Diseases and Pathogens
Modern Approaches to the Treatment of Sepsis: Are There New Hopes? (Lecture)
J. Cohen
Department of Infectious Diseases and Microbiology, Brighton University Medical School, Brighton, UK
Has been given on V IACMAC International conference «Antimicrobial therapy» 4–6 June 2002, Moscow.
Potential Infectious Triggers in Sarcoidosis
A.A. Vizel, M.E. Gurileva
Kazan State Medical University, Kazan, Russia
Sarcoidosis – it is a systemic granulomatous disease, the cause and the factors leading to the disease progression are not known. The present literature review devoted to the presumptive factors that can be involved in the onset and progression of sarcoidosis such as mycobacteria, chlamydia, propionibacteria, viruses. The role of the above pathogens as a probable causative agents as well as triggers that can affect the immunological reactivity of macroorganism is discussed. As a possible triggers in the onset of sarcoidosis the use of antivirals and immunomodulators is mentioned.
Key words: sarcoidosis, aetiology.
Antimicrobial Resistance
Epidemiology of Antimicrobial Resistance of Nosocomial Strains of Staphylococcus aureus in Russia: Results of Prospective Study
A.V. Dekhnich1, I.A. Edelstain1, A.D. Narezkina1, G.E. Afinogenov2, L.I. Akhmetova3, L.G. Boronina4, E.N. Gugutcidze5, L.V. Gudkova6, D.E. Zdzitovetcki7, V.N. Ilyina8, O.I. Kretchikova9, N.E. Marusina10, I.G. Multih11, S.I. Pylaeva12, I.V. Smirnov13, T.N. Suborova14, V.K. Taraban15, N.M. Furletova16, S.G. Hasanova17, E.V. Schetinin18, L.S. Stratchounski1
1 Institute of Antimicrobial Chemotherapy of Smolensk State Medical Academy, Smolensk, Russia
2 Russian Research Institute for Traumatology and Orthopedic named under R.R. Vreden, Saint-Petersburg, Russia
3 Diagnostic Center for Laboratory Diagnostics, Ekaterinburg, Russia
4 Pediatric Regional Clinical Hospital, Ekaterinburg, Russia
5 Central Clinical Hospital of Business Department of the President of Russian Federation, Moscow, Russia
6 Regional Clinical Hospital, Tomsk, Russia
7 Emergency City Hospital, Krasnoyarsk, Russia
8 Regional Clinical Hospital, Novosibirsk, Russia
9 Smolensk Regional Center for Epidemiology and Hygiene, Smolensk, Russia
10 Children Republican Clinical Hospital, Kazan, Russia
11 Clinical Diagnostic Centre, Krasnodar, Russia
12 Research Institute for Traumatology and Orthopedics, Nizhny Novgorod, Russia
13 Ryazan State Medical University named under I.P. Pavlov, Ryazan, Russia
14 Academy of Military Medicine, Saint-Petersburg, Russia
15 Regional Clinical Hospital, Krasnodar, Russia
16 City Clinical Hospital No. 23, Moscow, Russia
17 City Clinical Hospital No. 21, Ufa, Russia
18 Stavropol State Medical Academy, Stavropol, Russia
Objective. To determine in vitro activity of antimicrobials against S.aureus isolated from hospitalized patients from different regions of Russia.
Materials and methods. A total of 879 clinical strains of S.aureus isolated in 2000–2001 from patients hospitalized in 17medical institutions in different parts of Russia. Susceptibility to 18 antimicrobials: oxacillin, vancomycin, teicoplanin, linezolid, erythromycin, clindamycin, lincomycin, gentamicin, mupirocin, fusidic acid, ciprofloxacin, levofloxacin, moxifloxacin, quinupristin/dalfopristin, rifampicin, trimethoprim/sulfamethoxazole, tetracycline, chloramphenicol was determined by agar dilution method in accordance with the NCCLS recommendations.
Results. The most potent antimicrobials were vancomycin, linezolid, teicoplanin and fusidic acid to which no resistance was found. The other antimicrobials with low frequency of resistance were mupirocin, trimethoprim/sulfamethoxazole, quinupristin/dalfopristin and rifampicin (0,3, 0,8, 1,9 and 4,1% of strains were non-susceptible, respectively). Fluoroquinolones have shown moderate activities. The prevalence of MRSA among tested strains was 33,5% and varied from 0% to 89,5% in different hospitals. The high rates of resistance were found to clindamycin (27,1%), gentamicin (30,7%), tetracycline (37,1%), erythromycin (39,6%) and chloramphenicol (43,1%). Most frequently MRSA were isolated in the burn units (77,5%), ICU (54,8%), traumatology/orthopedics (42,1%). All MRSA were susceptible to vancomycin, teicoplanin, linezolid, fusidic acid and mupirocin; trimethoprim/sulfamethoxazole has shown the high activity as well.
Conclusions. (1) In the units with low frequency of MRSA (general medical and general surgical units) antistaphylococcal β-lactams can be considered as drugs of choice, alternative can be clindamycin and linezolid. (2) In the units with high frequency of MRSA (burn units, ICU, traumatology/orthopedics) vancomycin is a drug of choice, alternative can be linezolid and combination of fusidic acid and trimethoprim/sulfamethoxazole. (3) For the topical therapy of superficial S.aureus infections mupirocin and fusidic acid can be considered as drugs of choice. (4) The use of macrolides, tetracyclines, and, especially, of chloramphenicol should be significantly reduced.
Key words: Staphylococcus aureus, antimicrobial resistance, antimicrobial resistance, nosocomial infections, MRSA, vancomycin, linezolid, mupirocin, fusidic acid.
Guidelines
Guidelines on Antibacterial Therapy of Urinary Tract Infections in Children
N.A. Korovina1, I.N. Zakharova1, L.S. Stratchounski2, A.N. Shevelev2, I.A. Edelstain2, O.I. Kretchikova2, A.V. Papayan3, M.P. Fayazova3, S.N. Zorkin4, K.S. Abramov4, L.V. Kozlova5, V.V. Bekezin5, T.V. Druzhinina5, A.A. Vyalkova6, V.A. Gritcenko6, N.E. Marusina7, A.A. Akhunsyanov7, E.D. Agapova8, B.Yu. Fokina9, L.Yu. Paslova9, B.B. Milner9
1 Department of Pediatrics, Russian Medical Academy for Postgraduate Education, Moscow
2 Institute of Antimicrobial Chemotherapy, Smolensk
3 Department of Pediatrics, Saint-Petersburg Academy of Pediatrics, Saint-Petersburg
4 Scientific Center of Childrens Health, Russian Academy of Medical Sciences, Moscow
5 Department of Pediatrics, Smolensk State Medical Academy, Smolensk
6 Department of Pediatrics, Orenburg State Medical Academy, Orenburg
7 Republican Pediatric Clinical Hospital, Kazan
8 Regional Children Clinical Hospital, Irkutsk
9 Regional Children Clinical Hospital, Nizhni Novgorod
In the present guidelines the tactics of the choice of antibiotics in community+acquired urinary tract infections in children are presented. The guidelines are based on the results of multicentre study of antimicrobial resistance of the most common uropathogens «ARMID-1» in different regions of Russia.
For pediatricians and urologists.
Key words: urinary tract infections, pediatrics, antimicrobial therapy, antimicrobial resistance.
EAU Guidelines for the Management of Urinary and Male Genital Tract Infections
Kurt G. Naber, Bo Bergman, Michael C. Bishop, Truls E. Bjerklund-Johansen, Henro Botto, Bernard Lobel, F. Jimenez Cruz, Francesco P. Selvaggi
Urinary Tract Infection (UTI) Working Group of the Health Care Office (HCO) of the European Association of Urology (EAU)
Members of the UTI Working Group: K.G. Naber (Chairman), B. Bergman, M.C. Bishop, T.E. Bjerklund-Johansen, H. Botto, B. Lobel, F.J. Cruz, F.P. Selvaggi
A short version of the UTI Guidelines elaborated by the Urinary Tract Infection Working Group of the Health Care Office of the European Association of Urology is presented. The topics include classification, diagnosis, treatment and follow+up of uncomplicated UTI, UTI in children, UTI in diabetes mellitus, renal insufficiency, renal transplant recipients, and immunosupression, complicated UTI due to urological disorders, sepsis syndrome, urosepsis, urethritis, prostatitis, epididymitis, orchitis and principles of perioperative prophylaxis in urology.
Key words: urinary tract infections, male genital tract infections, classification, diagnosis, treatment.
Antimicrobial Therapy of Gonococcal Infections According to Recent International Guidelines
A.A. Kubanova1, S.V. Sekhin2, S.B. Yakushin2, A.A. Kubanov1
1 Central Research Dermato.Venerological Institute, Moscow, Russia
2 Institute of Antimicrobial Chemotherapy, Smolensk, Russia
Recommendations on the Optimization of Antimicrobial Chemotherapy of Nosocomial Infections Caused by Gram-negative Bacteria in Intensive Care Units
L.S. Stratchounski1, G.K. Reshedko1, E.L. Ryabkova1, O.U. Stetsiouk1, O.I. Kretchikova1, Z.M. Suina1, A.S. Andreeva1, Yu.G. Tikhonov2, S.V. Polikarpova3, V.M. Stroganov4, V.A. Kurtchavov5, T.Yu. Vostrikova5, E.N. Gugutcidze6, N.M. Furletova7, N.S. Bogomolova8, L.V. Bolshakov8, I.A. Aleksandrova9, L.A Ritchik10, V.V. Tetc11, N.V. Zaslavskaya11, G.E. Afinogenov12, M.V. Krasnova12, T.N. Suborova13, V.V. Biryukov14, L.I. Akhmetova15, S.M. Rozanova15, V.A. Rudnov16, L.G. Boronina17, V.K. Taraban18, I.G. Multikh19, E.V. Schetinin20, V.A. Baturin20, M.R. Rokitcky21, N.E. Marusina21, O.P. Galeeva22, S.F. Ivanova23, S.G. Khasanova24, V.N. Ilyina25, L.V. Gudkova26, D.E. Zdzitovetcky27, O.V. Peryanova28, L.N. Karpukhina29
1 Institute of Antimicrobial Chemotherapy, Smolensk, Russia
2 Main Military Clinical Hospital named under N.N. Burdenko, Moscow, Russia
3 City Clinical Hospital No. 15, Moscow, Russia
4 City Pediatric Clinical Hospital No. 9 named under G.N. Speransky, Moscow, Russia
5 City Pediatric Clinical Hospital No. 13 named under N.N. Filatova, Moscow, Russia
6 Clinical Hospital of Business Department of the President of Russian Federation, Moscow, Russia
7 City Clinical Hospital No.23, Moscow, Russia
8 Scientific Center of Surgery of the Russian Academy of Medical Science, Moscow, Russia
9 Research Institute of Neurosurgery named under N.N. Burdenko of the Russian Academy of Medical Science, Moscow, Russia
10 Central Clinical Hospital of Business Department of the President of Russian Federation, Moscow, Russia
11 Saint-Petersburg State Medical University named under I.P. Pavlov, Saint-Petersburg, Russia
12 Research Institute of Traumatology and Orthopedy named under R.R. Vreden, Saint+Petersburg, Russia
13 Academy of Military Medicine, Saint-Petersburg, Russia
14 Municipal Diagnostic Center, Ryazan, Russia
15 Diagnostic Center for Laboratory Diagnostics, Ekaterinburg, Russia
16 Ural State Medical Academy, Ekaterinburg, Russia
17 Pediatric Regional Clinical Hospital, Ekaterinburg, Russia
18 Regional Clinical Hospital, Krasnodar, Russia
19 Clinical Diagnostic Center, Krasnodar, Russia
20 Stavropol State Medical Academy, Stavropol, Russia
21 Children Republican Clinical Hospital, Kazan, Russia
22 Republican Clinical Hospital, Kazan, Russia
23 Regional Clinical Hospital, Omsk, Russia
24 City Clinical Hospital No.21, Ufa, Russia
25 Regional Clinical Hospital, Novosibirsk, Russia
26 Regional Clinical Hospital, Tomsk, Russia
27 Emergency City Hospital, Krasnoyarsk, Russia
28 City Clinical Hospital No. 7, Krasnoyarsk, Russia
29 Far-Eastern Hospital, Vladivostok, Russia