7 research outputs found
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 (18β66) years, male β 53% (n = 152). The majority of patients had acute leukemia β 62% (n = 178) and received transplant from matched unrelated β 42% (n = 120) or haploidentical donor β 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) β 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 β 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 β 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
ΠΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΠΈ ΠΌΠ°Π»ΡΠ°Π±ΡΠΎΡΠ±ΡΠΈΠΈ Π±Π΅Π»ΠΊΠΎΠ² ΠΈ ΠΊΠΎΠ±Π°Π»Π°ΠΌΠΈΠ½Π° Ρ ΡΠΎΠ±Π°ΠΊ ΠΏΡΠΈ ΠΏΡΠΎΡΠΎΠ·ΠΎΠΎΠ·Π½ΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ
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.ΠΠΎΠ»Π΅Π·Π½ΠΈ ΡΠΎΠ½ΠΊΠΎΠ³ΠΎ ΠΊΠΈΡΠ΅ΡΠ½ΠΈΠΊΠ° ΠΌΠΎΠ³ΡΡ ΠΏΡΠΈΠ²Π΅ΡΡΠΈ ΠΊ Π½Π°ΡΡΡΠ΅Π½ΠΈΡ ΡΡΠ²ΠΎΠ΅Π½ΠΈΡ Π±Π΅Π»ΠΊΠ°, ΡΠ°Π·ΡΡΡΠ΅Π½ΠΈΡ ΠΊΠΎΠ±Π°Π»Π°ΠΌΠΈΠ½ΠΎΠ²ΡΡ
ΡΠ΅ΡΠ΅ΠΏΡΠΎΡΠΎΠ² ΠΈ Π½Π°ΡΡΡΠ΅Π½ΠΈΡ Π°Π±ΡΠΎΡΠ±ΡΠΈΡ ΠΊΠΎΠ±Π°Π»Π°ΠΌΠΈΠ½Π°. ΠΡΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈΠΌΠΈ ΠΏΡΠΈΡΠΈΠ½Π°ΠΌΠΈ ΠΌΠ°Π»ΡΠ°Π±ΡΠΎΡΠ±ΡΠΈΠΈ ΠΌΠΎΠΆΠ΅Ρ ΡΠ»ΡΠΆΠΈΡΡ ΠΏΠ°ΡΠ°Π·ΠΈΡΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΠΏΡΠΎΡΡΠ΅ΠΉΡΠΈΡ
. Π¦Π΅Π»ΡΡ ΡΠ°Π±ΠΎΡΡ ΡΠ²ΠΈΠ»Π°ΡΡ ΠΎΡΠ΅Π½ΠΊΠ° ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠΉ Π±ΠΈΠΎΡ
ΠΈΠΌΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΠΎΠΊΠ°Π·Π°ΡΠ΅Π»Π΅ΠΉ ΠΊΡΠΎΠ²ΠΈ ΠΈ ΡΡΠΎΠ²Π½Ρ ΠΊΠΎΠ±Π°Π»ΡΡΡΠΎΠ΄Π΅ΡΠΆΠ°ΡΠΈΡ
Π±ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΈ Π°ΠΊΡΠΈΠ²Π½ΡΡ
Π²Π΅ΡΠ΅ΡΡΠ² (Π²ΠΈΡΠ°ΠΌΠΈΠ½Π° BJ2) ΠΈ ΡΠΎΠ»Π°ΡΠ° (Π²ΠΈΡΠ°ΠΌΠΈΠ½Π° Π9), ΠΈΠ½Π²Π°Π·ΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
Giardia sp. ΠΈ Cystoisospora sp. ΡΠΎΠ±Π°ΠΊ Ρ ΡΡΠ΅ΡΠΎΠΌ ΡΠΈΠΌΠΏΡΠΎΠΌΠΎΠ² Π½Π°ΡΡΡΠ΅Π½ΠΈΡ ΡΠ°Π±ΠΎΡΡ ΠΆΠ΅Π»ΡΠ΄ΠΎΡΠ½ΠΎ-ΠΊΠΈΡΠ΅ΡΠ½ΠΎΠ³ΠΎ ΡΡΠ°ΠΊΡΠ°. Π ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ 83 ΡΠΎΠ±Π°ΠΊ Ρ ΠΊΠΈΡΠ΅ΡΠ½ΡΠΌΠΈ ΠΏΡΠΎΡΡΠ΅ΠΉΡΠΈΠΌΠΈ Ρ 32 ΠΌΠΎΠ»ΠΎΠ΄ΡΡ
ΡΠΎΠ±Π°ΠΊ (72,7%) ΠΎΡΠΌΠ΅ΡΠ΅Π½Ρ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠ΅ ΠΏΡΠΈΠ·Π½Π°ΠΊΠΈ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ ΠΊΠΎΠ½ΡΠΈΡΡΠ΅Π½ΡΠΈΠΈ ΡΡΡΠ»Π°, Π° Ρ 12 ΡΠΎΠ±Π°ΠΊ ΡΠ°ΠΊΠΈΠ΅ ΠΏΡΠΈΠ·Π½Π°ΠΊΠΈ ΠΎΡΡΡΡΡΡΠ²ΠΎΠ²Π°Π»ΠΈ (27,3%). Π‘ΡΠ΅Π΄ΠΈ ΠΏΠΎΠΆΠΈΠ»ΡΡ
ΡΠΎΠ±Π°ΠΊ Ρ 26 (66,6%) Π±ΡΠ»Π° ΠΎΡΠΌΠ΅ΡΠ΅Π½Π° Π΄ΠΈΠ°ΡΠ΅Ρ ΠΈΠ»ΠΈ Π΄ΡΡΠ³ΠΈΠ΅ ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΡ ΡΡΡΠ»Π°, Ρ 13 (33,4%) ΠΆΠΈΠ²ΠΎΡΠ½ΡΡ
Π½ΠΈΠΊΠ°ΠΊΠΈΡ
ΠΈΠ·ΠΌΠ΅Π½Π΅Π½ΠΈΠΉ ΡΠΎ ΡΡΡΠ»ΠΎΠΌ ΠΎΡΠΌΠ΅ΡΠ΅Π½ΠΎ Π½Π΅ Π±ΡΠ»ΠΎ. Π£ ΠΈΠ½Π²Π°Π·ΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
ΠΊΠΈΡΠ΅ΡΠ½ΡΠΌΠΈ ΠΏΡΠΎΡΡΠ΅ΠΉΡΠΈΠΌΠΈ ΡΠΎΠ±Π°ΠΊ ΠΎΡΠΌΠ΅ΡΠ°Π»ΠΎΡΡ ΠΏΠΎΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ ΡΡΠΎΠ²Π½Ρ ΠΌΠΎΡΠ΅Π²ΠΈΠ½Ρ, ΠΎΠ±ΡΠ΅Π³ΠΎ Π±Π΅Π»ΠΊΠ°, Π°Π»ΡΠ±ΡΠΌΠΈΠ½ΠΎΠ² ΠΈ Π³Π»ΠΎΠ±ΡΠ»ΠΈΠ½Π°, Π° ΡΠ°ΠΊΠΆΠ΅ Ρ
ΠΎΠ»Π΅ΡΡΠ΅ΡΠΈΠ½Π°. Π£ΡΠΎΠ²Π΅Π½Ρ ΠΆΠ΅Π»ΡΠ½ΡΡ
ΠΊΠΈΡΠ»ΠΎΡ ΠΎΡΡΠ°Π²Π°Π»ΡΡ Π² ΠΏΡΠ΅Π΄Π΅Π»Π°Ρ
Π½ΠΎΡΠΌΡ. Π£ Π²ΡΠ΅Ρ
ΡΠΎΠ±Π°ΠΊ, Π²ΠΊΠ»ΡΡΠ΅Π½Π½ΡΡ
Π² ΠΎΠΏΡΡ, ΡΠΎΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ Π±Π΅Π»ΠΎΠΊ/ΠΊΡΠ΅Π°ΡΠΈΠ½ΠΈΠ½ ΠΌΠΎΡΠΈ ΠΎΡΡΠ°Π²Π°Π»ΠΎΡΡ Π² ΠΏΡΠ΅Π΄Π΅Π»Π°Ρ
ΡΠ΅ΡΠ΅ΡΠ΅Π½ΡΠ½ΡΡ
Π·Π½Π°ΡΠ΅Π½ΠΈΠΉ. Π£ 84% (37 Π³ΠΎΠ»ΠΎΠ²) ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½Π½ΡΡ
ΡΠΎΠ±Π°ΠΊ Ρ ΠΏΠΎΠ΄ΡΠ²Π΅ΡΠΆΠ΄Π΅Π½Π½ΡΠΌΠΈ ΠΏΡΠΎΡΠΎΠ·ΠΎΠΎΠ·ΠΎΠΌΠΈ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ ΡΡΠΎΠ²Π½Ρ Π²ΠΈΡΠ°ΠΌΠΈΠ½Π° BJ2 Ρ ΠΌΠΈΠ½ΠΈΠΌΠ°Π»ΡΠ½ΡΠΌ Π·Π½Π°ΡΠ΅Π½ΠΈΠ΅ΠΌ 102ng/L. Π‘ΡΠ΅Π΄ΠΈ ΡΠΎΠ±Π°ΠΊ Ρ ΠΏΠΎΠ΄ΡΠ²Π΅ΡΠΆΠ΄Π΅Π½Π½ΡΠΌ Π³ΠΈΠ°ΡΠ΄ΠΈΠΎΠ·ΠΎΠΌ ΡΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ ΠΎΡΠΌΠ΅ΡΠ΅Π½ΠΎ Ρ 73,7% (14 Π³ΠΎΠ»ΠΎΠ²), ΠΏΡΠΈ ΠΈΠ·ΠΎΡΠΏΠΎΡΠΎΠ·Π΅ Ρ 88,8% (16 Π³ΠΎΠ»ΠΎΠ²), Π° ΠΏΡΠΈ ΡΠΎΡΠ΅ΡΠ°Π½Π½ΠΎΠΉ ΠΈΠ½Π²Π°Π·ΠΈΠΈ Ρ 100% ΠΆΠΈΠ²ΠΎΡΠ½ΡΡ
ΠΎΡΠΌΠ΅ΡΠ΅Π½ΠΎ ΠΏΠΎΠ½ΠΈΠΆΠ΅Π½ΠΈΠ΅ Π²ΠΈΡΠ°ΠΌΠΈΠ½Π° BJ2