The microbiome of the maxillary sinus and middle nasal meatus in chronic rhinosinusitis.

AIM: This multicenter study was focused on the identification of the microorganisms inhabiting the maxillary sinus and middle nasal meatus in chronic rhinosinusitis. METHODOLOGY: 112 middle meatus swabs and 112 maxillary sinus aspirates from 103 patients were available for culture. RESULTS: A total of 244 strains of microorganisms representing more than 50 families were identified in the maxillary sinus and middle nasal meatus (164 and 80, respectively). These included 154 (63.0%) strains of aerobic bacteria from 32 species and 90 (37.0%) strains of anaerobic bacteria from 23 species. Aerobes were more common than anaerobes in both the nasal cavity (78.7% vs. 21.3%) and in the maxillary sinus (55.2% vs. 44.8%). Species of Streptococci (28.8%) and Prevotella (17.8%) were the most common findings in the maxillary sinus aspirates. S. pneumonia, H. influenza, and S. aureus were relatively rare, and found in only 6.7%, 5.4%, and 8.9% of the samples, respectively. CONCLUSIONS: The results obtained suggest that common upper airway pathogens do not play a major role in the pathogenesis of chronic rhinosinusitis. The microbiome of inflamed sinonasal mucosa is extremely diverse and involves exotic species of bacteria that, to date, have not been considered as potential inhabitants of the paranasal sinuses.

[Development and use of the assay for Legionella pneumophila detection based on fluorescent real-time/endpoint polymerase-chain reaction].

The aim of the work was to develop a PCR-based assay for detection of L. pneumophila and L. micdadei in environmental samples as well as in clinical samples from low respiratory tract and to assess its analytic characteristics. The assay was used during investigation of the outbreak developed in July 2007 in town Verkhnyaya Pyshma (Sverdlovsk region). Polymerase-chain reaction (PCR)with fluorescent detection,sequencing and cloning of DNA fragments were used. Developed assay based on the PCR with fluorescent real-time/ endpointdetection is able to detect L. pneumophila in clinical and environmental samples and to quantify amount of bacterial DNA in water. Specificity of analysis (100%) was assessed using the panel of bacterial strains and samples from healthy individuals. Analytic sensitivity of assay and quantitation limit was 1000 GU in 1 ml. Sensitivity of the assay of artificially contaminated biological samples was 1000 bacteria in 1 ml. During outbreak investigation L. pneumophila DNAwas detected in 4 lung samples from 4 fatal cases, from 1 of 2 sputum samples, 1 of 2 bronchoalveolar lavage samples with X-ray confirmed pneumonia. Legionella's DNA was found in samples from cooling towers, central hot water supply as well as from showerheads in apartments of 3 patients. Fountain and drinking water samples were PCR-negative. Specificity of PCR-positive results was confirmed by sequencing. Use of the assay during outbreak in- vestigation allowed to confirm the diagnosis in fatal cases and quickly identify the possible source of infection.

[Characteristic features of etiology and antibiotic susceptibility of urinary tract infection pathogens in patients with diabetes mellitus].

Patients with diabetes mellitus and urinary tract infection were examined. The structure of the pathogens and their antibiotic susceptibility were investigated. Escherichia coli was shown to be the main pathogen of urinary tract infections in the patients with diabetes mellitus. The highest activity against the E. coli isolates was revealed in amoxycillin/clavulanate (92% of the susceptible strains), the 3rd and 4th generation cephalosporins, carbapenems, amikacin (100%) and fluoroquinolones (96%). At the same time the isolates were resistant to aminopenicillins and co-trimoxazole (29.3 and 16% respectively).

[Resistance of ambulatory urinary infection pathogens according to the data of multicenter microbiological studies UTIAP-I and UTIAP-II]. / Rezistentnost' vozbuditelei ambulatornykh infektsii mochevyvodiashchikh putei po dannym mnogotsentrovykh mikrobiologicheskikh issledovanii UTIAP-I i UTIAP-II.

AIM: To study causative agents and sensitivity of E-coli strains isolated from adult outpatients with uncomplicated urinary infection (UI) in different regions of Russia. MATERIAL AND METHODS: A multicenter prospective epidemiological study included adult patients with uncomplicated infections of the upper or lower urinary tracts. MPK of antibiotics was established by dilution in agar according to NCCLS recommendations, 2000-2002. RESULTS: Among UI causative agents, E. coli was most frequent (85.9%). K. Pneumoniae, Proteus spp., Staphylococcus spp., P. Aeruginosa, Enterococcus spp. occurred much less frequently (6, 1.8, 1.6, 1.2, and 1.0%, respectively). E. Coli UI was highly resistant to ampicilline (37.1%), cotrimoxasol (21%), maximal resistance being in St-Petersburg (51.9 and 31.5%, respectively). Such oral antibiotics as norfloxacin and ciprofloxacin, cefuroxim, amoxicillin/clavulanat, nitrofurantoin were maximally active against E. Coli (4.3, 2.4, 2.6 and 1.2%, respectively). CONCLUSION: High resistance of E. coli, which is the chief causative agent of uncomplicated UI, to ampicillin, cotrimoxasol was detected. Fluoroquinolones, amoxicillin/clavulanat, nitrofurantoin, cefuroxim have high microbiological activity. On the basis of the pharmacokinetic, safety and other evidence it is concluded that drugs of choice for therapy of uncomplicated UI in Russia are oral fluoroquinolones.

[Antibacterial drug resistance of gram-negative agents causing urinary infections in female outpatients in Russia: results of multicenter study]. / Rezistentnost' gramotritsatel'nykh vozbuditelei infektsii mochevyvodiashchikh putei k antibakterial'nym preparatam u ambulatornykh patsientok v Rossii. Rezul'taty mnogotsentrovogo issledovaniia.

AIM: To investigate the spectrum of gram-negative agents causing acute and recurrent cystitis in outpatients and sensitivity of uropathogenic E. coli to antibacterial drugs; to compare drug resistance of uropathogenic E. coli isolated in Russia and other countries. MATERIAL AND METHODS: The spectrum of gram-negative bacteria was identified in 299 cases of acute and recurrent cystitis in Moscow, Smolensk and Novosibirsk. 271 E. coli uropathogenic strains were examined according to CA-SFM and NCCLS criteria for sensitivity to ampicilline, gentamycin, trimetoprim, co-trimoxasol, nitrofurantoine, nalidixic acid, pipemidine acid, norfloxacine, ciprofloxacine, nitroxoline. RESULTS: E. coli, K. pneumoniae, K. oxytoca, P. mirabilis, P. vulgaris caused acute and recurrent cystitis in 90.6, 6.4, 1, 1.7, 0.3% of the examinees, respectively. For Moscow relative agents were: E. coli (80.8%), K. pneumoniae (13.1%), K. oxytoca (2.3%), P. mirabilis (3.1%), P. vulgaris (0.7%). In Smolensk E. coli, K. pneumoniae, P. mirabilis were isolated in 96.3, 2.5 and 1.2%, respectively. E. coli occurred in 100% of Novosibirsk cases. Mean Russian values of the resistance to ampicilline, gentamycin, trimetoprim, co-trimoxasol, nitrofurantoin, nalidixic acid, pipemidine acid, norfloxacine, ciprofloxacine, nitroxoline were the following: 33.3, 5.9, 20.3, 18.4, 2.9, 5.5, 4.4, 2.6, 2.6 and 94.1%, respectively. Resistance to 2 and more drugs was registered in 18.4% of E. coli strains. CONCLUSION: Cystitis in women was in most cases caused by E. coli. The highest resistance among uropathogenic strains E. coli was observed to nitroxoline, ampicilline, trimetoprim and co-trimoxasole; maximal antibacterial activity against uropathogenic E. coli was shown by fluoroquinolones (norfloxacin and ciprofloxacin).

[Characterization of microflora in pyo-destructive lung diseases]. / Kharakter mikroflory pri gnoino-destruktivnykh zabolevaniiakh legkikh.

The microflora pattern of the endobronchial secretion was investigated in 74 patients with purulent destructive diseases of the lungs. Specimens of the endobronchial secretion were collected by transtracheal aspiration and bronchoalveolar lavage. The anaerobic isolates were cultivated in anaerostats (OXOID, England) with the use of GasPacks. Bacteriological identification of the pathogens was carried out with respect to 67 patients (90.5 per cent). Non-sporulating anaerobic microflora was isolated from 51 patients (76.1 per cent). Anaerobic causative agents in the patients with complicated pulmonary destructions were detected in 54.3 per cent of the cases. Mono-infection represented by one species of the anaerobes was stated in 23 patients (34.4 per cent). Associations of aerobes and anaerobes were isolated from 28 patients (41.7 per cent). Associations of one strain of the anaerobic causative agents and aerobic microflora were detected in 17 patients (60.7 per cent). In 11 patients the microflora pattern was polymicrobial (89.3 per cent). A total of 66 strains of non-sporulating anaerobic pathogens were isolated. Gram-negative bacilli represented by Prevotella spp., Porphiromonas asaccharolitica and Bacteroides spp. were the most frequent isolates.

[Use of cefoperazone in clinical practice]. / Primenenie tsefoperazona v klinicheskoi praktike.

The bacteriological and clinical efficacy and side effects of cefoperazone were studied in 45 patients with severe and moderate purulent inflammatory diseases. The study showed that its bacteriological and clinical efficacy was high in cases with peritonitis, cholecystitis, respiratory and urinary infections, as well as those of the eye and soft tissues. The general clinical efficacy amounted to 95.6 per cent. The number of the side effects was insignificant. This made it possible to recommend the use of cefoperazone in the therapy of many purulent inflammatory diseases, as well as in empirical therapy.