Biomedical subjects

Adam Szczesny

Publications and source records attributed to Adam Szczesny.

6 recordsLinked to original sources

PubMed2005

Clostridium difficile in emergency room.

Clostridium difficile strains are known as etiological agents of pseudomembranous colitis (PMC), antibiotic-associated diarrhea (AAC) and colitis (AAC) and hospital-acquired infections. The aim of this study was to determine the frequency of C. difficile infection among patients in the emergency room and to compare isolated strains by phenotypic and genotypic characteristics. During a period of 11 months, 56 stool samples taken from diarrheic patients hospitalized in the emergency room of the Medical Center UC Davis and 14 environmental samples were cultured for isolation of C. difficile strains. Eighteen C. difficile strains were isolated from stool samples cultured on selective TCCCA plates and 5 strains from environmental samples using Rodac plates. Eleven toxigenic (TcdA+/TcdB+), 6 non-toxigenic (TcdA-/TcdB-) and unique toxin A-negative/toxin B-positive (TcdA-/TcdB+) C. difficile strains were detected among patients' isolates and 3 toxigenic and 2 non-toxigenic strains-among environmental samples. The majority of C. difficile-positive patients were treated previously by antibiotics. Four strains isolated from patients' fecal samples and one strain isolated from the environment demonstrated high-level resistance to erythromycin and clindamycin (MIC >256mug/mL). The results obtained by AP-PCR and PCR-ribotyping revealed genetic heterogeneity among the strains isolated from patients' fecal samples. However, similarity was observed among environmental strains and strains isolated from patients' fecal samples. Considering the importance of emergency room patients as a potential source of C. difficile strains, it appears to be important examine these patients for C. difficile before transfer to the other hospital units.

Journal Article↗

PubMed2005

Analysis of Clostridium difficile-associated diarrhea among patients hospitalized in tertiary care academic hospital.

The frequency of Clostridium difficile strains in stool samples of patients with diarrhea hospitalized in the hematology/oncology, surgery, orthopedics, transplantology ward, and emergency room of Davis Medical Center was analyzed. A total of 786 stool samples collected from patients with diarrhea and 180 samples taken from the hospital environment were cultured for C. difficile by routine methods. There were 119 strains of C. difficile isolated: 97 (12.3%) strains from patients' stools (no enteropathogen other than C. difficile was detected in these stool samples) and 22 (12.2%) strains from the hospital environment. It was confirmed that hospital environment plays an important role in transmission of C. difficile by AP-PCR and PCR ribotyping. Among 97 C. difficile strains isolated from patient' stools 25 were nontoxigenic (A-/B-), 67 were toxigenic (A+/B+), and 5 strains were toxin B-positive/toxin A-negative. Analysis of concomitant symptoms among hospitalized patients with diarrhea demonstrated significantly longer duration of diarrhea caused by nontoxigenic strains than in cases of diarrhea caused by toxigenic strains. On the other hand, among patients infected by toxigenic strains, significantly higher leukocytosis and longer duration of fever were observed. The resistance of isolated C. difficile strains to erythromycin and clindamycin indicated the possibility of transmission in the hospital strains with macrolide-lincosamide-streptogramin B resistance type.

Bacterial Proteins↗

PubMed2005

Co-infection of hamsters with toxin A or toxin B-deficient Clostridium difficile strains.

Male Syrian hamsters (Mesocricetus auratus) were used to study interactions between different toxin deficient strains of C. difficile. After sensitization with clindamycin, hamsters were intragastrically co-infected with the appropriate dilutions corresponding to 100, 1000 and 10,000 cells of four (toxin A or B-deficient) C. difficile strains (8864, P-829, W-38 and W-74). In addition, a group of hamsters was infected with C. difficile VPI 10463, a reference toxigenic strain. Colonization and mortality was observed within 48 hours in the group of hamsters infected with the reference toxigenic strain. No clinical disease was observed in the groups of hamsters co-infected with the toxin A or B-deficient strains. Re-infection of these hamsters (co-infected with toxin deficient isolates) with C. difficile VPI 10463 resulted in clinical disease and death suggesting that these strains do not confer protection against infection with a toxigenic strain. Macroscopic and microscopic observations of the cecum of re-infected hamsters demonstrated uniformly multiple large hemorrhagic areas without pseudomembranes. Hamsters infected with as few as 100-500 cells of the toxigenic strain--VPI 10463 alone demonstrated pseudomembranes and multiple hemorrhages. These results suggest that even though the toxin deficient strains did not prevent re-infection with a toxigenic strain of C. difficile, they may play a role in the histopathologic changes after re-infections in the hamster model. Further studies with a larger number of hamsters and C. difficile strains of various molecular profiles are required to better understand the interaction between these strains.

Animals↗

PubMed2004

Isolation of non-toxigenic strains of Clostridium difficile from cases of diarrhea among patients hospitalized in hematology/oncology ward.

Clostridium difficile has become the most common cause of hospital acquired diarrhea after antibiotic treatment. The aim of this study was to determine the frequency of C. difficile associated diarrhea among hematology/oncology ward patients and to characterize isolated strains. Twenty three toxigenic and thirteen non-toxigenic strains were detected among fecal isolates. Antibiotic susceptibility testing to erythromycin and clindamycin demonstrated a high degree of resistance (MIC > 256 ug/ml) to both antibiotics in 9 out of 13 nontoxigenic C. difficle strains. Out of 7 patients with maximal frequency of diarrhea (10 empties/day) in 4 cases non-toxigenic strains of C. difficile were isolated. In these cases duration of diarrhea was longer in time than in cases of diarrhea caused by toxigenic strains. Further investigation with a larger patient population is necessary to better understand the role that non-toxigenic C. difficile strains play in disease development.

Clostridioides difficile↗

PubMed2003

[Treatment of infections associated with Clostridium difficile].

Cases of antibiotic-associated diarrhoea (AAD) associated with toxigenic C. difficile strains more frequently are described recently. In Polish studies diagnosis of AAD or PMC (pseudomembranous colitis) was confirmed by isolation of C. difficile strains in 52% of suspected cases. Strains of C. difficile were isolated also from samples taken from hospital environment (10.5% positive samples). Problem of C. difficile-associated infection is more frequently observed in Poland also because of uncontrolled using of wide spectrum antibiotics. These antibiotics destroy intestinal microflora--"colonization resistance factor". Cases of AAD or PMC were described even after treatment of patients by vancomycin or metronidazol--antibiotics of choice for treatment of C. difficile-associated diseases. Other risk factors as: age, long term hospitalization, previous surgery, colonoscopy are also taken into account, when C. difficile-associated infections are suspected. Different treatment methods of C. difficile-associated infections are reviewed here and discussed in light of recent publications.

Anti-Bacterial Agents↗

PubMed2002

[Epidemiology of Clostridium difficile infection].

Pseudomembranous colitis (PMC), antibiotic-associated diarrhoea (AAD), and colitis (AAC) caused by Clostridium difficile are recognized as complications of antibiotic treatment (cephalosporins, penicillins, clindamycin and others). Two groups are particularly at risk: older and immunocompromised patients. In recent years C. difficile has been recognized as a common nosocomial pathogen. To understand the epidemiology of the C. difficile infection, many outbreaks have been investigated by various methods. In the paper we reviewed different methods of C. difficile typing and discussed the epidemiology of C. difficile-associated infections in light of recent publications.

Age Factors↗