Organization of microbiologic monitoring in epidemiologic surveillance of community-acquired pneumonia

The article deals with the results of the microbiological monitoring during the observation of the patients with community-acquired pneumonia, who have been admitted to a hospital therapeutic department. The quantitative criteria for assessing the etiological significance of microorganisms isolated from sputum have been proposed. The microbial landscape in the presence of community-acquired pneumonia have been studied, the prevalence of the fungi of the genera Candida, Streptococcus spp. and Staphylococcus spp have been found. The differences in the etiological structure of pneumonia caused by monocultures and the microbial associations have been identified. The microbial associations including 2 to 4 microorganisms have been examined. While evaluating the susceptibility of pathogens to antibiotics a high proportion of multi-drug resistant strains has been established. The fact that the microbial associations demonstrate a higher prevalence of antibiotic resistance compared to monocultures has been proved. So, it has been established that the microbial associations manifest a greater stability and a higher resistance to the disinfectants compared to the single-associant microbes that form these associations. We have proved the efficacy of the microbiological monitoring organized along with the observation of patients according to the developed parameters. The ways of improving the microbiological monitoring system for epidemiological surveillance of communityacquired pneumonia have been suggested

ПРОБЛЕМНЫЕ ВОПРОСЫ СОЧЕТАННОСТИ КИШЕЧНЫХ ИНФЕКЦИЙ

The  article  presents the  possible combinations of intestinal   infections of  various   etiologies, some   pathogenetic, clinical  and  epidemiological features and  problems of epidemiological surveillance and  control  of  associated infections.  Details  the  combination of typhoid fever,  shigelloses, salmonelloses, yersiniosis, pseudotuberculosis, rotavirus and norovirus infections between itself  and  other  infectious and parasitic diseases. Discusses the clinical  and  epidemiological features different combinations of intestinal infections. It is shown  that  the proportion of combined intestinal infections  can reach  to 48.9±3.3% in the structure of all associated  infections. The proportion of combination of two intestinal  infections pathogens was  29,2±6,5%, 3 agents and 10,3±4,3% and  4 pathogens and  5,9±11,6 percent. In the overall structure of the combination of intestinal anthroponoses with anthroponoses was 61,9±5,3%, anthroponoses with zoonoses was 31,1±5,0%, the other combinations (zoonoses and  zoonoses, zoonoses and  sapronoses, antroponoses with zoonoses and  sapronoses) of  7,0±9,3  percent. The  article raises  the  question of  the  need to  introduce into  existing regulatory framework the  new  scientific data  on the  whole range of features of the epidemiology of intestinal infections combined.В статье представлены возможные  сочетания кишечных инфекций различной этиологии, некоторые патогенетические, клинико-эпидемиологические особенности, а также проблемы эпидемиологического надзора  и контроля за сочетанным инфекциями. Подробно представлены сочетания брюшного тифа,   шигеллеза, сальмонеллеза, иерсиниоза,  псевдотуберкулеза,  ротавирусной и норовирусной инфекций между собой  и другими инфекционными и паразитарными заболеваниями. Рассматриваются клинико-эпидемиологические особенности различных сочетаний кишечных инфекций. Показано, что удельный вес сочетанных кишечных инфекций может  достигать 48,9±3,3%  в  структуре всех  сочетанных инфекций. Удельный вес  сочетания 2 возбудителей кишечных инфекций составил 29,2±6,5%,  3 возбудителей – 10,3±4,3%, 4 возбудителей – 5,9±11,6%. В общей  структуре сочетания кишечных антропонозов с  другими антропонозами составили 61,9±5,3%,  антропонозов с зоонозами – 31,1±5,0%, другие сочетания (зооноз и зооноз, зооноз и сапроноз, антропоноз с зоонозом  и сапронозом) – 7,0±9,3%. В статье поднимается вопрос о необходимости внедрять в существующую нормативно-правовую базу  новые научные данные по всему  спектру особенностей эпидемиологии сочетанных кишечных инфекций

Evolution of the Seasonality of Shigelloses

The seasonality of shigellosis (bacillary dysentery) from the 20th century till nowadays in the Niznhiy Novgorod Region was compared with the data on the Russian Federation. The year dynamics was characterized by the transformation of the peak month from July (in the beginning of the 20th century) to the autumn and winter period (in the end of the 20th and beginning of the 21st century). We demonstrated the different statistical features of the shigellosis seasonality and its variations during more than hundred years. The range of variations per month decreased almost 20 times, the seasonality index dropped 8.3 times, the seasonality coefficient decreased almost 4 times. Thus, the different parameters of the shigellosis epidemiology were exposed to the significant evolutionary shifts. We critically estimated the opinions of different scientists concerning the factors that can influence the year dynamics of the dysentery morbidity rates. We also showed the need of the profound and complex studies of the evolutionary changes of shigelloses by different professionals

PROBLEMATIC ISSUES OF COMBINED INTESTINAL INFECTIONS

The  article  presents the  possible combinations of intestinal   infections of  various   etiologies, some   pathogenetic, clinical  and  epidemiological features and  problems of epidemiological surveillance and  control  of  associated infections.  Details  the  combination of typhoid fever,  shigelloses, salmonelloses, yersiniosis, pseudotuberculosis, rotavirus and norovirus infections between itself  and  other  infectious and parasitic diseases. Discusses the clinical  and  epidemiological features different combinations of intestinal infections. It is shown  that  the proportion of combined intestinal infections  can reach  to 48.9±3.3% in the structure of all associated  infections. The proportion of combination of two intestinal  infections pathogens was  29,2±6,5%, 3 agents and 10,3±4,3% and  4 pathogens and  5,9±11,6 percent. In the overall structure of the combination of intestinal anthroponoses with anthroponoses was 61,9±5,3%, anthroponoses with zoonoses was 31,1±5,0%, the other combinations (zoonoses and  zoonoses, zoonoses and  sapronoses, antroponoses with zoonoses and  sapronoses) of  7,0±9,3  percent. The  article raises  the  question of  the  need to  introduce into  existing regulatory framework the  new  scientific data  on the  whole range of features of the epidemiology of intestinal infections combined

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair

Importance Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors.Objective To ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR.Design, Setting, and Participants The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR.Exposure Open or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia.Main Outcomes and Measures The primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients.Results In total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72).Conclusions The findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies