[Development of a PCR-based method for diagnostics of mycoses]. / Razrabotka i aprobatsiia sistem PTSR-detektsii dlia vyiavleniia invasivnykh mikozov.

Since the express-diagnostics of mycoses in immune-deficit patients still remains an acute problem, we developed an effective test system (Kan-Am) to detect DNA Candida albicans, which is a leader in the list of causative agents of candidosis. A comparison study of three PCR-systems used to detect a broad spectrum of fungoid pathogens was carried out, and a universal system (FungAm), which ensures the detection of DNAs of above 78 strains of 25 types of pathogenic fungi, was selected. The results of clinical testing of the species-specific and universal PCR-systems are well confirmed by the culture method, and they are indicative of the efficacy of applying them for the diagnostics of mycoses in neonatology. The use of the mentioned systems is a promising factor for the express-diagnostics of mycoses in immunodeficiency patients. The high sensitivity of the method makes it possible to detect 10 to 100 cells of a causative agent in 100 mcl of the examined biological material, which is compatible with the culture method. A kit of dry reagents (IonoMix) designed for an accelerated sample preparation and isolation, from them, of DNAs on the basis of Chelex-100 and of proteinase K was worked out; the kit is portable and meant for a long-term storing.

[Comparison of linezolid and vancomycin in nosocomial pneumonia: results of the multicenter double-blind study]. / Linezolid pri nozokomial'nykh pnevmoniiakh: rezul'taty mnogotsentrovogo dvoinogo slepogo issledovaniia v sravnenii s vankomitsinom.

The results of multicenter, randomized, double-blind comparative study of linezolid and vancomycin efficacy, safety and tolerability in the treatment of nosocomial pneumonia are presented. The trial was performed on 69 patients. Clinical efficacy of linezolid was 83 per cent, of vancomycin--79 per cent. Bacteriological effect (pathogen eradication) was 83 per cent for linezolid group and 86 per cent for vancomycin group. During the study good clinical tolerability of linezolid was demonstrated along with lower side effects incidence and shortened recovery period when compared to vancomycin.

[Etiology and microbiological diagnosis of nosocomial pneumonia in newborns]. / Etiologiia i mikrobiologicheskaia diagnostika nozokomial'nykh pnevmonii u novorozhdennykh.

A comparative analysis of the cases of ventilator-associated pneumonia (VAP) among premature infants in intensive care units and premature infant nurseries in 1994 (group I) and 1999 (group II) is presented. It was shown that the number of the cases of ventilator-associated pneumonia in the premature infants of group. I was 2,4 times higher than that in the group II (45.8 and 19.2 per cent respectively). A marked difference in the species pattern of the pathogens isolated from the endobronchial aspirate in 1994 and 1999 was observed. The species pattern of the isolates from the respiratory tract (Pseudomonas aeruginosa--40 per cent; Klebsiella pneumoniae--31 per cent; Staphylococcus epidermidis and Enterococcus--rare) showed that the pneumonia were nosocomial. The revealed similarity of the species patterns of the microflora in various parts of the respiratory tract and the throat posterior wall made it possible to consider the isolates of the throat posterior wall as a relative guide for confirming the etiological diagnosis of nosocomial pneumonia.

[The results and characteristics of the mupirocin (Bactroban) sanative treatment of intranasal Staphylococcus carriers in a large hospital]. / Rezul'taty i osobennosti sanatsii mupirotsinom (baktroban) intranazal'nykh nositelei stafilokokka v usloviiakh krupnogo statsionara.

The action of mupirocin as a nasal ointment (Bactroban) was studied on intranasal carriers of the hospital staphylococcal strains. The study included 37 medical workers from different and mainly problem units of the large general hospital. The tolerability of the ointment was good. After the Bactroban use no complications of the patients were recorded. The efficacy of Bacroban by the microbiological criteria in total amounted to 100 per cent. The eradication of methicillin resistant Staphylococcus aureus (MRSA) was observed in 93 per cent of the cases. A decrease of the level of the nasal passages dissemination by MRSA and methicillin resistant coagulase-negative staphylococci (MRSC) up to such low titers as 100 and 90 per cent was stated. No difference in the action of Bactroban on MRSA, MSSA and MRSC was noted. The bacteriological monitoring for 3 to 4 months revealed a change of the staphylococcal strains in 94 per cent of the cases, recolonization by the same staphylococcal strain in 19 per cent, recolonization by some another staphylococcal strains in 33 per cent and no recolonization in 14 per cent. A stable decrease of staphylococcal strains was possible with simultaneous Bactroban sanitation of all the bacterial carriers of the hospital or its isolated unit.

[Multicenter trial of Enterococcus antibiotic susceptibility]. / Resul'taty mnogotsentrovogo issledovaniia antibiotikochuvstvitel'nosti énterokokkov.

Antibiotic susceptibility of 446 Enterococcus isolates from 9 medical centres of Moscow and St. Petersburg was tested. Among the isolates 386 belonged to E.faecalis, 48 to E.faecium and 12 to the other species. All the isolates were susceptible to vancomycin. As for E.faecalis 84 and 85 per cent of the isolates were susceptible to ampicillin and ampicillin/sulbactam respectively (no production of beta-lactamases), the frequency of high resistance to aminoglycosides amounted to 44 per cent with respect to streptomycin and to 25 per cent with respect to gentamicin, 75 per cent of the isolates was susceptible to ciprofloxacin. As for E.faecium and the rare species of Enterococcus more than 70 per cent of the isolates was resistant to ampicillin and ampicillin/sulbactam, the frequency of high resistance to aminoglycosides exceeded 60 per cent, 17 and 25 per cent of the isolates were susceptible to ciprofloxacin.

[Multicenter study of Staphylococcus susceptibility to antibiotics in Moscow and St. Petersburg]. / Rezul'taty mnogotsentrovogo issledovaniia chuvstvitel'nosti stafilokokkov k antibiotikam v Moskve i Sankt-Peterburge.

Antibiotic susceptibility of 898 Staphylococcus strains isolated in 9 medical centres of Moscow and St. Petersburg was tested. The frequency of methicillin resistant staphylococci (MRS) ranged from 0 to 40 per cent for Staphylococcus aureus and from 0 to 65.9 per cent for coagulase negative staphylococci (CNS). The highest frequencies of MRS were in hematologic, oncologic and traumatologic units as well as in intensive care units for newborns. The frequencies of MRS in St. Petersburg were much lower than those in Moscow. Among the methicillin susceptible staphylococci the frequency of the isolates that produced beta-lactamases amounted to 81 per cent for S. aureus and to 60 per cent for CNS. Practically 100 per cent of the isolates was susceptible to ampicillin/sulbactam and cephalosporins of the 1st, 2nd and 3rd generations. 86-99 per cent of the isolates was susceptible to erythromycin, clindamycin, tetracycline, gentamicin and trimethoprim/sulfamethoxasole. All the MRS isolates were susceptible to vancomycin. 95, 84 and 70 per cent of the S.aureus strains were susceptible to fusidin, rifampicin and ciprofloxacin, respectively. The susceptibility of the CNS isolates was somewhat lower.

[Comparative activity of meropenem and other antibiotics against the pathogens of nosocomial infections]. / Sravnitel'naia aktivnost' meropenema i drugikh antibiotikov v otnoshenii vozbuditelei nozokomial'nykh infektsii.

Comparative activity of meropenem and other antibacterial drugs against isolates from intensive care and reanimation units of various profiles was estimated. It was shown that the recommendations for the combined therapy with the 3rd generation cephalosporins and aminoglycosides should be revised, since none of the isolates resistant to ceftazidime or cefotaxime was susceptible to gentamicin or tobramycin. At present the most promising agents of empirical therapy are carbapenems (meropenem and imipenem). However, the resistance of methicillin resistant staphylococci and Enterococcus faecium to carbapenems and the intrinsic resistance of some gram-negative bacteria to carbapenems are indicative of the necessity of microbiological diagnosis, especially when the treatment with meropenem fails.