[The changes in urine microflora in patients with urinary stone disease].

INTRODUCTION: Since the results of treatment of chronic pyelonephritis (CP) depend on timely and rationally selected targeted antibiotic therapy, when choosing a treatment regimen, it is necessary to rely on the local data obtained by monitoring the state of microflora in a particular hospital. AIM: to monitor the changes in urine microflora in patients with urinary stone disease. MATERIALS AND METHODS: A total of 598 isolated bacteria and yeast-like fungi from patients with urinary stone disease who were treated in the Department of Urology during different time periods (1997-1999, 2010-2014 and 2015-2017 yy) were analyzed. A comparison of the urine microbiota in patients with single kidney stone (n=154) and staghorn stone (n=147) for the period 2015-2017 yy. was carried out. RESULTS: The significant changes of gram-positive and gram-negative bacteria were found with a tendency to decrease in the proportion of the latter (from 80.6% to 50.6%, p<0.05) due to a decrease in the proportion of P. mirabilis and complete absence of Enterobacter spp, Serraciae spp and Citrobacter spp. as well as an increase in the number of gram-positive bacteria (from 18 to 48.7%, p<0.05) owing to increase in the proportion of E. faecium + E. faecalis. During observation period, E. Coli has remained the leading pathogen (26.4+/-0.32%). During observation period, a permanent fourfold prevalence of gram-negative bacteria in clinically significant concentrations (>104 CFU/ml) was found: E. coli (36.8+/-4.1%). The proportion of K. Pneumonia increased from 8.5% to 17.4%, and proportion of P. mirabilis decreased from 20.3 to 10.4%. Despite a significant increase in the proportion of Enterococcus spp. (from 4.6 to 26.6%) in the general population, the incidence of microorganisms in clinically significant concentrations during analyzed period remained unchanged and did not exceed 8.46+/-4.76%. In patients with single stones and patients with staghorn stones there was no significant difference in the proportion of analyses with clinically significant concentrations of bacteria fer (p>0.05). The percentage of analyses with clinically significant concentration was 70.06%, while in all patients with urolithiasis it was 59.7%. In patients under and over 60 years old, the largest number of bacterial pathogens were represented by E. coli. (29.7% and 32.1%, respectively). CONCLUSION: E. Coli remains the leading bacterial causative agent of calculous pyelonephritis, both in the general population and in analyses with clinically significant concentrations of bacteria. There were no significant differences in urine microflora in patients with staghorn and single stones.

[The use of the enzymes for the enhancement of the effectiveness of antimicrobial photodynamic treatment of the patients presenting with chronic tonsillitis].

The objective of the present study was to enhance the effectiveness of the treatment of the patients presenting with various forms of chronic tonsillitis (CT) by means of antimicrobial photodynamic therapy (APDT). The study included 48 patients at the age from 18 to 55 years divided into three groups; all of them suffered from various forms of CT. Group 1 was comprised of 12 patients given a course of traditional conservative therapy. Group 2 consisted of 17 patients treated by APDT while group 3 included 19 patients in whom a course of antimicrobial photodynamic therapy was preceded by the treatment of the mucous membrane of the palatine amygdalae with a lidase solution. The microbiological testing was performed on days 5, 12, and 24 after APDT and also within the next 6-9 months. The results of the microbiological and clinical studies give evidence of the possibility to improve the effectiveness of the treatment of chronic tonsillitis by means of antimicrobial photodynamic therapy with the use of the preventive treatment of palatine tonsillar mucosa with a lidase solution. Such treatment was found to facilitate degradation of theintercellular matrix of the biofilm and reduced its resistance to the photodynamic impact.

[Characteristics of inflammatory response in patients after senile cataract surgery].

The aim of the work was to study prognostic value of some laboratory markers (anti-DNA antibodies, cell adhesive molecules, neopterin) in heriatric patients with exudative inflammation after cataract surgery. 12 in-patients with postoperative iridocyclitis and endophthalmitis were included. The assays were taken twice: after admission and before discharging. The follow-up period was 6 months. Preliminary data show that high serum levels of sVCAM, sICAM and anti-DNA antibodies, as well as very low levels of anti-DNA antibodies seems to be associated with poor outcomes in those patients (enucleation, blindness, lens extraction). Small cohort doesn't allow us to make strict conclusion about prognostic value of these laboratory markers. The study should be continued.

[Five-year analysis of microbial landscape of transplantation and dialysis center (20112015)].

INTRODUCTION: Treatment of bacterial infections is pressing and difficult task of modern transplantology. AIM: To analyze the spectrum of bacterial microflora and bacterial sensitivity to antibiotics in patients of the transplantation and dialysis center. RESULTS: The study analyzed the results of bacteriological tests performed in 534 patients with chronic kidney disease stage 5 in 2011-2015. Biomaterials for the examination included urine, blood, wound discharge and sputum. Gram-positive bacteria, Gram-negative bacteria, fungi and mixed flora were found in 42%, 39%, 4% and 15%, respectively. Among observed associations 51% were presented by a combination of Gram-positive and Gram-negative bacteria and the others were different combinations of fungi. The most often detected bacteria were Enterococcus spp. (37%), Klebsiella pneumoniae (25%), Staphylococcus spp. (19%), E. coli (13%), Streptococcus spp. (6%), P. aeruginosa (5%). Fungi of the genus Candida were isolated from 11% of all cultures. Enterococci and Klebsiella had pronounced resistance to most antibiotics. All gram-positive bacteria were highly sensitive to vancomycin and linezolid. DISCUSSION: The findings suggest that the percentage of Gram-negative bacteria that are resistant to antibiotics is increasing. CONCLUSION: Significant changes in the microbial landscape and the growing antibiotic resistance dictate the need for periodic analysis of the bacterial flora in the transplantation and dialysis center.

[ACTIVITY OF ANTIMICROBIAL NANOSTRUCTURED BARRIER LAYERS BASED ON POLYETHYLENETEREPHTHALATE IN RELATION TO CLINICAL STRAINES OF MICROORGANISMS FOR SICK PERSONS OF GASTROENTEROLOGICAL PROFILE].

Homeostasis transgressions of enteral medium including disbiotic ones are often accompanying deseases of digestive tract. Espessially it touches upon sick persons connected with probe nourishing. One of the way for solving this problem is normalization of digestion microflore by means of wares with nanotechnological modifications of walls (probes, stomic tubes) which provide them antimicrobial properties and assist to normalization of digestive microbiotis and enteral homeostasis completely. The aim to study is research of antimicrobial activity of of nanostructured barrier layers based on polyethyleneterephthalate (PET) in relation to clinical straines of microorganisms. For barrier layer creation the approach on the base of methods of ion-plasma technology was used including ion-plasma treatment (nanostructuring) of the surface by ions noble and chemically active gases and following formation nanodimensional carbon films on the surface/ For the study of antimicrobial activity in relation to clinical straines of microorganisms we used the technique which allowed to establish the influence of parting degree of microorganisms suspension and time for samples exposing and microorganisms adsorbed on the surface. In experiment clinical straines obtained from different materials were used: Staphylococcus Hly+ and Calbicans--from pharyngeal mucosa, E. coli--from feces, K.pneumoniae--from urine. Sharing out and species identification of microorganisms were fulfilled according with legasy documents. In results of the study itwas obtained not only the presence of staticticaly confirmed antimicrobial activity of PET samples with nanostructured barrier layers in relation to different stimulators of nosocomical infections but also the influence of different factors connected with formation of nanostructured layers and consequently based with them physicochemical characteristics such as, in particular, surface energy, surface relief parameters, surface charg and others, as well as influence of microorganisms nature onto the interaction of between barrier layers and microorganisms.

[Dioxidin: antimicrobial activity and prospects of its clinical use at present].

In vitro activity of dioxidin against pathogens of nosocomial infections and its cytotoxicity were estimated. The study involved 300 isolates from patients with nosocomial infections. The MICs of dioxidin were determined with the method of serial dilutions in broth. The dioxidin cytotoxicity was investigated with the MTI assay to assign the cell culture viability. In concentrations of 2 to 1024 meg/mi dioxidin was active against 279/300 (93%) strains. The drug inhibited the growth of all the gramnegative isolates. The highest activitywas observed against Enterobacteriaceae vs. nonfermenting gramnegative bacteria: the median, minimum and maximum MICs of dioxidin were 12 (4-32) and 32 (16-64) mcg/ml respectively. The dioxidin activity against gramnegative bacteria and fungi was lower. The MIC of dioxidin for 7/70 (10%) staphylococcal isolates, 9/28 (32%) enterococcal isolates and all the Candida isolates was > 1024 mcg/ml. The IC50 of dioxidin was 2.4+/-0.3 mM (low cytotoxicity). The results showed that the use of dioxidin as an antimicrobial for local application was advisable in the treatment of gramnegative bacterial infections provided adequate tissue concentrations were attained.

[In vitro comparison of antibacterial properties of antiseptics used in periodontology].

Antibacterial properties of antiseptics most commonly used in periodontology were examined in vitro showing al agents containing chlorhexidine to be the most effective against gram-negative (E. coli), gram-positive (staphylococcus, streptococcus, enterococcus) germs as well as а C. аlbicans.

[Transcutaneous nephrolithotripsy in presenile and senile patients].

A total of 323 transcutaneous roentgenoendoscopic operations were made in 212 patients from January 2000 to December 2009 including 96 operations in 81 presenile and senile patients (87 and 9 operations, respectively). Transcutaneous nephrolithotripsy (TCNT) eliminated concrement from the kidney for one session in 59 (72.8%) patients. It proved to be the most sparing treatment in serious clinical situations and provided maximally complete evacuation of the concrement from the kidney. A total complication rate was 14.8%. All the complications were cured with conservative pharmacotherapy. TCNT has the same indications as open surgery, is a method of choice in presenile and senile patients with large, stag-horn and recurrent concrements of the kidney, impacted pelvicoureteral concrements, in impaired renal urodynamics and high bacteriuria. TCNT can be used as a second-line treatment in failure of extracorporeal shock-wave lithotripsy or in combination with it (sandwich-therapy) for complete concrement elimination.

[Choice of urinary tract drainage in different age groups of patients with urolithiasis].

Retro- and prospective analyses of 802 case histories of patients with nephrostomic drainage (n=272), ureteral catheter (n=27) and ureteral stent (n=503) treated for urolithiasis in the urological department of M.F. Vladimirsky Moscow Region Research Clinical Institute and Zhukovsky city hospital hospitalized in 1995 to 2009 made it possible to develop algorithms of choice of upper urinary tract drainage depending on clinical and laboratory indices. Nephrostomic drainage is preferable in a single functioning kidney, acute obstructive pyelonephritis, anuria, hyperthermia above 38 degrees C, marked supravesical urodynamic disorder, in renal failure, serum creatinine over 200 mcmol/l, urea over 10 mmol/l, blood potassium over 5 mmol/l, uric acid over 380 mcmol/l and leukocytosis over 8 x 10(9) l. Draining with ureteral stent was used primarily in elective surgery--extracorporeal shock-wave lithotripsy and transurethral operations. Stenting was better tolerated and entailed less frequent complications. In the rest cases choice of drain method should be made by the urologist. In active inflammation, before getting antibioticogram, the drain should be followed by antibiotic treatment with fluoroquinolones, cephalosporines of the third or forth generation, aminoglycosides, carbapenems in standard doses.

[Rapid bioluminescent antibiotic susceptibility assay].

Rapid testing of pathogen susceptibility to antibiotics is of great practical value for rational chemotherapy of pyoinflammatory deseases and postoperative complications of microbial etiology. The standard microbiological methods, i.e., the disk diffusion method and the method of serial dilutions are labour- and time-consuming (not less than 18-36 hours). The method of the authors is based on measuring bioluminescence resulting from interaction of adenosine-5'-triphosphate (ATP) and ATP reagent, a standard reaction mixture of firefly luciferase (an enzyme) and luciferin. The bioluminescence intensity is proportional to the ATP concentration in the reaction mixture and the ATP concentration is proportional to the number of the pathogen viable cells in the sample. The bioluminescence intensity value in the pathogen suspension aliquots with and without (control) the antibiotic were compared after the incubation for 5 hours and the coefficient of the microbial cell growth inhibition was calculated. Satisfactory correlation (R2 > 88%) of the results of the bioluminescent assay and the assay with the disk diffusion method and the method of serial dilutions was observed.

[Some current aspects of diagnosis of calculous pyelonephritis].

Immunomicrobiological examination was made of 656 urine and 71 blood samples from 71 patients with chronic pyelonephritis and coral nephrolithiasis. Bacteriuria in blood agar was quantified in colony-forming cells (CFC) in 1 ml of the urine. Identification of the bacterial strains was made by conventional methods. Blood samples were examined for phagocytic activity (PA) of neutrophils and phagocytic index (PI) in incomplete (30 min) and complete (2 hours) variants (S.aureus-209P), levels of IgA, IgM, IgG (in IU/ml), complement (CH50), T- and B-lymphocytes and 0-cells. Opportunistic bacteria (OB) in titer from Ig 2 to Ig 5 CFC/ml and more were identified in 428 (65.25%) samples. OB monocultures prevailed (48.6%). In exacerbation of the disease the majority of the examinees (73.0%) showed deficiency of both cellular and humoral components of antiinfection resistance system (AIRS). First-line defense against bacterial invasion was impaired as shown by incomplete neutrophil digestion in 62.0% of examinees. Among patients with humoral immunodeficiency, those with low IgM were the minority (45.0%). T-RFC and B-RFC deficiency (in 68.0 and 52.0%, respectively), low levels of IgG and IgA (66.0 and 73.0% cases, respectively) indicated deficiency of immunocompetent cells and their functional activity. The study of the AIRS established significance of its components for early and significant diagnosis of calculous pyelonephritis. Pyelonephritis in nephrolithiasis runs with deficiency of both cellular and humoral components of AIRS.

[The role of nebulizer therapy in acute laryngeal inflammation].

The addition of nebulizer therapy with antiedematous, steroid and mucolytic drugs to antibacterial therapy in patients with different forms of acute laryngitis was assessed. Basing on the main symptoms of the disease, three variants of nebulizer therapy were proposed. As shown by the results of treatment of 48 patients with catarrhal laryngitis, 19 patients with laryngeal angina and 27 patients with phlegmonous laryngitis, nebulizer therapy is highly effective in different forms of laryngeal diseases including purulent process with stenosis.

[Infectious complications in using mofetil micofenolate in patients with renal allotransplant].

AIM: To study infectious complications in renal transplant recipients receiving mycophenolate mofetil (MMF) for prevention of acute transplant rejection or treatment of chronic allograft nephropathy (CAN). MATERIAL AND METHODS: A group of renal transplant recipients (n=47) receiving 1.0-2.0 g/day MMF with cyclosporine A (CsA) and steroids as maintaining immunosuppression was compared to a group (n=47) taking triple immunosuppressive therapy which included azathioprine (Aza). Separate group of patients (n=9) received MMF for treatment of CAN. In all groups etiology and incidence of infections were evaluated. RESULTS: During 2 years various posttransplant infections developed in 72.3% patients on MMF and 93.6% on Aza. The incidence of viral infections was 53.2% in MMF and 59.6% in Aza group, the incidence of bacterial infection--55.3 and 70.2%, respectively. Among 9 recipients with CAN the infections occurred in five. There were two cases of active tuberculosis in Aza group, one--in MMF group and one in patients with CAN. CONCLUSION: We suggest that MMF in the dose 1-2 g/day does not increase infection rates in renal transplant recipients comparing Aza.

[Monitoring of uropathogens and their susceptibility to antibiotics]. / Monitoring uropatogenov i ikh chuvstvitel'nosti k antibiotikam.

Samples of urine collected from patients with complicated urology infection and hospitalized to the Moscow Region Research Clinical Institute in 1986, 1991, 1995 and 1999 were analysed. Of 11,444 samples examined, bacteriuria was estimated in 7143 samples. 9786 strains (29 genus) of bacteria were isolated--56.9 per cent as mono culture and 43.1 per cent as associations. Susceptibility to 21 antibiotic was determined by disk diffusion method for 1607 strains; beta-lactamase production was determined in 198 strains, MIC was determined for 41 antibiotics. Gram-negative rods relative amount among pathogens decreased substantially (84.7 per cent in 1986 against 61.6 per cent in 1999), particularly Enterobacteriaceae (74.7 per cent in 1986 against 41.4 per cent in 1999). Nonfermenting Gram-negative rods (NFGNR) relative amount increased (10.8 per cent against 19.2 per cent), along with Gram-positive cocci (19.8 per cent against 64.2 per cent), particularly coagulasenegative staphylococci (CNS) (10.8 per cent against 35.9 per cent) and enterococci (5 per cent against 16.5 per cent) and candida and fungi (0.5 per cent in 1986 against 15.9 per cent in 1999). At the period 1986-1999 the main pathogens in urology infection were E. coli, Enterobacter spp., NFGNR (including P. aeruginosa), Staphylococcus, CNS, Enterococcus spp. The problem pathogens for urological department were the following: E. coli, Klebsiella spp., Enterobacter spp., Proteus spp., NFGNR including P. aeruginosa, CNS, Enterococcus spp., candida and fungi. At the period 1991-1997 Gram-negative pathogens susceptibility to amikacin, ofloxacin, ciprofloxacin, imipenem, ceftazidime, cefotaxime was not changed in general, Gram-positive cocci (staphylococci and enterococci) retained the same susceptibility to vancomicin, cefamandol and amoxyclave. Staphylococci were also susceptible to amikacin, imipenem, rifampicin, oxacillin, ciprofloxacin, and ofloxacin. Production of beta-lactamase was registered for 38.7 per cent of CNS, 26.5 per cent of E. coli, 38.5 per cent of K. pneumoniae, 25 per cent of P. mirabilis and 55.6 per cent of P. aeruginosa strains.

[Immuno-microbiological aspects of chronic bacterial prostatitis pathogenesis]. / Immunomikrobiologicheskie aspekty patogeneza khronicheskogo bakterial'nogo prostatita.

The paper deals with a role of the factors of the body's antiinfective resistance system in the pathogenesis of chronic bacterial prostatitis and with the identification of an etiological factor of the disease. Long-term studies have revealed that chronic bacterial prostatitis runs in the presence of impairments in the antiinfective resistance system, in failures of T lymphocytes, phagocytic activity, and opsonization in particular. Gram-positive cocci, predominantly Staphylococcus and Enterococcus alone or as part of 2-component associations have been found to be the leading agents in the etiology of chronic bacterial prostatitis.

[Effect of piperacillin/tazobactam on the anti-infection resistance in patients with infections in the peritoneal cavity]. / Vliianie piperatsillin/tazobaktama na sistemu antiinfektsionnoi rezistentnosti bol'nykh s infektsiei v briushnoi polosti.

The effect of the monotherapy with piperacillin/tazobactam (P/T) or tazocin on microflora of the mucous membranes of the nose and pharynx of 33 patients and the contents of the large intestine of 21 patients as well as on the immunological aspects (cellular and humoral factors) of the antiinfectious resistance systems (AIRS) in patients with abdominal cavity infection (ACI) was studied. Before the treatment serious impairment of the AIRS in all the patients was observed. The P/T monotherapy in a daily dose of 12/1.5 g at the average for 10 days had no unfavourable effect on the indices characterizing the phagocytic function of the neutrophils in the incompleted and completed variants, on the immunocompetent cells, hemolytic complement and the levels of IgM, IgG and IgA. No significant effect of the treatment on the mucosal microflora on the whole was detected. However, Neisseria spp. and Corynebacterium pseudodiphtheriticum were eradicated in the pharynx while the number of the Klebsiella pneumoniae [symbol: see text] Escherichia coli isolates from the pharynx mucosa increased. The number of the bifidobacteria in the contents of the large intestine significantly lowered while the number of the hemolyzing forms of enterococci and stapylococci increased. The investigation of the AIRS immunological aspects in the patient groups of different total (clinicomorphological) efficacy showed that the neutrophil phagocytic function was the efficacy predictor and P/T in its turn had an immunomodulating effect on the neutrophil phagocytic activity in the patients with ACI.

[Indicators of resistance to infection in children with respiratory papillomatosis]. / Pokazateli antiinfektsionnoi rezistentnosti u detei, bol'nykh respiratornym papillomatozom.

The study was made of microbiological and immunological aspects of antiinfectious resistance (AIR) in children with respiratory papillomatosis (RP). At admission to hospital RP patients exhibited dysbacteriosis of the upper respiratory tract and colon. Immunological and microbiological response to the infection recurrences was adequate. Interrelated immunological and microbiological indices in RP objectively reflect the course of the pathological process and may be used in objective assessment of the disease and choice of its treatment.

[Role of non spore-forming anaerobes in the formation of microbial landscape of the large intestine in patients with inflammatory processes at different sites]. / Rol' nesporoobrazuiushchikh anaérobov v formirovanii mikrobnogo peizazha soderzhimogo tolstoi kishki u bol'nykh s vospalitel'nymi protsessami razlichnoi lokalizatsii.

Clinical microbiological techniques were used to study 300 patients with clinically verified urinary infections and chronic intestinal diseases. It was ascertained that examining the large intestinal content in average statistical groups of patients with inflammatory processes at various sites cannot objectively characterize the presence or absence of clinical manifestations of gastrointestinal diseases. The pathogenetic factors that predispose to the development of intestinal diseases are lower phagocytic activity, decreased complement and deficiency of B lymphocytes and IgA. The concentrations of IgM, IgG, secretory IgA and protein, as well as those of B. bifidum in the large intestinal content may serve as an additional diagnostic criterion for evaluating the mucosa of the ecological niche.

[A method of sequential (intravenous and oral) use of ofloxacin in the treatment of patients with infections of organs of the peritoneal cavity]. / Metod posledovatel'nogo (vnutrivenno i vnutr') primeneniia ofloksatsina pri lechenii bol'nykh s infektsiiami organov briushnoi polosti.

Clinico-laboratory estimation of the efficacy and tolerance of ofloxacin used in succession, at first intravenously and then orally, in the treatment of 15 patients with infection of the abdominal cavity was performed. It was shown that after the use for a period of 10 years ofloxacin preserved its high antimicrobial activity against gram-positive and gram-negative organisms with multiple drug resistance and remained superior to the majority of broad spectrum antimicrobial agents by the number of susceptible isolates. The successive use of ofloxacin proved to be highly efficient. The total efficacy of the drug amounted to 80 percent and no side effects were recorded. The analysis of the microbiological state of the antiinfectious resistance system (AIRS) showed that the dysbiotic lesions on the mucosa of the upper respiratory tracts and large intestine detected in all the patients before the treatment with ofloxacin remained after the treatment. However, a change in the microflora responsible for dysbacteriosis was observed. The investigation of the immunological status of the AIRS suggested that the good and satisfactory results of the therapy with ofloxacin could to a significant extent be due to the proportion of the active neutrophils.

[The etiological factors in pyelonephritis occurring against a background of nephrolithiasis]. / Etiologicheskie faktory pielonefrita, protekaiushchego na fone nefrolitiaza.

656 urine and 78 blood samples were examined immunomicrobiologically. No bacterial growth was recorded in 43.8% of urine samples. Opportunistic bacteria were represented by Enterobacteriaceae, nonfermenting gram-negative bacteria with predominance of E. coli, P. mirabilis, P. aeruginosa isolated both in monocultures and in associations in conventional diagnostic titers (1g 5 CFU/ml). Throughout 40 days of the hospital stay microflora continuously changed, but until the discharge the infection persisted. The study of the immunological aspect of anti-infection resistance showed that most of the examinees (73%) at admission with pyelonephritis exacerbation have deficient cellular and humoral defense.