Adherence to recommendations and effectiveness of glucose-lowering treatment in type 2 diabetes patients receiving insulin based in the Nizhny Novgorod region on data of mobile diagnostic and therapeutic centre "Diabetes mellitus"

Adherence to treatment is an important factor in diabetes management. Poor adherence may cause ineffective control, especially in insulin-treated patients. Aim of the study: to evaluate the adherence to nutrition, physical activity and self-monitoring in T2DM patients who do and do not receive insulin treatment. Materials and methods. 550 T2DM patients were examined as a part of mobile diabetes center in different areas of the Nizhny Novgorod region. Clinical examination results, HbA1c, creatinine and microalbuminuria were assessed. Adherence to treatment was evaluated by questionnaire Diabetes Self-Care Activities. Results. Insulin-treated patients had longer diabetes duration and worse HbA1 с level and similar levels of adherence related to diet, physical activity, foot care. Only for glucose self-monitoring was adherence higher. Best HbA1c values were observed in patients with adherence in middle region of 3-5 days. Conclusion. Long diabetes duration and worse glycemic control in insulin-treated T2DM patients is not associated with&nbsp;better adherence to treatment. This may be viewed as evidence on insufficient patients education and can be a potential target for improvement of glycemic control.</p

Monitoring the puerperium microbiota is a necessary condition for diagnosing newborn infections in the early neonatal period

L.G. Boronina1,2, E.V. Samatova2, A.G. Asnovskaya2, S.A. Panova2, S.S. Ustyugova2, K.V. Zakharchuk2 1Ural State Medical University, Yekaterinburg, Russian Federation 2Regional Children's Clinical Hospital, Yekaterinburg, Russian Federation Background: maternal and child healthcare is considered a priority area of the public health services in all countries. Aim: to assess the birth canal microbiota in pregnant women and puerperia for diagnosing potential infections of newborn infants in the early neonatal period. Patients and Methods: this retrospective study analyses the results of microbiological examination of the samples taken from various loci of 1915 pregnant women and/or puerperia and newborn infants in the period of February 1, 2020, to February 28, 2022. The biological material samples for microbiological examination were obtained from the following locations: 1) in the pregnant women and/or puerperia: the posterior vaginal vault, cervical canal, afterbirth, and the uterine cavity; 2) in the newborn infants: the blood, cerebrospinal fluid, tracheal secretions, and the catheter. Results: in 38.1% of puerperia, the caesarean section was performed to deliver a baby. In 513 (26.8%) women in labor and their newborns, microbiological tests were not carried out, as they did not have clinical manifestations of infectious diseases. Based on the monitoring of the results of microbiological examination of the biomaterial samples taken from various loci, the following three groups were formed: group 1 — the samples were taken only from the newborns (n=458); group 2 — the samples were taken only from the mothers (n=294); group 3 — the samples were taken both from the mothers and newborns (n=650). Then, group 3 was divided into the following subgroups: the growth of microorganisms was not detected or the normal flora was found (n=459); the potential causative agents of infectious and inflammatory diseases were found in the mother, but not in the newborn (n=161); the same potential causative agents of infectious and inflammat ory diseases were detected in the newborn and the mother (n=19); different potential causative agents of infectious and inflammatory diseases were found in the newborn and the mother (n=6); potential causative agents of infectious and inflammatory diseases were detected in the newborns, but not in the mothers (n=5). Escherichia coli (31.6%) and Streptococcus agalactiae (15.7%) were the most prevalent microorganisms in the birth canal of the pregnant women and puerperia. In the newborns, the same agents were most frequently found in the blood or the tracheal secretions. Conclusion: the microbiological monitoring of the birth canal of pregnant women and puerperia, as well as of newborn infants is necessary for a timely prevention or treatment of infectious diseases. Keywords: monitoring, microbiota, puerperia, newborns, infection, bacterial carriage. For citation: Boronina L.G., Samatova E.V., Asnovskaya A.G. et al. Monitoring the puerperium microbiota is a necessary condition for diagnosing newborn infections in the early neonatal period. Russian Journal of Woman and Child Health. 2023;6(1):13–19 (in Russ.). DOI: 10.32364/2618-8430-2023-6-1-13-19. <br

Incidence of carbapenem-resistant Enterobacteriaceae in the multidisciplinary pediatric hospital

L.G. Boronina1,2, E.V. Samatova2, S.M. Blinova1, M.P. Kukushkina2, S.A. Panova2, S.S. Ustyugova2 1Ural State Medical University, Ekaterinburg, Russian Federation 2Regional Children’s Clinical Hospital, Ekaterinburg, Russian Federation Aim: to define the incidence of carbapenem-resistant Enterobacteriaceae in the bioassay of hospitalized children. Patients and Methods: From January to December 2019, 940 strains of gram-negative bacteria were isolated from clinical material of 900 patients. Antibiotic susceptibility testing was conducted using the disk diffusion method; SENSITITRE and Phoenix M50 analyzers used «CHROMagarTM KPC» medium. Also, Carbapenem Inactivation Method was used to detect the carbapenemase activity. Results: the species composition of carbapenem-resistant Enterobacteriaceae included: Pseudomonas aeruginosa (n=55), Acinnetobacter baumannii (n=22), Escherichia coli (n=2), Klebsiella pneumoniae (n=40), Klebsiella oxytoca (n=1), Enterobacter cloacae (n=7), Serratia marcescens (n=2), Proteus mirabilis (n=2), Pseudomonas putida (n=1). 12.1% of all Enterobacterales isolates and 29.4% Klebsiella pneumoniae strains were resistant to ertapenem; 17.2% of Enterobacteriaceae and 20% of K. pneumoniae strains were resistant to imipenem and meropenem. 50.9% of Pseudomonas aeruginosa strains were resistant to meropenem and imipenem, and 45% — to doripenem. Acinetobacter baumannii strains resistant to meropenem — 66.6%, imipenem — 63.6%, doripenem — 83.3%. In 30.4% of P. aeruginosa and A. baumannii strains, carbapenemase activity was not detected, which indicated other mechanisms of resistance to carbapenem. Conclusion: in most cases, phenotypic methods only allow to suspect the presence of certain mechanisms of acquired resistance. However, since the main, most common mechanism is the production of hydrolytic enzymes, the identification of mechanisms of resistance to carbapenems should be precisely directed at this. At present, in addition to phenotypic methods, it is optimal to use molecular methods, in particular, real-time PCR, to effectively monitor the distribution of carbapenemase producers. Keywords: Enterobacterales, non-fermenting gram-negative bacteria, carbapenemases, children, infection. For citation: Boronina L.G., Samatova E.V., Blinova S.M. et al. Incidence of carbapenem-resistant Enterobacteriaceae in the multidisciplinary pediatric hospital. Russian Journal of Woman and Child Health. 2020;3(4):295–301. DOI: 10.32364/2618-8430-2020-3-4-295-301. <br

Colonization of rectal mucosa by microbes with antibiotic resistance markers in children with hematological malignancies

L.G. Boronina1,2, E.V. Samatova2, M.P. Kukushkina2, S.A. Panova2, S.S. Ustyugova2, A.G. Asnovskaya2 1Ural State Medical University, Yekaterinburg, Russian Federation 2Regional Children’s Clinical Hospital, Yekaterinburg, Russian Federation Background: the steadily increasing occurrence of the infections caused by antibiotic-resistant germs and the reduction in the efficacy of antimicrobials is one of the important issues of modern medicine. Aim: to study the colonization of rectal mucosa by extended-spectrum beta-lactamase (ESBL) — producing carbapenem-resistant Enterobacterales, carbapenem-resistant Pseudomonas aeruginosa, and vancomycin-resistant Enterococci using phenotypic methods and gene tests. Patients and Methods: this study was performed from December 10, 2019, to March 30, 2020. 150 samples (131 fecal specimens and 19 rectal swabs) collected from 66 patients who were admitted to the Hematological Center were examined. All samples were inoculated into selective chromogenic media. Results: 67 strains of Enterobacterales, 71 Enterococci, and 7 P. aeruginosa were isolated. Rectal colonization by ESBL-producing Enterobacterales was identified in 17 patients (25.8%). Е. coli (13 strains, 44,8%) and K. pneumoniae (10 strains, 34,5%) prevailed. In 5 children, two or more ESBL-producing strains were isolated, i.e., Е coli plus K. pneumoniae (n=2), Е. coli plus E. cloacae (n=2), and Е. coli plus K. pneumoniae plus E. cloacae (n=1). The colonization by vancomycin-resistant Enterococci (predominantly E. faecium) was identified in 18 patients (27.3%). Vancomycin-resistant Enterococci plus ESBL-producing Enterobacterales were isolated in 9 patients (13.6%). Multidrug-resistant strains were isolated among Е. coli (n=1), K. pneumoniae (n=3), and P. aeruginosa (n=1). Conclusions: our findings demonstrate that the colonization by one and two antibiotic-resistant microbe was seen in every forth patient (25.8–27.3%) and every seventh patient (13.6%), respectively. Е coli and K. pneumoniae prevailed among Enterobacterales and E. faecium prevailed among Enterococci. Chromogenic agars are designed to examine the specimens collected from patients. Antibiotic-resistant microbes may be identified 24 hours after receiving specimen at a laboratory when using these media. Keywords: monitoring, colonization, resistance marker, microorganisms, children, hematological malignancies. For citation: Boronina L.G., Samatova E.V., Kukushkina M.P. et al. Colonization of rectal mucosa by microbes with antibiotic resistance markers in children with hematological malignancies. Russian Journal of Woman and Child Health. 2021;4(1):90–97. DOI: 10.32364/2618-8430-2021-4-1-90-97. <br