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Ninety nine patients with 101 bacteraemic episodes due to Ps. aeruginosa (PA) within 6 years were divided into two groups according to their resistance to imipenem-91 due to imipenem sensitive (ISPA) and 10 due to resistant (IRPA). Risk factors, the clinical course and the outcome were evaluated and compared. Acute leukaemia, prolonged neutropenia, previous therapy with amikacin, third generation of cephalosporins, imipenem and prophylaxis by quinolones were significantly more frequently associated with IRPA. Imipenem resistant PA bacteraemia were associated with higher incidence of septic shock (40% vs 19.8%, p < 0.02) and death (33.3%) than ISPA bacteraemias. Since 1992, when first IRPA appeared, the incidence of imipenem resistance increased tenfold, and in 1994, up to 10% of PA causing bloodstream infections in cancer patients in our center were imipenem resistant. (Tab. 3, Ref. 8.).

The authors studied a relationship between particular bacterial or fungal organisms isolated from blood cultures and type of malignancy and antineoplastic drugs in 237 cancer patients. Sixty four had acute myelogenous leukemia (AML), 43 non-Hodgkin's lymphoma (NHL) and 140 solid tumors (ST). All patients had at least one positive blood cultures for one or more microorganism drawn during 1-10 days after cytotoxic chemotherapy, viridans streptococcal bacteremia was more frequently observed in patients with AML (12.5%) and NHL (27.9%) than ST (43%, p < 0.01 and 0.03). The incidence of anaerobic bacteria was similar in patients with NHL and ST, and in both groups significantly higher (p < 0.05) than in AML. Enterobacteriaceae caused bacteremia less frequently in patients with AML than in those with ST (12.5 vs 27.8%, p < 0.05). However, the highest incidence of Stenotrophomonas maltophilia bacteremia was seen in patients with AML (6.3% vs 2.3%, p < 0.04 and 0.03). Concerning fungemia, Candida albicans occurred significantly more frequently in blood cultures in patients with NHL, and molds in patients with AML. Cytarabine and metothrexate seems to be more frequently associated with viridans streptococci, cytarabine and mitoxanthrone with Stenotrophomonas maltophilia, B. fragilis with cisplatin and 5-fluorouracil, Fusarium spp., Mucorales and Aspergillus spp. with acute leukaemia (AL) treated with cytarabine and mitoxantrone. The association of other pathogens with an underlying disease or chemotherapeutic regimen could not be documented. (Tab. 1, Ref. 19.).

One hundred twenty three breakthrough bacteraemias (BB) during 5 years in a National Cancer Institute, among 9986 admissions and 979 bacteraemic episodes were analysed. 123 BB were caused by 323 microbes, only 116 were resistant (31.5%) to currently administered antimicrobials. Sixty seven of 123 bacteraemic episodes were catheter associated confirmed by isolation of the same organisms from the blood and catheter tip. 77/123 BE were polymicrobial. The most frequently isolated strains were coagulase negative staphylococci (30.5%), Corynebacteria (10%), Ps. aeruginosa (10%), Str. faecalis (9%) and Viridans streptococci (8.5%). Gram-positive aerobes accounted for two-thirds of all organisms isolated during breakthrough bacteraemic and fungaemic episodes. Mixed polymicrobial breakthrough bacteraemic and fungaemic episodes were more frequently associated with vascular catheter insertion and neutropenia, and had a less favourable outcome in comparison to monomicrobial infections. The relapse was associated more frequently with catheter related bacteraemic and fungaemic episodes, but the overall mortality rate was similar independently from catheter insertion. Breakthrough bacteraemic and fungaemic episodes were associated more frequently with acute leukaemia. Polymicrobial breakthrough bacteraemic and fungaemic episodes were associated more frequently in neutropenic episodes and in venous catheters. Regarding the outcome, an extraction of the catheter with no dependence on variable and modification of antimicrobial therapy were essential for the improvement in the prognosis. (Tab. 5, Ref. 20.).

The development of antimicrobial resistance in main pathogens of respiratory system infections (S. pneumoniae, H. Influenzae, B. catarrhalis) reduces the range of unprotected penicillins indications. The inhibitors of beta-lactamase rendered back the original spectrum of antimicrobial activity to aminopenicillins and ureidopenicillins, and withheld them within the most frequently used armamentarium of antimicrobial drugs for the therapy of more severe infections. The prescription of penicillins is ruled according to the localization of infection, most frequent pathogens and by the epidemiologic situation. A combined antibiotic therapy is indicated in severe infections. An important indication area is the prophylactic administration of penicillins in recurring tonsilopharyngitis, recurring otitis media and eradication of meningococcal carriership. (Tab. 1, Ref. 3.).

Vancomycine serum levels were measured in 198 cancer patients with documented grampositive bacteremia and twenty two failed. Failures were analyzed for risk factors of therapy failure. Only 8 of 22 showed low serum peak or through vancomycin levels. One patient was treated less than 7 days, 9 had persisting and 4 catheter associated bacteremia. Bacteremias due to VAN resistant strains were excluded. In 14 out of 22 patients, multiple or one risk factor could be determined, but in 8 patients, no risk factor was found. Hence the, case control study was conducted to compare the group of failures in 22 patients with a group of patients with underlying disease and neutropenia treated successfully within the same period and same antibiotic policy at the same cancer center, by VAN for gram-positive bacteremia. Persisting, catheter associated and enterococcal bacteremias were the only statistical significant risk factors predicting a therapy failure in cancer patients. Neither Vancomycine serum peak nor through levels predicted the outcome: failure or cure of gram-positive bacteremia in cancer patients. (Tab. 1, Ref. 5.).

Risk factors, etiology, symptomatology and outcome of bacteremia in 276 patients with solid tumors were evaluated. A group of 78 patients with solid tumors and surgical therapy was compared with 172 patients with solid tumors but treated solely by chemotherapy. The most frequently observed risk factors of bacteremia in patients after surgery were the vascular and urinary catheter insertions, wound as source of bacteremia, staphylococci, enterococci and Enterobacteriaceae as etiologic agents. Comparing the group of therapeutically treated patients with solid tumors, with the group of those treated only by chemotherapy, a statistically significant difference in risk factors between both groups was observed only in the incidence of catheter insertion (more frequently in surgically treated patients), neutropenia (more frequently in those treated by chemotherapy). Wound as source of bacteremia was more frequently observed in those after surgery. Enterobacteriaceae and enterococci were significantly more frequently observed in patients with solid tumors treated by surgery. Surprisingly, patients after surgery the mortality due to septic shock was lower in (6.4% vs 16.9%, p < 0.03) than in the control group of patients with solid tumors treated solely by chemotherapy. (Tab. 1, Ref. 5.).

The authors present epidemiological data about congestive heart failure, its most common etiology and prognosis. They justify the performance of heart transplantation (HTx) in the treatment of congestive heart failure. They analyze the present state of HTx in the world and describe also the history of HTx in Slovakia. They present the review of contraindications and indications for the inclusion of recipients into the HTx programme and describe the further fates of these patients. They regard the HTx as an integral component of the therapeutical approach to the precisely defined group of patients with otherwise refractory congestive heart failure. (Tab. 4, Fig. 6, Ref. 38.)

Mechanisms of resistance of strains of Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Enterococcus faecalis, Enterococcus faecium, Neisseria meningitidis and Mycobacterium tuberculosis to antibiotics are presented and discussed. The resistance to methicillin-oxacillin in S. aureus and S. epidermidis is chromosomally-mediated by sequence of DNA, namely by gene mecA. This gene codes altered PBP-2A protein. Strains of S.pneumoniae contain PBP-1A, PBP-2B and PBP-2X proteins. They cause resistance to many beta-lactam antibiotics. Resistance to vankomycin, respectively to teikoplanin in strains of E. faecalis and E. faecium is coded by transferable vanA and vanB genes. Strains of N. meningitidis produce mostly the altered PBP-2 protein. The increase of resistance in strains of M. tuberculosis is also significant.

Background: Anthracycline antibiotics represent a part of therapeutic schemes in the treatment of a wide spectrum of malignancies. Precisely due to their cytostatic effectiveness they are being applied in spite of the risk of cardiac damage of patients. Anthracycline cardiotoxicity may culminate in potentially irreversible heart failure and fatal arrhythmias. Consequences of cardiotoxicity can complicate and shorten the lives of patients with formerly favourable prognosis of the malignant disease, and even of those that have been cured., Objectives: The aim of the presented study was to provide a review on current opinions concerning the pathophysiological mechanisms of cardiotoxicity due to anthracycline antibiotics, as well as the possibilities of cardiotoxicity prevention and detection. The procedure of cardiac monitoring of anthracycline effects is performed in order to detect the initial stage of myocardial impairment which is on the level of microstructural alterations. This requirement is mostly fulfilled by the invasive method of endomyocardial biopsy. Also the noninvasive method of high-resolution electrocardiography may reflect anatomic-electrophysiological abnormalities on the level of cardiomyocytes and interstitium. We decided to verify the usefulness of this method in the sense of the ability to detect the risk of the cardiotoxicity origin following anthracycline application., Methods: We have repeatedly observed 34 hospitalized patients with cancer before or during chemotherapy. On the basis of high-resolution electrocardiography we have analysed the ECG signal in regard to time, frequency and time-frequency relation., Results: In this study we present our initial experience with this method in combination with electrocardiographic and echocardiographic findings. In regard to the fact that the observations were of short term character we interpret our results of high-resolution electrocardiography as being preliminary. We report 4 illustrative cases of patients who independent of the dosage, yielded distinct responses toward the applied potentially cardiotoxic therapy., Conclusions: We consider the high-resolution electrocardiography in regard to its noninvasive character and low demand of time and finance to represent a perspective method of cardiac monitoring of the negative anthracycline effect. Not only ours but also the first experience in the world confirm this presupposition. By means of this method we have been able to detect initial alterations due to already low cumulative doses of anthracyclines (120 mg/m2 in a patient with ischemic heart disease and 260 mg/m2 in a patient with unimpaired myocardium prior to treatment). Our results also confirm the fact that the problem of cardiotoxicity must be necessarily strictly individualized. (Fig. 19, Ref. 80.)

The results of antibiotic treatment administered to 78 patients within one year are reported. Due to the nosocomial nature of the infections, the serious overall condition of the patients and the associated diseases, the prognosis remained unfavourable despite adequate antibiotic treatment. In the group of patients on dialysis ofloxacin and ciprofloxacin proved effective. Patients with exacerbation of chronic bronchitis responded well to doxycycline. In the treatment of infections of the urinary tract, the known favourable effect of cotrimoxazol was confirmed. Of the group of 78 patients with transitory or permanent cardiostimulation, 18 received antibiotic treatment. In 6 of them with transitory cardiostimulation antibiotics were given as a prophylactic measure, 4 patients developed febrile conditions after implantation of the cardiostimulator and 8 patients received antibiotics due to infections of the respiratory and urinary tract. After implantation of the cardiostimulator 60 patients (77%) did not require antibacterial treatment. (Ref. 5.)

Over a period of ten years prophylactic administration of selected antibiotics was evaluated three times (in 1973, 1983, and in 1988) in the same ten hospitals of the Slovak Republic. The study was focused on the use of gentamicin (GEN), cotrimoxasol (COT) and cephalosporins (CEP). Prophylactic administration of antibiotics was found to be increasing. GEN is being given less frequently, while CEP are administered more often, which is considered to be a positive trend. The period of prophylactic administration of antibiotics is still inadequately long with an average of 10.7 days. Evaluation of antibiotic administration showed that antibacterial substances have the highest rate of prophylactic administration in patients with oncologic diseases, followed by patients with diseases of the urinogenital system. A positive development was recorded in the perinatal period with a decreasing trend in the prophylactic administration of antibiotics.

The results obtained in treating infections in 53 patients involved in a chronic dialysis-transplantation program are reported. Higher susceptibility to infections and reduced immune functions were observed in dialyzed patients. The problem of the occurrence rate of individual infections was analyzed and infections of the respiratory system, particularly bronchopneumonia, were found to be predominant. No patient died of infection; in two patients the prescribed antibiotic of first choice had to be changed; positive clinical and laboratory effect was recorded in 51 of the 53 patients treated, and after change of the antibiotic in all the patients. Particular regimens of individual antibiotics in dialyzed patients are given along with the dialyzability of the drugs. The best results were obtained with ofloxacin and doxycycline of Czecho-Slovak make in monotherapy, in combined treatment gentamycin an amikacin with cefamezin or with cefotaxim proved to be most effective. Of the 45 pathogenic agents isolated, Staphylococcus aureus, Klebsiella spp, and Acinetobacter lwoffi, which have a good sensitivity to antibiotics, had the highest occurrence rates. (Tab. 4, Ref. 6.).

A review paper is presented treating of problems of organotoxicity, mutagenicity, carcinogenicity and adverse effects of quinolones, as well as their interaction with other drugs. Not considering some rather sporadic exceptions, quinolones are not regarded as safe in children up to the age of 14 and in pregnant and breast-feeding women. Compared to aminoglycosides, tetracycline, chloramphenicol, rifampicin and other antibacterial chemotherapeutics, the overall toxicity of quinolones is relatively low. The questions of adverse effects upon the intestinal microflora and of tolerance of novel quinolones are also addressed. With regard to the above mentioned aspects, ofloxanice, ciprofloxacine, enoxacine, pefloxacine, norfloxacine, and fleroxacine have been most thoroughly studied. For the other recently developed quinolones reliable information is scarce. (Tab. 2, Ref. 53).

The authors analyze ethico-philosophical and socio-legal problems of patients with AIDS in their relation to people they are in frequent contact with, i.e. family, relatives, sexual partners, as well as medical and paramedical staff. They deal with the problem of compulsory notification of the disease on the one hand, and of secrecy compelling for health care workers on the other hand. The potential penojudicial responsibility of subjects infected with AIDS in spreading the infection is being considered, as well as the problem of enforced diagnotic examination and hospitalization. The obligation of the doctor to provide therapeutic and preventive care to each citizen, and thus also to patients with AIDS, is being emphasized.