The work was created within the statutory activity of the National Research Institute of Tuberulosis and Lung Diseases in Warsaw, Poland, research task nr 1.10 "Molecular epidemiological investigation among staphylococci isolated from patients with granulomatosis with polyangiitis".

Objective Antineutrophil cytoplasmic antibodies (ANCAs) are considered a risk factor for granulomatosis with polyangiitis (GPA) exacerbation, especially when staphylococcal superantigens (SAgs) are present in nasal swabs. Their role in monitoring disease activity remains controversial. This study determined the relationship of ANCAs with disease activity and presence of SAgs in GPA patients. Methods Among a total of 115 GPA patients hospitalized in the period 2009-2016, we investigated the presence of SAgs and ANCA concentration. Blood samples and nasal swabs were taken at each visit (referred further to as episodes). Disease activity was assessed using the Birmingham Vasculitis Activity Score (BVAS). Results We analyzed 362 episodes. ANCAs were detected in 215 (59.4%), while SAgs were detected in 126 (34.8%) episodes. We found a significant correlation between the presence of ANCAs and disease activity (p = 0.0032), as well as between their level and GPA severity (r = 0.25363, p = 0.000001). We also determined that an ANCA values ≥ 138 Ru/ml were an indicator of active disease with high specificity and low sensitivity (84.4% and 37.3%, respectively). The relationship between ANCA presence and the presence of SAgs was not confirmed; however, when SAgs were analyzed based on the different types, ANCA levels were found to be significantly higher in the group with SAg type B (p = 0.031). Conclusions There was no detectable evidence for the association between ANCA level and the presence of SAgs. Although monitoring ANCA levels as a marker of disease activity may be clinically relevant, GPA management cannot proceed on the basis of ANCA levels alone. Key Points • ANCA concentration usually correlates with GPA activity, although in half of patients, ANCAs persist despite effective treatment and clinical remission. • ANCA values of 138 Ru/ml seem to be an indicator of active disease with high specificity, but low sensitivity. • Although there is a relevance for ANCA monitoring as a marker of disease activity, GPA management cannot be based on ANCA levels alone. • The suspected clinical correlation between ANCA formation and SAg presence in nasal swabs is not obvious and requires further investigations.

Introduction: Acinetobacter spp. is an important opportunistic pathogen responsible for increasing number of nosocomial infections. The majority of infections are of epidemic origin, and treatment has become difficult because many strains are resistant to a wide range of antibiotics. The aim of this study was to investigate the local infections caused by various species of the genus Acinetobacter, occurring in the hospital wards IGiChP in periods of increased prevalence: August 2007 and February and March 2008. Material and methods: Twenty three strains of Acinetobacter spp. were isolated from 19 patients residing in the same period and the same hospital ward (2007–2013 strains from 11 patients, 2008–2010 strains from 8 patients). Acinetobacter isolates obtained from these patients were characterized by phenotypic methods and genotypically by arbitrarily primed PCR (AP-PCR). Results: All strains of Acinetobacter (n = 23) were multi-drug resistant. Used AP-PCR method showed 10 genotypes among the all strains. Acinetobacter spp. strains cultivated in 2007 and 2008 belonged to one genotype, came from patients hospitalized on the same wards, which confirms the transmission of infection in the patientís residence. Conclusions: The same genotype Acinetobacter baumannii strains isolated from two patients in 2007, and two patients in 2008, showed the presence of bacteria in the hospital environment. In the present study, we also established the usefulness of AP-PCR in molecular epidemiological investigations.

The study was carried out in Polish goat population to estimate the prevalence of the nasal cavity infection with various staphylococcal species including methicillin-resistant Staphylococcus aureus (MRSA), investigate the potential permissive role of small ruminant lentivirus (SRLV) infection and determine the level of clonality of S. aureus nasal isolates. Nasal swabs and blood samples were collected from 1300 clinically healthy adult goats from 21 Polish goat herds. Blood samples were serologically screened for SRLV. Staphylococci were isolated from nasal swabs and identified using classical microbiological methods, MALDI-TOF, multiplex-PCR, and their clonality was assessed using PFGE. Antimicrobial resistance was determined on the basis of minimum inhibitory concentration and by demonstration of the presence of the mecA gene encoding the multiplex-PCR PBP2a protein and of the five main types of staphylococcal cassette chromosome mec. The apparent prevalence of staphylococcal and S. aureus infection of the nasal cavity was 29.1% (CI 95%: 26.9%, 31.5%) and 7.3% (CI 95%: 6.1%, 8.8%), respectively. No relationship was found between the SRLV-infection and the presence of any staphylococcal species including S. aureus (p=0.143). Only 9.8% of S. aureus isolates were resistant to amoxicillin/clavulanic acid and 5.9% to chloramphenicol and ciprofloxacin. All tested isolates proved to be phenotypically and genotypically sensitive to methicillin, which yielded the apparent prevalence of MRSA of 0% (CI 95%: 0%, 7.0%). S. aureus isolates show high genetic similarity within goat herds, however vary considerably between herds. Goats do not appear to be an important source of S. aureus for humans in Poland.

Introduction. Bacillus from Enterobacteriaceae ESBL (+) including Klebsiella pneumoniae are the most common pathogen of digestive tract. Patients colonized with hospital-acquired infections fall sick on hospital-pneumonia eight times more often than patients with their own bacterial flora. ESBL (+) strains determine serious threat with limited ways of treatment. Transfer of microorganisms in hospitals is followed by nursery and medicinal operations (thermometers, hands of staff). When the epidemic outbreak occurs in the hospital the procedure of contact isolation and microbiological monitoring must be conducted. Aim. The aim of the study was to analyze of genetic relationship between Klebsiella pneumoniae ESBL (+) strains isolated from patients hospitalized in the National Tuberculosis and Lung Diseases Research Institute (NTLDRI). Material and methods. Material of analysis were 64 strains of Klebsiella pneumoniae ESBL (+) isolated from 27 patients hospitalized on ICU. The phenotypic qualities were taken to the analysis and also the analysis of genetic relationship was conducted. The identification of species and the drug resistance phenotype were determined by the automatic system Vitek 2 Compact. Results. All of the isolated strains belonged to the Klebsiella pneumoniae species and presented the mechanism of ESBL (+) resistance type. The analysis of genetic relationship of 7 strains indicated the existence of the same molecular pattern for 5 of the isolated strains. Strains which belonged to the same genotype were isolated from patients hospitalized on the same units. Therefore it can be assumed that the transmission of infection occurred in the area of patient's residence. Conclusions. Molecular studies together with an indication of drug resistance should be the duty of laboratories and epidemiological investigation conducted in the supervision of nosocomial infections. S t r e s z c z e n i e Wstęp. Jednym z elementów kontroli zakażeń szpitalnych jest nadzór mikrobiologiczny, którego głównym celem jest analiza czynników etiologicznych zakażenia i określenie wzorów lekooporności na leki. Transmisja zakażenia w warunkach szpitalnych następuje podczas czynności pielęgnacyjnych i leczniczych chorego. W przypadku identyfikacji ogniska epidemicznego należy wprowadzić procedurę izolacji kontaktowej oraz monitorować wyniki badań. Postępowanie to jest konieczne w celu eliminacji lub ograniczenia ryzyka rozprzestrzeniania się zakażenia szpitalnego.