[qSOFA score for prediction of outcome in surgical patients in intensive care units. Post hoc analysis of the Russian multi-center trial Rises]. / Ispol'zovanie shkaly qSOFA v prognoze iskhoda lecheniya u khirurgicheskikh patsientov v orit. Subpopulyatsionnyi analiz materialov issledovaniya RISES.

OBJECTIVE: To define the informative value of qSOFA score in the prediction of outcomes in surgical patients admitted to the Intensive Care Units. STUDY DESIGN: Post hoc analysis of multicenter prospective observational study RISES. The following patient information was analyzed: gender, age, diagnosis, presence of infection, SIRS criteria, qSOFA and SOFA scores, outcomes. RESULTS: The study included data of 331 patients with surgical diseases. Infection was not observed in 174 (52.6%) cases, 157 (47.4%) patients had infection. In the group of patients without infection, area under ROC-curve for SIRS criteria was 0.519 (95% CI 0.429-0.610) and similar to that qSOFA (p=0.535). Area under ROC-curve for SOFA scale was 0.619 (95% CI 0.511-0.726) and did not significantly differ from this value for QSOFA (p=0.241). In the group of surgical patients with infection, area under ROC-curve for SIRS was 0.490 (95% CI 0.419-0.561), that was significantly lower than area under ROC-curve for qSOFA (p=0.016). Area under ROC-curve for SOFA scale was 0.803 (95% CI 0.681-0.924), that significantly exceeded area under ROC-curve for qSOFA (p=0.017). CONCLUSION: qSOFA scale is important in surgical patients with infection admitted to ICUs. Increased qSOFA score is associated with augmentation of mortality rate. qSOFA scale significantly exceeds the SIRS criteria, but is inferior to the SOFA in the prognosis of mortality in these patients.

[Epidemiology and risk factors of adverse outcome in nonvariceal upper gastrointestinal bleeding]. / Épidemiologiia i faktory riska neblagopriiatnogo iskhoda pri nevarikoznykh krovotecheniiakh iz verkhnikh otdelov zheludochno-kishechnogo trakta.

AIM: To identify risk factors of adverse outcomes in patients with nonvariceal upper gastrointestinal bleeding. MATERIAL AND METHODS: Epidemiological observational analytical longitudinal retrospective cohort study included 312 patients who were hospitalized in the Clinical Hospital #40 of Yekaterinburg in 2014-2016. The main inclusion criterion was nonvariceal upper gastrointestinal bleeding. RESULTS: In-hospital mortality was 31 (9.9%) of 312 patients. Multivariate analysis confirmed the following risk factors of mortality: severity of blood loss (OR 22.70, 95% CI 5.08-102.00); open surgery (OR 15.20, 95% CI 2.71-74.80); M. Charlson comorbidity index (OR 2.15, 95% CI 1.34-3.43); risk of recurrent bleeding according to T. Rockall scale (OR 1.76, 95% CI 1.18-2.64). CONCLUSION: Independent risk factors of adverse outcomes in patients with nonvariceal upper gastrointestinal bleeding are severe hemorrhagic shock, open surgery, high M. Charlson comorbidity index and risk of recurrent bleeding according to T. Rockall scale.

[Risk Factors for diarrhea associated with Clostridium difficile in patients at a clinical hospital].

AIM: to identify risk factors for Clostridium difficile infection in patients of a therapeutic clinic in a multidisciplinary hospital. MATERIALS AND METHODS: A retrospective analysis of 110 case histories of patients who were hospitalized in therapeutic departments in the Municipal Autonomous Institution "City Clinical Hospital No. 40" in Yekaterinburg (MAU City Clinical Hospital No. 40) in 2014-2015 was conducted, in which antibiotic therapy has developed diarrhea. According to the results of the study of coprofiltrate on Clostridium difficile (CD), patients were divided into 2 groups: 60 patients with a positive result and 50 patients with a negative result. RESULTS: The proportion of patients with CD infection in the structure of patients of the therapeutic profile of the MAU GKB No.40 for 2014-2015 amounted to 0.42%. Predictors of the risk of developing diarrhea associated with CD infection in patients are: age over 65 years (OS 4.33, 95% CI 1.15-16.20, p=0.028), Charlson comorbidity index more than 2 points (OS 3.05, 95% CI 1.29-7.23, p=0.016), the presence of anemia (OR 2.32, 95% CI 1.07-5.02, p=0.048), chronic dialysis in patients with chronic renal insufficiency (CRF) (OR 8.64, 95% CI 1.05-70.81, p=0.020), patients staying in hospital for more than 5 days (OR 3.50, 95% CI 1.57-7.75, p=0.003) and hospitalization of patients in the intensive care unit (ICU) lasting more than 1 day (OS 9.80, 95% CI 1.20-79.47, p=0.011), the use of proton pump inhibitors (PPIs) (OR 2.82, 95% CI 1.12-7.11, p=0.041), antibiotic therapy more than 10 days (OS 39.62, 95% CI 10.85-144.71, p.

Multicentre Study of the Prevalence and Clinical Value of Hospital-Acquired Infections in Emergency Hospitals of Russia: ERGINI Study Team.

BACKGROUND: Hospital-acquired infection (HAI) is a common problem in intensive care units (ICU) and other hospital units. The methodical system of surveillance of hospital-acquired infections (HAI) is not available in Russia and there is no reliable data about the prevalence or epidemiology of HAI. We aimed in this pioneer study to determine the prevalence, epidemiological and microbiological characteristics, risk factors, clinical value and outcomes of HAI in different units of emergency multifields hospitals of Russia. METHODS: This prospective multicentre 1-day prevalence study with 28-days follow-up was realized between January and May 2013. Thirty two emergency hospitals with more than 500-beds from 18 cities participated in this study. The study was conducted separately on 5 different days in ICU, therapeutic, surgical, urology and neurology units. All patients treated in the unit on the day of the study were examined for the presence of HAI according to CDC criterias. Risk factors of HAI, nosological and etiological structure, susceptibility of pathogens were also evaluated. RESULTS: Totally 3809 patients were included in the study during 5 days of investigation in ICU and therapeutic, surgical, urology and neurology units (respectively 449, 1281, 1431, 342 and 306 patients). The total number of registered HAI was 290 and the prevalence of HAI was 7.61% (95% CI 6.81%, 8.50%). The greatest rate of HAI was registered in ICU (26.28%) and neurological unit (13.73%); the rate was lower in therapeutic, surgical and urology units (4.76, 4.12 and 2.92%). The prevalence of HAI.was similar in adult and pediatric hospitals .(7.62 and 7.54%). The prevalence of community-acquired infections was 28.53%. The lower respiratory tract was the most common site of infection, accounting for 42.4%.of HAIs followed by the urinary tract (19.0%), skin and soft tissue (13.4%), abdomen (11.4%) and intravascular (4.8%). 311 pathogens were isolated: 58.8% of isolates were gram-negative, 32.8% gram-positive, and 8.4% Candida spp. The most common bacterial isolates were Klebsiella spp. (19.6%), E.coli (12.2%), S.aureus (11.3%), Acinetobacter spp. (10.9%), E.faecalis (7.4%) and P.aeruginosa (7.1%). The resistance rate of E.coli and Klebsiella spp. to 3rd generation of cephalosporins was 60.5 and 95.1%. Only 26.5% of Acinetobacter isolates and 59,1% of P.aeruginosa isolates were susceptible to imipenem. The MRSA rate was 48.6%; 17,4% of E.faecalis were resistant to ampicillin. The mortality rate was higher in patients with HAI (16.5%) than in patients without HAI (3.0%); the mean length of hospital stay was also higher in patients with HAI (24.6±11,4 vs. 16.2±15,3 days). CONCLUSION: The prevalence of HAI in Russian hospitals is high. According to the prevalence data the estimating annual number of HAI in Russia is approximately 2,300,000 cases. The multi-drug resistant microorganisms were dominated among causative agents of HAI.

[SYSTEMIC INFLAMMATORY RESPONSE ON NOSOCOMIAL BACTEREMIA].

GOAL: study of special aspects in system inflammatory reaction caused by nosocomial bacteremia in dependence of the pathogen Gram-origin. The study included 85 patients with nosocomial bacteremia in ICU from 2010 till 2012. The main inclusion criteria was bacteria identification in blood, which was taken more than 48 hours from arrival to ICU within the appearance of system inflammatory response signs. Key options for clinical rating of system inflammatory response was dynamic of patients condition according APACHE II, SOFA, SAPS-III/PIRO, Pitt scales and its correlation with durations of mechanical ventilation, length of staying in ICU, total hospital period and outcome. RESULTS: Gram-negative microorganisms are definitely leading in the modern ethiological structure of nosocomial bacteremia in ICU patients (64,4%). The main origin of Gram(+) agents is central venous catheter infections. The main reason of Gram(-) infections is ventilation-associated pneumonia. Appearance or persistence of system inflammatory response is associated with the rise of scale indexes (SOFA and Pitt from 5 scores and higher and SAPS-PIRO higher than 18 scores) and high risk of possible bacteremia.

[PREVENTION OF VENTILATOR ASSOCIATED INFECTION IN NEONATES WITH RESPIRATORY DISTRESS SYNDROME].

UNLABELLED: The aim of the research was to reduce the risk ventilator-associated infections (VAI) in neonates with respiratory distress syndrome. DESIGN: retrospective, observational, single center, historical control. MATERIALS AND METHODS: 113 newborns were included in the study. Ventilator-associated pneumonia was diagnosed based on the criteria of VAP CDC/NNIS. Ventilator-associated tracheobronchitis was determined on the basis of criteria of Code LRI-BRON proposed CDC National Healthcare Safety Network. Patients divided into two groups. In the main group (n=54) hand hygiene, closed suction system and non-invasive mechanical ventilation were used as a methods of prevention of ventilator-associated infection (IAI). In comparison group (n = 59) hand hygiene only. RESULTS: The frequency of VAI was 27.5 per 1000 days of ventilation. Timing of development and the etiology of VAI were comparable in both groups of patients the duration of mechanical ventilation was significantly (p = 0.01) lower in the main group. In the main group length of stay in the intensive care unit (p = 0.01) and duration of hospital treatment (p = 0.047) decreased The incidence of VAI was significantly lower in the main group (p < 0.05). CONCLUSIONS: Closed suction system with hand hygiene and early weaning from the respirator are acceptable methods of prevention of lower respiratory tract infection associated with mechanical ventilation in neonates with respiratorv distress syndrome.

[PERIOPERATIVE CARE FOR PATIENTS WITH UNDERLYING ARTERIAL HYPERTENSION (CLINICAL GUIDELINES)].

These clinical guidelines apply to the implementation of health care for all patients with concomitant hypertension in the perioperative period in a hospital. The guidelines specify the method of stratifying the risk of perioperative cardiac complications. We described methods for the treatment of urgent conditions with hypertension and hypertensive crises and identified the main features of the preoperative evaluation and preparation of patients with concomitant hypertension. The clinical guidelines contain recommendations on the management of intra- and postoperative period

[The use of tranexamic acid during large joint endoprosthetic surgeries].

The aim of the study is to measure the effectiveness and safety of tranexam acid during hip and knee joint endoprothesis surgeries. Tranexam (Mir-Pharm, Russia) was administered to 45 patients 30 minutes before the surgery in the dose of 10-15 mg/kg and 6 hours after first infusion in the same dose. In the control group (n = 45) Tranexam was not administered. The intraoperative, drain and general blood loss, need of donor blood and dynamics of hematological parameters were assessed. The total number of complications and potential transfusion complications was measured. The use of Tranexam acid allowed lowering the blood loss on all the stages of investigation for more than 50%. The general blood loss in the main group was 693.3 +/- 252.2 ml compared to 1259 +/- 454.6 ml in the control group. A need for donor erythrocytes occurred in 2 cases of the main group, who received the total of 3 doses of allogenic blood. In the control group 26 patients received 57 doses of donor blood. There was no need in donor plasma in the main group. The hemoglobin and hematocrit values were higher in the main group compared to the control group. In both cases there were no tromboembolic or transfusional complications. The potential risk of transfusional complications was lower in the main group. Tranexam acid is an effective and safe blood loss prophylaxis measure during the large joint prosthetic surgeries.

[Sepsis and the theory of systemic inflammatory reaction is an attempt of clinicomorphological consensus].

The authors propose to put the 1991 US Consensus Conference criteria for sepsis into practice and research methodology. This will be helpful in reaching the consensus in definitions.

[Role of closed aspiration systems in the prevention of lower respiratory tract infections during artificial ventilation].

Two large intensive care centers performed a prospective controlled, randomized study evaluating the efficiency of closed aspiration systems in the prevention of lower respiratory tract infections during sustained artificial ventilation. Analysis of the results of the study has ascertained that the closed aspiration systems make it possible to attenuate a colonization process and further lower respiratory tract infection, by statistically significantly reducing the risk of tracheobronchitis and pneumonia.

[Comparative estimation of currently available approaches to early identification of severe acute pancreatitis].

It is difficult to precisely predict the severity of each specific patient with acute pancreatitis (AP), by using conventional statistical methods or single clinical and laboratory criteria. By using the patient database, the authors developed an artificial neuronal network (ANN) to predict the severity of AP and compared it with the Ranson, Imrie/Glasgow, APACHE II, and Physiological Condition Severity scoring systems, ultrasound/radiological criteria, and linear regression analysis. ANN was found to be significantly better than all the scoring systems, but not better than a linear regression model (the area under the receiver operating characteristic curves were equal to 0.83). With 81% sensitivity, ANN showed a 70% specificity, and positive/negative predictive values of 73 and 79%, respectively. ANN is an effective tool in developing prediction models for poor outcomes in patients with AP that is precisely similar with linear regression models.

[Diagnosis and treatment of ventilator-associated pneumonia in children].

The purpose of the investigation was to optimize the diagnosis and treatment of ventilator-associated pneumonia (VAP) in children. The prevalence, etiology, and onset of VAP in a pediatric intensive care unit, and the diagnostic value the clinical pulmonary infection score scale were studied. The prevalence of VAP was found to be 37.56 per 1,000 mechanical ventilation days, and the CPIS scale was not always useful in diagnosing VAP in children. The most common causative agents of VAP were Enterobacteriaceae spp, and its major pathogen is P. aeruginosa. Early adequate antibacterial therapy prevents and treats VAP, without causing any complications.

[Sepsis on the threshold of the 21st century: the basic results. New problems and the immediate tasks]. / Sepsis na poroge XXI veka: osnovnye itogi. Novye problemy i blizhaishie zadachi.

The authors validate their positions in terminology of sepsis and evaluation of its severity, based on analysis of this problem evolution during the century, review of the most significant publications, and their own findings. Problems of intensive care are discussed. The authors claim that intensive care methods should be determined by the phase of the systemic inflammatory response syndrome (SIRS). One of the nearest goals for scientists and public health managers is an interdisciplinary consensus on terminology of sepsis and diagnostic criteria, creation of a standard protocol of laboratory studies and treatment, search for available markers of SIRS of infectious origin, regulation of cytokine response, creation of local data bases reflecting the etiological structure of the agents and their antibiotic resistance.

[The results of a multicenter study of the comparative activity of cefepime and other antibiotics against the causative agents of severe hospital infections (the Micromax program)]. / Rezul'taty mnogotsentrovogo issledovaniia sravnitel'noi aktivnosti tsefepima i drugikh antibiotikov v otnoshenii vozbuditelei tiazhelykh gospital'nykh infektsii (programma "Micromax").

A multicentre trial was performed on the activity of cefepime in comparison with ceftazidime, ceftriaxone, piperacillin/tazobactam, imipenem and ciprofloxacin against severe hospital infection pathogens in intensive care units. The isolates of Escherichia coli and Proteus spp. from the majority of the centres were highly susceptible to the antibiotics (90 to 100 per cent of the isolates). In some centres up to 40 per cent of the isolates produced ESBL. The isolates of Klebsiella spp. were characterized by lower susceptibility, in some centres the frequency of the strains producing ESBL exceeded 90 per cent, by the MIC geometric mean cefepime was superior to the third generation cephalosporins, the frequency of resistance to ciprofloxacin ranged from 0 to 31 per cent, no resistance to imipenem was recorded. The frequency of resistance to the third generation cephalosporins and piperacillin/tazobactam in Enterobacter spp., Serratia spp., Citrobacter spp., Morganella spp., and Providencia spp. ranged from 10 to 52 per cent, the resistance to cefepime equaled 0-11 per cent, 0 to 17 per cent of the isolates were resistant to ciprofloxacin, some isolates were resistant to imipenem. As for the nonfermenting microorganisms their resistance to all the antibiotics tested was comparatively high and markedly differed in various centres. As a whole, 7 per cent of all the isolates of the nonfermenting organisms was resistant to cefepime, 10 per cent was resistant to imipenem, 17 per cent was resistant to ceftazidime, 21 per cent was resistant to piperacillin/tazobactam and 36 per cent was resistant to ciprofloxacin.