Forty-one Pseudomonas aeruginosa isolates with extended-spectrum ␤-lactamases (ESBLs) from a hospital in Warsaw, Poland, were analyzed. Thirty-seven isolates from several wards were collected over 9 months in 2003 and 2004. The isolates were recovered from patients with multiple types of infections, mostly respiratory tract and postoperative wound infections. All 41 isolates produced the PER-1 ESBL, originally observed in Turkey but recently also identified in several countries in Europe and the Far East. The bla PER-1 gene resided within the Tn1213 composite transposon, which was chromosomally located. Pulsed-field gel electrophoresis and multilocus sequence typing (MLST) revealed the presence of three separate clones among the isolates. Two of these, corresponding to sequence types (STs) ST244 and ST235, were responsible for parallel outbreaks. Apart from PER-1, all the isolates produced OXA-2 oxacillinase. ST235 isolates additionally expressed a novel enzyme, OXA-74, differing by one amino acid from the OXA-17 ESBL identified originally in PER-1-and OXA-2-positive P. aeruginosa isolates from Ankara, Turkey, in 1992. These earlier Ankara isolates with PER-1, OXA-2, and OXA-17 were also classified into ST235, which is a single-locus variant of two other STs, ST227 and ST230. ST227, ST230, and ST235 all correspond to the recently described clonal complex BG11, which seems to be internationally distributed, having spread in Turkey, Greece, Italy, Hungary, Poland, Sweden, and much of Russia. It is associated with various ␤-lactamases, including PER-1 and VIM metalloenzymes. This work further demonstrates the value of MLST of P. aeruginosa.

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bPoland's first Enterobacteriaceae isolate producing the New Delhi metallo-␤-lactamase (NDM) was identified in August 2011. Escherichia coli sequence type ST410 NDM-1 was cultured from a critically ill patient who had been transferred directly from the Congo. The bla NDM-1 gene was carried by conjugative IncFII-type plasmid pMC-NDM (87,619 bp), which showed structural similarity to plasmid pGUE-NDM, which was identified earlier in France in an E. coli ST131 isolate of Indian origin.

Objectives In 2015 and 2016 Poland recorded rapid proliferation of New Delhi MBL (NDM)-producing Enterobacterales, with at least 470 and 1780 cases, respectively. We addressed the roles of the Klebsiella pneumoniae ST11 NDM-1 outbreak genotype, already spreading in 2012–14, and of newly imported organisms in this increase. Methods The study included 2136 NDM-positive isolates identified between April 2015 and December 2016, following transfer of patients with K. pneumoniae ST147 NDM-1 from Tunisia to Warsaw in March 2015. The isolates were screened by PCR mapping for variants of blaNDM-carrying Tn125-like elements. Selected isolates were typed by PFGE and MLST. NDM-encoding plasmids were analysed by nuclease S1/hybridization, transfer assays, PCR-based replicon typing and PCR mapping. Results The organisms were mainly K. pneumoniae containing the Tn125A variant of the ST11 epidemic lineage (n = 2094; ∼98%). Their representatives were of the outbreak pulsotype and ST11, and produced NDM-1, encoded by specific IncFII (pKPX-1/pB-3002cz)-like plasmids. The isolates were recovered in 145 healthcare centres in 13/16 administrative regions, predominantly the Warsaw area. The ‘Tunisian’ genotype K. pneumoniae ST147 NDM-1 Tn125F comprised 18 isolates (0.8%) from eight institutions. The remaining 24 isolates, mostly K. pneumoniae and Escherichia coli of diverse STs, produced NDM-1 or NDM-5 specified by various Tn125 derivatives and plasmids. Conclusions The K. pneumoniae ST11 NDM-1 outbreak has dramatically expanded in Poland since 2012, which may bring about a countrywide endemic situation in the near future. In addition, the so-far limited K. pneumoniae ST147 NDM-1 outbreak plus multiple NDM imports from different countries were observed in 2015–16.

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Liver abscesses are focal necroinflammatory lesions of bacterial, fungal, or amoebic origin. Pharmacological treatment is rarely sufficient if negative blood cultures are present. The report presents the case of a 62-year-old man with hypertension and type 2 diabetes, diagnosed with liver abscesses. The patient received two-stage empirical antibiotic therapy. Firstly in the hospital setting-cefuroxym, gentamicin, and metronidazole. After a 10-fold reduction in C-reactive protein and clinical improvement the patient was discharged home. In the second stage-ceftibutyn, metronidazole, and fluconasol were used in the outpatient setting. During rehospitalisation, a significant reduction in the size of abscesses was noted. The patient was twice consulted bacteriologically (treatment was accepted) and his computed tomography (CT) scans were sent for surgical consultation, which confirmed the effectiveness of the drug treatment and did not qualify for surgical treatment. In the 8-month follow-up there was no relapse and CT scans showed only scarring of the liver. Streszczenie Ropnie wątroby są zmianami ogniskowymi miąższu wątroby o etiologii bakteryjnej, amebowej lub grzybiczej. Rzadko udaje się je wyleczyć jedynie metodą farmakologiczną przy ujemnych wynikach posiewów krwi. W pracy przedstawiono przypadek 62-letniego mężczyzny leczącego się z powodu nadciśnienia tętniczego i cukrzycy typu 2, u którego rozpoznano ropnie wątroby. U chorego zastosowano dwuetapową antybiotykoterapię empiryczną. W pierwszym etapie (złożona antybiotykoterapia) w warunkach szpitalnych podawano cefuroksym, gentamycynę i metronidazol. Po 10-krotnej redukcji wartości stężenia białka C-reaktywnego oraz uzyskaniu poprawy klinicznej pacjenta wypisano do domu. W drugim etapie leczenia (ambulatoryjnym) stosowano ceftibutyn, metronidazol i flukonazol. Przy ponownej hospitalizacji stwierdzono znaczne zmniejszenie wymiaru ropni wątroby. Przypadek konsultowano 2 razy bakteriologicznie (zaakceptowano leczenie), a wyniki badań obrazowych przesłano na konsylium chirurgiczne, gdzie potwierdzono skuteczność leczenia farmakologicznego i nie zakwalifikowano chorego do leczenia operacyjnego. W obserwacji 8-miesięcznej nie stwierdzono nawrotu choroby, a w obrazie tomografii komputerowej jamy brzusznej opisano jedynie zmiany bliznowate w wątrobie.

Słowa kluczowe: infekcyjne zapalenie wsierdzia, udar niedokrwienny mózgu, udar niedokrwienny móżdżku, ropnie śledziony. AbstractA 59-year-old man was admitted to the Rheumatology Department in order to conduct diagnostics of a hypoechogenic lesion located in the lower pole of the spleen. After 17 days of hospitalisation at the Department of Rheumatology and the Department of Neurology, the patient was referred to the Internal Medicine Ward due to a suspicion of advanced infective endocarditis. Seven days of antibiotic and antifungal therapy resulted in a reduction of C-reactive protein levels from 133.38 mg/l to 29.78 mg/l. Control echocardiography did not show progression of bacterial vegetation, but revealed an increase in the severity of bicuspid valve regurgitation. Following pharmacotherapy, on the 23 rd day of hospitalisation the patient was transferred to the Department of Cardiosurgery and Transplantology at the Institute of Cardiology for urgent surgical treatment. After successful surgery the patient underwent physiotherapy, resulting in partial resolution of neurological symptoms. Currently, 2 years after the event, the patient remains in good general state. We therefore conclude that the IE Risk Index is of high clinical value. StreszczenieMężczyzna 59-letni został przyjęty do Kliniki Reumatologii w celu rozpoznania zmiany hipoechogennej w obrębie dolnego bieguna śledziony. Ze względu na podejrzenie infekcyjnego zapalenia wsierdzia po 17 dniach leczenia w Klinice Reumatologii oraz Klinice Neurologii został przeniesiony na Oddział Chorób Wewnętrznych. Po 7 dniach farmakoterapii antybiotykami oraz lekiem przciwgrzybiczym nastąpiło zmniejszenie stężenia białka C-reaktywnego z maksymalnej wartości 133,38 mg/l do 29,78 mg/l. Echokardiograficznie nie stwierdzono progresji wegetacji, natomiast zwiększyła się niedomykalność zastawki dwudzielnej. Z tego powodu chory w 23. dobie hospitalizacji został skierowany ze wskazań życiowych na pilną operację do Kliniki Kardiochirurgii. Operacja przebiegła bez powikłań. Po 2-letnim okresie rehabilitacji częściowo ustąpiły porażenia i zaburzenia równowagi związane z udarami. Obecnie chory jest w stanie dobrym.