Antibiotic prescribing practices and perceptions on antimicrobial resistance among healthcare practitioners in Russia.

OBJECTIVES: Antimicrobial resistance (AMR) is a growing global health threat. The misuse of antibiotics is the main factor contributing to the development of AMR. Healthcare practitioners (HCPs) play a crucial role in the use of antibiotics. There are limited data available on antibiotic prescribing patterns among physicians in Russia. The aim of this study was to explore antibiotic prescribing practices and perceptions of AMR among HCPs in the Russian Federation. STUDY DESIGN: A cross-sectional, multi-centre study was used. METHODS: A survey using an online questionnaire was conducted among HCPs. A qualitative study was conducted before the questionnaire was developed. The online questionnaire was distributed via email addresses obtained from the Consilium Medicum database, a specialised educational resource for healthcare professionals in Russia. RESULTS: In total, 746 HCPs from 74 regions of the Russian Federation were included in the study. Physicians who participated in this study did not frequently prescribe antibiotic drugs: 40.6% of participants recommended antibiotics less than five times per week. Gynaecologists, paediatricians, family doctors, and surgeons were the least likely study participants to prescribe antibiotics, whereas clinical pharmacologists, otolaryngologists, urologists, and infectious disease specialists prescribed antibiotics more often. Amoxicillin and amoxicillin/clavulanic acid were the most frequently prescribed antimicrobials. The majority of HCPs in Russia who took part in this survey reported relying on national guidelines for information on antibiotic prescribing. Only 67.8% of study participants perceived AMR as a challenge for their practice. CONCLUSIONS: Health authorities should regularly provide up-to-date reliable information on AMR in the region. Antimicrobial stewardship programmes are important for specialised medical professionals, such as urologists, gynaecologists, and otolaryngologists, since they are responsible for prescribing second-line antibiotics, which carries with it a greater responsibility.

[Medical and social assessment of the quality of life of a family with a child suffering from food allergy].

Food allergy (FA) is a health problem that adversely affect the quality of life of children and their family members. The purpose of the study was to assess the quality of life in families with children affected FA. Material and methods. A cross-sectional study was conducted in a group of 75 children with a confirmed FA (at the age of Me 4.9 years [1.3; 7.1]). One of the caregivers of the child was asked to complete the Russian version of a specialized questionnaire «The Food hypersensitivity famiLy ImPact, FLIP¼ for assessing the life quality of families with children affected FA. Results. Diet organization is the main concern affecting quality of life, while the daily life of the family and the emotional sphere are less impacted. Age, type of food allergens and clinical manifestations do not significantly contribute the life quality indicators. Hypersensitivity to several food is statistically associated with changes in everyday life and emotions. Non-compliance with the diet is associated with a lower impact of FA on quality of life. 56% of respondents worried about the nutritional value of child's diet and 49.3% of caregivers reported that a child's FA significantly impacted grocery shopping behaviors (reading labels, etc.). At the same time, 73.3% noted that child's FA does not affect the diet of other family members. Also, 33.3% of the parents experienced anxiety due to child's FA and 38.7% are worried that FA might stay persistent. 30.7% of respondents are afraid of accidental consuming of allergenic products. Conclusion. The acquired results indicate the importance of quality of life assessment for understanding the social aspects of FA. Strategies to improve the quality of life include the development of informational and educational programs both for parents and patients. In order to estimate impact of FA to life quality from the patient's perspective further development of questionnaires adapted for children and adolescents is necessary.

[Methods of gut microbiota correction for treatment and prevention of food allergy: a review of current research].

Food allergy (FA) is an actual problem in pediatric practice. The gut microbiota plays a crucial role in food sensitization development, since the maturation of immune system occurs under the influence of intestinal microorganisms. Immunoregulatory activity of gut microbiota is associated with the increase of IgA production and promotion of the barrier function of intestinal epithelium. Gut microbiota influence the activity of T-regulatory cells, as well. Violation of gut biocenosis, which occurs under the influence of various factors (artificial feeding, past diseases, the use of antibiotics, etc.), can lead to a shift in the balance of the immune system towards the increase of Th2-profile cytokines and the subsequent formation of hypersensitivity to food allergens. In this regard, the correction of the gut microbiome is a promising method of FA control, due to the ability of intestinal bacteria influence the production of T-regulatory cells and thus suppress allergy immune response. The aim of the review is to analyze experimental and clinical studies exploring effectiveness of methods modifying intestinal microbiota in order to treat and prevent FA. Material and methods. The analysis of the literature in eLIBRARY, MedLine and PubMed databases was carried out. Results. The analysis revealed the lack of rigorous evidence that pre-, pro- and synbiotics significantly increase the effectiveness of standard therapy of FA. However, the use of bifidobacteria, lactobacilli, lactic acid bacteria, in combination with the basic therapy of FA has general positive effect on the clinical outcome, especially in case of gastrointestinal symptoms. Also, the results of some studies indicate the effectiveness of synbiotics (Bifidobacterium breve M-16V, Lactobacillus rhamnosus GG in combination with oligosaccharides) for the prevention of FA in patients at risk of developing allergic diseases in the long-term period. Conclusion. At present, fecal microbiota transplantation is promising method for FA treatment. Polysaccharides fermented by the microflora, are also actively studied. Experimental studies and clinical trials are required to obtain substantiated conclusions about feasibility of these methods for treatment and prevention of FA.

Opisthorchis felineus negatively associates with skin test reactivity in Russia-EuroPrevall-International Cooperation study.

BACKGROUND: Most studies on the relationship between helminth infections and atopic disorders have been conducted in (sub)tropical developing countries where exposure to multiple parasites and lifestyle can confound the relationship. We aimed to study the relationship between infection with the fish-borne helminth Opishorchis felineus and specific IgE, skin prick testing, and atopic symptoms in Western Siberia, with lifestyle and hygiene standards of a developed country. METHODS: Schoolchildren aged 7-11 years were sampled from one urban and two rural regions. Skin prick tests (SPT) and specific IgE (sIgE) against food and aeroallergens were measured, and data on allergic symptoms and on demographic and socioeconomic factors were collected by questionnaire. Diagnosis of opisthorchiasis was based on PCR performed on stool samples. RESULTS: Of the 732 children included, 34.9% had opisthorchiasis. The sensitization to any allergen when estimated by positive SPT was 12.8%, while much higher, 24.0%, when measured by sIgE. Atopic symptoms in the past year (flexural eczema and/or rhinoconjunctivitis) were reported in 12.4% of the children. SPT was positively related to flexural eczema and rhinoconjunctivitis, but not to wheezing. Opisthorchiasis showed association with lower SPT response, as well as borderline association with low IgE reactivity to any allergen. However, the effect of opisthorchiasis on SPT response was not mediated by IgE, suggesting that opisthorchiasis influences SPT response through another mechanism. Opisthorchiasis also showed borderline association with lower atopic symptoms. CONCLUSIONS: There is a negative association between a chronic helminth infection and skin prick test reactivity even in a developed country.

[Food sensitization in children with Opisthorchis felineus invasion].

AIM: To determine the mechanism of food sensitization in children with chronic Opisthorchis felineus invasion. PATIENTS AND METHODS: During the epidemiological study the groups of patients (7-10 years) with chronic opisthorchiasis (n = 237) and children without chronic opisthorchiasis (n = 496) were formed. The investigation included interviewing of parents/guardians, measurement of total IgE, specific IgE to food allergens and component-resolved diagnostic, real-time PCR in stool samples. RESULTS: The chronic opisthorchiasis invasion in children is associated with reduced risk of food sensitization, compared with non-infected group (9.7 vs 16.94%, OR = 0.53; 95% CI 0.31-0.88; p = 0.01). Opisthorchiasis of high intensity negatively correlated with increased level of specific IgE to food allergens in serum (OR = 0.46; 95% CI 0.24-0.91; p = 0.023). The association between level of total IgE and intensity of opisthorchiasis combinated with food sensitization was found. The sensitization to allergens class I (cyp c1, cor a11, gal d2, pru p3) is more prevalent in patients with opisthorchiasis, in uninfected children the sensitization to bet v1-homologues (mal d1, pru p1, cor a1, ara h8) is most common. CONCLUSIONS: The epidemiological data on the effect of the Opisthorchis felineus invasion on mechanisms of food sensitization in children were obtained.

[The prevalence of food allergy to peanut and hazelnut in children in Tomsk Region].

Food allergy to peanuts and nuts is an actual problem of practical health care, associated with significant prevalence of this disease, severe clinical symptoms and difficulty of diet organization. Purpose of the study--to study the prevalence of food allergy to peanut and hazelnut in Russian children, the investigation of clinical characteristics of this disease, and the mechanisms of sensitization to allergen components. The cross-sectional study was performed in the framework of the EuroPrevall (No FP6-2006-TTC-TU-5 Proposal 045879). The first stage was performed in random samples of primary schoolchildren aged 7-10 years (n = 13 010) from the Tomsk Region, Russia using a standardized questionnaire. The case-control sample was recruited for the second stage (n = 1288). Thus who reported adverse reactions to food in the screening stage were considered as cases (n = 652), children without reported reactions were controls (n = 636). The case-control stage included the completion of a clinical questionnaire, skin-prick test (ALK-Abelly, Spain), serum specific IgE measurement and component-resolved diagnostic: IgE measurement of allergen components of peanut (Ara h1, Ara h26, Ara h34, Ara h8), hazelnut (Cor a1, Cor a8, Cor a11) and birch allergen Bet v1 (ImmunoCAP, Phadia, Sweden). The prevalence of food allergy to peanut and hazelnut in children aged 7-10 years in the Tomsk region is 0.08 and 0.09%, respectively. The manifestation of the food allergy to nuts occurs in the preschool years, main reactions associated with allergy to nuts were oral allergy syndrome (75-80%), gastrointestinal disorders (60-80%) and itching skin rash (20-50%). Sensitization to birch is significantly correlated with the level of specific IgE to hazelnut (r = 0.53, p < 0.05) and peanut (r = 0.56, p < 0.05). Sensitization to heat-labile proteins peanut Ara h8 (12.3%) and hazelnut Cor a1 (8.8%) (homologues of Bet v1) dominates in the sample of children with food sensitization, that determines the cross-reactivity mechanism in the formation of food sensitization in the studied sample. The prevalence of allergies to peanut and hazelnut in Russia is much lower than in Europe and North America. Sensitization to these foods develops by the mechanism of cross-reactivity with birch pollen allergen. This type of sensitization determines mild clinical symptoms of allergy to hazelnut and peanut.

[The prevalence of food allergies in children in world nidus of opisthorchiasis: background and study methodology of epidemiological survey EuroPrevall].

Accordingly to numerous surveys food allergy affects up to 2-6% of population in different countries and varies due to numerous factors including the prevalence of helminths infestation. The food allergy prevalence data in Russia are based on official medical statistics. The study was performed as part of "The Prevalence, Cost and Basis of Food Allergy Across Europe" (EU funded project No FP6-2006-TTC-TU-5 Proposal 045879 EuroPrevall). The aim is to create the concept offood allergy in children in opisthorchiasis endemic area based on epidemiological study of the prevalence, risk factors and clinical features. The main objective of the study will be the working out of the food safety regulations. This article describes the study design and its methodology.