Clinical Microbiology and Antimicrobial Chemotherapy
Volume 5, No 3, 2003

Guideline for Clinicians

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Community – Acquired Pneumonia: Giudelines on Diagnosis, Treatment and Prophylaxis

Guidelines for Clinicians (approved by the Ministry of Health of Russian Federation)

À.G. Chuchalin, À.I. Sinopalnicov, S.V. Yakovlev, L.S. Stratchounski, R.S. Kozlov, S.À. Rachina

Diseases and Pathogens

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Severe Acute Respiratory Syndrome (SARS)

A. Sinopalnikov¹, A.Vorobiov¹, J. Belotserkovskaya¹, I. Andreeva²

¹ Department of Pulmonology, State Institute of Postgraduate Medical Education of the Russian Ministry of Defense, Moscow, Russia.
² Institute of Antimicrobial Chemotherapy, Smolensk, Russia

Severe acute respiratory syndrome (SARS) is a new infectious disease, which first appeared in November 2002 in Southern China and spread through 29 countries of Europe, Asia, North and South America, Africa and Australia. According to official reports there were 8422 infected and more than 900 deaths of SARS.

The authors of the article tried to generalize the data on history of outbreak, etiology, epidemiology, variants of clinical pattern of SARS as well as existing standard treatment protocol of the disease.

Key words: Severe acute respiratory syndrome, viral infection, outbreak, SARS.

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Chryseobacterium (Flavobacterium) spp.: Clinical Significance, Identification, Antimicrobial Susceptibility

L.G. Boronina, Ì.P. Kukushkina, Ê.V. Krutova, S.Ì. Blinova

Ural State Medical Academy, Ekaterinburg, Russia
Region Children’s Hospital N 1, Ekaterinburg, Russia

Along with known human pathogens, such as Pseudomonas aeruginosa, Acinetobacter spp., Burkholderia spp., group of non-fermentative Gram-negative rods includes gender Chryseobacterium (former Flavobacterium). Chryseobacteria are ubiquitous microorganisms, which may contaminate hospital environment and be a source of infection for hospitalized patients.

Of the Chryseobacterium species, C.meningosepticum is the most important human pathogen, which may cause infections (primarily nosocomial), especially in immunocompromised patients. The main clinically significant types of infection, caused by C.meningosepticum are neonatal meningitis and bacteremia, especially in premature infants in the intensive care units, and nosocomial pneumonia. The most common presentation of Chryseobacterium spp. infection in adults is pneumonia, which is usually associated with mechanical ventilation.

Chryseobacterium spp. are usually resistant to most antimicrobials, used for treatment of infections, caused by Gram-negative microorganisms, - aminoglycosides, β-lactams, tetracyclines, chloramphenicol, but susceptible to such antimicrobials, as vancomycin, rifampicin, clindamycin, and in many cases to trimethoprim/sulfamethoxazole. Initial regimens for the treatment of clinically significant Chryseobacterium spp. infections include rifampicin in combination with vancomycin or trimethoprim/sulfamethoxazole, a fluoroquinolone.

Key words: non-fermentative Gram-negative rods, Chryseobacterium, Flavobacterium, C.meningosepticum, antimicrobial resistance, neonates, meningitis, bacteremia.

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Typing of Listeria monocytogenes on the Basis of Polymorphism of Genes Encoding the Pathogenecity Factors

T.I. Karpova¹, T.E. Firsova², L.V. Rodina³, V.M. Kotlyarov², I.S. Tartakovski¹, S.A. Ermolaeva¹

¹ Research Institute of Epidemiology and Microbiology named under N.F. Gamaleya of Russian Academy of Medical Sciences, Moscow, Russia
² Research Institute of Veterinary Virology and Microbiology of Russian Academy of Agricultural Sciences, Pokrov, Russia
³ State Center of Epidemiological Control, Moscow, Russia

Polymerase chain reaction (PCR) and restriction fragment length polymorphisms (RFLP) analysis revealed polymorphism of prfA and plcA genes, encoding the pathogenecity factors in strains of Listeria monocytogenes. Phylogenetic analysis confirmed the presence of at least two distinct evolutionary L.monocytogenes lines, existing of which was suggested in a number of studies based on analysis of other chromosomal DNA sites. There was shown to be a predominance of certain virulence-associated genes polymorphisms depending on type of sample (hospital environment, foods). The L.monocytogenes strains with a large number of sequence differences in this region (smaller than expected size of targeted DNA fragment or its absence) were found to be avirulent.

Key words: Listeria monocytogenes, polymerase chain reaction, restriction analysis.

Antimicrobials

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Comparative Activity of Cefepime and Other Antimicrobials Against Nosocomial Gram-Negative Pathogens in Russia

L.S. Stratchounski, G.K. Reshedko, M.V. Edelstain, O.U. Stetsiouk, E.L. Ryabkova, A.S. Andreeva, and the ROSNET Study Group

Institute of Antimicrobial Chemotherapy, Smolensk, Russia

The present in vitro study of antimicrobial susceptibility of nosocomial Gram-negative pathogens to cefepime and other antimicrobials has been performed by the ROSNET study group in 28 medical institutions in Russia.

The most active agent against Enterobacteriaceae among cefalosporins was cefepime. The rates of non-susceptibility to cefepime in E.coli, Klebsiella spp., Enterobacter spp., Serratia spp., Proteus spp. were 4,9, 13,6, 5,1, 9,4 and 4,2%, respectively. The penicillins, including antipseudomonal and inhibitor-protected, have shown poor activity against Enterobacteriaceae. All enterobacteria strains with the exception of Providencia spp. were susceptible to imipenem. Amikacin was significantly more active than gentamicin. The most active against nosocomial P.aeruginosa were cefepime, ceftazidime and amikacin with rates of resistance 2,2, 4,3 and 5,9%, respectively.

Taking into account the high activity of cefepime agains nosocomial Gram-negative bacteria it can be considered as one of drugs of choice in the treatment of nosocomial infections.

Key words: nosocomial infections, Enterobacteriaceae, P.aeruginosa, antimicrobial resistance, cefepime.

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The Place of Probiotics in Human Intestinal Infections

A. Sullivan, C.E. Nord

Department of Microbiology, Pathology and Immunology, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden

Reprinted from «International Journal of Antimicrobial Agents» 2002; 20:313-9 - with permission from Elsevier.
(The translation has not been rewieved by Elsevier prior to printing).

A number of studies have been carried out on the effect of several probiotic species on treatment and prevention of intestinal infections. The most commonly used microorganisms are lactic-acid producing bacteria such as lactobacilli and bifidobacteria belonging to the human normal microflora. In vitro and animal studies have shown that probiotic microorganisms interfere with the colonization of Helicobacter pylori and of enteropathogenic microorganisms. In humans the significance is more uncertain. Clinically significant benefits of probiotics have been demonstrated in the treatment of rotavirus induced diarrhoea and of Saccharomyces boulardii in the prevention of antibiotic-associated diarrhoea. In patient suffering from inflammatory bowel disease, several probiotic strains have been shown to be as effective as traditional medication in preventing relapses. Standardised and well performed studies are needed to elucidate further the mechanisms of action and the clinical significance of probiotics.

Key words: probiotics, intestinal infections, diarrhoea.

Pharmacoepidemiology

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Perioperative Use of Antimicrobials in Gynecology: Results of Pharmacoepidemiological Study

V.I. Petrov, G.V. Ershov, Yu.S. Kovaleva, D.N. Bochkarev, A.V. Tchernavin, Ya.G. Alekseeva

Volgograd State Medical University, Volgograd, Russia

The aim of study was to identify patterns of perioperative use of antimicrobials in patients undergoing hysterectomy and to study surgical site infection (SSI) rates in this category of patients. The medical records of 600 women who underwent hysterectomy (mean age 46,8±1,2 years) in 3 gynecological hospitals in Volgograd were analysed. Risk factors for SSI, choice of antimicrobials for perioperative prophylaxis, its regimen and duration were assessed. There were three groups of patients: group 1 (n=79) - «shortest» preoperative course of prophylactic antimicrobials; group 2 (n=64) - intra-operative intravenous administration of antibiotic in combination with postoperative short course of therapeutic antimicrobials; group 3 (n=457) - «preventive» antimicrobial therapy which begins after 24 h following surgery and lasts 5-7 days. Efficacy of antimicrobial prophylaxis was evaluated by SSI rates and length of postoperative hospital stay.

Risk factors for SSI were determined in 449 (74,8%) patients. In groups 1 and 2 the most commonly used prophylactic antimicrobials were cefazolin (75,9 and 56,3%) and cefotaxime (24,1 and 43,7%). In the group 2, 54,7% of patients received postoperatively the same antibiotic as for preoperative prophylaxis; in the rest 45,3% of patients antimicrobial regimen was changed. In group 3, second- or third-generation aminoglycosides (31,2%), cefazolin (17,5%), ampicillin (14,0%) were common «preventive» therapeutic antimicrobials. The combinations of antibiotics were administered to 18,7% of patients in the group 3. There have been reported 49 (8,1%) cases of SSI. All SSI cases were observed in the group 3 patients, i.e. in patients not receiving antimicrobial prophylaxis.

Perioperative antimicrobial prophylaxis hasn't shown to be routinely performed in 86,8% of patients undergoing hysterectomy in Volgograd. «Preventive» antimicrobial therapy in postoperative period is common practice, which is not justified. In 10,7% of cases antimicrobial prophylaxis is administered in combination with the postoperative course of therapeutic antimicrobials (5-7 days). Choice of prophylactic antibiotics doesn't comply with current international recommendations.

Key words: gynecology, surgical site infection, antimicrobial prophylaxis, hysterectomy, antibiotics.

ABC of New Antimicrobials

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New Oral Formulation of Amoxicillin/Clavulanic Acid