Racionalaus antibakterinių vaistų vartojimo algoritmo įtaka Staphylocoscus aureus atsparumo antibiotikams kitimui

Racionalaus antibakterinių vaistų vartojimo algoritmo įtaka Staphylococcus aureus atsparumo antibiotikams kitimui Rokas Bagdonas1, Algimantas Tamelis2, Rytis Rimdeika2, Mindaugas Kiudelis2, Vytautas Jankūnas21 Klaipėdos universitetas,H. Manto g. 84, LT-92294 Klaipėda2 Kauno medicinos universiteto klinikųChirurgijos klinika,Mickevičiaus g. 9, LT-44307 KaunasEl paštas: [email protected] Įvadas / tikslas Didžiausia nudegimų chirurgijos problema yra infekcija, nuo kurios miršta daugiau kaip 50% visų nudegusių pacientų. Nudegimų žaizda greitai infekuojasi, kadangi žaizdos aplinka yra ideali mikroorganizmams tarpti. Darbo tikslas – įvertinti racionalaus antibakterinių vaistų vartojimo algoritmo įtaką S. aureus mikroorganizmų atsparumo antibiotikams kitimui. Ligoniai ir metodai 2001 m. įdiegtas racionalaus antibakterinių vaistų vartojimo algoritmas Plastinės chirurgijos ir nudegimų skyriuje. Remdamiesi KMUK Mikrobiologijos laboratorijos kompiuterine duomenų baze atlikę perspektyviąją analizę, ištyrėme Staphylococcus aureus atsparumo antibakteriniams vaistams dažnį 2001–2002 metais. Analizuodami retrospektyviąją 2000 m. ir perspektyviąją 2001–2002 m. grupes lyginome, kaip šiose grupėse pakito Staphylococcus aureus atsparumo ciprofloksacinui, gentamicinui, eritromicinui, fucidinui, klindamicinui, oksacilinui, penicilinui, rifampicinui, tetraciklinui ir vankomicinui dažnis. Rezultatai Įdiegus racionalaus antibakterinių vaistų vartojimo algoritmą į klinikinę praktiką, S. aureus bendras atsparumas antibiotikams nereikšmingai sumažėjo. Statistiškai reikšmingai sumažėjo S. aureus atsparumas eritromicinui ir penicilinui. Išvados Racionalaus antimikrobinių vaistų vartojimo algoritmas leidžia kontroliuoti ir sumažinti S. aureus atsparumą antimikrobiniams vaistams. Įdiegus algoritmą į klinikinę praktiką, statistiškai reikšmingai sumažėjo S. aureus atsparumas penicilinui ir eritromicinui. Reikšminiai žodžiai: Stapylococcus aureus atsparumas antibiotikams, racionali antibiotikoterapija Rational application algorithm of antibacterial drugs to staphylococcus aureus resistance Rokas Bagdonas1, Algimantas Tamelis2, Rytis Rimdeika2, Mindaugas Kiudelis2, Vytautas Jankūnas21 Klaipėda Universitety,H. Manto str. 84, LT-92294 Klaipėda, Lithuania2 Kaunas University of Medicine, Clinic of Surgery,Mickevičiaus str. 9, LT-44307 Kaunas, LithuaniaE-mail: [email protected] Background / objective The major challenge for burn team is infection which is known to cause over 50% of burn deaths. Burns become infected because the environment at the site of the wound is ideal for the propagation of the infecting organism. The aim of the study was to evaluate the rational application algorithm of antibacterial drugs to influence the S. aureus resistance changes to antibiotics. Patients and methods In 2001, the Rational Application Algorithm of antibacterial drugs was introduced into the Plastic Surgery and Burns Department. Performing the perspective analysis, we investigated Staphylococcus aureus resistance and its dynamics to antibacterial drugs using the computerized database of the Microbiology Laboratory in KMUH in 2001–2002. Analyzing a retrospective group (2000) and a perspective one (2001–2002) we compared changes of Staphylococcus aureus resistance to ciprofloxacin, gentamicin, erythromycin, fucidin, clindamycin, oxacillin, penicillin, rifampicin, tetracycline and vancomycin. Results S. aureus resistance to antibiotics decreased after introducing the Rational Application Algorithm of antibacterial drugs. The difference is statistically insignificant. The resistance of this microorganism decreased slightly to erythromycin and statistically significantly to penicillin. Conclusions The Rational Application Algorithm of antibacterial drugs allows to reduce and control S. aureus resistance to antibacterial drugs. S. aureus resistance to erythromycin and penicillin decreased statistically significant after introducing the Rational Application Algorithm of antibacterial drugs into clinical practice. Key words: Staphilococcus aureus resistance to antibiotics, racional antibioticotherap

Patogeninių mikroorganizmų identifikavimas elektronine nosimi

Rokas Bagdonas1, Rytis Rimdeika1, Algimantas Tamelis1, Mindaugas Kiudelis1, Andrius Olekas2, Daiva Senulienė2, Arūnas Šetkus21 Kauno medicinos universiteto klinikų Chirurgijos klinika,Eivenių g. 2, LT-50009, Kaunas2 Puslaidininkių fizikos institutas,Goštauto g. 11, LT-01108 Vilnius*El paštas: [email protected] Įvadas / tikslas Atlikdami įprastinius mikrobiologinius tyrimus, atsakymą apie infekcijos sukėlėją paprastai gauname per 48–72 val. Tačiau neretai toks laiko tarpas yra per ilgas, todėl visi nauji infekcijos diagnostikos metodai, leidžiantys anksčiau nustatyti žaizdos infekciją, kelia itin didelį susidomėjimą ir yra labai perspektyvūs. Mūsų eksperimentuose elektronine nosimi buvo tiriami kvapai, susiję su patogeninių mikroorganizmų augimu maitinamojoje terpėje. Mikroorganizmai buvo paimti nuo žaizdas dengiančių tvarsčių. Eksperimentams buvo išskirti Acinetobacter, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus patogeniniai mikroorganizmai. Metodai Atlikta 313 matavimų su skirtingais mikroorganizmais, išsėtais skirtingose terpėse, sauso ir 100% oro drėgnio sąlygomis. Palyginti elektroninės nosies varžos kitimo parametrai tiriant Acinetobacter, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus patogeninius mikroorganizmus sauso (n-119) ir 100% santykinio oro drėgnio sąlygomis (n-194). Rezultatai Bendras ištirtų mėginių skaičius buvo 194, jį sudarė skirtingų mikroorganizmų testavimas elektronine nosimi, naudojant 100% santykinio drėgnio nešančiojo sintetinio oro srautą. Iš visų testų mėginiams naudojant Acinetobacter spp. atlikti 48 matavimai, Staphylococcus aureus – 20, Pseudomonas aeruginosa – 65 ir Escherichia coli – 61 matavimas. Bakterijų kvapų 2, 4, 6 ir 7-ojo jutiklių atsakas statistiškai reikšmingai skyrėsi. Kiekvienam atvaizdui, įskaitant ir signalų matavimą bei jų matematinį apdorojimą, suformuoti buvo sugaišta maždaug 30–40 minučių. Išvados Elektroninės nosies varžos kitimo parametrai, diagnozuojant Acinetobacter, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus patogeninius mikroorganizmus, reikšmingai skiriasi ir leidžia identifikuoti skirtingus mikroorganizmus. Elektroninė nosis gali būti tinkamas ankstyvesnio infekcijos diagnozės nustatymo metodas. Reikšminiai žodžiai: elektroninė nosis, dujų jutikliai, žaizdų patogeniniai mikroorganizmai, ankstyvoji diagnostika, neinvazinė diagnostika Identification of pathogenic microorganisms by electronic nose Rokas Bagdonas1, Rytis Rimdeika1, Algimantas Tamelis1, Mindaugas Kiudelis1, Andrius Olekas2, Daiva Senulienė2, Arūnas Šetkus21 Kaunas Medical University Hospital, Department of Surgery,Eivenių str. 2, LT-50009, Kaunas, Lithuania2 Semiconductor Physics Institute,Goštauto str. 11, LT-01108 Vilnius, Lithuania*E-mail: [email protected] Background / Objective Performing the routine microbiological assays the answer about infectious agent usually comes out in 48–72 hours. However, such a long time interval generally is too long and therefore all new diagnostic methods enabling earlier identification of wound infection generate great interest and are thought to be very promising. In our experiments with electronic nose we analysed odours related to growth of pathogenic microorganisms in nutrient medium. Microorganisms were taken from the wound dressing. For the experiments there were isolated Acinetobacter, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus pathogenic microorganisms. Methods There were 313 measurements performed with different microorganisms from different mediums under the conditions of dry air and 100% air humidity. A comparison of changing parameters in electronic nose resistance was made in studying Acinetobacter, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus pathogenic microorganisms under the conditions of dry air (n-119) and 100% air humidity (n-194). Results Overall there were 194 specimens analysed in which different microorganisms were tested with electronic nose using 100% relative humidity carrying the flow of synthetic air. From all the specimens 48 measurements were performed using Acinetobacter spp., 20 – Staphylococus aureus, 65 – Pseudomonas aeruginosa, and 61 measurement with Escherichia coli. The response of gas sensors 2, 4, 6 and 7 evoked by bacteria odours varied statistically significant. Composing each image took about 30–40 minutes including measuring and mathematical processing of signals. Conclusions The changing parameters of electronic nose resistance vary significantly in diagnosing Acinetobacter, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus pathogenic microorganisms and it enables to identify different microorganisms. Electronic nose may be an appropriate method for the earlier diagnostics of the infection. Keywords: electronic nose, gas sensors, pathogenic microorganisms of the wound, early diagnostics, noninvasive diagnostic

Nosies defekto rekonstrukcija išplėstu daugiasluoksniu kaktos lopu

Nasal tip and septal perforations may lead to significant upper airway problems as well as disturbing esthetic changes in the external contour of the nose. Nasal defects impede normal social contact and create great self-identity problems for the patients. We report the case of a 37-year-old woman, taking drugs for 10 years, who had sepsis and nasal abscess with necrosis of the nasal tip and septum. Using a composite expanded forehead flap for reconstruction of the nose, good esthetic and functional results were achieved

Nosies defekto rekonstrukcija išplėstu daugiasluoksniu kaktos lopu

Nasal tip and septal perforations may lead to significant upper airway problems as well as disturbing esthetic changes in the external contour of the nose. Nasal defects impede normal social contact and create great self-identity problems for the patients. We report the case of a 37-year-old woman, taking drugs for 10 years, who had sepsis and nasal abscess with necrosis of the nasal tip and septum. Using a composite expanded forehead flap for reconstruction of the nose, good esthetic and functional results were achieved

Nudegusių ligonių ir jų žaizdų patogenų analizė

Rokas Bagdonas, Algimantas Tamelis, Rytis Rimdeika, Mindaugas Kiudelis Įvadas / tikslas Didžiausia nudegimų chirurgijos problema yra infekcija, nuo kurios miršta daugiau kaip 50% visų nudegusių pacientų. Nudegimų žaizda greitai infekuojasi, kadangi žaizdos aplinka yra ideali mikroorganizmams atsirasti ir daugintis. Studijoje, patvirtintoje Universiteto etikos komiteto, analizuojami nudegę pacientai ir iš nudegimo žaizdų išskirti patogenai. Pacientai ir metodai Mes analizavome 2246 nudegusius pacientus (amžiaus vidurkis – 27 metai), gydytus KMU Chirurgijos klinikose 1997–2002 metais. Nudegimo sunkumas buvo vertintas pagal Amerikos nudegimų asociacijos (ABA) schemą. 2462 nudegimo žaizdos pasėliai (2246 pacientų) buvo paimti steriliu tamponu ir pasėti 5% kraujo ir MacConkey terpėse. Rezultatai Iš nudegusių pacientų 1447 (74%) buvo vyrai ir 799 (26%) – moterys (p < 0,001). Pacientų amžius – nuo 2 iki 47 metų. 1261 (56%, p < 0,05) pacientai patyrė lengvą, 522 – vidutinį ir 463 – sunkų kūno nudegimą. 2130 pasėliai (86,5%), paimti iš 2462 nudegimo žaizdų, buvo teigiami. Iš 2130 teigiamų pasėlių Staphylococcus aureus išskirtas 1110 (52,1%) pasėliuose, iš jų MRSA – 498 (23,4%). Išvados Jauni vyrai dažniausiai patiria lengvus kūno nudegimus. Nudegimo žaizda dažniausiai infekuojasi S. aureus mikroorganizmais. MRSA yra pagrindinis ligoninės patogenas, infekuojantis nudegimo žaizdą. Prasminiai žodžiai: nudegimo sunkumas, nudegimo žaizdos patogenai, išskirti sukėlėjai Analysis of burn patients and the isolated pathogens Rokas Bagdonas, Algimantas Tamelis, Rytis Rimdeika, Mindaugas KiudelisKaunas Medical University, Clinic of Surgery,Eivenių str. 2, LT-50009, Kaunas, LithuaniaE-mail: [email protected] Background / objective The major challenge for a burn team is infection, which is known to cause over 50% of burn deaths. Burns become infected, because the environment at the site of the wound is ideal for the proliferation of infecting organisms. This study, approved by the regional Ethics Committee, analyzes the features of burned patients and the rates of pathogens isolated from burn wounds. Patients and methods We studied 2246 burn patients (mean age 27 years) admitted to the tertiary academic hospital in 1997–2002. The differentiation of the severity of burn injury was based on the scheme of the American Burn Association (ABA). 2462 surface swabs for microbiological analysis were taken from all 2246 patients. The wound area was swabbed with an alginate swab and cultured in 5% blood and MacConkey agar. Results There were 1447 (74%) men and 799 (26%) women (p < 0.001), age range 2–47 years. There were 1261 patients (56%, p < 0.05) with minor, 522 with moderate and 463 with major burn injuries. 2130 swabs (86.5%) out of 2462 burn wound surface swabs were positive. Out of 2130 isolates positive for pathogenic bacterial culture, there were 1110 (52.1%) isolates positive for Staphylococcus aureus infection. The rate of MRSA was 23.4% (498 isolates). Conclusions Young male patients mostly have a minor burn injury. Burn wounds are most commonly infected with S. aureus. MRSA is still the main hospital pathogen in burns. Keywords: severity of the burn injury, burn swabs, isolated pathogen

The Effect of CaV1.2 Inhibitor Nifedipine on Chondrogenic Differentiation of Human Bone Marrow or Menstrual Blood-Derived Mesenchymal Stem Cells and Chondrocytes

Cartilage is an avascular tissue and sensitive to mechanical trauma and/or age-related degenerative processes leading to the development of osteoarthritis (OA). Therefore, it is important to investigate the mesenchymal cell-based chondrogenic regenerating mechanisms and possible their regulation. The aim of this study was to investigate the role of intracellular calcium (iCa2+) and its regulation through voltage-operated calcium channels (VOCC) on chondrogenic differentiation of mesenchymal stem/stromal cells derived from human bone marrow (BMMSCs) and menstrual blood (MenSCs) in comparison to OA chondrocytes. The level of iCa2+ was highest in chondrocytes, whereas iCa2+ store capacity was biggest in MenSCs and they proliferated better as compared to other cells. The level of CaV1.2 channels was also highest in OA chondrocytes than in other cells. CaV1.2 antagonist nifedipine slightly suppressed iCa2+, Cav1.2 and the proliferation of all cells and affected iCa2+ stores, particularly in BMMSCs. The expression of the CaV1.2 gene during 21 days of chondrogenic differentiation was highest in MenSCs, showing the weakest chondrogenic differentiation, which was stimulated by the nifedipine. The best chondrogenic differentiation potential showed BMMSCs (SOX9 and COL2A1 expression); however, purposeful iCa2+ and VOCC regulation by blockers can stimulate a chondrogenic response at least in MenSCs

The effect of CaV1.2 inhibitor nifedipine on chondrogenic differentiation of human bone marrow or menstrual blood-derived mesenchymal stem cells and chondrocytes

Abstract Cartilage is an avascular tissue and sensitive to mechanical trauma and/or age-related degenerative processes leading to the development of osteoarthritis (OA). Therefore, it is important to investigate the mesenchymal cell-based chondrogenic regenerating mechanisms and possible their regulation. The aim of this study was to investigate the role of intracellular calcium (iCa²⁺) and its regulation through voltage-operated calcium channels (VOCC) on chondrogenic differentiation of mesenchymal stem/stromal cells derived from human bone marrow (BMMSCs) and menstrual blood (MenSCs) in comparison to OA chondrocytes. The level of iCa²⁺ was highest in chondrocytes, whereas iCa²⁺ store capacity was biggest in MenSCs and they proliferated better as compared to other cells. The level of CaV1.2 channels was also highest in OA chondrocytes than in other cells. CaV1.2 antagonist nifedipine slightly suppressed iCa²⁺, Cav1.2 and the proliferation of all cells and affected iCa²⁺ stores, particularly in BMMSCs. The expression of the CaV1.2 gene during 21 days of chondrogenic differentiation was highest in MenSCs, showing the weakest chondrogenic differentiation, which was stimulated by the nifedipine. The best chondrogenic differentiation potential showed BMMSCs (SOX9 and COL2A1 expression); however, purposeful iCa²⁺ and VOCC regulation by blockers can stimulate a chondrogenic response at least in MenSCs