Skip to main content Skip to main navigation menu Skip to site footer
  • Register
  • Login
  • Menu
  • Home
  • Current
  • Archives
  • Announcements
  • About
    • About the Journal
    • Submissions
    • Editorial Team
    • Privacy Statement
    • Contact
  • Register
  • Login

Quality in Sport

The Issue of antibiotic-resistant bacterial infections in intensive care units (ICUs) – epidemiology, risk factors and prevention. Literature review.
  • Home
  • /
  • The Issue of antibiotic-resistant bacterial infections in intensive care units (ICUs) – epidemiology, risk factors and prevention. Literature review.
  1. Home /
  2. Archives /
  3. Vol. 20 (2024) /
  4. Medical Sciences

The Issue of antibiotic-resistant bacterial infections in intensive care units (ICUs) – epidemiology, risk factors and prevention. Literature review.

Authors

  • Maciej Choiński Maria Skłodowska-Curie Regional Specialist Hospital in Zgierz https://orcid.org/0009-0005-3348-1589
  • Paulina Wasiewicz-Ciach https://orcid.org/0009-0003-8631-7788
  • Marcelina Teresa Marzec https://orcid.org/0009-0002-6978-4969
  • Piotr Kuczyński https://orcid.org/0009-0004-9923-8154
  • Anna Marszałek https://orcid.org/0009-0000-7348-8498
  • Aleksandra Wydra-Rojek https://orcid.org/0009-0005-6046-6958
  • Weronika Zofia Marzec https://orcid.org/0009-0006-2990-4101
  • Katarzyna Kutyła https://orcid.org/0009-0007-3424-5291
  • Wojciech Jan Mokot https://orcid.org/0009-0004-3765-4902
  • Aleksandra Łakoma https://orcid.org/0009-0004-1019-0773

DOI:

https://doi.org/10.12775/QS.2024.20.53946

Keywords

antibiotic resistance, multidrug-resistant bacteria, risk factors, infection control, intensive care units

Abstract

Abstract

Infections caused by antibiotic-resistant pathogens in intensive care units (ICUs) present significant challenges for modern medicine. ICU patients are particularly vulnerable to HAI due to: severe conditions, frequent invasive procedures and extensive antibiotic use. It is estimated that about 9-20% of patients in intensive care units are affected by healthcare-associated infections (HAIs) and half of all hospital-acquired infections occur in the ICU. The antibiotic resistance is becoming a widespread issue. The incidence of HAIs caused by multi-dtug pathogens, especially Gram-negative bacteria, is dramatically rising. Uderstanding risk factors, epidemiology, routes of transmission, preventive measures may form the basis for limiting the spread of health-associated infections (HAI) caused by multidrug-resistance pathogens. Effective prevention measures comprise proper antibiotic management, personnel control and elimination of risk factors. Additional strategies like selective digestive decontamination (SDD), pathogen screening and isolation of infected patients may be considered to the successful control of outbreaks. Further studies are needed to better understand the transmission, epidemiology and prevention of multidrug-resistance infections. This review summarizes current knowledge on antibiotic resistance, risk factors, epidemiology and prevention methods of healthcare-associated infections (HAIs) in ICUs.

References

Brusselaers N, Vogelaers D, Blot S. The rising problem of antimicrobial resistance in the intensive care unit. Ann Intensive Care. 2011 Nov 23;1:47. doi: 10.1186/2110-5820-1-47. PMID: 22112929; PMCID: PMC3231873.

Magill SS, Edwards JR, Bamberg W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014;370(13):1198–208.

Litwin A, Fedorowicz O, Duszynska W. Characteristics of Microbial Factors of Healthcare-Associated Infections Including Multidrug-Resistant Pathogens and Antibiotic Consumption at the University Intensive Care Unit in Poland in the Years 2011-2018. Int J Environ Res Public Health. 2020 Sep 23;17(19):6943. doi: 10.3390/ijerph17196943. PMID: 32977435; PMCID: PMC7579392.

Dimopoulos G., Koulenti D., Blot S., Sakr Y., Anzueto A., Spies C., et al. Critically ill elderly adults with infection: analysis of the extended prevalence of infection in intensive care study. J. Am. Geriatr. Soc. 2013;61(12):2065–2071.

Sampathkumar P. Reducing catheter-associated urinary tract infections in the ICU. Curr Opin Crit Car. 2017;23:372–377.

E. Meyer, F. Schwab, B. Schroeren-Boersch, P. Gastmeier Dramatic increase of third-generation cephalosporin-resistant E. coli in German intensive care units: secular trends in antibiotic drug use and bacterial resistance, 2001 to 2008 Crit Care, 14 (3) (2010), p. R113, 10.1186/cc9062

Masters BR. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. Graefes Arch Clin Exp Ophthalmol. 2016;254(11):2285–2287. doi: 10.1007/s00417-015-2950-

Siegel JD, Rhinehart E, Jackson M, Chiarello L. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control. 2007;35(10 Suppl 2):S165–93. doi: 10.1016/j.ajic.2007.10.006

Magiorakos AP, Srinivasan A, Carey RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268–281. doi: 10.1111/j.1469-0691.2011.03570.x

Habboush Y, Guzman N. Antibiotic Resistance. 2023 Jun 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30020649.

Vincent J.-L., Rello J., Marshall J., Silva E., Anzueto A., Martin-Loeches I., Moreno R., Lipman J., Gomersall C.D., Sakr Y., et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302:2323. doi: 10.1001/jama.2009.1754.

Vincent J.-L., Sakr Y., Singer M., Martin-Loeches I., Machado F.R., Marshall J.C., Finfer S., Pelosi P., Brazzi L., Aditianingsih D., et al. Prevalence and Outcomes of Infection Among Patients in Intensive Care Units in 2017. JAMA. 2020;24:1478–1487. doi: 10.1001/jama.2020.2717.

Kiddee A., Assawatheptawee K., Na-Udom A., Treebupachatsakul P., Wangteeraprasert A., Walsh T. R., et al.. (2018). Risk factors for gastrointestinal colonization and acquisition of carbapenem-resistant gram-negative bacteria among patients in intensive care units in Thailand. Antimicrob. Agents Chemother. 62, e00341–18. doi: 10.1128/AAC.00341-18

Rosenthal V.D., Al-Abdely H.M., El-Kholy A.A., Alkhawaja S.A.A., Leblebicioglu H., Mehta Y., Rai V., Hung N.V., Kanj S.S., Salama M.F., et al. International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010–2015: Device-associated module. Am. J. Infect. Control. 2016;44:1495–1504. doi: 10.1016/j.ajic.2016.08.007.

European Centre for Disease Prevention and Control Surveillance of Antimicrobial Resistance in Europe. [(accessed on 15 November 2018)]; Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). ECDC (online) 2017. Available online: https://ecdc.europa.eu/sites/porta/files/documents/EARS-Net-report-2017-update-jan-2019.pdf

Z.R. Palacios-Baena, M. Giannella, D. Manissero, J. Rodríguez-Baño, P. Viale, S. Lopes, et al. Risk factors for carbapenem-resistant Gram-negative bacterial infections: a systematic review Clin Microbiol Infect, 27 (2) (2021), pp. 228-235, 10.1016/j.cmi.2020.10.016.

Strich JR, Palmore TN. Preventing transmission of multidrug-resistant pathogens in the intensive care unit. Infect Dis Clin North Am. 2017;31(3):535–550. doi: 10.1016/j.idc.2017.05.010

Wang L, Huang X, Zhou J, et al. Predicting the occurrence of multidrug-resistant organism colonization or infection in ICU patients: development and validation of a novel multivariate prediction model. Antimicrob Resist Infect Control. 2020;9(1):66. doi: 10.1186/s13756-020-00726-5.

Wu C, Lu J, Ruan L, Yao J. Tracking Epidemiological Characteristics and Risk Factors of Multi-Drug Resistant Bacteria in Intensive Care Units. Infect Drug Resist. 2023 Mar 15;16:1499-1509. doi: 10.2147/IDR.S386311. PMID: 36945682; PMCID: PMC10024905.

Kuloglu TO, Unuvar GK, Cevahir F, Kilic AU, Alp E. Risk factors and mortality rates of carbapenem-resistant Gram-negative bacterial infections in intensive care units. J Intensive Med. 2024 Jan 9;4(3):347-354. doi: 10.1016/j.jointm.2023.11.007. PMID: 39035617; PMCID: PMC11258511.

Chalmers JD, Rother C, Salih W, Ewig S. Healthcare-associated pneumonia does not accurately identify potentially resistant pathogens: a systematic review and meta-analysis. Clin Infect Dis. 2014;58(3):330-339. doi:10.1093/cid/cit734.

Sommerstein R., Merz T.M., Berger S., Kraemer J.G., Marschall J., Hilty M. Patterns in the longitudinal oropharyngeal microbiome evolution related to ventilator-associated pneumonia. Antimicrob. Resist. Infect. Control. BioMed Central. 2019;8(1):81–110.

Freedberg D.E., Zhou M.J., Cohen M.E., Annavajhala M.K., Khan S., Moscoso D.I., et al. Pathogen colonization of the gastrointestinal microbiome at intensive care unit admission and risk for subsequent death or infection. Intensive Care Med. Springer Berlin Heidelberg. 2018;44(8):1203–1211.

Frencken J.F., Wittekamp B.H.J., Plantinga N.L., Spitoni C., van de Groep K., Cremer O.L., et al. Associations between enteral colonization with Gram-negative bacteria and intensive care unit-acquired infections and colonization of the respiratory tract. Clin. Infect. Dis. 2018;66(4):497–503.

Freifeld A.G., Bow E.J., Sepkowitz K.A., Boeckh M.J., Ito J.I., Mullen C.A., et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases Society of America. Vol. 52, Clinical Infectious Diseases. 2011. pp. e56–93.

N. Yamamoto, R. Asada, R. Kawahara, H. Hagiya, Y. Akeda, R.K. Shanmugakani, et al. Prevalence of, and risk factors for, carriage of carbapenem-resistant Enterobacteriaceae among hospitalized patients in Japan J Hosp Infect, 97 (3) (2017), pp. 212-217, 10.1016/j.jhin.2017.07.015

Raman G, Avendano EE, Chan J, Merchant S, Puzniak L. Risk factors for hospitalized patients with resistant or multidrug-resistant Pseudomonas aeruginosa infections: a systematic review and meta-analysis. Antimicrob Resist Infect Control. 2018 Jul 4;7:79. doi: 10.1186/s13756-018-0370-9. PMID: 29997889; PMCID: PMC6032536.

P. Liu, X. Li, M. Luo, X. Xu, K. Su, S. Chen, et al. Risk factors for carbapenem-resistant Klebsiella pneumoniae infection: a meta-analysis Microb Drug Resist, 24 (2) (2018), pp. 190-198, 10.1089/mdr.2017.0061

A. Candevir Ulu, B. Kurtaran, A.S. Inal, S. Kömür, F. Kibar, H. Yapıcı Çiçekdemir, et al. Risk factors of carbapenem-resistant Klebsiella pneumoniae infection: a serious threat in ICUs Med Sci Monit, 21 (2015), pp. 219-224, 10.12659/MSM.892516.

Li Y., Shen H., Zhu C., Yu Y. (2019). Carbapenem-resistant klebsiella pneumoniae infections among ICU admission patients in central China: Prevalence and prediction model. BioMed. Res. Int. 2019, 9767313. doi: 10.1155/2019/9767313.

Garcia-Parejo Y, Gonzalez-Rubio J, Garcia Guerrero J, Gomez-Juarez Sango A, Cantero Escribano JM, Najera A. Risk factors for colonisation by Multidrug-Resistant bacteria in critical care units. Intensive Crit Care Nurs. 2024 Jul 9:103760. doi: 10.1016/j.iccn.2024.103760. Epub ahead of print. PMID: 38987037.

Liao Q, Feng Z, Lin H, Zhou Y, Lin J, Zhuo H, Chen X. Carbapenem-resistant gram-negative bacterial infection in intensive care unit patients: Antibiotic resistance analysis and predictive model development. Front Cell Infect Microbiol. 2023 Jan 30;13:1109418. doi: 10.3389/fcimb.2023.1109418. PMID: 36794004; PMCID: PMC9922834.

Kelly B.J., Imai I., Bittinger K., Laughlin A., Fuchs B.D., Bushman F.D., et al. Composition and dynamics of the respiratory tract microbiome in intubated patients. Microbiome BioMed Central. 2016;4(1):7–13

Silvestri L, Milanese M, Oblach L et al. Enteral vancomycin to control methicillin-resistant Staphylococcus aureus outbreak in mechanically ventilated patients. Am. J. Infect. Control 30(7), 391–399 (2002).

Huang SS, Septimus E, Kleinman K et al. Targeted versus universal decolonization to prevent ICU infection. N. Engl. J. Med 368(24), 2255–2265 (2013).

Bastin AJ, Ryanna KB. Use of selective decontamination of the digestive tract in United Kingdom intensive care units. Anaesthesia 64(1), 46–49 (2009).

Leone M, Albanese J, Antonini F, Nguyen-Michel A, Martin C. Long-term (6-year) effect of selective digestive decontamination on antimicrobial resistance in intensive care, multiple-trauma patients. Crit. Care Med. 31(8), 2090–2095 (2003).

Ochoa-Ardila ME, Garcia-Canas A, Gomez-Mediavilla K et al. Long-term use of selective decontamination of the digestivetract does not increase antibiotic resistance: a 5-year prospective cohort study. Intens. Care Med. 37(9), 1458–1465 (2011).

Kelly B.J., Imai I., Bittinger K., Laughlin A., Fuchs B.D., Bushman F.D., et al. Composition and dynamics of the respiratory tract microbiome in intubated patients. Microbiome BioMed Central. 2016;4(1):7–13

World Health Organization. WHO guidelines on hand hygiene in health care. Geneva (Switzerland): 2009. Available at: http://www.who.int/gpsc/5may/tools/9789241597906/en/

Derde LP, Cooper BS, Goossens H, et al. Interventions to reduce colonisation and transmission of antimicrobial-resistant bacteria in intensive care units: an interrupted time series study and cluster randomised trial. Lancet Infect Dis. 2014;14(1):31–9.

Erasmus V, Daha TJ, Brug H, et al. Systematic review of studies on compliance with hand hygiene guidelines in hospital care. Infect Control Hosp Epidemiol. 2010;31(3):283–94.

Stahmeyer JT, Lutze B, von Lengerke T, et al. Hand hygiene in intensive care units: a matter of time? J Hosp Infect. 2017;95(4):338–43.

Fagernes M, Lingaas E. Impact of finger rings on transmission of bacteria during hand contact. Infect Control Hosp Epidemiol. 2009;30(5):427–32.

Frost SA, Alogso MC, Metcalfe L, et al. Chlorhexidine bathing and health care-associated infections among adult intensive care patients: a systematic review and meta-analysis. Crit Care. 2016;20(1):379.

Dicks KV, Lofgren E, Lewis SS, et al. A multicenter pragmatic interrupted time series analysis of chlorhexidine gluconate bathing in community hospital intensive care units. Infect Control Hosp Epidemiol. 2016;37(7):791–7.

Chung YK, Kim JS, Lee SS, et al. Effect of daily chlorhexidine bathing on acquisition of carbapenem-resistant Acinetobacter baumannii (CRAB) in the medical intensive care unit with CRAB endemicity. Am J Infect Control. 2015;43(11):1171–7.

Borer A, Gilad J, Porat N, et al. Impact of 4% chlorhexidine whole-body washing on multidrug-resistant Acinetobacter baumannii skin colonisation among patients in a medical intensive care unit. J Hosp Infect. 2007;67(2):149–55.

Strich JR, Palmore TN. Preventing Transmission of Multidrug-Resistant Pathogens in the Intensive Care Unit. Infect Dis Clin North Am. 2017 Sep;31(3):535-550. doi: 10.1016/j.idc.2017.05.010. Epub 2017 Jul 5. PMID: 28687211; PMCID: PMC5584576.

Viale P, Tumietto F, Giannella M, et al. Impact of a hospital-wide multifaceted programme for reducing carbapenem-resistant Enterobacteriaceae infections in a large teaching hospital in northern Italy. Clin Microbiol Infect. 2015;21(3):242–7.

Derde LP, Cooper BS, Goossens H, et al. Interventions to reduce colonisation and transmission of antimicrobial-resistant bacteria in intensive care units: an interrupted time series study and cluster randomised trial. Lancet Infect Dis. 2014;14(1):31–9.

Huskins WC, Huckabee CM, O’Grady NP, et al. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med. 2011;364(15):1407–18.

Bootsma MC, Diekmann O, Bonten MJ. Controlling methicillin-resistant Staphylococcus aureus: quantifying the effects of interventions and rapid diagnostic testing. Proc Natl Acad Sci U S A. 2006;103(14):5620–5.

Shadel BN, Puzniak LA, Gillespie KN, et al. Surveillance for vancomycin-resistant enterococci: type, rates, costs, and implications. Infect Control Hosp Epidemiol. 2006;27(10):1068–75.

Klein BS, Perloff WH, Maki DG. Reduction of nosocomial infection during pediatric intensive care by protective isolation.

Schwaber MJ, Carmeli Y. An ongoing national intervention to contain the spread of carbapenem-resistant Enterobacteriaceae. Clin Infect Dis. 2014;58(5):697–703.

Nijssen S, Bonten MJ, Weinstein RA. Are active microbiological surveillance and subsequent isolation needed to prevent the spread of methicillin-resistant Staphylococcus aureus? Clin Infect Dis. 2005;40(3):405–9.

Lyons A, Rose LJ, Noble-Wang JA. Survival of healthcare pathogens on hospital surfaces. SHEA 2017 Spring Conference; St. Louis. March 31, 2017.

Otter JA, Mepham S, Athan B, et al. Terminal decontamination of the Royal Free London’s high-level isolation unit after a case of Ebola virus disease using hydrogen peroxide vapor. Am J Infect Control. 2016;44(2):233–5.

Williams MM, Armbruster CR, Arduino MJ. Plumbing of hospital premises is a reservoir for opportunistically pathogenic microorganisms: a review. Biofouling. 2013;29(2):147–62.

Harris AD, Pineles L, Belton B, et al. Universal glove and gown use and acquisition of antibiotic-resistant bacteria in the ICU: a randomized trial. JAMA. 2013;310(15):1571–80.

T. Karampatakis, K. Tsergouli, E. Iosifidis, C. Antachopoulos, A. Karapanagiotou, A. Karyoti, et al. Impact of active surveillance and infection control measures on carbapenem-resistant Gram-negative bacterial colonization and infections in intensive care J Hosp Infect, 99 (4) (2018), pp. 396-404, 10.1016/j.jhin.2018.05.010

Martinez JA, Nicolas JM, Marco F et al. Comparison of antimicrobial cycling and mixing strategies in two medical intensive care units. Crit. Care Med. 34(2), 329–336 (2006).

Sandiumenge A, Diaz E, Rodriguez A et al. Impact of diversity of antibiotic use on the development of antimicrobial resistance. J. Antimicrob. Chemother. 57(6), 1197–1204 (2006).

Damas P, Canivet JL, Ledoux D et al.Selection of resistance during sequential use

of preferential antibiotic classes. Intens. CareMed. 32(1), 67–74 (2006).

Bennett KM, Scarborough JE, Sharpe Met al. Implementation of antibiotic rotation protocol improves antibiotic susceptibility profile in a surgical intensive care unit. J. Trauma 63(2), 307–311 (2007).

Montravers P, Augustin P, Grall N, et al. Characteristics and outcomes of anti-infective de-escalation during health careassociated intra-abdominal infections. Crit Care. 2016;20(1):83. doi:10.1186/s13054-016-1267-8.

Chastre J, Wolff M, Fagon J-Y, et al. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults. Jama. 2003;290(19):2588. doi:10.1001/jama.290.19.2588

Turza KC, Politano AD, Rosenberger LH, Riccio LM, McLeod M, Sawyer RG. De-escalation of antibiotics does not increase mortality in critically ill surgical patients. Surg Infect (Larchmt). 2016;17(1):48-52. doi:10.1089/sur.2014.202.

Micek ST, Welch EC, Khan J, et al. Empiric combination antibiotic therapy is associated with improved outcome against sepsis due to gram-negative bacteria: a retrospective analysis. Antimicrob Agents Chemother. 2010;54(5):1742-1748. doi:10.1128/ AAC.01365-09.

Downloads

  • PDF

Published

2024-08-21

How to Cite

1.
CHOIŃSKI, Maciej, WASIEWICZ-CIACH, Paulina, MARZEC, Marcelina Teresa, KUCZYŃSKI, Piotr, MARSZAŁEK, Anna, WYDRA-ROJEK, Aleksandra, MARZEC, Weronika Zofia, KUTYŁA, Katarzyna, MOKOT, Wojciech Jan and ŁAKOMA, Aleksandra. The Issue of antibiotic-resistant bacterial infections in intensive care units (ICUs) – epidemiology, risk factors and prevention. Literature review. . Quality in Sport. Online. 21 August 2024. Vol. 20, p. 53946. [Accessed 5 July 2025]. DOI 10.12775/QS.2024.20.53946.
  • ISO 690
  • ACM
  • ACS
  • APA
  • ABNT
  • Chicago
  • Harvard
  • IEEE
  • MLA
  • Turabian
  • Vancouver
Download Citation
  • Endnote/Zotero/Mendeley (RIS)
  • BibTeX

Issue

Vol. 20 (2024)

Section

Medical Sciences

License

Copyright (c) 2024 Maciej Choiński, Paulina Wasiewicz-Ciach, Marcelina Teresa Marzec, Piotr Kuczyński, Anna Marszałek, Aleksandra Wydra-Rojek, Weronika Zofia Marzec, Katarzyna Kutyła, Wojciech Jan Mokot, Aleksandra Łakoma

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Stats

Number of views and downloads: 210
Number of citations: 0

Search

Search

Browse

  • Browse Author Index
  • Issue archive

User

User

Current Issue

  • Atom logo
  • RSS2 logo
  • RSS1 logo

Information

  • For Readers
  • For Authors
  • For Librarians

Newsletter

Subscribe Unsubscribe

Tags

Search using one of provided tags:

antibiotic resistance, multidrug-resistant bacteria, risk factors, infection control, intensive care units
Up

Akademicka Platforma Czasopism

Najlepsze czasopisma naukowe i akademickie w jednym miejscu

apcz.umk.pl

Partners

  • Akademia Ignatianum w Krakowie
  • Akademickie Towarzystwo Andragogiczne
  • Fundacja Copernicus na rzecz Rozwoju Badań Naukowych
  • Instytut Historii im. Tadeusza Manteuffla Polskiej Akademii Nauk
  • Instytut Kultur Śródziemnomorskich i Orientalnych PAN
  • Instytut Tomistyczny
  • Karmelitański Instytut Duchowości w Krakowie
  • Ministerstwo Kultury i Dziedzictwa Narodowego
  • Państwowa Akademia Nauk Stosowanych w Krośnie
  • Państwowa Akademia Nauk Stosowanych we Włocławku
  • Państwowa Wyższa Szkoła Zawodowa im. Stanisława Pigonia w Krośnie
  • Polska Fundacja Przemysłu Kosmicznego
  • Polskie Towarzystwo Ekonomiczne
  • Polskie Towarzystwo Ludoznawcze
  • Towarzystwo Miłośników Torunia
  • Towarzystwo Naukowe w Toruniu
  • Uniwersytet im. Adama Mickiewicza w Poznaniu
  • Uniwersytet Komisji Edukacji Narodowej w Krakowie
  • Uniwersytet Mikołaja Kopernika
  • Uniwersytet w Białymstoku
  • Uniwersytet Warszawski
  • Wojewódzka Biblioteka Publiczna - Książnica Kopernikańska
  • Wyższe Seminarium Duchowne w Pelplinie / Wydawnictwo Diecezjalne „Bernardinum" w Pelplinie

© 2021- Nicolaus Copernicus University Accessibility statement Shop