Prevalence and Antibiotic Resistance of Carbapenemase-Producing Gram-Negative Bacteria in Saint Petersburg and Some Other Regions of the Russian Federation.

Carbapenemase-producing gramnegative bacteria, which hydrolyze most offi-lactams, including carbapenems, is of global health care system threat. The number of the known carbapenemases is constantly increasing, however only four types are widely distributed: NDM-type, KPC-type, OXA-48-type and VIM-type. The frequency of carbapenemase-producing Klebsiellapneumoniae in hospitals of Saint Petersburg reached 9.2% (5.9% for NDM-type, 1.4% for OXA-48-type, 1.9% for NDM-type + OXA-48-type). Carbapenemase producers were also detected in hospitals of Moscow, Yekaterinburg, Vologda, Murmansk, Kurgan, Krasnoyarsk, Izhevsk, Krasnodar and Perm. In total 281 carbapenemase producers were recorded within 2011-2016, which were isolated from infected or colonized patients (K.pneumoniae - 247 isolates, Acinetobacter spp - 29 isolates, Enterobacter cloacae - 2 isolates, Serratia marcescens - 1 isolate, Escherichia coli - 1 isolate and Proteus mirabifis - 1 isolate). The carbapenemase-producing K.pneumoniae isolates were distinguished by considerable genetic diversity, the NDM-type carbapenemase-producers belonged to eight, KPC-type - to three and OXA-48-type - to four different sequence-types (STs) respectively. The representatives of the globally dominant genetic line, Clonal Group 258 (CG258), and also a number of the less common lines (ST147, ST273, ST307 and ST377) were detected. The K.pneumoniae strains were distinguished by a high frequency of cross-resistance and the associated resistance to antibiotics of different groups. The frequency of resistance to cephalosporins and fluoroquinolones reached 100%. Among the NDM-type carbapenemase producers the frequency of resistance to aminoglycosides exceeded 90%, among the KPC-type carbapenemase producers the frequency of resistance corresponded to 66% for amikacin and 93% for gentamicin, among the OXA-48 type carbapenemase producers the frequency of resistance was even lower (50% and 73% respectively). Approximately 80% of the NDM-type, 90% of the KPC-type and only 60% of the OXA-48-type carbapenemase producers showed a high level of resistance to imipenem and meropenem. The frequency of resistance to tigecycline varied within 6.7% to 14.8% and the frequency of resistance to polymyxin was within 4.2% to 20%. The OXA-40- and OXA-23-types carbapenemase-producing Acinetobacter spp. remained susceptible only to polymyxin. It is obvious that the possibility of antibacterial therapy of infections caused by carbapenemases producers is limited.

[Discovery of Genetic Markers of Resistance to ß-Lactams in Gramnegative Microorganisms by PCR Diagnosis].

Fifteen specimens of the hemoculture and 89 specimens of the broncho-alveolar lavage were used in the study. Monocultures of gramnegative bacteria resistant to cefotaxime, cefepime, imipenem and meropenem were isolated from the specimens. The PCR method with detection of the results in the real time regimen (PCR test-system Litekh) provided detection of the beta-lactamase genes: bla(CTX-M-like) (72/104, 69.2%), bla(NDM) (6/104, 5.8%), bla(VIM) (49/104, 47.1%) and bla(OXA48-like) (59/104, 56.7%). There was identified correlation between the phenotype of resistance of Acinetobacter spp., Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli to cefotaxime and carbopenems and detection of the bla(CTX-M-like) and bla(NDM) genes. At the same time, up to 70% of the K. pneumoniae isolates from the biological specimes positive with respect to the presence of the carbapenase bla(VIM) and bla(OXA48-like) genes demonstrated their phenotypic susceptibility to carbopenems. The results of the study confirmed the prognostic value of the genetic diagnosis for improvement of the routine bacteriological investigations.

[Pharmacological protection of the myocardium with reamberin in coronary artery bypass grafting in patients with postinfarction angina].

AIM: To assess efficacy of reamberin in preoperative preparation and after coronary bypass (CB) in patients with macrofocal myocardial infarction (MI) complicated with postinfarction angina. MATERIAL AND METHODS: A total of 45 patients with Q-positive MI complicated with postinfarction angina pectoris entered the trial. The study group consisted of 20 (44.4%) patients given 200-400 ml injections of 1.5% reamberin solution for 3 days before coronary artery bypass grafting (CABG) and 3-5 days after it. The control group consisted of 25 (55.6%) patients given basic therapy without cardioprotection. ECTG-60, echocardiography, CM-ECG, laboratory tests were made before CABG. CABG was made in conditions of artificial blood circulation in all the patients. RESULTS: Clinical stabilization was observed after direct myocardial revascularization in hospitalized 25 (100%) patients of the study group and 22 (88%) patients of the control group. Early postoperative acute cardiac failure (ACF) developed in 3 (12%) patients from the study group and 9 (36%) from the control group (p = 0.04), arrhythmia occurred in 2(8%) and 8(32%) patients, respectively (p = 0.03). Two (8%) control patients died in early postoperative period from acute cardiac failure. Perioperative MI occurred in 2(8%) control patients. After 12 months of the follow-up, patients of the study group had no recurrent angina pectoris, while among the controls 4(16%) patients had recurrent angina of FC III. After surgical intervention at discharge and 12 months after treatment patients of both groups improved systolic and diastolic functions of the left ventricle. Normalization of the diastolic function was registered in 80% patients of the study group (p < 0.001) and in 44% from the control group (p < 0.001) after 1 year follow-up. CONCLUSION: Reamberin reduces the number of postoperative complications, ischemic damage to the myocardium, significantly improves systolic and diastolic functions of the left ventricle.