[Taxonomic characteristics and mixed communities of wound infection agents in patients of reanimation and surgical departments of a hospital].

AIM: Study of taxonomical structure ofwound infection agents, prevalence of mixes, and detection of character of their possible connection with the results of various microorganisms population interaction in septic wounds. MATERIALS AND METHODS: A microbiological study of material from patients with wound infection (WI), 582 of those were cured in reanimation and intensive therapy departments (RITD; group 1) and 1455 - in surgical departments (SD; group 2), was performed. Taxonomic membership and ability to coexist was determined in 4129 microorganisms strains. Etiological role of the agents was evaluated by using values of consistency rate (CR). Species that were present in more than 50% of samples were considered consistent, in 25 to 50%--additional, and in less than 25%--random. Frequency rates (FR) were also determined, that is the fraction of a certain species (genus) of the microorganism (in %) from all the isolated cultures that correspond to 100%. For the determination of the significance of individual species of the agent in the structure of mixed microorganism populations, FR - their fraction (%) in mixed population from the number of strains of this species that correspond to 100% - was calculated. RESULTS: A significant part of the microorganisms strains, more frequently in reanimation department (65.5%), caused wound suppuration in populations mixed with other species of the agents. In reanimation and surgical departments consistent species of wound infection agents were not detected. A leading etiological role of Staphylococcus aureus (FR 19.2% and 23.9%) was determined, and FR of S. aureus strains in mixes was 64.6% in RITD and 46.8% in SD. The parameters ofotheragents of WI in the comparison groups were similar. However FR among mixes in RITD were significantly higher for streptococci that do not belong to S. pyogenes species (72,5%), and also nonfermentative microorganisms (67,2%), and in SD - in Klebsiella pneumoniae mixes. For agents of wound infection especially in RITD, low species diversity was characteristic and the number of mixes variants is significantly higher. In RITD mixed infections develop more frequently, and the ecological community of microorganisms reaches higher values than in SD. CONCLUSION: During the analysis of microbiologi-cal data in RITD and SD general patterns and specific features of taxonomical structure, prevalence of mixed populations and character of their ecological community in wound infection was determined.

[Microbiological diagnosis of gas gangrene caused by Clostridium septicum (a clinical case)].

Microscopy of gram-stained impression smears is used for the rapid diagnosis of microorganisms in the wound. The shin tissues of patient P. with suspected gas gangrene of lower extremity soft tissues were microscopically found to have gram-positive spore-forming bacteria that were morphologically similar to C. bifermentans that were identified as C. septicum on cultural diagnosis. The pathogenic C. septicum strain spores were likely to be formed in the macroorganism upon exposure of the pathogen to a patient's defense factors and to a package of therapeutic measures. Microbiological data should be used only in combination with clinical and instrumental findings and the results of other laboratory studies when the optimal technology is chosen to treat gas infection. By keeping in mind that there may be clostridial gangrene in the patients and the experience of clinicians and bacteriologists may be insufficient in diagnosing this pathology, it is necessary to strengthen the training of physicians in the diagnosis of this pathology.

[Mono- and associated microflora during wound infection in patients with burns].

AIM: To study etiologic role of microorganisms during wound infection and elucidation of their populations interaction in patientswith burns. MATERIALS AND METHODS: 2137 patients with wound infection treated in burn center were studied. 3179 samples of wound exudates and 6501 strains of microorganisms were studied. Assessment of microorganism's etiologic role was carried out using results of calculation of various statistic indexes, including indexes of ecological similarities of microorganisms in the wound (indexes of contamination, prevalence or persistence, incidence). Ecological similarity of wounds' microflora was determined by calculation of the coefficient Kj. RESULTS: It was established that Staphylococcus aureus is the most common cause of mono- and mixed wound infections. It was determined that Kj value for common agents points to antagonism or associative interaction. During particular time periods of the study values of Kj significantly differed and depended from species. Specifically, for Pseudomonas aeruginosa the values of Kj were equal or exceeded 30% during several years. It was the first time when correlation between persistence and ecological similarity indexes was studied in agents of wound infections. CONCLUSION: In order to reveal factors influencing on microbial etiology of mixed wound infections it is reasonable to consider the nature of interspecies interactions of causative agents.

[Influence of various pectins on production of staphylococcal enterotoxins types A and B].

Experimental in vitro study of influence of 2% solution of pectins (red beet, apple, citrus, manufactured by "Vitaline" company, citrus high- and low-etherified pectins, manufactured by "Hercules" company, Unipectine OB 700, and biologically active supplement "Pecto") on growth of staphylococci and production by them of type A and B enterotoxins was performed. It was shown that red beet, citrus high- and low-etherified pectins, as well as biologically active supplement "Pecto" render bactericidal effect on staphylococci and inhibit synthesis of types A and B staphylococcal enterotoxins. Citrus pectin "Vitaline" and Unipectine OB 700 don't have such influence. The most effective pectins, which were able to inhibit synthesis of types A and B staphylococcal enterotoxins, were red beet, apple, and citrus low-etherified pectins as well as biologically active supplement "Pecto".

[Microbiological diagnosis and antibacterial therapy of non spore-forming anaerobic infections in emergencies]. / Mikrobiologicheskaia diagnostika i antibakterial'naia terapiia nesporoobrazuiushchikh anaérobnykh infektsii pri neotlozhnykh sostoianiiakh.

A total of 240 patients with soft tissue and wound suppurations, peritonitis, and suspected sepsis were examined. Anaerobic isolates were more frequently obtained in 20-75% of patients infections associated with facultative microbes. The use of non-culture media (bacterioscopy and gas-liquid chromatography) increased the detection rate of anaerobic infection up to 82% as compared with bacteriological diagnosis (63%). The findings and the data of monitoring of suppuration agents for several years allowed the authors to work out effective combined treatment regimes for early mixed aerobic and anaerobic infections in 80-100% of patients.

[Identification of the enterobacteria isolated from patients by using the Enterotube test system]. / Identifikatsiia vydelennykh ot bol'nykh énterobakterii pri pomoshchi test-sistemy "Enterotube".

The Enterotube test system intended for the accelerated identification of enterobacteria was used to study 319 strains isolated from patients with suppurative complications after surgical operations and traumatic lesions. The test system was found to allow a reliable identification of Enterobacteriaceae having characteristic biochemical properties. It was also found that the kit intended for 10 tests could prove insufficient for the identification of atypical bacteria. The Enterotube test system made it possible to differentiate 95% of enterobacterial strains; in the identification of bacteria by their genus and species and results obtained with the use of the Enterotube test system and common biochemical methods were found to be identical (in 96.4% of tests).

[Characteristics of enterobacteria isolated during purulent-inflammatory processes in patients with critical diseases]. / Kharakteristika énterobakterii, vydelennykh pri gnoino-vospalitel'nykh protsessakh u bol'nykh s ékstrennoi patologiei.

A total of 238 patients were surveyed; 444 bacterial strains were isolated; of these 403 strains belonged to 7 out of 12 genera of the family Enterobacteriaceae and 41 strains were identified as Alcaligenes faecalis. The majority of enterobacteria were sensitive to broad-spectrum antibiotics. A characteristic feature of Proteus was polyresistance to antibacterial preparations. The active and passive immunization of patients with urgent pathology against infections caused by E. coli and Pr. mirabilis is recommended.

[The ecological communality of obligate anaerobic and aerobic causative agents of suppurative processes]. / Ekologicheskaia obshchnost' obligatno-anaérobnykh i aérobnykh vozbuditelei gnoinykh protsessov.

The composition of aerobic-anaerobic associations in peritonitis and mediastinitis has been found to correspond to the normal microflora of the biotope organ whose lesion leads to the development of the pathological process. As shown with the use of Jacquard's coefficient, in peritonitis the highest degree of ecological similarity is observed among bacteroids and enterobacteria (45.8%) and in mediastinitis and phlegmons, among bacteroids and staphylococci (45.0% and 45.4% respectively). The results of the study of symbiotic relationships among bacteria in the focus of inflammation may be used in the study of the pathogenesis of mixed infections.

[Pseudomonas aeruginosa and Proteus antigenemia and antibody formation in mono- and mixed infections in patients with suppurative inflammatory diseases]. / Sinegnoinaia i proteinaia antigenemiia i antiteloobrazovanie v usloviiakh mono- i smeshannykh infektsii u bol'nykh s gnoino-vospalitel'nymi zabolevaniiami.

P. aeruginosa and Proteus antigenemia and antibody production have been studied in 335 patients with purulent inflammatory diseases. The study has revealed that in the association of P. aeruginosa and Proteus with staphylococci and representatives of the family Enterobacteriaceae the level of antigenemia is considerably lower than in monoinfections or in the association of these microorganisms with streptococci. In mixed infections humoral immune response develops later than in cases of monoinfection. An important role of ecological and physiological relationships between microorganisms in the course of purulent processes and in their influence on the host has been confirmed. The use of the enzyme immunoassay in the clinical practice has made it possible to determine the etiological role of P. aeruginosa and Proteus in the development of suppurative-inflammatory diseases, to select adequate immunotherapy, including the use of anti-P. aeruginosa and anti-Proteus plasmas, and to evaluate the effectiveness of treatment.

[Immunologic methods in the diagnostics and treatment of nosocomial cases of pneumonia]. / Immunologicheskie metody v diagnostike i lechenii nozokomial'nykh pnevmonii.

The publications on the etiology, bacteriological and immunochemical diagnostics of pneumonia, as well as on the role of immunotherapy and prophylaxis in the treatment of this disease, are analyzed. The importance of immunological methods in the diagnostics of pneumonia is pointed out. Approaches to the immunotherapy and immunoprophylaxis of pneumonia are updated.

[Bacterial contamination of human blood in the early period after sudden death]. / Kontaminatsiia bakteriiami krovi cheloveka v rannie sroki posle vnezapnoi smerti.

The bacterial contamination of blood and its components was studied in 517 corpses during the first 2-4 hours after sudden death. Investigations were made with the use of anaerobic cultivation techniques, modern identification methods by means of test systems and gas-liquid chromatography. As revealed in this study, in 14.1% of the corpses different bacteria, belonging to the representatives of normal human microflora, were detected in the blood. More than a half of the isolates were represented by Propionibacterium (P. acnes and P. granulosum). The endogenous way of contamination from the lymph of the hepatic duct seems to be most probable.

[Coagulase-negative staphylococci isolated from patients. I. Biological properties and biotyping of the strains]. / Koagulazootritsatel'nye stafilokokki, vydelennye ot bol'nykh. Soobshchenie I. biologicheskie svoistva i biotipirovanie shtammov.

A total of 403 coagulase- and DNAase-negative staphylococcal strains isolated from patients with conjunctivitis, urological diseases, purulent inflammatory processes, septicemia, infected traumas, pyodermia were investigated in 18 biological tests. In a vast majority of cases the absence of correlation between the individual biological characteristics of the strains was revealed. The identification of S. epidermidis and S. saprophyticus, carried out by Akatov et al. in accordance with the schemes of the International Subcommittee, Digranes and Oeding, allowed to determine the species the organisms under test belonged to in 26%, 38% and 64% of the strains, respectively. Most of the identified strains belonged to S. epidermidis. Their biological typing by the methods of Baird-Parker and Akatov-Khatenever allowed the biotype to be determined in 79% and 69% of the cultures. Strains belonging to biotype 1 according to Baird-Peter were most frequently isolated in conjunctivitis, purulent processes and pyodermia, while strains belonging to biotype 2 according to Akatov-Khatenever were prevalent in urological diseases.

[Wound microflora in injured patients]. / Mikroflora ran u travmatologicheskikh bol'nykh.

The authors present the results of bacteriological study of fresh wounds in 165 traumatological patients and data on the character of microbial flora in the occurrence of purulent inflammatory complications. Microbes revealed in fresh wounds proved to differ by their species composition and antibiotic sensitivity from these causing suppuration. Purulent inflammatory complications were mostly caused by microbes which were not revealed in the wound at first.

[The infectivity of surgical wounds]. / Infitsirovannost' khirurgicheskikh ran

A study was made of microbial contamination of wounds and wound fluid in 114 patients operated upon (clean and conditionally clean operations). Directly before suturing the subcutaneous-fatty cellular tissue no microbes were revealed in 50% of cases, but in 23% of cases potentially pathogenetic microorganisms were isolated. Potential causative agents of purulent infection were revealed in 50% of the patients on the 1st-3rd postoperative days. Suppuration developed in 3 cases only. In a number of cases there were revealed in the wound discharge such microbes which were not detected before the wound was sutured. Sometimes the presence of even numerous potentially-pathogenic microbes in the wound secretion led to no suppuration.

[The microfloral wound dynamics of the victims in the railroad disaster in Bashkiria]. / Dinamika mikroflory ran postradavshikh pri katastrofe na zheleznoi doroge v Bashkirii.

The work deals with the microbial composition of burn wounds in the victims of the railroad catastrophe in Bashkiria during their stay in a hospital. The comparison of the microbial spectrum in the wounds of the burn victims of the catastrophe with the results of the monitoring of the causative agents of burn infections in patients treated at the department of thermal lesions over a period of 3 years is presented. The medicinal sensitivity of wound microflora at all stages of the hospital treatment of the patients was studied and compared with the medicinal sensitivity of microorganisms isolated from the wounds of burn patients in 1988.

[Frequency of detection and the species composition of anaerobic gram-negative nonsporulating bacteria in suppurative pathology in emergency surgery]. / Chastota obnaruzheniia i vidovoi sostav anaérobnykh gramotri-tsatel'nykh nesporoobrazuiushchikh bakterii pri gnoinoi patologii v ékstrennoi khirurgii.

The improved technique of cultivation allowed to detect obligatorily anaerobic microorganisms in 58 out of 94 samples from patients with purulent inflammatory processes. The results of the studies showed that anaerobic microorganisms were most frequently isolated from the exudate of the abdominal cavity and the purulent discharge of wounds in peritonitis patients. Gram-negative nonsporulating bacilli made up 25.3% of all the isolated cultures. The identification of these microorganisms allowed to determine that in the exudate of the abdominal cavity, the discharge of surgical and posttraumatic wounds, and of the pleural cavity the representatives of the family Bacteroidaceae mainly occurred. Most frequently B. thetaiotaomicron and B. fragilis were isolated.

[Changes in the composition of the causative agents of wound infection in emergency surgery in the period from 1967 through 1987]. / Izmeneniia sostava vozbuditelei ranevoi infektsii v ékstrennoi khirurgii za period s 1967 po 1987 g.

The composition of the causative agents of suppurations, isolated from suppurating wounds of patients hospitalized at different departments of the Sklifosovskii Emergency Aid Institute was studied. The proportion of representatives of different microbial families among more than 18,000 strains of the causative agents of wound infection was estimated. Fluctuations in the amount and structure of the agents were analyzed in different clinics over the period of 1967-1987. Under the conditions of emergency aid hospital Staphylococcus aureus proved to be the most frequent causative agent of suppurative inflammatory processes at different departments. At the same time no tendency towards an increase of the etiological role of any microbial family in the development of wound infections was noted. The incidence of different causative agents of suppurations was found to vary at different departments, depending on their specialization and season. The results of observations on the composition of the causative agents of wound infection may be used for the planning and evaluation of antiepidemic measures.

[Comparative population study of the etiological role of causative agents of purulent inflammatory diseases and serum antibodies to antigens of opportunistic microorganisms]. / Sravnitel'noe populiatsionnoe izuchenie étiologicheskoi znachimosti vozbuditelei gnoino-vospalitel'nykh zabolevanii i syvorotochnykh antitel k antigenam uslovnopatogennykh mikroorganizmov.

The comparative study of the relationship between the levels of serum antibodies to the antigens of opportunistic microorganisms of 5 genera (Pseudomonas, Proteus, Staphylococcus, Klebsiella, Escherichia) and the microbial status was carried out. A total of 854 patients from 10 profile departments of a surgical hospital were examined. Population analysis and statistical methods of processing the results of the examination of 353 practically healthy subjects and 268 blood and plasma donors permitted the norms for the levels of specific antimicrobial antibodies (decreased, normal, elevated levels) were established. The constancy coefficients of Pseudomonas, Staphylococcus, Klebsiella, Escherichia and the number of patients with elevated titers of specific serum antibodies were found to be positively correlated (r = +0.47-0.89, p < 0.01). The data thus obtained made it possible to substantiate the importance of population serological investigations for the evaluation of the epidemiological situation in the surgical hospital.

[Bacteriological monitoring of infective agents of purulent septic diseases in an emergency hospital]. / Monitoring vozbuditelei gnoino-septicheskikh zabolevanii v statsionare skoroi meditsinskoi pomoshchi.

During the period of 1995-2001 bacteriological examination of 13,842 patients with purulent septic diseases (PSD) was carried out. The statistical processing of data revealed that equalization of the dynamic rows of intensive and extensive values characterizing the number of patients with PSD caused by etiologically important infective agents made it possible to evaluate the reliability of information. A trend to increased etiological importance of the genera Pseudomonas, Escherichia and Klebsiella was established. The number of diseases caused by Staphylococcus, Streptococcus, Enterococcus and Proteus decreased.

[The dynamics of the wound microflora in the victims of the earthquake in Armenia]. / Dinamika mikroflory ran postradavshikh pri zemletriasenii v Armenii.

The data on the composition of wound microflora, as well as changes in the contamination index over the course of treatment of patients with the syndrome of prolonged compression, who were brought to the institute after the earthquake in Armenia, are presented. The authors characterize the structure of the causative agents of wound infection in the patients treated at the traumatological department of the institute over several years. The epidemiological situation in the hospital in the period when the earthquake victims were treated there is analyzed.