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.

[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).

[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.

[An outbreak of nosocomial candidiasis in a hematology ward]. / Vspyshka vnutribol'nichnogo kandidoza v gematologicheskom otdelenii.

The aim of the present investigation was the study of the epidemic process of hospital candidiasis. The study was carried out from October 1991 to May 1992 in a hematological ward of one of the hospitals of St.-Petersburg on 9 patients with generalized forms of candidiasis: in 4 of them the disease was caused by C. albicans and 5--by C. parapsilosis. Intestinal dysfunction as one of the first manifestations of candidosepsis caused by C. albicans, the isolation of C. albicans from feces, ulcero-necrotic colitis (established by postmortem examination), as well as the incapacity of these patients of immune response (in 2 serologically examined patients the titer of antibodies to fungi of the genus Candida was found to be lower than the diagnostic titer), were indicative of the dissemination of fungi from the gastrointestinal tract. The cases of fungemia caused by C. parapsilosis were due to the fungal contamination of vascular catheters in these patients. This infective agent was also isolated from washings obtained from the hands of nurses carrying out treatment and from medical rubber gloves. Moreover, some violations in the rules of the preparation of disinfecting solutions and the treatment of the hands of the personnel were established.

[Epidemiological features of hospital purulent-septic infections in otolaryngological wards]. / Epiemiologicheskie osobennosti gospital'nykh gnoi-septicheskikh infektsii v otolaringologicheskikh otdeleniiakh.

Prospective epidemiological observation in an otorhinolaryngological hospital has made it possible to distinguish the specific features of pyoseptic nosocomial infections. Such infections, appearing as cross re- and superinfections, are most frequently induced by staphylococci, as well as by Proteus and Pseudomonas aeruginosa. High risk groups include patients with purulent otitis and sinusitis, who have contacted infection through instruments in examination and dressing rooms. The main sources of infection are patients with pyoseptic infections of the ear and sinuses.

[The use of a method for the electrophoretic typing by protein profiles of bacteria in the genus Acinetobacter for epidemiological diagnosis]. / Ispol'zovanie metoda élektroforeticheskogo tipirovaniia po belkovym profiliam bakterii roda Acinetobacter dlia épidemiologicheskoi diagnostiki.

On the basis of data obtained by the biological characterization and electrophoretic typing of Acinetobacter sp. cultures by the spectra of membrane proteins epidemiological relationships, routes of transmission and specific features of the circulation of strains causing purulent inflammatory diseases have been determined.

[Characteristics of sources and means of spread of Pseudomonas aeruginosa infections in urology wards]. / Kharakteristika istochnikov i putei rasprostraneniia sinegnoinoi infektsii v urologicheskom otdelenii.

Patients with purulent septic infections form the main source of infection in urological departments. The spread of infection from these patients occurs mainly by contact in dressing and cystoscopy rooms. The complex of measures, planned in accordance with the results of diagnosis, makes it possible to decrease morbidity rate in the purulent septic infections of the urinary tract.

[Epidemiological characteristics of postoperative wound infections in a trauma center hospital]. / Epidemiologicheskaia kharakteristika posleoperatsionnykh ranevykh infektsii v travmatologicheskom statsionare.

The occurrence of cross infections in osteomyelitis patients has been proved by clinical, microbiological, and epidemiological methods. The patients are infected mainly in the dressing room for patients with purulent processes; the working conditions in this dressing room do not preclude the possibility of cross infections.

[The causes and prevention of postoperative osteomyelitis]. / Prichiny vozniknoveniia i profilaktika posleoperatsionnogo osteomielita.

An analysis of causes of the appearance of postoperative osteomyelitis in 537 patients treated in the clinic has shown that in 82% they resulted from errors made by surgeons during operations, in 16% from insufficient examination of the patient during the preoperative period and erroneous management of the patients after operation. Strict observation of the requirements during the preoperative period, good organization, supply and performing the operation and postoperative managements, as well as the elevation of immune reactivity of the macroorganism allowed the percentage of postoperative osteomyelitis to be considerably reduced.