March 11, 2020 WHO has declared the COVID-19 coronavirus pandemic. The European Society for Cystic Fibrosis (ECFS) has developed the ECFSCOVID- 19 surveillance program to collect information on the characteristics of COVID-19 in patients with cystic fibrosis (CF). CF centers in the Russian Federation also joined the ECFS study. The ECFS collected information only through national Registers. In our country, the national register of CF patients has existed since 2011, its data is included in the European Register. Тo analyze the prevalence and course of COVID-19 in adult CF patients in Saint-Petersburg and the Leningrad region.Methods. From 11.03.20 to 24.12.20, 10 cases of adult CF patients (4 women, 6 men) with COVID-19 were analyzed in Saint-Petersburg and the Leningrad region. At the beginning of the study, 56 adult CF patients lived in Saint-Petersburg and Leningrad Region. All patients were monitored remotely by telephone, in case of ARVI symptoms, disease exacerbation, a PCR smear was performed on SARS-CoV-2, therapy was prescribed remotely, and inpatient treatment was prescribed if indicated.Results. COVID-19 was diagnosed in 10 adult CF patients aged 21 to 43 years. Two patients (32-year-old male and 31-year-old female with severe mixed cystic fibrosis form) were hospitalized with polysegmental pneumonia. 8 people were treated on an outpatient basis. Only 1 outpatient patient aged 43 years had pronounced clinical manifestations of COVID-19, the condition was regarded as moderate, the remaining outpatient patients suffered from a mild ARI disease. All patients were treated with positive dynamics. During the period of this follow – up, 3 CF patients (2 men, 1 woman) died, the death cause was the respiratory failure progression. Clinical and radiological, repeated laboratory data for COVID-19 were not obtained. At the point of December 24, 2020 53 adult CF patients are alive.Conclusion. According to our data, the incidence of COVID-19 among adult CF patients in Saint-Petersburg and the Leningrad Region was 17.85%, which is a lower indicator than in the general population. The disease was rarely severe, and effective treatment was noted in outpatient settings. There were no deaths from COVID-19.
Background: in Russia, the life expectancy of cystic fibrosis (CF) patients increased by 10 years in 2011–2017 being 55.49 years in 2017. However, the number of patients with the chronic infection caused by non-fermenting gram-negative bacilli (NFGNB), e.g., Burkholderia cepacia, Achromobacter spp. etc., increased as well. Aim: to evaluate the differences in the nutritional and functional status and the severity of mutations in CF patients with chronic Pseudomonas infection or NFGNB infection and to assess the sensitivity of P. aeruginosa to tobramycin in CF patients in the Northwest region of Russia. Patients and Methods: 31 patients with CF aged 18–43 years (18 men and 13 women) were examined. The duration of the study was 12 months. Spirometry, anthropometry, and sputum culture were performed. Results: P. aeruginosa alone was isolated in 18 patients (58%), Achromobacter spp. in 9 patients (29%), and Burkholderia spp. in 4 patients (13%). The patients were divided into two groups, i.e., patients with chronic Pseudomonas infection (group 1, n=18, 10 out of 18 patients with mucoid strains of P. aeruginosa) or chronic NFGNB infection (group 2, n=13). The median age and the mode age were 27 years and 27 years, respectively, in group 1 and 24 years and 22 years, respectively, in group 2. It was demonstrated that CF patients with chronic NFGNB infection are characterized by poorer nutritional status (p<0.05) but similar functional status and the severity of CFTR gene mutation compared to CF patients with chronic Pseudomonas infection. It was also shown that Р. aeruginosa is highly sensitive to tobramycin (94.4%). Conclusions: in CF patients, chronic lower respiratory tract infections with Burkholderia cepacia and Achromobacter spp. account for 41.9% of gram-negative rod infections. Further studies and drug sensitivity monitoring are needed. KEYWORDS: cystic fibrosis, DNA test, chronic infection with Pseudomonas aeruginosa, Burkholderia cepacia, Achromobacter spp, non-fermenting gram-negative bacilli, CFTR mutation, nutritional status, pulmonary function tests, inhaled antibiotic therapy. FOR CITATION: Makhmutova V.R., Gembitskaya T.E., Chermenskiy A.G. et al. Comparative characteristics and clinical presentation of cystic fibrosis in adults with chronic lower respiratory tract infections with Pseudomonas aeruginosa and other non-fermenting gram-negative bacilli. Russian Medical Inquiry. 2020;4(4):186–191. DOI: 10.32364/2587-6821-2020-4-4-186-191.
The aim of this study was to evaluate clinical efficacy and safety of highly concentrated inhaled solution of tobramycin (Bramitob ® , Chiesi Farmaceutici S.p.A., Italy) in patients with cystic fibrosis (CF). This was 24 wk multicenter international double blind placebo controlled ran domized trial in parallel groups. In this study, 247 patients aged 6-45 yrs with Pseudomonas aeruginosa yielded in sputum and FEV1 40 % to 80 % pred. were randomized in 2 groups: those inhaling aerosol tobramycin (161 patients, mean age, 14.8 ± 5.7 yrs) or placebo (84 patients, mean age, 14.7 ± 6.6 yrs). Tobramycin 300 mg b.i.d. was given at the time of basic and antipseudomonal therapy. Efficacy criteria were as follows: lung venti lation parameters, sputum culture and yielding P. aeruginosa, rate of exacerbations of pulmonary disease, rate of hospitalisations, number of work off or school off days, number of courses of parenteral tobramycin and other antipseudomonal antibiotics, nutritional status (weight, BMI). Safety profile included serum creatinine level, audiometric test, vital signs (heart rate, blood pressure) and adverse events. To the end of the study, FEV1 improved by 7 % in the tobramycin group and by 1 % in the placebo group (p < 0.001), FVC improved by 5.7 and 1.3 %, respectively (p = 0.002), and FEF25-75 improved by 8.8 % and 0.7 %, respectively (p = 0.001). Frequency of P. aeruginosa eradication differed significantly between the groups to the end of 4th and 20th weeks of the study (30.8 % vs. 14.3 %; p = 0.011, and 33.3 % vs. 16.5 %; p = 0.024, respectively). Exacerbations of pul monary disease occurred in 39.8 % of tobramycin patients and in 51.2 % of placebo patients (р = 0.09). Hospital admission was required in 18.6 % and 36.9 % of patients, respectively (p = 0.002). Parenteral tobramycin was administered to 6.2 % and 16.7 % of patients, respectively (p = 0.009), other antipseudomonals were given in 55.9 % and 70.2 % of the patients, respectively (p = 0.029). Number of patients with missing work/school days due to exacerbation of pulmonary disease was 32.3 % in tobramycin group and 57.1 % in placebo group (p < 0.001). Serious adverse events related to treatment with tobramycin were not noted. In conclusion, long term intermittent treatment with inhaled solution of tobramycin additionally to basic and antipseudomonal therapy in CF patients significantly improved lung ventilation and eradication of P. aeruginosa, decreased the rate of exacerbations of pulmonary disease, rate of hospitalisations, and numbers of antipseudomonal courses and missing work days. The treatment was well tolerated and could be recommended for CF patients with P. aeruginosa in culture.
The article considers the incidence, mortality and in-hospital mortality rates from community-acquired pneumonia in St. Petersburg, 2009-2016. Epidemiological characteristics were studied in comparison with values in Russian Federation, as well as levels in Moscow and the Northwestern Federal District. The relationship between incidence and mortality rates from community-acquired pneumonia and epidemics of influenza was demonstrated. After the analysis of the medical records of patients who died of community-acquired pneumonia, defects in the organization of medical care, which had a negative prognostic impact, were indicated. A series of measures was proposed to improve the situation with community-acquired pneumonia in St. Petersburg.
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