The isolation of Candida may be related to comorbidity, prolonged mechanical ventilation, and survival during intensive care unit (ICU) stay, especially with non-albicans Candida (NAC). To examine the frequency of Candida isolation, associated comorbidities and outcomes in the surgical ICU in Osijek University Hospital, Croatia, the data from the electronic database from May 2016 to 30 June 2023 were analyzed. In a cross-sectional study examining 15,790 microbiological samples, different strains of Candida were observed in 581 samples from 236 patients. The control group (N = 261) was 130 consecutive patients from March to May 2019 and 131 in the same months in 2020 (pre- and post-COVID-19). Comorbidities, duration of mechanical ventilation, and survival were compared. Patients with isolated Candida were more often non-elective and had significantly more heart, kidney, and liver diseases and sepsis than the control group (p < 0.001). The duration of mechanical ventilation was 9.2 [2.2–9.24], 96 [24–146], 160 [19.5–343], and 224 [73.5–510] hours in the controls, in patients with Candida albicans, in patients with NAC, and in patients with ≥2 Candida species isolated, respectively. The mortality was significantly higher (42%) in patients with isolated Candida than in the control group (19%, p < 0.001). In a multivariate analysis adjusted for patients’ age, the Simplified Acute Physiology Score II, days of ICU, and type of admission, only sepsis on admission was an independent predictor of mortality (odds ratio = 2.27).

The ability of A cinetobacter baumannii strains to form biofilm is one of the most important virulence factor which enables bacterial survival in a harsh environment and decreases antibiotic concentration as well. Subminimal inhibitory concentrations (subMICs) of antibiotics may change bacterial ultrastructure or have an influence on some different molecular mechanisms resulting in morphological or physiological changes in bacteria itself. The aim of this study was to determine effects of 1/2, 1/4, 1/8 and 1/16 minimal inhibitory concentrationsof imipenem, ampicillin-sulbactam, azithromycin, rifampicin and colistin on biofilm formation ability of 22 biofilm non-producing and 46 biofilm producing A. baumannii strains (30 weak producing strains and 16 moderate producing strains). Results of this study indicate that 1/2–1/16 MICs of imipenem, azithromycin, and rifampicin can reduce bacterial biofilm formation ability in moderate producing strains (p < 0.05), whereas 1/16 MIC of imipenem and 1/4–1/8 MICs of rifampicin reduce the biofilm formation in weak producing strains (p < 0.05). Statisticaly significant effect was detected among biofilm non-producing strains after their exposure to 1/16 MIC of azithromycin (p = 0.039). SubMICs of ampicillin-sulbactam and colistin did not have any significant effect on biofilm formation among tested A. baumannii strains.

Uvod: Koncept ujedinjene bolesti disajnih puteva prepoznat je pre više decenija, kod pacijenata sa astmom. Nedavna istraživanja su ukazala na prisustvo i znaþaj simptoma rinitisa kod obolelih sa hroniþnom opstruktivnom bolešüu pluüa. Cilj: Cilj istraživanja bio je da se proceni uticaj simptoma rinitisa na težinu HOBP i pogoršanja. Materijal i metode: U prospektivnu studiju ukljuþeno je 49 pacijenata, 24 (48,98%) osobe ženskog i 25 (51,02%) muškog pola, proseþne starosti 66,49±7,461 godina. Težina HOBP-a odreÿena je spirometrijskim parametrom FEV1%. Za procenu izraženosti simptoma HOBP-a korišüen je CAT upitinik (COPD Assessment Test). Analizom krvne slike verifikovan je broj eozinofila, upitnikom SNOT22 (Sino-nasal Outcome Test) prisustvo simptoma rinitisa. Rezultati: Simptomi rinitisa utvrÿeni su kod 75,51% (37) pacijenata. Uoþena je statistiþki znaþajna razlika u ukupnom skoru SNOT-22 upitnika, rinološkom, ekstranazalnom/rinološkom i slušnom/facijalnom domenu ovog upitnika i krvnoj eozinofiliji u odnosu na prisustvo simptoma rinitisa (p<0,05). Korelacionom analizom potvrÿena je statistiþki znaþajna povezanost CAT i SNOT-22 upitnika (r=0,001; p<0,05), krvne eozinofilije i slušnog/facijalnog i psihološkog domena SNOT-22 uputnika i njegovog ukupnog skora (r=0,05; r=0,024; r=0,011; p<0,05). Statistiþki znaþajna povezanosti uoþena je i izmeÿu ekstranazalnog rinološkog domena SNOT-22 upitnika i broja hospitalnih egzacerbacija (r=0,038; p<0,05), kao i eozinofilije i broja hospitalnih pogoršanja (r=0,019; p0,05). Zakljuþak: Simptomi rinitisa znaþajno utiþu na izraženost simptoma hroniþne opstruktivne bolesti pluüa i broj hospitalnih pogoršanja. Krvna eozinofilija znaþajno utiþe na simptome rinitisa i poveüava rizik od hospitalnih pogoršanja.

During the COVID-19 pandemic, changes occurred within the surgical patient population. An increase in the frequency of resistant Gram-negative bacteria has since been recorded worldwide. After the start of the COVID-19 pandemic, microbiological diagnostics in our institution was performed using MALDI-TOF mass spectrometry. With this study, we wanted to confirm whether it contributed to a greater number of pathogenic bacteria detected in surgical ICU patients. A total of 15,033 samples taken from 1781 surgical patients were compared during the period from 2016 to February 2020 and during the COVID-19 pandemic from March 2020 to February 2023. On patients’ admission, pathogenic bacteria were mostly isolated from the respiratory system (43.1% and 44.9%), followed by urine cultures (18.4 vs. 15.4%) before and during the pandemic. After the onset of the COVID-19 pandemic, there was a significant increase in the frequency of isolation of Enterobacter spp. (5.4 before vs. 9%, p = 0.014) and other enterobacteria (6.9 vs. 10.8%, p = 0.017) on patients’ admission to the ICU, respectively. Despite this change, mortality in the ICU during the post-COVID-19 period was reduced from 23 to 9.6% (p < 0.001). The frequency of bacterial isolation did not change with the application of MALDI-TOF technology. By identifying the microorganism while simultaneously recognizing some resistance genes, we were able to start targeted therapy earlier. With the application of other infection control methods, MALDI-TOF may have contributed to the reduction in mortality in surgical ICU patients during the COVID-19 pandemic.

Background: Although anaerobic bacteria are not often isolated from clinical specimens, they are an important cause of morbidity. The aim of this study was to determine the distribution and antimicrobial resistance profile of strictly anaerobic bacteria at University Hospital Centre Osijek, Croatia over a two-year period.Methods: Data collected at the Department of Clinical Microbiology and Hospital Infections, University Hospital Centre Osijek, Croatia over a two-year period were analysed. Samples sent to the laboratory for anaerobic cultivation were inoculated onto solid and/or liquid media and incubated in an anaerobic atmosphere. Culture media were inspected every 48 hours, and grown colonies were subjected to an aerotolerance test. Identification of strictly anaerobic isolates was performed using a MALDI-TOF mass spectrometer (MALDI Biotyper, Bruker, Germany). Susceptibility of isolates was tested by the breakpoint method with a commercially available test (ATB ANA EU, Biomerieux, France) and interpreted according to EUCAST guidelines.Results: A total of 605 anaerobic isolates were detected, of which 274 were strictly anaerobic. The most abundant genus was Bacteroides spp., with 130 (47.45%) isolates, and B. fragilis was the predominant species with 71 (54.61%) isolates. The highest resistance among Gram-negative bacteria was to penicillin (80.17%). The highest resistance among Gram-positive bacteria was to metronidazole (38.46%).Conclusions: Bacteroides fragilis was the most frequently isolated anaerobic bacterium during the two-year period at University Hospital Centre Osijek, Croatia. Resistance to metronidazole, the first therapeutic choice, remains very low, but resistance to clindamycin is concerning. Further monitoring of the antimicrobial susceptibility profile of anaerobic bacteria is required.

Pojam sepse povezuje se s modernom medicinom, ali sam koncept seže daleko u prošlost. Stoljećima je bila inspiracija za gotovo sve vrste umjetnosti, vjerno oslikavajući težinu stanja koje izaziva, strah i visoku smrtnost koja ju prati u stopu. Unatoč različitim stilovima života, čovječanstvo već tisućama godina obolijeva od sepse. U početku se na nju gledalo kao na neizbježan ishod teških bolesti, bez mogućnosti izlječenja. Taj se pristup promijenio tek u 20. stoljeću zahvaljujući eksponencijalnom napretku dijagnostičkih metoda i terapije. Povijesno niska javna i profesionalna svijest o sepsi dovela je do toga da je dugo bila “tihi ubojica”. Moderna medicina nastoji raznim mjerama spriječiti nastanak infekcija i provesti liječenje odgovarajućom terapijom. Usprkos tome mikroorganizmi drže korak s čovjekom i jednostavnim, a brzim prilagodbama uspjeli su razviti značajnu otpornost na antibiotike. Antimikrobna rezistencija jedan je od vodećih problema današnje medicine. U ovom su radu prikazane značajne prekretnice u povijesti septičnih stanja i evolucija prema postantibiotskoj eri. Brz napredak u dijagnostičkim i terapijskim mogućnostima baca novo svjetlo na prirodu sepse, ali u praksi još uvijek čini vrlo malo za oboljele. Sveobuhvatan pogled u prošlost mogao bi pomoći u pronalaženju odgovora na još uvijek neriješena pitanja vezana uz ovu bolest.