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Izhodišče: Nezapletene okužbe sečil so ena najpogostejših okužb pri zdravih mladih ženskah. Za zdravljenje tovrstnih okužb izberemo antibiotike ozkega spektra z delovanjem na najpogostejše povzročitelje. Ker je zdravljenje nezapletenih okužb spodnjih sečil večinoma izkustveno, smo v raziskavi ocenili, kakšna je občutljivost najpogostejših povzročiteljev za peroralne betalaktamske antibiotike in ali so primerni za izkustveno zdravljenje nezapletenih okužb sečil v primerih, kadar ne moremo uporabiti antibiotikov izbire. Metode: Iz teoretične porazdelitve pogostosti različnih vrst povzročiteljev okužb sečil in deležev občutljivosti resničnih izolatov urinokultur pri ženskah smo z uporabo matematičnega modela izračunali oceno skupne občutljivosti za peroralne betalaktamske antibiotike. Rezultati: Ocenjena skupna občutljivost za ampicilin je bila slaba (50 %), za cefalosporine prve, druge in tretje generacije pa med 88 % in 90 %. Zaključek: Matematični model za oceno občutljivosti je zanimivo orodje, s katerim lahko napovemo klinično učinkovitost antibiotikov na podlagi lokalne občutljivosti in pogostosti povzročiteljev. Na podlagi naših rezultatov ugotavljamo, da so med betalaktamskimi antibiotiki za zdravljenje cistitisa najprimernejši cefalosporini prve generacije.

Background: The antibiotic surgical prophylaxis (ASP) is very important as it can decrease the incidence of surgical infections. However, selection pressure of antibiotics is an important driver of antimicrobial resistance and may stimulate development of post-operative infections with resistant bacteria. This study aims to explore the level of compliance of ASP in daily practice with the set guidelines. Methods: Consecutive patients treated in the years 2011 and 2012 in UKCL were included in this retrospective study. Their medical records were reviewed and the results compared against the US Guidelines published in 2013. The following parameters were included in the study: application of an antibiotic prior to surgery, the appropriateness of the antibiotic and its dosage, application time and the number of doses applied. Results: Altogether 451 surgical procedures from 8 different UKCL's surgical units were analyzed. Patients age ranged from 18 to 97 years. Total compliance with the recommendations of ASP was achieved in 26 % of the cases. Antibiotic prophylaxis was applied in 87 % (range 62–100 %) of procedures with the indicated ASP. Appropriate choice of antibiotic reached 95 % (range 46–100 %). The lowest score was observed for the number of doses applied; the average compliance across 8 units was 46 %. Overall, the ASP was compliant with guidelines in 26 %. Conclusion: The study revealed that there is much space for improvement regarding the studied parameters of the ASP, in particular with regard to the appropriate number of doses of antibiotics administered. The prescribing and administrating of ASP in accordance with the recommendations depend strongly on the awareness and education of health care personnel as well as on supervision, feedback and supportive and blameless organization with good interpersonal communication.

Aspergillus osteomyelitis is a rare manifestation of invasive aspergillosis which accounts for 1.8% to 5.6% of all invasive aspergillosis forms. As other forms of invasive aspergillosis, it predominantly occurs in immunosupressed patients with well established risk factors, but there are increasing reports of invasive aspergillosis cases in patients without traditional risk factors such as patients with chronic obstructive pulmonary disease on inhalatory corticosteroid therapy or patients with liver cirrhosis. We present a case of Aspergillus spondylodiscitis in a patient without other risk factors for invasive aspergillosis than liver cirrhosis and diabetes mellitus successfully treated with a 4-month course of voriconasole.

Abstract: Background.Evidence based recommendations for antibiotic prophylaxis in abdominal surgery are prepared to reduce postoperative complications and to reduce inappropriate prophylactic antibiotic prescribing. The original guidline address risk factors for surgical site infection (SSI), benefits and risks of antibiotic profilaxis and indications for surgical antibiotic profilaxis.Update of recommendations is an opportunity to expand and review the evidence supporting recommendations. Recommendations for common surgical procedures in abdominal surgery in adults are included in this guideline.Surgical antibiotic prophylaxis is and adjunct to, not a substitue for, good surgical tecnique. Antibiotic prophylactic should be regarded as one component of an effective policy for the control of healthcare-associated infection.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most important antibiotic-resistant bacteria causing nosocomial infections in the world. A first-line treatment for infections with MRSA continues to be vancomycin. Due to its increased consumption, three MRSA phenotypes with reduced susceptibility to vancomycin (hVISA, VISA, VRSA) have emerged. We wanted to know to what extent these phenotypes occur in the University Medical Centre Ljubljana.Material and methods: We tested susceptibility to vancomycin of 101 MRSA isolates obtained from blood samples of patients admitted to the University Medical Centre Ljubljana between August 2005 and September 2010; the isolates were stored in the database of the Laboratory of blood cultures at the Institute of Microbiology and Immunology. We carried out Etests to determine the minimum inhibitory concentration (MIC) and Etest macro-method to identify heterogeneous vancomycin-intermediate S. aureus strains (hVISA).Results: 100 MRSA isolates were susceptibile to vancomycin with Etest, and one was vancomycin-intermediate S. aureus (VISA). With Etest macro-method, four isolates were additionally characterized as hVISA. Average MIC values of vancomycin show a minimal growth over the years.Conclusions: hVISA and VISA isolates from blood samples are still rare in the University Medical Centre Ljubljana. MIC values will have to be closely monitored in the future. At the same time, we will have to reduce the use of vancomycin.

Introduction: The selection of perioperative prophylactic antibiotic is based on the expected bacterial flora in the site of the surgical procedure and its susceptibility to antibiotics. Recent reports on coagulase-negative staphylococci, typical representatives of skin flora, showed their resistance to methicillin. We may wonder whether cefazolin is still the antibiotic of choice for surgical prophylaxis in clean surgical procedures.Patients and methods: In a prospective study we included patients who underwent surgical treatment for various types of injuries. Three swab samples were taken in each patient.The first sample was taken from the incision site before the operating field was prepared. The second swab was taken after the operating field preparation and the third was taken at the end of the operation. The results of microbial growth and the susceptibility to antibiotics were recorded. The incidence of a wound infection in patients included in the study was followed prospectively. In the case of infection, the bacteria isolated intraoperatively during the surgical revision were compared to the bacteria isolated perioperatively at the time of the first surgery. All patients received cefazolin in a single dose of 1 to 2 grams according to their weight pre-operatively. The antibiotic was administered 20 minutes before the incision. No additional antibiotic dose was given after surgery.Results: Before the operating field was prepared, swabs were sterile in two patients (6.4 %), at the end of preparation the swabs remained sterile in 22 (71 %) patients and at the end of surgery in 13 (42 %) out of the 31 injured patients. There were no methicillin-resistant swab cultures after operative field preparation, but at the end of surgery in four patients (13 %) the swab cultures grew methicillin resistant Staphylococcus epidemidis. Bacillus sp. was isolated in five patients (16.1 %) after operative field preparation and in two patients (6.4 %) at the end of surgery. The susceptibility of the Bacillus sp. was not determined because of the lack of standardized testing method.Conclusion: In a pilot study we found a large proportion (4/31) of patients in whom colonization of the operative field with cefazolin-resistant bacteria developed during the surgical procedure. The result of our pilot study challenges the guidelines recommending cefazolin for surgical prophylaxis in clean surgery. Further studies in larger patient population are needed.

Postoperative infections increase morbidity and mortality of patients undergoing neurosurgical operations. Correct application of prophylactic antibiotics before, during and after surgery is therefore crucial. In this manuscript we present the first Slovenian guidelines that give details on recommended prophylactic regimen and its correct dosing for different types of neurosurgical operations.

Background:Sepsis is one of the most serious bacterial infections. The diagnosis of sepsis is clinical. Microbiologists can detect bacteremia, which however is not present in all septic patients, by the procedure called blood culture.Methods:Blood culture is a semi-automated procedure of culturing blood in liquid media to detect and identify the causative agents. It is important to take 2 to 3 blood cultures with adequate volume of blood. The new, faster methods for bacterial identification from positive blood cultures and molecular methods for the detection of bacterial DNA directly from a blood sample are also becoming available.Results:In the years 2006 to 2011, the number of blood cultures obtained from patients in the University Medical Centre in Ljubljana, Institute of Oncology and the General hospital of Trbovlje (from 2007) was constantly increasing, from 18,404 in 2006 to 25,214 in 2011. The number of patients with positive blood culture/s increased from 1,033 in 2006 to 1,396 in 2011. The rate of blood culture positivity ranged from 10.9 % to 12.3 %. The ratio between gram-positive and gram-negative bacteria was approximately 50:50 %. In all the years under study, Escherichia coliwas the most frequent pathogenic isolate (19.2 % to 22.9 %), followed by Staphylococcus aureus(15.3 % to 17.4 %). Klebsiellaspp. represented 5.3 % to 8.3 % of isolates, Pseudomonas aeruginosa1.8 % to 3.4 %, Streptococcus pneumoniae2.9 % to 4.7 %, Enterococcusspp. 5.4 % to 8.1 %, anaerobes 2.1 % to 3.2 %. Coagulase-negative staphylococci decreased from 23.3 % to 16.9 %. Today, bacteria are identified by the fast and accurate method of mass spectrometry. Bacteria can alternativelly be detected directly from blood by the molecular tests.Conclusions:Blood culture is a very common procedure, its rate of positivity is stable. Among bacteria, the number and the proportion of pathogenic bacteria such as E. coli, S. aureusand S. pneumoniaeis increasing and the proportion of contaminants is decreasing

BACKGROUND External ventricular drainage (EVD) is the most common method of treatment for patients with increased intracranial pressure due to acute hydrocephalus. The most frequent complications of EVD are infections of the central nervous system. Earlier studies indicated numerous risk factors, although the results of studies regarding the impacts of individual factors on the occurrence of infections differ. Our research was aimed at finding the risk factors for infection in patients with an inserted EVD, treated at the Department of Neurosurgery of University Medical Centre (UMC) Ljubljana. METHODS In the article we describe a retrospective research of EVDs inserted in the period from January 2000 to January 2009. Forty-eight cases of EVDs met the study inclusion criteria. Among them, there were 10 cases with an infection which occurred during inserted EVD. We recorded, compared and evaluated information about the patient, the EVD and infections. RESULTS The duration of the drainage was confirmed as a risk factor for EVD infections (p = 0.004). The infection occurred on average on day 8.9 ± 5.4. The shares of subarachnoid and intraventricular hemorrhage, previous neurosurgical procedures, EVD manipulations, number of successive drainages and duration of hospitalization were greater in the cases of infected EVDs. In the cases of EVD exchange, the average day of change in group without infection was day 10.9 ± 5.8 (p = 0.030). Among infectious agents, Gram-positive bacteria prevailed. CONCLUSIONS Strict asepsis is advised during insertion and handling of EVD and a prophylactic exchange of EVD on day 10 of insertion. Risk factors in our study do not differ from findings in other studies. Therefore it is suggested that prophylactic measures against drain-related infection should be developed and implemented and their efficacy confirmed in a prospective study.

Background. The soluble interleukin-2 receptor(s-IL-2R) is a soluble cytokine receptor which directly reflectsthe levels of the IL-2 receptor on lymphocytes T, which, alongwith the IL-2 itself, is important for the specific immune response. The aim of the study. We attempted to prove diagnostic andprognostic significance of s-IL-2R in sepsis cases.Patients and methods. In the period of three years we examined64 healthy blood donors and subjects in systematic healthexaminations and examined 50 septic patients with clinicaland laboratory symptoms of sepsis treated in units for the intensivetherapy of adults at the Clinic for Infectious Diseasesand Febrile States at the Clinic Centre of Ljubljana. The assayfor s-IL-2R was performed with a kit from Eurogenetics (Belgium).Results. We proved that the median concentration of s-IL-2R inseptic patients with positive and negative blood culture aresignificantly higher than healthy subjects (p < 0.05) and werealso significantly higher in the blood of dead patients than inthe blood of survivors (p < 0.05). The mean concentration ofs-IL-2R did not differ in septic patients with positive blood culturefrom those with negative blood culture and did not differfor gram negative pathogens from those for gram positive pathogens.Time dynamics showed the increase levels of s-IL-2Rfor the first 48 hours.Conclusions. s-IL-2R levels are elevated in adults with sepsis.Elevation of s-IL-2R are significantly associated with death.