Pub Date : 2022-01-01DOI: 10.36488/cmac.2022.1.47-51
O.S. Kozhushnaya, G. Solopova, M. I. Markelov, A.R. Oril, D. N. Balashov, L. Shelikhova, G. Novichkova
Objective. To perform genotyping of cytomegalovirus (CMV) phosphotransferase UL97 and investigate mutations associated with ganciclovir/valganciclovir (GCV/VGCV) resistance in children after allogeneic hematopoietic stem cell transplantation (HSCT) with confirmed CMV infection. Materials and Methods. This single-center prospective study was conducted from January 2020 to December 2021 and enrolled allogeneic HSCT recipients under 18 years of age with confirmed CMV infection. In case of possible GCV resistance, molecular genotyping with Sanger sequencing was performed. The search for mutations in the UL97 gene was carried out in the range of 425–670 codons. Results. Out of 168 patients with confirmed CMV infection, 72 patients met the criteria for possible resistance to GCV/VGCV. As a result of nucleotide sequencing of the CMV UL97 gene in 19 patients (11.3% of a total number of patients and 26.4% of patients meeting the resistance criteria) 11 genotypes of the following mutations were identified: H520Q, C592G, A594V, L595S, D605E, C603W, C607Y, C607F, M615V, M460V and E655K. The following mutations associated with resistance to HCV/VHCV: H520Q, C592G, A594V, L595S, C603W, C607Y, C607F, M460V were found in 12 patients (7% of a total number of patients and 9.7% of patients meeting the resistance criteria). Conclusions. Due to a high frequency of detection of the mutant form of phosphotransferase UL97 in allogeneic HSCT recipients with confirmed CMV infection, it is important to implement monitoring of resistant-associated mutations in order to administer appropriate antiviral therapy.
{"title":"Monitoring of resistanceassociated mutations in UL97 gene of cytomegalovirus in children after allogeneic hematopoietic stem cell transplantation","authors":"O.S. Kozhushnaya, G. Solopova, M. I. Markelov, A.R. Oril, D. N. Balashov, L. Shelikhova, G. Novichkova","doi":"10.36488/cmac.2022.1.47-51","DOIUrl":"https://doi.org/10.36488/cmac.2022.1.47-51","url":null,"abstract":"Objective. To perform genotyping of cytomegalovirus (CMV) phosphotransferase UL97 and investigate mutations associated with ganciclovir/valganciclovir (GCV/VGCV) resistance in children after allogeneic hematopoietic stem cell transplantation (HSCT) with confirmed CMV infection. Materials and Methods. This single-center prospective study was conducted from January 2020 to December 2021 and enrolled allogeneic HSCT recipients under 18 years of age with confirmed CMV infection. In case of possible GCV resistance, molecular genotyping with Sanger sequencing was performed. The search for mutations in the UL97 gene was carried out in the range of 425–670 codons. Results. Out of 168 patients with confirmed CMV infection, 72 patients met the criteria for possible resistance to GCV/VGCV. As a result of nucleotide sequencing of the CMV UL97 gene in 19 patients (11.3% of a total number of patients and 26.4% of patients meeting the resistance criteria) 11 genotypes of the following mutations were identified: H520Q, C592G, A594V, L595S, D605E, C603W, C607Y, C607F, M615V, M460V and E655K. The following mutations associated with resistance to HCV/VHCV: H520Q, C592G, A594V, L595S, C603W, C607Y, C607F, M460V were found in 12 patients (7% of a total number of patients and 9.7% of patients meeting the resistance criteria). Conclusions. Due to a high frequency of detection of the mutant form of phosphotransferase UL97 in allogeneic HSCT recipients with confirmed CMV infection, it is important to implement monitoring of resistant-associated mutations in order to administer appropriate antiviral therapy.","PeriodicalId":53392,"journal":{"name":"Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69623777","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 : 2022-01-01DOI: 10.36488/cmac.2022.2.139-146
D. Popov, T.Yu. Votrikova, T. Rogova, A.S. Magandalieva, M.A Kerefova
Objective. To determine resistant microorganisms carriage, the frequency and etiology of postoperative infectious complications in high-risk infants with congenital heart defects (CHD). Materials and Methods. The retrospective analysis included 489 patients admitted for surgical treatment for CHD. The median age was 0.23 (0–12) months. Swabs were taken from the oropharynx and rectum for microbiological examination no later than 72 hours after admission (a total of 978 samples). The growth of resistant microorganisms (ESBL and/or carbapenemase-producing Enterobacterales, resistant non-fermentative Gram-negative bacteria, MRSA and VRE) was recorded. Results. Of 489 patients, 128 (26.2%) were colonized with resistant bacteria. The majority of patients were carriers of ESBL-producers (81.3%), in some cases (24%) with concomitant production of several carbapenemases. The rate of VRE carriage was 21.1%, in 8 cases – in combination with other resistant microorganisms. MRSA was detected in 1.6% of carriers, other multidrug-resistant microorganisms – in 3.9% of carriers. In early postoperative period, 145⁄489 (29.7%) patients developed infectious complications. The ventilator-associated respiratory tract infections were the most common. In most cases (73.8%) infectious complications were caused by ESBL producers, in 43.9% of cases those microorganisms also produced carbapenemases. Resistant non-fermentative Gram-negative bacteria caused postoperative infections in 4.8% of cases. The rates of MRSA and VRE in infants with infectious complications were 3.4% and 1.4%, respectively. There were no differences in the incidence of infectious complications in colonized and non-colonized patients – 42⁄128 (32.8%) versus 103⁄361 (28.5%), respectively (p = 0.6). Postoperative infectious complications were caused by resistant microorganisms in colonized patients significantly more often than in non-colonized patients – 41⁄42 (97.6%) and 82⁄103 (79.6%) cases, respectively (p = 0.008). Conclusions. It is confirmed the active process of the introduction of resistant microorganisms into the hospital with the possible development of complications of the corresponding etiology. Gram-negative bacteria with different mechanisms of antibiotic resistance present the greatest problem. In order to manage this process, it is advisable to screen hospitalizing patients with the implementation of the infection control measures.
{"title":"Carriage of antibiotic-resistant bacteria and etiology of postoperative infectious complications in infants with congenital heart defects","authors":"D. Popov, T.Yu. Votrikova, T. Rogova, A.S. Magandalieva, M.A Kerefova","doi":"10.36488/cmac.2022.2.139-146","DOIUrl":"https://doi.org/10.36488/cmac.2022.2.139-146","url":null,"abstract":"Objective. To determine resistant microorganisms carriage, the frequency and etiology of postoperative infectious complications in high-risk infants with congenital heart defects (CHD). Materials and Methods. The retrospective analysis included 489 patients admitted for surgical treatment for CHD. The median age was 0.23 (0–12) months. Swabs were taken from the oropharynx and rectum for microbiological examination no later than 72 hours after admission (a total of 978 samples). The growth of resistant microorganisms (ESBL and/or carbapenemase-producing Enterobacterales, resistant non-fermentative Gram-negative bacteria, MRSA and VRE) was recorded. Results. Of 489 patients, 128 (26.2%) were colonized with resistant bacteria. The majority of patients were carriers of ESBL-producers (81.3%), in some cases (24%) with concomitant production of several carbapenemases. The rate of VRE carriage was 21.1%, in 8 cases – in combination with other resistant microorganisms. MRSA was detected in 1.6% of carriers, other multidrug-resistant microorganisms – in 3.9% of carriers. In early postoperative period, 145⁄489 (29.7%) patients developed infectious complications. The ventilator-associated respiratory tract infections were the most common. In most cases (73.8%) infectious complications were caused by ESBL producers, in 43.9% of cases those microorganisms also produced carbapenemases. Resistant non-fermentative Gram-negative bacteria caused postoperative infections in 4.8% of cases. The rates of MRSA and VRE in infants with infectious complications were 3.4% and 1.4%, respectively. There were no differences in the incidence of infectious complications in colonized and non-colonized patients – 42⁄128 (32.8%) versus 103⁄361 (28.5%), respectively (p = 0.6). Postoperative infectious complications were caused by resistant microorganisms in colonized patients significantly more often than in non-colonized patients – 41⁄42 (97.6%) and 82⁄103 (79.6%) cases, respectively (p = 0.008). Conclusions. It is confirmed the active process of the introduction of resistant microorganisms into the hospital with the possible development of complications of the corresponding etiology. Gram-negative bacteria with different mechanisms of antibiotic resistance present the greatest problem. In order to manage this process, it is advisable to screen hospitalizing patients with the implementation of the infection control measures.","PeriodicalId":53392,"journal":{"name":"Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69623992","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 : 2022-01-01DOI: 10.36488/cmac.2022.4.361-367
V. R. Shashmurina, A. I. Nikolaev, O. A. Vasiltsova, M.V. Dmitriev, E. Gladarevskaya, A. Shashmurina, S.M. Tyurin
Objective. To assess practicing dentists who treat patients conservatively attitude to antibiotic therapy in general, the degree of awareness of the rules for prescribing antibiotics, approaches to prescribing antibiotics for various dental diseases and therapeutic and preventive manipulations. Materials and Methods. The questionnaire was developed and an anonymous survey-questionnaire of 173 practical dentists conducting therapeutic reception of patients was carried out. The questionnaire included a list of diseases, therapeutic and prophylactic manipulations in which respondents consider the use of antibiotics indicated and questions to assess the respondents’ awareness of modern methods of antibiotic therapy and their views on the rules for prescribing antibiotics. Results. A statistical analysis showed that antibiotics using is considered inappropriate: in the conservative treatment of pulpitis after root canal filling (83.2%), during the conservative treatment of chronic apical periodontitis (66.5%, 95% CI: 59,4-73,5%), in patients with chronic catarrhal gingivitis (69.4%, 95% CI: 62,5-76,2%), in patients with chronic generalized periodontitis mild degree (without exacerbation) (75.1%, 95% CI: 68,7-81,6%), during professional cleaning of teeth (75.1%, 95% CI: 68,7-81,6%). The use of antibiotics is considered obligatory: in the treatment of acute apical periodontitis/exacerbation of chronic periodontitis (with suppuration from root canals) – 37.0% of respondents (95% CI: 29,8-44,2%); ulcerative necrotic gingivitis – 50.3% (95% CI: 42,8-57,7%), with chronic generalized periodontitis in the acute stage – 71.1% (95% DI: 64,3-77,9%), with professional cleaning of teeth in patients with concomitant pathology – 38.2% (95% DI: 30.9-45.4%) Conclusions. Insufficient awareness of practical dentists, leading the conservative reception of patients, about modern methods of antibiotic therapy was revealed. The problems of the current dentistry situation are identified under such conditions of legally approved standards of care and clinical recommendations absence, as well as absence of organizational opportunities to conduct tests to determinate the sensitivity of microflora to antimicrobial drugs before prescribing antibiotics in outpatient dentistry are identified.
{"title":"Attitude to antibiotic therapy in dentists conducting therapeutic treatment of patients","authors":"V. R. Shashmurina, A. I. Nikolaev, O. A. Vasiltsova, M.V. Dmitriev, E. Gladarevskaya, A. Shashmurina, S.M. Tyurin","doi":"10.36488/cmac.2022.4.361-367","DOIUrl":"https://doi.org/10.36488/cmac.2022.4.361-367","url":null,"abstract":"Objective. To assess practicing dentists who treat patients conservatively attitude to antibiotic therapy in general, the degree of awareness of the rules for prescribing antibiotics, approaches to prescribing antibiotics for various dental diseases and therapeutic and preventive manipulations. Materials and Methods. The questionnaire was developed and an anonymous survey-questionnaire of 173 practical dentists conducting therapeutic reception of patients was carried out. The questionnaire included a list of diseases, therapeutic and prophylactic manipulations in which respondents consider the use of antibiotics indicated and questions to assess the respondents’ awareness of modern methods of antibiotic therapy and their views on the rules for prescribing antibiotics. Results. A statistical analysis showed that antibiotics using is considered inappropriate: in the conservative treatment of pulpitis after root canal filling (83.2%), during the conservative treatment of chronic apical periodontitis (66.5%, 95% CI: 59,4-73,5%), in patients with chronic catarrhal gingivitis (69.4%, 95% CI: 62,5-76,2%), in patients with chronic generalized periodontitis mild degree (without exacerbation) (75.1%, 95% CI: 68,7-81,6%), during professional cleaning of teeth (75.1%, 95% CI: 68,7-81,6%). The use of antibiotics is considered obligatory: in the treatment of acute apical periodontitis/exacerbation of chronic periodontitis (with suppuration from root canals) – 37.0% of respondents (95% CI: 29,8-44,2%); ulcerative necrotic gingivitis – 50.3% (95% CI: 42,8-57,7%), with chronic generalized periodontitis in the acute stage – 71.1% (95% DI: 64,3-77,9%), with professional cleaning of teeth in patients with concomitant pathology – 38.2% (95% DI: 30.9-45.4%) Conclusions. Insufficient awareness of practical dentists, leading the conservative reception of patients, about modern methods of antibiotic therapy was revealed. The problems of the current dentistry situation are identified under such conditions of legally approved standards of care and clinical recommendations absence, as well as absence of organizational opportunities to conduct tests to determinate the sensitivity of microflora to antimicrobial drugs before prescribing antibiotics in outpatient dentistry are identified.","PeriodicalId":53392,"journal":{"name":"Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69624612","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 : 2022-01-01DOI: 10.36488/cmac.2022.3.220-225
I. Zakharenkov, S. Rachina, R. Kozlov, Y. Belkova
Objective. To assess level and the structure of systemic antibiotic consumption in Russia over the period 2017 to 2021. Materials and Methods. Data were collected and analysed in compliance with the standard protocol of the World Health Organization Regional Office for Europe by the means of ATC/DDD methodology for J01 group – antibacterials for systemic use. Consumption was calculated for outpatients and inpatients separately as a number of DDDs per 1000 inhabitants per day (DID) for the main classes of antibiotics and the agents with the highest or the most diverse consumption levels for the given period of time, and was based on the data of wholesale purchases and public tenders. Results. Antibiotic consumption in Russia in 2017, 2018, 2019, 2020, and 2021 was 16.6 DID, 14.3 DID, 14.8 DID, 19 DID, and 15.7 DID respectively. Penicillins, macrolides and lincosamides, and quinolones had the highest levels of consumption in outpatients. Prominent increase in outpatient consumption of antibacterials in 2020 was related to three agents: azithromycin, levofloxacin and ceftriaxone. Cephalosporins (mainly III–V generations), quinolones and penicillins had the highest levels of consumption in inpatients. Hospital consumption of meropenem, tigecycline, and vancomycin increased and amikacin and ciprofloxacin decreased over the duration of the study. Conclusions. Levels of systemic antibiotic consumption in Russia for the period 2017 to 2019 were relatively low and consistent with the average means for European Union and European Economic Area countries. The steep increase in consumption in 2020 was probably due to the wide use of antibiotics for the management of COVID-19 patients. The results of the study can be of value for the development of targeted national antibiotic stewardship programs and awareness campaigns as well as for the analysis of trends of emergence and spread of antibiotic resistance.
{"title":"Consumption of systemic antibiotics in the Russian Federation in 2017–2021","authors":"I. Zakharenkov, S. Rachina, R. Kozlov, Y. Belkova","doi":"10.36488/cmac.2022.3.220-225","DOIUrl":"https://doi.org/10.36488/cmac.2022.3.220-225","url":null,"abstract":"Objective. To assess level and the structure of systemic antibiotic consumption in Russia over the period 2017 to 2021. Materials and Methods. Data were collected and analysed in compliance with the standard protocol of the World Health Organization Regional Office for Europe by the means of ATC/DDD methodology for J01 group – antibacterials for systemic use. Consumption was calculated for outpatients and inpatients separately as a number of DDDs per 1000 inhabitants per day (DID) for the main classes of antibiotics and the agents with the highest or the most diverse consumption levels for the given period of time, and was based on the data of wholesale purchases and public tenders. Results. Antibiotic consumption in Russia in 2017, 2018, 2019, 2020, and 2021 was 16.6 DID, 14.3 DID, 14.8 DID, 19 DID, and 15.7 DID respectively. Penicillins, macrolides and lincosamides, and quinolones had the highest levels of consumption in outpatients. Prominent increase in outpatient consumption of antibacterials in 2020 was related to three agents: azithromycin, levofloxacin and ceftriaxone. Cephalosporins (mainly III–V generations), quinolones and penicillins had the highest levels of consumption in inpatients. Hospital consumption of meropenem, tigecycline, and vancomycin increased and amikacin and ciprofloxacin decreased over the duration of the study. Conclusions. Levels of systemic antibiotic consumption in Russia for the period 2017 to 2019 were relatively low and consistent with the average means for European Union and European Economic Area countries. The steep increase in consumption in 2020 was probably due to the wide use of antibiotics for the management of COVID-19 patients. The results of the study can be of value for the development of targeted national antibiotic stewardship programs and awareness campaigns as well as for the analysis of trends of emergence and spread of antibiotic resistance.","PeriodicalId":53392,"journal":{"name":"Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69624190","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 : 2022-01-01DOI: 10.36488/cmac.2022.2.147-154
T. Umpeleva, M. Shulgina, D. Vakhrusheva, N. Eremeeva
Objective. To assess minimal inhibitory concentrations (MICs) of antimicrobials for Mycobacterium avium complex (MAC) mycobacteria isolated from patients in Ural Federal District of the Russian Federation. Materials and Methods. We determined MICs for 33 M. avium and 34 M. intracellulare strains isolated from 67 patients with mycobacteriosis or tuberculosis/mycobacteriosis co-infection during 2018– 2019. SLOMYCO Sensititre test-system was used for susceptibility testing to 12 antibiotics: amikacin, streptomycin, clarithromycin, ethambutol, rifabutin, rifampicin, ciprofloxacin, ethionamide, isoniazid, linezolid, moxifloxacin, and doxycycline. Mycobacteria isolates were categorized according to their MICs as “susceptible”, “susceptible with increased exposure to the drug”, and “resistant” using CLSI breakpoints (2018). Breakpoints for amikacin, clarithromycin, linezolid and moxifloxacin were available for M. avium complex, for ciprofloxacin, doxycycline, rifabutin, rifampicin – for slow growing nontuberculous mycobacteria other than MAC mycobacteria. Breakpoints for ethambutol, isoniazid, streptomycin and ethionamide were not available. Results. Rates of susceptibility of M. avium and M. intracellulare were: amikacin – 96.9% and 97.0%, clarithromycin – 84.8% and 97.1%, linezolid – 9.1% and 23.5%, moxifloxacin – 57.6% and 38.2%, respectively. Majority of M. avium and M. intracellulare isolates were resistant to ciprofloxacin, doxycycline, and rifampicin. Ethambutol MICs for 84.4% of M. avium and for 67.7% of M. intracellulare isolates were > 8 mg/L. The majority of studied isolates (64.2%) were susceptible to at least three antimicrobials for the treatment of infections caused by MAC mycobacteria. Conclusions. Macrolides and aminoglycosides were the most effective against MAC mycobacteria in our study. Use of macrolides in combination with rifabutin and amikacin or moxifloxacin and amikacin may increase treatment efficacy in infections caused by M. avium and M. intracellulare.
{"title":"Antimicrobial susceptibility of Mycobacterium avium complex mycobacteria isolated from patients in Ural Federal District of the Russian Federation","authors":"T. Umpeleva, M. Shulgina, D. Vakhrusheva, N. Eremeeva","doi":"10.36488/cmac.2022.2.147-154","DOIUrl":"https://doi.org/10.36488/cmac.2022.2.147-154","url":null,"abstract":"Objective. To assess minimal inhibitory concentrations (MICs) of antimicrobials for Mycobacterium avium complex (MAC) mycobacteria isolated from patients in Ural Federal District of the Russian Federation. Materials and Methods. We determined MICs for 33 M. avium and 34 M. intracellulare strains isolated from 67 patients with mycobacteriosis or tuberculosis/mycobacteriosis co-infection during 2018– 2019. SLOMYCO Sensititre test-system was used for susceptibility testing to 12 antibiotics: amikacin, streptomycin, clarithromycin, ethambutol, rifabutin, rifampicin, ciprofloxacin, ethionamide, isoniazid, linezolid, moxifloxacin, and doxycycline. Mycobacteria isolates were categorized according to their MICs as “susceptible”, “susceptible with increased exposure to the drug”, and “resistant” using CLSI breakpoints (2018). Breakpoints for amikacin, clarithromycin, linezolid and moxifloxacin were available for M. avium complex, for ciprofloxacin, doxycycline, rifabutin, rifampicin – for slow growing nontuberculous mycobacteria other than MAC mycobacteria. Breakpoints for ethambutol, isoniazid, streptomycin and ethionamide were not available. Results. Rates of susceptibility of M. avium and M. intracellulare were: amikacin – 96.9% and 97.0%, clarithromycin – 84.8% and 97.1%, linezolid – 9.1% and 23.5%, moxifloxacin – 57.6% and 38.2%, respectively. Majority of M. avium and M. intracellulare isolates were resistant to ciprofloxacin, doxycycline, and rifampicin. Ethambutol MICs for 84.4% of M. avium and for 67.7% of M. intracellulare isolates were > 8 mg/L. The majority of studied isolates (64.2%) were susceptible to at least three antimicrobials for the treatment of infections caused by MAC mycobacteria. Conclusions. Macrolides and aminoglycosides were the most effective against MAC mycobacteria in our study. Use of macrolides in combination with rifabutin and amikacin or moxifloxacin and amikacin may increase treatment efficacy in infections caused by M. avium and M. intracellulare.","PeriodicalId":53392,"journal":{"name":"Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69624290","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 : 2022-01-01DOI: 10.36488/cmac.2022.2.165-170
A. Kozlov, A. Lyamin, A. V. Zhestkov, O. Gusyakova, A. Khaliulin
Infectious complications in the respiratory tract caused by microorganisms from the Burkholderia cepacia complex are the main cause of death among patients with cystic fibrosis. Natural and acquired resistance mechanisms allow Burkholderia cepacia complex pathogens to adapt to the conditions of regular antibiotic therapy, which necessitates the use of antibacterial drugs with an alternative mechanism of action. Studies on the importance of iron as an essential factor in the metabolism of bacteria and methods of its acquisition from the environment contributed to the development of a new antibiotic from a number of cephalosporins – cefiderocol. In the structure of cefiderocol, a fragment is formed that imitates siderophores – chelating molecules that ensure the transport of iron ions into the internal environment of the microorganism. A unique mechanism, described in the scientific literature as a “Trojan horse”, allows antibiotic molecules conjugated with siderophores to effectively penetrate into the bacterial cell, exerting a bactericidal effect. Thus, cefiderocol can be used to treat infectious complications in the lungs of patients with cystic fibrosis caused by bacteria from the Burkholderia cepacia complex, including multidrug-resistant strains. In addition, the spectrum of activity of cefiderocol allows the use of this antibiotic in the treatment of infections caused by nosocomial gram-negative bacteria such as Enterobacterales, Acinetobacter, Pseudomonas and Stenotrophomonas.
{"title":"Iron metabolism in bacterial cells: from physiological significance to a new class of antimicrobial agents","authors":"A. Kozlov, A. Lyamin, A. V. Zhestkov, O. Gusyakova, A. Khaliulin","doi":"10.36488/cmac.2022.2.165-170","DOIUrl":"https://doi.org/10.36488/cmac.2022.2.165-170","url":null,"abstract":"Infectious complications in the respiratory tract caused by microorganisms from the Burkholderia cepacia complex are the main cause of death among patients with cystic fibrosis. Natural and acquired resistance mechanisms allow Burkholderia cepacia complex pathogens to adapt to the conditions of regular antibiotic therapy, which necessitates the use of antibacterial drugs with an alternative mechanism of action. Studies on the importance of iron as an essential factor in the metabolism of bacteria and methods of its acquisition from the environment contributed to the development of a new antibiotic from a number of cephalosporins – cefiderocol. In the structure of cefiderocol, a fragment is formed that imitates siderophores – chelating molecules that ensure the transport of iron ions into the internal environment of the microorganism. A unique mechanism, described in the scientific literature as a “Trojan horse”, allows antibiotic molecules conjugated with siderophores to effectively penetrate into the bacterial cell, exerting a bactericidal effect. Thus, cefiderocol can be used to treat infectious complications in the lungs of patients with cystic fibrosis caused by bacteria from the Burkholderia cepacia complex, including multidrug-resistant strains. In addition, the spectrum of activity of cefiderocol allows the use of this antibiotic in the treatment of infections caused by nosocomial gram-negative bacteria such as Enterobacterales, Acinetobacter, Pseudomonas and Stenotrophomonas.","PeriodicalId":53392,"journal":{"name":"Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69624502","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 : 2022-01-01DOI: 10.36488/cmac.2022.1.39-46
L. Petrova, A. Kuzmenkov, D. Kamyshova, A. G. Vinogradova, V. Gusarov, M. Zamyatin
Objective. To create local antibiotic resistance surveillance system using the AMRcloud online platform to provide evidence base for activity of antimicrobials (AM) and antimicrobial resistance (AMR) epidemiology. Materials and Methods. This study was conducted at the Pirogov National Medical and Surgical Center (Moscow, Russia). The study is prospective, with two evaluations of the local AMR surveillance system (before and after the implementation of the AMRcloud online platform). Separately, the effects of implementing the AMRcloud platform were evaluated and the most frequent scenarios of using this system in hospital were studied. Results. With the help of the AMRcloud platform, which acts as one of the central links in the AMR surveillance process, a local AMR surveillance system was formed, providing continuity of historical data and evidence base on local AMR epidemiology with real-time access and bringing together specialists of various profiles. Conclusions. Implementation of the AMRcloud online platform into multidisciplinary hospital operations enables the creation of a local evidence base on AM activity and AMR epidemiology, as well as reducing the labor costs of several crucial stages of AMR surveillance – data storage, analysis and exchange.
{"title":"Experience in implementing the AMRcloud online platform for local antimicrobial resistance surveillance in a tertiary care hospital","authors":"L. Petrova, A. Kuzmenkov, D. Kamyshova, A. G. Vinogradova, V. Gusarov, M. Zamyatin","doi":"10.36488/cmac.2022.1.39-46","DOIUrl":"https://doi.org/10.36488/cmac.2022.1.39-46","url":null,"abstract":"Objective. To create local antibiotic resistance surveillance system using the AMRcloud online platform to provide evidence base for activity of antimicrobials (AM) and antimicrobial resistance (AMR) epidemiology. Materials and Methods. This study was conducted at the Pirogov National Medical and Surgical Center (Moscow, Russia). The study is prospective, with two evaluations of the local AMR surveillance system (before and after the implementation of the AMRcloud online platform). Separately, the effects of implementing the AMRcloud platform were evaluated and the most frequent scenarios of using this system in hospital were studied. Results. With the help of the AMRcloud platform, which acts as one of the central links in the AMR surveillance process, a local AMR surveillance system was formed, providing continuity of historical data and evidence base on local AMR epidemiology with real-time access and bringing together specialists of various profiles. Conclusions. Implementation of the AMRcloud online platform into multidisciplinary hospital operations enables the creation of a local evidence base on AM activity and AMR epidemiology, as well as reducing the labor costs of several crucial stages of AMR surveillance – data storage, analysis and exchange.","PeriodicalId":53392,"journal":{"name":"Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69623762","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 : 2022-01-01DOI: 10.36488/cmac.2022.4.295-302
O. Shadrivova, S. Rachina, D. Strelkova, K.A. Panchishina, D. Gusev, M. Vashukova, S. G. Meshchaninova, A. Zavrazhnov, M. Mitichkin, A. G. Mamonov, S. Khostelidi, O. Kozlova, V. Gusarov, M. Zamyatin, N. V. Lovtsevich, V.G. Kuleshov, E. Shagdileeva, É. Oganesyan, E. Desyatik, Y. Borzova, S. Ignatyeva, N. Vasilieva, N. Klimko
Objective. To study risk factors, clinical and radiological features and effectiveness of the treatment of invasive aspergillosis (IA) in adult patients with COVID-19 (COVID-IA) in intensive care units (ICU). Materials and Methods. A total of 60 patients with COVID-IA treated in ICU (median age 62 years, male – 58%) were included in this multicenter prospective study. The comparison group included 34 patients with COVID-IA outside the ICU (median age 62 years, male – 68%). ECMM/ISHAM 2020 criteria were used for diagnosis of CAPA, and EORTC/MSGERC 2020 criteria were used for evaluation of the treatment efficacy. A case-control study (one patient of the main group per two patients of the control group) was conducted to study risk factors for the development and features of CAPA. The control group included 120 adult COVID-19 patients without IA in the ICU, similar in demographic characteristics and background conditions. The median age of patients in the control group was 63 years, male – 67%. Results. 64% of patients with COVID-IA stayed in the ICU. Risk factors for the COVID-IA development in the ICU: chronic obstructive pulmonary disease (OR = 3.538 [1.104–11.337], p = 0.02), and prolonged (> 10 days) lymphopenia (OR = 8.770 [4.177–18.415], p = 0.00001). The main location of COVID-IA in the ICU was lungs (98%). Typical clinical signs were fever (97%), cough (92%), severe respiratory failure (72%), ARDS (64%) and haemoptysis (23%). Typical CT features were areas of consolidation (97%), hydrothorax (63%), and foci of destruction (53%). The effective methods of laboratory diagnosis of COVID-IA were test for galactomannan in BAL (62%), culture (33%) and microscopy (22%) of BAL. The main causative agents of COVID-IA are A. fumigatus (61%), A. niger (26%) and A. flavus (4%). The overall 12-week survival rate of patients with COVID-IA in the ICU was 42%, negative predictive factors were severe respiratory failure (27.5% vs 81%, p = 0.003), ARDS (14% vs 69%, p = 0.001), mechanical ventilation (25% vs 60%, p = 0.01), and foci of destruction in the lung tissue on CT scan (23% vs 59%, p = 0.01). Conclusions. IA affects predominantly ICU patients with COVID-19 who have concomitant medical conditions, such as diabetes mellitus, hematological malignancies, cancer, and COPD. Risk factors for COVID-IA in ICU patients are prolonged lymphopenia and COPD. The majority of patients with COVID-IA have their lungs affected, but clinical signs of IA are non-specific (fever, cough, progressive respiratory failure). The overall 12-week survival in ICU patients with COVID-IA is low. Prognostic factors of poor outcome in adult ICU patients are severe respiratory failure, ARDS, mechanical ventilation as well as CT signs of lung tissue destruction.
目标。探讨重症监护病房(ICU)成人COVID-19 (COVID-IA)患者侵袭性曲霉病(IA)的危险因素、临床和影像学特征及治疗效果。材料与方法。这项多中心前瞻性研究共纳入60例在ICU接受治疗的COVID-IA患者(中位年龄62岁，男性占58%)。对照组包括34例ICU外的COVID-IA患者(中位年龄62岁，男性68%)。采用ECMM/ISHAM 2020标准诊断CAPA，采用EORTC/MSGERC 2020标准评价治疗效果。采用病例对照研究(主组1例，对照组2例)研究CAPA发生的危险因素及特点。对照组为120例无IA的ICU成年COVID-19患者，人口学特征和背景条件相似。对照组患者中位年龄为63岁，男性占67%。64%的新冠肺炎患者留在ICU。慢性阻塞性肺疾病(OR = 3.538 [1.104-11.337]， p = 0.02)、淋巴细胞减少(OR = 8.770 [4.177-18.415]， p = 0.00001)是ICU发生新冠肺炎的危险因素。重症监护病房新冠病毒感染部位以肺部为主(98%)。典型临床症状为发热(97%)、咳嗽(92%)、严重呼吸衰竭(72%)、急性呼吸窘迫综合征(ARDS)(64%)和咯血(23%)。典型的CT表现为实变区(97%)、胸水(63%)和破坏灶(53%)。实验室诊断COVID-IA的有效方法是BAL中半乳甘露聚糖检测(62%)、BAL培养(33%)和镜检(22%)。新冠肺炎的主要病原体为烟曲霉(61%)、黑曲霉(26%)和黄曲霉(4%)。COVID-IA患者在ICU的总12周生存率为42%，阴性预测因素为严重呼吸衰竭(27.5% vs 81%， p = 0.003)、ARDS (14% vs 69%， p = 0.001)、机械通气(25% vs 60%， p = 0.01)、CT扫描肺组织病灶破坏(23% vs 59%， p = 0.01)。IA主要影响患有合并疾病的COVID-19 ICU患者，如糖尿病、血液系统恶性肿瘤、癌症和慢性阻塞性肺病。ICU患者发生新冠肺炎的危险因素为长期淋巴细胞减少和慢性阻塞性肺病。大多数COVID-IA患者的肺部受到影响，但IA的临床症状是非特异性的(发烧、咳嗽、进行性呼吸衰竭)。COVID-IA ICU患者的总12周生存率较低。严重呼吸衰竭、ARDS、机械通气以及肺组织破坏的CT征象是成人ICU患者预后不良的影响因素。
{"title":"Invasive aspergillosis in patients with COVID-19 in intensive care units: results of a multicenter study","authors":"O. Shadrivova, S. Rachina, D. Strelkova, K.A. Panchishina, D. Gusev, M. Vashukova, S. G. Meshchaninova, A. Zavrazhnov, M. Mitichkin, A. G. Mamonov, S. Khostelidi, O. Kozlova, V. Gusarov, M. Zamyatin, N. V. Lovtsevich, V.G. Kuleshov, E. Shagdileeva, É. Oganesyan, E. Desyatik, Y. Borzova, S. Ignatyeva, N. Vasilieva, N. Klimko","doi":"10.36488/cmac.2022.4.295-302","DOIUrl":"https://doi.org/10.36488/cmac.2022.4.295-302","url":null,"abstract":"Objective. To study risk factors, clinical and radiological features and effectiveness of the treatment of invasive aspergillosis (IA) in adult patients with COVID-19 (COVID-IA) in intensive care units (ICU). Materials and Methods. A total of 60 patients with COVID-IA treated in ICU (median age 62 years, male – 58%) were included in this multicenter prospective study. The comparison group included 34 patients with COVID-IA outside the ICU (median age 62 years, male – 68%). ECMM/ISHAM 2020 criteria were used for diagnosis of CAPA, and EORTC/MSGERC 2020 criteria were used for evaluation of the treatment efficacy. A case-control study (one patient of the main group per two patients of the control group) was conducted to study risk factors for the development and features of CAPA. The control group included 120 adult COVID-19 patients without IA in the ICU, similar in demographic characteristics and background conditions. The median age of patients in the control group was 63 years, male – 67%. Results. 64% of patients with COVID-IA stayed in the ICU. Risk factors for the COVID-IA development in the ICU: chronic obstructive pulmonary disease (OR = 3.538 [1.104–11.337], p = 0.02), and prolonged (> 10 days) lymphopenia (OR = 8.770 [4.177–18.415], p = 0.00001). The main location of COVID-IA in the ICU was lungs (98%). Typical clinical signs were fever (97%), cough (92%), severe respiratory failure (72%), ARDS (64%) and haemoptysis (23%). Typical CT features were areas of consolidation (97%), hydrothorax (63%), and foci of destruction (53%). The effective methods of laboratory diagnosis of COVID-IA were test for galactomannan in BAL (62%), culture (33%) and microscopy (22%) of BAL. The main causative agents of COVID-IA are A. fumigatus (61%), A. niger (26%) and A. flavus (4%). The overall 12-week survival rate of patients with COVID-IA in the ICU was 42%, negative predictive factors were severe respiratory failure (27.5% vs 81%, p = 0.003), ARDS (14% vs 69%, p = 0.001), mechanical ventilation (25% vs 60%, p = 0.01), and foci of destruction in the lung tissue on CT scan (23% vs 59%, p = 0.01). Conclusions. IA affects predominantly ICU patients with COVID-19 who have concomitant medical conditions, such as diabetes mellitus, hematological malignancies, cancer, and COPD. Risk factors for COVID-IA in ICU patients are prolonged lymphopenia and COPD. The majority of patients with COVID-IA have their lungs affected, but clinical signs of IA are non-specific (fever, cough, progressive respiratory failure). The overall 12-week survival in ICU patients with COVID-IA is low. Prognostic factors of poor outcome in adult ICU patients are severe respiratory failure, ARDS, mechanical ventilation as well as CT signs of lung tissue destruction.","PeriodicalId":53392,"journal":{"name":"Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69624527","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 : 2022-01-01DOI: 10.36488/cmac.2022.4.345-360
V. Andreev, O. Stetsiouk, I. Andreeva
Recent studies have strongly confirmed the health benefits of a variety of probiotic microorganisms. However, some issues regarding the use of probiotics currently remain unresolved or ambiguous. This article highlights some controversial issues of probiotic use in clinical practice such as regulatory status of probiotics, co-administration of probiotics and antibiotics, potential impact of probiotics on antimicrobial resistance emergence and spread, dosing and duration of probiotic use, contraindications and some other debatable topics.
{"title":"Probiotics: controversial issues","authors":"V. Andreev, O. Stetsiouk, I. Andreeva","doi":"10.36488/cmac.2022.4.345-360","DOIUrl":"https://doi.org/10.36488/cmac.2022.4.345-360","url":null,"abstract":"Recent studies have strongly confirmed the health benefits of a variety of probiotic microorganisms. However, some issues regarding the use of probiotics currently remain unresolved or ambiguous. This article highlights some controversial issues of probiotic use in clinical practice such as regulatory status of probiotics, co-administration of probiotics and antibiotics, potential impact of probiotics on antimicrobial resistance emergence and spread, dosing and duration of probiotic use, contraindications and some other debatable topics.","PeriodicalId":53392,"journal":{"name":"Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69624601","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 : 2021-01-01DOI: 10.36488/cmac.2021.1.66-91
A. V. Zhestkov, A. Lyamin, D. Ismatullin, A. Martinovich, E. V. Haykina
Non-tuberculous mycobacteria (NTM) include more than 190 species and subspecies. Some NTM species can cause human diseases of the lungs or extrapulmonary infections. The guidelines focus on pulmonary mycobacteriosis in adult patients without cystic fibrosis or HIV infection caused by the most common NTMs, such as Mycobacterium avium complex, Mycobacterium kansasii, and Mycobacterium xenopi among slow-growing NTMs and Mycobacterium abscessus complex among fast-growing species. Experts of American Thoracic Society (ATS), European Respiratory Society (ERS), European Society for Clinical Microbiology and Infectious Diseases (ESCMID), and American Society for Infectious Diseases (IDSA) contributed to the development of the guidelines. A total of 31 evidence-based recommendations are provided for the diagnosis and treatment of NTM-induced lung infections.
{"title":"Review of the international clinical practice guidelines for the treatment of lung infections caused by nontuberculous mycobacteria","authors":"A. V. Zhestkov, A. Lyamin, D. Ismatullin, A. Martinovich, E. V. Haykina","doi":"10.36488/cmac.2021.1.66-91","DOIUrl":"https://doi.org/10.36488/cmac.2021.1.66-91","url":null,"abstract":"Non-tuberculous mycobacteria (NTM) include more than 190 species and subspecies. Some NTM species can cause human diseases of the lungs or extrapulmonary infections. The guidelines focus on pulmonary mycobacteriosis in adult patients without cystic fibrosis or HIV infection caused by the most common NTMs, such as Mycobacterium avium complex, Mycobacterium kansasii, and Mycobacterium xenopi among slow-growing NTMs and Mycobacterium abscessus complex among fast-growing species. Experts of American Thoracic Society (ATS), European Respiratory Society (ERS), European Society for Clinical Microbiology and Infectious Diseases (ESCMID), and American Society for Infectious Diseases (IDSA) contributed to the development of the guidelines. A total of 31 evidence-based recommendations are provided for the diagnosis and treatment of NTM-induced lung infections.","PeriodicalId":53392,"journal":{"name":"Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69623958","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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