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Analysis of Genetic Similarities Between Clostridium Perfringens Isolates Isolated from Patients with Gas Gangrene and from Hospital Environment Conducted with the use of the PFGE Method

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Brzychczy-Włoch M., Bulanda M.
Polish Journal of Surgery
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2015
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vol. 86
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issue 3
141-146
EN
The objective of the study was to perform a comparative analysis of genetic similarity, with the use of pulsed field gel electrophoresis (PFGE), of Clostridium perfringens isolates originating from patients with gas gangrene and from the hospital environment. The study encompassed two patients with a clinical and microbiological diagnosis of gas gangrene, who were hospitalized in one of the hospitals of the Małopolska province in the time period between 31st March 2012 and 18th May 2012. Clostridium perfringens isolates genotyping indicated that the isolates originating from the two studied patients did not display genetic similarity and represented two different PFGE types, which corresponded to two different clones (clone A and B). Whereas the strains isolated from the hospital environment were genetically identical with the strain coming from the second patient and represented one PFGE type, which corresponded to one clone (clone A). As a result of the study, it is possible to conclude that both patients developed endogenous infection. Even so, the examination of the hospital environment indicates the possibility of the appearance of exogenous infections. It prompts recommending and following the exact regulations of sanitary regime in the ward and the operating theater if a patient is diagnosed with gas gangrene.
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Perioperative Antibiotic Prophylaxis in Clinical

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Jawień M., Bulanda M.
Polish Journal of Surgery
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2010
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vol. 82
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issue 4
219-225
EN
The aim of the study was to determine the efficiency of perioperative antibiotic prophylaxis in surgical patients.Material and methods. During the period between January and December, 2005, eight surgical Departments were subject to investigation, considering surgical wound infections following selected procedures: 3 orthopedic departments, 3 general surgery departments, and two vascular surgery departments. Based on obtained results the following parameters concerning perioperative antibiotic prophylaxis were evaluated: was the procedure performed with antibiotic prophylaxis?; type of chemotherapeutic agent used, and duration of prophylaxis.Results. Inguinal hernia repair procedures were most often performed without antibiotic (33% of procedures). The statistically significant higher incidence index of surgical wound infections was confirmed in case of cholecystectomy without (18.8 vs 2%). In case of vascular procedures cefuroxime was used in 8 doses. In case of hip or knee joint endoprosthesis surgery cefazolin was administered in five doses. In 70% of cholecystectomy and hernial repair procedures one dose of cefazolin was used. Considering colorectal operations the following antibiotics were used: 6 doses of cefazolin in 36% of cases, and 8 doses of amoxicillin with clavulanic acid. Twenty-five percent of colorectal procedures required the administration of amoxicillin with clavulanic acid and metronidazolConclusions. Analysis demonstrated that in spite of the many guidelines elaborated by scientific associations concerning perioperative antibiotic prophylaxis, the above-mentioned are rarely administered according to clinical practice.
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Wrodzony obrzęk naczynioruchowy u dzieci

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Czarnobilska E., Bulanda M.
Alergia Astma Immunologia - przegląd kliniczny
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2018
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vol. 23
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issue 4
193-198
EN
Hereditary angioedema (HAE) is a rare disease characterized by episodes of subcutaneous or submucosal oedema, without urticaria and itching, spontaneously resolving within 1-5 days, resistant to antihistamines and glucocorticosteroids. The average age of development of symptoms is 10 years, and 40% of affected individuals experience their first attack under the age of 5. HAE is most commonly associated with inherited decrease of the concentration of C1 inhibitor (C1 INH) or dysfunction of C1 INH. This activates the complement and causes bradykinin accumulation leading to tissue edema. Diagnosis of HAE includes an interview, the morphological characteristics of swelling and the results of additional tests (concentration and activity of C1 INH, concentration of complement component 4). The final diagnosis requires at least two consistent results of screening tests, the second one should be carried out after the first year of age. Genetic tests can be performed in families with a known mutation. Research on HAE reveal frequent delays in the diagnosis, which have a negative impact on quality of life. At present, 2 preparations used in treatment of HAE in pediatric population are refunded in Poland: concentrate of C1 INH: Berinert (no age restrictions) and recombinant concentrate of C1 INH: Ruconest (from 13 years of age).
PL
Wrodzony obrzęk naczynioruchowy (Hereditary angioedema, HAE) u dzieci jest rzadką chorobą charakteryzującą się epizodami obrzęku tkanki podskórnej lub podśluzowej bez bąbla pokrzywkowego i świą- du, ustępującymi spontanicznie w ciągu 1-5 dni, opornymi na działanie leków przeciwhistaminowych i glikokortykosteroidów. Średni wiek rozwoju objawów to 10 lat, a 40% dotkniętych chorobą osób przeżywa swój pierwszy atak w wieku poniżej 5 lat. HAE jest najczęściej zwią- zany z dziedzicznym zmniejszeniem stężenia lub dysfunkcją inhibitora C1 (C1-INH). Powoduje to aktywację układu dopełniacza i akumulację bradykininy prowadzącą do obrzęku tkanek. W diagnostyce HAE istotny jest wywiad, morfologiczne cechy obrzęku i wyniki badań dodatkowych (stężenie i aktywność C1-INH, stężenie składowej C4 dopełniacza). Ostateczna diagnoza wymaga co najmniej dwóch zgodnych wyników badań przesiewowych, przy czym drugie z nich powinno zostać przeprowadzone po 1. r.ż. W rodzinach ze znaną mutacją można wykonać badania genetyczne. Badania pokazują częste opóźnienia w diagnozie, które mają negatywny wpływ na jakość życia pacjentów. Obecnie w Polsce refundowane są dwa preparaty do stosowania w leczeniu HAE w populacji pediatrycznej - koncentrat C1 inhibitora: Berinert (bez ograniczeń wiekowych) i rekombinowany koncentrat C1 inhibitora: Ruconest (od 13. r.ż.).
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Comparison of in vitro activity of doripenem, imipenem and meropenem against clinical isolates of Enterobacteriaceae, Pseudomonas and Acinetobacter in Southern Poland

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Drzewiecki A., Bulanda M., Talaga K., Sodo A., Adamski P.
Polish Journal of Surgery
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2012
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vol. 84
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issue 9
449-453
EN
In the study we tested drug sensitivity to 3 carbapenems (doripenem, imipenem and meropenem) of Gram-negative clinical isolates from Southern Poland. Material and methods. 89 strains were examined: 42 from Pseudomonas genus, 16 Acinetobacter baumannii strains and 31 Enterobacteriaceae strains. Etests were used according to the producers instructions, MIC values were interpreted using EUCAST criteria. Results. Highest in vitro activity against Pseudomonas spp. was shown for doripenem, then meropenem and the lowest for imipenem (MIC values were definitely lower for doripenem; differences were statistically significant); A. baumannii strains showed similar sensitivity to doripenem, meropenem and imipenem (differences non-significant); all Enterobacteriaceae strains showed sensitivity to the tested antimicrobials. Conclusions. As a conclusion-doripenem, which has high in vitro activity (almost the same as imipenem and meropenem) as well as beneficial pharmacologic properties, may be an alternative solution in the treatment of multiresistant Gram-negative bacteria, especially in patients in severe status who require restrictive antibiotic regimens.
5
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Evaluation of the activity of thermostable DNA polymerases in the presence of heme, as a key inhibitor in the real time PCR method in diagnostics of sepsis

71%
Gosiewski T., Brzychczy-Włoch M., Pietrzyk A., Sroka A., Bulanda M.
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2013
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vol. 60
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issue 4
603-606
EN
The study aim was evaluation of the usefulness of several thermostable DNA polymerases in real time PCR conducted in the presence of the heme. Our study had the advantage of testing several different polymerases, one of which proved to be the least sensitive to heme activity. We also found that there is no need of supplementing the reaction mixture with protective substances like BSA. Selection of the appropriate polymerase can increase the efficiency of the PCR reaction which is very important for diagnosis of sepsis and for other analyses performed on DNA template isolated from the blood.
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