Infection control for inpatients with M/XDR-TB remains a problem in high incidence countries. Rifampicin resistance is readily detected, but tests to plan regimens tailored to the drug susceptibilities of the strain of Mycobacterium tuberculosis are significantly delayed, allowing for further drug resistance to develop.
2Ф ГБУ «Центральный научно-исследовательский институт организации и информатизации здравоохранения» М З Р Ф , М осква, Р осси я Наблюдающаяся в Российской Федерации тенденция снижения распространенности туберкулеза относится в основном к случаям заболевания без множественной лекарственной устойчивости (М Л У) возбудителя. Число больных с М ЛУ микобактерий туберкулеза (М Б Т) в целом по Р Ф сохраняет тенденцию к росту. Многолетнее достоверное снижение показателя отмечается только в Центральном и Северо-Западном федеральных округах с относительно низким уровнем распространенности М ЛУ МБТ. С 2017 г. в Р Ф ожидается доминирование больных с М ЛУ М Б Т в структуре состоящих на учете бактериовыделителей, что не может не оказать негативного влияния на эффективность лечения и направленность дальнейших эпидемических тенденций. Система диспансерного учета больных туберкулезом позволяет оценить годовое число источников М ЛУ М Б Т и проследить пути его увеличения и уменьшения. Взятие и снятие с учета источников М ЛУ М Б Т происхо дит менее интенсивно, чем аналогичное движение числа бактериовыделителей без М ЛУ МБТ. Пополнение числа источников М ЛУ М БТ происходит преимущественно за счет впервые выявленных случаев туберкулеза, однако отмечается существенный рост пополнения числа источников М ЛУ М Б Т за счет вторичной М ЛУ МБТ. Рост отношения числа больных туберкулезом органов дыхания с М ЛУ МБТ, у которых прекратилось бактериовыделение, к умершим отражает успехи в совершенствовании стратегии лечения больных туберкулезом с М ЛУ МБТ.
Военно-медицинская академия им. С. М. Кирова, Санкт-Петербург, Россия Цель исследования: оценить эффективность и безопасность противотуберкулезного препарата бедаквилин в комплексном лечении пациентов с ВИЧ-ассоциированным туберкулезом с множественной/широкой лекарственной устойчивостью (МЛУ/ШЛУ) возбудителя� Материалы и методы. С применением бедаквилина в схеме терапии туберкулеза пролечено 14 больных� Большинство пациентов (12; 85,7%) получали антиретровирусную терапию� В 11 (78,6%) случаях пациентам был выставлен диагноз генерализованного туберкулеза с пора-жением двух органов и более� Все 14 пациентов выделяли микобактерии туберкулеза (МБТ): у 2 -МЛУ МБТ, у 12 -ШЛУ МБТ, из них у 11 -ШЛУ МБТ с устойчивостью к 8-10 противотуберкулезным препаратам� Результаты. Шестимесячный курс интенсивной фазы с назначением бедаквилина закончили 12 из 14 пациентов� К концу 1-го мес� лечения симптомы интоксикации исчезли у 50,0% пациентов, в конце 2-го -не определялись у 83,5%� Положительная рентгенологическая динамика, зафиксированная у 50% пациентов, характеризовалась частичным рассасыванием очагово-инфильтративных изменений в легких� Прекра-щение бактериовыделения зафиксировано к концу 2-го мес� лечения у 6, в конце 3-го -у 1, к концу 6-го мес� -у 3 пациентов, всего у 10 из 12 пациентов (83,3%)� В ходе лечения всем пациентам один раз в 2 нед� выполняли электрокардиографическое обследование, ни у одного пациента не выявлено удлинения интервала QT� ключевые слова: туберкулез, сочетанный с ВИЧ-инфекцией, туберкулез с множественной лекарственной устойчивостью возбудителя, бе-даквилин, прекращение бактериовыделения, эффективность лечения Для цитирования: Баласанянц Г. С. Опыт использования бедаквилина в комплексном лечении пациентов с туберкулезом, сочетанным с ВИЧ-инфекцией // Туберкулёз и болезни лёгких� -2017� -Т� 95, № 9� -С� 49-54�
Results Over the study period, 1533 female patients were tested for TV using the rapid test, of which 539 (35.2%) were Black, with a median age of 28 years (range 6-82 years). The TV positivity rate based on the rapid test was 5.6% (86/1533), compared to 3.2% (54/1681) among those tested with WM. Among 77 unique female patients with TV infection, 467 (34.0%) were Black and had a median age of 28 years. Nearly half of infected women presented with a chief complaint of abdominal pain (49%); vaginal discharge was only reported by 10%. Among infected women, 55% had concomitant bacterial vaginosis (BV), and 16% were co-infected with gonorrhoea and/or chlamydia. Most infected women (84%) were prescribed metronidazole during the same ER visit. Purpose To estimate of drug resistances of (MBT) at patients with combination of tuberculosis and the HIV (TB+HIV). MBT excreting it has been identified at 67.7% TB+HIV cases, and in 53.2% cases baccilar TB have been revealed by culture. From them only at 19.9% of MBT were sensitive to antitubercular drugs, at others tests identified presence of resistance of various prevalence. Resistance to streptomycin (73.2%) and izoniasid 73.4% was more often, it is a little bit less -to rifampicin -than 63.3%, and ethambutol -41.2%. Among second line TB drugs the greatest resistance has been fixed to canamycin -36.7%, to other drugs of this group it did not exceed 20%. Conclusions Materials and MethodsThe proportion of patients with multi drug resistant MBT has determined in an interval of 80.6% of -65.3%; among patients with new cases of TB it was on the average 73.3%. Extremely drug resistant MBT (XDR) has registered among for the new cases within 7.9% -14.8%. Patients with XDR had expressed immune suppression and progressing of tuberculosis with development generalised forms even at use of ART. Lethal outcomes at them made 56.9%. Conclusion wide circulation of multi and extremely drug resistant MBT at patients with TB+HIV makes inefficient treatment at prescription of f standard TB schemes. Besides for these patients use of methods of fast identification of drug resistance is necessary. P2.080Background Appropriate and timely treatment for Neisseria gonorrhoeae infection is an essential clinical and public health action. Antimicrobial susceptibility testing (AST) predicts therapeutic failure and guides selection of appropriate treatment.Increasing antimicrobial resistance in N. gonorrhoeae prompted the publication of the global action plan by the World Health Organisation to control its spread. This document highlighted the lack of or use of different methodologies for AST making the inter-laboratories and international comparisons and monitoring difficult. Aims The aim of this study was to explore whether laboratories offered AST for N. gonorrhoeae and which methodologies were being used to detect resistance particularly to current recommended treatment. 196 respondents (95%) conducted AST for N. gonorrhoeae with 46% performing this daily. 147 respondents (75%) used British Society of...
38 patients with newly diagnosed tuberculosis, immediately after the end of the main course of treatment, when they were transferred to the third group of dispensary supervision (6-9 months) and when they were removed from the dispensary supervision (2-3 years later), a skin test with an allergen tuberculous recombinant was made. The positive skin test with tuberculosis recombinant allergen was defined at 20 patients - 13 mm. At the moment of removing to the III group only one skin test with tuberculosis allergen recombinant became negative, 19 (94,5%) patients had positive reactions - 13±2,3 mm. At the time of discharging from dispensary the positive reactions were determined at 16 (80%) cases - 10±2,3 mm, p0,05. In this group, 13 (65%) patients had normergic skin tests with tuberculosis allergen recombinant and 7 (35%) - hyperergic tests. At the time of removing to the III group at five from seven patients with hyperergic tests the results remained the same, median and at the moment of discharging from tuberculosis service only one patient had the hyperergic skin test with tuberculosis allergen recombinant - 18mm. Among patients with normergic skin tests with tuberculosis allergen recombinant at the time of group III removing median was 11±2,1 mm. At the last dynamic control the normergic results were determined at 15 (75%) patients and the tests median remained almost unchanged - 10±1,8 mm, the differences are reliable compared to the initial data (p0,05). In group which included 18 patients with negative skin tests with tuberculous allergen recombinant, the skin response stayed negative throughout all examination period except for one patient so patients of this group had not only clinical, radiological and bacteriological, but immunological signs of involution of the tuberculosis process. The study of the influence of clinical, epidemic and social factors to skin reaction showed that first group patients were significantly more likely to be unemployed (30% versus 5,5%; p0,05) whereas in second group married patients were reliably registered (61,1% versus 25%; p0,05). Other factors differed unreliably.
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