Проблема резистентности кишечной палочки в патологии мочевой системы

Centrul Naţional Ştiinţifico-Practic de Medicină Preventivă, Chişinău, Conferinţa Ştiinţifico-Practică „Medicina modernă, actualităţi şi perspective”, consacrată aniversării de 40 de ani ai Spitalului Clinic al Ministerului Sănătăţii, 27-28 mai, 2010, Chişinău, Republica MoldovaE. coli is the normal microflora of the gastrointestinal tract. In certain states of health it may cause intestinal or extraintestinal disorders. According to scientific studies it was established that a simple test of susceptibility to chemotherapy by conventional antibiogram does not provide sufficient data for proper monitoring of antibacterial chemotherapy being required to use interpretive antibiogram tests based on synergy to accurately assess the level of resistance and molecular mechanisms of resistance to beta-lactam antibiotics. Urinary infections are mostly determined by Enterobacteriaceae family, of which E. coli predominates.Кишечная палочка является нормальной микрофлорой желудочно-кишечного тракта. В некоторых состояниях здоровья она может вызвать кишечные и внекишечные инфекции. Согласно научным исследованиям установлено, что простой тест на чувствительность к химиотерапии обычными антибиотиками не дает достаточных данных для надлежащего контроля над антибактериальной терапией, следствием чего является необходимость точной оценки уровня резистентности и молекулярных механизмов устойчивости к беталактамным антибиотикам. В генезе мочевых инфекций преобладает семейство Enterobacteriaceae, из которой кишечная палочка самая частая

Аспекты устойчивости к антибиотикам штаммов Enterobacteriaceae, вызывающих инфекции мочевыводящих путей

Department of Microbiology, Virology and Immunology, Nicolae Testemitanu State Medical and Pharmaceutical University, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaThe aim of this retrospective study was to analyzethe resistance to antibiotics of the germs from the Enterobacteriaceae family implicated in urinary infections. The etiological spectrum of urinary tract infections was dominated by Escherichia coli species (62.69%), followed, with lower percentages, by Proteus spp., Klebsiella spp. and Enterobacter spp. All the isolated Enterobacteriaceae strains have presented different levels of resistance to antibiotics. The sensitivity to Imipenem and Meropenem was higher in all the analyzed bacterial genres.Целью данного ретроспективного исследования был анализ устойчивости к антибиотикам бактерий семейства Enterobacteriaceae, вызывающих инфекции мочевых путей. В этиологическом спектре инфекций мочевыводящих путей преобладает вид Escherichia coli (62,69%), а затем, в более низком процентом соотношении Proteus spp., Klebsiella spp. и Enterobacter spp. Все выделенные штаммы семейства Enterobacteriaceae показали различный уровень устойчивости к антибиотикам. Отмечена повышенная чувствительность к имипенему и меропенему у всех исследуемых бактерий

Энтеробактерии продуцирующие бета-лактамазы расширенного спектра, выделенных при инфекциях мочевыводящих путей

National Centre of Public Health, Congresul III al Medicilor de Familie din Republica Moldova, 17–18 mai, 2012, Chişinău, Republica Moldova, Conferinţa Naţională „Maladii bronhoobstructive la copii”, consacrată profesorului universitar, doctor habilitat Victor Gheţeul, 27 aprilie, Chişinău, Republica MoldovaIntroducere. Antibioticorezistenţa microorganismelor, implicate în etiologia maladiilor infecţioase, reprezintă o prioritate pentru sistemul de sănătate publică atât la nivel naţional cât şi global. Infecţiile tractului urinar (ITU) reprezintă una dintre cele mai frecvente maladii infecţioase întâlnite la toate vârstele. Prin numărul mare al infecţiilor urinare, cu consecinţe medicale şi economice considerabile, tulpinile implicate în etiologia acestora se menţin în atenţia studiilor epidemiologice şi bacteriologice. Majoritatea infecţiilor urinare sunt cauzate de bacterii din familia Enterobacteriaceae, care reprezintă flora indigenă a tractului gastrointestinal. Cel mai frecvent germene, implicat în patologia ITU, este cu preponderenţă Escherichia coli. Utilizarea expansivă în ultimele două decenii a betalactaminelor a dus la apariţia tulpinilor secretoare de beta-lactamaze, la creşterea numerică a infecţiilor urinare şi la complicarea tabloului clinic. Presiunea de selecţie, exercitată de antibioticele betalactamice asupra unei populaţii bacteriene, favorizează persistenţa tulpinilor care au capacitatea de a rezista la acţiunea antibioticelor datorită enzimelor beta-lactamaze. Aceste populaţii bacteriene proliferează şi răspândesc genele de rezistenţă la alte tulpini iniţial sensibile, iar răspândirea rapidă a acestui tip de rezistenţă se datorează faptului că genele codante se găsesc pe plasmide transmisibile sau mobilizabile. Cele mai cunoscute variante de BLSE (beta-lactamaze cu spectru extins) sunt de tip TEM şi SHV, dar tot mai mult apar atât în comunitate, cât şi în spital BLSE tip CTX-M. Tipul exact de beta-lactamază nu poate fi detectat cu ajutorul testelor de rutină. Asocierea mai multor tipuri de beta-lactamaze la acelaşi microorganism face şi mai dificilă depistarea corectă. În ultimii ani, au fost propuse metode alternative care să înlocuiască sau să completeze metodele fenotipice tradiţionale. Cele mai utilizate dintre aceste metode sunt testele PCR şi secvenţierea de gene. Material şi metode Au fost cercetate 118 tulpini de E. coli, izolate din uroculturile semnificativ pozitive (105 UFC/ml), recoltate de la pacienţii cu ITU. Tulpinile au fost identificate pe baza proprietăţilor morfotinctoriale, culturale şi biochimice, utilizând teste API 20E (Biomerieux). Sensibilitatea tulpinilor de E. coli la preparatele antimicrobiene a fost determinată prin metode fenotipice (discdifuzimetrică Kirby-Bauer, testul de sinergie) şi de biologie moleculară (reacţia de polimerizare în lanţ: PCR multiplex, Rep – PCR, secvenţiere). Rezultate obţinute Rezultatele obţinute prin testele biochimice de screening şi de confirmare pentru Enterobacteriaceae, au pus în evidenţă faptul că din totalul de tulpini izolate de la pacienţii cu ITU, predominante au fost tulpinile de E. coli (92,9%). Determinarea antibioticogramei şi raportarea periodică a sensibilităţii diferitor bacterii la antibiotice constituie un obiectiv major în instituirea unei terapii de primă intenţie adecvată, şi în realizarea unei strategii de prevenire a rezistenţei la preparatele antibacteriene. Determinând şi evaluând sensibilitatea la antibiotice a tulpinilor de E. coli studiate, a fost semnalat fenomenul de multirezistenţă la preparatele antibacteriene. Ponderea tulpinilor rezistentela fluorochinolone (acid nalidixic) a constituit 89%, la betalactamine (ticarcilina) – 77%, aminoglicozide (gentamicina) – 72% şi sulfamide (cotrimoxazol) – 72%. Betalactamazele cu spectru extins (BLSE), identificate la tulpinile de E. coli, au fost de tip CTX-M, şi anume: o tulpină tip CTX-M-1, trei tulpini de tip CTX-M-14; alte trei tulpini sunt de tip CTX-M-15. S-a constatat că filogenetic 58,5% tulpini de E. coli BLSE aparţin grupului B2 , grupului A – 27,9%, grupului D – 12,7%, alte grupuri – 0,9%. Tipizarea tulpinilor de E. coli BLSE urinare a evidenţiat faptul că tulpinile de la diferiţi pacienţi au avut profiluri BLSE CTX-M similare. Majoritatea tulpinilor au fost de tipul BLSE-CTX-M-14, aparţinând grupului filogenetic B2 , cu excepţia a două tulpini: CTX-M-15 grup filogenetic B2 , şi CTX-M-3 grup filogenetic A. Concluzii 1. Prezenţa E. coli, producătoare de BLSE la pacienţii cu ITU, este datorată utilizării expansive a antibioticelor cu spectru larg, fiind una din cauzele principale care a generat scăderea sensibilităţii bacteriene, datorate achiziţionării unor mecanisme variate de realizare a rezistenţei printre care şi producerea de BLSE. 2. Stoparea răspândirii tulpinilor bacteriene multirezistente la acţiunea antibioticelor impune cunoaşterea detaliată a mecanismelor de rezistenţă bacteriană, în paralel cu dezvoltarea şi aplicarea unor politici intraspitaliceşti adecvate de antibioticoterapie

Antibiotic resistance of S. pneumoniae and H. influnenzae strains isolated from the patients with community respiratory tract infections

Community respiratory tract infections are common in clinical practice. Antimicrobial treatment should be promptly administered taking into account a probable etiology and local patterns of bacterial resistance according to the clinical presentation. Bacterial resistance is widespread, with large geographical variations related to antibiotics prescription. S. pneumoniae and H. influenzae are the most frequent pathogens responsible for respiratory tract infections etiology. We have analyzed 2554 S. pneumoniae strains and 156 H. influenzae strains isolated during 2010-2012, mainly from sputum (69.2% and 76.7% respectively of total isolated strains). We have observed a high proportion of strains of S. pneumoniae resistant to oxacillin (75.3%), to co-trimoxazole (62.9%) and to penicillin (62.8%). H. influenzae strains have been resistant to aztreonam in 92.1% of cases and to ampicillin – in 26%. Antibiotic susceptibility testing has been conducted through Kirby-Bauer technique. The interpretation of the results has been carried out in accordance with the criteria recommended by NCCLS. In the case of H. influenzae strains the environment Hemophilus test has been selected and in the case of S. pneumoniae strains the environment based on Agar Mueller Hinton blood has been used. For quality control in determining the sensitivity of strains, the strains of S. pneumoniae ATCC 49619 and H. influenzae ATCC 49247 have been used

Острая диарея: проблемы и перспективы

Centrul Naţional Ştiinţifico-Practic de Medicină Preventivă, Chişinău, Conferinţa Ştiinţifico-Practică „Medicina modernă, actualităţi şi perspective”, consacrată aniversării de 40 de ani ai Spitalului Clinic al Ministerului Sănătăţii, 27-28 mai, 2010, Chişinău, Republica MoldovaIn order to determine etiologic factors of acute intestinal infections in the years 2007-2009, 7076 patients (adults and children) were examined for pathogenic flora (1518 patients), intestinal microflora (conditioned pathogenic; 5092 patients) and intestinal dismicrobism (466 patients). The study showed that acute diarrhea is caused by both pathogenic and conditioned pathogenic agents. Conditioned pathogenic agents may cause acute diarrhea in both microbial associations and as a single causative agent. Acute diarrhea can be caused by hemolylical microbial agents that need to be evaluated as pathogens. Diagnosis of “intestinal dismicrobism” can be considered as an intestinal syndrome only in cases when microbial agents are not detected in diagnosing titres.В целях определения этиологических факторов острых кишечных инфекций в 2007-2009 годах было обследовано 7076 пациентов (взрослых и детей), из них 1518 на патогенную флору, 5092 на кишечную микрофлору (условно патогенную) и 466 на кишечный дисмикробизм. Исследование показало, что острые диарейные заболевания обусловлены как патогенными, так и условно патогенными микроорганизмами. Условно патогенная флора вызывает острые диарейные заболевания, как при микробных ассоциациях, так и в случае выявления только одного возбудителя. Острая диарея может быть вызвана гемолитическими микробными агентами, которые должны быть оценены как патогенные организмы. Диагноз «кишечный дисмикробизм» может считаться кишечным синдромом только в тех случаях, когда патогенные микробы не обнаруживаются в диагностическом титре

The diversity and spread of genes encoding extended spectrum beta-lactamase enzymes in the strains of Escherichia coli

The aim of the study is to determine the mechanisms of antibiotic resistance of Escherichia coli (E. coli), the prevalence of extended spectrum betalactamase (ESBL) circulating strains of E. coli, establishing genotypes, phylogenetic groups of E. coli ESBL in the Republic of Moldova. On the basis of the data of local microbiological monitoring and using the phenotypic and molecular-genetic methods the genetic determinants (beta-lactamase), which cause the formation of resistance to beta-lactamase antibiotics have been identified. By polymerasis chaine reaction and the sequencing method the prevalence of E. coli strains producing ESBL in the urine probes has been identified. Such studies are unique for the Republic of Moldova and can serve as a basis for the establishment of the concept of causal and empirical treatment in our country. Urinary tract infections have been primarily (85%) determined by the E. coli species, followed by Enterococcus faecalis, Klebsiella pneumoniae, etc. The enzymes ESBL identified in the strains of E. coli in most of the cases have been of CTX-M type, the fact that explains the evolution and dissemination of E. coli producing ESBL. E. coli, a representative of the intestinal microflora, can serve as a reservoir of antibiotic resistance of microbic germs involved in the etiology of urinary tract infections. The detection of the type of beta-lactamase and the unification of the different subtypes of resistance to microorganisms are possible with the help of molecular biology techniques, by contrast with the phenotypic routine tests, the fact that is shown by the model of E. coli producing ESBL

Aspects of the population morbidity in some regions of the Republic of Moldova

General Hygiene Department, Nicolae Testemitsanu State University of Medicine and Pharmacy, National Centre of Public Health, Chisinau, the Republic of MoldovaBackground: The health of the Moldovan population requires special attention, due to direct and indirect biological, environmental, behavioural and health factors. Material and methods: We studied population morbidity from the following localities: town Cupcini, village Bratuseni, village Ruseni (Edinet district); town Vadul lui Voda, town Cricova, village Condrita (municipality Chisinău); village Rosu, village Moscovei, village Huluboaia (Cahul district). Statistical data were taken from the statistical report No 12, for the period from 2012 to 2014. Results: Morbidity analysis showed that the overall prevalence of increased average values was recorded in the village Bratuseni, Edinet district – 16119.0±247.70/000. In town Vadul lui Voda, Cricova, village Condriţa (municipality Chisinau), overall prevalence values ranged within 6967.0±813.0 – 8721.3±375.90/000. Meanwhile, village Rosu, village Moscovei, village Huluboaia (Cahul district), mean values of overall prevalence were included within 2379.8±574.8 and 3219.8±152.70/000. Analysis of the general incidence emphasized that the community in the North recorded mean values within 1370.5±0.7 – 11162.4±190.40/000, localities in the center and south - 1877.8±246.3 – 3149.0±187.80/000 and respectively 899.3±95.0 – 1244.8±339.80/000. Conclusions: Population morbidity was growing during 2012-2014. Prevalence of diseases of the circulatory, digestive and urogenital systems was higher in central areas and the osteoarticular system diseases – in northern communities. The incidence of cardiovascular, urogenital and osteoarticular diseases was higher in cities from North, and digestive system diseases – in central areas

Relative fecal abundance of extended-spectrum-ß-lactamase-producing Escherichia coli strains and their occurrence in urinary tract infections in women

PubMed ID: 23836184Extended-spectrum-beta-lactamase (ESBL)-producing Escherichia coli (ESBL E. coli) strains are of major concern because few antibiotics remain active against these bacteria. We investigated the association between the fecal relative abundance (RA) of ESBL-producing E. coli (ESBL-RA) and the occurrence of ESBL E. coli urinary tract infections (UTIs). The first stool samples passed after suspicion of UTI from 310 women with subsequently confirmed E. coli UTIs were sampled and tested for ESBL-RA by culture on selective agar. Predictive values of ESBL-RA for ESBL E. coli UTI were analyzed for women who were not exposed to antibiotics when the stool was passed. ESBL E. coli isolates were characterized for ESBL type, phylogroup, relatedness, and virulence factors. The prevalence of ESBL E. coli fecal carriage was 20.3%, with ESBL E. coli UTIs being present in 12.3% of the women. The mean ESBL-RA (95% confidence interval [CI]) was 13-fold higher in women exposed to antibiotics at the time of sampling than in those not exposed (14.3% [range, 5.6% to 36.9%] versus 1.1% [range, 0.32% to 3.6%], respectively; P<0.001) and 18-fold higher in women with ESBL E. coli UTI than in those with another E. coli UTI (10.0% [range, 0.54% to 100%] versus 0.56% [range, 0.15% to 2.1%[, respectively; P<0.05). An ESBL-RA of<0.1% was 100% predictive of a non-ESBL E. coli UTI. ESBL type, phylogroup, relatedness, and virulence factors were not found to be associated with ESBL-RA. In conclusion, ESBL-RA was linked to the occurrence of ESBL E. coli UTI in women who were not exposed to antibiotics and who had the same clone of E. coli in urine samples and fecal samples. Especially, a low ESBL-RA appeared to be associated with a low risk of ESBL E. coli infection. Copyright © 2013, American Society for Microbiology. All Rights Reserved

Abstracts of The IX Annual International Scientific-Practical Conference; Medicine Pressing Questions

This book contains the abstracts of the papers presented at The IX Annual International Scientific-Practical Conference “MEDICINE PRESSING QUESTIONS”, III Satellite Forum “Public Health and Healthcare Politics” and The III Simulation Training “LAPAROSCOPIC SURGERY” organized by NGO “Young Doctors of Azerbaijan” held on May 6-8, 2020, Baku, AZERBAIJAN. This abstract book contains few abstracts in English language and few abstracts in Russian language