[Antibacterial treatment of infectious-toxic shock]. / Antibakterial'naia terapiia pri infektsionno-toksicheskom shoke.

The studies enabled one to identify six leading clinicophysiological syndromes developing in patients with infective toxic shock (ITS). They include signs of purulent inflammatory processes, organ disorders and systems disturbances. Despite the clinical picture polymorphism, ITS has a clearly defined stage-by-stage process which makes it possible to determine hyperdynamic and hypodynamic phases of the pathological process within each stage. An absolute condition for antimicrobial drugs includes the following: drainage of the purulent inflammatory focus, arresting of pathogen discharge into the blood flow, recovery of host impaired functions and their maintenance. It was shown that a wrong choice of the drugs and antibacterial therapy regimens resulted in a 2-fold increase in fatal cases with ITS. Disorders in systemic and organ blood flows and microcirculation and coagulation disturbances played a particular role in decreasing antibacterial therapy efficacy. Further ways for optimizing antibacterial therapy are mainly connected with availability of efficient antibacterial drugs for practitioners and introduction of microbiological and pharmacokinetic monitoring of antibacterial therapy providing conditions for their rational and safe use.

[Bacteriocholia and cholic acid level in the bile in cholelithiasis]. / Bakteriokholiia i soderzhanie knolevoi kisloty v zhelchi pri zhelchnokamennoi bolezni.

Infection of the biliferous system in patients with cholelithiasis was shown to be the most frequent when the levels of cholic acid in bile were low. Physiological concentrations of cholic and deoxycholic acids have antimicrobial activity against organisms not adapted to the presence in bile. Outer drainage of the bile ducts was accompanied by an increase in the levels of cholic acid when at the background of outer decompression bacteria were eliminated from the biliferous system. In vitro studies revealed a synergistic antibacterial effect of cholic and deoxycholic acid combinations with cefazolin.

[Role of microbiological control in the choice of antibacterial therapy of respiratory infection in surgical patients during the postoperative period]. / Rol' mikrobiologicheskogo kontrolia v vybore antibakterial'noi terapii pri infektsii dykhatel'nykh putei u khirurgicheskikh bol'nykh v posleoperatsionnom periode.

The paper presents data on observation of 416 surgical patients subjected to investigation of sputum and washings from the tracheobronchial tree for estimating the role of clinico-microbiological study of respiratory tract excretions from surgical patients in choice of adequate therapy. On the basis of the obtained data and results of clinical observations a scheme of clinico-microbiological criteria was developed which would be of help for clinicians and microbiologists in difficult differential diagnosis of colonization and infection. The scheme will provide clinical microbiologists with possibility of correct interpretation of the results of studying respiratory tract excretions and presenting information containing preliminary positive or negative indications as to the presence of infection and recommendations for continuation or discontinuation of further clinico-microbiological investigations.

[Development of a data bank for control of antibiotic resistant causative agents of purulent-inflammatory diseases and complications]. / Razrabotka banka dannykh kontrolia za antibiotikorezistentnost'iu vozbuditelei gnoino-vospalitel'nykh zabolevanii i oslohneii.

To provide constant control of drug resistance in causative agents of surgical infections an automatized data bank based on computer SM-4 was filed at the All-Union Research Institute of Antibiotics. The bank includes information on 1500 objects described by 60 indices referring to the isolated pathogens. For every particular strain there are indicated data on the patients, characteristics of the pathogen biochemical profiles and sensitivity to various antibiotics (28 drugs). The data were obtained during identification of the cultures with automatized microbiological systems. The major functions of the data bank and standard information requests performed on its basis during solving particular epidemiological and clinical problems are described.

[Sensitivity to cephalosporin antibiotics of infectious causative agents in surgery]. / Chuvstvitel'nost' k tsefalosporinovym antibiotikam vozbuditelei infektsii v khirurgii.

Comparison of antimicrobial effects of cephalosporins of the 1st and 2nd generations showed that the latter were advantageous with respect to gram-negative bacteria causing surgical infections. Three cephalosporins of the 3rd generation were characterized by the highest activity against such bacteria, including Enterobacter spp. and indole positive strains of Proteus spp., as well as non-enzymatic bacteria. The antimicrobial spectra and MICs of the new cephalosporins with respect to the cultures isolated from surgical patients were different which requires in vitro sensitivity assay of each antibiotic.

[Comparative evaluation of the results of antibiotic sensitivity testing using automated microbiological systems and the disk diffusion method]. / Sravnitel'naia otsenka rezul'tatov opredeleniia antibiotikochuvstvitel'nosti s pomoshch'iu avtomatizirovannykh mikrobiologicheskikh sistem i diskodiffuzionnym metodom.

A total of 1120 comparative estimations of antibiotic sensitivity of clinical gram positive and gram negative bacteria isolated from patients with surgical and urological infections were performed. The data for comparison were obtained with the use of microbiological systems MIC-2000 and MS-2 and the disk diffusion method. A high percentage of coincidence for both gram negative and gram positive organisms was observed. The frequency of total coincidence was higher for Enterobacteriaceae. The results of disk diffusion estimations more frequently coincided with the results obtained with the use of apparatus MIC-2000 as compared to the results provided by MS-2. The choice of the nutrient medium markedly influenced the coincidence level of the results obtained with the apparatus and control methods.

[Modern diagnostic methods and the antibiotic sensitivity of the gram-negative causative agents of suppurative-inflammatory diseases of the extrahepatic bile ducts]. / Sovremennye metody diagnostiki i antibiotikochuvstvitel'nost' gramotritsatel'nykh vozbuditelei gnoino-vospalitel'nykh zabolevanii vnepechenochnykh zhelchnykh putei.

Microscopic examination of native bile and smears stained with the Gram procedure rapidly provided information on the presence of bactericholia and the necessity of antibacterial therapy prior to closing of the postoperative wound in accordance with the drug spectrum. Determination of the phagocytic and bactericidal activity of the bile leukocytes was a significant adjuvant to routine microscopic examinations, whereas evaluation of the average cytochemical coefficient and phagocytosis intensity was an important factor in prognosis of postoperative pyoinflammatory complications. Gram-negative bacteria were the predominating causative agents of acute cholecystitis and cholangitis (89 per cent). Among them Escherichieae, Klebsielleae and P. aeruginosa were isolated most frequently (32.4, 31.1 and 16.4 per cent, respectively). Amikacin, tobramycin, sisomicin, gentamicin and cefotaxime showed the highest activity against the above pathogens. However, comparative analysis of the antibioticograms revealed differences in antibiotic sensitivity of separate bacterial species.

[Unimicon-s (universal microbiological control--sensitivity) standardized medium for determining the antibiotic sensitivity of microorganisms]. / Unifitsirovannaia sreda "Unimikon-ch" dlia opredeleniia antibiotikochuvstvitel'nosti mikroorganizmov.

A nutrient medium Unimicon-s for determination of antibiotic sensitivity of microorganisms is described. The medium is based on the raw material not used as a food, i. e. a clarified enzyme lysate of microbial biomass obtained at the All-Union Research Institute for Protein Synthesis. Unimicon-s provided satisfactory growth of various cultures and the sensitivity determination results analogous to those obtained with medium 1 (MPA) or Muller-Hinton medium recommended by the WHO as a standard medium for determination of microbial antibiotic sensitivity. The study on estimation of the fitness of the present criteria for dividing cultures by the sensitivity levels, i. e. into sensitive, moderate sensitive and resistant showed that with the use of an inoculation dose of 2.5 X 10(7) microbial cells per 1 ml the growth inhibition zones of the standard strains on the Unimicon-s medium were within the ranges of the permissible limits for medium 1. The Unimicon-s medium was tested with positive results in the laboratories of the A. N. Bakulev Institute of Cardiovascular Surgery and the 1st N. I. Pirogov City Clinical Hospital.

[Clinical and experimental study of dioxidine. Its antibacterial action]. / Kliniko-éksperimental'noe izuchenie dioksidina. Antibakterial'noe deistvie.

The effect of dioxidine on the growth of freshly isolated clinical strains of microorganisms with various levels of resistance to antibiotics was studied. It was shown that strains of Ps.aeruginosa not resistant to carbenicillin, chloramphenicol and nalidixic acid were most sensitive to the drug. Similar correlation was found in Proteus strains with various levels of resistance to chloramphenicol. Sensitivity of these organisms to dioxidine did not depend on their resistance to gentamicin, ampicillin and neomycin. The antibacterial effect of the drug is based on inhibition of the synthesis of nucleic acids, the level of DNA synthesis inhibition being the highest. Dioxidine had practically no effect on protein synthesis.

[Selective media for isolating Pseudomonas aeruginosa]. / Selektivnye sredy dlia vydeleniia Pseudomonas aeruginosa.

The comparative study of 4 selective media (medium containing N-cetylpyridinium chloride, acetamide agar, cetrimide agar, medium containing irgasane) showed that their use permitted one to enhance the isolation of P. aeruginosa, especially pigment-free forms, from pathological material and to reduce the time of their isolation by 24-48 hours. Of all the media subjected to testing medium containing N-cetylpyridinium chloride and acetamide medium proved to have the highest selectivity.