W Hryniewicz

Publications of W Hryniewicz

• Outbreak of invasive meningococcal disease in Goleniow County, northwest Poland, March 2009.

  Authors: A Skoczyńska, I Wasko, A Kuch, A Gołebiewska, M Foryś, W Hryniewicz

  Euro surveillance : bulletin européen sur les maladies transmissibles = European communicable disease bulletin. 01/2010; 15(34).

• Invasive pneumococcal disease in children up to 5 years of age in Poland.

  Authors: P Grzesiowski, A Skoczynska, P Albrecht, R Konior, M Patrzalek, M Sadowska, J Staroszczyk, L Szenborn, J Wysocki, W Hryniewicz

  European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 07/2008;

• Hospital outbreak of vancomycin-resistant enterococci caused by a single clone of Enterococcus raffinosus and several clones of Enterococcus faecium.

  Authors: M Kawalec, J Kedzierska, A Gajda, E Sadowy, J Wegrzyn, S Naser, A B Skotnicki, M Gniadkowski, W Hryniewicz

  Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 10/2007; 13(9):893-901.

  A mixed outbreak caused by vancomycin-resistant Enterococcus raffinosus and Enterococcus faecium carrying the vanA gene was analysed. The outbreak occurred in a large hospital in Poland and affectedA mixed outbreak caused by vancomycin-resistant Enterococcus raffinosus and Enterococcus faecium carrying the vanA gene was analysed. The outbreak occurred in a large hospital in Poland and affected 27 patients, most of whom were colonised, in three wards, including the haematology unit. The E. raffinosus isolates had a high-level multiresistant phenotype and were initially misidentified as Enterococcus avium; their unambiguous identification was provided by multilocus sequence analysis. The molecular investigation demonstrated the clonal character of the E. raffinosus outbreak and the polyclonal structure of the E. faecium isolates. All of the isolates carried the same Tn1546-like element containing an IS1251-like insertion sequence, located on a c. 50-kb conjugative plasmid. One of the E. faecium clones, found previously to be endemic in the hospital, was probably the source of the plasmid. The results of the study suggest that difficulties in identification may have led to an underestimate of the importance of E. raffinosus in vancomycin-resistant enterococci (VRE) control strategies.

• Resistance patterns of selected respiratory tract pathogens in Poland.

  Authors: A Skoczyńska, M Kadłubowski, I Waśko, J Fiett, W Hryniewicz

  Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 05/2007; 13(4):377-83.

  This study presents the results of a survey of the in-vitro susceptibility to antimicrobial agents of major pathogens responsible for community-acquired respiratory tract infections in Poland duringThis study presents the results of a survey of the in-vitro susceptibility to antimicrobial agents of major pathogens responsible for community-acquired respiratory tract infections in Poland during 2002-2004. The collection of 1184 bacterial isolates comprised 398 Streptococcus pneumoniae, 344 Haemophilus influenzae, 302 Streptococcus pyogenes and 140 Moraxella catarrhalis. Among the pneumococcal isolates, 16.8% were penicillin-non-susceptible (PNSP), of which 80.6% were identified as multidrug-resistant. Overall, 9.0% of H. influenzae isolates were beta-lactamase-positive, although this percentage increased noticeably in the third year of the study. Based on PCR results, 12.8% of H. influenzae isolates were identified as low-level beta-lactamase-negative, ampicillin-resistant (BLNAR), and one isolate as low-level beta-lactamase-positive, amoxycillin-clavulanic acid-resistant (BLPACR). Pulsed-field gel electrophoresis (PFGE) classified 45 H. influenzae isolates with altered penicillin-binding proteins into 15 PFGE types, including two predominant types (with four and six sub-types) containing 15 and ten isolates, respectively. Resistance to tetracycline, erythromycin and clindamycin was found in 20.9%, 8.9% and 4.6% of S. pyogenes isolates, respectively. The production of beta-lactamase characterised 91.4% of M. catarrhalis isolates. In summary, the overall occurrence of PNSP in Poland remains stable, although there was a noticeable increase in the proportion of fully-resistant isolates. A rising trend in the prevalence of beta-lactamase producers and low-level BLNAR isolates was observed among Polish isolates of H. influenzae.

• Invasive meningococcal disease at a military base in Warsaw, January 2007.

  Authors: M Kadlubowski, I Wasko, A Klarowicz, W Hryniewicz

  Euro surveillance : bulletin européen sur les maladies transmissibles = European communicable disease bulletin. 04/2007; 12(3):E070301.2.

• Characterisation of Neisseria meningitidis C:2b:P1.2,5 isolates in Poland.

  Authors: A Skoczyńska, M Kadłubowski, I Waśko, W Hryniewicz

  Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 11/2006; 12(10):1027-30.

  This study aimed to characterise Neisseria meningitidis C:2b:P1.2,5 isolates from Poland, which have now become predominant among serogroup C isolates in this country. Overall, 44 isolates (25This study aimed to characterise Neisseria meningitidis C:2b:P1.2,5 isolates from Poland, which have now become predominant among serogroup C isolates in this country. Overall, 44 isolates (25 invasive and 19 from contact carriers) were typed by whole-cell ELISA and pulsed-field gel electrophoresis. Additionally, the invasive isolates were analysed by multilocus sequence typing, which revealed that they all belonged to the ST-8 complex/cluster A4. The emergence of this clone in other countries has resulted in mass immunisation campaigns and has been associated with a higher level of decreased susceptibility to penicillin; however the present study detected only one isolate that was penicillin-non-susceptible.

• Antimicrobial susceptibility patterns of Staphylococcus aureus in Poland obtained by the National Quality Assurance Programme.

  Authors: B Matynia, E Młodzinska, W Hryniewicz

  Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 05/2005; 11(5):379-85.

  As part of the Polish external quality assurance scheme, clinical laboratories were asked to send five consecutive isolates of Staphylococcus aureus and the corresponding susceptibility results toAs part of the Polish external quality assurance scheme, clinical laboratories were asked to send five consecutive isolates of Staphylococcus aureus and the corresponding susceptibility results to the national Centre of Quality Control in Microbiology. Of 1376 isolates submitted as S. aureus from 276 medical centres, 13 (< 1%) had been misidentified by local laboratories. Of 181 (13.5%) methicillin-resistant S. aureus (MRSA) isolates, most were identified correctly (c. 98% of laboratories). Although all MRSA isolates were fully susceptible to vancomycin, teicoplanin and linezolid, they were usually multiresistant; almost 23% were resistant to seven antimicrobial agents. Most (> 90%) MSSA isolates were susceptible to the tested antibiotics, except penicillin (21% susceptible) and tetracycline (62.4% susceptible). In addition to evaluating the proficiency of testing by local laboratories, the study yielded valuable information regarding the susceptibility patterns of S. aureus isolates in Poland.

• Identification of Neisseria meningitidis sequence type 66 in Poland.

  Authors: A Skoczynska, R Konior, E Sadowy, M Piatkowska-Smietanska, B Lelek, M Gniadkowski, W Hryniewicz

  Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 10/2004; 10(9):848-50.

  Investigation of two cases of invasive meningococcal disease within a single family revealed the presence of isolates of Neisseria meningitidis phenotype C:2b:P1.2,P1.5 belonging to sequence typeInvestigation of two cases of invasive meningococcal disease within a single family revealed the presence of isolates of Neisseria meningitidis phenotype C:2b:P1.2,P1.5 belonging to sequence type (ST) 66. The ST66 clone is a single-locus variant of the widely distributed ST8 complex, which has been observed previously in Spain, Belgium, Australia and New Zealand. This hypervariable meningococcal lineage has been responsible for local epidemics worldwide. This is the first report of ST66 meningococcal isolates of this phenotype from Poland.

• Evaluation of the BD Phoenix automated identification and susceptibility testing system in clinical microbiology laboratory practice.

  Authors: E Stefaniuk, A Baraniak, M Gniadkowski, W Hryniewicz

  European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology. 09/2003; 22(8):479-85.

  The Phoenix Automated Microbiology System (BD Biosciences, USA) is a new, fully automated system for the rapid identification and antimicrobial susceptibility testing of gram-positive andThe Phoenix Automated Microbiology System (BD Biosciences, USA) is a new, fully automated system for the rapid identification and antimicrobial susceptibility testing of gram-positive and gram-negative bacteria. The objective of this study was to evaluate the quality of performance of the Phoenix system in the identification and antimicrobial susceptibility testing of 260 gram-negative ( n=174) and gram-positive ( n=86) isolates collected from Polish hospitals in recent years. Two Phoenix panel types for identification/antimicrobial susceptibility testing, NMIC/ID-5 for gram-negative rods and PMIC/ID-4 for gram-positive cocci, were used in the analysis according to the manufacturer's recommendations. The results produced by the system were compared with data obtained by reference or conventional microbiological methods. A high rate of agreement between the Phoenix and the conventional methods was observed for identification, ranging from 100% for gram-positive cocci to 96.0% for gram-negative nonfermenters and 92.5% for members of the family Enterobacteriaceae. Similarly, a high level of agreement characterized the antimicrobial susceptibility data obtained with the Phoenix and by the agar dilution method (2,361 test results). For staphylococci, enterococci and Enterobacteriaceae, the methods were 100% concordant in determining the category of susceptibility of isolates to the majority of the antimicrobial agents tested. A category agreement value of below 90% was found for the susceptibility of enterococci and gram-negative nonfermenters to ciprofloxacin (84.6% and 88.5%, respectively) and for susceptibility of Stenotrophomonas maltophilia to trimethoprim-sulfamethoxazole (80.0%).

• Susceptibility to moxifloxacin and other antimicrobial agents of major pathogens responsible for community acquired respiratory tract infection in Poland.

  Authors: K Betlejewska, W Hryniewicz

  International journal of antimicrobial agents. 02/2002; 19(1):47-52.

  The in vitro activity of moxifloxacin was compared with that of other antimicrobial agents against 470 bacterial strains isolated from patients with respiratory tract infection. Bacteria studiedThe in vitro activity of moxifloxacin was compared with that of other antimicrobial agents against 470 bacterial strains isolated from patients with respiratory tract infection. Bacteria studied included 110 penicillin susceptible and 110 penicillin non-susceptible Streptococcus pneumoniae, 50 strains of S. pyogenes, 120 strains of Haemophilus influenzae and 80 strains of Moraxella catarrhalis. Moxifloxacin was the most active of the antimicrobials tested.

• Selection of a teicoplanin-resistant Enterococcus faecium mutant during an outbreak caused by vancomycin-resistant enterococci with the vanB phenotype.

  Authors: M Kawalec, M Gniadkowski, J Kedzierska, A Skotnicki, J Fiett, W Hryniewicz

  Journal of clinical microbiology. 01/2002; 39(12):4274-82.

  Vancomycin-resistant enterococci (VRE) have recently become an increasing problem in hospitals in Poland, being responsible for a growing number of nosocomial outbreaks. In this work, we haveVancomycin-resistant enterococci (VRE) have recently become an increasing problem in hospitals in Poland, being responsible for a growing number of nosocomial outbreaks. In this work, we have analyzed the second outbreak of VRE with the VanB phenotype to be identified in the country. It was caused by clonal dissemination of a single strain of vancomycin-resistant Enterococcus faecalis (VRES) and horizontal transmission of vancomycin resistance genes among several vancomycin-resistant Enterococcus faecium (VREM) strains. Two similar restriction fragment length polymorphism types of the vanB gene cluster characterized VRES and VREM isolates, and they both contained the same vanB2 variant of the vanB gene. Two vancomycin-susceptible E. faecium (VSEM) isolates, recovered from the same wards during the outbreak, proved to be related to certain VREM isolates and could represent endemic strains that had acquired vancomycin resistance. One VSEM and four VREM isolates, all identified in the same patient, belonged to a single clone, although they revealed remarkable diversity in terms of susceptibility, PFGE patterns, plasmid content, and number of vanB gene cluster copies. Most probably they reflected the dynamic evolution of an E. faecium strain in the course of infection of a single patient. One of the VREM isolates turned out to be resistant to teicoplanin, which coincided with the use of this antibiotic in the patient's therapy. Its vanB gene variant differed by a single mutation from that found in other isolates; however, it also lacked a large part of the vanB gene cluster, including the regulatory genes vanR(B) and -S(B), and the vancomycin-inducible promoter P(YB). Expression of the resistance genes vanH(B), -B, and -X(B) was constitutive in the mutant, and this phenomenon was responsible for its unusual phenotype.

• Hospital infection control in Poland.

  Authors: W Hryniewicz, P Grzesiowski, T Ozorowski

  The Journal of hospital infection. 11/2001; 49(2):94-8.

  During the last 10 years, as in other areas of the public sector in Poland, the healthcare system has undergone important changes presenting a challenge for medical staff and healthcare managersDuring the last 10 years, as in other areas of the public sector in Poland, the healthcare system has undergone important changes presenting a challenge for medical staff and healthcare managers alike. Since 1997, the Polish Government has undertaken important healthcare reforms. New regulations have introduced decentralization of management and a financing system for hospitals. These changes have provided favourable conditions in which to implement an infection control system for hospitals. The most important recent initiatives are training courses and workshops for hospital staff organized in co-operation with microbiologists and epidemiologists as well as preparation of recommendations and guidelines for hospitals. Several non-governmental organizations have been set up to improve hospital hygiene, infection control and monitoring of antimicrobial resistance.

• Antibiotic susceptibility of bacterial strains isolated from urinary tract infections in Poland.

  Authors: K Hryniewicz, K Szczypa, A Sulikowska, K Jankowski, K Betlejewska, W Hryniewicz

  The Journal of antimicrobial chemotherapy. 07/2001; 47(6):773-80.

  Worldwide data show that there is increasing resistance among urinary tract pathogens to conventional drugs. The aim of this study was to obtain data on susceptibility patterns of pathogensWorldwide data show that there is increasing resistance among urinary tract pathogens to conventional drugs. The aim of this study was to obtain data on susceptibility patterns of pathogens responsible for urinary tract infections (UTIs) in Poland to currently used antimicrobial agents. A multicentre study of 141 pathogens from hospital-acquired infections and 460 pathogens from community-acquired infections was carried out between July 1998 and May 1999. The most prevalent aetiological agent was Escherichia coli (73.0%), followed by Proteus spp. (8.9%) and other species of Enterobacteriaceae (9.6%). Few community infections were caused by Gram-positive bacteria (2.2%). Gram-positive cocci were isolated more frequently from a hospital setting (14.1%) and the most common were Enterococcus spp. (8.5%). Pseudomonas aeruginosa was found only among hospital isolates and was responsible for 10.7% of infections. E. coli isolates from both community and hospital infections were highly susceptible to many antimicrobial agents with the exception of those isolates producing extended-spectrum beta-lactamases (ESBLs). Of all Enterobacteriaceae tested, 38 strains (6.9%) were capable of producing ESBLs.

• Outbreak of vancomycin-resistant Enterococcus faecium of the phenotype VanB in a hospital in Warsaw, Poland: probable transmission of the resistance determinants into an endemic vancomycin-susceptible strain.

  Authors: M Kawalec, M Gniadkowski, M Zaleska, T Ozorowski, L Konopka, W Hryniewicz

  Journal of clinical microbiology. 06/2001; 39(5):1781-7.

  The first outbreak caused by vancomycin-resistant enterococci of the VanB phenotype in Poland was analyzed. It occurred in a single ward of a Warsaw hospital which is a specialized center for theThe first outbreak caused by vancomycin-resistant enterococci of the VanB phenotype in Poland was analyzed. It occurred in a single ward of a Warsaw hospital which is a specialized center for the treatment of hematological disorders. Between July 1999 and February 2000, 11 patients in the ward were found to be infected and/or colonized by Enterococcus faecium that was resistant in vitro to vancomycin and susceptible to teicoplanin. PCR analysis confirmed that the vancomycin-resistant E. faecium (VREM) isolates carried the vanB gene, which is responsible for the VanB phenotype. Pulsed-field gel electrophoresis (PFGE) typing revealed that the isolates belonged to four distinct PFGE types and that one of these was clearly predominant, including isolates collected from seven different patients. The isolates contained one or more copies of the vanB gene cluster of the identical, unique DraI/PagI (BspHI) restriction fragment length polymorphism type, which resided in either the same or different plasmid molecules or chromosomal regions. All this data suggested that the outbreak was due to both clonal spread of a single strain and horizontal transfer of resistance genes among nonrelated strains, which could be mediated by plasmids and/or by vanB gene cluster-containing transposons. The comparative analysis of vancomycin-susceptible E. faecium (VSEM) isolates collected from infections in the same ward at the time of the VREM outbreak has led to identification of a widespread VSEM strain that was possibly related to the major VREM clone. It is very likely that this endemic VSEM strain has acquired vancomycin-resistance determinants and that the acquisition occurred more than once during the outbreak.

• The prevalence of diphtheria immunity in healthy population in Poland.

  Authors: J Walory, J Grzesiowski, W Hryniewicz

  Epidemiology and infection. 04/2001; 126(2):225-30.

  The degree of seroprotection against diphtheria in Poland was evaluated by determination of IgG antibodies to Corymebacterium diphtheriae toxin (IgG-DTAb). The study population consisted of 4,829The degree of seroprotection against diphtheria in Poland was evaluated by determination of IgG antibodies to Corymebacterium diphtheriae toxin (IgG-DTAb). The study population consisted of 4,829 healthy subjects aged from 1 day to 85 years from 7 regions of Poland. Serum samples collected between 1996 and 1998 were assayed for IgG-DTAb antibodies using a toxoid enzyme immunoassay. Neutralization of toxin in Vero cells was performed as a reference method with the WHO standard for human diphtheria antitoxin. The study revealed a lack of seroprotection (IgG-DTAb < 0.1 IU/ml) in 23% of individuals, basic seroprotection (0.1-1.0 IU/ml) in 64%, and effective seroprotection (> 1.0 IU/ml) in 13%. The non-protected group consisted of non-vaccinated children below 2 months of age (10%), individuals between 2 months and 18 years old (20%) and greater than 19 years old (70%). Of the adults, 32% were seronegative, 63% had basic seroprotection and only 5% were fully protected; 43% of adults between 30 and 64 years, who had not been vaccinated at least during the previous 10 years were not protected against diphtheria. The geometric mean titre (GMT) of IgG-DTAb was 0.25 IU/ml in the total population. Age-related GMTs differed significantly from each other and were higher (0.44 IU/ml) in individuals from 2 months to 18 years old, compared with 014 IU/ml and 0.17 lU/ml in children under 2 months and adults, respectively. No significant difference was found in the GMTs of men and women in all age groups. We conclude that the currently used vaccination programme in Poland is highly effective and assures protection against diphtheria in the majority of the population in the 10-year period following the last booster. However, a significant proportion of adults between 30 and 64 years lack protection and this indicates a need for booster immunization for this group.

• [Activity of cefepime compared with other antibiotics against major hospital bacterial pathogens]

  Authors: W Hryniewicz, A Skoczyńska, K Szczypa

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 03/2001; 10(56):80-2.

  The aim of the study was to evaluate susceptibility of 976 bacterial isolates from nosocomial infections to cefepime and 9 other antibiotics used in the treatment of hospitalised patients. BacterialThe aim of the study was to evaluate susceptibility of 976 bacterial isolates from nosocomial infections to cefepime and 9 other antibiotics used in the treatment of hospitalised patients. Bacterial strains were mainly derived from wound and soft tissue infections, sputum, abscesses and blood. The most prevalent etiologic agents were: Pseudomonas aeruginosa (18.7%), Escherichia coli (13.8%), Staphyloccocus aureus (9.7%, Acinetobacter baumannii (9.12%), Klebsiella pneumoniae (7.38%), Enterobacter cloacae (5.6%). The most susceptible to cefepime were strains of K. pneumoniae (98.62%), E. coli (98.52%) and E. cloacae (98.19%) including those producing extended spectrum beta-lactamases. The degree of susceptibility to cefepime was equal to that of imipenem. A. baumannii was the least susceptible species (67.42%). This study indicate that cefepime may play an important role in therapy of nosocomial infections in particular caused by Enterobacteriace.

• Vancomycin-resistant Enterococcus faecium strain carrying the vanB2 gene variant in a Polish hospital.

  Authors: M Kawalec, M Gniadkowski, U Zielińska, W Kłos, W Hryniewicz

  Journal of clinical microbiology. 03/2001; 39(2):811-5.

  About 2.5 years after the first isolation of the VanA phenotype of vancomycin-resistant Enterococcus faecium (VREM) in Poland, the first VREM strains with the VanB phenotype have emergedAbout 2.5 years after the first isolation of the VanA phenotype of vancomycin-resistant Enterococcus faecium (VREM) in Poland, the first VREM strains with the VanB phenotype have emerged independently in two different Warsaw hospitals. In one of these the VREM strain was selected during the long-term antimicrobial treatment of a patient with a wide variety of infection risk factors who died after 3 months of hospitalization. The strain was found to contain the transferable vanB2 gene cluster variant of the polymorphic type that was identified earlier in vancomycin-resistant enterococci from several different countries. In the course of infection the strain underwent genetic diversification due to DNA recombination.

• Comparison of four serological methods for the detection of diphtheria anti-toxin antibody.

  Authors: J Walory, P Grzesiowski, W Hryniewicz

  Journal of immunological methods. 12/2000; 245(1-2):55-65.

  The aim of this study was to compare four serological methods for the detection of Corynebacterium diphtheriae IgG anti-toxin antibodies (IgG-DTAb) in human serum. One hundred serum samples wereThe aim of this study was to compare four serological methods for the detection of Corynebacterium diphtheriae IgG anti-toxin antibodies (IgG-DTAb) in human serum. One hundred serum samples were evaluated for C. diphtheriae IgG-DTAb by four different methods: passive haemagglutination (PHA), latex agglutination test (LA), toxoid enzyme-linked immunosorbent assay (Toxoid-ELISA), and toxin-binding inhibition enzyme-linked immunosorbent assay (ToBI-ELISA). As the external standardisation the neutralisation test for C. diphtheriae toxin in Vero cells (TN Vero) was used. For internal standardisation of IgG-DTAb titres, the WHO standard serum of human diphtheria antitoxin was used. The study revealed a poor correlation between the reference test and the PHA (r=0.34 Pearson's correlation coefficient), an acceptable correlation for the LA (r=0.74), a good correlation for the Toxoid-ELISA (r=0.81) and a very good correlation for ToBI-ELISA (r=0.93). The sensitivity measurements of PHA, LA, Toxoid-ELISA and ToBI-ELISA tests, were 14, 100, 94, 96% respectively and the corresponding specificity characteristics were 86, 76, 94, 90 respectively. Of the four evaluated methods, the ToBI-ELISA could be recommended for scientific and precise laboratory assays of diphtheria antibody levels in humans. For screening purposes the Toxoid-ELISA could be used, but the accuracy of antibody titres below 0.1 IU/ml, considered as the limits of protection, is questionable. Both tests offer very useful alternatives to the in vitro diphtheria toxin neutralisation test in Vero cells. Because of their unsatisfactory correlation and sensitivity as compared to the reference method, PHA and LA should be avoided and replaced by one of the two enzyme immunoassays.

• [Immunity against diphtheria and tetanus in the adult Polish population]

  Authors: J Walory, P Grzesiowski, W Hryniewicz

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 11/2000; 9(52):687-92.

  The aim of the study was to evaluate immunity against diphtheria and tetanus in healthy adult population in Poland. For determination of antitoxin IgG antibody, toxoid enzyme-linked immunosorbentThe aim of the study was to evaluate immunity against diphtheria and tetanus in healthy adult population in Poland. For determination of antitoxin IgG antibody, toxoid enzyme-linked immunosorbent assay (Toxoid-ELISA) was used. Serum samples were obtained from different regions of Poland and titrated for diphtheria (n = 2442) and tetanus (n = 827) IgG antitoxin. For calibration of anti-toxins determination, the WHO standard of human diphtheria and tetanus antitoxin was used. About 32% (n = 787) of persons were non-protected against diphtheria (IgG-DTAb < 0.1 IU/ml) and 24% (n = 195) against tetanus (IgG-TTAb < 0.1 IU/ml). In 63% (n = 1528) individuals basic protection for diphtheria and 48% (n = 402) for tetanus (0.1-1.0 IU/ml IgG-DTAb and IgG-TTAb) were observed. Only 5% (n = 127) were fully protected for diphtheria and 28% (n = 230) for tetanus (IgG-DTAb and IgG-TTAb > 1.0 IU/ml). In adults between 30-64 years of age, not vaccinated at least during last 10 years, 43% of persons were non-protected. The study showed insufficient immunity against diphtheria in adults. We indicate booster immunisation for selected group of persons.

• Outbreak of vancomycin-resistant enterococci in a hospital in Gdask, Poland, due to horizontal transfer of different Tn1546-like transposon variants and clonal spread of several strains.

  Authors: M Kawalec, M Gniadkowski, W Hryniewicz

  Journal of clinical microbiology. 10/2000; 38(9):3317-22.

  Twenty-two vancomycin-resistant enterococcal (VRE) isolates of the VanA phenotype (21 Enterococcus faecium isolates and 1 E. faecalis isolate), representative of a large outbreak that occurred in aTwenty-two vancomycin-resistant enterococcal (VRE) isolates of the VanA phenotype (21 Enterococcus faecium isolates and 1 E. faecalis isolate), representative of a large outbreak that occurred in a hospital in Gdańsk, Poland, were studied. All of the isolates demonstrated resistance to a wide variety of other antimicrobial agents in addition to glycopeptides. Several lines of evidence suggested that the outbreak most probably consisted of two epidemics that followed the independent introduction of VanA determinants into two separate hematological wards of the hospital. This hypothesis is supported by the fact that isolates recovered in these wards possessed two different polymorphs of the highly conserved DNA region encompassing the vanRSHAX genes and two distinct polymorph types of Tn1546-like transposons, which contain these genes. According to pulsed-field gel electrophoresis data, the outbreak in the adult hematology ward (HW) was highly polyclonal, which suggested a major role for the horizontal transmission of Tn1546-like elements among nonrelated strains of E. faecium and E. faecalis in this environment. On the other hand, the outbreak in the pediatric hematology ward (PHW) was most probably due to the clonal spread of two epidemic E. faecium strains, which had exchanged a plasmid carrying the Tn1546-like transposon. Restriction fragment length polymorphism studies of transposons and their insertion loci in plasmid DNA have suggested that numerous isolates from both HW and PHW contained two or more copies of Tn1546-like elements that underwent diversification due to various genetic modifications. The reported data demonstrated a very complex epidemiology of the first, and up to now the only, VanA VRE outbreak characterized in Poland.