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Proton pump inhibitors (PPIs) may increase the risk of Clostridium difficile infections. There are interactions between gut microbiota and innate immune cells including neutrophils. We evaluated the effect of treatment with omeprazole on the gut microflora and neutrophil function.In 50 patients, we evaluated the effect of 4-week omeprazole treatment (n=25 with 20mg per day and n=25 with 20mg twice daily) on intragastric pH, results of stool culture and lactulose hydrogen breath test (LHBT) and neutrophil function.The treatment caused significant increase of the mean intragastric pH, especially in the group with 20mg omeprazole twice daily (from 2.05±0.59 to 5.06±1.6, P0.001). In LHBT, the increase of hydrogen concentration was observed in higher percentage of patients with 20mg of omeprazole twice daily, compared to patients with the lower dose (42.1% vs 29.4%; ns). Four weeks of omeprazole treatment have caused considerable changes in stool culture results. Patients treated with higher dose of omeprazole have had some tendency to decrease diversity of colonic microflora in comparison with patients treated with the lower dose of omeprazole. Treatment with omeprazole did not result in C. difficile positive stool culture and had no significant effect on neutrophil function.Omeprazole treatment have caused considerable changes in stool culture results. Patients treated with the higher dose had some tendency to decreased diversity of colonic microflora and towards changes in fermenting bacteria of the gut. The potential effect of omeprazole on gut microflora does not depend on neutrophil function deterioration.

An increase in the antibiotic resistance among members of theEnterobacteriaceaefamily has been observed worldwide. Multidrug-resistant Gram-negative rods are increasingly reported. The treatment of infections caused byEscherichia coliand otherEnterobacteriaceaehas become an important clinical problem associated with reduced therapeutic possibilities. Antimicrobial carbapenems are considered the last line of defense against multidrug-resistant Gram-negative bacteria. Unfortunately, an increase of carbapenem resistance due to the production ofKlebsiella pneumoniaecarbapenemase (KPC) enzymes has been observed. In this study we describe the ability ofE. colito produce carbapenemase enzymes based on the results of the combination disc assay with boronic acid performed according to guidelines established by the European Community on Antimicrobial Susceptibility Testing (EUCAST) and the biochemical Carba NP test. Moreover, we evaluated the presence of genes responsible for the production of carbapenemases (blaKPC,blaVIM,blaIMP,blaOXA-48) and genes encoding otherβ-lactamases (blaSHV,blaTEM,blaCTX-M) amongE. coliisolate. The tested isolate ofE. colithat possessed theblaKPC-3andblaTEM-34genes was identified. The tested strain exhibited susceptibility to colistin (0.38 μg/mL) and tigecycline (1 μg/mL). This is the first detection ofblaKPC-3in anE. coliST479 in Poland.

Since about twenty years, following the introduction into therapeutic of news beta-lactam antibiotics (broad-spectrum cephalosporins, monobactams and carbapenems), a very significant number of new beta-lactamases appeared. These enzymes confer to the bacteria which put them, the means of resisting new molecules. The genetic events involved in this evolution are of two types: evolution of old enzymes by mutation and especially appearance of new genes coming for some, from bacteria of the environment. Numerous mechanisms of enzymatic resistance to the carbapenems have been described in Pseudomonas aeruginosa. The important mechanism of inactivation carbapenems is production variety of b-lactam hydrolysing enzymes associated to carbapenemases. The metallo-beta-enzymes (IMP, VIM, SPM, GIM types) are the most clinically significant carbapenemases. P. aeruginosa posses MBLs and seem to have acquired them through transmissible genetic elements (plasmids or transposons associated with integron) and can be transmission to other bacteria. They have reported worldwide but mostly from South East Asia and Europe. The enzymes, belonging to the molecular class B family, are the most worrisome of all beta-lactamases because they confer resistance to carbapenems and all the beta-lactams (with the exception of aztreonam) and usually to aminoglycosides and quinolones. The dissemination of MBLs genes is thought to be driven by regional consumption of extended--spectrum antibiotics (e.g. cephalosporins and carbapenems), and therefore care must be taken that these drugs are not used unnecessarily.

The microbiological monitoring in the Intensive Care Units, in the last few years, revealed a significant increase of infections caused by Gram+ bacteria. Authors of multi-center studies focus upon the problems related to the treatment of the infections caused by the methicilline-resistant staphylococci (MRS) as well as to its spreading. The Staphylococcal infections were 26.6 % of all bacterial infections in the Intensive Care Unit of the Department of Anesthesiology and Intensive Care of the Medical Academy in Białystok, during one year observation. MRS rods counted 21.4% among all pathogens isolated from the specimens collected from the patients, undergoing the treatment in the ICU, and were responsible for 83.6% of all Staphylococcal infections. The analysis revealed the significant percentage MRS rods resistant to commonly used empirical antibiotic therapy. Our experience shows that vancomycin or linezolid should be used, as an empirical antibiotic therapy, in suspected MRS-caused severe infections along with the simultaneous monitoring of changes in G+ bacteria drug resistance and strict infection-control regime.