[Molecular epidemiology peculiarities in forming of antimicrobial resistance of Streptococcus pneumonia strains, isolated in elderly patients.]

Despite of advances in diagnostics and treatment of respiratory tract infections, respiratory tract bacterial infections morbidity is still remaining the significant problem of modern medicine. Moreover, microbiological diagnostics of etiology identified in community-acquired aged patients pathogens spectrum allows to consider the main causative agent Streptococcus pneumoniae. Antimicrobial agents resistance of this pathogen is the actual problem in treatment of all forms of pneumococcal infections and is till one of the factor defining the epidemiology significance of pneumococcal infection as the source of forming of epidemiological clone. Aim of our study was to estimate the peculiarities of antimicrobial agents resistance of S. pneumoniae strains, isolated in aged patients with diagnosis of community-acquired pneumonia and bronchitis. There were used such methods as disco-diffusion method, method of minimum inhibitory concentration, strains were isolated from patients with community-acquired pneumonia, bronchitis, and carriers, then there were conducted molecular epidemiology monitoring of the isolated strains to the main antimicrobial agents resistance determinants. There were revealed that in all groups multidrugresistance had been caused with the similar process of forming to macrolides. In colculsion, the gained results allows to consider that in population causing invasive and non-invasive forms there are the same processes of antimicrobial agents resistance to macrolides.

[Level of N-terminal fragment of brain natriuretic peptide progenitor and atherosclerotic damage of brachocephalic arteries in patients with rheumatoid arthritis with inefficiency and/or injurability of basic anti - inflammatory treatment].

The high prognostic significance of the concentration of the N-terminal - pro-B-type natriuretic peptide (NT-proBNP) in the development of cardiovascular diseases (CVD) was identified for rheumatoid arthritis (RA) and general populations. AIM: to investigate the significance of NT-proBNP level in patients (pts) with RA with the ineffectiveness and/or intolerance of basic anti - inflammatory therapy; compare the level of NT-proBNP with atherosclerotic lesion of the brachiocephalic arteries (BCA), traditional risk factors and inflammatory markers. MATERIALS AND METHODS: The investigation enrolled 28 pts (24women/4men) with the lack of efficacy/resistance and/or intolerance of basic anti - inflammatory drugs (DMARDs); median age was 55 [46; 61] years, median disease duration 114 [60; 168] month; DAS28 6,2 [5.1; 7.0]; SDAI 35.0[23.9; 51.0], CDAI 30.0[21.0; 42.0], serum positivity for rheumatoid factor (RF) (100%)/anti - cyclic citrullinated peptide antibodies (ACCP) (86%). The study did not include RA pts with congestive heart failure. High incidence of traditional risk factors was found in RA pts: arterial hypertension - in 75%, dyslipidemia - 61%, smoking - 17%, overweight - 61%, family history of cardiovascular diseases - 36%, hypodynamia - 68%. Coronary artery disease was diagnosed in 11% RA pts. Lack of efficacy of 3 or more DMARDs was found in 46% of pts, intolerance to previous therapy with DMARDs - in 54% pts. 47% were receiving methotrexate (20 [18; 25] mg/week), 11% - leflunomide, 7% - sulfasalazine, 46% - glucocorticoids, 75% - non - steroidal anti - inflammatory drugs. The control group consisted of 20 healthy donors, comparable to pts by age and sex. Serum levels of of NT-proBNP were measured using electrochemiluminescence method Elecsys proBNP II (Roche Diagnostics, Switzerland). The determination of the intima - media thickness (IMT) BCA were assessed from duplex scanning. Atherosclerotic lesion of BCA was assessed by the presence of atherosclerotic plaque (IMT ≥1.2 mm). RESULTS: NT-proBNP concentrations in RA pts proved to be higher (78.7 [41.4; 101.3] pg/ml) than those in the control group (55.3 [36.6; 67.3] pg/ml, p100 pg/ml - 1 group (n=6) and ≤100 pg/ml - 2 group (n=22). Groups of RA pts did not differ in gender, age, activity of RA, frequency of detection of traditional risk factors. Atherosclerotic lesion of the BCA was detected in 3 (50%) pts of the 1 group and in 8 (36%) pts of the 2 group (p>0.05). In RA pts the level of NT-proBNP correlated with age (r=0.39; p.

[HPLC analysis of dehydroepiandrosterone sulfate in serum with use of solid-phase extraction on hyper cross-linked polystyrene (Purosep-200)].

We have developed a simple HPLC method for analysis of the dehydroepiandrosterone sulfate (DHEA-sulfate) in serum with use a new procedure of solid-phase extraction (SPE) on hyper cross-linked polystyrene (Purosep-200) and fast chromatographic separation on the monolithic column under isocratic elution and UV detection at 200 nm. Complete SPE procedure lasts for about 7 min, chromatographic separation takes less than 6 min. Simplicity and high reproducibility of this method makes it attractive in routine clinical practice.

[The ethiology structure of community-acquried pneumonia of young adults in closed communities].

Despite of success in ethiology evaluation of community-acquired pneumonia (CAP) and instant improvement of diagnostic methods microbiological spectrum of CAP is still remaining underestimated and is still the problem for the routine clinical practice. In our study we estimated the role of fastidious bacteria which cause atypical CAP such as Chlamydophilla pneumoniae, Mycoplasma pneumoniae, Legionella pneumophila. Furthermore we also defined the role of viral pathogens in ethiology of CAP.

[Molecular biological monitoring for Streptococcus pneumoniae isolated from patients with invasive pneumococcal infection].

Pneumococcal infection is one of the most important problems of the modern medicine. Need for organization of system of epidemiological surveillance for this infection with obligatory assessment of epidemic genovariants by molecular biological methods is evident. Assessment of pneumococci isolated from patients and carriers by using multilocus sequence typing, pulse-field electrophoresis, and restriction fragments length polymorphism analysis allowed to conclude that the latter method, which have high discriminating ability, is advantageous for these purposes.

[Epidemiological features of noninvasive pneumococcal infections in different age groups of population].

The aim of the study was to determine nosological structure, sex and age of patients with non-invasive pneumococcal infections (otitis and sinusitis). Medical cards of 80 inpatients and results of clinico-microbiological tests have been analysed. Otitis and sinusitis morbidity is about 12+/-0.54 and 36+/-1.04 per 10 000, respectively. Acute otitis occurred in 47.5%, acute sinusitis or exacerbation of chronic sinusitis - in 52.5% (S. pneumoniae was isolated). Males suffered more frequently (57.9%) from otitis, females - from sinusitis (54.76%). Registration of pneumococcal otitis and sinusitis morbidity is important for organization of anti-epidemic measures.

[Epidemiological analysis of the incidence of invasive and non-invasive pneumococcal infections in different population groups].

Despite modern achievements in diagnostics and treatment, invasive and non-invasive pneumococcal infections remain a topical public health problem. To a large extent, it is connected with the absence or inconsistence of evidence-based information on this kind of infection. In this paper, retrospective analysis of the incidence of pneumococcal infections was performed on the basis of medical records available today in every health institution; the peculiarities of their nosologic structure were revealed. Among invasive forms, pneumococcal pneumonias prevailed (50.06%); apparent hypodiagnostics of pneumococcal meningitis was noted (only 4.02%). Among non-invasive forms, acute otitis with various complications prevailed (47.5%), acute sinusitis was registered in 37.5% of cases, and other ENT diseases (sphenoiditis, frontitis, ethmoiditis, etc.) were registered in 15% of cases. The study found that the main risk factors in these patients had been different ENT diseases which the patients had suffered from during the previous three months before the actual illness. Thus, the necessity for the development and perfection of techniques of microbiological diagnostics and the development of epidemiological control methods on their basis are obvious.

[Epidemiological features of antibiotic resistance in Streptococcus pneumoniae strains isolated from patients with pneumococcal pneumonias].

Despite advances in the diagnosis and treatment of pneumococcal infections, effective antibiotic therapy for pneumococcal pneumonias remains to be a topical problem. The investigation was undertaken to study the specific features of development of antibiotic resistance in S. pneumoniae strains isolated in patients with pneumococcal pneumonias. In the Primorye Territory, pneumococcal pneumonia mortality rates were established to be 32.73 +/- 1.58 (28.98-36.48) per 10,000. At the same time the major portion of drug-resistant strains was those that were resistant to trimetroprim- sulfamethoxazole (52.34%), tetracycline (58.4%), clindamycin (32.88%), erythromycin (12.08%), and ciprofloxacin (12.75%). The increase in the number of pneumococcus strains resistant to macrolides and fluoroquinolones in the age group of 5 to 18 ages allows one to recommend that the use of drugs of these groups be improved first of all in patients of this age who have invasive forms of pneumococcal infections.

[Identification of the optochin-resistant Streptococcus pneumoniae strains].

So far the prevalent method of the identification of pneumococci in the routine diagnostic practice has included three tests: sensitivity to optoxin, solubility in biliary salts and reaction with omniserum. At present optoxin-resistant pneumococcal strains, as well as those giving dual reaction to solubility in biliary salts, occur sufficiently often thatconsiderably complicates the identification of this infective agent. We have summarized experience in the isolation of S. pneumoniae strains, resistant to optoxin and not soluble in biliary salts; in addition, the prospects of introducing the complex approach to the identification of a given culture with the use of molecular diagnostic methods into daily practice are evaluated.

[Antibiotic resistance of Streptococcus pneumoniae isolated from patient with home care pneumonia]. / Antibiotikorezistentnost' kul'tur Streptococcus pneumoniae, vydelennykh u lits s vnebol'nichnoi pnevmoniei.

The monitoring of the resistance of Streptococcus pneumoniae, one of the most important causative agents of extrahospital pneumonia, has been carried out. The data on its sensitivity to antibacterial preparations, widely used in clinical practice, have been summarized.