[Comparative evaluation of the antagonistic activity of collection lactobacilli against the multidrug-resistant Klebsiella pneumoniae].

Taking into account the known data on the high prevalence of multi-drug-resistant Enterobacteriaceae, such as Klebsiella spp., enterohemorrhagic Escherichia coli, and their properties to maintain viability in fermented milk products when using technologies in which, along with starter microorganisms, some enterobacteria with increased resistance to environmental factors (primarily active acidity) can survive and even multiply, the search for new strains of lactic acid probiotic bacteria with a pronounced antimicrobial effect are currently one of the most relevant areas of research in food biotechnology. Representatives of the Lactobacillus genus are currently considered as the most promising objects for the search for producers with probiotic properties. Their antagonistic activity is an important condition for ensuring the biological safety of foods created using fermentation and for developing effective measures to combat conditionally pathogenic and pathogenic microorganisms of the highest priority in terms of epidemiological significance. The aim of the research was to study the antagonistic activity of collectible probiotic Lactobacillus strains in relation to multi-resistant Klebsiella pneumoniae, to assess their suitability in the production of specialized fermented milk products. Material and methods. To determine the antagonistic activity of Lactobacillus collection strains in relation to the Klebsiella pneumoniae strain, two methods were used: co-cultivation and diffusion into agar using wells. Results. As a result of the study of 2 strains of lactic acid bacteria - Lactobacillus helveticus NK1 and Lactobacillus (Lacticaseibacillus rhamnosus) rhamnosus F as antagonists against Klebsiella pneimopiae hospital strain, characterized by multiresistance to antibiotics of different groups, the high efficacy of the L. rhamnosus F. strain was confirmed. Antagonistic activity of the L. helveticus NK1 strain was insignificant, which suggests the variability of Klebsiella and the importance of searching for an antagonist strain with the widest possible spectrum of action. Conclusion. The confirmed high antagonistic activity of the L. rhamnosus F strain makes it possible to recommend it for inclusion in starter cultures. The prospects of using the L. rhamnosus F strain, including for the production of fermented milk products for therapeutic nutrition and other special dietary uses, and for use in the diets of people with dysbiotic disorders, patients with intestinal infections, in particular, caused by multi-resistant strains of Klebsiella pneumoniaе, related to nosocomial infections, are shown. However, further research is needed to determine (identify) the mechanisms of the antimicrobial action of L. rhamnosus F. strain.

[Morphological justification of the effectiveness of ultrasonic cavitation with 0.2]. / Morfologicheskoe obosnovanie éffektivnosti primeneniia ul'trazvukovoi kavitatsii s 0,2 % rastvorom lavasepta pri lechenii gnoino-nekroticheskikh oslozhnenii sindroma diabeticheskoi stopy.

AIM: Structural and functional analysis of cells from purulent-necrotic wounds in patients with diabetic foot syndrome undergoing ultrasonic treatment with 0.2% Lavasept solution. MATERIAL AND METHODS: It is presented morphological/ultrastructural analysis of wound specimens in 90 (DFS) patients aged 27-80 years with diabetic foot syndrome and purulent-necrotic complications who were hospitalized in the department of wounds and wound infections of the Vishnevsky Institute of Surgery in 2013-2016. Main group consisted of 75 patients, control group - 15 patients. Mean age was 58.4±8.2 years. All patients had diabetes mellitus type II for previous 13±4.5 years. Severity of foot tissue damage was assessed according to Wagner classification (F. Wagner, 1981). 46 (51.1%) patients had Wagner III-IV, 44 (48.9%) patients - Wagner II. Complex treatment included radical surgical management of purulent lesion, surgical revascularization for critical limb ischemia and foot reconstruction at the final stage. Additional measures were complete unloading of the foot, correction of carbohydrate metabolism and concomitant diseases. Topical treatment between surgical stages included dressing with 1.0% betadine solution (once a day). Ultrasonic cavitation was additionally applied in the main group. Electron microscopic examination of specimens was used before treatment, after 3-5 and 7-10 days in order to assess effectiveness of ultrasound cavitation for purulent-necrotic complications of DFS. RESULTS: Ultrasound cavitation with 0.2% Lavasept solution effectively cleans wounds from microbial and cellular detritus, destroys cellular membranes of biofilm-forming microorganisms, prevents their redo development and reinfection of the wound. Effective management of the wounds accelerates reparative processes that allows to perform foot reconstruction early.

[Oflomelid ointment: activity against hospital microbial strains].

Ofloxacin susceptibility was tested with the use of 100 hospital isolates by the disk diffusion method vs. the activity of Oflomelid ointment tested by the cavity method. It was shown that the hospital isolates of all the species were susceptible to the Oflomelid ointment, while susceptibility to ofloxacin was preserved in S. epidermidis, the susceptibility of Acinetobacter spp., E. coli, Proteus spp. being intermediate. Such a difference in the susceptibility of the isolates was evidently due to the properties of polyethylene glycols in the ointment composition.

[Morphological and functional aspects of wound regeneration in the treatment by iodine-containing ointments].

The comprehensive morphological investigation indicated a high antimicrobial activity of iodine-containing ointments in the treatment of septic wounds from the first days of the ointments using. 3% ointment "Stellanin-PEG" helps to reduce the local inflammatory changes by activating neutrophils and macrophages. A management of wounds by 3% ointment "Stellanin-PEG" improves their condition by stimulating regeneration, which leads to an intensification of the proliferative and functional activity of granulation tissue. Clinical, morphological and cytological data are evidence of time reduction of relief of purulent process, which leads to an earlier (in comparison with the use of ointment "Betadine") wound epithelization.

[Rapid bioluminescent antibiotic susceptibility assay].

Rapid testing of pathogen susceptibility to antibiotics is of great practical value for rational chemotherapy of pyoinflammatory deseases and postoperative complications of microbial etiology. The standard microbiological methods, i.e., the disk diffusion method and the method of serial dilutions are labour- and time-consuming (not less than 18-36 hours). The method of the authors is based on measuring bioluminescence resulting from interaction of adenosine-5'-triphosphate (ATP) and ATP reagent, a standard reaction mixture of firefly luciferase (an enzyme) and luciferin. The bioluminescence intensity is proportional to the ATP concentration in the reaction mixture and the ATP concentration is proportional to the number of the pathogen viable cells in the sample. The bioluminescence intensity value in the pathogen suspension aliquots with and without (control) the antibiotic were compared after the incubation for 5 hours and the coefficient of the microbial cell growth inhibition was calculated. Satisfactory correlation (R2 > 88%) of the results of the bioluminescent assay and the assay with the disk diffusion method and the method of serial dilutions was observed.

[Stellanin-PEG 3% ointment: comparative antimicrobial activity against surgical infection pathogens].

Comparative antimicrobial activity of four ointments, i. e. stellanin-PEG, levomecole, dioxydin 5% ointment and betadin was studied with the use of collection microbial strains and the most frequent pathogens of pyoinflammary processes in surgical patients. Clinical strains of gram positive and gram negative organisms were used as the test cultures. Stellanin-PEG 3% ointment showed high antimicrobial activity against both the gram positive and the gram negative organisms, including methicillin resistant staphylococci, E. faecalis, E. faecium, as well as E. coli and Klebsiella spp. producing extended spectrum beta-lactamases. As a whole, stellanin-PEG 5% ointment was inferior only to 5% dioxydin ointment.

[Hemostasis system disturbances and their correction in patients with pyonecrotic forms of diabetic foot].

Severe hypercoagulation syndrome was diagnosed in patients with various forms of diabetic foot. Pathology at coagulogram parameters reflects systemic metabolic and inflammatory disturbances. Anticoagulant therapy should be combined with correction of glycemia, treatment of infection and critical ischemia. Only this complex therapy can normalize coagulation parameters and reduce the risk of thrombotic complications.

[Clinical efficacy of a novel antimicrobial drug combination containing ciprofloxacin and tinidazole in the treatment of patients with skin and soft tissue infections].

Clinical and microbiological efficacies of a combined drug, a fixed combination of ciprofloxacin and tinidazole in the form of tablets (Cifran ST, Ranbaxy, India) were studied. The drug was given to 40 patients with skin and soft tissue infections in the complex surgical treatment. The clinical effect and bacteriological efficacy were observed in 97.5 and 75% of the cases respectively. The drug tolerability was good and no adverse reactions were stated.

[Clinical importance of early diagnosis of anaerobic non-clostridial infection].

Anaerobic infection is one of the most complicated problems of pyosurgery. The algorithm of examination of patients with anaerobic infection including intraoperative diagnosis is proposed. Surgical treatment playing also diagnostic role is the basis of combined treatment of soft tissues anaerobic infection. Early diagnosis and active surgical policy is one of the main ways of problem solving.

[Pathogenesis and combined surgical treatment of the pyonecrotic diabetic foot]. / Voprosy patogeneza i taktiki kompleksnogo khirurgicheskogo lecheniia gnoino-nekroticheskikh form sindroma diabeticheskoi stopy.

Three hundred and fifteen patients with necrotic forms of diabetic foot were examined and treated. Neuropathic infected form of diabetic foot was diagnosed in 45.7% patients, neuro-ischemic form--in 54.3%. Mixed aerobic-anaerobic infection in foot's necrotic focus was detected in 87.6% diabetic patients, only aerobic--in 12.4%. High level of intoxication was seen in these patients. Algorithm of complex surgical treatment of different forms of diabetic foot is presented.

[Experimental study of photodynamic effect on bacterial wound microflora]. / Fotodinamicheskoe vozdeistvie na bakterial'nuiu mikrofloru v éksperimente.

The in vitro study of the influence of photodynamic action (with the use of photosensitizer "Photosens", laser and non-laser irradiation) on the strains of the main representatives purulent wound microflora was carried out. Staphylococcus aureus, S. epidermidis, Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis cultures have been isolated from wound secretions and identified. The photosensitizer was shown to produce no bactericidal effect by itself. Irradiation with laser and non-laser light sources induced a sharp decrease in the number of viable cells in the cultures under study. The irradiation of the photosensitizer led to its activation, manifested in bactericidal action. The results thus obtained confirm good prospect of using photodynamic therapy for the treatment of purulent wounds.

[Experience in the use of vessel due F (sulodexide) in patients with suppurative-necrotic forms of diabetic foot without critical ischemia]. / Opyt primeneniia Vessel dué F (sulodeksid) u bol'nykh s gnoino-nekroticheskimi formami diabeticheskoi stopy bez kriticheskoi ishemii.

AIM: To evaluate effectiveness of sulodexide in patients with pyonecrotic complications of diabetic foot. MATERIAL AND METHOD: Sulodexide was given to 15 patients which were examined for blood fibrinogen, foot tissues saturation with oxygen, microbic contamination of the wound tissue. In addition, ultrasound dopplerography of foot arteries, laser doppler flowmetry were performed. RESULTS: Fibrinogen in peripheral blood fell, arteriovenous shunting diminished, capillary blood flow and oxygen saturation of the tissues improved. CONCLUSION: Even early sulodexide treatment is effective at different stages of the pathological process in diabetic patients with severe pyonecrotic lesion of the lower limbs as it recovers microcirculatory blood flow.

[Antimicrobial chemotherapy in patients with pyo-septic diseases in intensive care units]. / Antimikrobnaia khimioterapiia bol'nykh s gnoino-septicheskimi zabolevaniiami v otdelenii intensivnoi terapii.

The analysis of the treatment of 900 patients with large festered wounds of various genesis and location for the period from 1973 to 1998 years in the intensive care department has shown, that infection of respiratory ways is encountered in 30% of cases (in patients with nonsporeforming anaerobic bacteria--in 11-12%), bacteriuria--in 70-80%, bacteriamia--in 75% of patients with sepsis. In acute pyogenous diseases of soft tissues microbes from the wounds in monoculture were isolated out in 83.3% of cases, associations of gram-positive and gram-negative bacteria--in 16.7%, in chronic pyogenous diseases of soft tissues--in 60 and 40% of cases, respectively. In sepsis associations of gram-positive and gram-negative microbes were isolated in 55.6% of cases. Most often (91%) pathogenic staphylococcus was found in hemocultures. Uring in 62% of cases contained association of gram-positive and gram-negative microorganisms, in sputum gram-positive microflora in monoculture (69%) prevailed. In the group of patients with peritonitis, phlegmon of the anterior abdominal wall, diabetic phlegmon and gangrene, crush syndrome the association of anaerobic and aerobic microflora (from 57.1 to 98.8%) prevailed in the wounds. Application of up-to-date antimicrobial means in the intensive care unit resulted in a decrease of mortality rate in sepsis and complicated course of wound infection up to 23%, and in anaerobic nonsporeforming infection--up to 15%.

[Substantiation and varieties of complex surgical treatment tactics for pyo-necrotic forms of diabetic foot]. / Obosnovanie i varianty taktiki kompleksnogo khirurgicheskogo lecheniia gnoino-nekroticheskikh form "diabeticheskoi stopy".

For the period from 1996 to 1998 in the Division of wounds and wound infection of A.V. Vishnevsky Institute of Surgery 92 patients with pyonecrotic forms of "diabetic foot" underwent thorough examination and treatment. The patients were divided into groups by the form of "diabetic foot": with pyonecrotic forms of "diabetic foot" without critical ischemia (group 1) and with it (group 2). In 18 patients of both groups the data of electron autoradiography were used to reveal peculiarities of the wound process. Group 1 patients had at admittance a large number of neutrophiles in various stages of destruction in biopsies of the wound. In patients of group 2 a great majority of the vessels in biopsies of the wound were in different stages of destruction with lost connections between their separate cells or some of their part absent. Separate cells (endotheliocytes and pericytes) which make up the walls of destroying vessels, were synthesizing RNA and were functionally active. In both groups, the studied parts of the wound before plastic repair of its defect usually represented as well developed granulation tissues with a number of microvessels and cells. Intensive synthesis of PNA in the cells of microvascular wall evidenced of their high functional activity, and the synthesis of DNA in them showed their ability for proliferation, i.g.--for growth. Thus, microangiopathy was reversible, and the solution of the problem of critical ischemia should be considered in the light of macroangiopathy. Thus, in patients of group 1 the cause of pyonecrotic damage consists in infection process, while in patients of group 2--in combination of infection with ischemia of the extremity. In both groups pyonecrotic disease of the extremity ruses at the background of severe disturbances of cellular immunity.

[Clinico-laboratory study of piperacillin/tazobactam in the treatment of patients with would infection]. / Kliniko-laboratornoe izuchenie piperatsillin-tazobaktama pri lechenii bol'nykh s ranevoi infektsiei.

Piperacillin/tazobactam (P/T) or tazocin was used in the treatment of 40 patients with soft tissue purulent necrotic wounds of various genesis and localization. In the majority of the patients the affection was of recurring nature. P/T was administered in a dose of 4.5 g 3 times a day for 1 to 14 days (mainly for 8 to 10 days) as 30-minute intravenous infusions. The clinical effect of the treatment was stated in 36 patients (90 per cent). In 3 out of 8 patients with diabetes mellitus the treatment failed. In 1 patient the treatment was discontinued after the first dose because of asphyxia and a short-term decrease of the arterial pressure. Among 105 microbial strains isolated from 75 patients 64 were highly susceptible to P/T, 33 were moderately susceptible and 8 were resistant. 76.3 per cent of the isolates produced beta-lactamase, 66.3 per cent of them were susceptible to P/T. 54 gram-positive and gram-negative strains were isolated from 40 patients. 16 out of the 54 strains were isolated as monocultures and the others as associations. After the treatments the pathogen eradication and the pathogen eradication followed by superinfection were stated in 26 patients (66.7 per cent). In 11 patients (28.2 per cent) the pathogen persistence was observed at the background of the clinical improvement in the majority of the patients. The relapses were recorded in 2 patients (5.1 per cent).