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КРАТКИЕ СООБЩЕНИЯ
ABSTRACTS
© Group of authors, 2014 UDC 615.11:616.9-616.022
DOI - http://dx.doi.org/10.14300/mnnc.2014.09052 ISSN - 2073-8137
EVALUATION OF KLEBSIELLA SPP. AND ACINETOBACTER SPP. ANTIBIOTIC RESISTANCE IN HOSPITAL ENVIRONMENT (STAVROPOL, RUSSIA)
Baturin V. A.1, Shchetinin E. V.1, Demidenko I. F.2, Kunitsina E. A.2, Korableva O. N.1, Baturina M. V.12, Kharitonova Ya. P.1
1 Stavropol State Medical University, Russian Federation
2 Centre for Clinical Pharmacology and Pharmacotherapy (LLC), Stavropol, Russian Federation
One of the major issues modern medicine is facing is the resistance microorganisms develop to antibacterial drugs. This appears especially urgent as we speak of treating nosocomial infections [1]. In the latest years there has been special concern in relation to progressive growth of the resistance to numerous antibacterial drugs seen in Klebsiella spp. and Acinetobacter spp. [2, 3]. Due to this it was quite of interest to evaluate the antibiotic sensitivity that these microorganisms demonstrate in patients with nosocomial infections in the hospitals of Stavropol.
Material and Мethods. The research was carried out on the premises of the Bacteriological Laboratory of Centre for Clinical Pharmacology and Pharmacotherapy, LLC (Stavropol, Russia). The focus of the study was the biological material from patients with nosocomial infections obtained from the hospitals of Stavropol (Clinical Hospitals № 2 & № 3, Stavropol Regional Child Hospital, Stavropol Regional Perinatal Center) in 2013. The bacteriologic examination was carried out following the respective approved recommendations [4, 5], while the Klebsiella spp. and Acinetobacter spp. sensitivity was evaluated towards a wide range of antibiotics, which was done employing the disk diffusion method.
Results. The research helped isolate and identified 50 strains of Acinetobacter baumannii
Baturin Vladimir, MD, PhD, Professor, Head of Department of Clinical Pharmacology, Allergology and Immunology Stavropol State Medical University;
tel.: (9614)650167; e-mail: v_baturin@mail.ru
Shchetinin Eugeny, MD, PhD, Head of Department of Pathological Physiology, Stavropol State Medical University; tel.: (8652)352524; e-mail: ev.cliph@rambler.ru
Demidenko Inna, MD, Physician and Bacteriologist, head of the Laboratory of Bacteriology, Centre for Clinical Pharmacology and Pharmacotherapy; tel.: +79054969094; e-mail: demide-inna@yandex.ru
Kunitsina Elena, MD, Physician and Bacteriologist, Centre for Clinical Pharmacology and Pharmacotherapy; tel.: +79620227970; e-mail: kynavi@mail.ru
Korableva Oksana, MD, Clinical intern,
Stavropol State Medical University;
tel.: +79624480594; e-mail: oksi-j@yandex.ru
and 119 strains of Klebsiella spp. During that all the 50 strains of Acinetobacter baumannii were evaluated as resistant to penicillins and to 1st, 2nd and 3rd generation cephalosporins. The exception was found in the «protected» p-Lactam antibiotics -piperacillin/tazobactam and cefoperazone/ sulperazone. The sensitivity to them was 100 %. Cefepime - a 4th generation cephalosporin -proved of little efficiency stirring sensitivity in 10 % of Acinetobacter baumannii strains only. The sensitivity to carbapenems proved insufficient as well with 40 % of bacterial strains only evaluated as sensitive to imipenem and meropenem. Virtually inefficient in vitro were aminoglycosides (gentamycin and amikacin), ciprofloxacin, levomycetin and co-trimoxazole. Resistance to doxycycline was revealed in 48 % of Acinetobacter baumannii strains, while tigecycline's activity was at 100 %.
Therefore, in case of nosocomial infections caused by Acinetobacter baumannii an advisable choice would be either «protected» p-Lactam antibiotics (namely piperacillin/tazobactam or cefoper-azone/sulperazone) or tigecycline. Carbapenems and 2nd and 3rd generation fluoroquinolones could be viewed as an option only after a preliminary bacteriologic study of the patient's material.
The isolated strains of Klebsiella spp. (84 % of them accounted for by Klebsiella pneumoniae) also proved resistant to penicillins and 1st, 2nd and 3rd generation cephalosporins. Cefepime was effective in vitro in 21 % of cases alone; at the same time the microorganisms showed high sensitivity to piperacillin/tazobactam (100 %) and cefoperazone/ sulbactam (92.4 %). To carbapenems (imipenem and meropenem) only 60.5 % Klebsiellae were sensitive, while a low level of sensitivity (below 30 % of strains) was detected to aminoglycosides (gentamycin and amikacin), ciprofloxacin, levomycetin, and co-trimoxazole. Ofloxacin/levofloxacin caused resistance in 60 % of microorganisms, while doxycycline - in 52 %. Tigecycline showed a high level of efficiency with 100 % of Klebsiella spp. of strains sensitive to it.
Mention to be made here that around 40 % of Klebsiellae strains produced extended spectrum beta lactamases (ESBL).
МЕДИЦИНСКИЙ ВЕСТНИК СЕВЕРНОГО КАВКАЗА
2014. Т. 9. № 2
MEDICAL NEWS OF NORTH CAUCASUS
2014. Vоl. 9. Iss. 2
This means that in hospital setting in case of infections caused by Klebsiella spp. a preferred choice would be either piperacillin/tazobactam or cefoperazone/sulperazone, or tigecycline. Employing carbapenems, ofloxacin/levofloxacin or doxycycline could allow us counting on a proper effect in slightly more than 50 % of cases.
Conclusion. Developing the resistance in hospital environment microorganisms would have a significant impact on the treatment outcomes regarding patients with nosocomial
References
1. Sievert D. M., Ricks P., Edwards J. R., Schneider A.,
Patel J. et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010. Infect Control Hosp Epidemiol. 2013;34(1):1-14.
2. Rudnov V. A., Belsky D. V., Dekhnich A. V. Infections at
Emergency and Intensive Care Units (EICU): Results of National Multicenter Trial. Clin Microbiol Antimicrob Chemotherap. 2011;13(4):294-303.
EVALUATION OF KLEBSIELLA SPP.
AND ACINETOBACTER SPP. ANTIBIOTIC RESISTANCE
IN HOSPITAL ENVIRONMENT (STAVROPOL, RUSSIA)
BATURIN V. A., SHCHETININ E. V., DEMIDENKO I. F.,
KUNITSINA E. A., KORABLEVA O. N.,
BATURINA M. V., KHARITONOVA Yа. P.
Key words: Klebsiella spp., Acinetobacterspp., nosocomial infections
infections. A bacteriologic monitoring of such microorganisms evaluating their resistance to a wide range of anti-microbial medications should be a mandatory activity not only in particular inpatient units yet in the region as a whole. This work would contribute both to the development of general standard requirements for empirical therapy of infections in hospitals and to establishing individual approaches when shaping the therapeutic tactics for particular patients.
3. Reshedko G. K., Ryabkova E. L., Krechikova O. I., Sukhorukova M. V., Shevchenko O. V. et al. Resistance to antibiotics for gram-negative causative agents of nosocomial infections at EICU in multifield hospitals of Russia. Clin Microbiol Antimicrob Chemotherap. 2008;10(2):163-179.
4. CLSI Performance standards for antimicrobial susceptibility testing; 21st informational supplement. 2011;(31):165.
5. Evaluation of Microorganisms Sensitivity to Antibacterial
Medications (Methodological Guidelines MUK 4.2.1890-04). Clin Microbiol Antimicrob Chemotherap. 2004;6(4):306-357.
ОЦЕНКА АНТИБИОТИКОРЕЗИСТЕНТНОСТИ
KLEBSIELLA SPP. И ACINETOBACTER SPP.
В СТАЦИОНАРАХ Г. СТАВРОПОЛЯ
В. А. БАТУРИН, Е. В. ЩЕТИНИН, И. Ф. ДЕМИДЕНКО,
Е. А. КУНИЦЫНА, О. Н. КОРАБЛЕВА,
М. В. БАТУРИНА, Я. П. ХАРИТОНОВА
Ключевые слова: Klebsiella spp., Acinetobacter spp., нозокомиальные инфекции
© Group of authors, 2014
UDC 616.126.3-007.271:546.41:577.125
DOI - http://dx.doi.org/10.14300/mnnc.2014.09053
ISSN - 2073-8137
GENE POLYMORPHISM OF LIPID METABOLISM MARKERS IN CALCIFIC AORTIC VALVE DISEASE
Shcheglova E. V.1, Baikulova M. Kh.2, Boeva O. I.1, Laipanova A. I.2, Chotchayeva Z. Kh.2, Khait G. Ya.1
1 Stavropol State Medical University, Russian Federation
2 Regional Clinical Cardiology Center, Stavropol, Russian Federation
Shcheglova Elena, MD, Assistant Professor, Department of Hospital Therapy, Stavropol State Medical University; tel.: +79034142734; e-mail: smets_82@mail.ru
Baikulova Madina, Cardiologist, Regional Clinical Center of Cardiology, Stavropol; e-mail: m.baykulova@mail.ru
Boeva Olga, MD, PhD, Professor, Department of Clinical Physiology, Cardiology and Introscopy, Stavropol State Medical University; e-mail: box0271@mail.ru
Laipanova Asiyat, Postgraduate Student, Department of Clinical Physiology, Cardiology and Introscopy, Stavropol State Medical University; e-mail: adzi777@mail.ru
Chotchayeva Zarema, Postgraduate Student, Department of Clinical Physiology, Cardiology and Introscopy, Stavropol State Medical University; e-mail: chotchaeva@yandex.ru
Calcific aortic valve disease (CAVD) (senile, degenerative aortic stenosis) is the process of thickening and calcification of aortic valve (AV) leaflets in the absence of rheumatic heart disease. In the cases of AV sclerosis (calcification) thickened leaflets don't impact normal intracardiac hemodynamics. Aortic stenosis is characterized by obstruction of the left ventricle outflow tract. Pathogenesis of cal-cific aortic valve disease involves lipid disme-tabolism. [4]. A thorough analysis of the lipid profile in the CAVS patient population revealed increased levels of total cholesterol and athe-
