[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.

[Isolation rate of enterotoxigenic staphylococci in patients with sepsis, pneumonia and burns].

The occurrence of Staphylococcus aureus strains producing enterotoxins of types SEA and SEB, which isolated from patients of different profile and caused the infectious process accompanied by pronounced intoxication without vomiting and enteric disturbances, was determined by means of the indirect hemagglutination test. The collection included 28 strains isolated in sepsis, 38 strains isolated in pneumonia, 57 strains isolated from patients with burns and 23, from the hands and nasopharynx of the medical staff. Among the staphylococcal strains isolated in sepsis, 75.6% synthesized SEA and 5.4%, SEB. The occurrence of SEA- and SEB-positive strains isolated in pneumonia was, respectively, 42.1% and 2.6%. From patients with burns SEA-positive staphylococci were mainly isolated (92.9%). Only 3% of the cultures isolated in wound infections produced SEA. From the medical staff, 13.4% of SEA-positive strains and 17.3% of SEB-positive strains were isolated. The data obtained from this study indicate the expediency of the determination of the enterotoxigenic properties of S. aureus clinical isolates in medical institutions for prophylactic measures with a view to the prevention of the spread of pathogenic clones.

[Etiology of severe hospital infections in intensive care units and antibiotic resistance of pathogens].

The leading pathogens of severe infections in intensive care units were the following: respiratory tract infections--bacteria of the famility of Enterobacteriaceae (33.8%), Pseudomonas spp. (24.9%), Acinetobacter spp. (18.1%), Staphylococcus aureus (16.0%), blood flow infections--coagulase negative staphylococci (33.6%), S. aureus (26.1%), Enterobacteriaceae (17.6%), wound infections--Enterobacteriaceae (35.7%), coagulase negative staphyloccocci (17.8%), Pseudomonas spp. (14.3%). As for various species of Enterobacteriaceae, susceptibility was preserved in 91-100% of the isolates to meropenem, in 72-100% to cefoperazone/sulbactam, in 51-65% to cefepime, in 72-86% to amikacin, and in less than 50% to cephalosporins and fluoroquinolones. As for P.aeruginosa, 28% of the isolates was resistant to all the antibacterials, except polymyxin. The highest susceptibility to cefoperazone/sulbactam and meropenem was revealed in the isolates of Acinetobacter baumannii. Oxacillin resistance was detected in 64.9% of the S.aureus isolates. The oxacillin resistance as a rule was associated with resistance to macrolides, aminoglycosides and fluoroquinolones. As for coagulase negative staphylococci, oxacillin resistance was stated in 75.6% of the isolates. All the isolates of the Staphylococcus spp. preserved their susceptibility to vancomycin and linezolid.

[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.

[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.

[Role of pectins in the complex treatment in patients in neurointensive care units]. / Znachenie pektinov v komplekse lechebnykh meropriiatii u neiroreanimatsionnykh bol'nykh.

Clinical and laboratory estimation of the efficacy of pectins in complex treatment of patients with intracranial hematoma was performed. It was shown that in the group of the patients treated with pectins vs the control group development of pyo-inflammatory infections was less frequent, the indices of the immunity status improved and a more rapid decrease of the intoxication and a more rapid normalization of the composition of various biotopes in the patients were observed.

[Possibilities of fiber bronchoscopy in complex diagnosis and treatment of inhalation injuries of the tracheobronchial tree]. / Vozmozhnosti fibrobronkhoskopii v kompleksnoi diagnostike i lechenii ingaliatsionnoi travmy verkhnikh dykhatel'nykh putei.

The treatment of patients with burn injuries of the tracheobronchial tree is a pressing problem today, because of rather high prevalence of this injury and high mortality (90%). Clinical signs during the first 24 h do not allow evaluating the severity of the injury. Based on analysis of case histories of 24 patients, the authors sum up results of complex examinations including fibrobronchoscopy, microbiological, and histological studies. Fibrobronchoscopy precisely showed the degree and extension of airway involvement in burn injuries, while accessory microbiological and histological studies help timely predict the development of pyoseptic complications. Endoscopic methods of therapy promote a more rapid reduction of inflammation and healing of erosive ulcerative involvement of the tracheobronchial mucosa.

[Dynamics of antibiotic resistance of purulent septic pathogens at an emergency facility]. / Dinamika antibiotikorezistentnosti vozbuditelei gnoino-septicheskikh protsessov v statsionare skoroi pomoshchi.

The predominant pathogens at the emergency medicine hospital were analysed and its resistance to antibiotics was investigated in dynamics. The susceptibility of the pathogens was analysed by the method of dynamic equalibration. Statistically significant reduction of resistant bacteria isolation was demonstrated for 2 species of 7--that is S. aureus and E. faecalis regarding 4 antibiotics. The ratio of staphylococci resistant to cefazolin, ceftazidime, doxycyclin reduced, the ratio of enterococci resistant to chloramphenicol and doxycyclin also diminished. No correlation was demonstrated between the pathogen isolation frequency and ratio of resistant strains.

[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.

[Antibiotic susceptibility of the bacterial strains isolated at the emergency hospital]. / Lekarstvennaia chuvstvitel'nost' vozbuditelei gnoino-septicheskikh protsesov v statsionare skoroi pomoshchi.

Comparative evaluation of the incidence of the drug resistant pathogens at the patients with sepsis was performed. High ratio of the resistnt strain was shown and the most potent drugs were estimated. The investigation results demonstrates the necessity to improve diagnostic quality control. The data on drug susceptibility of the pathogens may be used for their taxonomic clarification.

[Possibility of using microbiological data in epidemiological analysis of hospital pneumonias]. / Vozmozhnosti ispol'zovaniia mikrobiologicheskikh dannykh pri épidemiologicheskom analize vnutribol'nichnykh pnevmonii.

A total of 528 patients with nosocomial pneumonias were examined by bacteriological methods during 4 years. The data on the patients and on 2468 bacterial strains isolated from them were computer processed using original software "Hospital Infection". Special attention was paid to hospital strains of pneumonia agents of the same taxonomic position with identical markers of antibacterial resistance. Tendencies and seasonal fluctuations in the prevalence of hospital serovars were detected. Special bacteriological studies helped detect differences in the translocation capacity of different biological variants of the agents. Routine bacteriological studies and their adequate statistical computer processing yield information needed for epidemiological analysis of the development of nosocomial pneumonias in patients of clinical wards of different profile.

[The use of data on the composition and drug resistance of the causative agents of suppuration in a retrospective analysis of the epidemiological situation in a hospital]. / Ispol'zovanie dannykh o sostave i lekarstvennoi ustoichivosti vozbuditelei nagnoenii pri retrospektivnom analize épidemiologicheskoi situatsii v statsionare.

The analysis of bacterial 16,530 strains, dynamically isolated from 6,157 patients with purulent septic processes (PSP) in surgical, traumatological, burn, toxicological and resuscitation departments, was made. The computer processing of data on the spread of the causative agents of PSP, depending on their taxonomic classification and drug resistance spectra, was carried out, which made in possible to obtain information on the outbreaks of hospital infections. Correlation of the number of PSP cases and the spread of hospital resistovars was analyzed. The data on the composition and drug resistance of pyogenic microorganisms could be used in the retrospective analysis of the epidemiological situation in a hospital. 3-year observations revealed the tendency to a decrease in the spread of the hospital variants of the causative agents of PSP, multiresistant to antibacterial preparations, which was indicative of the effectiveness of the antiepidemic measures carried out during this period.

[Use of bacteriophages as selective factors in bacteriological diagnosis of mixed infections]. / Ispol'zovanie bakteriofagov v kachestve selektivnogo faktora pri bakteriologicheskoi diagnostike smeshannykh infektsii.

A new method is proposed for detecting aerobic and anaerobic bacteria during diagnostic culturing by exposure of mixed microorganism populations to bacteriophages. By lysing homologous bacteria, the phages facilitate the detection and isolation of associates resistant to them in pure cultures. The proposed method is compared with the selective media techniques and a conclusion is made on the advantages of selective decontamination of biological samples by bacteriophages in experiments and diagnostic culturing of material from patients with pyo-inflammatory processes.