Представлены результаты исследования бактериальной микрофлоры двух групп пациентов, больных внебольничной пневмонией («Covid+», N=86 и «Covid–», N=87). Обе группы характеризуются высоким уровнем выделения бактериальной флоры (81,4% и 74,7%), в том числе общепринятых возбудителей внебольничных пневмоний, существенной частотой выделения грибов рода Candida и микробных ассоциаций.
Группа больных «Covid+» характеризуется более широким спектром определяемых возбудителей, выявлением полирезистентных грамотрицательных энтеробактерий – продуцентов БЛРС, грамотрицательных неферментирующих полирезистентных бактерий, более выраженным проявлением микробных ассоциаций.
В группе наблюдения «Covid-» лекарственноустойчивая флора представлена только стафилококками групп MRSA, MRSE и др.
Objective: to study the bacterial microflora in the sputum of patients with pneumonia caused by SARSCoV-2 or other pathogens.Materials and methods. The bacterial microflora of sputum of 173 patients with pneumonia admitted to hospitals in Khabarovsk and the Khabarovsk Territory in May – June 2020 was examined. Detection of RNA of the SARS-CoV-2 virus was carried out by PCR with the Vector-PCRRV-2019-nCoV-RG test system (manufactured by the State Scientific Center of VB “Vector”, Koltsovo). Determination of the DNA of mycoplasmosis agents and chlamydia was carried out with the test system “AmpliSens® Mycoplasma pneumoniae/Chlamydophila pneumonia” (manufactured by CRIE). Statistical data processing was performed using the Excel program. Results and discussion. Both groups of patients (Covid-19+ and Covid-19–) had high levels of bacterial flora isolation (81.4 and 74.7 %) including common pathogens for community-acquired pneumonia as well as notable detection frequency of Candida spp. and microbial associations. The group of Covid-19+ patients demonstrated a wider range of detected pathogens, was positive for poly-resistant gram-negative Enterobacteriaceae, non-fermenting gram-negative poly-resistant bacteria, with more expressed manifestation of microbial associations. In the group of Covid-19– participants drug-resistant microflora was presented only by MRSA and MRSE staphylococci.
The research included evaluation of express-diagnosis capability of immunochromatographic assay (ICA) Binax NOW (Alere, Inc., USA) for diagnosis of the rhinosinusitis caused by to detect the Streptococcus pneumoniae antigen directly in clinical samples. The unique feature of the method included obtaining samples with an electric suction machine in order to evaluate aspirate from deep parts of the nasal cavity. Diagnostic capability of the Binax NOW was determined in a comparative study using classical bacteriological method in 100 clinical samples. Pneumococcus was isolated in 16 patients (16±3,7%) via bacteriological method. ICA utilization allowed to reveal pneumococcal antigen in 20 cases (20±4,0%). ICA test sensitivity equaled 87,5%, specificity - 92,9%. Obtained results allow us to recommend ICA for identification of pneumococcal infection in patients with sinusitis for practicing physicians. The advantages of the evaluated method were fast results (for up to 15 min) and possibility of non-invasive sampling technique of clinical specimens.
Aim: epidemiological zoning of the territory of Khabarovsk region that was conducted in accordance with levels of potential epidemic risk regarding dysentery in order to specify the priority of vaccination measures and non-specific prophylaxis of the reported infection under conditions of liquidation of flood aftermath. Materials and methods. Epidemiological zoning of the territory of Khabarovsk region was conducted by ranging based on the sigmal deviation method of long-term annual average dysentery incidence rates. Efficiency evaluation of specific and non-specific prophylactic measures were conducted by comparison of dysentery incidence rates in 2013 with long-term annual average rates. Results and discussion. In the study, calculated sigmal intervals were used as criteria to classify administrative entities of Khabarovsk region as one of the groups ranged by the levels of tension of epidemiological situation in the territory: satisfactory, relatively tense, significantly tense, and critical. Two last groups of Khabarovsk region territories most of which are geographically associated with basin of the Amur River were classified as territories that are under risk of complication of the epidemiological situation on dysentery during the period of large-scale flood. Conducted analysis was used as the basis to provide emergency measures on preventive vaccination against dysentery and coverage with phage therapy of the population aggravated by flood of 2013. Conclusion. Through the example of Khabarovsk region, it was shown significance of detection of risk territories in order to substantiate specific prophylaxis of dysentery that is performed under epidemic indications. Significant decrease of dysentery incidence rates due to introduction of vaccination among inhabitants of most territories of Khabarovsk region covered by flood, it proves to be epidemiologically effective in the period of emergency situations.
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