5 research outputs found
Tuberculosis and HIV β Doubling the Fatality
Tuberculosis (TB) and HIV/AIDS infection are one of the most ubiquitous and deadliest communicable diseases in the world. They cause millions of deaths each year and are recognized as major threats for public health worldwide. The corresponding pathogens (Mycobacterium tuberculosis and HIV) share overlapping epidemiologyβthey affect low-income countries and place an immense burden on their feeble health care systems. Over the last decades, the natural history of both diseases has changed; in addition to devastating single HIV and TB infections, the coinfection with both pathogens has emerged and has spread in pandemic scale. When present as dual infection in an individual, Mycobacterium tuberculosis and HIV potentiate each other and kill in cooperation the host. TB is the leading cause of death in HIV-positive patients and in turn HIV infection is the strongest risk factor for the development of new or reactivation of dormant TB disease. Both pathogens (as single or dual infection) provoke a robust immune response in the infected host but the immune system does not achieve to eliminate the infectious agent(s). The failure of immune defense results in vulnerable immune balance between the micro- and the macroorganism and often ends up in a fatal outcome
Extended-spectrum beta-lactamase-producing microorganisms as causes of urinary tract infections in ambulatory and hospitalized patients in childhood - characteristics and epidemiology. // Π¨ΠΈΡΠΎΠΊΠΎΡΠΏΠ΅ΠΊΡΡΡΠ½ΠΈ Π±Π΅ΡΠ°-Π»Π°ΠΊΡΠ°ΠΌΠ°Π·Π° ΠΏΡΠΎΠΈΠ·Π²Π΅ΠΆΠ΄Π°ΡΠΈ ΠΌΠΈΠΊΡΠΎΠΎΡΠ³Π°Π½ΠΈΠ·ΠΌΠΈ ΠΊΠ°ΡΠΎ ΠΏΡΠΈΡΠΈΠ½ΠΈΡΠ΅Π»ΠΈ Π½Π° ΡΡΠΎΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ ΠΏΡΠΈ Π°ΠΌΠ±ΡΠ»Π°ΡΠΎΡΠ½ΠΈ ΠΈ Ρ ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·ΠΈΡΠ°Π½ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ β Ρ Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΡΡΠΈΠΊΠ° ΠΈ Π΅ΠΏΠΈΠ΄Π΅ΠΌΠΈΠΎΠ»ΠΎΠ³ΠΈΡ.
[EN] The theme of the thesis is "Extended spectrum betalactamase producing microorganisms as causes of urinary tract infections in ambulatory and hospitalized patients in childhood characteristics and epidemiology". The author of the study is Neli Mitkova Lodozova, who is a assistant professor in MU Varna, under the guidance of Prof. dr. Krasimir Metodiev (MU Varna) and Assoc. prof. Dimitrichka Bliznakova (MU Varna). Thesis includes 15 sections, 120 literature sources, as most of the publications cited are from the last 10 years. A considerable attention is paid to the scientific work of the leading Bulgarian specialists worked on the problem. For the purpose of the thesis have been used 4204 pieces of urine samples, provided from three medical diagnostic laboratories in the city of Varna - "Laborekspres 2000", "St. Anna ", "RHI - Varna". Samples are from pediatric patients - up to 18 years and taken in 2010-2012 year. The first part of the paper is a detailed literature review that presents anatomical characteristics of the urinary system, the main characteristics of urinary infections and their causes, nature of extended spectrum beta-lactamase-producing microorganisms (ESBLs), and their dissemination in the world, in Europe and in Bulgaria. The paper set and executed tasks to characterize specific antibiotic drugs and Ξ²-lactam group they belong to, witch are not effective against ESBL-strains and thus those that can still be effectively implemented to combat these bacteria as and presented morbidity of urinary infections in children, caused by ESBL-producing organisms of the family Enterobacteriaceae, several epidemiologichni indicator - sex and age structure, type of disease agent. Results and their discussion are presented in the following sections - general data, positive for the presence of an infectious agent urine samples, identified ESBL-positive strains of all samples, grouped by sex, age and antibiotic resistance. Results are divided into three groups, according to the samples in the three laboratories: for example, the data from "Laborekspres 2000" shows that, from 3702 urine samples, taken from children, 719 were positive for the presence of an infectious agent which represents 19% of them. Out of 353 tested samples from "St. Anna ", 85 were positive for the same indicator, ie 24% in βRZI-Varnaβ, 149 samples tested, 30 were positive - 20%. This means, that there is a relatively constant rate (with minimal deviations from 19% to 24%) reported positive tests in different laboratories. A difference by sex has been found out, in the three medical institutions. As a result, from 493 girls with positive urine infection, tested in three laboratories, 32 are ESBLs, which is 6.5% and for boys - from 340 samples, 16 were proven multidrug-resistant strains of the species, ie 4.7%. The separation by age group also gives a very clear picture:the results from the three laboratories shows that the largest share of clients are 1-3 years old children. In "Laborekspres" they are 224 719 people (31%) in "St. Anna "- 28 of the 85 patients with positive test for urinary tract infection, ie 32%, while in βRZI-Varnaβ - 12 of 30 people (40% of the positive urine samples). Through analysis of the date from the three laboratories, a variety number of microorganisms has been found in the samples. In general the microorganisms are mainly Gram-negative bacteria, such as E. coli, Proteus spp., Klebsiella spp., have the highest share, which supports the results of several other studies conducted by other authors. Since the main purpose of the dissertation work is a broad spectrum Ξ²-lactamase producing organisms (ESBLs), it will be allocated for the type of microorganism is of particular importance. Emphasis is placed on the fact that in 48 ESBL- isolates identified in total urine samples, the largest number are those with E. coli - 22 (whose share in % corresponds to 45% of all detected extended spectrum beta-lactamase-containing microorganisms in the three laboratories for the period), followed by a 14 number of K. pneumoniae (29% of ESBLs), 5 E. aerogenes (10%) 4 K. oxytoca (8%) 2 E. cloacae (4%) and 1 M. morganii (2%). Considering the data obtained from the establishment of ESBL-isolates, the author draws the following conclusions: E. coli represent almost half of all isolated bacteria containing spectrum beta-lactamases (47%) or 22 isolates. This value of ESBLs in type represents 5% of all detected E. coli, as a cause of urinary tract infections in pediatric patients in three laboratories. K. pneumoniae is the second most common ESBL-isolate, which represents 29% of beta-lactamase-containing bacteria. Other types of bacteria present presence of the enzyme beta-lactamase are E. aerogenes, K. oxytoca, E. cloacae and M. morganii. Mixed infections of two, rarely three microorganisms give priority to E. coli, present in 77% of cases. Thoroughly analyzed part of the study antibiotic resistance, and for this purpose the results are presented in tables, giving excellent visibility of what is found. Conclusions and recommendations include concrete conclusions, which are 14 in number. From the collected and processed data author gives recommendations aimed at health professionals involved in the detection of ESBL-containing bacteria to doctors who employ appropriate treatment of a patient diagnosed with urinary tract infection, to units of health, aiming combat antibiotic resistance and not least in patients with urinary tract infections, which must be aware of the risks that a seemingly harmless healing. The contributions of the thesis are of particular importance for the Municipality of Varna, where author of the thesis lives and works, and where there is the opportunity to give their expertise to improve the situation with frequent urinary tract infections in childhood.[BG] Π’Π΅ΠΌΠ°ΡΠ° Π½Π° Π΄ΠΈΡΠ΅ΡΡΠ°ΡΠΈΠΎΠ½Π½ΠΈΡ ΡΡΡΠ΄ Π΅ "Π¨ΠΈΡΠΎΠΊΠΎΡΠΏΠ΅ΠΊΡΡΡΠ½ΠΈ Π±Π΅ΡΠ°Π»Π°ΠΊΡΠ°ΠΌΠ°Π·Π° ΠΏΡΠΎΠΈΠ·Π²Π΅ΠΆΠ΄Π°ΡΠΈ ΠΌΠΈΠΊΡΠΎΠΎΡΠ³Π°Π½Π΅Π·ΠΌΠΈ ΠΊΠ°ΡΠΎ ΠΏΡΠΈΡΠΈΠ½ΠΈΡΠ΅Π»ΠΈ Π½Π° ΡΡΠΎΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ ΠΏΡΠΈ Π°ΠΌΠ±ΡΠ»Π°ΡΠΎΡΠ½ΠΈ ΠΈ Ρ
ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·ΠΈΡΠ°Π½ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ Π² Π΄Π΅ΡΡΠΊΠ° Π²ΡΠ·ΡΠ°ΡΡ - Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΡΡΠΈΠΊΠ° ΠΈ Π΅ΠΏΠΈΠ΄Π΅ΠΌΠΈΠΎΠ»ΠΎΠ³ΠΈΡ". ΠΠ²ΡΠΎΡ Π½Π° ΡΠ°Π·ΡΠ°Π±ΠΎΡΠΊΠ°ΡΠ° Π΅ ΠΠ΅Π»ΠΈ ΠΠΈΡΠΊΠΎΠ²Π° ΠΠΎΠ΄ΠΎΠ·ΠΎΠ²Π°, ΠΏΡΠ΅ΠΏΠΎΠ΄Π°Π²Π°ΡΠ΅Π» Π² ΠΠ£-ΠΠ°ΡΠ½Π°, ΠΏΠΎΠ΄ ΡΡΠΊΠΎΠ²ΠΎΠ΄ΡΡΠ²ΠΎΡΠΎ Π½Π° ΠΏΡΠΎΡ. Π΄-Ρ ΠΡΠ°ΡΠΈΠΌΠΈΡ ΠΠ΅ΡΠΎΠ΄ΠΈΠ΅Π² (ΠΠ£-ΠΠ°ΡΠ½Π°) ΠΈ Π΄ΠΎΡ. Π΄-Ρ ΠΠΈΠΌΠΈΡΡΠΈΡΠΊΠ° ΠΠ»ΠΈΠ·Π½Π°ΠΊΠΎΠ²Π° (ΠΠ£-ΠΠ°ΡΠ½Π°). ΠΠΈΡΠ΅ΡΡΠ°ΡΠΈΠΎΠ½Π½ΠΈΡ ΡΡΡΠ΄ Π²ΠΊΠ»ΡΡΠ²Π° 15 ΡΠ°Π·Π΄Π΅Π»Π°, 120 Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΠ½ΠΈ ΠΈΠ·ΡΠΎΡΠ½ΠΈΠΊΠ°, ΠΊΠ°ΡΠΎ Π³ΠΎΠ»ΡΠΌΠ°ΡΠ° ΡΠ°ΡΡ ΠΎΡ ΡΠΈΡΠΈΡΠ°Π½ΠΈΡΠ΅ ΠΏΡΠ±Π»ΠΈΠΊΠ°ΡΠΈΠΈ ΡΠ° ΠΎΡ ΠΏΠΎΡΠ»Π΅Π΄Π½ΠΈ 10 Π³ΠΎΠ΄ΠΈΠ½ΠΈ. ΠΠ½Π°ΡΠΈΡΠ΅Π»Π½ΠΎ Π²Π½ΠΈΠΌΠ°Π½ΠΈΠ΅ Π΅ ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΎ Π½Π° Π½Π°ΡΡΠ½ΠΈΡΠ΅ ΡΡΡΠ΄ΠΎΠ²Π΅ Π½Π° Π²ΠΎΠ΄Π΅ΡΠΈΡΠ΅ Π±ΡΠ»Π³Π°ΡΡΠΊΠΈ ΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΡΡΠΈ ΡΠ°Π±ΠΎΡΠΈΠ»ΠΈ ΠΏΠΎ ΠΏΡΠΎΠ±Π»Π΅ΠΌΠ°. ΠΠ° ΡΠ΅Π»ΠΈΡΠ΅ Π½Π° Π΄ΠΈΡΠ΅ΡΡΠ°ΡΠΈΠΎΠ½Π½ΠΈΡ ΡΡΡΠ΄ ΡΠ° Π·Π°ΠΈΠΌΡΡΠ²Π°Π½ΠΈ 4 204 Π±ΡΠΎΡ ΡΡΠΈΠ½Π½ΠΈ ΠΏΡΠΎΠ±ΠΈ ΠΎΡ ΡΡΠΈ ΠΌΠ΅Π΄ΠΈΠΊΠΎ-Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ½ΠΈ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠΈΠΈ Π½Π° ΡΠ΅ΡΠΈΡΠΎΡΠΈΡΡΠ° Π½Π° Π³ΡΠ°Π΄ ΠΠ°ΡΠ½Π° β βΠΠ°Π±ΠΎΡΠ΅ΠΊΡΠΏΡΠ΅Ρ 2000β, βΠ‘Π². ΠΠ½Π½Π°β, βΠ ΠΠ β ΠΠ°ΡΠ½Π°β. ΠΡΠΎΠ±ΠΈΡΠ΅ ΡΠ° ΠΎΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ Π² Π΄Π΅ΡΡΠΊΠ° Π²ΡΠ·ΡΠ°ΡΡ - Π΄ΠΎ 18 Π³ΠΎΠ΄ΠΈΠ½ΠΈ ΠΈ Π²Π·Π΅ΡΠΈ Π² ΠΏΠ΅ΡΠΈΠΎΠ΄Π° 2010-2012 Π³ΠΎΠ΄ΠΈΠ½Π°. ΠΡΡΠ²Π°ΡΠ° ΡΠ°ΡΡ Π½Π° ΡΠ°Π·ΡΠ°Π±ΠΎΡΠΊΠ°ΡΠ° Π΅ ΠΏΠΎΠ΄ΡΠΎΠ±Π΅Π½ Π»ΠΈΡΠ΅ΡΠ°ΡΡΡΠ΅Π½ ΠΎΠ±Π·ΠΎΡ, ΠΊΠΎΠΉΡΠΎ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Ρ Π°Π½Π°ΡΠΎΠΌΠΈΡΠ½ΠΈΡΠ΅ ΠΎΡΠΎΠ±Π΅Π½ΠΎΡΡΠΈ Π½Π° ΠΎΡΠ΄Π΅Π»ΠΈΡΠ΅Π»Π½Π°ΡΠ° ΡΠΈΡΡΠ΅ΠΌΠ°, ΠΎΡΠ½ΠΎΠ²Π½ΠΈΡΠ΅ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΡΡΠΈΠΊΠΈ Π½Π° ΡΡΠΎΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈΡΠ΅ ΠΈ ΡΠ΅Ρ
Π½ΠΈΡΠ΅ ΠΏΡΠΈΡΠΈΠ½ΠΈΡΠ΅Π»ΠΈ, ΡΡΡΠ½ΠΎΡΡ Π½Π° ΡΠΈΡΠΎΠΊΠΎΡΠΏΠ΅ΠΊΡΡΡΠ½ΠΈΡΠ΅ Π±Π΅ΡΠ°-Π»Π°ΠΊΡΠ°ΠΌΠ°Π·Π° ΠΏΡΠΎΠΈΠ·Π²Π΅ΠΆΠ΄Π°ΡΠΈΡΠ΅ ΠΌΠΈΠΊΡΠΎΠΎΡΠ³Π°Π½ΠΈΠ·ΠΌΠΈ (ESBLs), ΠΊΠ°ΠΊΡΠΎ ΠΈ ΡΡΡ
Π½ΠΎΡΠΎ ΡΠ°Π·ΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½ΠΈΠ΅ Π² ΡΠ²Π΅ΡΠ°, Π² ΠΠ²ΡΠΎΠΏΠ° ΠΈ Π² ΠΡΠ»Π³Π°ΡΠΈΡ. Π ΡΠ°Π·ΡΠ°Π±ΠΎΡΠΊΠ°ΡΠ° ΡΠ° Π·Π°Π»ΠΎΠΆΠ΅Π½ΠΈ ΠΈ ΠΈΠ·ΠΏΡΠ»Π½Π΅Π½ΠΈ Π·Π°Π΄Π°ΡΠΈΡΠ΅ Π΄Π° ΡΠ΅ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΠΈΡΠ°Ρ ΠΊΠΎΠ½ΠΊΡΠ΅ΡΠ½ΠΈΡΠ΅ Π°Π½ΡΠΈΠ±ΠΈΠΎΡΠΈΡΠ½ΠΈ ΠΏΡΠ΅ΠΏΠ°ΡΠ°ΡΠΈ ΠΈ Ξ²-Π»Π°ΠΊΡΠ°ΠΌΠ½Π°ΡΠ° Π³ΡΡΠΏΠ°, ΠΊΡΠΌ ΠΊΠΎΡΡΠΎ ΡΠΏΠ°Π΄Π°Ρ, ΠΊΠΎΠΈΡΠΎ Π½Π΅ ΡΠ° Π΅ΡΠ΅ΠΊΡΠΈΠ²Π½ΠΈ ΡΠΏΡΡΠΌΠΎ ESBL-ΡΠ°ΠΌΠΎΠ²Π΅ΡΠ΅ ΠΈ ΡΡΠΎΡΠ²Π΅ΡΠ½ΠΎ ΡΠ΅Π·ΠΈ, ΠΊΠΎΠΈΡΠΎ Π²ΡΠ΅ ΠΎΡΠ΅ ΠΌΠΎΠ³Π°Ρ Π΅ΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎ Π΄Π° ΡΠ΅ ΠΏΡΠΈΠ»Π°Π³Π°Ρ Π² Π±ΠΎΡΠ±Π°ΡΠ° Ρ ΡΠ΅Π·ΠΈ Π±Π°ΠΊΡΠ΅ΡΠΈΠΈ, ΠΊΠ°ΠΊΡΠΎ ΠΈ Π΄Π° ΡΠ΅ ΠΏΡΠ΅Π΄ΡΡΠ°Π²ΠΈ Π·Π°Π±ΠΎΠ»ΡΠ²Π°Π΅ΠΌΠΎΡΡΡΠ° Π½Π° ΡΡΠΎΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈΡΠ΅ ΠΏΡΠΈ Π΄Π΅ΡΠ°, ΠΏΡΠΈΡΠΈΠ½Π΅Π½ΠΈ ΠΎΡ ESBL-ΠΏΡΠΎΠ΄ΡΡΠΈΡΠ°ΡΠΈ ΠΌΠΈΠΊΡΠΎΠΎΡΠ³Π°Π½ΠΈΠ·ΠΌΠΈ ΠΎΡ ΡΠ΅ΠΌ. Enterobacteriaceae, ΠΏΠΎ Π½ΡΠΊΠΎΠ»ΠΊΠΎ Π΅ΠΏΠΈΠ΄Π΅ΠΌΠΈoΠ»ΠΎΠ³ΠΈΡΠ½ΠΈ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π° β ΠΏΠΎΠ»ΠΎΠ²Π° ΠΈ Π²ΡΠ·ΡΠ°ΡΡΠΎΠ²Π° ΡΡΡΡΠΊΡΡΡΠ°, Π²ΠΈΠ΄ Π½Π° ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ·Π½ΠΈΡ ΠΏΡΠΈΡΠΈΠ½ΠΈΡΠ΅Π». ΠΠΎΠ»ΡΡΠ΅Π½ΠΈΡΠ΅ ΡΠ΅Π·ΡΠ»ΡΠ°ΡΠΈ ΠΈ ΡΡΡ
Π½ΠΎΡΠΎ ΠΎΠ±ΡΡΠΆΠ΄Π°Π½Π΅ ΡΠ° ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π΅Π½ΠΈ Π² ΡΠ»Π΅Π΄Π½ΠΈΡΠ΅ ΡΠ°Π·Π΄Π΅Π»ΠΈ β ΠΎΠ±ΡΠΈ Π΄Π°Π½Π½ΠΈ, ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»Π½ΠΈ Π·Π° Π½Π°Π»ΠΈΡΠΈΠ΅ Π½Π° ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ·Π΅Π½ ΠΏΡΠΈΡΠΈΠ½ΠΈΡΠ΅Π» ΠΏΡΠΎΠ±ΠΈ ΡΡΠΈΠ½Π°, ΠΎΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈ ESBL-ΡΠ°ΠΌΠΎΠ²Π΅ ΠΎΡ Π²ΡΠΈΡΠΊΠΈ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»Π½ΠΈ ΠΏΡΠΎΠ±ΠΈ, ΡΠ°Π·ΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠ΅ ΠΏΠΎ ΠΏΠΎΠ», ΡΠ°Π·ΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠ΅ ΠΏΠΎ Π²ΡΠ·ΡΠ°ΡΡΠΎΠ²ΠΈ Π³ΡΡΠΏΠΈ ΠΈ ΠΏΠΎ Π°Π½ΡΠΈΠ±ΠΈΠΎΡΠΈΡΠ½Π° ΡΠ΅Π·ΠΈΡΡΠ΅Π½ΡΠ½ΠΎΡΡ. Π Π΅Π·ΡΠ»ΡΠ°ΡΠΈ ΡΠ° ΡΠ°Π·ΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈ Π² ΡΡΠΈ Π³ΡΡΠΏΠΈ, ΡΡΠΎΡΠ²Π΅ΡΠ½ΠΎ Π½Π° ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½ΠΈΡΡΠ° Π½Π° ΠΏΡΠΎΠ±ΠΈΡΠ΅ Π² ΡΡΠΈΡΠ΅ Π²ΠΈΠ·ΠΈΡΠ°Π½ΠΈ ΠΏΠΎ-Π³ΠΎΡΠ΅ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠΈΠΈ: ΡΠ°ΠΊΠ° Π½Π°ΠΏΡΠΈΠΌΠ΅Ρ, Π² ΠΠΠ βΠΠ°Π±ΠΎΡΠ΅ΠΊΡΠΏΡΠ΅Ρ 2000β, ΠΎΡ ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½ΠΈΡΠ΅ Π·Π° ΠΏΠ΅ΡΠΈΠΎΠ΄Π° 3 702 ΠΏΡΠΎΠ±ΠΈ ΡΡΠΈΠ½Π° ΠΎΡ Π΄Π΅ΡΠ°, 719 ΡΠ° ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»Π½ΠΈ Π·Π° Π½Π°Π»ΠΈΡΠΈΠ΅ Π½Π° ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ·Π΅Π½ ΠΏΡΠΈΡΠΈΠ½ΠΈΡΠ΅Π», ΠΊΠΎΠ΅ΡΠΎ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ²Π° 19% ΠΎΡ ΡΡΡ
. ΠΡ 353 ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½ΠΈ ΠΏΡΠΎΠ±ΠΈ Π² Π£Π½ΠΈΠ². Π±ΠΎΠ»Π½ΠΈΡΠ° βΠ‘Π². ΠΠ½Π½Π°β, 85 ΡΠ° ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»Π½ΠΈ ΠΏΠΎ ΡΡΡΠΈΡ ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π», Ρ.Π΅. 24%, Π° Π² Π ΠΠ-ΠΠ°ΡΠ½Π°, ΠΎΡ 149 ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½ΠΈ ΠΏΡΠΎΠ±ΠΈ, 30 ΡΠ° ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»Π½ΠΈ β 20%. Π’ΠΎΠ΅ΡΡ, ΠΈΠΌΠ° Π΅Π΄ΠΈΠ½ ΡΠ΅Π»Π°ΡΠΈΠ²Π½ΠΎ ΠΏΠΎΡΡΠΎΡΠ½Π΅Π½ ΠΏΡΠΎΡΠ΅Π½Ρ (Ρ ΠΌΠΈΠ½ΠΈΠΌΠ°Π»Π½ΠΈ ΠΎΡΠΊΠ»ΠΎΠ½Π΅Π½ΠΈΡ, ΠΎΡ 19% Π΄ΠΎ 24%) Π½Π° ΠΎΡΡΠ΅ΡΠ΅Π½ΠΈΡΠ΅ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»Π½ΠΈ ΡΠ΅ΡΡΠΎΠ²Π΅ Π² ΠΎΡΠ΄Π΅Π»Π½ΠΈΡΠ΅ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠΈΠΈ. Π£ΡΡΠ°Π½ΠΎΠ²Π΅Π½ΠΎ Π΅ ΡΠ°Π·Π»ΠΈΡΠΈΠ΅ ΠΏΠΎ ΠΏΠΎΠ» ΠΏΡΠΈ ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½ΠΈΡΠ΅ ΠΏΡΠΎΠ±ΠΈ Π½Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈΡΠ΅ Π² ΠΎΡΠ΄Π΅Π»Π½ΠΈΡΠ΅ ΠΌΠ΅Π΄ΠΈΡΠΈΠ½ΡΠΊΠΈ Π·Π°Π²Π΅Π΄Π΅Π½ΠΈΡ. ΠΡ ΠΎΠ±ΡΠΎ 493 ΠΌΠΎΠΌΠΈΡΠ΅ΡΠ° Ρ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»Π½Π° ΡΡΠΈΠ½Π½Π° ΠΏΡΠΎΠ±Π° Π·Π° ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡ, ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½ΠΈ Π² ΡΡΠΈΡΠ΅ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠΈΠΈ, 32 ΡΠ° ESBLs, ΠΊΠΎΠ΅ΡΠΎ Π΅ 6,5 %, Π° ΠΏΡΠΈ ΠΌΠΎΠΌΡΠ΅ΡΠ°ΡΠ° β ΠΎΡ 340 ΠΏΡΠΎΠ±ΠΈ, 16 ΡΠ° Ρ Π΄ΠΎΠΊΠ°Π·Π°Π½ΠΈ ΠΌΡΠ»ΡΠΈΡΠ΅Π·ΠΈΡΡΠ΅Π½ΡΠ½ΠΈ ΡΠ°ΠΌΠΎΠ²Π΅ ΠΎΡ Π²ΠΈΠ΄Π°, Ρ.Π΅. 4,7 %. ΠΡΠ΅Π΄ΡΡΠ°Π²Π΅Π½ Π΅ Π°Π½Π°Π»ΠΈΠ· Π½Π° ΠΎΡΠΊΠ»ΠΎΠ½Π΅Π½ΠΈΡΡΠ° Π² ΡΠ²Π΅Π»ΠΈΡΠ°Π²Π°Π½Π΅ ΠΈΠ»ΠΈ Π½Π°ΠΌΠ°Π»ΡΠ²Π°Π½Π΅ Π½Π° ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»Π½ΠΈΡΠ΅ ΠΏΡΠΎΠ±ΠΈ ΠΈ ΡΠ°Π·ΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠ΅ΡΠΎ ΠΈΠΌ ΠΏΠΎ ΠΏΠΎΠ» Π² ΠΎΡΠ΄Π΅Π»Π½ΠΈΡΠ΅ ΡΡΠΈ Π³ΠΎΠ΄ΠΈΠ½ΠΈ Π½Π° ΠΏΡΠΎΡΡΠ²Π°Π½Π΅ΡΠΎ, ΠΊΠ°ΡΠΎ ΡΡΡΠ°Π½ΠΎΠ²ΡΠ²Π° ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠ° Π΄ΠΎΡΡΠΎΠ²Π΅ΡΠ½ΠΎΡΡ Π½Π° ΡΠ°Π·Π»ΠΈΠΊΠΈΡΠ΅ Π² ΡΡΠΈΡΠ΅ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠΈΠΈ. Π Π°Π·ΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠ΅ΡΠΎ ΠΏΠΎ Π²ΡΠ·ΡΠ°ΡΡΠΎΠ²ΠΈ Π³ΡΡΠΏΠΈ ΡΡΡΠΎ Π΄Π°Π²Π° Π΅Π΄Π½Π° ΠΌΠ½ΠΎΠ³ΠΎ ΡΡΠ½ΠΎ ΠΏΠΎΠ΄ΡΠ΅ΡΡΠ°Π½Π° ΠΊΠ°ΡΡΠΈΠ½Π°: Π΄Π°Π½Π½ΠΈΡΠ΅ ΠΈ ΠΎΡ ΡΡΠΈΡΠ΅ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠΈΠΈ ΡΠΎΡΠ°Ρ, ΡΠ΅ Π½Π°ΠΉ-Π³ΠΎΠ»ΡΠΌ Π΄ΡΠ» ΠΈΠΌΠ°Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈΡΠ΅ Π²ΡΠ² Π²ΡΠ·ΡΠ°ΡΡΠΎΠ²Π°ΡΠ° Π³ΡΡΠΏΠ° ΠΌΠ΅ΠΆΠ΄Ρ 1-3 Π³ΠΎΠ΄ΠΈΠ½ΠΈ. Π ΠΠΠ βΠΠ°Π±ΠΎΡΠ΅ΠΊΡΠΏΡΠ΅Ρβ ΡΠ΅ ΡΠ° 224 ΠΎΡ 719 Π΄ΡΡΠΈ (31 %), Π² Π£Π½ΠΈΠ². Π±ΠΎΠ»Π½ΠΈΡΠ° βΠ‘Π². ΠΠ½Π½Π°β β 28 ΠΎΡ 85 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° Ρ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»Π½Π° ΠΏΡΠΎΠ±Π° Π·Π° ΡΡΠΎΠΈΠ½ΡΠ΅ΠΊΡΠΈΡ, Ρ.Π΅. 32 %, Π° Π² Π ΠΠ-ΠΠ°ΡΠ½Π° β 12 ΠΎΡ 30 Π΄ΡΡΠΈ ( 40 % ΠΎΡ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»Π½ΠΈΡΠ΅ ΠΏΡΠΎΠ±ΠΈ ΡΡΠΈΠ½Π°). ΠΠ½Π°Π»ΠΈΠ·ΠΈΡΠ°ΠΉΠΊΠΈ Π΄Π°Π½Π½ΠΈΡΠ΅ ΠΎΡ ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½ΠΈΡΡΠ° Π² ΡΡΠΈΡΠ΅ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠΈΠΈ, Π΅ ΠΎΡΡΠ΅ΡΠ΅Π½ ΡΠ°Π·Π½ΠΎΠΎΠ±ΡΠ°Π·Π΅Π½ Π½Π°Π±ΠΎΡ ΠΎΡ ΠΌΠΈΠΊΡΠΎΠΎΡΠ³Π°Π½ΠΈΠ·ΠΌΠΈ, ΡΡΡΠ°Π½ΠΎΠ²Π΅Π½ΠΈ Π² ΠΏΡΠΎΠ±ΠΈΡΠ΅. ΠΠ°ΠΉ-ΠΎΠ±ΡΠΎ ΠΌΠΎΠΆΠ΅ Π΄Π° ΡΠ΅ ΠΏΠΎΡΠΎΡΠΈ, ΡΠ΅ ΠΌΠΈΠΊΡΠΎΠΎΡΠ³Π°Π½ΠΈΠ·ΠΌΠΈΡΠ΅ ΡΠ° Π³Π»Π°Π²Π½ΠΎ ΠΡΠ°ΠΌ-ΠΎΡΡΠΈΡΠ°ΡΠ΅Π»Π½ΠΈ Π±Π°ΠΊΡΠ΅ΡΠΈΠΈ, ΠΊΠ°ΡΠΎ E. coli, Proteus spp., Klebsiella spp., ΡΠ° Ρ Π½Π°ΠΉ-Π²ΠΈΡΠΎΠΊ Π΄ΡΠ», ΠΊΠ°ΡΠΎ ΡΠΎΠ²Π° ΠΏΠΎΠ΄ΠΊΡΠ΅ΠΏΡ ΡΠ΅Π·ΡΠ»ΡΠ°ΡΠΈΡΠ΅ Π½Π° ΡΠ΅Π΄ΠΈΡΠ° Π΄ΡΡΠ³ΠΈ ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½ΠΈΡ, ΡΠ°Π·ΡΠ°Π±ΠΎΡΠ²Π°Π½ΠΈ ΠΎΡ Π΄ΡΡΠ³ΠΈ Π°Π²ΡΠΎΡΠΈ. Π’ΡΠΉ ΠΊΠ°ΡΠΎ ΠΎΡΠ½ΠΎΠ²Π½Π°ΡΠ° ΡΠ΅Π» Π½Π° Π΄ΠΈΡΠ΅ΡΡΠ°ΡΠΈΠΎΠ½Π½Π°ΡΠ° ΡΠ°Π±ΠΎΡΠ° Π΅ ΡΠΈΡΠΎΠΊΠΎΡΠΏΠ΅ΠΊΡΡΡΠ½ΠΈΡΠ΅ Ξ²-Π»Π°ΠΊΡΠ°ΠΌΠ°Π·Π° ΠΏΡΠΎΠΈΠ·Π²Π΅ΠΆΠ΄Π°ΡΠΈ ΠΌΠΈΠΊΡΠΎΠΎΡΠ³Π°Π½ΠΈΠ·ΠΌΠΈ (ESBLs), ΡΠΎ ΡΡΡ
Π½ΠΎΡΠΎ ΡΠ°Π·ΠΏΡΠ΅Π΄Π΅Π»Π΅Π½ΠΈΠ΅ ΠΏΠΎ ΡΡΠΎΡΠ²Π΅ΡΠ½ΠΈΡ Π²ΠΈΠ΄ Π½Π° ΠΌΠΈΠΊΡΠΎΠΎΡΠ³Π°Π½ΠΈΠ·ΠΌΠ° ΠΈΠΌΠ° ΠΎΡΠΎΠ±Π΅Π½ΠΎ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅. ΠΠΊΡΠ΅Π½ΡΠΈΡΠ° ΡΠ΅ Π²ΡΡΡ
Ρ ΡΠ°ΠΊΡΠ°, ΡΠ΅ Π² 48-ΡΠ΅ ESBL- ΠΈΠ·ΠΎΠ»Π°ΡΠ°, ΡΡΡΠ°Π½ΠΎΠ²Π΅Π½ΠΈ Π² ΠΎΠ±ΡΠΈΡ Π±ΡΠΎΠΉ ΠΏΡΠΎΠ±ΠΈ ΡΡΠΈΠ½Π°, Π½Π°ΠΉ-Π³ΠΎΠ»ΡΠΌ Π±ΡΠΎΠΉ ΡΠ° ΡΠ΅Π·ΠΈ Ρ E. coli β 22 (ΡΠΈΠΈΡΠΎ Π΄ΡΠ» Π² % ΠΎΡΠ³ΠΎΠ²Π°ΡΡ Π½Π° 45 % ΠΎΡ Π²ΡΠΈΡΠΊΠΈ Π΄Π΅ΡΠ΅ΠΊΡΠΈΡΠ°Π½ΠΈ ΡΠΈΡΠΎΠΊΠΎΡΠΏΠ΅ΠΊΡΡΡΠ½ΠΈ Π±Π΅ΡΠ°-Π»Π°ΠΊΡΠ°ΠΌΠ°Π·Π°- ΡΡΠ΄ΡΡΠΆΠ°ΡΠΈ ΠΌΠΈΠΊΡΠΎΠΎΡΠ³Π°Π½ΠΈΠ·ΠΌΠΈ Π² ΡΡΠΈΡΠ΅ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠΈΠΈ Π·Π° ΠΏΠ΅ΡΠΈΠΎΠ΄Π°), ΡΠ»Π΅Π΄Π²Π°Π½ΠΈ ΠΎΡ 14 Π±ΡΠΎΡ K. pneumoniae (29 % ΠΎΡ ESBLs), 5 E. aerogenes (10 %), 4 K. oxytoca (8 %), 2 E. cloacae (4 %) ΠΈ 1 M. morganii (2 %). ΠΡΡΠΈΡΠ°ΠΉΠΊΠΈ Π΄Π°Π½Π½ΠΈΡΠ΅, ΠΏΠΎΠ»ΡΡΠ΅Π½ΠΈ ΠΎΡ ΡΡΡΠ°Π½ΠΎΠ²ΡΠ²Π°Π½Π΅ΡΠΎ Π½Π° ESBL-ΠΈΠ·ΠΎΠ»Π°ΡΠΈΡΠ΅, Π°Π²ΡΠΎΡΡΡ ΡΡΠΈΠ³Π° Π΄ΠΎ ΡΠ»Π΅Π΄Π½ΠΈΡΠ΅ ΠΈΠ·Π²ΠΎΠ΄ΠΈ: E. coli ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ²Π°Ρ ΠΏΠΎΡΡΠΈ ΠΏΠΎΠ»ΠΎΠ²ΠΈΠ½Π°ΡΠ° ΠΎΡ Π²ΡΠΈΡΠΊΠΈ ΠΈΠ·ΠΎΠ»ΠΈΡΠ°Π½ΠΈ Π±Π°ΠΊΡΠ΅ΡΠΈΠΈ, ΡΡΠ΄ΡΡΠΆΠ°ΡΠΈ ΡΠΈΡΠΎΠΊΠΎΡΠΏΠ΅ΠΊΡΡΡΠ½ΠΈ Π±Π΅ΡΠ°-Π»Π°ΠΊΡΠ°ΠΌΠ°Π·ΠΈ (47 %) ΠΈΠ»ΠΈ 22 ΠΈΠ·ΠΎΠ»Π°ΡΠ°. Π’Π°Π·ΠΈ ΡΡΠΎΠΉΠ½ΠΎΡΡ Π½Π° ESBLs ΠΏΡΠΈ Π²ΠΈΠ΄Π° ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ²Π° 5 % ΠΎΡ Π²ΡΠΈΡΠΊΠΈ Π΄Π΅ΡΠ΅ΠΊΡΠΈΡΠ°Π½ΠΈ E. coli, ΠΊΠ°ΡΠΎ ΠΏΡΠΈΡΠΈΠ½ΠΈΡΠ΅Π»ΠΈ Π½Π° ΡΡΠΎΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ ΠΏΡΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ Π² Π΄Π΅ΡΡΠΊΠ° Π²ΡΠ·ΡΠ°ΡΡ Π² ΡΡΠΈΡΠ΅ Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠΈΠΈ. K. pneumoniae Π΅ Π²ΡΠΎΡΠΈΡΡ Π½Π°ΠΉ-ΡΠ΅ΡΡΠΎ ΡΡΠ΅ΡΠ°Π½ ESBL-ΠΈΠ·ΠΎΠ»Π°Ρ, ΠΊΠΎΠΈΡΠΎ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ²Π° 29 % ΠΎΡ Π±Π΅ΡΠ°- Π»Π°ΠΊΡΠ°ΠΌΠ°Π·Π°-ΡΡΠ΄ΡΡΠΆΠ°ΡΠΈΡΠ΅ Π±Π°ΠΊΡΠ΅ΡΠΈΠΈ. ΠΡΡΠ°Π½Π°Π»ΠΈΡΠ΅ Π²ΠΈΠ΄ΠΎΠ²Π΅ Π±Π°ΠΊΡΠ΅ΡΠΈΠΈ, ΠΊΠΎΠΈΡΠΎ ΠΏΡΠ΅Π΄ΡΡΠ°Π²ΡΡ Π½Π°Π»ΠΈΡΠΈΠ΅ Π½Π° Π΅Π½Π·ΠΈΠΌΠ° Π±Π΅ΡΠ°-Π»Π°ΠΊΡΠ°ΠΌΠ°Π·Π° ΡΠ° E. aerogenes, K. oxytoca, E. cloacae ΠΈ M. morganii. Π‘ΠΌΠ΅ΡΠ΅Π½ΠΈΡΠ΅ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ, ΠΎΡ Π΄Π²Π°, ΠΈ ΡΡΠ΄ΠΊΠΎ ΡΡΠΈ ΠΌΠΈΠΊΡΠΎΠΎΡΠ³Π°Π½ΠΈΠ·ΠΌΠ°, ΠΎΡΠ½ΠΎΠ²ΠΎ Π΄Π°Π²Π°Ρ ΠΏΡΠΈΠΎΡΠΈΡΠ΅Ρ Π½Π° E. coli, ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π΅Π½ Π² 77% ΠΎΡ ΡΠ»ΡΡΠ°ΠΈΡΠ΅. ΠΠ±ΡΡΠΎΠΉΠ½ΠΎ Π΅ Π°Π½Π°Π»ΠΈΠ·ΠΈΡΠ°Π½Π° ΡΠ°ΡΡΡΠ° Ρ ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½Π°ΡΠ° Π°Π½ΡΠΈΠ±ΠΈΠΎΡΠΈΠΊ ΡΠ΅Π·ΠΈΡΡΠ΅Π½ΡΠ½ΠΎΡΡ, ΠΊΠ°ΡΠΎ Π·Π° ΡΠ΅Π»ΡΠ° ΡΠ΅Π·ΡΠ»ΡΠ°ΡΠΈΡΠ΅ ΡΠ° ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π΅Π½ΠΈ Ρ ΡΠ°Π±Π»ΠΈΡΠΈ, Π΄Π°Π²Π°ΡΠΈ ΠΎΡΠ»ΠΈΡΠ½Π° ΠΎΠ½Π°Π³Π»Π΅Π΄ΡΠ΅ΠΌΠΎΡΡ Π½Π° ΡΠΎΠ²Π°, ΠΊΠΎΠ΅ΡΠΎ Π΅ ΡΡΡΠ°Π½ΠΎΠ²Π΅Π½ΠΎ. Π Π·Π°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅, ΠΈΠ·Π²ΠΎΠ΄ΠΈ ΠΈ ΠΏΡΠ΅ΠΏΠΎΡΡΠΊΠΈ Π²ΠΊΠ»ΡΡΠ²Π°Ρ ΠΊΠΎΠ½ΠΊΡΠ΅ΡΠ½ΠΈ ΠΈΠ·Π²ΠΎΠ΄ΠΈ, ΠΊΠΎΠΈΡΠΎ ΡΠ° 14 Π½Π° Π±ΡΠΎΠΉ. ΠΠ° Π±Π°Π·Π°ΡΠ° Π½Π° ΡΡΠ±ΡΠ°Π½ΠΈΡΠ΅ ΠΈ ΠΎΠ±ΡΠ°Π±ΠΎΡΠ΅Π½ΠΈ Π΄Π°Π½Π½ΠΈ Π°Π²ΡΠΎΡΠ° Π΄Π°Π²Π° ΠΏΡΠ΅ΠΏΠΎΡΡΠΊΠΈ, ΠΊΠΎΠΈΡΠΎ ΡΠ° Π½Π°ΡΠΎΡΠ΅Π½ΠΈ ΠΊΡΠΌ Π·Π΄ΡΠ°Π²Π½ΠΈΡΠ΅ ΡΠ°Π±ΠΎΡΠ½ΠΈΡΠΈ, ΠΈΠΌΠ°ΡΠΈ ΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ ΠΊΡΠΌ Π΄Π΅ΡΠ΅ΠΊΡΠΈΡΡΠ° Π½Π° ESBL-ΡΡΠ΄ΡΡΠΆΠ°ΡΠΈΡΠ΅ Π±Π°ΠΊΡΠ΅ΡΠΈΠΈ, ΠΊΡΠΌ Π»Π΅ΠΊΠ°ΡΠΈΡΠ΅, ΠΊΠΎΠΈΡΠΎ Π½Π°Π·Π½Π°ΡΠ°Π²Π°Ρ ΡΡΠΎΡΠ²Π΅ΡΠ½ΠΎΡΠΎ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Π½Π° ΠΏΠ°ΡΠΈΠ΅Π½Ρ Ρ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠΈΡΠ°Π½Π° ΡΡΠΎΠΈΠ½ΡΠ΅ΠΊΡΠΈΡ, ΠΊΡΠΌ Π·Π²Π΅Π½Π°ΡΠ° Π½Π° Π·Π΄ΡΠ°Π²Π΅ΠΎΠΏΠ°Π·Π²Π°Π½Π΅ΡΠΎ, ΠΊΠΎΠΈΡΠΎ ΠΈΠΌΠ°Ρ Π·Π° ΡΠ΅Π» Π±ΠΎΡΠ±Π° Ρ Π°Π½ΡΠΈΠ±ΠΈΠΎΡΠΈΡΠ½Π°ΡΠ° ΡΠ΅Π·ΠΈΡΡΠ΅Π½ΡΠ½ΠΎΡΡ ΠΈ Π½Π΅ Π½Π° ΠΏΠΎΡΠ»Π΅Π΄Π½ΠΎ ΠΌΡΡΡΠΎ ΠΊΡΠΌ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈΡΠ΅ Ρ ΡΡΠΎΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ, ΠΊΠΎΠΈΡΠΎ ΡΡΡΠ±Π²Π° Π΄Π° ΡΠ° Π·Π°ΠΏΠΎΠ·Π½Π°ΡΠΈ Ρ ΡΠΈΡΠΊΠΎΠ²Π΅ΡΠ΅, ΠΊΠΎΠΈΡΠΎ ΠΊΡΠΈΠ΅ Π΅Π΄Π½ΠΎ Π½Π° ΠΏΡΡΠ² ΠΏΠΎΠ³Π»Π΅Π΄ Π±Π΅Π·ΠΎΠ±ΠΈΠ΄Π½ΠΎ ΡΠ°ΠΌΠΎΠ»Π΅ΡΠ΅Π½ΠΈΠ΅. ΠΡΠΈΠ½ΠΎΡΠΈΡΠ΅ Π½Π° Π΄ΠΈΡΠ΅ΡΡΠ°ΡΠΈΠΎΠ½Π½ΠΈΡ ΡΡΡΠ΄ ΠΎΡ ΠΎΡΠΎΠ±Π΅Π½Π° Π²Π°ΠΆΠ½ΠΎΡΡ ΡΠ° Π·Π° ΠΠ±ΡΠΈΠ½Π° ΠΠ°ΡΠ½Π°, ΠΊΡΠ΄Π΅ΡΠΎ ΠΆΠΈΠ²Π΅Π΅ ΠΈ ΡΠ°Π±ΠΎΡΠΈ Π°Π²ΡΠΎΡΡΡ Π½Π° Π΄ΠΈΡΠ΅ΡΡΠ°ΡΠΈΠΎΠ½Π½ΠΈΡ ΡΡΡΠ΄, ΠΈ ΠΊΡΠ΄Π΅ΡΠΎ ΠΈΠΌΠ° Π²ΡΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡ Π΄Π° Π΄Π°Π΄Π΅ ΡΠ²ΠΎΡΡΠ° Π΅ΠΊΡΠΏΠ΅ΡΡΠΈΠ·Π° Π·Π° ΠΏΠΎΠ΄ΠΎΠ±ΡΡΠ²Π°Π½Π΅ Π½Π° ΡΠΈΡΡΠ°ΡΠΈΡΡΠ° ΡΡΡ Π·Π°ΡΠ΅ΡΡΡΠ²Π°ΡΠΈΡΠ΅ ΡΡΠΎΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ Π² Π΄Π΅ΡΡΠΊΠ° Π²ΡΠ·ΡΠ°ΡΡ
HEPATITIS B INFECTION IN EASTERN REGIONS OF BULGARIA
Background: Bulgaria is a country of moderate endemicity for hepatitis B infection with 3-7% of the general population chronically infected with the virus. Since 1991, an obligatory vaccination has been implemented for all healthy newborns. As a result, twenty years later, hepatitis B prevalence is significantly reduced but viral hepatitides still represent an important public health problem that needs to be addressed especially in some ethno-religious and regional groups.
Purpose: No recent published data are available about hepatitis B circulation in Bulgaria and in its Eastern part particularly. In the current study, we analyze the epidemiological data on hepatitis B cases in easternmost Bulgarian regions and try to determine the possible risk, which the infection poses to public health in these regions.
Material/Methods: We performed a retrospective analysis (2008-2014) using epidemiological data from the National surveillance system for hepatitis B notification.
Results: The incidence of acute hepatitis B in all considered regions has been durably decreasing for the last seven years: while in 2014 its total value was 9,69%000, in 2014 it reached a minimal rate of 3,09%000. We found that young individuals in their 20s years (the borderline generation before and after implementation of mandatory vaccination) are most vulnerable to hepatitis B. South regions are also more affected by hepatitis B infection when compared with regions on the North.
Conclusions: We reported a stable downward trend in the incidence of hepatitis B infection in all studied regions of Bulgaria. This result can be directly linked with the presence of effective vaccination program at national level
KNOWLEDGE AND ATTITUDE TOWARDS HEPATITIS B AND HEPATITIS C AMONG DENTAL MEDICINE STUDENTS.
Background: Hepatitis B (HBV) and hepatitis C viruses (HCV) are highly contagious and important occupational hazard for health workers. Dental practice often includes direct contact with patientsβ body fluids and exposure at high degree to potentially HBV and HCV infected materials and instruments.
Purpose: The purpose of this study is to investigate the level of knowledge about hepatitis B and C infections and the attitude towards hepatitis B virus vaccination among Dental Medicine students.
Materials and Methods: A cross-sectional survey was conducted among 96 students of Faculty of Dental Medicine, Medical University of Varna in March, 2015. The questionnaire contained 22 questions divided into 4 major sections. SPSS ver.16 software package was used for statistical data processing.
Results: Most of the participants (82,3 %) considered hepatitis B and C as serious diseases and had positive attitude towards HBV vaccination (75 %). Almost 90 % considered that dental practice could enhance the risk of infection with HBV and HCV. Unfortunately, only 57,4 % of students knew their vaccination status and 13,9 % had checked HBV antibodiesβ level.
Conclusions: The majority of respondents demonstrated a high level of knowledge of HBV and HCV infections. All participants were aware about the risk of potential HBV and HCV transmission in their future practice and anticipated applying preventive measures at work. However, deeper information about HBV vaccination and checking anti HBs titer is still needed among dental students, as well continuous target education in the field