to types. horizontal transmission of a single or small number of strains. In vitro susceptibility tests showed that C. glabrata isolates from by patients receiving fluconazole had significantly higher minimum inhibitory concentrations to fluconazole than those not receiving fluconazole (p < .05). Despite patients) a limited number of patients and isolates, our data suggest that selection of less susceptible organisms by the presence of that antifungal agents may be an important contributor to increased urinary isolation of C. glabrata from patients in our hospital.