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To study in vitro activity of antimicrobials against clinical isolates from patients with community-acquired urinary tract infections (UTIs) in different regions of Russia, Belarus and Kazakhstan in 2017-2018.A total of 1260 isolates collectedin the Russian Federation, Belarus and Kazakhstanas a part of the international multicenter prospective epidemiological study of the dynamics of antimicrobial resistance of uropathogens causing community-acquired urinary tract infections in different subsets of patients ("DARMIS-2018") were included in the analysis. 1124 strains represented the Enterobacterales order. Uropathogenswere isolated from children and adults of both sexes of all age groups with acute (and recurrences of chronic) community-acquired UTIs including pregnant women with asymptomatic bacteriuriain 34 centers of 26 cities of Russia, Kazakhstan and Belarus in 2017-2018.Enterobacterales jointly comprised a total of 89,2% of all isolated bacterial pathogens (88,9% in the adult subset; 89,3% in the subset of pregnant women and 91,4% in the subset of children and adolescents under 18). The most prevalent species were Escherichia coli (69,4% in the adult subset; 73,6% in the subset of pregnant women and 77,1% in the subset of children and adolescents under 18) and Klebsiella pneumoniae (11,5% in the subset of adults; 10,4% in the subset of pregnant women and 7,1% in the subset of children and adolescents under 18 years of age). The maximum activity against E. coli among oral drugs demonstrated fosfomycin (97,9% in the adult subset; 95,9% in the subset of pregnant women and 99,1% in the subset of children and adolescents under 18) and nitrofurantoin (97,9% in adult subset; 100% in the subset of pregnant women and 96,3% in the subset of children and adolescents under 18). Out of the parenteral drugs meropenem (out of carbapenems) and amikacin showed the highest activity (99,5% and 97,7% in the adult subset; 99,5% and 99,1% in the subset of pregnant women; 100% and 97,2% in the subset of children and adolescents under 18 years of age, respectively). Ampicillin, amoxicillin/clavulanic acid and trimethoprim/sulfamethoxazole demonstrated the lowest in vitro activity against Escherichia coli (less than 80% for everypatient subset). The susceptibility of E. colito ciprofloxacin was 60,4% in the adult subset; 80,0% in the subset of pregnant women and 80,6% in the subset of children and adolescents under 18. The rate of production of extended spectrum beta-lactamases among E. coli isolates based on the results of phenotypic tests was 21,9%.Results of this study indicate the increase of resistance of community-acquired isolates of Enterobacterales and in particular E. coli to the most of antimicrobials in Russia, Belarus and Kazakhstan.

The results of the systemic antimicrobials (AM) consumption and expenditures assessment in the departments of surgery of multi-profile hospitals in different regions of the Russian Federation and the Republic of Belarus in 2009-2010 based on retrospective collection and analysis of the data from the hospital expenditure notes using ATC/DDD methodology are presented. The average AM consumption and expenditure rates in the above mentioned departments varied from 24.9 DDD/100 bed-days to 61.7 DDD/100 bed-days depending on the department profile, with beta-lactams (cephalosporins and penicillins) share in the consumption being as high as 70-90%, followed by fluoroquinolones and aminoglycosides. Only 55-70% of the consumed AM belonged to the drugs of choice, whereas the improper AM consumption and expenditure rates amounted up to 10-18%. The study outputs can be used for the budget allocation and AM distribution improvement in the departments of surgery, as well as for the development and efficacy control of the local antimicrobial stewardship programs.

An immunochromatographic strip (ICS) test was developed for the detection of diphtheria toxin by using an equine polyclonal antibody as the capture antibody and colloidal gold-labeled monoclonal antibodies specific for fragment A of the diphtheria toxin molecule as the detection antibody. The ICS test has been fully optimized for the detection of toxin from bacterial cultures; the limit of detection was approximately 0.5 ng of diphtheria toxin per ml within 10 min. In a comparative study with 915 pure clinical isolates of Corynebacterium spp., the results of the ICS test were in complete agreement with those of the conventional Elek test. The ICS test was also evaluated for its ability to detect toxigenicity from clinical specimens (throat swabs) in two field studies conducted within areas of the former USSR where diphtheria is epidemic. Eight hundred fifty throat swabs were examined by conventional culture and by use of directly inoculated broth cultures for the ICS test. The results showed 99% concordance (848 of 850 specimens), and the sensitivity and specificity of the ICS test were 98% (95% confidence interval, 91 to 99%) and 99% (95% confidence interval, 99 to 100%), respectively.

To assess an incidence rate of surgical site infections (SSI) after open appendectomy and effectiveness of combined preventive measures (CPM).This study was performed at three surgical departments of Smolensk hospitals. A total of 150 consecutive patients (50 at each department) hospitalized since January 2012 were included into the retrospective observation (period I). In order to perform prospective evaluation of CPM, a total of 66 consecutive patients (randomized 1:1) hospitalized since December 2012 (period II) were followed up at each of the departments. Antibiotic prophylaxis (AP) with IV amoxicillin/clavulanate (1.2 g) was planned for all patients from period II. The study group (group 1) included patients with surgical wound closure with triclosan-coated polyglactin 910 and additionally with a skin 2-octylcyanoacrylate-based adhesive. The control group (group 2) included patients with surgical wound closure with non-triclosan-coated polyglactin 910. Each patient from the period II was assigned to an "Individual SSI Prevention Package" (IPP), which included an antibiotic, sutures, skin adhesive (only in a package for CPM) and label "AP" for patients' medical records. Patients' medical records were reviewed by one expert. Exclusion criteria were: age14 years; transition to midline laparotomy; drainage of the abdominal cavity through the surgical wound; simultaneous interventions; secondary appendicitis; refusal to use of sutures from the IPP. In order to determine signs of SSI presence/absence within 30 days after surgery, attempts to contact with patients by phone were made. The data obtained was recorded into case report forms and then entered into the study database.A total of 322 patients were included into the final analysis (mean age: 34.8±17.1 years). The mean length of hospital stay was 8.2±2.5 days. The mean duration of hospital stay with or without SSI was 7.9±1.8 and 14.2±4.0 days, respectively (p0.001). The AP during the periods I and II was performed in 56.1% (83/148) and 97.7% (170/174) of patients, respectively (p0.00001). Cephalosporins I-IV were the most frequently used antibiotics during the period I (85.6%). During the period II, amoxicillin/clavulanate from IPP was used in 98.2% of patients. Percentage of IV antibiotic administration in different time periods was 57.3% and 98.2%, respectively (p0.0001); frequency of the first administration before skin incision was 53.6% and 97.1%, respectively (p0.0001). The telephone contact with patient was successful in 74.8% (both periods), 56.8% (period I) and 90.2% (period II) of cases, respectively. SSI was recorded only once per patient with the following priority: SSI was documented in the patient's medical record; patient developed SSI that was not documented (in the expert's opinion) in the patient's medical record; SSI signs were determined during the telephone contact or reported by the patient. The incidence of SSI in both study periods, period I and period II was 14.9%, 15.5% and 14.4%, respectively (p0.05 for all comparisons). In the patient subgroup with successful telephone contact, the incidence of SSI in both study periods, period I and period II was 17.4%, 21.4% and 15.3%, respectively; the incidence of SSI in group 1 and group 2 of the period II was 12.0% and 18.9%, respectively (p0.05 for all comparisons).SSI after an open appendectomy remains an important problem. In order to determine a true incidence of SSI, it is necessary to improve the national nosocomial infection surveillance system. The CMP used in the study have showed a trend to significant SSI risk reduction and may be recommended to maximize patient protection. Further large studies are needed to confirm effectiveness of the proposed CMP.Цель работы. Определить актуальность инфекций области хирургического вмешательства (ИОХВ) после аппендэктомии с лапаротомным доступом по Волковичу-Дьяконову на современном этапе и оценить эффективность комплексного подхода к профилактике их развития. Материал и методы. Проведено многоцентровое проспективное рандомизированное слепое исследование в трех хирургических отделениях (центрах) стационаров Смоленска, в которых в наблюдение были включены первые 50 пациентов, госпитализированных последовательно с 01.01.12 по 30.11.12 (I период). Истории болезни (ИБ) пациентов были запрошены в архиве и подвергнуты ретроспективной оценке одним экспертом. Для проспективной оценки эффективности комплексного подхода к профилактике ИОХВ в наблюдение были включены пациенты, последовательно поступавшие с 01.12.12 (II период) в те же хирургические отделения. В каждом центре были включены по 66 пациентов, которые предварительно были рандомизированы на равные группы по 33 человека. Всем пациентам планировалось проведение профилактики ИОХВ амоксициллином/клавуланатом, т.е. 'стандартизированной' антибактериальной профилактики (АБП), под которой понимали ограничение выбора антибиотика при хирургических вмешательствах одного вида в обычных условиях одним препаратом в отличие от 'рутинной' практики АБП без какой-либо регламентации (на усмотрение врача). Анализируемую (1-ю) группу с комплексным подходом к профилактике ИОХВ составили пациенты, которым операционная рана была ушита шовным материалом полиглактином 910, импрегнированным триклозаном и дополнительно закрыта кожным клеем на основе 2-октилцианоакрилата, а контрольную (2-ю) - без триклозана. В наблюдение были включены 198 пациентов (по 99 в каждой группе). Для каждого пациента были приготовлены 'индивидуальные пакеты профилактики ИОХВ', включавшие помимо антибиотика, шовного материала и клея (последний - только в пакетах для комплексной профилактики) еще и 'стикер АБП' - наклейку в ИБ о факте проведения процедуры. ИБ пациентов II периода были подвергнуты анализу одним экспертом. При указании в ИБ контактных телефонов пациентов обоих периодов была предпринята попытка их телефонного опроса в целях установления факта развития/отсутствия ИОХВ после выписки в сроки до 30 дней с момента оперативного вмешательства. Критериями исключения из окончательного анализа являлись следующие условия: возраст менее 14 лет, конверсия (переход на срединную лапаротомию); выполнение дренирования брюшной полости через операционную рану; симультанные вмешательства; вторичный аппендицит; полный отказ от использования шовного материала из индивидуального пакета профилактики ИОХВ'. Все полученные в результате исследования сведения были внесены в индивидуальные регистрационные карты (ИРК) с последующим переносом информации в единую электронную базу данных методом двойного ввода. Результаты. В окончательный анализ были включены 322 пациента - 158 (49,0%) женщин и 164 (50,9%) мужчины, средний возраст которых составил 34,8±17,1 года. Средняя длительность госпитализации составила 8,2±2,5 сут. Длительность госпитализации пациентов без и с ИОХВ составила в среднем 7,9±1,8 и 14,2±4,0 сут соответственно (р0,001). Частота проведения АБП в I и II периодах исследования составила 56,1% (83/148) и 97,7% (170/174) соответственно (р0,00001). В ИБ 98,9% (90/91) пациентов 1-й группы II периода и 92,8% (77/83) пациентов 2-й группы II периода присутствовал стикер АБП о проведении процедуры. Наиболее часто для профилактики ИОХВ в I периоде использовались цефалоспорины I-IV поколений, общая доля которых составила 85,6% (83/97). Во II периоде исследования в 98,2% (167/170) случаев использовали амоксициллин/клавуланат из индивидуального пакета профилактики ИОХВ. Почти половину всех случаев в I периоде составили случаи в/м введения антибиотика, в/в введение отмечено в 57,3% (55/96). Во II периоде подавляющее большинство случаев было представлено в/в введением препарата - 98,2% (167/170), р0,0001. В I и II периодах первое введение препарата до разреза (предоперационная АБП) отмечено у 53,6% (44/82) и 97,1% (165/170) пациентов соответственно (р0,0001). За оба временных периода исследования ИОХВ в ИБ документирована у 3,7% (12/322) пациентов и недокументирована, по мнению эксперта, еще у 2,5% (8/322) пациентов. Таким образом, частота развития 'суммарной ИОХВ' на госпитальном этапе составила 6,2% (20/322). Доля пациентов, с которыми был осуществлен телефонный контакт в оба периода исследования, составила 74,8% (241/322), 56,8% (84/148) и 90,2% (157/174) соответственно. Частота 'заявленной ИОХВ', развившейся на госпитальном этапе и после выписки у пациентов в I и II периодах составила 10,1% (15/148) и 12,1% (21/174) соответственно (р0,05). Абсолютное большинство пациентов 86,1% (31/36) с 'заявленной ИОХВ' обращались по этому поводу за медицинской помощью после выписки из стационара. Регистрация 'общей ИОХВ' происходило только один раз для одного пациента со следующим приоритетом: ИОХВ диагностирована и документирована на госпитальном этапе, ИОХВ не документирована, заявленная ИОХВ. Таким образом, частота развития общей ИОХВ у всех пациентов в оба временных периода исследования, I и II периодах составила 14,9% (48/322), 15,5% (23/148) и 14,4% (25/174) соответственно. Частота развития общей ИОХВ в 1-й и 2-й группах II периода составила 11,0% (10/91) и 18,1% (15/83) соответственно. Различия не являлись статистически значимыми для всех пар сравнений (р0,05). При оценке субпопуляции пациентов, с которыми был осуществлен телефонный контакт, частота общей ИОХВ в оба временных периода исследования, I и II периодах 17,4% (42/241), 21,4% (18/84) и 15,3% (24/157) соответственно. Частота развития общей ИОХВ в 1-й и 2-й группах II периода в субпопуляции составила 12,0% (10/83) и 18,9% (14/74) соответственно, р0,05 для всех пар сравнения. Выводы. ИОХВ после традиционной аппендэктомии остаются актуальной проблемой современной хирургии. Для определения истинной частоты развития ИОХВ необходимо совершенствовать национальную систему регистрации нозокомиальных инфекций. Комплексный подход к профилактике ИОХВ с использованием 'индивидуального пакета профилактики ИОХВ' продемонстрировал тенденцию к значительному снижению риска развития таких осложнений в сравнении со стандартизированной АБП и рутинной практикой АБП, что позволяет рекомендовать его для максимального повышения противоинфекционной защиты пациентов. Для достоверного подтверждения этого факта необходимы дальнейшие, более масштабные исследования.

A rise in efficacy of the treatment of acute infection affecting the lower urinary tract (LUTI) and prolongation of recurrence-free interval in chronic LUTI can be achieved only by an optimal antibacterial treatment. The study was made of 987 community-acquired strains of uropathogens from the patients living in 20 cities of the Russian Federation, Belarus and Kazakhstan (of them, 903 strains were from Russia). Enterobacteriaceae comprised 83.5%. E. coli infection of LUTI was found in 63.5% patients. The incidence of this infection was about the same both in uncomplicated and complicated cases (64.6 and 62.1%, respectively). Most active oral drugs against E.coli were phosphomycin (98.4%), furasidin (95.7%), nitrofurantoin (94.1%) and oralcefalosporins of the third generation (ceftibuten and cefixim). As to Enterobacteriaceae, only phosphomycin had activity against these bacteria above 90%, i.e. 91.5%. Furasidin and nitrofurantoin activity was 86.3 and 76.8%, respectively. From parenteral drugs, most active against E. coli were carbapenems (ertapenem, meropenem, imipenem. Strains resistant to them were not isolated. High in vitro activity was demonstrated also by cefoperason/sulbactam (97.4%), piperacillin/tasobactam (95.7%), cefalosporins of the third/fourth generation and amikacin (98.9%). Carbapenems were also highly active against Enterobacteroaceae. Empiric treatment of uncomplicated urinary infection should be performed with medicines which are not used for other indications.

A total of 656 female patients from Russia aged between 18 to 65 years with uncomplicated cystitis entered the international ARESC trial, of them 647 were eligible for final analysis. Positive cultural urine tests (10(4) CFU/ml) were in 419 (64.7%) patients, 393 (93.8%) patients had monoinfection. The central laboratory of Genoa (to which the isolated samples were sent) has tested 416 uropathogens from 399 patients. The following pathogens were isolated: E. coli (72.6%), enterococcus (7.0%), Klebsiella pneumoniae (4.6%), Staphylococcus saprophyticus (3.6%), Proteus mirabilis (2.4%) and Staphylococcus aureus (1.7%). E. coli was most sensitive to phosphomycin (99.3%), mecillinam (97.3%), nitrofurantoin (94.7%), ciprofloxacin (87.4%). The lowest sensitivity was to ampicillin (42.1%) and cotrimoxasol (69.4%). As to the whole bacterial spectrum, the highest sensitivity was found to phosphomycin (96.5%), nitrofurantoin (85.6%) and citrofloxacin (82.8%), the less sensitivity--to ampicyllin (44.3%) and co-trimoxasol (70.1%). Phosphomycin, mecillinam (not registered in Russia) and nitrofurantoin showed activity in vitro and can be considered as drugs of choice for empiric therapy of cystitis. Because of high resistance of pathogens, co-trimoxasol (trimetoprim) and fluoroquinalones are not recommended as first-line treatment for uncomplicated cystitis in females.

International audience; The increased incidence over the past decade of bloodstream infections (BSIs) caused by gram-positive bacteria, particularly methicillin-resistant Staphylococcus aureus, highlights the critical need for a consistent approach to therapy. However, there is currently no international consensus on the diagnosis and management of gram-positive BSIs. The Clinical Consensus Conference on Gram-Positive Bloodstream Infections was convened as a session at the 9th International Symposium on Modern Concepts in Endocarditis and Cardiovascular Infections held in 2007. Participants discussed various aspects of the practical treatment of patients who present with gram-positive BSI, including therapeutic options for patients with BSIs of undefined origin, the selection of appropriate empirical therapy, and treatment of complicated and uncomplicated BSIs. The opinions of participants about these key issues are reflected in this article.