Epidemiology and impact of colonization by multidrug-resistant Gram-negative bacteria on bloodstream infections in early phase of allogeneic hematopoietic stem cell transplantation

Objective. To study epidemiology and impact of colonization by multidrug-resistant Gram-negative bacteria (MDRGNB) on bloodstream infections (BSI) during allogeneic hematopoietic stem cell transplantation (allo-HSCT). Materials and Methods. The retrospective study included 288 patients received the first allo-HSCT between 2018 and 2019. The median age was 32 (18–66) years, male – 53% (n = 152). The majority of patients had acute leukemia – 62% (n = 178) and received transplant from matched unrelated – 42% (n = 120) or haploidentical donor – 26% (n = 75). Relapse of underlying disease at the moment of all-HSCT was registered in 23% (n = 66) of patients. Results. Colonization of non-sterile sites before allo-HSCT by at least one MDRGNB was detected in 28% (n = 64). In most cases resistance is due to extended spectrum beta-lactamases (ESBL) – 86% (n = 55), while carbapenemases in combination with ESBL were detected in 14% (n = 9) of patients. After allo-HSCT the colonization was significantly higher than before transplantation (n = 161, 56%, p = 0.001), mainly due to carbapenemase- and ESBL-producing bacteria – 73% (n = 118) (p = 0.001). BSI in the early period after transplantation developed in 26% (n = 76), and in 56% (n = 43) was caused by MDRGNB. The etiology of BSI included K. pneumoniae – 51% in mostly cases. The etiology of BSI was the same bacteria that colonized non-sterile sites 2 weeks before the detection bacteria in bloodstream in 69% (n = 30) patients. Colonization by MDRGNB was associated with the development of BSI (p < 0.0001). The 100-day overall survival (OS) after all-HSCT was significantly lower in patients with colonization of non-sterile sites by MDRGNB compared with patients without colonization (60.6% vs 88.2%, p = 0.001). Conclusions. Colonization of MDRGNB after allo-HSCT reached 56%. K. pneumoniae was predominant etiology in both colonization and bloodstream infections. Colonization by MDRGNB was associated with the development of BSI and decreased OS after allo-HSCT

Клинические особенности мальабсорбции белков и кобаламина у собак при протозоозной патологии

Diseases of the small intestine can lead to disruption of protein absorption, destruction of cobalamin receptors and impaired absorption of cobalamin. Etiological causes of malabsorption may be parasitic protozoa. The aim of the work was to assess the clinical changes in the biochemical parameters of blood and the level of cobalt-containing biologically active substances (vitamin B12) and folate (vitamin B9) infested by Giardia sp. and Cystoisospora sp. dogs. Evaluated the symptoms of disorders of the gastrointestinal tract. As a result of a study of 83 dogs with intestinal protozoa, 32 young dogs (72.7%) showed clinical signs of changes in feces consistency, while 12 dogs showed no such signs (27.3%). Among older dogs, 26 (66.6%) had diarrhea or other changes in the feces, and 13 (33.4%) had no changes with bowel movements. Dogs infected with intestinal protozoa had lower levels of urea, total protein, albumin and globulin, as well as cholesterol. The level of bile acids remained within the normal range. All dogs included in the experiment, the ratio of protein / creatinine urine remained in the normal range. In 84% (37 animals) of the studied dogs with a confirmed protozoa, the level of vitamin B12 was reduced with a minimum value of 102ng / L. Among dogs with confirmed giardiosis, a decrease was observed in 73.7% (14 heads), with isosporosis in 88.8% (16 goals), and with combined invasion in 100% of animals, a decrease in vitamin B12 was noted.Болезни тонкого кишечника могут привести к нарушению усвоения белка, разрушению кобаламиновых рецепторов и нарушению абсорбцию кобаламина. Этиологическими причинами мальабсорбции может служить паразитирование простейших. Целью работы явилась оценка клинических изменений биохимических показателей крови и уровня кобальтсодержащих биологически активных веществ (витамина BJ2) и фолата (витамина В9), инвазированных Giardia sp. и Cystoisospora sp. собак с учетом симптомов нарушения работы желудочно-кишечного тракта. В результате исследования 83 собак с кишечными простейшими у 32 молодых собак (72,7%) отмечены клинические признаки изменения консистенции стула, а у 12 собак такие признаки отсутствовали (27,3%). Среди пожилых собак у 26 (66,6%) была отмечена диарея или другие изменения стула, у 13 (33,4%) животных никаких изменений со стулом отмечено не было. У инвазированных кишечными простейшими собак отмечалось понижение уровня мочевины, общего белка, альбуминов и глобулина, а также холестерина. Уровень желчных кислот оставался в пределах нормы. У всех собак, включенных в опыт, соотношение белок/креатинин мочи оставалось в пределах референтных значений. У 84% (37 голов) исследованных собак с подтвержденными протозоозоми снижение уровня витамина BJ2 с минимальным значением 102ng/L. Среди собак с подтвержденным гиардиозом снижение отмечено у 73,7% (14 голов), при изоспорозе у 88,8% (16 голов), а при сочетанной инвазии у 100% животных отмечено понижение витамина BJ2