Introduction: Staphylococcus aureus is one of the major pathogens that causes of surgical site infection (SSI). Scant information is available on the occurrence and antimicrobial susceptibility of S. aureus in patients with SSI in Ear, Nose and Throat (ENT) surgery. The aim: To assess the activity of antimicrobials against S.aureus, isolated from patients with SSI by the ENT departments of Kyiv hospitals. Materials and methods: A total of 516 S. aureus isolates from of patients with SSI in ENT surgery. Antimicrobial susceptibility of S. aureus were determined, using automated microbiology analyzer. Some antimicrobial susceptibility test used Kirby – Bauer antibiotic testing. Interpretative criteria were those suggested by the Clinical and Laboratory Standards Institute (CLSI). Results: The most active antibiotics found in the study were linezolid and tigecycline, showing growth inhibition of 100% strains tested. Susceptibility to the other antimicrobials was also on a high level: 98,4% of strains were found susceptible to nitrofurantoin, 98.1% – to trimethoprim/sulphamethoxazole, 97.6% – to fusidic acid, 97.1% – to mupirocin, 95.9% – to teicoplanin, 94.7% – to vancomycin and fosfomicin, 90.6% – to moxifloxacin, 89.1% – to tobramycin, 87.3% – to gentamycin. Susceptibility to rifampicin (85.5%), cefoxitin (84.6%), levofloxacin (84.3%), erythromycin (82.6%), tetracycline (76.3%), and clindamycin (75.4%) was observed to be some lower. Resistance to oxacyllin S.aureus (MRSA) came up to 21.1%. Conclusions: S. aureus in ENT departments to be a serious therapeutic and epidemiologic problem. The constant monitoring of antimicrobials resistance in every hospital is required. Antibiotics application tactics should be determined in accordance with the local data of resistance to them.
The aim: To obtain the first estimates of the current prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) among healthcare workers (HCWs) in the departments of Otorinolaryngology and Dentistry and to determine of genes virulence factors (Panton Valentine Leukocidine (PVL) genes). Materials and methods: We performed a multicenter cross-sectional study. The susceptibility to antibiotics was determined by disk diffusion method according to the European Committee on Antimicrobial Susceptibility Testing. The virulence factor encoding genes, mecA, lukS-lukF, were detected by Polymerase Chain Reaction (PCR). Results: Incidence rate of S. aureus nasal carriage among HCWs was 36.2%, whereas MRSA carriage was 17%. Prevalence of MRSA carriage rate was 34.9% in Otorhinolaryngology departments and 9.7% in Dentistry. PCR testing confirmed that all MRSA strains were mecA gene-positive. The virulence factor encoding genes were detected in 82.3% of the S. aureus isolates from HCWs. Among S.aureus, the lukS-lukF genes were detected in over 59% of the strains. The lukS-lukF genes were detected in 55.5% of MRSA and in 58.9% of MSSA strains. LukS-lukF genes were most commonly co-present in MRSA strains. No significant difference was detected between the occurrences of lukS-lukF genes (P > 0.05). Conclusions: Personnell in otorhinolaryngology and dentistry departments have a high rate of nasal colonization of MRSA. This carrier state may be an important risk factor for transmission MRSA from physicians and nurses to patients and vice-versa. Screening for MRSA nasal carriage of HCWs is a key element in enabling infection control measures and early therapeutic decisions.
The one of the most informative method of preoperative diagnosis of fungal paranasal sinuses is computed tomography. The radiological marker that allows to identify chronic sinusitis of fungal origin is an eclipse with hyperintensive inclusions. The sensitivity of this criterion for fungal ball is about 80%. In addition, a sign of recalcitrant chronic sinusitis is the presence of reactive changes in the bone wall of the sinus – "osteitis". The purpose of the work was to study the frequency of radiological signs of osteitis and areas of increased radiological density in the maxillary sinuses of the patients with chronic sinusitis of fungal and non-fungal etiology, to clarify the diagnostic significance of these symptoms in the differential diagnostics. Material and methods. The results of a retrospective study of computer tomography data of 60 people with chronic rhinosinusitis (intraoperative was verified fungal ball in the maxillary sinus space of 30 patients, other 30 patient had no signs of fungal etiology). Results and discussion. In patients with chronic rhinosinusitis of non-fungal nature, hyperintensive inclusions in the sinus were found in 13.3%, and signs of osteitis were detected in 36.7%, which was significantly less common than in patients with fungal processes, 83.3% and 80,0% respectively (p <0,05). The presence of both of the radiological symptoms was observed in 63.3% of patients from the group of chronic rhinosinusitis in the presence of a fungal body in the space of the sinus and in 6.7% of cases the chronic rhinosinusitis of non-fungal etiology. The severity of osteitis according to KOS, in patients with a fungal body in the sinus was 0.71 ± 0.15 points, and 0.55 ± 0.2 points in patients without a fungus. The pathogenesis of osteitis in the cases of sinusitis with fungal origin is a violation of bone trophism, which develops due to periostitis after the influence of biologically active substances secreted by the fungus. The increase of radiation density in areas of osteitis indicates the predominance of osteogenesis over osteolysis in the inflammatory focus of the bone wall of the maxillary sinus. Conclusion. The frequency of detecting radiological signs of osteitis in patients with chronic rhinosinusitis of the maxillary sinus with fungal bodies was 80%, that was comparable to the frequency of detecting hyperintense inclusions in the lumen of the sinus in these patients (83.3%), and was significantly more than in patients with chronic sinusitis nonfungal etiology. The presence of radiological signs of osteitis of the bone wall of the maxillary sinus in computed tomography should be regarded as an additional symptom in the differential diagnosis of maxillary sinusitis of fungal origin
The state of the mucoperiostasis of the maxillary sinus is one of the important factors that affect the effectiveness of dental implantation, especially in case of need for augmentation of the maxillary bone. Chronic rhinosinusitis with nasal polyps, chronic rhinosinusitis with fungal bodies, and sinus cysts are among the most common pathological processes in the maxillary sinus that are encountered when performing subantral augmentation. In addition, a separate category of patients is made up of those with a history of sinus surgery in their anamnesis. The condition of sinus mucoperiosteum can be estimated based on results of processus uncinatus research, because it has a similar histological structure, directly contacts with all maxillary sinus excretion and, as usual, gets removed while endoscopic sinusotomy. The purpose of the work was to study the histological features of mucoperiostasis and adjacent bone in the ostiomeatal complex in discrete diseases of paranasal sinuses: chronic rhinosinusitis with nasal polyps, maxillary sinus cysts, fungal balls and postoperative scar changes in the ostium. Materials and methods. Histological features of processus uncinatus fragments removed during endoscopic interventions in 45 patients were investigated: with sinus cysts – 12 patients (group 1), chronic rhinosinusitis with nasal polyps – 13 patients (group 2), sinus fungal body – 13 patients (group 3) and postoperative scarring changes in the ostiomeatal complex – 7 patients. The condition of the epithelial layer of the mucoperiosteum, the structure of its own plate, the periosteal layer and the bone to be treated were evaluated. Results and discussion. In 91.67 ± 0.08% of patients with maxillary sinus cysts, there were no changes in the mucoperiostasis and the bone of processus uncinatus. Most patients in groups 2 and 3 showed mucoperiostal edema with a predominant reaction of the mucosal layer and lamina propria. Fibrous changes of the processus uncinatus were most often detected after the intervention was performed at 71.43 ± 0.13% and in chronic rhinosinusitis with nasal polyps – 53.85 ± 0.14%. This confirms the significance of the mucoperiostasis injury factor with the underlying bone for the development of gross adhesive changes between the periosteum and bone tissue. Osteitis of the processus uncinatus was detected in 38.46 ± 0.13% of patients in group 2, 15.38 ± 0.1% in group 3, and 28.57 ± 0.17% in group 4. Conclusion. Signs of periostitis and processus uncinatus osteitis were most often detected in patients with neutrophilic mucoperiosteum infiltration in chronic rhinosinusitis with nasal polyps and in fungal balls sinus. History of surgery with periosteal and bone trauma promotes scarring and results in a tight connection between bone and periosteum, which can be regarded as a risk factor in relation to the rupture of the later in its peeling off during sinus lifting procedure. Therefore, when performing surgery on the maxillary sinus, in order to maintain conditions for possible dental implantation, excessive trauma of the periosteal layer of mucoperiosteum should be avoided
Introduction: There are various theories of the origin of areas with high radiation density in the fungal ball of the paranasal sinuses: X-ray contrast dentist filling material; accumulation of zinc due to enzymes of the metalloproteinase group; formation of osteophytes, etc. The purpose of the study: to study the chemical composition of areas of fungal balls that have high radiological density. Methods and materials: The results of research of 26 samples of fungal bodies by scanning electron microscopy and spectrometry removed from maxillary sinuses in patients with fungal sinusitis (4 – nonodontogenic, 22 – odontogenic origin) are presented. In addition, 5 types of material most commonly used for endodontic treatment were studied. The results: It was found that fungal bodies of odontogenic origin have a heterogeneous structure with the presence of crystalline inclusions, the elemental composition of which has the characteristics of materials for endodontic treatment (Ba, Zr, W, Co), or increased content in the fungal ball of trace elements (Ti, Al and Zn), in quantities that are not characteristic of organic compounds. Conclusions: Scanning electron microscopy in combination with spectrometry can be used to identify foreign bodies of the maxillary sinus of exogenous (iatrogenic) origin and determine their role in the development of the fungal ball.
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