[Epidemiology and prophylaxis of septic infectious complications in patients from critical and intensive therapy surgical units].

AIM: To investigate efficacy of the extended complex of preventive and antiepidemic measures for reduction of nosocomial infections incidence in patients treated in critical and intensive therapy (CIT) surgical units. MATERIAL AND METHODS: From 2003 to 2005 CIT units of N.N. Burdenko Central Military Hospital conducted a study with participation of 200 patients aged 50 to 77 years after extended abdominal operations. The patients were divided into 2 groups. Group 1 (n = 100) received standard prophylaxis of infectious complications, group 2 (n = 100) received an extended complex of prophylactic and antiepidemic measures. First-line antibacterial therapy in all the patients included cephalosporines of the third generation and metronidasol. The extended complex included air decontamination with application of the system "Clean room complex"; prevention of nosocomial, particularly ventilator-associated pneumonia (VAP); prevention of catheter-associated sepsis; use of disposable sterile items. RESULTS: Group I patients developed sepsis in 30%, septic shock and polyorganic insufficiency (POI)--in 16% cases; lethality due to infectious complications was 13%. Gram-negative microflora was dominating. In group 2 sepsis was diagnosed in 22%, septic shock and POI--in 11%, lethality was 11%. CONCLUSION: The extended complex ofpreventive and antiepidemic measures significantly reduced the rate of severe infectious complications and related lethality. Among the agents of nosocomial infection the percentage of staphylococci and blue pus bacillus decreased while that of enterococci and E. coli increased. Contamination of the ambient air and CIT units reduced significantly.

[Severe community-acquired pneumonia: etiology]. / Tiazhelaia vnebol'nichnaia pnevmoniia: étiologicheskaia struktura.

A complex microbiological (sputum, protected brush biopsy of the bronchial mucosa) and immunological examination of 40 male patients (the average age of 55.4 +/- 8.8 years) with severe community-acquired pneumonia (risk classes III-V according to Fine M.J. et al., 1997) revealed the disease etiology in 52.5 per cent of the cases. The leading pathogen was Streptococcus pneumoniae. It was detected in 61.6 per cent of the cases of the etiologically verified pneumonia. Staphylococcus aureus and Klebsiella pneumoniae were also among the actual pathogens (14.3 and 14.3 per cent respectively). The Legionnaires infection was not confirmed in any of the patients (enzyme-linked immunological analysis of urine for the serotype 1-6 Legionella pneumophila antigen). In the absolute majority of the patients the isolated pneumococci were susceptible (E-test) to benzylpenicillin. Only in 1 patients with severe pneumonia and secondary bacteriemia the pneumococcal isolates were moderately resistant to benzylpenicillin (the MIC of 0.125 mg/ml). Still, they were susceptible to ceftriaxone (the MIC of 0.023 mg/ml). The data are useful in the development of a national (regional) programme for empirical antibacterial therapy of severe community-acquired pneumonia.

[The current course and treatment of infectious endocarditis]. / Sovremennoe techenie i lechenie infektsionnogo éndokardita.

Clinical study of 172 patients treated in the Burdenko Military Hospital for subacute infectious endocarditis in 1980-1996 compared with 192 cases in 1950-1979. Contemporary course of the disease is attended by a few symptoms, primordiality and single-valve affection. On the grounds of antibiotics sensitivity of the most prevalent infection agents discovered in 1996, the article develops some schemes of antibacterial therapy for Streptococcus, Enterococcus and staphylococcal etiology of disease. Rational antibiotic therapy together with surgery measures reduced lethality to 14.3% for Streptococcus endocarditis, to 16.7%--for Enterococcus and to 34.4%--for Staphylococcus.

[An improvement in the methods for the microbiological study of the blood from patients with suppurative-septic infections]. / Sovershenstvovanie metodov mikrobiologicheskogo issledovaniia krovi u bol'nykh s gnoino-septicheskimi infektsiiami.

The new method for microbiological analysis of blood in patients with pyoseptic infections is based on separate inoculations of plasma, erythrocyte mass, and leukocyte layer in nutrient medium providing conditions for growth of a wide spectrum of aerobes and obligate anaerobes. The method in general ensures a more rapid result and permits differentiation between true and false-positive bacteremia and between stages of septic process (bacteremia and septicemia).