[Study of sensitivity of microflora isolated from biosubstrates of surgical profile patients to bacteriophage].

AIM: Study sensitivity of nosocomial microbes--causative agents of post-operative infectious complications in surgical profile patients to bacteriophages. MATERIALS AND METHODS: Microbe isolates from biosubstrates of 223 surgical patients served as material. Microbes were isolated from blood, urine, wounds, intravascular catheters, abdominal cavity drainage, discharge of pharynx, trachea (343 strains). Phagolysability of strains was determined by Ott method. RESULTS: A good lysability of Pseudomonas aeruginosa, Klebsiella, Escherichia coli by specific complex and monophages and lower--of staphylococci and enterococci was found in the presence of 83% methicillin-resistant staphylococci strains and 94% Gram-negative bacteria strains producing extended spectrum beta-lactamases. CONCLUSION: Continuation of use of various bacteriophage preparations against Gram-negative bacteria and implementation of measures to adopt phage preparations to staphylococci and enterococci are perspective considering multiple resistance of microbes to antibiotics.

[Persistence of Pseudomonas aeruginosa strains in patients of Federal Scientific Center of Transplantology and Artificial Organs].

AIM: Study genetic diversity of P. aeruginosa strains persisting in patients of Federal Scientific Center of Transplantology and Artificial Organs, and main factors facilitating persistence of strains in the hospital. MATERIALS AND METHODS: 136 P. aeruginosa strains isolated from patients of the center for 3 years 6 months were genotyped by RAPD-PCR and MLST methods and studied for antibiotics resistance and presence of integrons. RESULTS: Genetic diversity of strains persisting in hospital was established. Strains of main genotypes ST235, ST446, ST598 were isolated from patients of various surgical departments. Patients were shown to be colonized by these strains during stay in reanimation and intensive therapy department (RITD) of the hospital. Strains of dominant genotype 235 were isolated from 47% of examined patients during more than 3 years. Only genotype 235 strains contained integron with cassettes of antibiotics resistance genes blaGES5 and aadA6 in the genome. CONCLUSION: The data obtained show that over the period of observation in the center 1 clone of P. aeruginosa that belonged to genotype 235 dominated. This clone was endemic for this hospital and in the process of prolonged persistence became more resistant to antibiotics. Colonization of patients with these strains occurs in RITD. This confirms the necessity of constant monitoring of hospital microflora for advance detection of potentially dangerous epidemic hospital strains able to cause hospital infections.

[Genotypic features of Pseudomonas aeruginosa strains circulating in surgical hospital].

AIM: To study genetic diversity of Pseudomonas aeruginosa strains circulating in intensive care unit (ICU), to determine the source of these strains and duration of circulation of epidemically-significant clone in the hospital. MATERIALS AND METHODS: Genotyping of 106 P. aeruginosa strains isolated from patients, clinical specimens and fomites was performed by random amplified polymorphic DNA analysis with oligonucleotide primer Sh1 of 10 bp long. RESULTS: Out of 106 P. aeruginosa isolates, 72.6% belonged to the same genotype, which was dominated in ICU during whole study period. It was established that 58.3% of examined patients were colonized by identical strains belonged to prevalent genotype that indicates the intrahospital transmission of epidemic strain. CONCLUSION: Obtained data show that during the period of observation (15 months) one clone of P. aeruginosa dominated in ICU, which was characterized by multiple resistance to antibiotics and caused nosocomial infection in 58.3% of patients. This confirms the need of continuous molecular-microbiological monitoring of hospital microflora in order to early detect potentially dangerous epidemic hospital strains, which are able to cause nosocomial infections.

[Transposition of autologous cultivated bone marrow cells promotes prevention and treatment of immunodependent complications in cardiosurgical patients].

Coronary artery bypass grafting (CABG) has been made in two groups of patients with chronic heart failure (CHF) with further estimation of the rate of postoperative organic dysfunctions and pyoseptic complications. In group 1 (n = 50) CABG was combined with intracoronary or intramyocardial injection of autologous precultivated for 7-8 days mononuclear cells of the bone marrow (1 x 10(9) cells). In group 2 (n = 479) the intraoperative injection of the above cells was not made. It was found that autologous cultivated mononuclear bone marrow cells prevent organic dysfunction and reduce frequency of infectious-septic complications especially in patients with preoperative focuses of chronic infections.

[Enterococci as a cause of infectious complications after surgery].

Self-obtained data about study of enterococci as etiologic agents of infectious complications after cardiovascular and transplantation surgery are presented in the article. 465 strains of enterococci were isolated from different biosubstrates. Isolation rate of different species of enterococci in blood, urine, fromwounds, trachea, cardiacvalves, as well as in the environment and on wear of healthcare workers were determined. Most frequently enterococci were isolated from urine (47.7% of cases) and from trachea (24.3% of cases). Enterococcal bacteremia was determined in 9.7% of cases and represented a significant part in Grampositive microflora--38.5% of all isolates. High resistance of enterococci to antibiotics and well lysis by phages were noted.

[Sensitivity of nosocomial microflora circulating in a transplantation clinic to medicinal bacteriophages]. / Chuvstvitel'nost' nozokomial'noi mikroflory, tsirkuliruiushchei v transplantatsionnoi klinike, k lechebnyum bakteriofagam.

The sensitivity of 239 isolates obtained from patients with postoperative infectious complications to phagolysis was determined. Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli were found to have the highest sensitivity to phages. Variations in the sensitivity of the same cultures to phages from different producers and even from the same producer were established. The sensitivity of cultures to phages may serve as an additional criterion of the biological properties of strains and their marker.

[Infectious complications following heart transplantation]. / Infektsionnye oslozhneniia posle transplantatsii serdtsa.

The work analyses infectious complications after 35 orthotopic transplantations of the heart. The infectious complications are divided into 2 groups. Group 1 consisted of 6 patients with local complications. Group 2 was made up of 8 patients who died from bacterial infectious complications (mediastinitis 3, sepsis 2), from miliary tuberculosis of the lungs 1, cytomegaloviral infection 1, and systemic candidiasis 1.

[A comparative evaluation of various methods for determining the degree of endogenous intoxication in patients with phlegmons of the maxillofacial area]. / Sravnitel'naia otsenka razlichnykh metodov opredeleniia stepeni éndogennoi intoksikatsii u bol'nykh s flegmonami cheliustno-litsevoi oblasti.

Comparison of 3 methods for the assessment of the severity of intoxication in patients with maxillofacial phlegmons, i.e. the leukocytic index of intoxication (LII), Paramecium test (PT), and measurement of the middle molecule level (MML), has shown that all these methods sufficiently well reflect the severity of the disease clinical course. LII and PT values are below the norm just before the patient's discharge, whereas MML is virtually normal. Bearing in mind the high toxicity of the middle molecules, one should acknowledge that of the 3 methods for estimation of the severity of intoxication in patients with maxillofacial phlegmons only MML reflects the disease onset, this being of practical value.

[A comparative evaluation of the efficacy of methods of determining osmolality and middle molecules in the prognosis of the course of strokes]. / Sravnitel'naia otsenka éffektivnosti metodov opredeleniia osmolial'nosti i srednykh molekul v prognoze techeniia insul'tov.

The authors compare the efficacies of methods for assessing osmolality (OSM) and analysis of medium molecules (MM) in the prediction of the post-stroke period course in the first 7 days from the stroke onset. Prognostically unfavorable MM and OSM values were found, predicting the possible lethal outcome. On the whole the MM index was found 1.7 times more sensitive for this prediction than the OSM index; the possibility of predicting a lethal outcome from the MM value within the first 24 hrs was 3 times higher and within the first 48 hrs 4 times higher vs. the OSM value.

[Endogenous toxemia in acute disorders of cerebral circulation]. / Endogennaia intoksikatsiia pri ostrykh narusheniiakh mozgovogo krovoobrashcheniia.

Critical conditions that develop because of hypoxia of different genesis are accompanied by endogenous intoxication induced to a considerable degree by the appearance in the blood of an excess amount of medium-sized molecules (MSM). An appreciable increase of the content of MSM was demonstrated since the very first days after the brain stroke as a result of examining 100 patients who suffered brain stroke, including 83 patients during the first week of the disease and 17 patients of the reference group with a history of acute impairment of cerebral circulation which had occurred over a month before. A reverse correlation was established between the level of endogenous intoxication and the clinical status of the patients which could be observed every day during the acute disease phase. The critical level of MSM was determined in the patients' blood plasma. In the majority of cases, the attainment of the above level resulted in a lethal outcome irrespective of the pattern of acute impairment of cerebral circulation. The data obtained make it possible to recommend using the level of MSM as one of the simple and rapid quantitative methods for assessment of the patients' status gravity and monitoring of persons with acute impairment of cerebral circulation.

[The role of lipids in middle molecular weight fractions as a feature of the pathological process]. / Rol' lipidov fraktsii srednikh molekul v kharakteristike patologicheskogo protsessa.

About 20-66% of lipids was found in the middle molecular fraction of blood serum from neurosurgical patients. Content of the substances extracted with organic solvents was distinctly increased as the clinical status aggravated. Precipitation of proteins using chloric acid instead of trichloracetic acid proved to be more convenient for isolation of the middle molecular fraction from blood serum and for the subsequent studies of its composition.

[The level of middle molecules in endogenous intoxication in neurosurgical patients]. / Uroven' srednikh molekul pri éndogennoi intoksikatsii u neirokhirurgichekikh bol'nykh.

The article deals with the results of study of the level of medium-size molecules in blood and urine of neurosurgical patients in the early postoperative period. It correlated with the severity of the patients' condition and with the values of osmolarity and the level of consciousness in a complicated postoperative period and a fatal outcome. The presence of pyoseptic complications may be judged according to the P value and prognosticated.

[Diagnosis of septic conditions in newborn infants with surgical diseases]. / Diagnostika septicheskikh sostoianii u novorozhdennykh s khirurgicheskimi zabolevaniiami.

An analysis of 65 case histories of newborns with pyo-septic surgical diseases has been made. The extraction-spectrometrical method of analysis of blood serum is proposed. The distribution index (DI) in sepsis was always less than 1. Local forms of purulent infection were diagnosed if the DI was more than 1.

[Practical significance of middle molecules of the blood in assessing the severity of the status of neurosurgical patients]. / Prikladnoe znachenie srednikh molekul krovi dlia otsenki tiazhesti sostonianiia neirokhirugicheskikh bol'nykh.

Study of the content of medium-size molecules (MM), residual nitrogen, creatinine, and urea in the blood of 80 neurosurgical patients with various diseases showed correlation between the severity of the patient's general condition and the MM level. No correlation was noted between the content of MM, creatinine, and urea. The MM level in the blood correlated with that of residual nitrogen in 20% of cases. The MM dynamics may serve as a prognostic sign of the course and outcome of the disease. The MM content corresponds to the severity of the patient's general condition and is not dependent on the etiological and pathogenetic factors.