Questions of terminology and systematization of new infections

Department of Epidemiology, State Medical Academy of Nijniy Novgorod, RussiaThe article is controversial and designed to give not only a certain holistic view of new infections occurring in the last 75 years, but also to initiate a discussion on this issue. The authors examine the issues of terminology, periodization and classification of new infections on the base of extensive factual material (the data about 208 new infections) and the works of Russian and foreign authors, in accordance with theoretic and practical fundamentals of modern epidemiology. While considering various terms and their definitions, the differences in the interpretations and understanding of the newness of the infections, possessing all the attributes of infectious diseases nosology, have been revealed. The authors have developed the following approaches to the systematization of the data on new infections: classification of new infections from a position of a “newness” of the infection; classification of new infections by the ways of their identifying; grouping the new infections on the base of a variety of epidemiological evidences; classification of the pathogens of new infections by their newness and the ways of their emergence; classification of the factors affecting the appearance of new infections. Based on the length of the generation life and a conventional change of generations as the new infections have appeared for the period from 1950, they are defined as the infections of 3 generations: new infections of “ancestors’ generation”, identified in the period of 1950-1975 (more than 100 nosologic forms); new infections of “parents’ generation”, identified in 1976-2000 (approximately 90 diseases); new infections of “children’s generation”, identified in 2001-2010 and those that will be identified until 2025 (15 nosologies for the time being). The proposed systematization allows one to structure already identified new infections, to position the new infections and new pathogens that may arise in the future, to trace the evolutionary paths of each infection and to realize a forecast

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

Фактическая эпидемиологическая эффективность оценки и совершенствования системы обеспечения эпидемиологической безопасности медицинской помощи катетеризированным пациентам

The basis of optimized conventional system of surveillance and control for catheter-related bloodstream infections (CRBI) was priority in detection and risk assessment an infectious complication of puncture catheterization that substantially justified with inclusion of two main components as an addition to the existing system: monitoring of puncture catheterization, which allows to obtain and analyze data on risk factors for infections associated with the catheterization procedure and subsequent manipulations of the device, standardize approaches to working with a venous catheter and improve the diagnosis of CRBI; assessment of ensuring the epidemiological safety of medical care for catheterized patients. Epidemiological efficiency risk-based surveillance, primarily determined to reduce the incidence of CRBI by 1.8 times compared to initially defined real incidence: 12.5‰ (95% CI — CI 11,8–13 2) vs 22.8‰ (95% CI 21,1–24,5) catheterized patients, p=0.0001.Базисом оптимизированной традиционной системы эпидемиологического надзора и контроля катетер-ассоциированных инфекций кровотока (КАИК) стал принцип первоочередности выявления и оценки риска возникновения инфекционного осложнения пункционной катетеризации, что практически оправдано включением двух основных компонентов как дополнение к существующей системе: мониторинг пункционной катетеризации, который позволяет получать и анализировать данные о факторах риска возникновения инфекций, связанных с процедурой катетеризации и последующими манипуляциями по эксплуатации устройства, стандартизировать подходы к работе с венозным катетером и усовершенствовать диагностику КАИК; оценка обеспечения эпидемиологической безопасности оказания медицинской помощи катетеризированным пациентам. Эпидемиологическая эффективность риск-ориентированного эпидемиологического надзора, в первую очередь, определялась по снижению уровня заболеваемости КАИК в 1,8 раза по сравнению с исходно определенным реальным уровнем заболеваемости: 12,5‰ (95% доверительный интервал — ДИ 11,8–13,2) vs 22,8‰ (95% ДИ 21,1–24,5) катетеризированных пациентов, p=0,0001

ЭПИДЕМИОЛОГИЧЕСКАЯ ОЦЕНКА ЗАБОЛЕВАЕМОСТИ ОРВИ В ДЕТСКОМ МНОГОПРОФИЛЬНОМ СТАЦИОНАРЕ

The results of the evaluation of the incidence of acute respiratory viral infection (ARVI) in a large children's multidisciplinary hospital are presented.It was established that the epidemic process of ARVI in the conditions of a children's versatile hospital was characterized by high intensity, the prevalence of infections associated with the provision of medical care, and different intensity in the departments, due to the contingent of patients, the features of the treatment and diagnostic process, the intensity of infection drifts. The risk factors for ARVI were high rates of infection drift, overconsolidation of departments, untimely isolation of patients, as well as inefficient ventilation.The introduction of targeted epidemiological surveillance for ARVI in hospital conditions made it possible to quickly assess the epidemiological situation in a multidisciplinary hospital in general and separately for each department for timely and adequate implementation of preventive and anti-epidemic measures. Представлены результаты оценки заболеваемости ОРВИ в крупном детском многопрофильном стационаре. Установлено, что эпидемический процесс ОРВИ в условиях детского многопрофильного стационара характеризовался высокой интенсивностью, преобладанием инфекций, связанных с оказанием медицинской помощи, и различной интенсивностью по отделениям, обусловленной контингентом больных, особенностями лечебно-диагностического процесса, интенсивностью заносов инфекций. К факторам риска возникновения ОРВИ были отнесены высокая частота заносов инфекции, переуплотнение отделений, несвоевременность изоляции больных, а также неэффективная вентиляция.Внедрение целенаправленного эпидемиологического надзора за ОРВИ в госпитальных условиях позволило оперативно оценивать эпидемиологическую ситуацию в многопрофильном стационаре в целом и отдельно по каждому отделению для своевременного и адекватного проведения профилактических и противоэпидемических мероприятий

Аспекты коморбидности у детей с COVID -19

Numerous literature data and our observations testify to the widespread permanent growth of combined infections, especially new ones, as well as combined infectious diseases with somatic ones. This is a new scientific direction in medicine, which we have designated as «complex comorbidity», and which can be considered as one of the main trends in the evolution of infectious pathology in general. The article presents an analysis of scientific articles on comorbidity with COVID-19 in children, taking into account clinical and epidemiological features in the pandemic (2020—2021) and pre-pandemic (2015—2019) periods. It has been estab- lished that the emergence of a new subtype of coronavirus at the end of 2019. An unfavorable epidemiological situation for seasonal coronavirus infection preceded by a pronounced trend towards an increase in the proportion of cases of diseases associated with coronavirus from 10.5% in the 2014—2015 epidemic season. up to 32.8% in the 2018—2019 season. The pandemic period was characterized by a lower susceptibility of children compared to adults, as well as a high proportion of «asymptomatic» and mild forms of infection. In turn, in the pre-pandemic period, «seasonal» coronaviruses preferred to infect, for the most part, precisely children's contingents with moderate onset of the disease.Многочисленные данные литературы и наши наблюдения свидетельствуют о повсеместном перманентном росте сочетанных инфекций, особенно новых, а также сочетании инфекционных болезней с соматическими. Это является новым научным направлением в медицине, которое нами обозначено как «комплексная коморбидность», и которое можно рассматривать как одну из основных тенденций эволюции инфекционной патологии в целом. В статье представлен анализ научных статей, касающихся сочетанной патологии с COVID-19 у детей с учетом клинико-эпидемиологических особенностей в пандемический (2020—2021 гг.) и в предпандемический (2015—2019 гг.) периоды. Установлено, что появлению нового подтипа коронавируса в конце 2019 г. предшествовала неблагоприятная эпидемиологическая ситуация по сезонной коронавирусной инфекции с выраженной тенденцией к увеличению удельного веса случаев заболеваний, связанных с коронавирусом с 10,5% в эпидсезон 2014—2015 гг. до 32,8% в сезон 2018—2019 гг. Пандемический период характеризовался более низкой восприимчивостью детей по сравнению со взрослыми, а также высокой долей «бессимптомных» и легких форм течения инфекции. В свою очередь в предпандемическом периоде «сезонные» коронавирусы предпочитали инфицировать в большинстве своем именно детские контингенты со средне-тяжелыми появлениями заболевания

Эффективность использования бактериофагов для лечения и профилактики инфекции: систематический обзор

Successful implementation of lytic virulent bacteriophages in clinical practice requires convincing evidence of its safety and efficacy.Design: We searched in CENTRAL, MEDLINE, Embase, and Russian-language literature databases in May 2018. Original articles must fulfill the following eligibility criteria: randomized, controlled trials investigating the effects of phage therapy in people with bacterial infections; at least one patient outcome was reported. Three review authors independently selected, studies, extracted, data, and. assessed, risk of bias. We used, random-effects models for meta-analysis.Participants: adults and. children of both, sexes with bacterial infection, including multi-drug resistant variants, or individuals at risk of infection.Outcomes: recovery or resolution of infection; clinical improvement; change in number of exacerbations; recurrence of infection; quality of life; elimination or load, reduction of a pathogen in an anatomical compartment.Results: We included 13 trials (issued in 1965-2018) including 9 treatment studies and. 4 prevention studies. Overall, eight randomized, trials involved, adults. Five studies addressed skin and soft tissues infections, six studies concerned intestinal infections, one study addressed respiratory tract infection and. one study — ear infection. Across bias domains, 35-90% of trials scored, low risk of bias. Meta-analysis for adverse events attributable to phages and. for wound, healing provided us with pooled relative risks of 0.74 (95% CI 0.68;1.2) and 0.91 (95% CI0.68;1.2) respectively.Conclusions: Beneficial effect of bacteriophages can be demonstrated, and. not refuted. However, our study led. to tentative conclusions. The conduct of well-designed and sufficiently powered, trials would, facilitate registration and. wide accepting of bacteriophage treatment.Цель: оценка использования бактериофагов, применяемых для профилактики или лечения бактериальных инфекций у людей.Метод: поиск информации проведен в англо- и русскоязычных базах данных в 2018 г. Критерии отбора оригинальных статей: рандомизированные контролируемые испытания; описан как минимум, один исход, значимый для пациента; взрослые и дети, обоего пола, с диагнозом бактериальной инфекции или лица с риском, заражения. Три автора независимо друг от друга отбирали исследования, извлекали данные и оценивали риск систематической ошибки. Для мета-анализа использована модель случайных эффектов. Исходы: выздоровление; клиническое улучшение; изменение числа обострений; рецидив инфекции; качество жизни; элиминации или уменьшение нагрузки патогена в анатомическом, локусе.Результаты: после критической оценки литературы, мы. включили 13 публикаций: исследования лечения (n = 9) и исследования профилактики (п = 4). Из них 5 исследований были проведены, в России и бывшем. СССР, 3 — в США, 2 — в Западной Европе, 2—в Азии. 8 исследований было с участием взрослых пациентов. 5 работ касались инфекций кожи и мягких тканей, 6 — кишечных инфекций, 1 — инфекции дыхательных путей, 1 — болезни уха. Включенные исследования были опубликованы, в 1965—2018 гг. По всем, видам, систематической ошибки 35—90% РКИ имели низкий риск. Мета-анализ был возможен только для побочных явлений, связанных с фагами, и для заживления ран: 0,74 (95% ДИ 0,68—1,2) и 0,91 (95% ДИ 0,68—1,2) соответственно.Выводы: с учетом, сформировавшейся доказательной базы, благоприятный эффект фаготерапии не вызывает сомнений. Однако наше исследование позволяет сделать лишь предварительные выводы. Широкое признание бактериофагов мировой наукой для лечения и профилактики требует, проведения РКИ должного методологического качества и мощности

Clinical features of post-COVID-19 period. Results of the international register “Dynamic analysis of comorbidities in SARS-CoV-2 survivors (AKTIV SARS-CoV-2)”. Data from 6-month follow-up

Aim. To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register. Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 — 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months. Results. According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure. Conclusion. According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period

GENERAL CHARACTERISTICS AND ISSUES MIXED INFECTIONS CAUSED BY OPPORTUNISTIC MICROORGANISMS

Infections caused by opportunistic microorganisms occupy a special position. In microbial associations of opportunistic microorganisms is easier to implement its low pathogenic potential, activate properties of each other. Group polyetiologic infections caused by conditionally pathogenic microorganisms are quite diverse in terms of a nosological forms and groups. These include the so-called septic infection, which are also very diverse and clinical, epidemiological and etiological characteristics. Scientific evidence shows the urgency of the problem mixed infections, especially in surgery and indicate a lack of systematic data about the whole spectrum and the composition of microbial associations in different infections, quantification, insufficient study of the properties compared to monoagents. The problem mixed infections practically not been studied with epidemiologic standpoint, only a few studies devoted to the study of nosocomial infection of microbial associations are not developed microbiological monitoring. In this connection, you need comprehensive research mixed infections compared with monoagents to identify the characteristics and development of epidemiologic surveillance and control

Activities of the National Association of Specialists for the Control of Healthcare-Associated Infections

The article presents the results of the activities of the National Association of Specialists for the Control of Healthcare -Associated Infections of ensuring epidemiological safety of medical care. Educational projects, development and the statement of federal clinical guidelines, participation in development of criteria of an assessment of epidemiological safety and audit of the healthcare settings for system of ensuring quality and safety of medical care are discussed. Priority tasks to safety of patients and the medical staff, assistance in improving immunization programs and the National Schedule of preventive vaccinations, transition to new risk-to the focused strategy of an epidemiological surveillance and prevention of infections in the healthcare settings are defined