medical and biological sciences - Collegium Medicum - Uniwersytet ...

More documents

Recommendations

Info

14Dorota Gregorowicz-Warpascalled contacts in case of syphilis and gonorrhea;relative increase of women number, where syphilisduring pregnancy or childbirth was recognized;childbirths with innate syphilis [15]. Inadequaterecognition of latent syphilis is a result of restrictionsin performing screening towards syphilis in pregnantwomen and blood donors. An obligation of women tobe examined twice during pregnancy is not fullyrealized. At present syphilis is affirmed in the samenumber of pregnant women as when the number ofchildbirths was 4 times higher. It is worth mentioningthat the decrease of registered (but not actual)incidences of sexually transmitted diseases takes placedue to an oversight of doctors of different specialtiesalthough reporting incidences is a statutory duty [15].The testing for syphilis is recommended forpregnant women. In the field of pre-delivery care fornormal pregnancy, Polish Gynecological SocietyManagement recommended in 2005 examination ofVDRL (flocculation reagin with cardiolipin antigen) asas a mandatory. It is recommended to perform VBRLexamination during the first visit between 7th and 8thweek of pregnancy up to 10th week of pregnancy. Ina group of women with increased population orindividual risk of infection another examinationsshould be performed between 33rd and 37th week ofpregnancy. The course of innate syphilis may varydepending on its escalation. Innate syphilis may causefetal atrophy or premature birth of ill and unable to livechild, or an infant is seemingly healthy and onlypositive serological reaction confirms that infectiontook place in mother’s womb. In that case the changesmay occur after many years or not occur at all [14].A program of hospital accreditation worked out bythe Health Protection Quality Monitoring Centerassumes fulfillment of determined standardsinfluencing the quality of healthcare given to patients.In order to complete the standards of hospital infectioncontrol for psychiatric healthcare there is a need towork out effective mechanisms allowing earlydetection of spreading sexually transmitted diseases.The second standard concerns realization ofa program which promotes body and mouth cavityhygiene [16].Center of Diagnosis and Treatment of SexuallyTransmitted Diseases in Warsaw in a letter to thehospital recommends to perform screening tests forsyphilis especially in patients hospitalized inobstetrical, gynecological, psychiatric and neurologicalwards.TESTING FOR STREPTOCOCCUS AGALACTIAEI STREPTOCOCCUS PYOGENESAt the beginning of the seventies of the 20thcentury invasive infections caused by Streptococcusagalactiae turned out to be a leading factor causingmortality of neonates and infants in the USA. Thatalarming information in the eighties led to a series ofclinic examinations utilizing chemoprophylaxis inorder to diminish or eliminate incidence rate. Theexaminations proved that intradeliverychemoprophylaxis application in pregnant carriers ofStreptococcus agalactiae essencially protectednewborn infants against incidence [17, 18].In 1996 the Center for Disease Control andPrevention in cooperation with the American Collegeof Obstetricians and Gynecologists and the AmericanAcademy of Pediatrics worked out a prophylacticrecommendation for women during pregnancy, servingto prevent infections from Streptococcus agalactiae inneonates and infants [17, 18,19].The pattern recommends to applicate one of the twoprevention methods: the first – applying antibiotictherapy based on the risk evaluation (risk-basedstrategy) and the second – utilizing microbiologicalscreening (screening strategy). The doctors using thefirst method qualify a woman to intradeliverychemoprofylaxis when one of the following risk factorsis affirmed: childbirth before 37th week of pregnancy,body temperature during delivery ≥38°C or when timewhich elapsed from fetal membrane fracture exceeded18 hours. In case of the second method it isrecommended to perform microbiologicalexaminations: inoculation from vagina and smear testfrom anus in all pregnant women between 35th and37th week of pregnancy. Positive infection test resultdetermines serving antibiotics during delivery [17, 18,19].The conditions in urinary and sexual tractsappearing during pregnancy, the vicinity of anus,chronic inflammation processes, the vicinity ofdelivery channel are the factors which predestine toinfections coming from vagina microflore. A seriousproblem are infections of neonates, which are closelyconnected with the bacteria colonizing mother’sdelivery channel . Bacteremia usually appears duringthe first week of life but meningitis in the course of 2-3weeks. Inflammation caused by microflore may bea result of the fetal bladder’s injury and also may
The benefits resulting from introduction of microbiological screening standard on the day of admitting a patient... 15appear during the passage of an infant throughdelivery channel [20].The factors causing infection in mother’s womb areoverruning deliveries, infection of amniotic fluid andpremature fracture of fetal bladder. Delivery channelmay be a starting point of lethal sepsis for an infant[20].Streptococcus agalactiae is a basic etiologic factorof infections in neonatal period and its carrying invagina of healthy women amounts to 50-75% [22]. Thefact of colonization in pregnant woman is a key riskfactor of infant infection [22]. It is believed that amongthe etiologic factors of bacterimia and neonate sepsis,the second place after coagulase-negative staphylococciis assigned to streptococci. It was proved thatinfections spreading out in a hospital were in thosedepartments, where there was a high level of carryingamong women giving birth [22].Infections from Streptococcus agalactiae inneonates and infants were characterized as 2 distinctsyndromes. Early syndromes appeared in neonates upto 7 days of life and its symptoms are sepsis,pneumonia, seldom meningitis.Mortality in such cases is very high and can amountto 50 % [17,18, 22]. Subsequent syndrome occur inneonates and infants between 7 days and 3 months oflife. It is manifested first of all by meningitis. In orderto prevent infant infection essential meaning isascribed to perinatal chemoprophylaxis in femalecarriers [22].In pregnant women or after delivery Streptococcusagalactiae is responsible for infection of urinal tracts,fetal membrane infection, uterus infection, septicinfection, seldom meningitis [17].In Poland there are still no epidemiological data,which would allow to evaluate the problem’s scale andto make coordinated efforts in aid of introducing theaction procedures in case of perinatal infection causedby Streptococcus agalactiae [17].Streptococcus pyogenes is a cause of hospital infectionsmainly in obstetric and infant wards. The sourceof those microorganisms may be respiratory paths,alimentary tract or vagina in women (carrying). Thecarrying factor may amount to 15-20% [22].Streptococcus pyogenes as a cause of septic infectionin parturients (so called postnatal fever) wasknown as early as in the 20th century. It may alsocause an infection in neonates.Those bacteria predominantly infect a stump ofumbilical cord and may be carried by the hands ofnursing personnel [22, 21].The decision of the hospital, which concerns performingtests for Streptococcus pyogenes in the patientsof obstetrical ward was caused among otherthings by the level of carrying and mainly by virulenceof those microorganisms, especially in the context ofknown septic infection incidents of such etiology followedby lethal effect.CONCLUSIONSA meticulous realization of all the activity encompassedby the standard of screening leads to:1. Identification of the infection source and introductionof antibiotic therapy, thanks to rapid microbiologicaldiagnosis .2. Introduction of active isolation of the patient.3. Cost reduction connected with antibiotic therapy.4. Cost reduction of treatment and consequentlyshortening of patient’s stay in hospital5. Improvement of the sanitary state of a hospital byreducing the number of hospital infections.6. Control of application of selected antibiotics, i.e.vancomycin, teicoplanin, imipenem7. Reduction of a hospital’s costs due to possiblecompensations resulting from infections and consequentlyan increase of insurance rates.REFERENCES1. Ozorowski T.: Postępowanie w przypadku identyfikacjiGram-dodatnich drobnoustrojów alarmowychw środowisku szpitalnym, SHL, 2005, 1-2/27, 5-8.2. Fleischer M.: Nadzór mikrobiologiczny w świetle wymagańprawnych, Aktualności bio Merieux 2007, 41, 21-25.3. Dzierżanowska D. i wsp.: Lekooporne drobnoustrojew zakażeniach szpitalnych, Post. Mikrobiol. 2004,43/1,81-105.4. Kramer A. i wsp.: Jak długo patogeny szpitalne mogąprzetrwać na powierzchniach nieożywionych? Przeglądsystematyczny, Zakażenia 2007, 7/4, 16-24.5. Brońska K.: W jaki sposób dochodzi do wprowadzeniaMRSA do szpitala i jego transmisji, Informator PolskiegoStowarzyszenia Pielęgniarek Epidemiologicznych2006, 2/25, 21-23.6. Młynarczyk A. i wsp.: Metycylinooporne gronkowcezłociste, molekularne typowanie szczepów MRSA wyhodowanychod studentów Akademii Medycznej w Warszawiew latach 1999-2003, Zakażenia 2003,4,75-80.7. Hartmann B. i wsp.: Computer keyboard and mouse asa reservoir of patogens in an intensive care unit, J ClinMonit 2004, 18,7.
Page 8: 8Wojciech J. Baranowskirating) move
Page 13: The benefits resulting from introdu
Page 17 and 18: Medical and Biological Sciences, 20
Page 19 and 20: The history and the present of hern
Page 21 and 22: The history and the present of hern
Page 23: The history and the present of hern
Page 26: 26Anna Budzyńska et al.Gram-dodatn
Page 32 and 33: 32Piotr Kamiński et al.Streszczeni
Page 34 and 35: 34Piotr Kamiński et al.both in Pom
Page 36 and 37: 36Piotr Kamiński et al.hemoglobin
Page 41 and 42: Impact of mandatory vaccination pro
Page 45 and 46: Bone turnover during pregnancy 45ra
Page 47: Bone turnover during pregnancy 47pl
Page 50 and 51: 50Jan Styczyński, Anna Jaworska(p
Page 52 and 53: 52Jan Styczyński, Anna JaworskaRES
Page 57 and 58: Analysis of immunophenotype at seco
Page 59: Analysis of immunophenotype at seco
Page 62 and 63: 62Ana-Maria ŠimundićINTRODUCTIOND
Page 64 and 65:
64Ana-Maria ŠimundićThe shape of
Page 67 and 68:
Medical and Biological Sciences, 20
Page 69 and 70:
Quantitative anatomy of the aortic
Page 71 and 72:
Quantitative anatomy of the aortic
Page 73 and 74:
Page 75 and 76:
Volumetric growth of various aortic
Page 77 and 78:
Volumetric growth of various aortic
Page 79 and 80:
Page 81 and 82:
Effect of Low Level Laser Therapy a
Page 83 and 84:
Effect of Low Level Laser Therapy a
Page 85 and 86:
Page 87 and 88:
Body weight support during treadmil
Page 89 and 90:
Body weight support during treadmil
Page 91 and 92:
show all

medical and biological sciences - Collegium Medicum - Uniwersytet ...

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?