ЧАСТОТА РАЗВИТИЯ И СВОЙСТВА ВОЗБУДИТЕЛЕЙ ИНФЕКЦИОННЫХ ОСЛОЖНЕНИЙ У ПАЦИЕНТОВ, ПЕРЕНЕСШИХ ОРТОТОПИЧЕСКУЮ ТРАНСПЛАНТАЦИЮ ПЕЧЕНИ

A bacteriological study of 105 patients after orthotopic liver transplantation was conducted. The frequency and etiology of infectious complications and antibacterial sensitivity were analyzed. We established that isolated or associated infectious reactions developed in 24.8% of the surveyed patients. The C. albicans fungus was found to be the agent which caused most of the early infectious complications. Late complications were induced by the multiresistant gram-negative bacteria. Проведено бактериологическое обследование 105 пациентов, перенесших ортотопическую трансплан- тацию печени. Проанализированы частота развития инфекционных осложнений, спектр и чувствитель- ность к антибактериальным препаратам возбудителей осложнений. Установлено, что изолированные или ассоциированные инфекционные осложнения развились у 24,8% обследованных пациентов. Среди воз- будителей ранних инфекционных осложнений преобладали микромицеты С. albicans, поздних – полире- зистентные грамотрицательные бактерии.

Natural antimicrobial peptide complexes in the fighting of antibiotic resistant biofilms: Calliphora vicina medicinal maggots

Biofilms, sedimented microbial communities embedded in a biopolymer matrix cause vast majority of human bacterial infections and many severe complications such as chronic inflammatory diseases and cancer. Biofilms' resistance to the host immunity and antibiotics makes this kind of infection particularly intractable. Antimicrobial peptides (AMPs) are a ubiquitous facet of innate immunity in animals. However, AMPs activity was studied mainly on planktonic bacteria and little is known about their effects on biofilms. We studied structure and anti-biofilm activity of AMP complex produced by the maggots of blowfly Calliphora vicina living in environments extremely contaminated by biofilm-forming germs. The complex exhibits strong cell killing and matrix destroying activity against human pathogenic antibiotic resistant Escherichia coli, Staphylococcus aureus and Acinetobacter baumannii biofilms as well as non-toxicity to human immune cells. The complex was found to contain AMPs from defensin, cecropin, diptericin and proline-rich peptide families simultaneously expressed in response to bacterial infection and encoded by hundreds mRNA isoforms. All the families combine cell killing and matrix destruction mechanisms, but the ratio of these effects and antibacterial activity spectrum are specific to each family. These molecules dramatically extend the list of known anti-biofilm AMPs. However, pharmacological development of the complex as a whole can provide significant advantages compared with a conventional onecomponent approach. In particular, a similar level of activity against biofilm and planktonic bacteria (MBEC/MIC ratio) provides the complex advantage over conventional antibiotics. Available methods of the complex in situ and in vitro biosynthesis make this idea practicable.Russian Science Foundation, grant № 16-14-0004

РАННЯЯ ДИАГНОСТИКА ИНФЕКЦИОННЫХ ОСЛОЖНЕНИЙ У ПОСТРАДАВШИХ С ТЯЖЁЛЫМИ ТРАВМАМИ

In this study specific features of the etiological structure of infectiouscomplications occurring early in treatment of heavily injured patients is established and the need is demonstrated for bacteriological examination of clinicalmaterials according to a developed algorithm on the second or third day after admission to hospital, which contributes totimely isolation of etiological agents of infectiouscomplications, rational etiotropic antibacterial treatment and reduced mortality.В работе установлены особенности этиологической структуры инфекционных осложнений, возникающих в ранние сроки лечения у пострадавших с тяжёлыми травмами и доказана необходимость проведения бактериологических исследований клинического материала по разработанному алгоритму, начиная со вторых – третьих суток после поступления в стационар. Ранняя этиологическая диагностика позволяет своевременно выявлять возбудителей инфекционных осложнений и рационально проводить этиотропную антибактериальную терапию, улучшать исходы лечения раненых и пострадавших

Оптимизация стартовой эмпирической антибактериальной терапии у больных ВИЧ-инфекцией – пациентов специализированного стационара

Objective: to analyze the adequacy of the scheme of empirical antibiotic therapy in patients with complicated forms of HIV infection in a specialized hospital and propose a set of measures for its optimization.Materials and methods: Clinical and demographic characteristics, results of bacteriological studies, risk factors of infection with resistant and multiresistant pathogens were studied in patients with HIV infection at the stage of progression with infectious complications of bacterial etiology, and the adequacy of empirical antibiotic therapy was evaluated. Results: The analysis of bacterial infectious complications in 21 HIV-infected patients with advanced stages of the disease was carried out. It was established that the profiles of the starting ABT only in 47% of cases coincide with the results of the antibiogram. To increase the effectiveness of empirical antibacterial therapy, stratification of risk groups for the detection of multiresistant bacterial pathogens has been developed. The basis of stratification: the severity of immunodeficiency, the presence of previously conducted antibacterial therapy, the period and place of detection of infectious complications, the localization of the infectious process.Conclusion: the use in clinical practice of a differentiated approach to the appointment of antibacterial drugs for starting empirical therapy in patients with HIV infection can improve the quality of treatment of infectious complications in patients with immunosuppression.Цель: провести анализ адекватности схемы эмпирической антибактериальной терапии у больных с осложненными формами ВИЧ-инфекции в специализированном стационаре и предложить комплекс мероприятий по ее оптимизации.Материалы и методы: у больных ВИЧ-инфекцией в стадии прогрессирования с инфекционными осложнениями бактериальной этиологии изучены клинико-демографическая характеристика, результаты бактериологических исследований, факторы риска инфицирования резистентными и полирезистентными возбудителями, проведена оценка адекватности эмпирической антибактериальной терапии.Результаты: проведен анализ бактериальных инфекционных осложнений у 21 ВИЧ-инфицированного с поздними стадиями заболевания. Установлено, что профили стартовой АБТ только в 47% случаев совпадают с результатами антибиотикограммы. Для повышения эффективности эмпирической антибактериальной терапии разработана стратификация групп риска выявления полирезистентных бактериальных возбудителей. В основе стратификации: выраженность иммунодефицита, наличие ранее проводимой антибактериальной терапии, период и место выявления инфекционного осложнения, локализация инфекционного процесса.Заключение: использование в клинической практике дифференцированного подхода к назначению антибактериальных препаратов для стартовой эмпирической терапии у больных ВИЧ-инфекцией может повысить качество лечения инфекционных осложнений у пациентов с иммуносупрессией

INFECTIOUS COMPLICATIONS IN LIVER TRANSPLANT PATIENTS: MORBIDITY AND PATHOGEN CHARACTERISTICS

A bacteriological study of 105 patients after orthotopic liver transplantation was conducted. The frequency and etiology of infectious complications and antibacterial sensitivity were analyzed. We established that isolated or associated infectious reactions developed in 24.8% of the surveyed patients. The C. albicans fungus was found to be the agent which caused most of the early infectious complications. Late complications were induced by the multiresistant gram-negative bacteria

Early diagnostics of infectiouscomplications in injured persons with heavy traumas

In this study specific features of the etiological structure of infectiouscomplications occurring early in treatment of heavily injured patients is established and the need is demonstrated for bacteriological examination of clinicalmaterials according to a developed algorithm on the second or third day after admission to hospital, which contributes totimely isolation of etiological agents of infectiouscomplications, rational etiotropic antibacterial treatment and reduced mortality

Optimization of starting empirical antibacterial therapy in patients with HIV infection – specialized hospital patients

Objective: to analyze the adequacy of the scheme of empirical antibiotic therapy in patients with complicated forms of HIV infection in a specialized hospital and propose a set of measures for its optimization.Materials and methods: Clinical and demographic characteristics, results of bacteriological studies, risk factors of infection with resistant and multiresistant pathogens were studied in patients with HIV infection at the stage of progression with infectious complications of bacterial etiology, and the adequacy of empirical antibiotic therapy was evaluated. Results: The analysis of bacterial infectious complications in 21 HIV-infected patients with advanced stages of the disease was carried out. It was established that the profiles of the starting ABT only in 47% of cases coincide with the results of the antibiogram. To increase the effectiveness of empirical antibacterial therapy, stratification of risk groups for the detection of multiresistant bacterial pathogens has been developed. The basis of stratification: the severity of immunodeficiency, the presence of previously conducted antibacterial therapy, the period and place of detection of infectious complications, the localization of the infectious process.Conclusion: the use in clinical practice of a differentiated approach to the appointment of antibacterial drugs for starting empirical therapy in patients with HIV infection can improve the quality of treatment of infectious complications in patients with immunosuppression

THE SPECTRUM OF BACTEREMIA PATHOGENS IN PATIENTS WITH IMMUNE DEFICIENCY STATES OF VARIOUS ORIGINS

Abstract. A comparative analysis of the results of bacteriological study of blood samples obtained from 1608 patients with secondary immunodeficiency of different origins has been conducted. It was established that within the spectrum of pathogens of bacteremia in these onco-urological profile patients, enterobacteria was the predominant one. In post–liver transplantation patients micromycete was predominant, and for wounded patients and victims with serious injuries staphylococci were more often isolated

Comparative analysis of the results of bacteriological and chromato-mass-spectrometric studies of pleural exudate in patients with pleural empyema

The OBJECTIVE was to determine the possibility of using chromatography-mass spectrometry to select causal treatment for patients with pleural empyema.METHODS AND MATERIALS. The analysis of the results of examination and treatment of 207 patients with pleural empyema for the period from 2017 to 2018 was done. All patients underwent bacteriological examination, twenty patients from them underwent chromato-mass-spectrometric examination of pleural exudate.RESULTS. Patients were transferred to a specialized thoracic hospital from other medical institutions, where they received a course of empirical antibacterial therapy and drainage of the pleural cavity was performed. Bacteriological examination of the contents of the pleural cavity was positive in 112 (54.1 %) patients. The leading pathogens were gram-negative bacteria isolated from the contents of the pleural cavity in 45 % of patients with closed and 63.5 % – open pleural empyema. Polyantibiotic-resistant stocks of P. aeruginosa (30.4 %), K. pneumoniae (19.6 %) and A. baumannii (12.5 %) prevailed, which remained sensitive to polymyxin and, in some cases, to amikacin. In 25 (22.3 %) patients, micromycetes of the genus Candida were found. No growth of anaerobic microflora was detected. Chromato-mass-spectrometric examination of pleural exudate revealed markers of 30 taxa of bacteria, viruses and fungi that exceeded the norm by more than two times. Markers of gram-negative bacteria were not detected. The proportion of anaerobic microorganisms was 76.6 %, with the highest concentration found for bacteria of the genus Clostridium and Eubacterium.CONCLUSION. The choice of causal treatment for patients with pleural empyema is difficult due to the negative culturing from the contents of the pleural cavity in 45.9 % of patients, as well as the discordance between the results of bacteriological and chromato-mass-spectrometric studies. Diagnostic methods for detecting pathogens of pleural empyema require further improvement