Diseases and pathogenes
Candidemia In Hospitalized Patients In Saint-Petersburg
N.N. Klimko1, T.C. Bogomolova1, Z.K. Kolb1, A.V. Saturnov2, T.N. Perekatova2, M.B. Belogurova3, V.F. Lebedev4, S.A. Shliapnikov5, E.M. Petrova6, E.K. Sokirski2, I.S. Zuzgin2, T.V. Shneyder2, I.E. Karyagin2, V.A. Edelstain3, G.J. Timokhovskaya3, A.S. Kolbin6, L.A. Pestova1, F.V. Ivanuk2
1 Research Institute of Medical Mycology named under P.N. Kashkin, Saint-Petersburg Postgraduate Education Medical Academy, Saint-Petersburg, Russia
2 Leningrad Regional Clinical Hospital, Saint-Petersburg, Russia
3 Clinical Center of Advanced Medical Technologies (Hospital ¹ 31), Saint-Petersburg, Russia
4 Academy of Military Medicine, Saint-Petersburg, Russia
5 Road Clinical Hospital, Saint-Petersburg, Russia
6 Pediatric Municipal Hospital ¹1, Saint-Petersburg, Russia
During prospective study carried out in 1998–2000 risk factors, spectrum of pathogens, treatment options and mortality in 45 episodes of candidemia in 45 patients from 16 Saint-Petersburg’s hospitals have been analyzed. Majority (84%) of patients with candidemia were hospitalized in intensive care units (ICU), 13% – in therapeutic wards and 3% – in surgical one. The main reasons for admission in ICU were operations (36%), neoplasms (33%) and traumas (13%). Etiologic agents of candidemia were Candida parapsilosis (32%), C.albicans (28%), C.tropicalis (10%), C.glabrata (8%), Ñ.guilliermondii (2%), C.famata (2%), C.zeylanoides (2%), C.rugosa (2%), Ñ.krusei (2%), C.lusitaniae (2%), Candida sp. (10%). Two and more species of Candida spp. has been isolated from blood in 9% of patients. Localized lesions in different organs have been found in 38% of patients. Antifungal therapy was administered to 60% of patients; intravenous catheters were removed in 68%. Total mortality within 30 days after diagnosis of candidemia was 49%. Mortality in patients who received antifungal therapy was 37%, in patients without specific therapy – 72%. Mortality after removal of intravenous catheter was 35%, without removal – 92%.
Key words: candidemia, acute disseminated candidosis, Candida, fluconazole, amphotericin B.
Antibiotic-Associated Diarrhea
V.A. Malov
Department of Infectious Diseases, Moscow Medical Academy named under I.M. Setchenov, Moscow, Russia
Diarrhea, which is associated with the usage of antimicrobials, is one of the important problems in clinical practice. This article reviews the questions of etiology, pathogenesis and epidemiology of antibiotic-associated diarrhea (AAD). Clinical forms and features of the AAD are discussed. Advantages and disadvantages of different microbiological diagnostics for Clostridium difficile infection, which is the most common cause of the AAD are also analyzed. The main approaches to the management of Clostridium difficile colitis, indications for use ofantibacterial therapy and problems of the choice of antimicrobials are presented.
Key words: antibiotic-associated diarrhea, Clostridium difficile, pseudomembranous colitis, antimicrobial therapy.
Antimicrobial Resistance
Resultst of the Multicentre study of Nasopharyngeal Isolates of Haemophilus influenzae from Healthy Children in Day-Care Centers
L.S. Stratchounski1, O.I. Kretchikova2, G.K. Reshedko1, O.U. Stetciouk1, O.A. Egorova1, M.M. Kandalov1, L.M. Boyko1, E.L. Ryabkova1, G.D. Tarasova3, B.M. Blokhin4
1 Institute of Antimicrobial Chemotherapy, Smolensk, Russia
2 Smolensk Regional Center for Epidemiology and Hygiene, Smolensk, Russia
3 Russian State Medical University, Moscow, Russia
4 Moscow Research Institute of Ear, Throat and Nose, Moscow, Russia
The rates of nasopharyngeal carriage of Haemophilus influenzae and epidemiology of its antimicrobial resistance in healthy children from day-care centers have been investigated. The overall rate of nasopharyngeal H.influenzae carriage was 44%. The susceptibility testing was performed by E-tests. The resistance rates (including intermediately resistant strains) was: 2,1% to ampicillin, 0,6% to amoxycillin/clavulanate, 0,6% to cefaclor, 18,7 to clarithromycin (only intermediate resistance), 20,9% to trymethoprim/sulphamethoxazole. The antimicrobial resistance profiles varied in different centers. The clinical use of trimethoprim/sulphamethoxazole in respiratory tract infections should be restricted because of the high resistance of H.influenzae to this antimicrobial.
Key words: antimicrobial resistance, Haemophilus influenzae, carriage.
Antimicrobials
Antiseptics and Disinfectants in the Prophylaxis of Nosocomial Infections
T.Ya. Pkhakadze
Central Institute of Traumatology and Orthopedy named under N.N. Priorov, Moscow, Russia
Medical equipments, instruments and hands of medical personnel serve as one of the most important vehicles for the transmission of nosocomial infections, and as a result of this, disinfection and sterilization are considered as a main part of any infection control program. Wide range of different disinfectants is currently available, but outdated recommendations for its use are often published in domestically produced literature. In the article the main questions of terminology are discussed; the most commonly used groups of disinfectants and antiseptics are described; the approaches for disinfectants selection depending on the type of the disinfecting surface are advised.
Key words: nosocomial infections, infection control, disinfection, sterilization.
Pharmacoepidemiology
Antiviral Therapy of Chronic Hepatitis B: Cost-Effectiveness Analysis
A.V. Rudakova1, Yu.V. Lobzin1, P.F. Chveshuk2
1Academy of Military Medicine, Saint-Petersburg, Russia
2Central Agency of Military Medicine of Ministry of Defense of Russian Federation, Moscow, Russia
The objective of this study was to estimate the potential economic and clinical effects of treatment of chronic hepatitis B with lamivudine and a-interferon in the Russian military healthcare system based on computer-generated decision analysis model. The main outcome of this analysis was to provide the rationale for more effective use of limited healthcare resources. The analysis showed that the use of lamivudine for treatment of chronic hepatitis B was more advantageous that a-interferon in increase of the life expectancy and reduction of life-time risk of development of both compensated and non-compensated cirrhosis and hepatocellular carcinoma.
Key words: chronic hepatitis B, lamivudine, interferon, cost-effectiveness, decision tree, Markov model.
Immunisation
Current Possibilities of Specific Prophylaxis of Pneumococcal Infections
R.S. Kozlov
Institute of Antimicrobial Chemotherapy, Smolensk, Russia
Streptococcus pneumoniae is one of the leading pathogens causing meningitis, otitis media, sinusitis, and community-acquired pneumonia in different age groups. A special problem for the time being is an increase of drug-resistant pneumococci isolated in different nosological forms, which leads to the additional expenses on management of such patients. Together with of effective antimicrobial agents, currently there is a possibility of implementation of specific prophylaxis of pneumococcal infections both in adults and children. Licensed in Russian Federation 23-valent polysaccharide vaccine is effective and safe upon usage in individuals of >2 years of age, but, it provides insufficient protection in children <2 years old. However, licensed in 2000 in the USA and some countries of Western Europe conjugated 7-valent vaccine showed efficacy in children of this age group, which give wide prospective for prophylaxis of pneumococcal infections. This review presents current, evidence-based recommendations on usage of pneumococcal vaccines and also perspectives of vaccination.
Key words: pneumococcus, pneumococcal vaccine, immunization, prophylaxis.
Guideline for Clinicians
Acute Bacterial Rhinosinusitis: Current Approaches to the Diagnostic and Antibacterial Therapy in Outpatient Settings
(According to the guidelines of American Academy of Otolaryngology-Head and Neck Surgery,
American Rhinologic Society, American Academy of Otolaryngic Allergy, 2000, Clinical Advisory
Committee on Pediatric and Adult sinusitis, 2000, American Academy of Pediatrics, 2001,
Centers for Disease Control and Prevention, 2001)
A.A. Tarasov1, E.I. Kamanin1, A.I. Kryukov2, L.S. Stratchounski3
1 Department of Otolaryngology, Smolensk State Medical Academy, Smolensk, Russia
2 Moscow Scientific and Practical Center of Otolaryngology, Moscow, Russia
3 Institute of Antimicrobial Chemotherapy, Smolensk, Russia
Acute rhinosinusitis is one of the most common disorders in otolaryngology and is on 5th place among all diseases based on the amount of all prescribed antimicrobials. But a number of problems in the antimicrobial therapy of this pathology still remain, among which the overuse of antibiotics and administration of antibiotics without taking into account the activity against the most common pathogens are the main. The review of four recent recommendations on diagnostic and therapy of acute rhinosinusitis is given in this article. The attention is focused on the differential diagnostic of viral and bacterial rhinosinusitis, and the significance of different methods of diagnostic procedures. The current data on the antimicrobial resistance trends in common bacterial pathogens are given. Principles of choice of antimicrobials and therapeutic regimens are described. Validity of administration of non-antimicrobial therapy is analyzed on the basis of evidence-based data.
Key words: acute rhinosinusitis, acute respiratory viral infection, S.pneumoniae, H.influenzae, antimicrobial resistance, antimicrobial therapy.