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.

[MULTI-LEVEL EVALUATION OF BIOSOCIAL RISK FACTORS OF HIV-INFECTION AMONG MIGRANT WORKERS].

AIM: Multi-level evaluation by case-control method of social, sociocultural and behavioural risk factors of HIV-infection spread among male migrant workers arriving to Russia from near abroad countries. MATERIALS AND METHODS: Interviews of migrants, that had appealed for medical examination for work permit, were carried out for detection of risk factors. Results of interviewing of 191 migrants with HIV-infection (case group) and 190 migrants without HIV-infection (control group) were analyzed. Methods of descriptive statistics and logistical regression were used for the analysis. RESULTS: Factors, related to dangerous sexual behavior, were leading in development of HIV-infection. Furthermore, HIV-infected migrants had inferior work and accommodation conditions, lower salary, lower subjective health evaluation, became object of xenophobia more frequently and had more previous travels into the receiving country. Factors, that reduce risk of infection and spread of HIV-infection, were detected: HIV-infection awareness, adherence to religion and legal requirements of the receiving country. Advantages and disadvantages of survey- ing during detection of HIV-infection risk factors are discussed. CONCLUSION: The same risk factors of HIV-infection spread are significant in the population of migrant workers as in the indigenous population. Factors specific for migrants, that facilitate infection spread, were also established. HIV prophylaxis system among migrants should be based on prevention and correction of risk factors detected in the study and enhancement of factors, that cause preventive effect.

[Contemporary view on the role of bacteriophages in evolution of nosocomial strains and prophylaxis of healthcare associated infections].

One of the actual problems of contemporary healthcare are healthcare associated infections (HAI). An important aspect of study of HAI problem is the study of evolution of hospital strains causing HAI. The knowledge accumulated to date in the field of bacteria genetics gives evidence on the significant role of phages in the mechanism of virulence obtaining by pathogenic and opportunistic microorganisms. The studies of the authors of this article show that bacteriophages may play a significant role in the formation of virulent properties in hospital conditions that in different hospitals with participation of phages form virulent and antibiotic resistant hospital strains of HAI causative agents. At the same time bacteriophages are effective means for HAI therapy and prophylaxis. Under the condition of mass and irrational use of antibiotics, HAI causative agents form multiple resistance to the existing antibacterial preparations. In this regard bacteriophages as antimicrobial agents become especially actual. To date in Russian and foreign literature considerable material has been accumulated that shows high effectiveness of bacteriophages under the conditions of rational use. The aim of this review is to evaluate contemporary achievements in the field of study of bacteriophage role in evolution of hospital strains and therapy and prophylaxis of healthcare associated infections.

[Zoflox, an antibacterial drug, in treatment of infectious pathologic processes in the lower respiratory tract complicating acute respiratory viral infection in elderly patients].

Clinical trial of Zoflox, an antimicrobial drug, was performed in complex therapy of elderly outpatients with acute pneumonia complicating acute respiratory viral infection. Among the outpatients there were elderly subjects with hepatic insufficiency. The drug showed to be efficient and safety when used in a middle therapeutic dose of 400 mg twice a day daily for 10-14 days.

[Terminologic aspects of infections associated with administration of medical aid].

Evolution of key terms used in epidemiology of nosocomial infections is discussed. A modern point of view on terminology and comparison of Russian terms with foreign analogues are presented.

[Epidemic strain of methicillin-resistant Staphylococcus aureus in hospitals of Saint-Petersburg].

AIM: To study genetic characteristics of methicillin-resistant Staphylococcus aureus (MRSA) causing nosocomial infections in specialized inpatient clinics of Saint-Petersburg. MATERIALS AND METHODS: Nine cultures of S. aureus, which caused nosocomial infections in patients of 3 clinics in Saint-Petersburg, were studied by pulse-electrophoresis and spa-sequence typing. Identification of superantigens' genes pvl, sea, seb, sec, tst was performed by PCR. RESULTS: Circulation of epidemic clone BT2007 attributed to spa-type t008 was revealed. According to pulse-electrotype, this epidemic clone was related with European epidemic clones of widespread cluster A. CONCLUSION: Epidemiologic surveillance for MRSA should incorporate monitoring of clonal structure of the agent on both local (intra-clinic) and regional level.

[Antioxidant gene polymorphism and longevity].

On sample of 1534 ethnic Tatars catalase (CAT, -262C/T), glutathione peroxidase 1 (GPX1, L198P) and methionine sulfoxide reductase A (MSRA, -402C/T) gene polymorphisms in connection with lifespan were studied. On each separate polymorphic marker nonlinear character of alleles and genotypes frequencies changes with age was revealed. Combinations of genotypes CAT*C/*T-GPX1 *L/*L were significant for elderly and senile age.

[Paraoxonase 1 gene polymorphism 192Q/R in old men and long-livers from Tatars ethnic group].

Comparison in genotype and allele frequencies of people groups of younger (from 1 till 20 years), middle (21-55 years), elderly (56-74 years), senile (75-89 years) age and long-livers (90-109 years) have been performed (only 1116 person) with the purpose of analysis of molecular-genetic bases of ageing and longevity of the person. Allele variants of PON1 gene have been identified by polymerase chain reaction in a combination with restriction analysis. In the general sample of Tatars genotypes PON1*Q/*Q, PON1*Q/*R and PON1*R/*R are revealed with frequencies of 46.15, 44.35 and 9.5%, alleles PON1*Q and PON1*R are found with frequencies of 68.32 and 31.68% accordingly. Statistically significant distinctions on frequencies of genotypes and alleles between separate age groups are found. It has appeared, that frequency of PON1*R allele (28.46%) is lowered among old men in comparison with those among persons of younger age (37.42%, P = 0.009). However essentially above in group of long-livers, than in group of old men, frequencies allele PON1*R (P = 0.005) and genotype PON1*R/*R (P = 0.01).

Recruitment of synapses in the neurosecretory process during long-term facilitation at the lobster neuromuscular junction.

We investigated long-term facilitation at the lobster neuromuscular synapse employing a combination of FM1-43 staining of synaptic vesicles, electron microscopy analysis, and electrical recordings of synaptic activity. Synaptic terminals were loaded with the fluorescent dye FM1-43 producing clusters of activity-dependent fluorescent spots. Electron microscopy analysis of synaptic ultrastructure suggested that fluorescent spots represent compartments of synaptic terminals filled with vesicles. Excitatory postsynaptic currents were recorded from the stained synaptic terminals using focal macropatch electrodes. Terminals were stained during the nerve stimulation at a low stimulation frequency (2, 5 or 10 Hz) before and after long-term facilitation was elicited by high-frequency stimulation (20 or 30 Hz for 5 min). We found that staining after long-term facilitation results in the appearance of new fluorescent spots, as well as in the increase in fluorescence of the spots that appeared before long-term facilitation. This increase in fluorescence accounted for the increase in quantal release. Activation of individual fluorescent spots was found to be non-uniform. In spite of overall increase in fluorescence, some synaptic compartments decreased their staining after long-term facilitation. Thus, our study demonstrates that long-term facilitation produces non-uniform activation of FM1-43 uptake in synaptic compartments that correlates with the increase in quantal neurosecretion.

[Mode of the rational use of Pseudomonas aeruginosa bacteriophages in therapeutic and epidemic control practice]. / Puti ratsional'nogo ispol'zovaniia sinegnoinykh bakteriofagov v lechebnoi i protivoépidemicheskoi praktike.

Ecological aspects of the circulation of P. aeruginosa and P. aeruginosa bacteriophages under hospital conditions were under study. The statement concerning the formation of triple parasitic systems was put forward. The influence of these systems on the formation of phage and antibiotic resistance in P. aeruginosa hospital strains was studied. Spontaneous circulation of faintly virulent phages taking part in the formation of triple parasitic systems was shown not to ensure the elimination of P. aeruginosa hospital strains in clinics. Construction of highly virulent phages adapted to local P. aeruginosa strains was the only way of ensuring the protection of patients. Theoretical and practical approaches to the use of highly active bacteriophages for controlling P. aeruginosa infection were substantiated. The realization of these approaches resulted in achieving not only a clinical, but also essential epidemic control effect in cases of purulent septic infections caused by P. aeruginosa (a decreased frequentcy of hospital infections from 40.8% to 8.93%).

[Biological factor of work conditions in medical institutions and its influence on health status of medical personnel]. / Biologicheskii faktor uslovii truda v lechebnykh uchrezhdeniiakh i ego vliianie na sostoianie zdorov'ia meditsinskikh rabotnikov.

The article covers epidemiologic analysis of medical staff health state, epidemiologic evaluation of biologic factor's influence (degree and character of) on clinical staff, detection of principal risk factors for being infected. The aim is to create a supervision system and to elaborate effective measures for occupational risk prevention in medical personnel. Organizing a goal-seeking and effective system for occupational risk prevention and health care in medical staff, one should consider specificity in each medical establishment and in each occupational task.

[The possibilities for using combined methods in typing Candida albicans for establishing epidemiological relationships]. / Vozmozhnosti primeneniia kombinirovannykh metodov tipirovaniia Candida albicans dlia ustanovleniia épidemiologicheskikh sviazei.

An outbreak of candidiasis caused by C. albicans was registered in a neonatal intensive care unit of one of the hospital of St.-Petersburg at the period of August 12-October 8, 1992. C. albicans were isolated from 21 out of 87 patients. To achieve their more detailed deciphering and to establish epidemiological relationships, the intraspecific typing of C. albicans was carried out by DNA typing and by the electrophoretic spectrum of exoproduct proteins. The analysis of the results of this typing revealed that strains classified with the same biotype belonged to different electrophoretic groups and, vice versa, strains of the same electrophoretic group could belong to different biotypes. The analysis of the data obtained by taking into account the results of typing by the two methods, the time of the patients stay in the unit, the number of the maternity clinic from which an individual patient arrived, the number of the reanimation place and the number of the apparatus for artificial lung ventilation made it possible to establish epidemiological relationships between the patients in all cases.