RESUMEN
OBJECTIVES: To characterize genomes of Klebsiella pneumoniae ST11 NDM-1 responsible for a countrywide outbreak in Poland and compare them phylogenetically with other Polish and international ST11 strains. METHODS: Seventy-one carbapenemase-producing K. pneumoniae ST11 isolates from Poland, including 66 representatives of the NDM-1 epidemic from 2012-18, were sequenced using Illumina MiSeq. Additionally, three outbreak isolates were also sequenced using MinION. The clonality and phylogenetic analysis was done by core-genome MLST and SNP approaches. Resistomes, virulomes, K/O antigens and plasmid replicons were screened for. The detailed plasmid analysis was based on full assemblies using Oxford Nanopore Technologies data. RESULTS: Chromosomes of the outbreak isolates formed an essentially homogeneous cluster (though accumulating SNPs gradually with time), differing remarkably from other Polish NDM-1/-5-, KPC-2- or OXA-48-producing K. pneumoniae ST11 strains. The cluster belonged to a clade with 72 additional isolates identified worldwide, including closely related NDM-1 producers from several countries, including organisms from Bulgaria and Greece. All these had KL24 and O2v1 antigens and the chromosomal yersiniabactin locus YbST230 residing in the ICEKp11 element. The specific blaNDM-1-carrying Tn125 transposon derivative, named Tn125A, was located in IncFII/pKPX-1- and/or IncR-like plasmids; however, the IncRs rearranged extensively during the outbreak, contributing to highly dynamic plasmid profiles and resistomes. CONCLUSIONS: The K. pneumoniae ST11 NDM-1 genotype that has been expanding in Poland since 2012 is largely monoclonal and represents a novel international high-risk lineage that is also spreading in other countries.
Asunto(s)
Infecciones por Klebsiella , Klebsiella pneumoniae , Antibacterianos/farmacología , Bulgaria , Brotes de Enfermedades , Genómica , Grecia , Humanos , Infecciones por Klebsiella/epidemiología , Klebsiella pneumoniae/genética , Pruebas de Sensibilidad Microbiana , Tipificación de Secuencias Multilocus , Filogenia , Plásmidos/genética , Polonia/epidemiología , beta-Lactamasas/genéticaRESUMEN
The clinical usefulness was assessed of ultrasonography in the study of fetal hypotrophism determining the parameters BIP, THQ and placental parameters. Fetal growth was assessed and in case of hypotrophism adequate therapeutic management was undertaken. The study was carried out on 56 pregnant women referred for diagnosis and treatment of fetal hypotrophism in the period 1983-1985. The control group comprised 56 women with physiological pregnancy. The study was carried out with examinations at weekly intervals from the 24th week of pregnancy till labour using a Hellige-Panavista unit with a 2.5 MHz probe. The BIP and THQ dimensions were calculated a together with placental parameters. The oestriol level was determined in 24-hour urine. The underlying disease and fetal hypotrophism were treated. The most valuable indicator for the determination of asymmetrical and symmetrical type of hypotrophism and for its monitoring was the BIP/THQ index. Ultrasonography makes possible a rapid and accurate diagnosis of fetal condition and control of its treatment. Ultrasonographic observation of the placenta is a source of valuable information for the obstetrician. Oestriol determination is without any greater significance for monitoring of fetal hypotrophism.
Asunto(s)
Retardo del Crecimiento Fetal/diagnóstico , Feto/patología , Enfermedades Placentarias/diagnóstico , Placenta/patología , Insuficiencia Placentaria/diagnóstico , Diagnóstico Prenatal , Ultrasonografía , Adolescente , Adulto , Antropometría , Femenino , Retardo del Crecimiento Fetal/etiología , Retardo del Crecimiento Fetal/terapia , Humanos , Insuficiencia Placentaria/complicaciones , Embarazo , Segundo Trimestre del Embarazo , Tercer Trimestre del EmbarazoAsunto(s)
Histerectomía Vaginal , Histerectomía , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Uterinas/cirugía , Prolapso Uterino/cirugíaRESUMEN
Results of surgical treatment of cervical insufficiency according to McDonald's method in 150 pregnant women are discussed. The diagnosis was based upon anamnesis, examination of the vaginal segment of the uterus and the behaviour of cervix throughout the gestation period. The results depended upon the extent to which uterine cervix dilated before operation. Sutures were inserted in 150 pregnant women, and positive results were obtained in 119 cases (79%). In pregnant women with obstetric history of incompetence a prophylactic application of cervical sutures seems to be justified.