[Healthcare-associated infections. The current state of the problem].

The current article elucidates some novel trends in the field of healthcare-associated infections emerged in the foreign scientific medical publications over the last year and a half (January 2013 - June 2014). The following topics are covered: definition of the term, the body of publications bibliometrics, classification, statistics, patient-to-professional infection transmission, control and prevention, specialized national organizations, new guidelines and a new monograph on the theme. The conducted analysis demonstrates the significance of the topic and the high rate of research in the field.

[Medical-and-economic substantiation of rational antibacterial therapy for patients with pleural empyema in the conditions of military medical institutions].

We have performed a post-hoc analysis of the results of using antibacterial therapy in patients with pleural empyema. The cost-effectiveness analysis of rational and empiric antibacterial therapies was performed. The cost-effectiveness ratio for rational antibacterial therapy was lower than for empiric one (2889 and 4480 rubles for 1 treated patient correspondingly). The use of the rules of rational antibacterial therapy in practice leads to proved saving of economic costs.

[Primary causative agents of infectious complications in injured with severe trauma].

AIM: Study etiologic structure of infectious complications in injured with severe-trauma. MATERIALS AND METHODS: Retrospective analysis of results of therapy outcomes in 5966 wounded and injured (1999 - 2009) and prospective observation of 142 injured (2008 - 2009) by using epidemiologic, statistical and microbiological methods was carried out. RESULTS: Frequency of isolation and specific weight of causative agents depending on localization of infectious complication was established. Among 11486 isolated microorganism strains 4 causative agents dominated: Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter spp. and Staphylococcus aureus. The proportion of these causative agents differed in various years. Interconnections of microorganisms composing associations were determined. CONCLUSION: Conduction of microbiological monitoring is determined by the necessity of constant control for leading causative agents of infectious complications in injured with severe trauma in the dynamic of their therapy.

[Sanitary-bacteriological control of artificial ventilation apparatuses in the prevention of nosocomial respiratory tract infections in a surgical hospital].

Airway damage in intensive care unit patients at surgical hospitals is a common manifestation of nosocomial pyoseptic infections. Artificial ventilation (AV) apparatuses used in a therapeutic and diagnostic process are vital to the transmission of their pathogens. The paper shows that various units and surfaces of the apparatuses are differently contaminated with nosocomial microorganisms. In this connection, their microbial contamination should be evaluated without fail when the higher rate of nosocomial respiratory tract infections is recorded in patients. Decontamination of the most important parts and surfaces of AV apparatuses and control over medical staff's hand scrubbing can upgrade the quality of measures to prevent respiratory tract infections in patients.

[Detection of the genes of pyrogenic toxins of superantigens in clinical isolates of methicillin resistant Staphylococcus aureus].

The content of methicillin resistant S. aureus (MRSA) genes, coding the synthesis of staphylococcal enterotoxins A, B, C (sea, seb, sec) and the toxin of the toxic shock syndrome (tst-H) which was classified with pyrogenic toxins of superantigens (PTSAgs), was studied with the use of PCR amplification. The study revealed the specific features of the content of genes sea and sec, detected in epidemic strains, identified earlier and found to circulate in Russian hospitals. Among the isolates, genetically related to international epidemic strain EMRSA-1, isolates containing no gene sea were detected, while among the isolates genetically related to strain EMRSA-2, isolates containing not only gene sea, but also gene sec were detected, which was indicative of the tendence of this epidemic strain in the direction of further acquisition of pathogenicity genes. As revealed in further studies, among the cultures obtained in bacteriemia, 88% contained gene sea. Two out of three isolates obtained from patients with the symptoms of toxic shock also contained this gene. The differences in the content of genes PTSAgs (sea, seb, sec and tst-H) could serve as a genetic criterium for the differention of isolates circulating in a hospital, as well as for a more complete characterization of the epidemic strains MRSA. The determination of the given genetic markers in genetic strains in circulating strains will make it possible to prognosticate the structure, severity and outcomes of hospital infections. The conditions of PCR amplification for the determination of genes sea, seb, sec and tst-H, as well as multiplex PCR for the determination of genes sea and seb, were developed.

Antimicrobial resistance of nosocomial strains of Staphylococcus aureus in Russia: results of a prospective study.

A total of 879 Staphylococcus aureus clinical isolates from 17 medical institutions in different regions of Russia were tested. Susceptibility to 18 antimicrobials was determined by agar dilution in accordance with the NCCLS recommendations. The most potent antimicrobials were glycopeptides, linezolid, and fusidic acid, to which no resistance was found. Other antimicrobials with low frequency of non-susceptibility were mupirocin (0.3%), trimethoprim/sulfamethoxazole (0.8%), quinupristin/dalfopristin (1.8%) and rifampicin (7.0%). Fluoroquinolones displayed moderate activity (5.8% of non-susceptible strains to moxifloxacin, 9.1% to levofloxacin, 13.1% to ciprofloxacin). High rates of non-susceptibility were found to clindamycin (27.1%), gentamicin (30.7%), tetracycline (37.1%), erythromycin (39.6%) and chloramphenicol (43.1%). The prevalence of oxacillin-resistant S. aureus (ORSA) was 33.5% and varied from 0% to 89.5% in different hospitals. ORSA were isolated most frequently in the burn units (77.5%), intensive care units (54.8%), trauma and orthopedics units (42.1%). This is the first multicenter study published of antimicrobial resistance of S. aureus in Russia which meets international standards.

[Problems of prevalance and resistance of nosocomial Klebsiella pneumonia in hospitals of Russia].

Prevalence of Klebsiella pneumoniae among gramnegative pathogens of nosocomial infections in intensive care units of 33 hospitals of 22 towns in Russia was investigated. Antibiotic susceptibility and extended-spectrum beta-lactamase production were tested in 420 nosocomial K. pneumoniae isolates. Carbapenems (imipenem, meropenem and ertapenem) showed the highest activity. Extended-spectrum beta-lactamase production based on the phenotyping methods was revealed in 342 (81.4%) isolates. The maximum activity against the K. pneumoniae isolates producing extended-spectrum beta-lactamase was observed in imipenem and meropenem (no unsusceptible strains were isolated). 3.2% of the isolates was not susceptible to ertapenem. Differences in the activity of cefoperazone/sulbactam, amikacin, ciprofloxacin and levofloxacin against the extended-spectrum beta-lactamase producing isolates in various hospitals were recorded.