Clinical Microbiology and Antimicrobial Chemotherapy
Volume 5, No 2, 2003

Diseases and Pathogens

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Pancreatitis and Associated Infections

E.P. Dellinger

Department of Surgery, Division of Surgery, University of Washington, Seattle, USA

Pancreatitis-associated infections (PAI) are among of the most serious complications of acute pancreatitis. Only about 5–7% of all patients with diagnosis of acute pancreatitis develop infection, but in patients with severe necrotizing pancreatitis and extended pancreatic necrosis their rates may be as high as 40–70%. Infectious complications of the pancreatitis are responsible for 70–80% of deaths in patients with acute pancreatitis. The main types of PAI are infected pancreatic necrosis, pancreatic and peripancreatic abscesses and infected pseudocysts. Etiology of PAI is often polymicrobial and involves both aerobic and anaerobic bacteria.

Clinical trials show benefits from the early prophylactic administration of antibiotic to patients with severe pancreatitis. Choice of antimicrobial agents should be based primarily on susceptibility patterns of the organisms most commonly recovered from patients with PAI. Penetration of antibiotics into pancreatic and peripancreatic tissue should be another determinant factor. In most cases antibacterial therapy combines with surgical treatment. Antimicrobial choices are carbapenems, a third generation cephalosporin or ciprofloxacin combined with metronidazole or clindamycin, and inhibitor-protected β-lactams.

Key words: pancreatitis, pancreatitis-associated infections, infected pancreatic necrosis, antimicrobial therapy.

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Diagnosis and Antimicrobial Therapy of Skin and Soft Tissue Infections (Lecture)

T. File

Northeastern Ohio Universities College of Medicine, Ohio, USA

Antimicrobials

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Carbapenems: Myths and Reality

I.G. Bereznyakov

Kharkov Medical Academy of Postgraduate Education, Kharkov, Ukraine

This paper presents analysis of microbiological, clinical and pharmacoeconomic studies of carbapenems. Use of carbapenems during the last two decades was not associated with emergence of resistance to these agents among clinically significant human pathogens, except for Pseudomonas aeruginosa. Clinical efficacy of carbapenems in patients with different infections is similar to and often higher than those of other comparative antimicrobials and their combinations. In spite of expensiveness of carbapenems, pharmacoeconomic studies have demonstrated advantages of these drugs over the number of cheaper conventional antibiotics. Taking into consideration that inadequate empirical antimicrobial treatment is associated with significant increase in mortality, particularly in patients with serious infections, carbapenems are no longer considered as second line antimicrobials. The main ways to improve use of carbapenems are de-escalation therapy and optimal dosing of these antimicrobials.

Key words: carbapenems, imipenem, meropenem, clinical trials, pharmacoeconomics.

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Treatment of Sepsis in Intensive Care Units – Pharmacoepidemiological Study

V.A. Rudnov, S.N. Lozhkin, F.S. Galeev, I.B. Zabolotskih, E.M. Kon, M.I. Neymark, M.I. Tchelyuk, V.V. Golubtzov, V.A. Martynenko, A.Yu. Elisariev, A.I. Merkulov, A.V. Nikolenko, Yu.A. Antonov, Yu.M. Fedotova, I.V. Kikomban, Yu.S. Kalashnikova, V.I. Smytchkov

This paper presents retrospective analysis of currently existing approaches to the medical treatment of severe sepsis and septic shock in patients from 7 hospitals in 6 Russian cities. Two hundreds and eighty eight patients aged 16 to 75 years were included in this study. The most common diagnosis was sepsis associated with intra-abdominal infections (63,9%). Systemic antimicrobials (100%), unfractionated heparin (63,9%), corticosteroids (35,1%), protease inhibitors (26,8%) were the most frequently administered medications. Artificial colloidal solutions, primarily a dextrans (96% of cases), fresh frozen plasma and albumin were added to treatment regimens in 57,9%, 45,2% and 24,3% of patients, respectively.

The most commonly administered antimicrobials were aminoglycosides (28,2%), penicillins (24,7%) and first-generation cephalosporins (9,7%). Combination regimens were used in 90% of patients. Choice of empiric antimicrobials and a number of used medications varied in different hospitals. Change of empiric regimens and multiple courses of antimicrobial therapy were experienced in 63,9% of cases.

There have shown to be great differences between the currently existing practice of medical treatment of sepsis in Russian ICUs and national and international guidelines. These include inadequate initial antimicrobial therapy and dosing regimens as well as unjustified use of medications with unproven clinical efficacy.

Key words: pharmacoepidemiology, sepsis, ICU, antimicrobial treatment.

Guidelines for clinicians

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Antimicrobial Therapy of Intra-Abdominal Infections

(According to the guidelines of Surgical Infection Society)

N.A. Efimenko, A.S. Bazarov

Department of Surgery, State Institute of Postgraduate Medical Education of the Russian Ministry of Defense, Moscow, Russia

Treatment of intra-abdominal infections (IAI) is à significant problem in surgery. Taking into consideration the clinical practice in Russia, this paper presents an analysis of guidelines on antimicrobial therapy for IAI, developed by Surgical Infection Society and published in 2002. The main issues of antimicrobial therapy of IAI, such as patient selection and optimal duration of antimicrobial therapy are considered. Recommended their antimicrobial agents and combinations for treatment of IAI, which were shown in large number of prospective controlled trials to have high clinical efficacy, are listed. Risk factors for treatment failure and death in patients with IAI are identified. Choice of antimicrobials in higher-risk patients is provided as well. Relevant areas for future investigations, focusing on improving antimicrobial therapy of IAI, are presented.

Key words: abdominal surgery, intra-abdominal infections, antimicrobial therapy, guidelines

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Practice Guidelines on Antimicrobial Therapy of Sinusitis

Yu.K. Yanov, S.V. Ryazantsev, L.S. Stratchounski, O.U. Stetsiouk, E.I. Kamanin, A.A. Tarasov, I.V. Otvagin, A.I. Kryukov, M.R. Bogomilski

This paper presents data on epidemiology and etiology of sinusitis in Russia as well as antimicrobial susceptibility patterns of most likely pathogens, causing different forms of the disease. Choice of antimicrobials for treatment of different types of sinusitis is reviewed. Etiology and antimicrobial treatment of nosocomial sinusitis are also described. Special emphasis is made on common errors of antimicrobial therapy.

For otorhinolaryngologists, physicians, pediatricians.

Key words: sinusitis, Streptococcus pneumoniae, antimicrobials, antimicrobial resistance.

Guidelines for microbiologists

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Guidelines on Antimicrobial Susceptibility Testing of Neisseria gonorrhoeae

S.V. Sekhin, D.L. Voznesenskiy, M.M. Vasilev, A.A. Kubanova

Short review of antibacterial resistance in Neisseria gonorrhoeae in different parts of the world including Russia is given. In this paper antimicrobial susceptibility testing of gonococci by agar dilution and disk diffusion methods as well as determination of β-lactamase production are presented.

For clinical microbiologists, STD specialists, obstetricians and gynecologists.

Key words: Neisseria gonorrhoeae, susceptibility testing, antimicrobial resistance.

Personal Experience

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The Protocols of Antibacterial Therapy

N.V. Vlasova, I.G. Multykh, A.I. Greshishkin

Krasnodar municipal medical center, Russia

Present article describes the experience of development of the protocols of antimicrobial therapy in one single medical institution – the hospital of Krasnodar municipal medical center. The main purpose for the development of such protocols is the optimization of the use of antimicrobials not only on the basis of international and national guidelines but also taking into account the local conditions including the epidemiology of main pathogens and their antimicrobial resistance patterns.

Key words: antimicrobial therapy, antimicrobial resistance, nosocomial infections.