[Fecal microbiota transplantation for graft-versus-host disease in children and adults: methods, clinical effects, safety].

AIM: Was to evaluate clinical efficacy, adverse events and changes in the gut microbiome after fecal microbiota transplantation (FMT) in patients with gastrointestinal (GI) form of graft-versus-host disease (GVHD). MATERIALS AND METHODS: The prospective single-center study in R.M. Gorbacheva institute included 27 patients with GI GVHD after allogeneic stem cell transplantation. 19 patients received FMT, 8 patients received placebo. Clinical scales for GI autoimmune diseases were used to evaluate response. Microbiome alterations were assessed with multiplex PCR. RESULTS: After FMT higher overall bacterial mass (р=0.00088), higher bacterial numbers ofBifidobacteriumspp. (р=0.021),Escherichia coli(р=0.049) andBacteroides fragilisgr. (р=0.000043) compared to placebo group. Also higher bacterial mass was observed in patients with clinical response (р=0.0057). The bacterial mass after procedure in non-responders was compared to the placebo group (р=0.31). Partial response of GVHD was achieved faster in the FMT group compared to placebo (median 4 days vs 48 days,p=0.014). Complete response was observed in 8 (42%), 14 (74%) and 16 (84%) at 30, 60 and 90 days respectively, while in the placebo group only 0%, 1 (13%) and 4 (50%) achieved complete response at the same time points. The incidence and severity of adverse events was comparable between FMT and the placebo group. CONCLUSION: FMT in patients with refractory GI GVHD was associated with favorable clinical outcomes and recovery in certain marker bacterial populations. Multiplex PCR can be used to assess an engraftment of a donor microbiota. FMT in GI GVHD was not associated with life-threatening adverse events, but further studies are required to validate clinical efficacy.

Carriage of methicillin-resistant staphylococci by healthy companion animals in the US.

UNLABELLED: Antimicrobial-resistant staphylococci have been associated with wounded or ill companion animals, but little is known about the prevalence of resistant staphylococci among healthy animals. In this study, 276 healthy dogs and cats from veterinary clinics were tested for the presence of antimicrobial-resistant Staphylococcus spp. Isolates were tested for antimicrobial susceptibility and the presence of select resistance genes, and typed using Pulsed-Field Gel Electrophoresis (PFGE). Staphylococcus aureus and Staphylococcus pseudintermedius were also characterized using multilocus sequence typing (MLST), spa typing and SCCmec typing. Approximately 5% (14/276) of the animals were positive by enrichment for five species of staphylococci [Staph. aureus (n = 11), Staph. pseudintermedius (n = 4), Staphylococcus sciuri (n = 6), Staphylococcus simulans (n = 1) and Staphylococcus warneri (n = 1)]. Seventy-eight per cent (18/23) of staphylococci were resistant to oxacillin and also multidrug resistant (resistance to ≥ 2 antimicrobials). All Staph. aureus isolates were mecA+ and blaZ+, SCCmec type II, spa type t002, ST5 and clonal using PFGE. Staphylococcus pseudintermedius were SCCmec type IV or V, spa type t06 and ST170; two of the isolates were pvl(+) . These results suggest that healthy companion animals may be a reservoir of multidrug-resistant staphylococci, which may be transferred to owners and others who handle companion animals. SIGNIFICANCE AND IMPACT OF THE STUDY: In this study, antimicrobial-resistant coagulase-negative and coagulase-positive staphylococci were isolated from various body sites on healthy dogs and cats. Resistance to 14 antimicrobials was observed including resistance to oxacillin; the majority of staphylococci were also multidrug resistant. Results from this study suggest that healthy dogs and cats may act as reservoirs of antimicrobial-resistant bacteria that may be transferred to people by simple interaction with the animals. Such carriage poses an underlying risk of infection, which should be considered during handling of healthy dogs and cats by pet owners and veterinary personnel.

Anatomical distribution and genetic relatedness of antimicrobial-resistant Escherichia coli from healthy companion animals.

AIMS: Escherichia coli have been targeted for studying antimicrobial resistance in companion animals because of opportunistic infections and as a surrogate for resistance patterns in zoonotic organisms. The aim of our study is to examine antimicrobial resistance in E. coli isolated from various anatomical sites on healthy dogs and cats and identify genetic relatedness. METHODS AND RESULTS: From May to August, 2007, healthy companion animals (155 dogs and 121 cats) from three veterinary clinics in the Athens, GA, USA, were sampled. Escherichia coli was isolated from swabs of nasal, oral, rectal, abdomen and hindquarter areas. Antimicrobial susceptibility testing against 16 antimicrobials was performed using broth microdilution with the Sensititre™ system. Clonal types were determined by a standardized pulsed-field gel electrophoresis protocol. Although rectal swabs yielded the most E. coli (165/317; 52%) from dogs and cats, the organism was distributed evenly among the other body sites sampled. Escherichia coli isolates from both dogs and cats exhibited resistance to all antimicrobials tested with the exception of amikacin, cephalothin and kanamycin. Resistance to ampicillin was the most prevalent resistance phenotype detected (dogs, 33/199; 17%; and cats, 27/118; 23%). Among the resistant isolates, 21 resistance patterns were observed, where 18 patterns represented multidrug resistance (MDR; resistance ≥ 2 antimicrobial classes). Also among the resistant isolates, 33 unique clonal types were detected, where each clonal type contained isolates from various sampling sites. Similar resistance phenotypes were exhibited among clonal types, and three clonal types were from both dogs and cats. CONCLUSIONS: Healthy companion animals can harbour antimicrobial-resistant E. coli on body sites that routinely come in contact with human handlers. SIGNIFICANCE AND IMPACT OF THE STUDY: This study is the first report that demonstrates a diverse antimicrobial-resistant E. coli population distributed over various sites of a companion animal's body, thereby suggesting potential transfer of resistant microflora to human hosts during contact.

[Use of various nutritional support regimens in patients with transplanted hematopoietic stem cells].

AIM: To study the impact of modified nutritional support (NS) versus standard NS on therapy tolerability and posttransplantation in patients with oncohematological diseases. SUBJECTS AND METHODS: Fifty-three patients, who had been diagnosed as acute myeloblastic (n = 19) or acute lymphoblastic (n = 16) leukemias, lymphomas (n = 10), and other oncohematological diseases (n = 8) and had received large-dose polychemotherapy followed by hematopoietic stem cell transplantation (HSCT), were prospectively examined. The control group (n = 27) used standard NS (NS was prescribed when gastrointestinal (GI) events occurred; on day 1 after HSCT, the study group (n = 26) had modified NS added by glutamine dipeptide (0.57 g/kg/day). Energy demands were 35 kcal/kg/day; protein requirements were 1.5-1.7 g/kg/day. Artificial nutrition preparations were daily given through infusion pumps for 24 hours. In both groups, the criteria for NS discontinuation were natural assimilation of 60% of the required energy within 3 consecutive days or day 14 after HSCT when Gl function was preserved. RESULTS: The patients receiving modified NS showed reductions in the incidence and severity of mucositis (p = 0.05), a less significant decrease in the laboratory and anthropometric indicators of nutritional status (p = 0.01), and a better hospital outcome on day 100 after HSCT (p = 0.01). There were no differences in the rate and severity of acute graft-versus-host reaction (p = 0.7%) and in one-year overall survival (p = 0.7%). CONCLUSION: As compared with standard NS, modified NS enables a patient to sustain negative consequences of the conditioning regimen, HSCT in the early posttransplantation period.

Mechanisms of antimicrobial resistance and genetic relatedness among enterococci isolated from dogs and cats in the United States.

AIMS: In this study, mechanisms of antimicrobial resistance and genetic relatedness among resistant enterococci from dogs and cats in the United States were determined. METHODS AND RESULTS: Enterococci resistant to chloramphenicol, ciprofloxacin, erythromycin, gentamicin, kanamycin, streptomycin, lincomycin, quinupristin/dalfopristin and tetracycline were screened for the presence of 15 antimicrobial resistance genes. Five tetracycline resistance genes [tet(M), tet(O), tet(L), tet(S) and tet(U)] were detected with tet(M) accounting for approx. 60% (130/216) of tetracycline resistance; erm(B) was also widely distributed among 96% (43/45) of the erythromycin-resistant enterococci. Five aminoglycoside resistance genes were also detected among the kanamycin-resistant isolates with the majority of isolates (25/36; 69%) containing aph(3')-IIIa. The bifunctional aminoglycoside resistance gene, aac(6')-Ie-aph(2'')-Ia, was detected in gentamicin-resistant isolates and ant(6)-Ia in streptomycin-resistant isolates. The most common gene combination among enterococci from dogs (n = 11) was erm(B), aac(6')-Ie-aph(2'')-Ia, aph(3')-IIIa, tet(M), while tet(O), tet(L) were most common among cats (n = 18). Using pulsed-field gel electrophoresis (PFGE), isolates clustered according to enterococcal species, source and antimicrobial gene content and indistinguishable patterns were observed for some isolates from dogs and cats. CONCLUSION: Enterococci from dogs and cats may be a source of antimicrobial resistance genes. SIGNIFICANCE AND IMPACT OF THE STUDY: Dogs and cats may act as reservoirs of antimicrobial resistance genes that can be transferred from pets to people. Although host-specific ecovars of enterococcal species have been described, identical PFGE patterns suggest that enterococcal strains may be exchanged between these two animal species.

[Solid pseudopapillary epithelial pancreatic tumor].

Solid pseudopapillary pancreatic neoplasm-is a tumor, which appears rarely, predominantly in young women, has low malignant potential and unknown histogenesis. Morphological peculiarities of the tumor may be the same as in endocrinal tumors and ductal pancreatic adenocarcinoma, with which it must be differed. Immunohistochemical investigation of the tumor does not permit to obtain information for strict diferential diagnosis conduction; macroscopic and microscopic peculiarities of the tumor while staining with hematoxilin and eosin give more important information for its diagnosis. The treatment is surgical and consists of radical resection of the tumor.

[Late results of laparoscopic rectal fixation for its prolapse].

Late functional results of laparoscopic rectal fixation in 14 patients, performed for its total prolapse were estimated. In majority of the patients, suffering concurrent somatic diseases, laparoscopic rectopexy was performed without rectal resection. This method of treatment was suggested as an effective one, permitting to escape recurrence and to improve the quality of life significantly.

[A comparative analysis of changes in immune homeostasis in laparoscopic and conventional surgical interventions on the large intestine]. / Porivnial'nyi analiz zmin imunnoho homeostazu pry laparoskopichnykh ta tradytsiinykh operatyvnykh vtruchanniakh na tovstii kyshtsi.

A comprehensive evaluation has been done of parameters characterizing cell-bound immunity, cytokinic profile, stress hormones (hydrocortisone), and C-reactive protein in a comparative aspect in those patients having undergone laparoscopic or conventional colectomy. The above indices were determined before surgery, in the early postoperative period, 24 h and 7 days subsequent to surgery. Laparoscopic surgical intervention was found out to lower somewhat the level of immunosuppression early in the postoperative course, which fact is manifested by retaining of expression HLA-DR on monocytes of the peripheral blood. Further randomized investigations should allow the final judgement about the degree of surgical stress.

[Laparoscopic resection of the colon]. / Laparoscopichna rezektsiia tovstoï kyshky.

Possibilities of laparoscopic colonic resection and colectomy in the treatment of the patients with tumoral and nontumoral affection of colon and rectum were determined. Laparoscopic resection of colon and rectum was performed in 94 patients, including 67--for colorectal cancer. Due to the disease recurrency 10 patients died. Laparoscopic resection is the method of choice in the treatment of patients with nontumoral affection of colon.

[The usage of the laser induced fluorescence in laparoscopy]. / Vykorystannia indukovanoï lazerom fluorestsentsiï v laparoskopiï.

Optic biopsy (the laser-induced fluorescence) was applied in laparoscopic surgery in 14 patients with colonic malignancy. There were investigated 66 lymph nodes. Trustworthiness of the laser induced fluorescence was 80.7%.