Healthcare associated infections (HAI) — infections that patients develop during the course of receiving healthcare in hospitals, outpatient department and at home, out of healthcare facilities, and infection resulting from occupational exposure. Patients with diabetes are vulnerable to HAI. Infections increase metabolism problems in patients with diabetes; and vice versa, high blood glucose level increases risk of infections. For assuring epidemiological safety for patients with diabetes infection control must be provided for the following medical practices: insulin injections; blood glucose test; care of diabetes foot; intravascular catheterization and surgery. Any invasive procedures increase the HAI risk. HAI are most commonly transferred through direct and indirect contact with the infection. Some of the main HIA preventive practices: staff cleaning hands with alcohol based sanitizer, single use of medical gloves, single use of insulin needles and syringes. In health facilities only multiple users and multiple blood glucose monitoring devices must be used by health providers. The protocol of glucose blood testing should include detailed disinfection procedures and additional measures to decrease the risk of potentially transmitting disease between patients and between patients and providers. Health providers should have special skills to care of patients with diabetes foot to perform non-traumatic procedures and infections control practices. Proper hand hygiene and gloves use combined with effective aseptic technique before catheter insertion and maintenance protect against severe HAI. Risk of infections significantly decreases when single-dose antibiotic was used before surgery as antimicrobial prophylaxis. To disease risk of infections patients should be recommended to strictly control diabetes during the weeks before elective surgical procedures.
Invasive Streptococcal (Group A) Infection of Soft Tissues in a Moscow Surgical HospitalAim. To study features and risk factors of soft tissue's invasive streptococcal infection in surgical unit's patients: a) emm-types of the most often recovered streptococcus; b) human immune response for streptococcal antigens (streptolysin-O and the group A carbohydrate antigen); c) main patient's conditions that complicate the course of soft tissue's streptococcal infection. Patients and methods. 101 surgical unit's patients with soft tissue's infection, which group A streptococcal (GAS) nature, were examined. Emm-types were determined by comparison of emm gene sequenced part with data of CDC Streptococcus Laboratory. ASO and specific anti-group-carbohydrate IgM were measured with photometry and ELISA accordingly. Patient's personal data were analyzed by standard statistical programs. Results. Among 34 emm-types of all streptococcal isolates emm28 and emm64 were registered only in invasive infection. 49, 60, 66, 77, 84, 88 were most often. Among 23 sera from invasive GAS-infection's patients, 15 (65%) were ASO-negative, 6 (26%) were ASO-low-positive, and 2 (8%) were positive, but negative for the anti-group-A-carbohydrate IgM. Conclusion.Lower levels of the humoral immune response as well as risk factors such as trauma, alcoholism, diabetes, chronic venous insufficiency contributed to development of severe forms of GAS-infection. The main streptococcal emm-types for soft tissue's invasive GAS infection in one of Moscow surgical unit's patients in 2008Moscow surgical unit's patients in -2011
Aim. To compare the molecular properties and antibiotic susceptibility of GAS isolates in patients with respiratory and soft tissue infections. Materials and methods. 86 GAS isolates from patients with respiratory infections and 91 isolates with soft tissue infections were studied. The antimicrobial susceptibility profile of six antibiotics (clindamycin, erythromycin, azithromycin, clarithromycin, tetracycline, levofloxacin) was performed by the microdilution method. PCR and sequencing were used in emm-typing and detection SpeA, SpeB and SpeC genes. Results. Emm-types: 49, 66, 88 and 169 were the most prevalent in patients with soft tissue infections, and 1, 3, 12, 28, 75, 89 - in patients with respiratory infections. One strain was new. Isolates were representatives of the three patterns (A-C, D, E). 116 strains of both groups comprised to pattern E. 15 strains (21%) exclusively from soft tissue infections comprised to pattern D. More than half of isolates from patients with soft tissue infections had resistant to tetracycline. Resistance to macrolides was determined in both groups. In each of the studied groups were isolated strains with multidrug resistant. Eryphrogenic toxins gene A and C was more frequently in respiratory isolates. Conclusion. The group of respiratory GAS was less heterogenic in emm-types composition. Pattern D was not contain any pharyngeal GAS strains. Eryphrogenic toxin gene speA was identified twice as likely in respiratory isolates. The use of tetracycline and macrolides would be ineffective in approximately half of the cases among the patients with soft tissue infections.
Aim. Goal of the study is characterization and analysis of an occurrence of ICE-emm12 genetic element associated with streptococcal outbreaks, among Vietnamese and Russian GAS strains. Materials and methods. A total of 96 strains isolated in 2007 - 2014 in Moscow, Saint-Petersburg and different provinces of Vietnam were studied. Molecular genetic experiments were done as previously described. Whole genome sequencing was done using MiSeq technology. Results. Complete genome sequencing of Vietnamese strain V31 revealed the presence of 61028 bp fragment homologous to integrative and conjugative element ICE-emm12 containing resistance genes to MLS-antibiotics (ermB) and tetracycline (tetM). This element was discovered in 12 (26,1%, types emm12.0, emm12.22) out of 46 Vietnamese strains, and 2 (4,0%, types emm12.0, emm88.2) out of 50 Russian strains. In 13 out of 14 strains, ICE-emm12 was integrated in RNA-methyltransferase gene, which is possibly the «hot spot» for recombination. In all the strains ICE-emm12 was present in two forms: integrated linearized form and excised circular form with potential to be horizontally transferred. Conclusion. The presence of ICE-emm12 containing antibiotic resistance genes and associated with streptococcal outbreaks in South East Asia, among Russian GAS strains together with the fact of intensive tourism industry indicate the need of molecular epidemiological surveillance for circulation of epidemiologically actual streptococcal clones in Russia.
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