Objective. To evaluate resistance rates to carbapenems and III–IV generation cephalosporins among gramnegative bacteria, including production of carbapenemases and extended-spectrum beta-lactamases (ESBL). Materials and Methods. A total of 460 gram-negative bacteria isolated from hospitalized patients aged 1 to 85 years from 8 medical institutions of Rostov-on-Don and the region from April 2018 to December 2019 were tested by conventional microbiological methods. The most common acquired carbapenemases genes were determined by real-time PCR using commercial kits (Central Research Institute of Epidemiology, Russia). Results. The tested isolates included 180 (39.1%) isolates of K. pneumoniae, 87 (18.9%) – E. coli, 101 (22.0%) – A. baumannii and 92 (20.0%) – P. aeruginosa. K. pneumoniae and E. coli isolates exhibited the high resistance rates to cefotaxime – 96.7% and 71.2%, to ceftazidime – 95.5% and 54.0%, and to cefepime – 95.5% and 54.0%, respectively. ESBL production was detected in 35.0% and 78.2% of K. pneumoniae and E.coli isolates, respectively. K. pneumoniae and E. coli isolates were resistant to imipenem, meropenem, and ertapenem: 57.8% and 3.4%; 55.0% and 2.3%; 60.0% and 4.6%, respectively. Carbapenemase production was detected in 27.8% of K. pneumoniae and 4.6% of E. coli isolates. The most common beta-lactamases were metallo-beta-lactamases (NDM) and serine carbapenemases (OXA-48). A. baumannii isolates showed the high resistance rates to imipenem and meropenem (87.1% and 85.1%). The most common beta-lactamases were metallo-beta-lactamases (NDM) and serine carbapenemases (OXA-24⁄40 and OXA-23). P. aeruginosa isolates also showed the high resistance to carbapenems – imipenem (61.9%) and meropenem (58.7%). The most common betalactamases were metallo-beta-lactamases (VIM) and GES-5. Conclusions. The results of this microbiological study indicate the extremely high prevalence of aerobic gram-negative bacteria in different infections. A. baumannii, P. aeruginosa, K. pneumoniae and E. coli isolates being resistant to third- and fourth-generation cephalosporins and carbapenems are particularly dangerous, especially due to production of ESBL and carbapenemases. The most clinically important are OXA and NDM beta-lactamases.
Objectives: to analyze the prevalence of strains of gram-negative bacteria - pathogens of infectious complications resistant to carbapenems, including through the production of carbapenemases isolated from various clinical biomaterials in hospitalized patients of hospitals in the city of Rostov-on-Don.Materials and methods: 366 gram-negative bacterial isolates were studied, from patients from 16 wards, 9 treatment-and-prophylactic institutions of the city of Rostov-on-Don and the region. The study was conducted by traditional microbiological method. Species identification of strains and sensitivity to antimicrobial drugs were determined on a Vitek 2 automatic analyzer (BioMerieux, France). The strains insensitive to carbapenems were tested for the presence of carbapenemases using CIM-test. MBL was detected by the effect of suppression of their activity in the presence of EDTA. MBL genes were detected by PCR-RV test kit “AmpliSens MDR MBL-FL”, “AmpliSens MDR KPC/OXA-48-FL”. The conclusion about the production of BLRS was made by the presence of synergism of cephalosporins of III-IV generation with clavulanic acid by the method of double discs.Results: of the 366 isolates tested, gram-negative bacteria accounted for 74.2 %: Klebsiella pneumoniae — 33.0 %, Escherichia coli — 19.0 %, Acinetobacter baumannii — 18.0 %, Pseudomonas aeruginosa — 15.0 %. Resistance to carbapenems was detected in 90.9 % of A.baumannii strains, more than 50 % of P.aeruginosa and K.pneumoniae. LBR production was detected in more than 90 % of K.pneumoniae and about 80 % of E. coli. In A. baumannii and K.pneumoniae isolates, the presence of OXA and NDM genes was found, and in P.aeruginosa, VIM groups.Conclusion: enterobacteria resistant to beta-lactams, producing extended-spectrum beta-lactamases and carbapenemases are one of the leading causative agents of infectious complications in hospitals of Rostov-on-don and the region, almost not inferior in frequency of occurrence of bacteria of the genus Acinetobacter spp. and Paeruginosa. This determines the importance of detection of resistance mechanisms not only for the purpose of optimal etiotropic therapy, but also for epidemiological control of the spread of resistant strains and the development of infection control measures.
Introduction. Despite the advances in modern anesthesiology, it is impossible to guarantee a safe course of anesthesia, and even with planned surgical interventions, there is a risk of death. At present, there is no unanimity in approaches to assessing perioperative risk, and many systems for determining this risk have not been validated in Russia. The question of the contribution of pre-operative factors to the likelihood of an unfavorable outcome also remains open, which requires large multicenter national studies. Objectives. To assessment the predictive value of preoperative factors in determining the risk of death and complications based on the analysis of data obtained during the first year of the STOPRISK study. Materials and methods. An analysis of data on perioperative indices of 3002 patients operated on the abdominal and pelvic organs from 30 centers in 21 cities of Russia participating in the STOPRISK study is presented. Results. The mortality rate in the study was 0.47 %, the rate of postoperative complications was 3.9 %. Most often, an unfavorable outcome developed after upper abdominal and colorectal surgery. Despite the fact that the severity of surgery and the ASA class are independent predictors of an unfavorable outcome, the use of these parameters allows to predict postoperative mortality (AUROC = 0.85) and (with age) postoperative complications (AUROC = 0.77) with limited accuracy. Conclusions. Thus, the probability of an unfavorable outcome can be estimated using factors such as the severity of surgery and the initial physical status, but their predictive value for determining the risk of mortality is clearly insufficient, and even less is their ability to assess the risk of postoperative complications. As shown by literature data, inclusion in model additional risk factors allows to increase the accuracy of the forecast, however, given the peculiarities of the structure of comorbidities and their impact on outcome in the studied population, we need further evaluation of their contribution to perioperative risk. Also, taking into account the peculiarities of the occurrence of some concomitant diseases, further research is required to identify a significant impact on mortality and postoperative complications.
INTRODUCTION. The need for accurate risk stratification is obvious. Modern methods are quite cumbersome, which can cause difficulties when applied in routine practice, and therefore relatively simple but accurate forecasting methods have become very popular, which, however, have not been validated in Russia: SORT (Surgical Outcome Risk Tool), SRS (Surgical Risk Scale), POSPOM (Preoperative Score to Predict Postoperative Mortality), NZRISK (New Zealand RISK), SMPM (Surgical Mortality Probability Model). OBJECTIVES. The aim of this work is to determine the prognostic value of risk assessment scales in predicting an unfavorable postoperative outcome based on the analysis of data obtained in the STOPRISK study in patients undergoing open abdominal surgery. MATERIALS AND METHODS. The analysis of data on perioperative parameters of 1,179 patients who underwent open abdominal surgery is presented. RESULTS. The fatal outcome was recorded in 14 patients (1.18 %). A total of 135 complications were registered in 92 patients (7.8 %). All scales demonstrated satisfactory prognostic value in assessing the risk of complications (the area under the operating characteristic curve (AUROC) for the Physical Status Scale of the American Society of Anesthesiologists (ASA) was 0.714 (0.687-0.739), for the Surgical Risk Scale (SRS) - 0.727 (0.701-0.753), for the Surgical Outcome Risk Scale (SORT) - 0.738 (0.712-0.763), for the New Zealand Risk Scale (NZRISK) - 0.763 (0.738-0.787)), for the Surgical Mortality Probability Scale (SMPM) - 0.732 (0.706-0.757), for the Preoperative Postoperative mortality Prediction Scale (POSPOM) - 0.764 (0.738-0.788)) and good in assessing the risk of death (AUROC for the ASA scale was 0.82 (0.804-0.843), for the SRS scale - 0.860 (0.838-0.879), for the SORT scale - 0.860 (0.838-0.879), for the NZRISK scale - 0.807 (0.783-0.829), for the SMPM scale - 0.852 (0.831-0.872), for the POSPOM scale - 0.811 (0.788-0.833)). CONCLUSIONS. All the studied scales have good prognostic value in assessing the risk of 30-day mortality after major abdominal surgery. The NZRISK and POSPOM scales demonstrate good prognostic value for cardiovascular complications, POSPOM and SRS scales - for acute renal injury. POSPOM and NZRISK scales showed an excellent prognostic value in relation to the risk of postoperative delirium.
Stroke as the cause of death stably ranks second in world reports of the World Health Organization. Recently, one of the most pressing problems is the rehabilitation of this category of patients. The authors analyzed the realities of the modern approach to the verticalization of patients with acute disorders of the cerebral circulation and checked the possibility of improving control over it. The article condemns the possibility of using the method of early vertical introspection at the stage of early verticalization for possible prevention of perfusion complications with disturbance of oxygenation of the brain tissue during verticalization. A study of groups with ischemic strokes in carotid basins was carried out. Data were obtained on a significant decrease in cerebral oximetry indices during early verticalization in this category of patients. Conclusions are drawn on the need for further study with the purpose of introducing this technology into recommendations for the rehabilitation of patients with ischemic stroke.
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