Infectious Diseases Department

A microbiological examination has detected bacteria resistant to certain antibiotics in some areas of your body.

Every person is permanently colonized by different types of bacteria. Bacteria are found mainly in the oral cavity, in the colon, but also on the skin, on the nasal mucosa and so on. These bacteria do not normally cause any problems or illnesses; humans are adapted to their presence. However, when the mucous membrane is broken or when the immunity is severely compromised, even these common bacteria can cause unpleasant complications – we call these bacteria conditionally pathogenic.

Such conditionally pathogenic bacteria were cultured in the samples from your body. In weakened individuals, these bacteria can cause inflammatory diseases in organs and tissues. They can also cause sepsis (blood poisoning).

These bacteria belong to the commonly occurring strains and differ only in one important way, their insensitivity to commonly used antibiotics. This insensitivity has recently been cultivated and expanded by the bacteria, as a defence against antiobiotic treatment. The highest prevalence of insensitive bacteria is always in those hospital departments where antibiotics are most commonly administered. There are countries in the world where the proportion of insensitive bacteria reaches 50 % or more; fortunately, in our country these are still only isolated cases.

Resistant bacteria still remain sensitive to some antibiotics, which we keep as a reserve. However, the treatment with these antibiotics is longer and more complicated. We therefore try to isolate any patient found to have resistant bacteria from other patients to prevent the disease from spreading.

In case of just colonization /not inflammation/ antibiotics are not administered.

Please note that the detection of resistant bacteria is not necessarily a sign of disease. It may simply be a stage of a carrier, i.e. colonisation by a resistant form of the bacterium. In this case, the bacterium does not cause any problems for its carriers and does not threaten healthy people around. However, it can cause disease in individuals with broken skin, for example if they have eczema or some flesh wounds. Such places can easily become a gateway to infection.

Cariers of the resistant bacteria can be cured in some cases by disinfectants or it may spontaneously end when the natural microbial colonisation is restored. However, before the bacterium can gradually disappear, certain precautions must be taken to prevent the resistant bacterium from spreading to other people and becoming more widespread in the population.

We have made rules that will restrict you to a certain extent. However, they will protect the people around you, and increase the chances of curing you.

There are following measures we will try to observe:

During your hospitalization, you will be in an isolation room. The medical staff will follow stricter hygiene measures when entering your room (for example, wearing a special gown, using gloves, disinfecting their hands before leaving the room, etc.).

Visits of your close person during hospitalization in our hospital will be limited, they can be allowed by the head of the department only exceptionally. However, visitors must observe the precautions in your room by wearing a protective gown, an apron and disinfecting their hands after leaving the room to prevent the transmission of resistant bacteria.

The presence of resistant bacteria is not a reason for prolonged hospitalisation or a sick leave. If your basic illness is cured, you may be discharged to the home care. In the home environment, to follow the standard hygienic rules is adequate. If your family members have cancer or an immune-related illness, consult your treating physician for further arrangements. In case of the wound colonisation by resistant bacteria, hand disinfection with an alcohol-based disinfectant should be performed after redressing the wound. If you are treated by a home care, they should be informed of your positivity. The home-care worker will use gloves or other protective equipment when caring for you.

After discharging you to the home care, you will be informed of any further check-up, the location and date of the examination. If it is not possible to keep the appointment, a new appointment must be arranged by calling the Infectious Diseases Department by phone: 567 157 352. Screening of chronically positive patients is usually carried out in the infectious disease clinic only in the morning on weekdays. For these patients, there is a speical clinic with a waiting room in the outpatient section of the Infectious Diseases Department. This is where another relevant specialist (surgeon, internist, neurologist, urologist, etc.) can participate in your treatment.

If you need any treatment by another doctor or if you are hospitalized anywhere else, please inform your doctor about your condition. This will help you to recover, because your physician will be able to choose the appropriate diagnostic and treatment procedures. If you are scheduled to undergo a medical procedure (planned surgery, catheterisation, infusion treatment, etc.), you need to inform the medical staff about your condition in advance.

When the resistant bacteria disappears, you will be discharged from the monitoring.

What is Lumbar Puncture (LP)

LP means the insertion of a needle into the lower part of the spinal canal and the collection of cerebrospinal fluid, in places where the spinal cord no longer passes, so there is no risk of its damaging.

The reason for this procedure is most often diagnostics (clarification of the disease cause), less often therapeutic LP can be performed (reduction of the increased cerebrospinal fluid pressure).

Preparation for the procedure

Prior to the procedure, a CT scan of the brain or a background eye examination is performed to rule out increased pressure in the cranial cavity. No special preparation is necessary, only in some cases we administer medication to relax the spinal muscles, disinfect the injection site and if necessary shave it. Prepare for the following resting regime (shower, toilet before the procedure).

Procedure method

The procedure is most often performed sitting up, in some cases also lying down. Sterile requirements are observed (disinfection of the injection site, sterile gloves, disposable needle). After disinfecting the injection site, the doctor palpates the injection spot, the patient "arches" the lumbar spine against the doctor and, most often between the 4-5th lumbar vertebrae, the needle is inserted into the spinal canal. After collecting cerebrospinal fluid for all examinations, the puncture needle is withdrawn and the site is sterilely covered. On the same day we will have basic information to rule out or confirm infection of the nervous system; the appearance of the cerebrospinal fluid checked immediately after the puncture may also give a clue.

Arrangements

After the procedure, the patient stays in bed for 24 hours, of which 2 hours after the procedure he lies on the stomach, optimally without a pillow if he can. Adequate fluid intake (no-sugar tea, regular table water, not mineral water or juice) is essential. The attending physician will also prescribe infusion therapy to supplement fluids.

The doctor may offer you to perform a procedure called "atraumatic needle", which is paid – the fee is 150 CZK – in this case the resting period after the procedure is 2 hours only.

Complications

Despite all efforts, these cannot be completely eliminated; the staff of the Infectious Diseases Department strives to minimize the risk of complications.

Regardless of the length of the procedure, predisposed patients may experience a brief fainting episode (which resolves after the patient is laid down). Please advise us if you have experienced this condition before.

Even if sterile conditions are maintained, it is rarely possible to transmit and infection from an undetectable source in the patient's body into the cerebrospinal fluid. In the following days after the procedure, some patients may experience a drop in cerebrospinal fluid pressure (so-called post-puncture syndrome), manifested by headache on standing, dizziness, feelings of vomiting... The risk of post-puncture syndrome is minimized by observing the above-mentioned measures. Post-puncture syndrome is unpleasant, may last for several days, but is not dangerous, and can be managed relatively well with symptomatic therapy.

• Recommended visiting time is 14.30 -17.00.
• Outside of these visiting hours, visits are allowed on an individual basis after consultation with the attending physician.
• Visits to patients with highly contagious diseases (COVID-19, influenza...) are only allowed on an individual basis after consultation with the attending physician.
• Visitors respect the instructions of the medical staff, including the use of recommended personal protective equipment (gowns, respirators, gloves), hand washing and disinfection.
• Children under 12 years of age and pregnant women are not allowed to visit ( except on an individual basis after consultation with the attending physician).

• ID card, insurance card,
• a doctor's referral with the results of an examination (for planned hospital admissions),
• medications and their list,
• medical and compensatory aids you use (glasses, cane, hearing aid, etc.),
• personal items - slippers, toiletries,
• cell phone and a charger.

Visits to the ICU patients are possible on the basis of an individual agreement with the attending physician.

Based on Decree No. 306/2012 Coll., visitors to acute inpatient intensive care units must use protective clothing. Visitors will receive this from ICU staff before entering the ward.