[Drainage-associated meningitis in neurocritical care patients. The results of a five-year prospective study]. / Drenazh-assotsiirovannye meningity u patsientov otdeleniia neiroreanimatsii. Rezul'taty piatiletnego prospektivnogo nabliudeniia.

AIM: to determine the incidence rate and risk factors for drainage-associated meningitis in neurocritical care patients. MATERIAL AND METHODS: The prospective study included 539 patients who spent more than 48 h at the Department of Neurocritical Care and underwent external ventricular drainage. The incidence rate and risk factors for drainage-associated meningitis were evaluated. RESULTS: Over a 5-year period, 2140 patients have been hospitalized to the Department of Critical and Intensive Care (DCIC) for more than 48 h; of these, 539 patients underwent external ventricular drainage (EVD). Drainage-associated meningitis developed in 99 patients, which amounted to 19.8 (CI 16.3-23.3) per 100 patients with drainage and 18.3 (CI 14.3-22.2) per 1000 days of drainage. The incidence rate of drainage-associated meningitis did not significantly correlate with different neurosurgical diseases, but there was a tendency for meningitis to predominate in EVD patients with vascular pathology of the central nervous system (CNS). The rate of artery catheterization for direct measurement of systemic BP and the use of vasopressor agents were significantly higher in the group of patients with drainage-associated meningitis (p<0.05). ALV was used in 98 (99%) of 99 patients with drainage-associated meningitis; respiratory support was used in 325 (80.8%) patients without meningitis (p<0.01). An analysis of the ventricular drainage duration revealed a significantly (p<0.05) larger number of days of using EVD in the group of patients with drainage-associated meningitis. In most critical care patients (57.6%), meningitis developed during the first week of drainage. Cerebrospinal fluid leakage occurred significantly more frequently in patients with drainage-associated meningitis than in patients with EVD and without meningitis (p<0.01). Based on a microbiological examination, the etiology of drainage-associated meningitis was established in 57.1% of cases. The leading pathogens were coagulase-negative staphylococci (48.3%) and Acinetobacter baumannii (18.3%). CONCLUSION: The incidence rate of drainage-associated meningitis was 19.8 per 100 patients and 18.3 per 1000 days of drainage. The risk factors significantly predominating in patients with drainage-associated meningitis include the duration of drainage, association with external CSF leakage, as well as factors associated with indicators of the overall severity of the condition.

[Features of the course of nosocomial meningitis in patients of neurosurgical intensive care unit].

OBJECTIVE: To determine the incidence rate and risk factors of nosocomial meningitis in patients with complicated postoperative period. MATERIAL AND METHODS: We report the results of prospective observation of the course of bacterial meningitis in patients with complicated postoperative period at neurosurgical intensive care unit in 2010-2014. RESULTS: Nosocomial meningitis (NM) developed in 146 patients, which accounted for 12.6±1.0% (CI, 10.74-14.66). Patients with meningitis were characterized by longer stay at ICU, prolonged mechanical ventilation, need for central venous access and invasive hemodynamic monitoring, as well as longer course of antibacterial therapy. Frequency of invasive monitoring of intracranial pressure was similar in these two groups of patients. Bloodstream infections (14.8% vs. 4.9%; p<0.000), respiratory tract infections (55% vs. 35.6%; p<0.000), and urinary tract infections (56.4% vs. 30.9%; p<0.000) were more frequently observed in patients with NM. The following significant differences were observed between the group of NM patients and the control group: more frequent use of external ventricular drain (72.5% vs. 26.1%; p<0.000), number of reoperations (64.7% vs. 36.3%; p<0.000), and the total operating room time (417.3 min vs. 337.5 min; p<0.000). Etiology was ascertained in 61.0±4.0% of cases of nosocomial meningitis. CoNS (33.0%) and Acinetobacter baumannii (21.3%) were the main pathogens isolated from cerebrospinal fluid. The mortality in patients with meningitis was 31.5±3.8%. CONCLUSION: External ventricular drain, repeated surgery, long-term stay in the operating room, as well as other types of infections may be considered as risk factors for developing nosocomial meningitis in neurosurgical patients at ICU.

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

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

[Study of dominant symbiotic mutants of pea Pisum sativum L].

Phenogenetic studies of four symbiotic hypernodulating mutants of pea (Pisum sativum L.) induced from seeds of cultivar Rodno by chemical mutagen EMS were conducted. All mutants have improved symbiotic traits, i.e., an increased number of root nitrogen fixating nodules and high activity of nitrogenase. Symbiotic traits were shown to be inherited dominantly. Mutants grown in the field or in a greenhouse showed superiority over the original cultivar in productivity. An important feature of hypernodulating mutants was found that is responsible for the appearance of high-height productive plants in F2 after crossing mutants and the original cultivar. Constant lines retaining the ability for high-level production up to the F5 generation were created based on individual plants.

[Multiple cerebral abscess caused by Nocardia brasilientis].

Streptococcus aureus, streptococci, and enterobacteria were major causative agents of abscesses of the brain. At present, associated infection is responsible for 60% of cerebral abscesses. When systemic and specific immunities are diminished, a risk for cerebral abscesses caused by fungi increases. Among them, there are the most common fungi Candida species or Aspergillus species. The paper gives an example of successful complex treatment of multiple cerebral abscesses caused by an association of Nocardia brasiliensis and Staphylococcus epidermidis. The specific feature of the observation was the correct diagnosis before intraoperative verification of cerebral abscesses. The disease developed in the presence of diminished systemic immunity and in the absence of specific immunity to Nocardia. Immunodeficiency could be caused by prior herpetic infection, Epstein-Barr disease, a wasp bite. The pathogen that was able to cause microstrokes played an indubitable role in the pathogenesis of the disease, which predisposed to the development of cerebral abscesses in patients with immunodeficiency. Impaired blood circulation in the occipital region could be also induced by wasp venom.

[Problems of prevalance and resistance of nosocomial Klebsiella pneumonia in hospitals of Russia].

Prevalence of Klebsiella pneumoniae among gramnegative pathogens of nosocomial infections in intensive care units of 33 hospitals of 22 towns in Russia was investigated. Antibiotic susceptibility and extended-spectrum beta-lactamase production were tested in 420 nosocomial K. pneumoniae isolates. Carbapenems (imipenem, meropenem and ertapenem) showed the highest activity. Extended-spectrum beta-lactamase production based on the phenotyping methods was revealed in 342 (81.4%) isolates. The maximum activity against the K. pneumoniae isolates producing extended-spectrum beta-lactamase was observed in imipenem and meropenem (no unsusceptible strains were isolated). 3.2% of the isolates was not susceptible to ertapenem. Differences in the activity of cefoperazone/sulbactam, amikacin, ciprofloxacin and levofloxacin against the extended-spectrum beta-lactamase producing isolates in various hospitals were recorded.

[Aspergillosis of the central nervous system (clinical observation and review of literature)]. / Aspergillez (Aspergilosis) tsentral'noi nervnoi sistemy (klinicheskoe nabliudenie i obzor literatury).

Aspergillosis of the central nervous system presents a challenge faced with the problems arising from the establishing the diagnosis, the low efficiency of treatment, and high mortality rates (about 95% as shown by some data). This paper presents a clinical case of a patient with aspergillosis-induced central nervous system lesion verified by autopsy. Possible errors in the diagnosis and treatment of the patient are analyzed. The literature data including clinical cases, etiopathogenesis, and clinical manifestations and its possible complications are presented. Groups of patients at risk for invasive aspergillosis are considered. The paper gives the data available in the foreign literature on the methods and efficiency of treatment and mortality rates in different groups of patients. The urgency of the problem in the diagnosis and treatment of cerebral aspergillosis rises with the increased number of patients with immunological disorders due to infectious diseases (HIV), social (drug addiction, alcoholism), environmental, and other factors.

[Nosocomial pneumonia in patients with severe craniocerebral trauma in intensive care units]. / Nozokomial'naia pnevmoniia u bol'nykh s tiazheloi cherepno-mozgovoi travmoi v otdalenii reanimatsii i intensivnoi terapii.

Eighty-three patients with severe craniocerebral injuries (CCI) were treated at Institute of Neurosurgery in 1999. Pulmonary infectious complications occurred in 16 of 25 patients with severe CCI. Early nosocomial pneumonia (NP) was diagnosed in 18% and the so-called late NP (associated with artificial ventilation of the lungs) in 35%. Coma longer than 4 days increased the incidence of NP to 62%. The main pathogens of NP are gram-negative aerobic bacteria (61%), the predominant agent being Pseudomonas aeruginosa (18.9%). 76% isolated microorganisms were multiresistant. The most significant risk factors as regards NP in patients with severe CCI were coma combined with bulbar and pseudobulbar disorders.

[Craniocerebral suppurative-inflammatory complications in nervous system cancer patients in the postoperative period]. / Kraniotserebral'nye gnoino-vospalitel'nye oslozhneniia u neiroonkologicheskikh bol'nykh v posleoperatsionnom periode.

Retrospective analysis of case records of 9793 patients with brain tumors operated on at the Burdenko Neurosurgical Institute from 1985 to 1992 was done. 323 patients (3.2%) had postoperative CNS infectious complications with deaths registered in 46 cases. Cholesteatomas and choriopapillomas had the highest complication rates: 12% of all cases and 11.4%, respectively. Variable incidence was observed in the glial tumors group: from 3% in glioblastoma patients to 4.7% in oligodendroglioma patients. Concurrent infections, surgical approaches via parabasal sinuses and CSF leakage at the operation site were considered as risk factors for postoperative CNS infectious complications.

[Comparative activity of meropenem and other antibiotics against the pathogens of nosocomial infections]. / Sravnitel'naia aktivnost' meropenema i drugikh antibiotikov v otnoshenii vozbuditelei nozokomial'nykh infektsii.

Comparative activity of meropenem and other antibacterial drugs against isolates from intensive care and reanimation units of various profiles was estimated. It was shown that the recommendations for the combined therapy with the 3rd generation cephalosporins and aminoglycosides should be revised, since none of the isolates resistant to ceftazidime or cefotaxime was susceptible to gentamicin or tobramycin. At present the most promising agents of empirical therapy are carbapenems (meropenem and imipenem). However, the resistance of methicillin resistant staphylococci and Enterococcus faecium to carbapenems and the intrinsic resistance of some gram-negative bacteria to carbapenems are indicative of the necessity of microbiological diagnosis, especially when the treatment with meropenem fails.

[A system of processing data of clinical microbiology laboratories]. / Sistema obrabotki dannykh laboratorii klinicheskoi mikrobiologii.

The COBAS BACT automized system (Hoffman la Roche, Switzerland) was used in the practical work of the laboratory of clinical microbiology. The analyzer performed two functions i.e. the identification of gram-negative pathogens of the family Enterobacteriaceae and the rapid assay of their susceptibility to antibacterial drugs. The primary computer processing was embedded in the COBAS BACT machine. An information system providing the automatization of the secondary processing of the results of microbiological tests was developed. It included not only a system of the data bases for storage of the information and accumulation of the statistical data on the assays and their results but also the automized position of the microbiologist providing the possibility of the statistical information accumulation and reading. The CLIPPER program was used as a basis for the system development. The results of the secondary computer processing are illustrated by the actualities of the determination of the etiological factor of postoperative meningitis and septicemia carried out in 1993.

Effects of bulbectomy and subsequent antidepressant treatment on brain 5-HT2 and 5-HT1A receptors in mice.

The effects of bilateral olfactory bulbectomy on serotonergic 5-HT2 and 5-HT1A receptor binding were studied in the frontal cortex (FC), limbic structures (LS), including the hippocampus, amygdala, olfactory tubercule, and piriform cortex, and hypothalamus (HTH) in mice. Bulbectomy resulted in the increase of Bmax for [3H]spiperone binding with 5-HT2 receptors in FC in C57Bl/6j. The receptors in LS and HTH remained unchanged. Subchronic treatment of the bulbectomized mice with antidepressant trazodone (20 mg/kg/day, IP, 14 days) induced downregulation of 5-HT2 receptors in FC and LS. The other two antidepressants used, amitriptyline (20 mg/kg/day, IP, 14 days) and imipramine (10 mg/kg/day, IP, 14 days), did not alter these receptors. [3H]8-OH-DPAT binding with 5-HT1A receptors was not altered by bulbectomy in any brain area in C57Bl/6j mice. Amitriptyline and trazodone decreased Bmax for these receptors in FC in the bulbectomized mice while imipramine was ineffective. Amitriptyline and imipramine significantly increased Bmax and decreased Kd in HTH, and trazodone displayed the same tendency. Bulbectomy did not alter 5-HT2 receptors in DBA/2j mice. Amitriptyline increased Kd in the all brain areas without changing Bmax in the bulbectomized DBA/2j mice. Trazodone significantly decreased Bmax in FC and increased Kd in FC and LS. Imipramine decreased Bmax while increasing Kd in LS. The possible involvement of the serotonin receptor subtypes in the bulbectomy-induced behavioral deficits and in the restorative action of the antidepressants is discussed.

[The diagnostic effectiveness of erythrocyte immunoreagents made from different Pseudomonas aeruginosa antigens]. / Diagnosticheskaia éffektivnost' éritrotsitarnykh immunoreagentov iz razlichnykh antigenov Pseudomonas aeruginosa.

The diagnostic effectiveness of the passive hemagglutination (PHA) tests with the use of erythrocyte diagnostica (ED based on exotoxin A (ETA) and poly- and monovalent ED based on lipopolysaccharides (LPS) isolated from 5 most widespread P. aeruginosa serogroups was compared. 97 patients with different purulent septic diseases and 100 practically healthy adult donors were examined. The treatment of serum samples with 2-mercaptoethanol decreased the diagnostic effectiveness of serological examination. The simultaneous determination of the activity of antibodies to ETA and LPS essentially increased the number of positive results of the PHA tests in patients with bacteriologically confirmed P. aeruginosa infection, but not in patients from whom other bacteria were isolated. Considering the sensitivity and specificity of serological examination, as well as the decrease of the volume of necessary work and the consumption of immunoreagents, the optimum test conditions proved to be ensured by the use of two ED: LPS-based polyvalent ED and ETA-based ED.

[Erythrocyte diagnostic kits for detection of Pseudomonas aeruginosa exotoxin A]. / Eritrotsitarnye diagnostikumy dlia vyiavleniia ékzotoksina A Pseudomonas aeruginosa.

The use of formulated chick red blood cells loaded with IgG preparations and affinity-purified antibodies, in comparison with initial immune serum to P. aeruginosa exotoxin A (ETA), has been shown to increase the sensitivity of antibody erythrocyte diagnosticum (AbED) 17-fold and to ensure the detection of ETA at a concentration of 1.2 mg of protein per ml. The passive hemagglutination (PHA) test with AbED has proved to be a more sensitive method for the detection of ETA than the antibody neutralization test with the use of antigenic erythrocyte diagnosticum, the latex agglutination test, the coagglutination test and the enzyme immunoassay. The PHA test has permitted the detection of ETA in the culture fluid of 80% of P. aeruginosa cultures under study.

[Use of a polyvalent erythrocyte diagnostic agent for determining antibodies to Pseudomonas aeruginosa in clinical practice]. / Primeneneie polivalentnogo éritrotsitarnogo diagnostikuma dlia opredeleniia antitel k Pseudomonas aeruginosa v klinicheskoi praktike.

The use of polyvalent erythrocyte diagnosticum prepared on the basis of 5 polysaccharide antigens of P. aeruginosa slime, isolated from strains belonging to the most widespread serovars, makes it possible to check up the humoral response of donors after their immunization with P. aeruginosa polyvalent corpuscular vaccine with the aim of obtaining anti-P. aeruginosa donor plasma. Antibody titers, determined in the passive hemagglutination test with the use of the proposed diagnosticum and corresponding to a serum dilution of 1:320 and greater, age tentatively diagnostic, which may be indicative of P. aeruginosa in the development of purulent septic complications in patients. The use of the passive hemagglutination test with the newly developed polyvalent erythrocyte diagnosticum makes it possible to check up the specific response of patients having P. aeruginosa infection in the process of their treatment with anti-P. aeruginosa hyperimmune plasma used as a part of complex therapy.

[Immunoenzyme method of determining Pseudomonas aeruginosa exotoxin A by using a conjugate of beta-lactamase with specific antibodies]. / Immunofermentnyi metod opredeleniia ékzotoksina A Pseudomonas aeruginosa s ispol'zovaniem kon''iugata beta-laktamazy so spetsificheskimi antitelami.

Specific antibodies for immunoenzymatic assay of P. aeruginosa exotoxin A were isolated with affinity chromatography on exotoxin A-Sepharose 4B. A conjugate of the antibodies to exotoxin A with beta-lactamase from Bacillus licheniformis 749/c was prepared by linking glutaric aldehydes. The conjugate showed high immunospecific and enzymatic activity and was used for competitive solid phase immunoenzymatic assay. Sensitivity of the assay provided determination of exotoxin A in concentration of 20 ng/ml. It was used for determining P. aeruginosa exotoxin A in culture fluids.

[Liver microsomal lipids of mice irradiated and administered an extract of turtle spleen]. / Lipidy mikrosom pecheni myshei v usloviiakh oblucheniia i vvedeniia ékstrakta selezenki cherepakhi.

The influence of a tortoise spleen extract (TSE) on lipids of liver endoplasmic reticulum of irradiated (8 Gy) mice has been studied. The administration of TSE immediately after irradiation changes the content of lipid fractions in microsomal membranes preventing the accretion of cholesterol, nonesterified fatty acids, and triacylglycerol. The preparation under study exerts an antioxidant effect.