Against a background of rapid increase of β-lactamase-producing or multi-resistant pathogenic bacteria and the resulting lack of effective antibiotic treatment, some older antibiotics have been tested for new therapeutic uses. One of these is fosfomycin, to which according to studies these resistant bacteria are very sensitive. Our study was designed because there is no data on the fosfomycin susceptibility rate in the Czech Republic. In this study from January 2013 to June 2014 3295 unique isolates of Gram-negative bacteria which had caused urinary tract infections were examined. The antibiotic susceptibility was measured by disk diffusion test. Both EUCAST and CLSI guidelines criteria (for fosfomycin only) were used for the antibiotic susceptibility evaluation. The most frequently tested bacterial isolates were Escherichia coli (51.3%, n = 1703), Klebsiella pneumoniae (19.4%, n = 643) and Proteus spp. (11.8%, n = 392). Among all isolates 29.0% (n = 963) were resistant to fluoroquinolones, 11.3% (n = 374) produced extended spectrum β-lactamase and 4.2% (n = 141) produced AmpC β-lactamase. The overall in vitro susceptibility was significantly higher for fosfomycin compared to the other tested per-oral antibiotics (nitrofurantoin, ampicillin, co-trimoxazole, ciprofloxacin and cefuroxime) against all tested Gram-negative rod isolates (excluding Morganella morgani and Acinetobacter spp. isolates). Fosfomycin also remained highly active against those isolates with extended spectrum β-lactamase (ESBL) production (95.8% in Escherichia coli isolates and 85.3% in Klebsiella pneumoniae isolates), unlike other tested per-oral antibiotics, which showed significant (p < 0.0001) susceptibility decrease. We have confirmed in the Czech Republic the very high susceptibility to fosfomycin trometamol of urinary tract infection pathogens, particularly Gram-negative rods including those producing β-lactamase.

Fosfomycin represents a relatively old antibiotic, but it is experiencing a comeback in recent years. According to some studies, the increasing therapeutic use of this drug led to a rapid increase in the levels of resistance in bacteria causing urinary tract infection. In the presented study, levels of resistance to fosfomycin in more than 3500 bacterial isolates before and after fosfomycin introduction into therapeutic use in the Czech Republic and the clinical efficacy of treatment in 300 patients using this drug were assessed. The results show that the resistance levels to fosfomycin in Escherichia coli isolates before and after the drug registration were not significantly different (3.4% and 4.4%, respectively). In some other Gram-negative rods, such as otherwise susceptible Enterobacter, resistance to fosfomycin increased significantly from 45.6% to 76.6%. Fosfomycin treatment of urinary tract infections showed an excellent seven-day clinical efficacy (79.7%). However, when used to treat recurrent or complicated urinary tract infections, fosfomycin treatment was associated with high levels of infection relapse, leading to relapse in a total of 20.4% of patients during the first two months. This indicates that fosfomycin exhibits good efficacy only for the treatment of uncomplicated urinary tract infections

Background/Aim. Obesity is currently considered to be the most frequent metabolic disease worldwide, not only in developed but also in developing countries. The aim of this work was to describe the development of health status in soldiers of the Armed Forces of the Czech Republic (ACR) and to emphasize the markers of non-communicable diseases. Our study describes the anthropometric and biochemical parameters of a large group of Czech Army professional soldiers. Data were obtained over a period of 11 years. Methods. During the monitored period, from 1999 to 2009, military physicians carried out on the average 6,360 examinations on professional soldiers per year and monitored their health and nutritional status with the aim of preventing the risk factors of non-communicable diseases. These examinations are compulsory for all professional soldiers at the age of 25, 30, 33, and 36 years. From the age of 39, these examinations are carried out every year till the end of their career. Besides taking personal histories and carrying out standard physical examinations, blood was taken for biochemical examination. The following anthropometric parameters were monitored: body constitution using body mass index (BMI) and waist circumference. Our study describes only part of the data concerning anthropometric and biochemical parameters of professional soldiers which were obtained over a period of 11 years. Results. Average BMI values in men were in the overweight range (26.5-27 kg/m2). Average values of waist circumference, however, ranged from 91.9 cm to 93.4 cm. Between the first and the last year of monitoring a statistically significant decrease in these values ranging from 93.4 ? 9.8 cm to 92.7 ? 9.5 cm (p < 0.001) was observed. All monitored anthropometric parameters in female professional soldiers were within normal limits. During the monitored period the proportion of overweight men gradually increased from 52% to 57.1% (p < 0.001). There were no statistically significant changes in the prevalence of obesity in men (12-15%). Average glycaemia levels were within normal range in both men and women. A statistically significant decrease in these levels, however, was observed in men (from 5.1 ? 0.9 mmol/L to 4.8 ? 0.7 mmol/L (p < 0.001) and in women (from 4.9 ? 0.6 mmol/L to 4.6 ? 0.6 mmol/L (p < 0.001). Concerning the lipid profile in men, a significant decrease in average values of total cholesterol, triglycerides and LDL cholesterol was observed; from 5.5 ? 1.1 mmol/L to 5.1 ? 1.0 mmol/L (p < 0.001), from 2.0 ? 1.6 mmol/L to 1.6 ? 1.2 mmol/L (p < 0.001) and from 3.4 ? 1.1 mmol/L to 3.2 ? 0.9 mmol/L (p < 0.001), respectively. Conclusion. During the monitored period only one-third of military professionals had normal body weight. More favorable situation was in female professional soldiers, two-thirds of them had normal body weight during the monitored period. Additionally, the increase in the number of individuals with BMI values in the overweight range was observed. Although the number of overweight soldiers was overestimated as a result of the inclusion of individuals with increased body weight due to well-developed musculature, the number of overweight and obese soldiers is still high.

We report the case of isolation ofBordetella trematumfrom the respiratory tract of a patient with lung carcinoma. This gram-negative, opportunistic rod was firstly described in 1996. To date, only several strains ofBordetella trematumhave been isolated and reported, mostly from skin and soft tissue infections. The patient was admitted to the ICU of the Pulmonary Department in incipient septic shock with respiratory failure. Intravenous fluid resuscitation and non-invasive ventilation were administered immediately. A broad spectrum antibiotic piperacillin/tazobactam was administered empirically after sampling of material for microbiological examination. The bronchoscopy showed a large cavern of decayed tumour invading into mediastinum. Both sample cultures showed significant quantities of gram-negative non-fermenting bacteria. The isolate was identified using MALDI-TOF MS asBordetella trematumand the identification was confirmed using 16S ribosomal RNA sequencing. In the last few years, routine bacterial identification using MALDI-TOF MS has enabled correct discrimination of this species. Nevertheless, isolation ofBordetella trematumin clinical samples is still very uncommon, and it is appropriate to confirm the species identification via 16S ribosomal RNA sequencing. To our knowledge, this is the first case ofB. trematumisolated from the human respiratory tract since its first description. The clinical significance ofBordetella trematumin the rapid deterioration of the patient’s status remains unclear.