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1.
Klin Lab Diagn ; 67(10): 581-587, 2022 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-36315173

RESUMO

Community-acquired bloodstream infections (CBSIs) occur in the out-of-hospital setting (44%) and increase the overall mortality from bloodstream infections (BSIs) by 7.2% per year. The development of CBSIs depends on both comorbid and polymorbid diseases and the patients' age. The causes of CBSIs are: respiratory, hepatobiliary gastrointestinal and urogenital tracts and dental interventions. The etiology of CBSIs is characterized by the isolation of coagulase-negative staphylococci (CNS) (32%), E. coli (27%). To investigate community-acquired bloodstream infection in therapeutic patients. The study included out-of-hospital patients (n=382). 4.5 ml of blood were taken intravenously into a closed vacuum system in order to obtain a buffy coat of blood, which was put on glasses for microscopy and Petri dishes with blood agar for cultivating under aerobic and anaerobic conditions. Microorganisms were identified by mass spectrometry. Microscopy of blood smears was used for rapid diagnosis of infection in the bloodstream. BSI was diagnosed in 183 (48.0%) out of 382 out-of-hospital patients. The etiology of CBSIs was studied on 297 isolated strains of microorganisms. CBSIs rather often complicated the underlying disease in women and young people. The spectrum of CBSI pathogens included aerobic and anaerobic bacteria and fungi. Gram-positive cocci with the leadership of S.epidermidis (25.7%) were more often isolated among bacteria. 70% of all isolated pathogens grew under anaerobic conditions. CBSIs were characterized by polymicrobiality (33.5%) of two to four different microorganisms in one blood culture; the species of associates of polymicrobial blood cultures are shown. Microscopic examination of blood smears revealed microorganisms in 97.1% of cases, including associations of bacteria with fungi (66.9%). CBSIs occurred after contour plastic, in diseases of the respiratory system, genitourinary system, oral cavity, skin and subcutaneous tissue. Microbiological examination of the buffy coat is an alternative microbiological method of CBSIs diagnosis, which includes microscopy and blood cultivating and has a high diagnostic efficiency (97.1% and 48% respectively). It can become an option for replacing imported blood culture automated systems.


Assuntos
Bacteriemia , Infecções Comunitárias Adquiridas , Sepse , Humanos , Feminino , Adolescente , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Escherichia coli , Infecções Comunitárias Adquiridas/diagnóstico , Hemocultura , Fungos , Sepse/diagnóstico , Staphylococcus epidermidis , Estudos Retrospectivos
2.
Klin Lab Diagn ; 67(6): 355-361, 2022 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-35749601

RESUMO

Bloodstream infection (BI) is the cause of high mortality. Hospital bloodstream infection (HBI) complicates hemodialysis, pneumonia, oncohematological diseases. Positive hemoculture obtaining depends on the volume of blood inoculation, the number of blood samples, the incubation time. To test the principles of microbiological culturomics in the diagnosis BI of hospital patients with a therapeutic profile. 848 hospital cardiac patients with suspected BI were included. 10 ml of blood were taken intravenously with a syringe, blood was inoculated into 200 ml of the heart-brain medium (HBM) in an anaerobic bottle. It was incubated for 7 or more days in a thermostat at +37º C. The hemocultures were obtained in 64.3% of cases with paired blood sampling with an interval of 30 minutes whereas an increase in the number of blood samples reduced the effectiveness of obtaining hemocultures to 9.1%. When incubating bottles for more than 7 days there were obtained 200 additional hemocultures containing 239 strains of microorganisms. Episodes of HBI were observed more often in the cases of the circulatory system (77.8%), including infectious endocarditis (IE) (47.0%), rheumatism (22.1%), myocarditis (14.6%). Episodes of HBI occurred more often in men with IE and coronary heart disease, in women - with rheumatism and myocarditis. Patients aged 45-75 were in the group of risk with a probability of complications of HBI up to 73.7%. When examining the blood of 848 hospital patients of cardiological profile HBI was detected in 38.3% of cases. Among clinical isolates gram-positive cocci with a great number S.epidermidis prevailed. Polymicrobial hemocultures (16.3%) were characterized by two and three associates in one blood sample. Among the hematological indicators in HBI there were: leukocytosis, increased ESR, lymphocytosis, decreased hemoglobin; increased values of fibrinogen, CRP, γ-globulin, α2-globulin, low levels of total protein and A/G coefficient. The techniques of microbiological culturomics were used. HBI was diagnosed in 38.3% of the therapeutic patients of cardiological profile. The etiology of HBI was characterized by polymicrobicity in 16.3% of cases. Hematological markers of HBI were identified.


Assuntos
Bacteriemia , Miocardite , Doenças Reumáticas , Sepse , Feminino , Coração , Hospitais , Humanos , Masculino , Sepse/diagnóstico
3.
Klin Lab Diagn ; 65(6): 375-381, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32459897

RESUMO

When diagnosing bloodstream infection (BI) the culture medium is the basis for growth of microorganisms and obtaining the blood culture. Pancreatic digest from fish meal is the basis of all culture media in Russia. In European countries brain-heart media (BHM) are used for detecting microorganisms in blood. In Russia BHM is not produced. The aim is to work out the formulation and the way of the BHM (broth and agar) preparation in order to improve the efficiency of obtaining blood culture. There were defined the physical and chemical indices and biological parameters of the BHM. The microbiological control of the BHM was carried out by diagnostic study of cardiological patients' blood. On the basis of the developed technique of the brain-heart extraction (BHE) preparation there was created the liquid and agar BHM (LBHM, BHA). The LBHM was poured into bottles which then were filled with the inert gas. The bottles were closed with rubber stoppers and rolled in metal caps became a closed system. Microbiological qualities of LBHM were tested on 260 blood samples and thioglycollate medium (TGM) and LBHM. Aerobic microorganisms grew in LBHM 2,4 times more often than in TGM. The microaerophilic microbes grew in LBHM 3,2 times more often than in TGM. Anaerobic microbes did not show any growth in TGM, (p<0,001). Monomicrobes hemocultures were obtained in LBHM 13,4 times more often than in glucose broth and 2,3 times more often than in TGM, (p<0,001). Polymicrobes hemocultures were obtained in LBHM more often than in TGM (7,3% and 1,7%, respectively). The quality of brain-heart agar (BHA) was tested on 300 blood samples in 5% blood meat-pepton agar (MPA) and BHA in aerobic and anaerobic conditions for both the media. Aerobic microorganisms grew in BHA 2 times more often than in MPA. The microaerophilic microbes grew in BHA 3,6 times more often than in MPA. In anaerobic condition in BHA aerobic microorganisms grew 2 times more often than in MPA and the microaerophilic microbes grew 2,5 times more often than in MPA, (p<0,001). Anaerobic microbes did not grow in MPA. When diagnosing bloodstream infection the BHM (liquid and agar) are able to create the optimal conditions for the increase of the wide range pathogen growth.


Assuntos
Bactérias/isolamento & purificação , Hemocultura , Meios de Cultura , Ágar , Bactérias/crescimento & desenvolvimento , Encéfalo , Coração , Humanos , Federação Russa
4.
Klin Lab Diagn ; 65(3): 185-190, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32163694

RESUMO

Diagnosing of bloodstream infection (BSI) in outpatients is essential. A large blood volume is required to obtain blood culture (CLSI): 2 sets, 40ml of blood for diagnosing in 95% cases of bacteremia. Molecular-genetic methods can not replace blood culture method, but they accelerate the identification of any pathogen. Culturomics gives a combination of different conditions for isolating microorganisms from a sample and along with their genetic identification. We used the patent method for direct inoculation of buffy-coat from 4,5ml of a venous blood sample and MALDI-ToF identification method. In 382 outpatients examined there were received 183 blood cultures (48,0%), more often among women (65,6%) and young people (74,9%). The causative agents of community-acquired bloodstream infection were aerobes (73,4%), anaerobes (24,2%), fungi (2,4%). The gram-positive cocci were prevailing (51,4%) and the gram-negative rods were isolated rather seldom (9,6%). BSI was monomicrobial (66,5%) and polymicrobial (33,5%). Polymicrobial blood cultures had 2, 3, 4 agents in one blood sample (75,4%, 18,8%, 5,8%, respectively). There were also found combinations of different species of aerobes (47,8%), aerobes with anaerobes (42%). BSI caused complications of the primary disease of the respiratory system, urogenital system and in 100% of cases after plastic surgery. A small blood volume is required for buffy-coat inoculation, the direct agar culture reduces the response time to 2 days, so it makes genetic identification possible on the 2nd day from the moment of blood collection.


Assuntos
Bacteriemia/diagnóstico , Hemocultura/métodos , Adolescente , Bactérias , Feminino , Fungos , Bactérias Gram-Negativas , Humanos , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz
5.
Klin Lab Diagn ; 64(7): 435-442, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31408597

RESUMO

In response to inflammation there appear «reactants of acute phase¼ which are nonspecific but they can show the disease gravity and prognosis. The markers of the acute phase are: C-reactive protein (CRP), procalcitonin (PCT), neopterin (NP), presepsin (PSP), necrosis tumor factor α (NTF-α), erythrocyte sedimentation rate (ESR), the total amount of leucocytes, neutrophils, protein fractions (α, ß2, γ-globulins), IgM. CRP concentrations rise in the presence of bacterial infections and they are significanly higher in the positive blood cultures than in the contamination or negative ones. PCT levels grow in case of gram-negative bacteremia, but the levels are normal in case of coagulase-negative staphylococci bacteremia. PCT levels are more helpful here than CRP levels with suspected bacteremia. NP levels rise in patients with bacteremia. In the presence of infection, PSP becomes more active than CRP and PCT, and PSP sensitivity is 91,4% in patients with sepsis. Patients with infectious endocarditis have high levels of NTF-α in case of staphylococci infection in blood but the levels of NTF-α are low with enterococci and corynebacterium bloodstream infection. In case of inflammation the acute phase protein level changes are infection markers including bloodstream infection but they are not specific for determining any bacteremia aetiology.


Assuntos
Bacteriemia/diagnóstico , Biomarcadores/sangue , Inflamação/sangue , Proteína C-Reativa/análise , Humanos , Receptores de Lipopolissacarídeos/sangue , Fragmentos de Peptídeos/sangue , Pró-Calcitonina/sangue , Fator de Necrose Tumoral alfa/sangue
6.
Klin Lab Diagn ; 61(8): 494-7, 2016 Aug.
Artigo em Russo | MEDLINE | ID: mdl-30601642

RESUMO

The sampling of270 out-patients was examined to detect principal clinical symptoms under infection of bloodstream. The principal clinical symptoms the form of complaints were collected using specially developed questionnaire. The patients mentioned most frequently low-grade fever, shivering, furuncles of skin, unstable stool (diarrhea or constipation), diseases of upper respiratory ways. The microbiological diagnostic of infection of bloodstream included microscopy and inoculation of leukocyte layer of blood sample. At microscopy of blood smears microorganisms were detected in 98.5% of cases. The positive findings were presented by associations of various morphological forms in 82.6% of cases. The hemoculture was obtained from 55.2% of patients and characterized by polymicrobility in 35.7% of cases. The greatest number of hemoculture were obtained from patients with low-grade fever and shivering (53.4%), furuncles (55.8%), unstable stool (53.6%), diseases of upper respiratory ways (53.8%) that substantiate presence of infection of bloodstream.


Assuntos
Diarreia/microbiologia , Febre/microbiologia , Infecções/sangue , Infecções/microbiologia , Adulto , Diarreia/sangue , Fezes/microbiologia , Feminino , Febre/sangue , Febre/complicações , Febre/patologia , Humanos , Infecções/complicações , Infecções/patologia , Leucócitos/microbiologia , Leucócitos/patologia , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Inquéritos e Questionários
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