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Mucormycosis following COVID19: clinical case and literature review covid - 19后毛霉菌病:临床病例及文献复习
Q4 Medicine Pub Date : 2021-01-01 DOI: 10.36488/cmac.2021.3.255-262
S. Khostelidi, V. A. Zaytsev, E. V. Pelikh, É. Yashina, O.N. Rodionova, T. Bogomolova, Y. Avdeenko, N. Klimko
Mucormycosis is one of the most aggressive invasive mycoses. The mortality rate of patients with mucormycosis, depending on clinical form and background disease, varies from 30% to 100%. This article provides the first description of mucormycosis in Russia after infection caused by SARS-CoV-2, as well as a review of literature reports on mucormycosis in patients with COVID-19 (as of September 2021).
毛霉病是最具侵袭性的真菌病之一。毛霉菌病患者的死亡率取决于临床形式和背景疾病,从30%到100%不等。本文首次介绍了俄罗斯由SARS-CoV-2引起的感染后的毛霉病,并回顾了关于COVID-19患者毛霉病的文献报道(截至2021年9月)。
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引用次数: 5
In vitro activity of thiamphenicol against Haemophilus influenzae, Streptococcus pneumoniae and Streptococcus pyogenes clinical isolates 硫胺霉素对流感嗜血杆菌、肺炎链球菌和化脓性链球菌临床分离株的体外活性研究
Q4 Medicine Pub Date : 2021-01-01 DOI: 10.36488/cmac.2021.1.92-99
N. Ivanchik, М.V. Sukhorukova, А.N. Chagaryan, I. V. Trushin, A. Dekhnich, R. Kozlov
Objective. To determine in vitro activity of thiamphenicol and other clinically available antimicrobials against clinical isolates of Haemophilus influenzae, Streptococcus pneumoniae and Streptococcus pyogenes. Materials and Methods. We included in the study 875 clinical isolates from 20 Russian cities during 2018–2019. Among tested strains, 126 were H. influenzae, 389 – S. pneumoniae, 360 – S. pyogenes. Antimicrobial susceptibility testing was performed using broth microdilution method according to ISO 20776-1:2006. AST results were interpreted according to EUCAST v.11.0 clinical breakpoints. Results. The minimum inhibitory concentrations (MICs) of thiamphenicol did not exceed 2 mg/L for 94.4% of H. influenzae strains (MIC50 and MIC90 were 0.5 and 1 mg/L, respectively). Thiamphenicol was active against 76.9% of ampicillin-resistant H. influenzae strains (MIC of thiamphenicol < 2 mg/L). The MIC of thiamphenicol was in the range of 0.06–2 mg/L for 96.7% of S. pneumoniae strains (MIC50 and MIC90 were 0.5 and 2 mg/L, respectively). The MIC of thiamphenicol for 90.6% of S. pneumoniae strains with reduced susceptibility to penicillin (MIC of penicillin > 0.06 mg/L) did not exceed 2 mg/L. A total of 88.1% of S. pneumoniae strains resistant to erythromycin were highly susceptible to thiamphenicol (MIC < 2 mg/L). The MIC of thiamphenicol did not exceed 8 mg/L for 96.1% of S. pyogenes strains (MIC50 and MIC90 were 2 and 4 mg/L, respectively). Conclusions. Thiamphenicol was characterized by relatively high in vitro activity, comparable to that of chloramphenicol, against tested strains of H. influenzae, S. pneumoniae and S. pyogenes, including S. pneumoniae isolates with reduced susceptibility to penicillin.
目标。测定硫霉素和其他临床可用抗菌剂对流感嗜血杆菌、肺炎链球菌和化脓性链球菌临床分离株的体外活性。材料与方法。我们在研究中纳入了2018-2019年期间来自俄罗斯20个城市的875例临床分离株。其中流感嗜血杆菌126株,肺炎链球菌389株,化脓性链球菌360株。药敏试验采用微量肉汤稀释法,按照ISO 20776-1:2006进行。结果硫霉素对94.4%的流感嗜血杆菌菌株的最低抑菌浓度(mic)不超过2mg /L (MIC50和MIC90分别为0.5和1mg /L)。硫胺霉素对76.9%的耐氨苄西林流感嗜血杆菌(硫胺霉素的MIC < 2 mg/L)有活性。96.7%的肺炎链球菌对硫霉素的MIC在0.06 ~ 2 mg/L范围内(MIC50和MIC90分别为0.5和2 mg/L)。对青霉素敏感性降低的肺炎链球菌中,90.6%的菌株对硫霉素的MIC不超过2 mg/L(青霉素的MIC为0.06 mg/L)。对红霉素耐药的肺炎链球菌中,有88.1%对硫霉素高度敏感(MIC < 2 mg/L)。96.1%的化脓性葡萄球菌对硫霉素的MIC不超过8 mg/L (MIC50和MIC90分别为2和4 mg/L)。硫胺霉素具有相对较高的体外活性,与氯霉素相当,可用于对抗流感嗜血杆菌、肺炎链球菌和化脓性链球菌,包括对青霉素敏感性降低的肺炎链球菌分离株。
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引用次数: 1
Cytomegalovirus after allogeneic hematopoietic stem cell transplantation: reactivation or reinfection? 异基因造血干细胞移植后巨细胞病毒:再激活还是再感染?
Q4 Medicine Pub Date : 2021-01-01 DOI: 10.36488/cmac.2021.2.138-145
М.V. Demin, D. C. Tikhomirov, B. Biderman, О.А. Glinschikova, М.Yu. Drokov, А. Sudarikov, Т.А. Tupoleva, Е.N. Parovitchnikova, F. P. Filatov
Objective. To determine type of cytomegalovirus (CMV) infection (reactivation of a virus strain that was present before transplantation or re-infection with another virus strain) in allogeneic hematopoietic stem cell recipients by sequencing. Materials and Methods. Clinical and laboratory data of 179 recipients of allogeneic hematopoietic stem cells collected from 2014 to 2018 were analyzed for CMV DNA in clinical specimens before and after transplantation. A total of 14 patients (28 samples) were included in the study. The CMV UL139 gene encoding viral glycoprotein was chosen for virus genotyping and sequence alignment. The primers complementary to its conservative sites were used. The resulting DNA sequence was analyzed using nucleotide BLAST software (https://blast.ncbi.nlm.nih.gov/Blast.cgi) and Genome compiler (https://designer.genomecompiler.com). The type of infection was determined by comparing DNA sequences before and after transplantation. Results. All enrolled patients were anti-CMV-positive prior to transplantation, which indicates the presence of CMV infection. Therefore, none of the patients had a primary infection as a result of transplantation. Of 14 patients, high percentage of sequence alignment (~100%) was observed in 8 patients. For the other 6 patients, substantial differences in sequences which indicate the different genotypes and the different type of infection were found. However, there was no statistically significant difference in the time to viral DNA appearance after transplantation in patients with re-infection and reactivation (p > 0.05), nor was there a statistically significant correlation between the type of infection (reactivation/re-infection) and the main diagnosis or transfusion load. Conclusions. Reactivation of the previously registered viral strain and re-infection with another viral strain were equally probable (8 vs. 6 cases). There were no associations between the main diagnosis and the type of infection (reactivation/re-infection) possibly due to a small sample size. Time to post-transplantation CMV DNA detection in blood was longer for re-infection (median of 69.5 days) compared to reactivation (median of 27 days), but this difference was also non-statistically significant. In addition, there was no significant contribution of blood transfusion burden to the type of CMV infection, which may suggest the donor blood is not a source of the different strains.
目标。通过测序确定同种异体造血干细胞受体的巨细胞病毒(CMV)感染类型(移植前存在的病毒株再激活或再感染另一种病毒株)。材料与方法。对2014 - 2018年收集的179例同种异体造血干细胞受者的临床和实验室资料进行移植前后临床标本的CMV DNA分析。本研究共纳入14例患者(28份样本)。选择编码病毒糖蛋白的CMV UL139基因进行病毒基因分型和序列比对。采用与其保守位点互补的引物。利用核苷酸BLAST软件(https://blast.ncbi.nlm.nih.gov/Blast.cgi)和基因组编译器(https://designer.genomecompiler.com)分析得到的DNA序列。结果:所有入组患者移植前抗巨细胞病毒阳性,提示存在巨细胞病毒感染。因此,没有患者因移植而发生原发性感染。在14例患者中,8例患者的序列比对率高(~100%)。在其他6例患者中,序列存在显著差异,表明不同的基因型和不同的感染类型。再次感染和再激活患者移植后出现病毒DNA的时间差异无统计学意义(p < 0.05),感染类型(再激活/再感染)与主要诊断或输血负荷之间也无统计学意义。结论:先前登记的病毒株再激活和再次感染另一病毒株的概率相等(8例vs. 6例)。主要诊断与感染类型(再激活/再感染)之间没有关联,可能是由于样本量小。移植后再感染的CMV DNA检测时间(中位数为69.5天)比再激活的时间(中位数为27天)更长,但这种差异也无统计学意义。此外,输血负担对巨细胞病毒感染的类型没有显著贡献,这可能表明献血者的血液不是不同毒株的来源。
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引用次数: 0
War and Peace: the difficult treatment of urinary tract infections and fosfomycin trometamol 战争与和平:尿路感染的疑难治疗与磷霉素曲美他莫
Q4 Medicine Pub Date : 2021-01-01 DOI: 10.36488/cmac.2021.1.44-53
I. Palagin, T. Perepanova, D. Pushkar, R. Kozlov
The title of this review “War and peace” is not accidental and the analogies with a well-known literary masterpiece have absolutely justified ground. As in the case of Lev Tolstoy’s novel this title has a profound philosophical meaning, although at first glance it may seem quite obvious. The word «war» may well correspond to those hostile changes of microorganisms leading to the current problem of antimicrobial resistance recognized worldwide. This is the “war” we have to wage against the antibiotic-resistant bacteria today. And the «peace» in this context is considered as the world, the entire universe, all people, the whole society and its reaction to what is happening. On the other hand, the word «peace» means something opposite in meaning to the word «war». Thus, the essence of the title bears a sharp contrast between military actions and peacetime, between something that carries a threat to life and peace, or illness and recovery. Preserving original novel’s structure the authors of this review consistently consider justification of fosfomycin trometamol as a first-line drug in the treatment of acute uncomplicated cystitis in women taking into account the latest research, publications and global trends.
这篇评论的标题“战争与和平”不是偶然的,与一个著名的文学名著的类比是绝对有道理的。就像列夫·托尔斯泰的小说一样,这个标题有着深刻的哲学意义,尽管乍一看似乎很明显。“战争”一词很可能与微生物的敌对变化相对应,这些变化导致了目前全世界公认的抗微生物药物耐药性问题。这是我们今天必须对耐抗生素细菌发动的“战争”。在这种情况下,“和平”被认为是世界,整个宇宙,所有的人,整个社会及其对正在发生的事情的反应。另一方面,“和平”一词在意义上与“战争”一词相反。因此,书名的实质是军事行动与和平时期、威胁生命与和平的事物、疾病与康复之间的鲜明对比。本综述的作者考虑到最新的研究、出版物和全球趋势,一致认为磷霉素曲美他莫作为治疗女性急性无并发症膀胱炎的一线药物是合理的。
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引用次数: 0
Antibacterial agents reducing the risk of resistance development 抗菌剂减少耐药性发展的风险
Q4 Medicine Pub Date : 2021-01-01 DOI: 10.36488/cmac.2021.2.184-194
N. Zigangirova, N. L. Lubenec, A. Zaitsev, D. Pushkar
The most important goal of medical microbiology in terms of treating infectious diseases nowadays and in the coming decades will be the development of antibacterial agents that are effective against resistant pathogens and reduce the selection of antimicrobial resistance. In this regard, along with the search for new classic antibiotics, it is necessary to develop alternative strategies. Virulence factors that determine the key stages of the infection process, both acute and chronic, including adhesins, toxins, bacterial quorum sensing, secretory systems, could be potential targets. The strategy for the development of antivirulence drugs is already showing its potential in the treatment of nosocomial, complicated and chronic infections as part of complex therapy and for prevention. The review presents the results of studies of drugs that have already shown efficacy in model infections in animals or have either passed to the stage of clinical trials or have already been registered. The development of effective combination therapy regimens will minimize the risks of acquiring resistance.
目前和未来几十年,医学微生物学在治疗传染病方面最重要的目标将是开发出能够有效对抗耐药病原体并减少耐药性选择的抗菌药物。在这方面,随着寻找新的经典抗生素,有必要制定替代策略。决定急性和慢性感染过程关键阶段的毒力因子,包括粘附素、毒素、细菌群体感应、分泌系统,可能是潜在的目标。作为综合治疗和预防的一部分,开发抗毒药物的战略已经显示出其在治疗院内、复杂和慢性感染方面的潜力。这篇综述介绍了一些药物的研究结果,这些药物已经在动物模型感染中显示出疗效,或者已经进入临床试验阶段,或者已经注册。开发有效的联合治疗方案将使获得耐药性的风险降到最低。
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引用次数: 2
Antibiotic therapy under polypragmatic conditions: a course to safety 多重实用条件下的抗生素治疗:一个安全的过程
Q4 Medicine Pub Date : 2021-01-01 DOI: 10.36488//cmac.2021.4.367-373
I. Sychev, L. Fedina, D. Sychev
Prescribing safe and effective drug therapy is becoming increasingly challenging. Recently, there has been an upward trend in the number of patients experiencing polypragmasy. Thus, according to epidemiological analysis of 180,815 outpatient records in Scotland, 4–9 medications were simultaneously prescribed in 16.9% of cases, 10 or more drugs – in 4.6% of cases. As the number of medications taken by an individual patient increases, so does the likelihood of drug-drug interactions which have clinically important consequences. The number of drug-drug interactions is increasing as new drugs are approved, different metabolic pathways and drug transporters are discovered, and co-prescribing recommendations emerge. This article provides an overview of principles and mechanisms of drug-drug interactions and describes pharmacokinetic and pharmacodynamic interactions associated with antibiotic therapy.
开出安全有效的药物治疗处方正变得越来越具有挑战性。最近,有一个上升的趋势,在病人的数量经历多实用症。因此,根据对苏格兰180815份门诊记录的流行病学分析,16.9%的病例同时开具4-9种药物,4.6%的病例同时开具10种或更多药物。随着单个患者服用的药物数量的增加,药物与药物相互作用的可能性也会增加,从而产生重要的临床后果。随着新药的批准,不同的代谢途径和药物转运体的发现,以及联合处方建议的出现,药物-药物相互作用的数量正在增加。本文概述了药物-药物相互作用的原理和机制,并描述了与抗生素治疗相关的药代动力学和药效学相互作用。
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引用次数: 2
Ventilatorassociated lower respiratory tract infections: etiology and diagnosis 呼吸机相关下呼吸道感染:病因和诊断
Q4 Medicine Pub Date : 2021-01-01 DOI: 10.36488/cmac.2021.1.17-25
V. Rudnov, V. Bagin, D. Belsky, M. Astafyeva, N. Nevskaya, G. Kolotova, S.M. Rosanova, T.I. Bykova
Objective. To review a literature published over the past 5 years and our own data on the etiology of lower respiratory tract infections (LRTI), antimicrobial resistance and its relationships between sepsis and choice of appropriate antibiotic therapy. Materials and Methods. National Nosocomial Infections Surveillance (NNIS) criteria were used to diagnose LRTI. A review of the articles regarding LRTI from the Russian and international English language journals published over 6 years was performed. Identification of microorganisms was performed by culture over the period of 2003–2013; since 2014, MALDI-TOF MS method was used for this purpose. Results. Despite the ongoing policy to limit the use of antimicrobial therapy in the ICUs, there is an increase in carbapenemase-producing isolates in the ICUs from 2.2% (2018) to 11.7% (2020, 9 months). Along with the trend to increase in carbapenemase-producing pathogens causing LRTI, their variability is also increasing. In particular, it applies to strains producing carbapenemases OXA-48 or combination of OXA-48 with KPC; with the trend to combined production of carbapenemase beginning at 2019. Conclusions. Carbapenemase producers are becoming more widespread in the ICU settings, including the lower respiratory tract in mechanically ventilated patients. Practitioners didn’t get used to associate VAP with the Sepsis-3 criteria. The changes in etiology include the increased rate of carbapenem-resistant Enterobacterales and non-fermenting Gram-negative bacteria, primarily Acinetobacter spp., in Russia. It’s due to improved quality of respiratory support and increased consumption of carbapenems, tigecycline and polymyxins. Significant increase of OXA-48-producing pathogens is likely to be associated with a poor compliance with temporary guidelines on COVID-19 with regard to antibiotic therapy.
目标。回顾过去5年发表的文献和我们自己的数据,关于下呼吸道感染(LRTI)的病因、抗生素耐药性及其败血症与适当抗生素治疗选择之间的关系。材料与方法。采用国家医院感染监测(NNIS)标准诊断下呼吸道感染。对6年来俄罗斯和国际英语期刊上发表的关于LRTI的文章进行了回顾。在2003-2013年期间通过培养进行微生物鉴定;结果:尽管目前的政策限制了icu中抗菌药物的使用,但icu中产生碳青霉烯酶的分离株从2.2%(2018年)增加到11.7%(2020年,9个月)。随着引起LRTI的产碳青霉烯酶病原体数量的增加,其变异性也在增加。特别适用于产生碳青霉烯酶OXA-48或OXA-48与KPC的组合菌株;2019年开始有联合生产碳青霉烯酶的趋势。碳青霉烯酶制造者在ICU环境中变得越来越普遍,包括机械通气患者的下呼吸道。从业者不习惯将VAP与败血症-3标准联系起来。病因学的变化包括俄罗斯碳青霉烯耐药肠杆菌和非发酵革兰氏阴性菌(主要是不动杆菌)的发病率增加。这是由于呼吸支持质量的提高和碳青霉烯类、替加环素和多粘菌素的消耗增加。产生oxa -48的病原体的显著增加可能与未严格遵守关于抗生素治疗的COVID-19临时指南有关。
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引用次数: 1
Comparison of culture and isolation methods for Clostridioides difficile and other anaerobes from stool samples in a routine microbiological laboratory practice 从粪便样本中培养和分离艰难梭菌和其他厌氧菌的方法比较
Q4 Medicine Pub Date : 2021-01-01 DOI: 10.36488/cmac.2021.2.212-216
Maria G. Shvydkaya, A. M. Zatevalov, S. D. Mitrokhin, D. T. Dzhandarova
Objective. To improve stool sample culture and isolation of anaerobic flora, including Clostridioides difficile in the routine microbiological laboratory practice at the children’s oncology hospital. Materials and Methods. A total of 517 stool samples collected from patients in children’s oncology hospital from 2013 to 2015 were studied. All samples were analyzed by ELISA for C. difficile toxins and by culture according to dedicated 5 schemes for isolation of anaerobic bacteria, including C. difficile. Statistical significance of differences in isolation rates between the studied groups (culture schemes) was assessed by Pearson test. Results. Culture in liver broth and covering with technical agar followed by culture on anaerobic agar yielded 100% isolation rate of toxigenic C. difficile strains. This culture scheme is also suitable for isolating concomitant anaerobic flora: non-toxigenic C. difficile strains, Clostridium perfringens, other Clostridia spp. and Bacteroides spp. Conclusions. Use of the liquid accumulation medium and covering with technical agar make it possible to isolate anaerobic flora from stool samples and increase an isolation rate of toxigenic C. difficile strains to 100% of ELISA-positive samples.
目标。在儿童肿瘤医院的常规微生物实验室实践中,改进粪便样本培养和厌氧菌群的分离,包括艰难梭菌。材料与方法。本研究收集2013 - 2015年儿童肿瘤医院患者粪便样本517份。所有样品均采用ELISA法检测艰难梭菌毒素,并按照包括艰难梭菌在内的5种厌氧细菌分离方案进行培养。结果:肝肉汤培养、技术琼脂覆盖、厌氧琼脂培养,产毒艰难梭菌的分离率为100%。该培养方案也适用于同时存在的厌氧菌群的分离:非产毒艰难梭菌、产气荚膜梭菌、其他梭菌属和拟杆菌属。结论:利用液体积累培养基和技术琼脂覆盖,可以从粪便样品中分离出厌氧菌群,使产毒艰难梭菌的分离率提高到100%。
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引用次数: 0
Almost two years with COVID-19: some aspects of antibiotic use COVID-19近两年:抗生素使用的某些方面
Q4 Medicine Pub Date : 2021-01-01 DOI: 10.36488/cmac.2021.3.248-253
E. A. Ortenberg
The objective of this review was to summarize impact of the widespread administration of antibiotics in treatment algorithms for patients with COVID-19 on treatment outcomes. The experience of antimicrobial use agents during COVID-19 pandemic did not show any life-saving effect. It justifies a need to limit their administration to COVID-19 patients.
本综述的目的是总结COVID-19患者治疗算法中广泛使用抗生素对治疗结果的影响。在COVID-19大流行期间使用抗微生物药物的经验没有显示出任何挽救生命的效果。这证明有必要将它们的使用限制在COVID-19患者身上。
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引用次数: 1
Assessment of biofilmforming activity of Fusarium solani isolated from patients’ skin 患者皮肤分离的茄枯菌生物膜形成活性评价
Q4 Medicine Pub Date : 2021-01-01 DOI: 10.36488/cmac.2021.3.330-336
R. I. Valieva, S. Lisovskaya, G. Isaeva
Objective. To study pathogenic factors (adhesion and biofilm formation) in F. solani isolated from skin of patients Materials and methods. A total of 86 strains of F. solani isolated from the skin of patients with a diagnosis of L30.3 “Infectious dermatitis” were selected. The reference strain F. solani F-819 was used for quality control. Samples were collected using a sterile cotton swab from an area of 5 × 5 cm. The primary incubation was at Saburo media (HiMedia, India). Determination of the adhesion of the strains was carried out in the previously developed model from a nitrocellulose plate. Biofilms were formed using the method by Pierce C. et al. in 96-well flat bottom polystyrene plates. The efficiency of F. solani biofilms was assessed by the optical density of the total biomass (staining with Cristal Violet extract) and exopolysaccharide matrix (staining with Congo Red extract). Results. The studied F. solani strains were divided into two groups: isolates from patients with acute course of the disease (group I, n = 54), and isolates from patients with chronic relapsing disease (group II, n = 32). The adhesion of microconidia of isolates from patients with a chronic form is higher compared to isolates from patients with an acute form (p = 0.013) and the reference strain (p = 0.007). 26 (81.2%) isolates from patients with chronic form of the disease and 19 (35.2%) isolates from patients with acute form had an increased ability to form biofilms. The total biofilm mass was higher in F. solani isolates from the patients with chronic disease than that in isolates from the patients with acute course of the disease, and already matured on the 4th day of incubation. An increase in number of exopolysaccharide matrix was observed in F. solani isolated from patients with chronic disease on the 5th day of incubation, which led to increase in total biofilm mass. Conclusions. This study showed that F. solani can form biofilms. Significant differences in adhesion and biofilm formation between clinical strains of F. solani isolated from patients with various forms of the disease were found.
目标。目的:研究从患者皮肤分离的茄内生真菌的致病因素(粘附性和生物膜的形成)。从诊断为L30.3“感染性皮炎”的患者皮肤中分离到86株梭兰氏菌。以参比菌株F-819为质量控制菌株。用无菌棉签在5 × 5 cm的面积上采集样本。最初的孵化是在Saburo media (HiMedia,印度)。在先前开发的模型中,从硝化纤维板上进行了菌株粘附性的测定。采用Pierce C.等人的方法在96孔平底聚苯乙烯板上形成生物膜。通过总生物量光密度(结晶紫提取物染色)和胞外多糖基质(刚果红提取物染色)对茄茄菌生物膜的效率进行评价。将所研究的梭兰氏菌分为两组:急性病程患者分离株(I组,n = 54)和慢性复发疾病患者分离株(II组,n = 32)。与急性型患者分离株(p = 0.013)和参考菌株(p = 0.007)相比,慢性型患者分离株的微分生孢子粘附性更高。来自慢性型患者的26株(81.2%)和来自急性型患者的19株(35.2%)分离株具有增强的生物膜形成能力。从慢性疾病患者分离的梭氏梭菌总生物膜质量高于急性病程患者分离的梭氏梭菌,且在培养第4天就已成熟。从慢性疾病患者体内分离的梭菌培养第5天,胞外多糖基质数量增加,导致生物膜总质量增加。结论:本研究表明梭菌能够形成生物膜。发现从不同形式的疾病患者分离的临床菌株之间的粘附和生物膜形成有显著差异。
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引用次数: 0
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Klinicheskaia mikrobiologiia i antimikrobnaia khimioterapiia
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