[The identification and sensitivity to antibiotics of clostridia, including Clostridia difficile isolated under infectious complications in oncologic patients.]

The 76 strains of Clostridium related to 14 species including 28 strains of C.difficile, were isolated from 74 samples of biological material taken out of oncologic patients. The species identification of strains was implemented by MALDI-TOF mass spectrometry using technique of direct application without extraction. The 74 strains (97.4%) were identified up to specie with reliability evaluation 2.0-2.5. Among C.non-difficile the most frequently were separated C.perfringens (42%), group of C.clostridioforme (24%). The sensitivity of separated strains to anti-microbial preparations was established with E-tests technique. The different species of Clostridia had different sensitivity to antibiotics. The strains C.perfringens are sensitive to all testing antibiotics whereas species related to group C.clostridioforme are resistant to fluoroquinolones (100%)б penicillin (67%). The resistance to fluoroquinolones was observed in C.scindens, C.ramosum, C.symbiosum. The strains C.scindens, C.tertium are resistant to penicillin. Among C.difficile, 93% of strains were resistant to penicillin, 57% - to imipenem and 100% - to fluoroquinolones.

[Effect of adrenocorticotropic hormone (ACTH4-10) on information network of the cardiovascular systems].

The polyparametric description of adaptation syndromes in students using a uniform set of parameters of cardiovascular system and their relationships is presented. An analog of adrenocorticotropic hormone (ACTH4-10) is shown to exert varying effects on the development of different adaptation syndromes. Adaptation syndromes characterized by moderately active physiological processes (as judged by EGG, rheovasogram, respiration rate) and lowered vascular tonus were associated with marked improvement of the health status.

[Infectious complications in patients with Hodgkin's lymphoma of unfavourable prognosis].

Analysis of the infectious complications in 48 primary patients with Hodgkin's lymphoma of infavourable prognosis recorded within 1998-2006 is presented. Respiratory tract infections, mucositis and Herpes infection were stated in 43, 24 and 22% of the patients respectively. Bacterial infections predominated (61% of the patients), then followed viral and fungal infections (26 and 43% of the patients respectively). Associations of bacterial and fungal infections were most frequent (50% of the patients). Associations of bacterial and viral infections were less frequent (30%) and fungal and viral infection associations were revealed in 20% of the patients. The structure of the bacterial, viral and fungal infections and the dynamics of the pathogen spectra are presented. The results of the analysis showed that the infections were frequent complications in such patients and could be due not only to obligate but also to opportunistic pathogens, that requires design of the diagnostic algorithm for prediction of the complication process and outcome, thus improving the remote results of the treatment.

[Prophylaxis of wound infection in patients with head and neck tumors with an account of the pathogen taxonomic pattern].

The most important problem of onkology, i. e. antibiotic prophylaxis and treatment of postoperative infectious complications is touched upon in the paper. The current publications on the problem are discussed and the autors' experience on the treatment is described. The spectrum of the main pathogens of wound infections in patients with head and neck tumors is considered.

[Infectious complications after prosthesis implantation in patients with bone tumors].

Data on the retrospective analysis of 245 cases of endoprosthetic replacement of bones and major joints are presented. Intraprosthetic infection-related complications were reported in 11%. They developed within 3 months in 64% and their frequency was significantly higher in cases of repeat surgery, resection of proximal tibia with subsequent endoprosthetic replacement of defective knee joint as well as adjuvant polychemotherapy. Anti-infective treatment alone was effective in 11%; complications were aborted by means of surgery of varying extent in 75%.

[Production of active oxygen by neutrophils in patients with cancer of the esophagus and stomach before and after surgical interventions].

The state of the oxygen-depended antimicrobial activity of neutrophils on oncologic patients was studied. Production of active oxygen by non-activated and activated neutrophils of peripheral blood from 19 patients (the average age of 56 years, 16 males and 3 females) with esophageal cancer and cancer of the stomach and metastasis to the esophagus was recorded by chemiluminescence before and after surgical interventions (transpleural gastrectomy, Lewis type operation) on the 1st, 3rd and 7th days after the operations. The oxygen-depended antimicrobial activity of the neutrophils was investigated by their ability to produce active oxygen when incubated with opsonized zymosan and N-formyl-methionyl-leucyl-phenylalanine. Luminol chemiluminescence recorded the whole pool of active oxygen and showed the summary activity of myeloperoxidase and NADPH-oxidase, while luceginin chemiluminescence measured formation of superoxide anion radical (*O(-)2) and evaluated the activity of NADPH-oxidase. The results showed that the procedure provided estimation of the functional state of the neutrophil leukocytes and their ability to produce active oxygen. Impairment of the myeloperoxidase- and NADPH-depended production of active oxygen by non-activated and activated neutrophils observed before operations resulted in altered synthesis of active oxygen after the surgery. This is one of the leading factors of the infection development in the end. Detection of the myeloperoxidase- and NADPH-depended production of active oxygen could be of help in revealing the groups of risk among patients at the stage of the preoperative examination and serve as a prognostic factor of the development of severe infectious complications during the postoperative period.

[Efficacy of moxifloxacin (Avelox) in prophylaxis of infection in patients with profound neutropenia]. / Effektivnost' ispol'zovaniia moksifloksatsina (Aveloks) dlia profilaktiki infektsii u bol'nykh s glubokoi neitropeniei.

Comparative efficacy of moxifloxacin and ciprofloxacin as prophylactics of infection in cancer patients with severe neutropenia after the chemotherapy was studied. The study included 40 patients with malignant lymphomas and solid tumore who received 52 courses of the aggressive chemotherapy. Twenty four patients (30 courses) received oral moxifloxacin in a dose of 400 mg once a day from the first day of the neutrophil count decrease below 1.0 x 10(9)/l until its recovery to > 1.0 x 10(9)/l or when the signs of infection appeared. In the control group 16 patients (22 courses) received oral ciprofloxacin in a dose of 500 mg twice a day. The patients in both the groups were compatible by the diagnosis, age and neutropenia duration. The median of the days of the febrile neutropenia duration in the patients prophylactically treated with moxifloxacin was statistically lower (2.1 vs 3.6 in the control group, p < 0.05). The incidence of febrile neutropenia in the moxifloxacin group was significantly lower than that in the control group (73 and 100% respectively, p = 0.01). The incidence of bacteriologically confirmed infection in the moxifloxacin group was also lower (6% vs 27.2%, p = 0.04). Therefore, moxifloxacin proved to be a more efficient agent vs ciprofloxacin (standard prophylactic) in prevention of febrile neutropenia and neutropenic infection in cancer patients, which is likely due to its higher activity against grampositive organisms.

["Augmentin" in the antibiotic prevention of postoperative infections complications in gynecological cancer patients]. / Augmentin v antibiotikoprofilaktike posleoperatsionnykh infektsionnykh oslozhnenii u onkoginekologicheskikh bol'nykh.

Hysterectomies are arbitrarily pure operations and thus require antibiotic prevention. A great risk for postoperative infections is particularly high after Wertheim's operation. This study evaluated the efficiency of infection prevention in 19 cancer gynecological patients by using the antibiotic augmentin (amoxicillin/clavulanic acid). The first dose was administered 30 minutes before surgery in order to achieve the maximum drug concentration in blood and tissue at surgery. There was no wound suppuration. One patient (5.3%) undergone Werthein's operation was diagnosed to have retroperitoneal hematoma suppuration. One more patient (5.3%) had fever of unknown genesis. Urinary infections that are not considered to be a sign of inefficiency of antibiotic prevention and that were due to long-term catheter placement developed in 4 (21.1%) of the 19 patients. The postoperative period was smooth in 14 (73.7%) of the 19 patients. The perioperative Augumentin administration regimen used by the authors was easy-to-use and beneficial and the drug shows a low toxicity so it may be used for antibiotic prevention in cancer gynecological patients.

[Antibiotic prophylaxis with amoxicillin/clavulinate (Augmentin) in extended and combined operations in gynecologic cancer patients]. / Antibiotikoprofilaktika amoksitsillinom/klavulanatom (Augmentinom) pri rasshirennykh i kombinirovannykh operatsiikh u onkoginekologicheskikh bol'nykh.

Frequency of postoperation complications at oncological patients deviates in the range from 10 to 70 per cent. The highest frequency of infectious complications is registered after extended and complex operations (cervical carcinoma, cancer of vulva, ovarian cancer). The most frequent aerobic pathogens in oncology are enterococci, staphylococci and streptococci, in the case of urinary tract operations--enterococci and Erscherichia coli. Perioperation prophylaxis with amoxycillin/clavulanate (Augmentin) effective against this microorganisms and also against anaerobic bacteria (usual pathogens of post operation infections in oncogynecology) resulted with lower frequency of wound infections. Demonstrated prophylaxy efficacy was more potent than that of cefotaxime (p < 0.05) or when compared to results of other antibiotics administration after operations only.

[Benzylpenicillin efficacy for neutropenic infection prophylaxis in patients with cancer and postcytostatic neutropenia]. / Effektivnost' naznacheniia benzilpenitsillina dlia profilaktiki neitropenicheskoi infektsii u bol'nykh s opukholevymi zabolevaniiami i posttsitostaticheskoi neitropeniei.

Evaluation of benzylpenicillin (penicillin G) effect for infection prophylaxis at the oncological patients with severe postcytostatic neutropenia was performed. All the patients with neutrophils levels lower than 0.5 x 10(9)/L were recommended to use antibiotics for infection prophylaxis. Test-group (n = 40) used ciprofloxacin (0.5 g twice daily, per os) combined with benzylpenicillin (1.0 g four times daily, i/v); control group was treated by ciprofloxacin in the same dose only. Combination with benzylpenicillin resulted in statistically significant reduction of infections frequency among oncological patients.

[A trial of the use of mupirocin in the nasal carriage of Staphylococcus aureus in medical personnel]. / Opyt primeneniia mupirotsina pri nazal'nom nositel'stve zolotistogo stafilokokka u meditsinskogo personala.

Many hospital-acquired purulent diseases and wound infections are due to multiresistant hospital strains of Staphylococcus aureus. The role of S. aureus nasal carriage in development of wound infections due to autoinfection is confirmed. Not only inpatients but also hospital staff can be highly colonized with coagulase positive staphylococci. The S. aureus persistence in hospital personnel results in distribution of the microorganisms in the environment. Therefore, detection of S. aureus carriers without signs of the infection among the hospital personnel and eradication of the pathogen make it possible to control outbreaks of S. aureus infection in hospitals. Clinical efficacy of nasal ointment of mupirocin in the treatment of S. aureus carriers among the intensive care personnel of the N. N. Blokhin Cancer Research Center was evaluated. S. aureus nasal carriage was diagnosed in 17 (26 per cent) out of 65 persons. All the isolates were susceptible to oxacillin. 5-7 days after discontinuation of the mupirocin nasal ointment use eradication of S. aureus was stated in 100 per cent of the cases. The effect was still observed in 94 per cent of the cases in 1 month, in 76 per cent of the cases in 5-6 months and in 60 per cent of the cases in 8-9 months. It is believed that mupirocin nasal ointment (Bactroban) is convenient to use, low toxic and highly active in the treatment of persons with S. aureus nasal carriage.

[Non-sporulating anaerobic bacteria and anastomosis failure in patients with gastric carcinoma]. / Nesporoobrazuiushchie anaéroby pri razvitii nesostoiatel'nosti anastomozov u bol'nykh rakom zheludka.

Cases of anastomosis suture failure within the period from 1977 to 1987 and from 1988 to 1998 in 139 patients after various surgical operations for gastric carcinoma were analyzed. Infection in the cases of the anastomosis sUture failure at the early terms was mainly due to representatives of Enterobacteriaceae and at the later terms the failure was mainly due to non-sporulating anaerobes belonging to Bacteroidaceae. The data are indicative of the fact that the use of antimicrobials requires a differential approach.

[Fungal infection in the oncologic clinic]. / Gribkovaia infektsiia v onkologicheskii klinike.

Fungal infection in oncologic hospitals is a serious threat for the patients that can undermine the results of the specific treatment of the main disease. Most frequently fungal infection is developing in localities naturally disseminated with microbial flora. The infection is usually mixed: bacterial/fungal and even fungal/fungal. The most frequent members of the associations are the representatives of Candida albicans: 63 per cent in the bacteria + fungi associations and up to 60 per cent in the fungi + fungi associations. The preventive use of azoles can lower the threat of fungal affection of the organs. However, the danger of mixed fungal/bacterial infection remains rather high.

[Purulent complications in the surgical treatment of patients with mouth cancer and their prevention]. / Gnoinye oslozheneniia pri khirurgicheskom lechenii bol'nykh rakov polosti rta i ikh profilaktika.

Local purulent complications after surgical operations for mouth cancer were recorded in 49 (61.3 per cent) out of 80 cases and were mainly due to associations of 2 or more pathogens. The analysis of the factors influencing the development of the complications showed that there was no reliable increase in the number of the complications in the patients subjected at the first stage to the treatment with various antitumor agents: 17 (53.1 per cent) events in the group of the patients subjected to radiotherapy in a total focal dose of 40 Gy, 8 (72.7 per cent) events in the group of the patients subjected to radiotherapy in a dose of more than 60 Gy, 13 (59.1 per cent) events in the group of the patients treated with antitumor drugs and 8 (66.7 per cent) events in the group of the patients operated at the first stage of the treatment. The incidence of osteomyelitis was significantly higher in the group of the patients subjected to radiotherapy before the operation: 13 (30.2 per cent) events vs. 2 (5.4 per cent) in the group of the patients not subjected to radiotherapy. With increasing of the radiation dose, the incidence of osteomyelitis as well increased: 8 (25.0 per cent) osteomyelitis events in the group of the patients subjected to radiotherapy in a dose of 40 Gy and 5 (45.5 per cent) events in the group of the patients subjected to radiotherapy in a dose of more than 60 Gy. The method of osteosynthesis of the lower maxilla with titanium miniplates was also of great importance. The use of various schemes for antibiotic prophylaxis of wound infection in such patients was equally efficient.

[The microbiological aspects of infectious complications in the oncology clinic]. / Mikrobiologicheskie aspekty infektsionnykh oslozhnenii v onkologicheskoi klinike.

At present 10 to 30 per cent of the microbial strains from cancer patients are problem ones: oxacillin resistant strains of Staphylococcus aureus, coagulase negative strains of Staphylococcus spp., aminoglycoside resistant strains of Escherichia coli, 3rd generation cephalosporin resistant strains of Klebsiella spp. and fungi of Candida which requires development of more rational approaches to antibacterial chemotherapy and prophylaxis of infectious complications. The infectious processes in the cancer patients proved to be highly polyetiological. Therefore, the study is significant for epidemiologic and therapeutic measures. Such an analysis in oncological clinic should be regular.

[Cefepime in the treatment of infection in neutropenic patients]. / Tsefepim pri lechenii infektsii u bol'nykh s neitropeniei.

Cefepime, a fourth-generation cephalosporin, was used in the treatment of 11 febrile episodes in 8 patients with profound neutropenia. The patients were neutropenic because of high-dose chemotherapy with stem-cell rescue or second-line salvage chemotherapy for malignant lymphomas (5 patients) or solid tumors (3 patients). The median duration of grade-IV neutropenia (according to the WHO classification) was 11 days (7 to 14). Cefepime was used as the monotherapy in a dose of 2 g thrice daily. Disappearance of the infection signs was recorded in 8 episodes (73 per cent). In 3 episodes (23 per cent) cefepime was replaced by another drug. The tolerability of cefepime was good and no adverse events were observed with the exception of 1 event of an allergic reaction.

[Systems analysis of polyparametrical syndromes in students under study-induced stress]. / Sistemnyi analiz poliparametricheskikh sindromov u studentov pri razvitii stressa v period ucheby.

In addition to routine physical examinations, the polyparametrical method was used to examine 250 students to assess their health. For this, the methods of pattern discrimination and classification were employed to analyze multiparameter data. Clinical and polymetric findings correlated well. The polymetric method revealed 4 main classes of the students' functional and autonomic status. Autonomic changes can be systemic and local. The visualized data of objective functional parameters controlled by the autonomic system made it possible to give a syndromal assessment of functional states and to reveal the intermediate stage between health and disease.