Pub Date : 2023-01-01DOI: 10.36488/cmac.2023.1.4-12
A.O. Nosova, E. V. Bogoslovskaya, G. Shipulin
Measles virus causes an acute infectious disease with high contagiousness. It is possible to limit the spread of measles virus only with a sufficiently wide coverage of the population by vaccination. Despite the success of measles elimination programs, many countries have seen an increase in the incidence of measles in recent years, making early diagnosis increasingly important. The importance of laboratory diagnosis is related to the difficulties of clinical differential diagnosis of measles in the early stages of the disease. This review is devoted to an analysis of existing methods for diagnosing measles. It demonstrates the limitations of the most commonly used method, the enzyme immunoassay, and the need to develop and implement alternative diagnostic methods. Particular attention in the review is paid to molecular diagnostic methods, the sensitivity of which is reviewed for different types of biological sampled at different stages of the disease. Characteristics of the measles virus that are of key importance in the development of PCR tests are described. Studies evaluating the significance of introducing PCR in the routine diagnosis of measles are presented. The main advantages of molecular methods are the possibility of early detection of the virus and the possibility of simultaneous detection of several pathogens, which allows differential diagnosis of diseases with a similar clinical presentation. The development and implementation of rapid and accurate approaches based on molecular diagnostic methods into the health care system is an urgent need in the implementation of global and local programs for the elimination of measles.
{"title":"Current approaches and prospects for the development of laboratory diagnosis of measles","authors":"A.O. Nosova, E. V. Bogoslovskaya, G. Shipulin","doi":"10.36488/cmac.2023.1.4-12","DOIUrl":"https://doi.org/10.36488/cmac.2023.1.4-12","url":null,"abstract":"Measles virus causes an acute infectious disease with high contagiousness. It is possible to limit the spread of measles virus only with a sufficiently wide coverage of the population by vaccination. Despite the success of measles elimination programs, many countries have seen an increase in the incidence of measles in recent years, making early diagnosis increasingly important. The importance of laboratory diagnosis is related to the difficulties of clinical differential diagnosis of measles in the early stages of the disease. This review is devoted to an analysis of existing methods for diagnosing measles. It demonstrates the limitations of the most commonly used method, the enzyme immunoassay, and the need to develop and implement alternative diagnostic methods. Particular attention in the review is paid to molecular diagnostic methods, the sensitivity of which is reviewed for different types of biological sampled at different stages of the disease. Characteristics of the measles virus that are of key importance in the development of PCR tests are described. Studies evaluating the significance of introducing PCR in the routine diagnosis of measles are presented. The main advantages of molecular methods are the possibility of early detection of the virus and the possibility of simultaneous detection of several pathogens, which allows differential diagnosis of diseases with a similar clinical presentation. The development and implementation of rapid and accurate approaches based on molecular diagnostic methods into the health care system is an urgent need in the implementation of global and local programs for the elimination of measles.","PeriodicalId":53392,"journal":{"name":"Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69624670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.36488/cmac.2023.1.93-99
K. A. Safonova, N. Dekhnich, N. D. Elistratov, E. D. Rzhevtseva, P.G. Filina, A. Kuzmenkov, I. V. Trushin, A. A. Punin
Objective. To identify risk factors for fatal outcome and COVID-19-associated liver damage in hospitalized adult patients with coronavirus infection. Materials and Methods. In a retrospective cohort study, 389 cases of patients with coronavirus infection complicated by bilateral viral pneumonia were studied. Demographic characteristics, clinical features of the course of the disease, anamnestic data, results of laboratory and instrumental methods of examination were analyzed and correlated with mortality. At the time of admission, the following were taken into account: fever, severity of the patient’s condition according to COVID-19 classification of severity, body mass index (BMI), oxygen saturation (SpO2), percentage of lung tissue damage according to computed tomography (CT). Laboratory indices of biochemical blood analysis were assessed in dynamics: alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, total protein, albumin, C-reactive protein (CRP). Data analysis was performed using the R programming language (ver. 4.1.1.). Results. The following risk factors, assessed at the time of hospitalization, increased the likelihood of death: severe and extremely severe condition of the patient (RR = 4.77; 95% CI: 3.33–6.83); SpO2 less than 93% (RR = 3.76; 95% CI: 2.57–5.49); diabetes mellitus (RR = 2.94; 95% CI: 2.01–4.30); lung tissue damage CT-3 and CT-4 (RR = 2.66; 95% CI: 1.79–3.75); concomitant chronic pyelonephritis and chronic kidney disease (CKD) (RR = 2.59; 95% CI: 1.79–3.74); age 65 years and older (RR = 2.50; 95% CI: 1.70–3.67); ischemic heart disease (IHD) (RR = 2.39; 95% CI: 1.42–4.01); an increase in the level of CRP more than 15 mg/l (RR = 2.22; 95% CI: 1.16–4.24); BMI 35 kg/m2 or more (RR = 1.89; 95% CI: 1.28–2.77); AST level more than 2 upper limit of normal (ULN) (RR = 1.75; 95% CI: 1.20–2.55). Risk factors for an increase in AST more than 2 ULN were: SpO2 less than 93% (RR = 1.53; 95% CI: 1.15– 2.03), severe and extremely severe course of coronavirus infection (RR = 1.83; 95% CI: 1.38–2.43), concomitant chronic liver disease (RR = 1.45, 95% CI: 1.08–1.95). Conclusions. Risk factors for fatal COVID-19 in hospitalized patients are: severe and extremely severe initial condition of the patient, oxygen saturation less than 93%, lung tissue damage more than 50%, age older than 65 years, presence of concomitant diabetes mellitus, chronic pyelonephritis and CHD, CHD, obesity, increased CRP level more than 15 mg/l, and AST more than 70 units/l. Elevation of AST over 2 IU/L can be considered as one of the prognostic laboratory markers of adverse prognosis COVID-19.
{"title":"COVID-19 risk factors for mortality in hospitalized patients: results\u0000of a retrospective study","authors":"K. A. Safonova, N. Dekhnich, N. D. Elistratov, E. D. Rzhevtseva, P.G. Filina, A. Kuzmenkov, I. V. Trushin, A. A. Punin","doi":"10.36488/cmac.2023.1.93-99","DOIUrl":"https://doi.org/10.36488/cmac.2023.1.93-99","url":null,"abstract":"Objective. To identify risk factors for fatal outcome and COVID-19-associated liver damage in hospitalized adult patients with coronavirus infection. Materials and Methods. In a retrospective cohort study, 389 cases of patients with coronavirus infection complicated by bilateral viral pneumonia were studied. Demographic characteristics, clinical features of the course of the disease, anamnestic data, results of laboratory and instrumental methods of examination were analyzed and correlated with mortality. At the time of admission, the following were taken into account: fever, severity of the patient’s condition according to COVID-19 classification of severity, body mass index (BMI), oxygen saturation (SpO2), percentage of lung tissue damage according to computed tomography (CT). Laboratory indices of biochemical blood analysis were assessed in dynamics: alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, total protein, albumin, C-reactive protein (CRP). Data analysis was performed using the R programming language (ver. 4.1.1.). Results. The following risk factors, assessed at the time of hospitalization, increased the likelihood of death: severe and extremely severe condition of the patient (RR = 4.77; 95% CI: 3.33–6.83); SpO2 less than 93% (RR = 3.76; 95% CI: 2.57–5.49); diabetes mellitus (RR = 2.94; 95% CI: 2.01–4.30); lung tissue damage CT-3 and CT-4 (RR = 2.66; 95% CI: 1.79–3.75); concomitant chronic pyelonephritis and chronic kidney disease (CKD) (RR = 2.59; 95% CI: 1.79–3.74); age 65 years and older (RR = 2.50; 95% CI: 1.70–3.67); ischemic heart disease (IHD) (RR = 2.39; 95% CI: 1.42–4.01); an increase in the level of CRP more than 15 mg/l (RR = 2.22; 95% CI: 1.16–4.24); BMI 35 kg/m2 or more (RR = 1.89; 95% CI: 1.28–2.77); AST level more than 2 upper limit of normal (ULN) (RR = 1.75; 95% CI: 1.20–2.55). Risk factors for an increase in AST more than 2 ULN were: SpO2 less than 93% (RR = 1.53; 95% CI: 1.15– 2.03), severe and extremely severe course of coronavirus infection (RR = 1.83; 95% CI: 1.38–2.43), concomitant chronic liver disease (RR = 1.45, 95% CI: 1.08–1.95). Conclusions. Risk factors for fatal COVID-19 in hospitalized patients are: severe and extremely severe initial condition of the patient, oxygen saturation less than 93%, lung tissue damage more than 50%, age older than 65 years, presence of concomitant diabetes mellitus, chronic pyelonephritis and CHD, CHD, obesity, increased CRP level more than 15 mg/l, and AST more than 70 units/l. Elevation of AST over 2 IU/L can be considered as one of the prognostic laboratory markers of adverse prognosis COVID-19.","PeriodicalId":53392,"journal":{"name":"Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69624834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.36488/cmac.2023.2.211-216
Olga V. Kondratenko, K.V. Zubova
Objective. Analysis of the distribution of the values of the minimum inhibitory concentrations (MIC) of a number of antibacterial drugs in relation to representatives of the order Flavobacteriales isolated from respiratory samples from patients with cystic fibrosis of the Russian Federation by the method of double serial dilutions. Materials and Methods. The distribution of the values of MIC of a number of antibacterial drugs was evaluated in relation to 100 strains of bacteria, representatives of the order Flavobacteriales, isolated from respiratory samples from patients with cystic fibrosis from 60 regions of the Russian Federation as part of a routine microbiological examination. Of these, 75 representatives of Chryseobacterium spp., among which C. arthrospherae – 28, C. formosense – 1, C. gambrini – 3, C. gleum – 10, C. indologenes – 20, C. joostei – 1, C. oraniemense – 10, C. shandongense – 2 strains, 4 strains of Elizabethkingia spp., among which 2 – E. miricola, and one strain of E. meningoseptica and E. anopheles, respectively, as well as 21 strains of E. falsenii. Identification of all isolated cultures was carried out using MALDI-ToF mass spectrometry (Bruker, Germany). The MIC values were determined for 17 antimicrobial drugs: amikacin, amoxicillin/clavulanate, aztreonam, cefotaxime, ceftazidime, ceftazidime/avibactam, ceftolozane/ tazobactam, ciprofloxacin, colistin, ertapenem, gentamicin, imipenem, meropenem, piperacillin/ tazobactam, tigecycline, tobramycin and trimethoprim/sulfamethoxazole using Sensititre kits DKMGN. Results. The MIC values of colistin, cefotaxime and tobramycin more than 8 µg/ml, as well as more than 2 µg/ml with respect to ertapenem was demonstrated for 100% of isolates. For most strains, the MIC values of imipenem and meropenem were more than 4 µg/ml. MIC of ceftazidime against 20% of Chryseobacterium spp. strains was up to 2 µg/ml. Indicators of MIC of amikacin in relation to Elizabethkingia spp. strains were 32 µg/ml or more. For 38% of the strains of Chryseobacterium spp. and E.falsenii, this value did not exceed 8 µg/ml. As in the case of amikacin, all Elizabethkingia spp. strains demonstrated high levels of gentamicin MIC – 8 µg/ml (25% of strains) and more (75% of strains). For 20% of all tested strains, the MIC value was in the range of ≤ 2 µg/ml. In relation to half of the tested isolates, the MIC values for ceftazidime/avibactam, as well as ceftolozane/tazobactam were at the level of up to 2⁄4 µg/ml inclusive. More than a third of the strains had a level of MIC ciprofloxacin up to 0.25 µg/ml inclusive. For 25% of strains, the level of MIC of tigecycline was up to 0.5 µg/ml, inclusive, the lowest MIC indicators for the tested group of strains were demonstrated for trimethoprim/sulfamethoxazole: for 88% of strains, the MIC value was ≤ 1⁄19 µg/ml, for another 9% of strains, this indicator was 2⁄38 µg/ml. Conclusions. Representatives of the order Flavobacteriales are a group of microorganisms characterized
{"title":"Distribution of MIC values of antibacterial drugs for Flavobacteriales isolated from respiratory samples in Russian patients with cystic fibrosis","authors":"Olga V. Kondratenko, K.V. Zubova","doi":"10.36488/cmac.2023.2.211-216","DOIUrl":"https://doi.org/10.36488/cmac.2023.2.211-216","url":null,"abstract":"Objective. Analysis of the distribution of the values of the minimum inhibitory concentrations (MIC) of a number of antibacterial drugs in relation to representatives of the order Flavobacteriales isolated from respiratory samples from patients with cystic fibrosis of the Russian Federation by the method of double serial dilutions. Materials and Methods. The distribution of the values of MIC of a number of antibacterial drugs was evaluated in relation to 100 strains of bacteria, representatives of the order Flavobacteriales, isolated from respiratory samples from patients with cystic fibrosis from 60 regions of the Russian Federation as part of a routine microbiological examination. Of these, 75 representatives of Chryseobacterium spp., among which C. arthrospherae – 28, C. formosense – 1, C. gambrini – 3, C. gleum – 10, C. indologenes – 20, C. joostei – 1, C. oraniemense – 10, C. shandongense – 2 strains, 4 strains of Elizabethkingia spp., among which 2 – E. miricola, and one strain of E. meningoseptica and E. anopheles, respectively, as well as 21 strains of E. falsenii. Identification of all isolated cultures was carried out using MALDI-ToF mass spectrometry (Bruker, Germany). The MIC values were determined for 17 antimicrobial drugs: amikacin, amoxicillin/clavulanate, aztreonam, cefotaxime, ceftazidime, ceftazidime/avibactam, ceftolozane/ tazobactam, ciprofloxacin, colistin, ertapenem, gentamicin, imipenem, meropenem, piperacillin/ tazobactam, tigecycline, tobramycin and trimethoprim/sulfamethoxazole using Sensititre kits DKMGN. Results. The MIC values of colistin, cefotaxime and tobramycin more than 8 µg/ml, as well as more than 2 µg/ml with respect to ertapenem was demonstrated for 100% of isolates. For most strains, the MIC values of imipenem and meropenem were more than 4 µg/ml. MIC of ceftazidime against 20% of Chryseobacterium spp. strains was up to 2 µg/ml. Indicators of MIC of amikacin in relation to Elizabethkingia spp. strains were 32 µg/ml or more. For 38% of the strains of Chryseobacterium spp. and E.falsenii, this value did not exceed 8 µg/ml. As in the case of amikacin, all Elizabethkingia spp. strains demonstrated high levels of gentamicin MIC – 8 µg/ml (25% of strains) and more (75% of strains). For 20% of all tested strains, the MIC value was in the range of ≤ 2 µg/ml. In relation to half of the tested isolates, the MIC values for ceftazidime/avibactam, as well as ceftolozane/tazobactam were at the level of up to 2⁄4 µg/ml inclusive. More than a third of the strains had a level of MIC ciprofloxacin up to 0.25 µg/ml inclusive. For 25% of strains, the level of MIC of tigecycline was up to 0.5 µg/ml, inclusive, the lowest MIC indicators for the tested group of strains were demonstrated for trimethoprim/sulfamethoxazole: for 88% of strains, the MIC value was ≤ 1⁄19 µg/ml, for another 9% of strains, this indicator was 2⁄38 µg/ml. Conclusions. Representatives of the order Flavobacteriales are a group of microorganisms characterized","PeriodicalId":53392,"journal":{"name":"Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135495218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.36488/cmac.2023.2.142-149
A.A. Tryapyshko, Natalya N. Dekhnich
Objective. To compare efficacy and safety of 14-day triple eradication therapy with the addition of methylmethionine sulfonium chloride and a probiotic complex and 14-day triple eradication therapy boosted with bismuth tripotassium dicitrate and a probiotic complex in a prospective comparative randomized clinical trial. Materials and Methods. A total of 70 patients with confirmed H. pylori infection were enrolled into the study. The first group (n = 35) received esomeprazole 20 mg 2 bid, clarithromycin 500 mg bid and amoxicillin 1000 mg bid for 14 days, methylmethionine sulfonium chloride 300 mg once a day for 1 month, probiotic complex (bifidobacteria [Bifidobacterium longum CBT BG7, Bifidobacterium lactis CBT BL3, Bifidobacterium bifidum CBT BF3], lactobacilli [Lactobacillus acidophilus CBT LA1, Lactobacillus rhamnosus CBT LR5], Streptococcus thermophilus CBT ST3) 1 capsule once a day for 1 month. The second group (n = 35) received esomeprazole 20 mg 2 bid, clarithromycin 500 mg 2 bid, amoxicillin 1000 mg 2 bid and bismuth tripotassium dicitrate 240 mg 2 bid for 14 days, probiotic complex (bifidobacteria [Bifidobacterium longum CBT BG7, Bifidobacterium lactis CBT BL3, Bifidobacterium bifidum CBT BF3], lactobacilli [Lactobacillus acidophilus CBT LA1, Lactobacillus rhamnosus CBT LR5], Streptococcus thermophilus CBT ST3) 1 capsule once a day for 1 month. Eradication of H. pylori was assessed using stool antigen test. Results. Eradication rates for the first and second groups in the intent-to-treat (ITT) population were 77.1% and 88.6% (p = 0.205), respectively. In the per-protocol (PP) population, eradication rates were 81.8% and 96.9% (p = 0.051), respectively. Adverse events were reported in 34.3% of patients in the first group and 34.3% of patients in the second group (p = 1). Conclusions. 14-day standard triple therapy boosted with bismuth tripotassium dicitrate and a probiotic complex demonstrates high efficacy and safety profile, and therefore can be recommended as first-line therapy for H. pylori infection in adults.
{"title":"Combination of gastroprotectors and probiotics in the eradication of H. pylori infection: results of a randomized comparative clinical trial","authors":"A.A. Tryapyshko, Natalya N. Dekhnich","doi":"10.36488/cmac.2023.2.142-149","DOIUrl":"https://doi.org/10.36488/cmac.2023.2.142-149","url":null,"abstract":"Objective. To compare efficacy and safety of 14-day triple eradication therapy with the addition of methylmethionine sulfonium chloride and a probiotic complex and 14-day triple eradication therapy boosted with bismuth tripotassium dicitrate and a probiotic complex in a prospective comparative randomized clinical trial. Materials and Methods. A total of 70 patients with confirmed H. pylori infection were enrolled into the study. The first group (n = 35) received esomeprazole 20 mg 2 bid, clarithromycin 500 mg bid and amoxicillin 1000 mg bid for 14 days, methylmethionine sulfonium chloride 300 mg once a day for 1 month, probiotic complex (bifidobacteria [Bifidobacterium longum CBT BG7, Bifidobacterium lactis CBT BL3, Bifidobacterium bifidum CBT BF3], lactobacilli [Lactobacillus acidophilus CBT LA1, Lactobacillus rhamnosus CBT LR5], Streptococcus thermophilus CBT ST3) 1 capsule once a day for 1 month. The second group (n = 35) received esomeprazole 20 mg 2 bid, clarithromycin 500 mg 2 bid, amoxicillin 1000 mg 2 bid and bismuth tripotassium dicitrate 240 mg 2 bid for 14 days, probiotic complex (bifidobacteria [Bifidobacterium longum CBT BG7, Bifidobacterium lactis CBT BL3, Bifidobacterium bifidum CBT BF3], lactobacilli [Lactobacillus acidophilus CBT LA1, Lactobacillus rhamnosus CBT LR5], Streptococcus thermophilus CBT ST3) 1 capsule once a day for 1 month. Eradication of H. pylori was assessed using stool antigen test. Results. Eradication rates for the first and second groups in the intent-to-treat (ITT) population were 77.1% and 88.6% (p = 0.205), respectively. In the per-protocol (PP) population, eradication rates were 81.8% and 96.9% (p = 0.051), respectively. Adverse events were reported in 34.3% of patients in the first group and 34.3% of patients in the second group (p = 1). Conclusions. 14-day standard triple therapy boosted with bismuth tripotassium dicitrate and a probiotic complex demonstrates high efficacy and safety profile, and therefore can be recommended as first-line therapy for H. pylori infection in adults.","PeriodicalId":53392,"journal":{"name":"Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135495905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.36488/cmac.2023.1.56-67
R. Mustafin
Inhibitors of hydroxymethylglutaryl-CoA reductase, in addition to suppressing cholesterol synthesis, have an antiviral effect. Clinical studies have shown antiviral efficacy of statins against COVID-19, HCV, HBV, RSV, HIV, influenza viruses. The ability of statins to inhibit influenza viruses, COVID-19, RSV, HIV, as well as Ebola, Zika, Dengue, Coxsackie, rotaviruses, ADV, HDV, HHV was experimentally confirmed. Statins can also enhance the effects of antiviral drugs, making them more effective in treating infections. Therefore, the use of statins in the complex therapy of viral infections is promising. In addition, the role of influenza viruses, T-cell leukemia and herpesviruses, HIV, HBV, HCV, HPV in the development of atherosclerosis has been identified, so the use of statins in complex treatment is also necessary to correct endothelial dysfunction that occurs under the influence of viruses. Since the activity of retroelements that are evolutionarily related to exogenous viruses increases with aging, it has been suggested that retrotransposons can also be targets for statins. This is evidenced by a change in the expression of non-coding RNAs under the action of statins, since the key sources of non-coding RNAs are retroelements. This property may be an additional factor in the prescription of statins to increase life expectancy, in addition to the prevention and treatment of atherosclerosis, since pathological activation of retroelements are the causes of aging. Viruses, like retroelements, are involved in the pathogenesis of malignant neoplasms, in the treatment of which statins have shown their effectiveness and the ability to enhance the effect of anticancer drugs, overcoming chemoresistance (similar to the potentiation of antiviral drugs). One of the mechanisms of this activity of statins may be their effect on retroelements and viruses.
{"title":"Prospects for the use of statins in antiviral therapy","authors":"R. Mustafin","doi":"10.36488/cmac.2023.1.56-67","DOIUrl":"https://doi.org/10.36488/cmac.2023.1.56-67","url":null,"abstract":"Inhibitors of hydroxymethylglutaryl-CoA reductase, in addition to suppressing cholesterol synthesis, have an antiviral effect. Clinical studies have shown antiviral efficacy of statins against COVID-19, HCV, HBV, RSV, HIV, influenza viruses. The ability of statins to inhibit influenza viruses, COVID-19, RSV, HIV, as well as Ebola, Zika, Dengue, Coxsackie, rotaviruses, ADV, HDV, HHV was experimentally confirmed. Statins can also enhance the effects of antiviral drugs, making them more effective in treating infections. Therefore, the use of statins in the complex therapy of viral infections is promising. In addition, the role of influenza viruses, T-cell leukemia and herpesviruses, HIV, HBV, HCV, HPV in the development of atherosclerosis has been identified, so the use of statins in complex treatment is also necessary to correct endothelial dysfunction that occurs under the influence of viruses. Since the activity of retroelements that are evolutionarily related to exogenous viruses increases with aging, it has been suggested that retrotransposons can also be targets for statins. This is evidenced by a change in the expression of non-coding RNAs under the action of statins, since the key sources of non-coding RNAs are retroelements. This property may be an additional factor in the prescription of statins to increase life expectancy, in addition to the prevention and treatment of atherosclerosis, since pathological activation of retroelements are the causes of aging. Viruses, like retroelements, are involved in the pathogenesis of malignant neoplasms, in the treatment of which statins have shown their effectiveness and the ability to enhance the effect of anticancer drugs, overcoming chemoresistance (similar to the potentiation of antiviral drugs). One of the mechanisms of this activity of statins may be their effect on retroelements and viruses.","PeriodicalId":53392,"journal":{"name":"Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69624724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.36488/cmac.2023.1.84-92
A. Kurkova, S. Rachina, R.S. Kozlov, U. Portnyagina, S. Palyutin, O. V. Reshetko, M. Zhuravleva, O. Karpova, O.G. Myagkova, E. Kuznetsova, T. Kameneva
Objective. To evaluate the existing patterns of antimicrobials dispensing in community pharmacies during the COVID-19 pandemic. Materials and Methods. In a cross-sectional study conducted from October 2020 to January 2021 it was obtained the data on the major antimicrobials dispensing in community pharmacies in Moscow and four regions of Russian Federation: date of release, customer’s age and gender, drug name and formulation, the reason for the release (symptoms, preliminary or confirmed diagnosis), prescription-based supply or not/emergency releasing. Results. The study included 71 pharmacies, including 41 private and 30 public organizations. During the mentioned period of time 5514 antimicrobials were supplied to 5270 customers. Antibiotics and antiviral drugs for systemic use accounted the largest share in the structure of purchased antimicrobials (60.5% and 26.3% of all sales, respectively). The frequency of non-prescription-based supplies was 28.5%. The greatest demand among antibiotics was registered for macrolides (14.9%), combinations of penicillins with beta-lactamase inhibitors (12.3%) and fluoroquinolones (11.4%). Upper respiratory tract infections were the most frequent reason for antimicrobials releasing – 36,9%. COVID-19 was the reason for 8.4% of antimicrobials sales. Azithromycin and umifenovir were the most frequently used drugs for SARS-CoV-2. Conclusions. Antibiotics for systemic use have still remained the commonly used ones, whereas upper respiratory tract infections are the main indication for their purchase. Nearly a third of antimicrobials, including systemic antibiotics, were dispensed in private pharmacies without prescription. COVID-19 is uncommon cause of outpatient antimicrobial sales, but a common reason for systemic antibiotic prescribing.
{"title":"Patterns of antimicrobial dispensing in community pharmacies in Russia during the COVID-19 pandemic","authors":"A. Kurkova, S. Rachina, R.S. Kozlov, U. Portnyagina, S. Palyutin, O. V. Reshetko, M. Zhuravleva, O. Karpova, O.G. Myagkova, E. Kuznetsova, T. Kameneva","doi":"10.36488/cmac.2023.1.84-92","DOIUrl":"https://doi.org/10.36488/cmac.2023.1.84-92","url":null,"abstract":"Objective. To evaluate the existing patterns of antimicrobials dispensing in community pharmacies during the COVID-19 pandemic. Materials and Methods. In a cross-sectional study conducted from October 2020 to January 2021 it was obtained the data on the major antimicrobials dispensing in community pharmacies in Moscow and four regions of Russian Federation: date of release, customer’s age and gender, drug name and formulation, the reason for the release (symptoms, preliminary or confirmed diagnosis), prescription-based supply or not/emergency releasing. Results. The study included 71 pharmacies, including 41 private and 30 public organizations. During the mentioned period of time 5514 antimicrobials were supplied to 5270 customers. Antibiotics and antiviral drugs for systemic use accounted the largest share in the structure of purchased antimicrobials (60.5% and 26.3% of all sales, respectively). The frequency of non-prescription-based supplies was 28.5%. The greatest demand among antibiotics was registered for macrolides (14.9%), combinations of penicillins with beta-lactamase inhibitors (12.3%) and fluoroquinolones (11.4%). Upper respiratory tract infections were the most frequent reason for antimicrobials releasing – 36,9%. COVID-19 was the reason for 8.4% of antimicrobials sales. Azithromycin and umifenovir were the most frequently used drugs for SARS-CoV-2. Conclusions. Antibiotics for systemic use have still remained the commonly used ones, whereas upper respiratory tract infections are the main indication for their purchase. Nearly a third of antimicrobials, including systemic antibiotics, were dispensed in private pharmacies without prescription. COVID-19 is uncommon cause of outpatient antimicrobial sales, but a common reason for systemic antibiotic prescribing.","PeriodicalId":53392,"journal":{"name":"Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69624797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.36488/cmac.2023.1.13-18
K.A. Kaiumov, A. Lyamin, A. V. Zhestkov, I. Bazhutova
Fusobacterium nucleatum is a component of the oral microflora, and in clinical practice it is associated primarily with periodontal diseases. Since 2011, the scientific community has confirmed the association of F. nucleatum with colorectal cancer (CRC) by seeding it from tumor tissue samples. Research has led to the discovery of mechanisms by which this bacterium may contribute to the development, metastasis of CRC and chemoresistance. With the help of its adhesion proteins (FadA and Fap2) F. nucleatum specifically attaches to colorectal carcinoma cells. Following invasion, F. nucleatum induces inflammation, activates β-catenin signaling, and creates a favorable microenvironment for tumor growth and development. Recently, the role of F. nucleatum in other types of oncological pathology, such as oral cavity cancer, head and neck cancer, gastric cancer, esophageal cancer, pancreatic cancer, cervical cancer and breast cancer, has been confirmed. Understanding the mechanisms of association of F. nucleatum with oncological diseases will help to find new approaches in the treatment, prevention and diagnosis of cancer. Thus, further studies of the correlation between F. nucleatum and carcinogenesis are needed, using a multidisciplinary approach and physicians from other specialties.
{"title":"Fusobacterium nucleatum: from a classic periodontal pathogen to a complete participant of carcinogenesis","authors":"K.A. Kaiumov, A. Lyamin, A. V. Zhestkov, I. Bazhutova","doi":"10.36488/cmac.2023.1.13-18","DOIUrl":"https://doi.org/10.36488/cmac.2023.1.13-18","url":null,"abstract":"Fusobacterium nucleatum is a component of the oral microflora, and in clinical practice it is associated primarily with periodontal diseases. Since 2011, the scientific community has confirmed the association of F. nucleatum with colorectal cancer (CRC) by seeding it from tumor tissue samples. Research has led to the discovery of mechanisms by which this bacterium may contribute to the development, metastasis of CRC and chemoresistance. With the help of its adhesion proteins (FadA and Fap2) F. nucleatum specifically attaches to colorectal carcinoma cells. Following invasion, F. nucleatum induces inflammation, activates β-catenin signaling, and creates a favorable microenvironment for tumor growth and development. Recently, the role of F. nucleatum in other types of oncological pathology, such as oral cavity cancer, head and neck cancer, gastric cancer, esophageal cancer, pancreatic cancer, cervical cancer and breast cancer, has been confirmed. Understanding the mechanisms of association of F. nucleatum with oncological diseases will help to find new approaches in the treatment, prevention and diagnosis of cancer. Thus, further studies of the correlation between F. nucleatum and carcinogenesis are needed, using a multidisciplinary approach and physicians from other specialties.","PeriodicalId":53392,"journal":{"name":"Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69625056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In modern medicine, the extracorporeal membrane oxygenation (ECMO) is becoming increasingly common in the treatment of severe respiratory failure. The development of infectious complications in patients receiving ECMO often leads to an increase in the duration of the procedure and significantly increases the risk of death. Dosing of antimicrobials during ECMO remains uncertain and requires further research. Diagnosis of infectious complications during ECMO is a difficult and requires the development of diagnostic protocols and the use of routine microbiological studies. The use of antimicrobials during ECMO could be complicated due to decrease in effective plasma concentration. The adsorption of antibacterial drugs in the ECMO circuit and oxygenator, the use of infusion therapy, the development of hypoalbuminemia, as well as the high incidence of acute renal and hepatic dysfunction in critically ill patients lead to an inevitable change in the volume of distribution and clearance of antibacterial drugs. These conditions require an individual approach to the choice of antimicrobials and optimization of dosing regimens in critically ill patients receiving ECMO.
{"title":"Specific features of antimicrobial therapy in patients with severe respiratory failure receiving veno-venous extracorporeal membrane oxygenation (ECMO)","authors":"M.A. Petrushin, P.I. Melnichenko, P.A. Vlasov, I.S. Nikiforov, E.A. Kudryashova, I.A. Glushchenko","doi":"10.36488/cmac.2023.2.171-177","DOIUrl":"https://doi.org/10.36488/cmac.2023.2.171-177","url":null,"abstract":"In modern medicine, the extracorporeal membrane oxygenation (ECMO) is becoming increasingly common in the treatment of severe respiratory failure. The development of infectious complications in patients receiving ECMO often leads to an increase in the duration of the procedure and significantly increases the risk of death. Dosing of antimicrobials during ECMO remains uncertain and requires further research. Diagnosis of infectious complications during ECMO is a difficult and requires the development of diagnostic protocols and the use of routine microbiological studies. The use of antimicrobials during ECMO could be complicated due to decrease in effective plasma concentration. The adsorption of antibacterial drugs in the ECMO circuit and oxygenator, the use of infusion therapy, the development of hypoalbuminemia, as well as the high incidence of acute renal and hepatic dysfunction in critically ill patients lead to an inevitable change in the volume of distribution and clearance of antibacterial drugs. These conditions require an individual approach to the choice of antimicrobials and optimization of dosing regimens in critically ill patients receiving ECMO.","PeriodicalId":53392,"journal":{"name":"Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135495001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.36488/cmac.2023.2.202-210
Dmitriy A. Popov, R. A. Osokina, T. Yu. Vostrikova
Objective. To evaluate frequency of pharyngeal and rectal mucosa colonization by K. pneumoniae strains in infants with congenital heart defects at the stage of cardiosurgical hospital admission, as well as dynamic analysis of production frequency and molecular structure of K. pneumoniae carbapenemases. Materials and Methods. A total of 1445 patients with risk factors (antibiotic therapy in the anamnesis, emergency hospitalization, transfer from other hospitals) admitted for surgical treatment of congenital heart defects (CHDs) between January 1, 2020 and December 31, 2022 were included in the retrospective analysis. Median age was 1.08 months (between 0 and 12 months). Smears from the pharyngeal and rectal mucosa (2890 samples) were taken for microbiological examination no later than 72 h after admission. The isolation of extended-spectrum beta-lactamases (ESBLs) and/or carbapenemases producing K. pneumoniae in the absence of symptomatic infection was considered as colonization. K. pneumoniae strains were considered as «problematic» in the absence of susceptibility to three or more groups of antimicrobials: the third- and fourth-generation cephalosporins, carbapenems, fluoroquinolones, aminoglycosides. The profile of antibiotic resistance, carbapenemases production and their molecular type were determined in the isolated strains. Results. K. pneumoniae carriage with «problematic» sensitivity was detected in 252 out of 1445 (17.4%) patients: 153 out of 1445 (10.6%) children were colonized by only ESBLs producers, and 99 out of 1445 (6.9%) children – by both ESBLs and carbapenemases producers. In dynamics, the number of ESBLs producers carriers decreased by 1.5 times (50 out of 448 – 11.2% and 37 out of 506 – 7.3% in 2020 and 2022, respectively). The number of K. pneumoniae producing both ESBLs and carbapenemases carriers increased by 4.9 times (11 out of 448 – 2.5% and 62 out ogf 506 – 12.3% in 2020 and 2022, respectively), in 2022 exceeding the proportion of only ESBLs producers carriers by 1.7 times. The molecular structure of carbapenemases was represented by OXA-48 carbapenemases (44 out of 99 – 44.5%), NDM metalloenzymes (35 out of 99 – 35.4%), OXA-48 and NDM combinations (13 out of 99 – 13.1%), KPC (3 out of 99 – 3%), NDM, KPC and OXA-48, NDM and KPC combinations: 3 out of 99 – 3% and 1 out of 99 – 1% of carriers, respectively. In dynamics, the number of isolates with the production of OXA-48 carbapenemases increased by 34.8% (from 18.2% to 53% in 2020 and 2022, respectively), NDM carbapenemases and co-producers of OXA-48, NDM decreased by 25.9% (from 54.5% to 28.6% in 2020 and 2022) and 19.1% (from 27.3% to 8.2% in 2020 and in 2022), respectively. In 2022, strains with the production of KPC carbapenemases and co-producers of carbapenemases of three classes (OXA-48, NDM and KPC) were identified for the first time. Conclusions. The data obtained indicate an increase in the frequency of initial colonization of patients with carbapenem-resistan
{"title":"Carriage of K. pneumoniae and molecular structure of produced carbapenemases in infants with congenital heart defects","authors":"Dmitriy A. Popov, R. A. Osokina, T. Yu. Vostrikova","doi":"10.36488/cmac.2023.2.202-210","DOIUrl":"https://doi.org/10.36488/cmac.2023.2.202-210","url":null,"abstract":"Objective. To evaluate frequency of pharyngeal and rectal mucosa colonization by K. pneumoniae strains in infants with congenital heart defects at the stage of cardiosurgical hospital admission, as well as dynamic analysis of production frequency and molecular structure of K. pneumoniae carbapenemases. Materials and Methods. A total of 1445 patients with risk factors (antibiotic therapy in the anamnesis, emergency hospitalization, transfer from other hospitals) admitted for surgical treatment of congenital heart defects (CHDs) between January 1, 2020 and December 31, 2022 were included in the retrospective analysis. Median age was 1.08 months (between 0 and 12 months). Smears from the pharyngeal and rectal mucosa (2890 samples) were taken for microbiological examination no later than 72 h after admission. The isolation of extended-spectrum beta-lactamases (ESBLs) and/or carbapenemases producing K. pneumoniae in the absence of symptomatic infection was considered as colonization. K. pneumoniae strains were considered as «problematic» in the absence of susceptibility to three or more groups of antimicrobials: the third- and fourth-generation cephalosporins, carbapenems, fluoroquinolones, aminoglycosides. The profile of antibiotic resistance, carbapenemases production and their molecular type were determined in the isolated strains. Results. K. pneumoniae carriage with «problematic» sensitivity was detected in 252 out of 1445 (17.4%) patients: 153 out of 1445 (10.6%) children were colonized by only ESBLs producers, and 99 out of 1445 (6.9%) children – by both ESBLs and carbapenemases producers. In dynamics, the number of ESBLs producers carriers decreased by 1.5 times (50 out of 448 – 11.2% and 37 out of 506 – 7.3% in 2020 and 2022, respectively). The number of K. pneumoniae producing both ESBLs and carbapenemases carriers increased by 4.9 times (11 out of 448 – 2.5% and 62 out ogf 506 – 12.3% in 2020 and 2022, respectively), in 2022 exceeding the proportion of only ESBLs producers carriers by 1.7 times. The molecular structure of carbapenemases was represented by OXA-48 carbapenemases (44 out of 99 – 44.5%), NDM metalloenzymes (35 out of 99 – 35.4%), OXA-48 and NDM combinations (13 out of 99 – 13.1%), KPC (3 out of 99 – 3%), NDM, KPC and OXA-48, NDM and KPC combinations: 3 out of 99 – 3% and 1 out of 99 – 1% of carriers, respectively. In dynamics, the number of isolates with the production of OXA-48 carbapenemases increased by 34.8% (from 18.2% to 53% in 2020 and 2022, respectively), NDM carbapenemases and co-producers of OXA-48, NDM decreased by 25.9% (from 54.5% to 28.6% in 2020 and 2022) and 19.1% (from 27.3% to 8.2% in 2020 and in 2022), respectively. In 2022, strains with the production of KPC carbapenemases and co-producers of carbapenemases of three classes (OXA-48, NDM and KPC) were identified for the first time. Conclusions. The data obtained indicate an increase in the frequency of initial colonization of patients with carbapenem-resistan","PeriodicalId":53392,"journal":{"name":"Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135495216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective. To analyze spontaneous reports (SRs) from the Russian database of adverse reactions (Automated information system «Pharmacovigilance» of Roszdravnadzor), containing information on fatal outcomes during ceftriaxone treatment, and to identify factors associated with an increased risk of death with ceftriaxone use. Materials and Methods. The study included 122 SRs concerning fatal cases during ceftriaxone therapy. All SRs were submitted to the Russian pharmacovigilance database from 06 May 2019 to 23 November 2022. A retrospective analysis of fatal adverse reactions cases in ceftriaxone treatment was carried out according to the following parameters: gender, age, drug intake and route of administration, clinical symptoms of anaphylaxis. Additionally, indications for the simultaneous use of drugs for local anesthesia as a solvent were evaluated. Results. A total of 86 SRs (70.5%) were primary and relevant for further analysis. 16 SRs (18.6%) were registered in the database for 8 months of 2019, 25 (29.1%) – for 2020, 15 (17.4%) – for 2021, for less than 11 months 2022 received 30 reports (34.9%). The number of adverse reactions reports in male and female patients was similar. Among the age groups, the largest number of SRs was observed in middleaged and elderly patients – 27 (31.4%) and 23 (26.7%) reports, respectively, 8 cases (9.3%) were registered in pediatric population. The development of fatal adverse reactions in the hospital was reported in 50 (58.1%) SRs, in outpatient setting – in 31 (36.1%) SRs. 18 SRs were identified with an indication of the patient’s self-treatment, which is 20.9% of all primary reports. Clinical symptoms of anaphylactic shock were noted in 63 reports (73.3%). Additional analysis of the combined use of ceftriaxone and local anesthetics cases revealed a range of medical errors. Conclusions. Ceftriaxone treatment was associated with a high risk of anaphylactic shock. The use of this antibiotic in outpatient setting, especially as self-treatment is an additional risk factor for death. Inappropriate use of local anesthetics in combination with ceftriaxone is an additional serious risk factor for fatal outcome.
{"title":"Analysis of fatal outcomes associated with ceftriaxone treatment from the Russian database of spontaneous reports","authors":"Daria L. Klabukova, A.R. Titova, I.S. Krysanov, V.A. Polivanov, V.S. Krysanova, V.Yu. Ermakova","doi":"10.36488/cmac.2023.2.159-164","DOIUrl":"https://doi.org/10.36488/cmac.2023.2.159-164","url":null,"abstract":"Objective. To analyze spontaneous reports (SRs) from the Russian database of adverse reactions (Automated information system «Pharmacovigilance» of Roszdravnadzor), containing information on fatal outcomes during ceftriaxone treatment, and to identify factors associated with an increased risk of death with ceftriaxone use. Materials and Methods. The study included 122 SRs concerning fatal cases during ceftriaxone therapy. All SRs were submitted to the Russian pharmacovigilance database from 06 May 2019 to 23 November 2022. A retrospective analysis of fatal adverse reactions cases in ceftriaxone treatment was carried out according to the following parameters: gender, age, drug intake and route of administration, clinical symptoms of anaphylaxis. Additionally, indications for the simultaneous use of drugs for local anesthesia as a solvent were evaluated. Results. A total of 86 SRs (70.5%) were primary and relevant for further analysis. 16 SRs (18.6%) were registered in the database for 8 months of 2019, 25 (29.1%) – for 2020, 15 (17.4%) – for 2021, for less than 11 months 2022 received 30 reports (34.9%). The number of adverse reactions reports in male and female patients was similar. Among the age groups, the largest number of SRs was observed in middleaged and elderly patients – 27 (31.4%) and 23 (26.7%) reports, respectively, 8 cases (9.3%) were registered in pediatric population. The development of fatal adverse reactions in the hospital was reported in 50 (58.1%) SRs, in outpatient setting – in 31 (36.1%) SRs. 18 SRs were identified with an indication of the patient’s self-treatment, which is 20.9% of all primary reports. Clinical symptoms of anaphylactic shock were noted in 63 reports (73.3%). Additional analysis of the combined use of ceftriaxone and local anesthetics cases revealed a range of medical errors. Conclusions. Ceftriaxone treatment was associated with a high risk of anaphylactic shock. The use of this antibiotic in outpatient setting, especially as self-treatment is an additional risk factor for death. Inappropriate use of local anesthetics in combination with ceftriaxone is an additional serious risk factor for fatal outcome.","PeriodicalId":53392,"journal":{"name":"Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135494542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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