[Clinicomicrobiological characteristics of community-acquired infections of the urinary tracts in Moscow].

The structure and sensitivity of the agents of community-aquired urinary infections (CUI) in Moscow were studied in a prospective clinicomicrobiological trial carried out in 2005 with participation of 8 Moscow outpatient clinics. Minimal inhibitory concentration (MIC) of antimicrobial drugs was estimated using agar dilution test according to NCCLS recommendations (2000-2002). Acute and chronic cystitis, chronic pyelonephritis and acute pyelonephritis were most frequent CUI (49.1, 39.8 and 5.3%, respectively, while among complicating factors most frequently occurred urolithiasis (48.5%), diabetes mellitus (24.2%), renal cysts (7.6%), infravesical obstruction (6,1%). CUI in Moscow were primarily caused by E.coli (72.5%). Compared to complicated CUI, uncomplicated ones were characterized by less frequent E. coli isolation (53 and 80.9%, respectively), but significantly more frequent isolation of P.aeruginosa (4.5 and 0%) and E. faecalis (9.1 and 4.2% isolation. High resistance of E.coli isolated from patients with uncomplicated CUI was seen to cotrimoxasol (28.7%) and ampicillin (39.1%), low resistance--to amoxicilline/ clavulanate (6.3%), fluoroquinolones (6.3%), nitrofurantoin (0%), cefuroxime (6.3%), cefotaxime (0%), phosphomicine (0%). Patients with complicated CUI compared to uncomplicated CUI significantly more often had E.coli strains nonsensitive to amoxicilline/clavulanate (14 and 6.3%), cotrimoxasol (25.6 and 18.8%), nalidixic acid (18.6 and 6.3%, respectively). Polyresistant E. coli strains were significantly more prevalent in complicated CUI than in uncomplicated CUI (45.4 and 25.1%, respectively). Thus, E. coli, a main causing agent of uncomplicated CUI, demonstrates high resistance to ampicilline and cotrimoxasol. High microbiological activity is shown byfluoroquinolones, nitrofurantoin, oral cephalosporines of the second-third generation.

[Resistance of causative agents of uncomplicated urinary tract infections in Russia].

A prospective epidemiological study of the spectrum of causative agents (CA) of uncomplicated urinary tract infections (UTI) in adult patients and CA resistance to antimicrobial drugs was conducted in nine cities of the Russian Federation in 2004-2005. Minimum inhibiting concentrations were ascertained by dilution in agar according to NCCLS (2000-2002) recommendations. The study has found that uncomplicated UTI are most frequently caused by E.coli (73.9%). Other CA occur much less frequently: K.pneumoniae--6.4%, E. faecalis--4.4%, S. epidermidis--4.1%, Staphylococcus spp--3.4%, others--2% patients. E. coli demonstrated high resistance to ampicilline (33.1%), co-trimoxasol (19.4%). Most active against E. coli were fluoroquinolones (norfloxacin, ciprofloxacin, levofloxacine), the resistance being 4.8%; cefalosporins of the second and third generation (cefuroxim, ceftibuten), nitrofurantoin, no resistant strains were found.

[Efficacy of ciprofloxacine antibiotic prophylaxis of infectious complications after TUR of the prostate].

We compared efficacy of preoperative prophylactic antibiotic treatment (PPAT) with cyprofloxacine used orally (0.5 g), intravenously (0.4 g) and routine antibiotics in TUR of the prostate. A multicenter open randomized study covered 120 patients. PPAT efficacy was estimated by the rate of urinary infection (UI), frequency and duration of antibiotic treatment in the postoperative period, hospitalization duration. All the patients were divided into three groups: 39 patients of group 1 received oral cyprofloxacine 90-120 min before TUR of the prostate, 38 patients of group 2 received intravenous cyprofloxacine 30-60 min before TUR, 43 patients of group 3 (control) received routine antibiotic prophylaxis. The following results were obtained: 24-48 hours after the operation no cases of UI in group 1, 11.5 and 11.6% in groups 2 and 3, respectively, (p = 0.048); 7 days after TUR--UI in all the groups (2.6, 20, 23.3%, respectively); 14 days after TUR--UI in 5.1, 28.6, 27.9% patients, respectively. Mean duration of hospital stay was 11.7 +/- 7.6 days in group 1, 12.1 +/- 8.1 days in group 2, 12.5 +/- 7.8 days in group C (p > 0.05). Postoperative antibiotics were given to 16.7, 34.1 and 68.9% patients, respectively. Thus, cyprofloxacine in group 1 lowered UI risk and postoperative antibiotics significantly, in group 2 it had no influence on UI rate but reduced postoperative antibiotics significantly.

[Antibacterial therapy of complicated urinary infections in outpatients]. / Antibacterial'naia terapiia oslozhnennykh infektsii mochevyvodiashchikh putei.

The term complicated urinary infections (CUIs) includes infections developing in the presence of anatomic anomalies, metabolic or hormonal disorders, immunodeficiency or infection with atypical microorganisms. Complicating factors diminish efficiency of antibiotic treatment, raise probability of recurrence. CUIs account for 45.2% of all cases of outpatient urinary infections in adults in Russia. Nephroliths, diabetes mellitus and renal cysts are most prevalent complicating factors. CUIs causative agents' spectrum is wider and resistance bacteria isolation is more frequent compared to uncomplicated urinary infections. In addition to antibiotic therapy, CUIs treatment should be focused on detection and elimination of the complicating factor. If complicating factors are unremovable, antibiotic therapy should be directed to management of clinical symptoms of urinary infection, prevention of complications and damage to renal parenchyma. CUIs demand longer courses of antibiotics than uncomplicated urinary infections: 7-14 days in infection of the lower urinary tracts, at least 14 days in infection of the upper urinary tracts and 4-6 weeks in failure of the standard course. Fluoroquinolones are drugs of choice in adults.

[Pharmacotherapy of acute tonsillitis-pharyngitis in ambulatory practice: results of a multicenter pharmaco-epidemiological study]. / Farmakoterapiia ostrogo tonzillofaringita v ambulatornoi praktike: rezul'taty mnogotsentrovogo farmakoépidemiologicheskogo issledovaniia.

AIM: To analyse current practice of pharmacotherapy (PT) in outpatient treatment of acute tonsillopharyngitis (ATP) in different regions of Russia. MATERIAL AND METHODS: Case reports for 1333 outpatients (493 male and 840 female, age 16-76 years) with ATP from 7 cities of Russia have been studied. Each ATP case was documented on a special chart to contain the following information: demographic data, history of the disease, bacteriological findings, PT regimens, complications, treatment outcomes. RESULTS: PT of ATP was made primarily with antibiotics. Most frequent of them was ampicillin (about half the cases). Further antibiotics by frequency of use were: erythromycin, ciprofloxacin, doxicyclin, amoxicillin, midecamycin, ampicillin/oxacillin. Among other drugs, wide use was registered of antihistamine drugs, throat disease drugs, analgetic and antipiretic drugs, vitamins. Bacteriological examinations were conducted rarely. CONCLUSION: The problems of PT of ATP patients consist in overuse of systemic antibiotics as a result of adequate differential diagnosis of this infection and choice of antibiotics without consideration of current recommendations on the treatment of streptococcal ATP.

[Microbiological characteristics and clinical efficacy of phosphomycin]. / Microbiologicheskaia kharakteristika i klinicheskaia éffektivnost' fosfomitsina.

E. coli is the most frequent agent causing urinary infection (UI) both in adults and children. E. coli of UI outpatients is often resistant to ampicilline, amoxicilline and co-trimoxasol. The study of phosphomycin in UI outpatients showed its highest efficacy against E. coli. Phosphomycin in a single daily dose of 3 g is a drug of choice in acute uncomplicated cystitis. The results of the study also demonstrate that phosphomycin can be used for prevention of pyoinflammatory complications before endoscopic manipulations and operations as well as open operations on the lower urinary tracts and genital organs.

[Analysis of parameters of the antibacterial treatment of acute otitis media in adults: results of a multicenter study]. / Analiz osobennostei antibakterial'noi terapii ostrogo srednego otita u vzroslykh: resul'taty mnogotsentrovogo issledovaniia.

The programme was aimed at audit of the parameters of antibacterial therapy for acute otitis media in adult outpatients in 8 cities of Russia (Smolensk, Volgograd, Ekaterinburg, Yaroslavl, Nizhny Novgorod, Tyumen, Ryazan, Vladivostok). The information sources were the case records. The data from the records were structurally fixed in specially designed individual registration charts for further computer processing. The analysis of the results showed that the real practice of the antibacterial therapy for acute otitis media was not based on a unique approach and did not mainly correspond to the present standards. Ampicillin proved to be preferential, whereas it is known that the drug of choice for such cases is amoxicillin. Antibacterial agents with low activity against the basic pathogens of the infection (doxycycline and others) and high toxicity (co-trimoxazol) were often prescribed, while the recommended up-to-date antibiotics (amoxicillin/clavulanate and others) were prescribed extremely rare or not prescribed at all. Scientifically unreasonable combined antibiotic therapy and prescription of parenteral drugs not rational for the treatment of outpatients were practiced.

[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 therapy of acute sinusitis in outpatient practice: results of a multicenter trial]. / Analiz antibakterial'noi terapii ostrogo sinusita v ambulatornoi praktike: rezul'taty mnogotsentrovogo issledovaniia.

Now there is no generally accepted practice of antibacterial therapy of acute sinusitis in outpatient clinics of Russia. Choice of antibacterial drugs is often made without consideration of the most probable causative agents of the infection. Out-of-date antibiotics used in many cases do not satisfy modern requirements. Clinically essential features of pharmacokinetics are in some cases ignored. Parenteral administration is often unjustified, combined antibiotic treatment is not always validated.

[Comparative clinical efficacy and tolerance of cefuroxime axetil (zinnat) and ceftibuten (cedex) in patients with acute sinusitis]. / Sravnitel'naia otsenka klinicheskoi éffektivnosti i perenosimosti tsefuroksim aksetila (zinnata) i tseftibutena (tsedeksa) u patsientov s ostrym sinusitom.

The aim of the study was to substantiate clinically and microbiologically administration of such oral cephalosporins as cefuroxime axetil and ceftibuten in acute sinusitis. The spectrum of causative agents of acute sinusitis was determined, most common pathogens were identified and their sensitivity to antibiotics was tested. The conclusion is made that cephalosporins of the II-III generation meet the requirements to antibacterial drugs for treatment of acute sinusitis.

[Aspects of nasopharyngeal microflora and middle ear function in children]. / Osobennosti mikroflory nosoglotki i funktsional'noe sostoianie srednego ukha u detei.

Exudative otitis media (EOM) was detected in 13 (14.8%) children out of 88 preschool children at audiological investigation. In their nasopharynx, these children carried pneumococci and hemophylic bacilli. The latter were identified 1.7 times more often in children with EOM than in those free of it. Both pathogens were encountered in EOM children 2.6 times more frequently. It is suggested that the above pathogens may support development and maintenance of EOM.

[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).

[Practical approaches of antibiotics choice in uncomplicated urinary tract infections]. / Prakticheskie podkhody k vyboru antibiotikov pri neoslozhnennykh infektsiiakh mochevyvodiashchikh putei.

Infections of the urinary tract (IUT) belong to the most prevalent infectious diseases. Acute cystitis is the most frequent symptom of uncomplicated IUT. The main agents of IUT are gram-negative enterobacteria, mainly Escherichia coli (80%). The agents of uncomplicated IUT are the least resistant (5%) to fluoroquinolones (norfloxacin and ciprofloxacin). The duration of antibiotic therapy for acute cystitis is determined predominantly by risk factors: a 7-day course is recommended for cases with risk factors and a 3-day one for cases without risk factors. In acute pyelonephritis antibiotic therapy should be longer (10-14 days). Preventive therapy is recommended for patients with frequent relapses of IUT.