ИССЛЕДОВАНИЕ АНТИБИОТИКО- И ФАГОЧУВСТВИТЕЛЬНОСТИ НОЗОКОМИАЛЬНЫХ ШТАММОВ МИКРОБОВ, ВЫДЕЛЕННЫХ ОТ ПАЦИЕНТОВ ТРАНСПЛАНТОЛОГИЧЕСКОЙ КЛИНИКИ

Antibiotic and fagosensitivity most etiologically important nosocomial strains of bacteria – Pseudomonas aeru- ginosa, Klebsiella pneumoniae, E. coli, Proteus spp., Staphylococcus spp. were studied. Multiple drug-resistant bacteria as gram-positive and gram-negative, isolated from 8 substrates, had been demonstrated. With regard to the sensitivity of Pseudomonas aeruginosa >40% was observed in 40–50% of the strains to aminoglycosides – aztreonam, amikacin, netilmicin, and only 23–25% of the strains – to gentamicin and levofloxacin (an average of antibiotic susceptibility was 27%). All strains of ESBL Klebsiella drew up and were sensitive only to imipenem, meropenem and aminoglycosides. Specific phages lysed 43–48% of the strains Pseudomonas aeruginosa and Klebsiella pneumoniae, E. coli, Pro- teus spp., multidrug resistant strains of Staphylococcus spp. It is proposed to introduce the use of phages in clinical practice. Исследована антибиотико- и фагочувствительность наиболее этиологически важных нозокомиальных штаммов микробов – синегнойных палочек, клебсиелл, кишечных палочек, протеев, стафилококков. Установлена множественная резистентность штаммов бактерий как грамположительных, так и грамотрицательных, изолированных из 8 субстратов. В отношении синегнойной палочки чувствительность >40% отмечена у 40–50% штаммов к аминогликозидам – азтреонаму, амикацину, нетилмицину и только у 23–25% штаммов – к гентамицину и левофлоксацину (в среднем антибиотикочувствительность составила 27%). Все штаммы клебсиелл вырабатывали БЛРС и были чувствительны только к имипенему, меропенему и аминогликозидам. Специфические бактериофаги лизировали 43–48% штаммов синегнойных палочек и клебсиелл, кишечные палочки, протеи, множественно резистентные штаммы стафилококков. Предлагается внедрять использование бактериофагов в клиническую практику трансплантологических клиник.

THE STUDY OF ANTIBIOTIC- AND FAGOSENSITIVITY OF NOSOCOMIAL STRAINS BACTERIA ISOLATED FROM TRANSPLANTED PATIENTS

Antibiotic and fagosensitivity most etiologically important nosocomial strains of bacteria – Pseudomonas aeru- ginosa, Klebsiella pneumoniae, E. coli, Proteus spp., Staphylococcus spp. were studied. Multiple drug-resistant bacteria as gram-positive and gram-negative, isolated from 8 substrates, had been demonstrated. With regard to the sensitivity of Pseudomonas aeruginosa >40% was observed in 40–50% of the strains to aminoglycosides – aztreonam, amikacin, netilmicin, and only 23–25% of the strains – to gentamicin and levofloxacin (an average of antibiotic susceptibility was 27%). All strains of ESBL Klebsiella drew up and were sensitive only to imipenem, meropenem and aminoglycosides. Specific phages lysed 43–48% of the strains Pseudomonas aeruginosa and Klebsiella pneumoniae, E. coli, Pro- teus spp., multidrug resistant strains of Staphylococcus spp. It is proposed to introduce the use of phages in clinical practice

NEW OPPORTUNITIES OF LIFE PROLONGATION IN PATIENTS WITH END STAGE DILATED CARDIOMYOPATHY

In the present study we summarize our fist experience in multi stage Surgical reconstruction of left ventricle, heart valves and coronary arteries in patients with the end stage dilated cardiomyopathy. 21 patients (aged 24 to 63) had been operated on during last 3 years. Five patients were presented with idiopathic cardiomyopathy and 13 – with ischemic cardiomyopathy. All patients were in NYHA class lll and lV. Cardio-thoracic ratio was more then 60% in all cases. Mean LV diastolic volume was 283,6±93,7 ml, mean LV diastolic diameter - 76,8±9,1 mm, ejection fraction 25,7±5,8%. Mean LV and diastolic pressure ranged 15-62 mm Hg. Coronary stenoses (1 to 3 arteries) were presented in all patients with ischemic cardiomyopathy. Mitral regurgitation (grade II-III ) was found in all patients and associated with tricuspid insufficiency. Five patients suffered from atrial fibrillation. Three types of procedure were performed including Batista procedure (1), mitral and/or mitral-tricuspid annuloplasty (5), Dor procedure with mitral annuloplasty and CABG where necessary (13). Four patients died postoperatively. All survivors demonstrated significant clinical improvement (2 shifted to NYHA class III and 9 – to NYHA class II) with reduction of cardio-thoracic ratio and increasing of ejection to 37,5-4,1%