The aim of this study was to prospectively investigate 120 cases of viridans streptococcal bacteraemia (VSB) in 117 patients in major university hospitals in Slovakia in 2000-2002 (3 y) for antibacterial susceptibility, risk factors and outcome. From 127 episodes, 16 (13%) of VSB were caused by PEN-R strains and 13 (10%) by ERY-R strains. 32 cases had cancer as underlying disease (20 haematological), 41 had endocarditis and 35 were elderly (>65 y of age) patients. Concerning mortality, 29 of 127 patients died (24%). There were several risk factors associated with mortality. Solid tumour as underlying disease (p<0.02), stroke (p<0.002), concomitant lung infection (p<0.01), endoscopic procedure (p<0.036), intubation (p<0.0008), ventilatory support (p<0.002), and coma (p<0.009) were associated with more deaths. A comparison of 115 bacteraemias to 13 bacteraemias caused by erythromycin-resistant strains of Streptococcus viridans was performed. There were no significant differences in underlying disease, risk factors and mortality. Erythromycin resistance in bacteraemias caused by S. viridans did not have significant impact on outcome of the patients, nor did it show specific relation to analysed risk factors in our study. 14.5% of VSB were cause by PEN-resistant viridans streptococci. Risk factors for penicillin resistance were ventilatory support (p<0.01), intubation (p<0.001) and resistance to other antibiotics: 8 of 16 (50%) of PEN-R VSB were resistant also to erythromycin or cotrimoxazole or tetracycline compared with 9% of PEN-R VSB (p<0.005). Endoscopic procedures in the upper respiratory system were at risk for development of PEN-R VSB. There was also difference in outcome; 71% vs 22.5% (p<0.0002) of cases infected with PEN-R VSB died compared to PEN-S VSB. PEN-R is therefore clinically significant in VSB.

Risk factors, mortality and antimicrobial susceptibility of Pseudomonas aeruginosa bacteremias isolated from 148 patients from all University Hospitals in Slovakia were analyzed. Only 1.2% of 169 strains of P. aeruginosa were resistant to meropenem, 4.1% to piperacillin/tazobactam, 7.7% to ceftazidime as well as cefepime and 12% to amikacin. More than 30% of P. aeruginosa were resistant to ciprofloxacin. Our analysis of risk factors for antimicrobial resistance to the particular antimicrobials, indicated no difference in risk factors and outcome in cases infected with P. aeruginosa bacteremias resistant to amikacin, piperacillin/tazobactam or ceftazidime in comparison to episodes caused by P. aeruginosa due to susceptible isolates. When comparing risk factors for P. aeruginosa bacteremia in children vs. adults, cancer vs. non-cancer patients, several differences in risk factors were observed. Neither antimicrobial resistance to amikacin, ceftazidime or piperacillin/tazobactam, nor appropriateness of therapy according to two separate analyses were associated with better outcome.

Nosocomial Postsurgical Meningitis in Children:A 12-Year Survey Comparing Data From 1993-1998 With Data From 1999-2004 TO T H E EDITOR-The incidence of nosocomial meningitis after neurosurgery is increasing. 12 In a previous study, a survey of all 8 pediatric and neonatal neurosurgery departments in Slovakia revealed that 101 cases of pediatric bacterial meningitis were recorded during 1993-1998, with an attributable mortality of 15% and sequelae detected in 18% of cases. 1 We conducted a similar survey during 1999-2004, which revealed an additional 57 cases of disease. Here, cases of pediatric nosocomial meningitis during [1999][2000][2001][2002][2003][2004] are compared with those during 1993-1998 with respect to etiology, risk factors, and outcome. A prospective protocol was used to assess each case of meningitis that occurred during hospitalization in persons aged 18 years or less at any of the 8 pediatric and neonatal neurosurgery departments in Slovakia; the number of such departments has not changed during the past 10 years. Nosocomial meningitis was clinically defined as onset of meningitis after neurosurgery in patients with a positive result of a cerobrospinal fluid culture. Risk factors were assessed, including the etiology of meningitis, the type of neurosurgery, and the presence of underlying disease(s), trauma, abnormal central nervous system findings, central nervous system disease, positive results of blood cultures, malignancy, and hemorrhage. Mortality rates associated with infection and/or to central nervous system sequelae and treatment (ie, surgery and antibiotics therapy) were assessed, and antimicrobial resistance was measured for the pathogens most commonly isolated from the cerebrospinal fluid of study subjects (coagulase- (66) 13 (11) , whereas no cases of meningitis were caused by these pathogens during the first study period ( P < .01). All 10 non-S. epidermis CoNS strains were resistant to methicillin (minimum inhibitory concentration, >8 /xg/mL), and 6 were also resistant to teicoplanin (minimum inhibitory concentration, >16 /xg/mL); 20 cases of meningitis (35%) in the second study period had a polymicrobial etiology (CoNS and P. aeruginosa or CoNS and A. baumannii)The following gram-negative bacteria were isolated more frequently during the second study period: A. baumannii (10 isolates [13%] vs 10 isolates [8.7%]) and P. aeruginosa (7 isolates [9.3%] vs 6 isolates [5.2%]). Three of 10 Enterobacteriaceae organisms were resistant to cefepime, and 2 of 7 P. aeruginosa isolates were resistant to meropenem (Table 2). DNA fingerprinting was not performed, but clusters of resistance patterns were not detected in resistance phenotypes.There was no significant difference in mortality between the 2 study periods. However, there was a significant decrease in the frequency of neurologic complications (eg, hydrocephalus, palsy, and epilepsy) during 1999-2004, compared with 1999-2004 ; P< .002) were more common during the first study period. The incidence of meningitis per 100 neurosurge...

1 Klinika detskej hematológie a onkológie LF UK a Národný ústav detských chorôb, Bratislava, Slovenská republika 2 Neurocentrum, Klinika detskej chirurgie LF UK a Národný ústav detských chorôb, Bratislava, Slovenská republika 3 Ústav patologickej anatómie, JLF UK a UN Martin, Slovenská republika 4 Centrum molekulární bio logie a genové terapie, Interní hematologická a onkologická klinika LF MU a FN Brno SúhrnVýchodiská: Invazívne mykotické infekcie predstavujú život ohrozujúcu komplikáciu liečby imunokompromitovaných pa cientov, obzvlášť u hematologických malignít. Mukormykóza je po aspergilovej a kandidovej infekcii tretia najčastejšia príčina invazívnych mykóz. Prvé symptómy sú väčšinou nešpecifické, čo môže viesť k oddialeniu dia gnózy a liečby. Cieľ: Cieľom tejto práce je súhrn literárnych údajov o mukormykóze a prezentácia kazuistiky pa cientky s akútnou leukémiou, u ktorej bola dia gnostikovaná táto infekcia na Klinike detskej hematológie a onkológie v Bratislave. Retrospektívne boli vyhodnotené rizikové faktory, klinické symptómy, zobrazovacie a laboratórne nálezy a výsledok liečby. Prípad: Opisujeme kazuistiku 6-ročnej pa cientky s dia gnózou akútnej lymfoblastovej leukémie. Počas indukčnej liečby sa u pa cientky rozvinula febrilná neutropénia nereagujúca na kombinovanú antibio tickú a podpornú liečbu. U pa cientky sa objavila pansinusitída a následná orbitocelulitída. Vyšetrením biologického materiálu sa nám podarilo identifikovať pôvodcu ochorenia -Rhizopus sp. Pa cientka dostávala kombinovanú antimykotickú liečbu, avšak jej stav progredoval do rozšírenia patologického procesu do centrálnej nervovej sústavy. Podstúpila radikálnu chirurgickú resekciu postihnutého tkaniva. T. č. pokračuje v antimykotickej a onkologickej terapii, pretrváva u nej remisia základného ochorenia a je v dobrom klinickom stave. Záver: Mukormykóza je invazívna mykotická infekcia s vysokou morbiditou a mortalitou. K zvládnutiu ochorenia je nevyhnutná včasná dia gnostika a skorý začiatok efektívnej terapie, ktorou je kombinácia amfotericínu B a chirurgickej liečby. Klúčové slová mukormykóza -akútna leukémia -RhizopusAutoři deklarují, že v souvislosti s předmětem studie nemají žádné komerční zájmy.

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