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.
Objective of the research to specify respiratory tract bacterial microflora in patients suffering from community-acquired pneumonia (CAP) during initial and repeat examination. To determine local factors affecting microflora in the cohort examined.
Materials and methods. Surveillance subject 241 patients with CAP differed by their status and age who stayed in two healthcare facilities of the Khabarovsk city. Examination of respiratory smears was performed. Results. Indices of Gram-negative enterobacteria (30.8% [22.639.7%]) and Gram-negative nonfermentable bacteria (14.5% [8.621.7%]), isolated from patients hospitalized in healthcare institution No. 1 and mostly comprised of the elderly (aged over 61 years 82.0%; 74.388.6%) with more severe disease state including patients at the ICU, were higher compared to data obtained from healthcare institution No. 2 (19.8% (13.427.0); 6.1% (2.710.8) respectively). Prevalent pathogen was Klebsiella pneumoniae 13.6% (7.820.6) and 10.7% (6.016.5). Identification of Acinetobacter baumannii complex 6.4% (2.611.7) and 3.1% (0.86.7) should be also noted. A high percentage of drug-resistant bacterial variants was observed and for Klebsiella pneumoniae totaled 66.7% (41.887.4) and 57.1% (32.280.2) at the healthcare institutions No. 1 and No. 2, respectively. A. baumannii complex drug resistant variants were found in 85.7% (52.799.97) at healthcare institution No. 1. All isolates of A. baumannii complex at the healthcare institution No. 2 were drug resistant. High prevalence of Candida spp. was revealed in both healthcare institutions reaching 54.5% (45.263.7) and 58.0% (49.566.3), respectively, with minimal detection rate of classic pathogens such as S. pneumoniae 5.4% (2.010.4) and 5.3% (2.19.8) and H. influenzae 3.6% (0.97.9) and 3.8% (1.27.7), respectively. Repeat examination of 122 patients conducted 710 days later showed diverse changes in microflora spectrum regardless of the healthcare institution that was manifested as loss or emergence of drug-resistant variants as well as simultaneous presence of different variants of the same pathogen.
Conclusion. The results obtained evidence about complexity and variety of mechanisms underlying microorganism community formation during the course of infectious process in patients. Local factors influencing microflora characteristics of patients at the two healthcare institutions were revealed.
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