[Susceptibility of gramnegative carbapenemase-producing bacteria to various group antibiotics].

The study involved 25 isolates of gramnegative carbapenemase-producing bacteria. 17 isolates of Klebsiella pneumonia produced carbapenemase NDM-1 and were highly resistant to cephalosporins (MIC>128 mcg/ml), carbapenems (MIC>16 mcg/ml), aminoglycosides and fluoroquinoiones, while among them 4 isolates preserved susceptibility to azthreonam and all of them were susceptible to tigecycline and polymyxin. 2 isolates of Acinetobacter genomospecies 13 produced NDM-1 and were resistant to all the beta-lactams and amikacin, while preserved susceptibility to gentamicin, co-trimoxazole, tigecycline and polymyxin, the susceptibility to ciprofloxacin being lowered. Carbapenemase VIM-4 was produced by 2 isolates of Enterobacter cloacae, which were highly resistant to cephalosporins and azthreonam, significant synergism being observed between cefepim and clavulanate. The resistance of the isolates to carbapenems was low (MIC 0.5-4.0 mcg/ml), they also being resistant to aminoglycosides and ciprofioxacin and susceptible to tigecycline and polymyxin. Carbapenemases KPC-2 were detected in 2 isolates of K.pneumoniae and in 1 isolate of E.cloacae. The above isolates were resistant to all the beta-lactams, ciprofloxacin, aminoglycosides and co-trimoxazole. I isolate of E.cloacae showed resistance to tigecychine and I isolate of K.pneumoniae was resistant to polymyxin. Carbapenemase OXA-48 was detected in 1 isolate of K.pneumoniae. It was resistant to all the beta-lactams, ciprofloxacin and co-trimoxazole and susceptible to aminoglycosides, tigecycline and polymyxin.

[Cholangitis and biliary sepsis: problem and ways of solution].

The distinctions and interrelationship were established between acute cholangitis and biliary sepsis. Patients with hyperbilirubinemia were divided into four groups according to the developed criteria of inclusion and of using a new strategy of treatment for each group. It determined the result of treatment, i.e. resulted in lower lethality, shorter stay at hospital, less cost of treatment. One of the main criteria for the inclusion into a certain group was considered to be the index of blood plasma procalcitonin.

[Erysipelatous inflammation: a new view on a long-standing problem]. / Rozhistoe vospalenie: novyi vzgliad na nestareiushchuiu problemu.

Under observation there were 72 patients with primary and recurring forms of erysipelatous inflammation. The data obtained have shown the reliable (p<0.001) effectiveness of antimitotic treatment with terbinaphin hydrochloride (lamizil) for prophylactics of recurrences of erysipelatous inflammation: the frequency of recurrences in the group of the treatment was 7.1%, in the control group it was 45.5%.

[Comparative clinical-economic analysis of antibiotic therapy in pyogenic inflammatory diseases of the lower extremities]. / Sravnitel'nyi kliniko-ékonomicheskii analiz programm antibiotikoterapii gnoino-vospalitel'nykh zabolevanii nizhnikh konechnostei.

A randomized comparative investigation was carried out in two equal groups of patients with pyo-inflammatory diseases of lower extremities (the total number 50 patients) in order to study effectiveness and tolerance to Netilmycin (1st group) and Gentamycin (2nd group) given in combination with Cefasolin. Clinical symptoms were estimated immediately after operation, in 3, 6 and 10-12 days after it. Bacteriological investigations were fulfilled immediately after operation, in 72 h and in 6-10 days after the beginning of antibacterial therapy. Clinical and biochemical investigations of blood were fulfilled before and in 10 days after the beginning of the treatment. Effectiveness of the treatment in the first group was 100%, in the second group--80%. In the second group the antibiotics were changed in 20% of cases and the average duration of hospitalization among the patients of this group was reliably longer that in the first group. The eradication rating of Netilmycin was higher than that of Gentamycin (25 strains from 25 and 20 from 25 respectively). Gentamycin had a pronounced nephrotoxic effect (elevation of the level of creatinin and urea of blood in dynamics by 21% and 32%), as compared with Netilmycin (9% and 3%). Total expenses to antibiotic therapy in the first group made up 97,650 rub, and in the second group 106,245 rub. Netilmycin in combination with Cefasolin was more effective for acute pyo-inflammatory diseases of lower extremities than a combination of Gentamycin with Cefasolin, it more rapidly resulted in reduction of clinical signs of inflammation, was better endured and more economical.

[The role of cefepime, a 4th-generation cephalosporin, in treating patients with surgical sepsis]. / Rol' tsefalosporina IV pokoleniia tsefepima v lechenii bol'nykh s khirurgicheskim sepsisom.

Cefepime (Maxipime) was used in the management of 22 patients at the age of 18 to 73 years with the surgical sepsis syndrome (SAPS > 15). In 16 patients surgical sepsis was due to pancreatitis, appendititis, abdominal wound or trauma or complications after planned surgical interventions on the organs of the abdominal cavity. In the other 6 patients surgical sepsis was due to inflammatory processes in soft tissues after minor trauma. In 10 patients (group 1) cefepime was used after the pathogen verification and antibioticogram examination. In 12 patients (group 2) the antibiotic was used in the empirical therapy as the first line drug after the patients acceptance from another unit when the pathogen nature was obscure. Cefepime was administered intravenously in a dose of 2.0 g twice daily for 7 to 10 days in combination with metronidazole in a dose of 0.5 g thrice daily. After 5-6 days of the treatment the patients of group 1 were switched to the cefepime intramuscular regimen. The lethality totaled 18 per cent (4 patients). Three of them were from group 2. The patients died of progressive polyorgan insufficiency. It is characteristic that in no cases cefepime induced septic shock due to the endotoxin escape. No septicopyemia was as well observed even in the patients with verified bacteremia due to Staphylococcus aureus.

[Pseudomembranous colitis and "intestinal sepsis" as a consequence of dysbacteriosis due to antibiotics]. / Psevdomebranoznyi kolit i "kishechnyi sepsis" vsledstvie disbakterioza, vyzvannogo antibiotikami.

Based upon 11 personal observations and data of literature the authors describe etiopathogenesis, clinical picture, diagnosis and treatment of pseudomembranous colitis. The recommended complex therapy resulted in the recovery of all the patients.

[The principle of cytokine therapy in the sepsis syndrome (a preliminary report)]. / Printsip tsitokinovoi terapii sepsis-sindroma (predvaritel'noe soobshchenie).

The results of using recombinant interleukin-2 from yeast for the treatment of patients with the sepsis syndrome are discussed. It is noted that there was a marked immunomodulating effect, the amount of endogenous interleukin-2 increased. The patients' state was shown to become less severe (according to the SAPS criterion), the patients felt better. A conclusion is made of the possibility in principle and expediency of using cytokines for the treatment of patients with the sepsis syndrome.

[Wound infection]. / Ranevaia infektsiia.

A present-day view on the problem of wound infection is analyzed with special reference to recent data. Active surgical approach in combination with many-component antibacterial and correcting treatment still remains important in prevention and treatment of wound infection.