Clinical Microbiology and Antimicrobial Chemotherapy
Volume 5, No 4, 2003

Guideline

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Antibiotic Policy in Surgery, 2003

Editors: L.S. Stratchounski (Russia), J.C. Pechere (Switzerland), P.E. Dellinger (USA)
Contributors: À. Aasen (Norway), J. Garbino (Switzerland), B.R. Gelfand (Russia), S. Geroulanos (Greece), H. Giamarellou (Greece), N.N. Klimko (Russia), P. Montravers (France), À. Rodloff (Germany), S.B. Yakushin (Russia).

The document was approved by International Society of Chemotherapy (ISC), Surgical Infection Society Europe (SIS-E), Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy (IACMAC), Russian Association of Surgical Infections Specialists (RASIS).

Diseases and Pathogens

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Efficacy of Cefoperazone/Sulbactam in the Therapy of Bacterial Sepsis: Results of a Multicentre Study «IRIS»

L.S. Stratchounski, D.V. Galkin, R.S. Kozlov, and IRIS Study Group

Institute of Antimicrobials Chemotherapy, Smolensk, Russia

The objective of this prospective multicentre study was to evaluate the efficacy of cefoperazone/sulbactam for monotherapy of patients with bacterial sepsis in different wards of multifield hospitals in Russia. Overall, in 14 study centers 127 patients with sepsis were enrolled, organ dysfunction was diagnosed in 53,5%. All patients received cefoperazone/sulbactam 4-8 g per day for 7-14 days. Clinical examination was performed on 3-5, 7-14 and 28-30 study days. Clinical efficacy of cefoperazone/sulbactam reached 95,8% with 76,5% patients cured and 19,3% - improved. Infection was confirmed microbiologically in 57,5% patients. Pathogens were: Enterobacteriaceae - 44 strains (37%); Pseudomonas aeruginosa - 22 (18,5%) strains; Enterococcus spp. - 22 (18,5%); Staphylococcus aureus - 19 (16%); other nonfermentative gram-negative rods - 12 (10%). The most active against prevalent pathogens (Enterobacteriaceae) were imipenem/cilastatin and cefoperazone/sulbactam with accounting resistance of 2,3% and 6,9% respectively (ð>0,05). Bacteriological efficacy on 7-14 days of treatment in 82 (64,6%) patients was considered as «eradication». In 4 (3,2%) patients a relation of adverse drug events to drug intake was assessed as «probable». Based on the results of the study cefoperazone/sulbactam may be recommended for empirical monotherapy of bacterial sepsis.

Key words: sepsis, ICU, cefoperazone/sulbactam, clinical efficacy, bacteriological efficacy.

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Microbiological Description of Bordetella pertussis and Laboratory Diagnosis of Whooping Cough

G.Ya. Tseneva, N.N. Kurova

Laboratory of droplet bacterial infections, Research Institute of Epidemiology and Microbiology named under L. Pasteur, Saint-Petersburg, Russia

Whooping cough remains a significant problem worldwide, even in countries with high number of immunized people. However, a lack of sensitive, specific and reproducible diagnostics for this infection that would meet the needs of health-care system still exists. In 1980-90s, novel information on antigen structure and virulence factors of Bordetella pertussis was discovered. This paper presents a review of data on microbiological properties of B.pertussis and related bacteria. Virulence factors of Bordetella pertussis as well as their role in pathogenesis of pertussis and protective immunity to the infection in humans are described. Some aspects of pathogenesis of whooping cough are also considered. Currently existing laboratory methods for the diagnosis of infection caused by Bordetella pertussis, their advantages and disadvantages are reviewed.

Key words: whooping cough, Bordetella pertussis, virulence factors, pertussis toxin, laboratory diagnosis.

Antimicrobials

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New Antifungals for the Treatment of Invasive Mycoses

N.N. Klimko¹, A.V. Veselov²

¹ Saint-Peterburg Medical Academy for Postgraduate Education, St.-Petersburg, Russia
² Institute of Antimicrobial Chemotherapy, Smolensk, Russia

Invasive mycoses becoming more and more important problem of the modern medicine that is reflecting the increasing number of immunocompromised patients population. Despite the fact that the main causative agents remain Candida albicans, Aspergillus fumigatus and Cryptococcus neoformans, the number of cases of systemic fungal infection due to rare molds and non-albicans strains of Candida spp. is increasing. Changes in the spectrum of causative agents and unacceptable high number of adverse events during the therapy with many of the traditional systemic antifungals leads to the necessity of creating new antifungal agents by widening of existing classes and by making new ones. In this article an attempt to describe the main representatives of the new antifungals and comparative analysis including pharmacokinetic, spectrum of activity, adverse events and the perspectives of their usage is made.

Key words: invasive mycoses, antifungals, antifungal therapy.

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Prophylactic and Empirical Use of Antifungals in Neonates

À.S. Kolbin, D.Î. Ivanov, N.P. Shabalov, V.A. Lyubimenko, Î.I. Karpov, N.N. Klimko

The aim of this study was to review published data on efficacy and safety of prophylaxis and empirical therapy with antifungals in neonates. We have found 37 reports on use of antimycotics in neonates, which had been published by June 2003. Of 37 reports 5 were clinical trials of antifungals for prophylaxis and empirical therapy of invasive candidiasis in neonates: 3 were prospective randomized controlled studies and 2 were prospective descriptive studies. One report represented meta-analysis. Fluconazole was shown to be a single drug that can be used for prophylaxis of invasive candidiasis in preterm and low-birth-weight infants. However, at least four problems remain unresolved: drug of choice for the empirical antifungal treatment of invasive mycoses in neonates and optimal dose of fluconazole for primary prophylaxis of invasive candidiasis have not so far been determined; there are no clear recommendations on duration of antifungal prophylaxis; groups of neonatal patients at risk for invasive candidiasis have not yet been defined.

Key words: neonates, preterm infants, invasive candidiasis, prophylaxis, empirical therapy, fluconazole.

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Antiretroviral drugs

A.V. Kravtchenko¹, V.V. Rafalski²

¹ Federal Scientific Centre on the Prophylaxis and Control of AIDS of the Ministry of Health of Russian Federation, Moscow, Russia
² Institute of Antimicrobial Chemotherapy, Smolensk, Russia

Antiretroviral drugs today are the basis of HIV therapy. The severe and progressive nature of the disease and the need for lifelong therapy make the correct choice of drugs for HIV therapy of particular importance. A large number of antiretroviral drugs, regular entering of the market by new compounds and quick renovation of information provide clinicians with a wide spectrum of opportunities in the choice of therapy, however, at the same time, it can make the selection of optimal antiretroviral drug regimen more difficult.

This review presents the data on available antiretroviral drug classes. The descriptions of particular drugs are given. Indications, dosage, drug interactions and the most common side-effects are listed.

Key words: antiretroviral drugs, HIV-infection, AIDS

Personal Experience

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First 24-hours Lethality in Hospitalized Patients with Community-Acquired Pneumonia

À.L. Vertkin, À.V. Naumov, Å.I. Vovk, L.À. Alexanyan, N.V. Vertkina, Å.N. Arinina

Department of clinical pharmacology, Moscow State Medical and Dental University named under N.A. Semashko, Moscow, Russia
National Scientific and Practical Society for Emergency Care, Russia

Ñommunity-acquired pneumonia remains one of the most common infections in population, and despite the wide array of antimicrobials, it is associated with high lethality rate. First 24-hours mortality is an integral characteristic of the quality of emergency medical care. A total of 17 community-acquired pneumonia cases, which consist 3% of all 580 deaths within the first 24 hours of hospitalization were accounted in this study. The aim of this study was to reflect a real practice of the management of community-acquired pneumonia. The paper represents an analysis of medical care patterns in cases of deaths within 24 hours of hospitalization due to community-acquired pneumonia. The possible causes of first 24-hours lethality associated with medical interventions and organization were also considered. A focus on assessment of severity of the disease, prognosis as well as identification of risk factors for complicated course and death was made. Authors highlight that physicians both in hospital and outpatient settings should adhere to current guidelines for diagnosis and treatment of community-acquired pneumonia and use antimicrobials as early as within an outpatient emergency care.

Key words: community-acquired pneumonia, lethality, emergency care, risk factors, severe pneumonia, guidelines.