[Fungal infection in the oncologic clinic]. / Gribkovaia infektsiia v onkologicheskii klinike.

Fungal infection in oncologic hospitals is a serious threat for the patients that can undermine the results of the specific treatment of the main disease. Most frequently fungal infection is developing in localities naturally disseminated with microbial flora. The infection is usually mixed: bacterial/fungal and even fungal/fungal. The most frequent members of the associations are the representatives of Candida albicans: 63 per cent in the bacteria + fungi associations and up to 60 per cent in the fungi + fungi associations. The preventive use of azoles can lower the threat of fungal affection of the organs. However, the danger of mixed fungal/bacterial infection remains rather high.

[The microbiological aspects of infectious complications in the oncology clinic]. / Mikrobiologicheskie aspekty infektsionnykh oslozhnenii v onkologicheskoi klinike.

At present 10 to 30 per cent of the microbial strains from cancer patients are problem ones: oxacillin resistant strains of Staphylococcus aureus, coagulase negative strains of Staphylococcus spp., aminoglycoside resistant strains of Escherichia coli, 3rd generation cephalosporin resistant strains of Klebsiella spp. and fungi of Candida which requires development of more rational approaches to antibacterial chemotherapy and prophylaxis of infectious complications. The infectious processes in the cancer patients proved to be highly polyetiological. Therefore, the study is significant for epidemiologic and therapeutic measures. Such an analysis in oncological clinic should be regular.

[Infections of a fungal etiology in the cancer clinic]. / Infektsii gribkovoi etiologii v onkologicheskoi klinike.

Candida fungi, more than half of which are Candida albicans, are responsible for up to 28% of microflora contaminating the pathological material during infectious processes coursing in cancer patients. They may be isolated as a monoculture or in associations with bacteria, depending on the localization of the process. In both cases their pathogenetic significance is really great, which is confirmed by the efficacy of antimycotic therapy and prophylactic measures. The prevalence of fungal infections necessitates taxonomic identification of the isolated fungal cultures.

[Etiologic structure of infectious complications in the urogenital tract of oncologic patients]. / Etiologicheskaia struktura infektsionnykh oslozhnenii v urogenital'nom trakte onkologicheskikh bol'nykh.

The investigation of the microflora of infectious complications in the urogenital tract of oncological patients showed that in spite of the similarity of the microbiotypes, the microflora of the infectious complications in the patients had marked differences. The causative agents in urological patients were mainly monocultures (69.9 per cent), whereas in gynecological patients they were mainly associations (67.2 per cent), more frequently of 2 and sometimes of 3 and even 4 or 5 taxa. The taxonomic spectra of such pathogens were also different. In the urological patients a much broader spectrum of the bacterial species with the predominance of gram-negative rod-shaped bacteria was detected. In the gynecological patients the predominating taxa were Candida spp., Staphylococcus spp., Escherichia coli and S. faecalis. The other bacteria in total amounted to 13.9 per cent. In the urological patients the predominating taxa were Pseudomonas aeruginosa, E. coli, Candida spp. and S. faecalis. The frequency of Staphylococcus spp. and Candida spp. was twice as low as that in the gynecological patients. Therefore, the comparative investigation of the causative agents in the urinary tract and female genitalia of the oncological patients revealed significant differences which cast doubt on the validity of empirical antibacterial therapy according to the principle of "above and below the waist" practiced by many physicians in the treatment of infectious complications in somatic hospitals.

[In vitro activity of surgical suture materials containing cephalosporin antibiotics]. / Issledovanie in vitro aktivnosti khirurgicheskikh shovnykh materialov, soderzhashchikh tsefalosporinovye antibiotiki.

Surgical threads containing cefazolin and cefoperazone were studied comparatively. Cefazolin was shown to incorporate into the structure of caproamide threads in an amount of 20 per cent by the thread weight while the cefoperazone incorporation amounted only to 3.7 per cent. The dynamics of the antibiotic release from the threads was investigated in detail and it was found that cefazolin had no advantages over cefoperazone. In spite of the equal value with respect to the antibiotic release, cefoperazone proved to be a better drug, its use was more economic and the spectrum was broader. Therefore, the threads containing cefoperazone could be considered more promising for the prophylaxis of surgical infections.

[Mycoses in oncologic patients]. / Mikozy u onkologicheskikh bol'nykh.

Lately the frequency of fungal infections in oncological patients considerably increased. The cause is a decreased immune status and in particular decreased immunity against fungal infections in oncological patients because of the oncological disease and aggressive treatment. In the patients treated with immunodepressants the frequency of Candida vegetating on the skin and in open cavities was higher. Fungi were isolated from the pathological materials of 8.9 per cent of the patients in 1981, 12 per cent in 1990, 17 per cent in 1991 and 24 per cent in 1992. Candida were more frequent than other taxa. The frequency of Candida amounted to 92-97 per cent of all the fungal isolates. This stipulated for the necessity of not only an adequate use of antimycotics in the treatment of fungal infections and more often mixed bacterial and fungal infections but also the prophylaxis of fungal infections.

[Prolonged antibacterial action of synthetic suture materials containing gentamicin]. / Prolongirovannoe antibakterial'noe deistvie sinteticheskikh shovnykh materialov, soderzhashchikh gentamitsin.

A new sutural material in the form of polyacrylamide threads containing gentamicin in an amount of 10 per cent by the thread weight was studied. After storage for a year under refrigerator conditions the threads preserved their antibacterial activity when studied in vitro. Since gentamicin was included within the threads by means of the ionic links its release from the threads to the environment either in vitro or in vivo was gradual and uniform within at least 10 days. The quantity of the released antibiotic depended on its content per unit of thread length. The marked antibacterial effect within the prolonged period is a basis for the use of the threads in surgical practice for the prevention of infections in the early postoperative period.

[The antibiotic prophylaxis of postoperative complications in breast cancer patients]. / Antibiotikoprofilaktika posleoperatsionnykh oslozhnenii u bol'nykh rakom molochnoi zhelezy.

The studies showed that infectious complications in patients operated for breast cancer (BC) most frequently developed after removal of the drainage tube resulting in poorer discharge favourable for development of infections. The causative agents in such cases are usually exogenous bacteria differing from endogenous ones (Staphylococcus epidermidis) inhabiting the human skin and sometimes contaminating the operative field. The endogenous bacteria are detectable bacteriologically in 60 per cent of the cases. Still, since the operation wound contains humoral and tissue immunity factors (specifically active against the host microflora) such bacteria rarely grow on artificial media (18 per cent) and even more rarely cause infections. Therefore, to prevent postoperative infections in patients with BC it should be recognized rational to use broad-spectrum antibacterial drugs such as ampiox, ampicillin, doxycycline, cephalosporins of the 2nd and 3rd generations, etc. for 5 to 6 days after the drainage removal. If an infection develops the preventive therapy should be replaced by an adequate therapy in accordance with the pathogen sensitivity.

[Prevention of postoperative infectious complications with suture materials containing gentamicin]. / Profilaktika posleoperatsionnykh infektsionnykh oslozhnenii s pomoshch'iu shovnykh materialov, soderzhashchikh gentamitsin.

Sutural materials containing antibiotics such as gentamicin and tetracycline were studied on dogs with respect to the action on development of inflammation reactions after operations on the large intestine. It was shown that the antibacterial surgical threads had a prophylactic action and inhibited infection development. There was noted a significant advantage of the threads over the control ones not containing the antibiotics. The inflammatory reactions were less intensive and of shorter duration. The terms of onset and completion of the reparation also markedly shortened.

[The resistance of the bacterial flora in cancer patients to drug therapy]. / Issledovanie ustoichivosti bakterial'noi flory onkologicheskikh bol'nykh k lekarstvennoi terapii.

Agents etiologically relevant to hospital infection have been studied in an oncologic clinic for the period of 20 years since 1969. Pronounced changes in the profile of basic infections have been observed. In 1969, Staphylococcus accounted for 46% of cases of infection and E. coli was isolated in 22% whereas in 1987 and 1988, the respective figures for staphylococcus were 18 and 16% only while for E. coli--8.4 and 8.6%, respectively. At the same time, the occurrence of all types of streptococcal infections has risen from 17 to 26-27%. As regards gram-negative bacilli such as Klebsiella spp., Ps. aeruginosa, Enterobacter, Acinetobacter and Serrata spp., their share has increased and spectrum has become wider. The level and spectrum of drug resistance have changed, too. The level of plasmid genes accounting for resistance and pathogenicity in bacterial genomes, particularly, in gram-negative bacilli, have increased. Formation of multidrug resistant strains was shown to depend both on intensity of drug treatment in the clinic and presence and activity of R plasmids, particularly, with a wide spectrum of hosts.

[Taxonomic spectrum of pathogens of mixed infections in oncology patients and principles of their antibacterial therapy]. / Taksonomicheskii spektr vozbuditelei smeshannykh infektsii v onkologicheskoi klinike i printsipy antibakterial'noi terapii.

Mixed infections were observed in oncological patients irrespective of the tumor or infectious process localization. 25-30 per cent of the pathological materials from such patients were contaminated with bacterial associations. The number of the associates ranged from 2 to 5 depending on the pathological material tested. Therapy of infectious complications due to pathogen associations should stem from analysis of many factors, i.e. properties of the isolated or likely pathogens, individual characteristics of the patients, compatibility of the drugs used and their pharmacokinetic features.

[Determination of the sensitivity to antibacterial preparations of the microflora in the sputum of patients with nonspecific lung diseases]. / Opredelenie chuvstvitel'nosti k antibakterial'nym preparatam mikroflory mokroty liudei s nespetsificheskimi zabolevaniiami legkikh.

Nonspecific pulmonary diseases (NPD) of infectious etiology often complicate and aggravate the course of various somatic diseases. Isolation, identification, and assessment of the drug sensitivities of the agents are obligatory for effective therapy. The sputum is the most frequent object of microbiologic investigation. Such investigation is fruitful if the sputum is properly collected and the quantitative method is used for inoculation in a set of nutrient media, that provide the maximum growth of the agents. A correct estimation of the role of isolated bacteria in the infectious process involves additional studies of their biological characteristics and clinical interpretation of the findings. Assessment of antibiotic sensitivity provides the most valuable information for a clinician, but these data are clinically useful only if referred to the agent and not to the contaminating flora.

[Combined antibacterial therapy of infectious complications in oncological patients]. / Kombinirovannaia antibakteria'lnaia terapiia infektsionnykh oslozhnenii u onkologicheskikh bo'lnykh.

Rational antibacterial therapy of infections in oncological patients in relation to the polyetiological nature of the infections and polyresistance of their causative agents contemplates the use of drug combinations. The necessity of long-term antibacterial therapy in many oncological patients also predisposes to it. The choice of drugs for every patient should stem from bacteriological findings: isolation of the pathogen, its identification and assay of its antibiotic sensitivity. When isolation of the causative agent is not possible or could not be done immediately the drug should be chosen according to the general data on the etiological structure of infectious complications in the particular department and particular pathological process as well as antibiotic sensitivity of the bacteria isolated under such conditions.

[Use of cephalosporins for the prevention of mixed infection during surgical treatment of rectal cancer]. / Primenenie tsefalosporinovykh antibiotikov dlia profilaktiki smeshannoi infektsii vo vremia operativnogo vmeshate'lstva po povodu raka priamoi kishki.

Cephalosporin antibiotics such as cephaloridine, cephazolin and cephalothin++ were used during operations for rectum cancer. The antibiotics were administered intravenously and immediately into the superior rectal artery. It provided high levels of the antibiotics in blood and discharge of the small pelvis cavity and prevented development of infectious complications during the postoperative period.

[Microbial ecology of the intestines in health and in pathology]. / Mikrobnaia ékologiia kishechnika v norme i pri patologii.

Bifidoflora constitute 85--95 per cent of the large intestine microbiocenosis in children under 1 year of age. Bacteroides are not specific of children under 6 months of age. Lactobacilli, lactic acid streptococci, colon bacilli, enterococci and staphylococci (saprophytic, epidermal) constitute not more than 15 per cent. The predominating group peculiar of eubiosis in adults includes bifidobacteria and bacteroides. Changes in human autoflora are often induced by such factors as impaired ecology, stress, uncontrolled use of antibacterial drugs, radio- and chemotherapy, etc. Dysbacteriosis (first of all lower quantitative contents of bifidoflora) has an unfavourable effect on the intestine secretory function, absorption and certain indices of protein, lipid and mineral metabolism, vitamin synthesizing and fermentative functions and leads to disfunction of the gastrointestinal tract. It is a cause of persisting and relapsing infections in children and adults. High and optimal levels of bifidoflora in the intestine usually prevent the pathogenic action of pathogens. Lysozyme of digestive secretion and secretory immunity with immunoglobulin A prevalence also play an important role in the complicated mechanism of the protective barrier. The use of bacterial preparations such as bifidumbacterin, lactobacterin or bifilact for stabilization and recovery of high bifidoflora levels is indicated in all the cases with impaired microbiocenosis of the intestine.

[Plasmids and genetic determinants of antibiotic resistance of gram-negative bacteria]. / Plazmidy i geneticheskie determinanty rezistentnosti k antibiotikam gramotritsatel'nykh bakterii.

Distribution of plasmids and genetic determinants of antibiotic resistance was studied in 129 strains of Pseudomonas, Klebsiella, Serratia and Enterobacter isolated from oncological patients. It was shown that 56 isolates contained the plasmids, 9 conjugative plasmids being plasmids with broad bacterial host spectrum. A significant part of the strains contained genes controlling production of APH (3"), type II APH (3'), type I and II DHPS and type type II DHFR. Genetic determinants of tetracycline resistance of classes D and E were detected for the first time in the strains of Klebsiella, Serratia and Pseudomonas aeruginosa.

[Characteristics of Pseudomonas aeruginosa pili and an elucidation of their relation to the virulence of the bacteria]. / Kharakteristika pilei Pseudomonas aeruginosa i vyiasnenie ikh sviazi s virulentnost'iu bakterii.

The electron microscopic study of 175 P. aeruginosa museum and newly isolated strains has been made and their virulence has been determined. In 32% of these strains the presence of pili has been established. However, among the museum strains those with pili have been found to constitute only 19.5%, while among newly isolated strains pili have been detected in 39.7% of cases (the difference is statistically significant at p less than 0.01). No correlation between the formation of pili and the virulence of P. aeruginosa has been established.

[Dysbacteriosis--infectious processes of mixed etiology]. / Disbakteriozy--infektsionnye protsessy smeshannoi étiologii.

At present dysbacteriosis or altered normal and sometimes very individual proportion of microorganisms in various macroorganism microbiotopes is considered as an infectious disease since it results from pathogenic action of microbes, is characterized by a set of features relating to pyoinflammatory processes and even can be contagious.