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Broad-spectrum antibiotics administered to patients with severe COVID-19 pneumonia pose a risk of infection caused by Clostridioides difficile. This risk is reduced mainly by strict hygiene measures and early de-escalation of antibiotic therapy. Recently, oral vancomycin prophylaxis (OVP) has also been discussed. This retrospective study aimed to assess the prevalence of C. difficile in critical COVID-19 patients staying in an intensive care unit of a tertiary hospital department of anesthesiology, resuscitation, and intensive care from November 2020 to May 2021 and the rates of vancomycin-resistant enterococci (VRE) after the introduction of OVP and to compare the data with those from controls in the pre-pandemic period (November 2018 to May 2019). During the COVID-19 pandemic, there was a significant increase in toxigenic C. difficile rates to 12.4% of patients, as compared with 1.6% in controls. The peak rates were noted in February 2021 (25% of patients), immediately followed by initiation of OVP, changes to hygiene precautions, and more rapid de-escalation of antibiotic therapy. Subsequently, toxigenic C. difficile detection rates started to fall. There was a nonsignificant increase in VRE detected in non-gastrointestinal tract samples to 8.9% in the COVID-19 group, as compared to 5.3% in the control group. Molecular analysis confirmed mainly clonal spread of VRE.

Ventilator-associated pneumonia (VAP) is one of the most severe complications affecting mechanically ventilated patients. The condition is caused by microaspiration of potentially pathogenic bacteria from the upper respiratory tract into the lower respiratory tract or by bacterial pathogens from exogenous sources such as healthcare personnel, devices, aids, fluids and air. The aim of our prospective, observational study was to confirm the hypothesis that in the etiology of VAP, an important role is played by etiological agents from the upper airway bacterial microflora. At the same time, we studied the hypothesis that the vertical spread of bacterial pathogens is more frequent than their horizontal spread among patients. A total of 697 patients required mechanical ventilation for more than 48 h. The criteria for VAP were met by 47 patients. Clonality of bacterial isolates from 20 patients was determined by comparing their macrorestriction profiles obtained by pulsed-field gel electrophoresis (PFGE). Among these 20 patients, a total of 29 PFGE pulsotypes of Klebsiella spp. and Escherichia spp. strains were observed. The high variability of clones proves that there was no circulation of bacterial pathogens among hospitalized patients. Our finding confirms the development of VAP as a result of bacterial microaspiration and therefore the endogenous origin of VAP.

Objective: Administration of large-volume blood transfusions can cause electrolyte and acid-base balance disturbances in the plasma of the patient. The ongoing metabolism and haemolysis in the transfusion unit can change the initial values of some biochemical parameters. The aim of this study was to describe the influence of the number of transfusion units and their age on the biochemical values in vivo. Design: Prospective observational study. Setting: Multidisciplinary intensive care unit (ICU) in a tertiary care centre. Materials and methods:We compared the biochemical values in the arterial blood before and after the administration of the transfusion. We recorded the data and analysed their dependence on the volume and duration of storage of the administered transfusion units (TU). Results:We examined 46 patients who received total 354 TUs of packed red blood cells (PRBC), mean 7.7 (range 2-38) TU of PRBC per patient. The mean duration of storage of the administrated PRBC was 16.2 days. The administration of 1 TU of PRBC led to a rise of K+ values by 0.07 mmol/l and a rise of lactate values by 0.13 mmol/l. Other biochemical values (pH, Ca++, Na+, glycaemia) were stable. Conclusion: The administration of large-volume blood transfusion can pose a significant risk of hyperkalaemia and hyperlactataemia. [ABSTRACT FROM AUTHOR]