Comparative analysis of resistance of main etiological agents of chronic osteomyelitis isolated from association and in monoculture

Introduction. To date, a significant number of works have been published devoted to the analysis of the sensitivity of the leading causative agents of osteomyelitis to modern drugs, however, in the available literature there are no data on a comparative analysis of the antibiotic resistance of bacteria isolated from the osteomyelitis focus from the association and in monoculture. Purpose of the work: to compare the resistance profiles of the leading causative agents of osteomyelitis, depending on the bacterial composition of the focus of infection.Materials and methods. The study included 216 clinical isolates, of which 114 were isolated as part of two-component associations, 102 – in a monoculture from pathological material in patients with chronic osteomyelitis who were treated in the purulent department of National Medical Scientific Centre of Traumatology and Orthopedics n.a. academician G.E. Ilizarov (Kurgan, Russia) from 2018 to 2020. To analyze the resistance profiles, depending on the type of microorganism, modern drugs used in the clinic for the treatment of osteomyelitis were taken into account.Results and its discussion. Effective drugs against P. aeruginosa strains isolated from the association were polymyxin and meropenem, and in monoculture–polymyxin, piperacillin/tazobactam, tobramycin; in relation to strains of K. pneumoniae isolated from the association, it was imipenem, in monoculture – amikacin. S. aureus strains isolated both from the association and in monoculture were highly susceptible to antibacterial drugs.Conclusion. The analysis of the sensitivity of the leading causative agents of osteomyelitis, isolated in monoculture and from the association, to the antibacterial drugs used in the clinic, showed significant differences in the resistance profiles between the groups: for S. aureus strains, 4 antibiotics tested out of 13, for P. aeruginosa strains – 7 out of 13, for K. pneumoniae strains – 12 out of 16. The tested antibacterial drugs were less active against P. aeruginosa and S. aureus strains isolated from associations. In contrast, the percentage of resistant strains of K. pneumoniae was higher among monocultures.

Pertussis in Children: Clinical and Epidemiological Features, the Possibilities of Vaccine Preventio

Relevance. Despite the specific immunization carried out, pertussis still has great medical and social significance for pediatricians, since it continues to remain a common bacterial infection, involving children of different age groups in the epidemic process. The lack of persistent immunity to whooping cough, combined with a high susceptibility index, contributes to an increase in the incidence among schoolchildren and adolescents, who are diagnosed only during epidemiological and laboratory examinations, and who, in most cases, serve as sources of infection for young children. Aim. To study the clinical and epidemiological features of whooping cough in children aged 0 to 14 years hospitalized in an infectious diseases hospital under conditions of mass vaccine prevention, as well as to identify the features of the disease in vaccinated people using the example of an outbreak of the disease in an organized group. Materials and methods. A retrospective analysis of 164 case histories of children diagnosed with Pertussis hospitalized in the infectious hospital of the Regional Interdistrict Children’s Clinical Hospital № 1 in Krasnoyarsk in 2015–2019, as well as 25 outpatient records of patients identified during the epidemiological investigation of the focus of infection in December 2019 was carried out. For the etiological interpretation of the diagnosis of whooping cough, a comprehensive laboratory examination was carried out using bacteriological, serological and molecular genetic research methods. Results. According to official statistics, in the Krasnoyarsk territory in 2019, among children with pertussis, patients aged 7 to 17 prevailed (38,7%). At the same time, in the age structure of patients hospitalized in a hospital, the primary importance was occupied by children of the first year of life, unvaccinated against this disease. Most of them were diagnosed with a moderate form of the disease with frequent development of complications from the respiratory and nervous systems. At the same time, among schoolchildren and adolescents, as a rule, who have received a completed course of vaccination, there is an atypical, erased course of the disease, while the difficulties of its diagnosis lead to a high incidence of pertussis in children of the first year of life who have not yet been protected by vaccination. Conclusions. Despite the high coverage of decreed groups with preventive vaccinations against whooping cough in the Krasnoyarsk territory, an assessment of the state of specific immunity based on the results of a serological survey conducted in 2019 revealed 50.6% of seronegative individuals already at the age of 3–4 years, which confirms the need to improve the schemes immunization against this disease; and inclusion of pertussis vaccination in the regional immunization schedule.

Territorial pattern between outbreaks of ASF among wild and domestic pigs in Ukraine

The article presents the results of the analysis of the epizootic situation in Ukraine regarding African swine fever among domestic and wild pigs from 2012 to 2020 and identifies the main sources of virus spread as well as weak links in the biological safety system of farms. When studying the statistical material of the Food and Agriculture Organization of the United Nations (FAO) and the State Service of Ukraine on Food Safety and Consumer Protection regarding animal morbidity, revealed a territorial pattern between the outbreaks of African swine fever among wild boars and domestic pigs of private farms and pig-breeding complexes, and proved the involvement of the European boar in the epizootic process as a natural reservoir and mobile focus of infection. Calculated the number of outbreaks of African swine fever among wild boars and domestic pigs within the same region and district, and studied the sequence of the emergence of foci on limited territories. Analyzed the natural focality of the disease, the probability of infection transmission to the domestic pig farm sector, and the role of infected objects in the spread of the virus among wild animal populations. From 2012 to 2020 inclusive, according to FAO statistics, 537 cases of African swine fever were recorded in Ukraine, 21.7 % of which were associated with wild boars. In 2017 and 2018, the role of the European wild boar in the epizootic process is best reflected, when 10.9 % (2017) and 20.4 % (2018) of outbreaks of African swine fever among domestic animals recorded in the same administrative districts, where during a year this desiase was detected among wild pigs. When analyzing statistical data of the recent years, the effectiveness of introducing more detailed monitoring of African swine fever among wild boars using modern laboratory methods and improving biosafety measures in the private sector and directly on hunting grounds has been proved. Further research is based on predicting the dynamics of the spread of African swine fever in Ukraine and the role of wild boar in this epizootic process. In addition, the role of wild boar in the spread of African swine fever in other countries and the most effective foreign methods of disease control and prevention will be analyzed.

Clinical importance of determination of procalcitonin in diagnosis of sepsis

The review presents an assessment of the dynamics of the change in procalcitonin as the main marker of bacterial inflammation in patients with the syndrome of systemic inflammatory reaction, sepsis and septic shock, clarification of the practical and predictive significance of PCT in patients with an identified and not identified focus of infection.

Autotransplantation of Flaps in the Treatment of Peri-Implant Infection After Osteosynthesis (Analysis of Clinical Observations)

Unfortunately, suppuration of a postoperative wound remains the most frequent complication of surgical intervention. If suppuration is located superficially, within the subcutaneous fat, it can be successfully managed with minimal functional losses. The clinical course is significantly complicated if the focus of infection is located under the skin, in the thickness of the muscles, in the fracture zone. In the case of suppuration in the area of osteosynthesis, the complication may become critical.Such a complication is a serious condition that requires multi-stage complex and sometimes multidisciplinary treatment.The conditions for a successful outcome in this pathology are the minimum period from the moment of suppuration, active surgical tactics, stability of the implant, and good vascularization of the surrounding soft tissues.Active surgical tactics involves the opening and sanitation of purulent foci, leaks, recesses. Staged necrectomies are inevitable companions of surgical treatment and can cause the formation of defects in the skin, subcutaneous tissue, and muscles.The resulting soft tissue defect leads to exposure of the bone and plate. Removal of the metal fixator becomes inevitable.Only the closure of the defect with a complex of tissues based on free vascularized composite grafts can radically solve the problem.The article presents two clinical observations of deep wound infection after bone osteosynthesis, where autotransplantation of a vascularized flap was used. The use of this technique made it possible to achieve suppression of infection, wound healing by primary intention, to create conditions for consolidation of the fracture, restoration of function and preservation of the limb as a whole.

Report On Complete Endpoints and Predictors of Response to Plasma Exchange – Results From a Randomized Controlled Trial in Septic Shock Patients

Background: Recently, a randomized controlled trial (RCT) demonstrated rapid but individually variable hemodynamic improvement with therapeutic plasma exchange (TPE) in patients with septic shock. Prediction of clinical efficacy in specific sepsis treatments is fundamental for individualized sepsis therapy.Methods: In the original RCT patients with septic shock of < 24 h duration and norepinephrine (NE) requirement ≥ 0.4 μg/kg/min received standard of care (SOC) or SOC + one single TPE. Here we report all clinical and biological endpoints of this study. Subgroup analysis of NE reduction and 28-day mortality was performed to investigate characteristics that could be associated with clinical response.Results: Early hemodynamic stabilization was preserved in the TPE group for 24 hours and was accompanied by a reduction of lactate suggestive for shock reversal. A reduction of injurious mediators (such as PCT, vWF:Ag, Angpt-2, sTie-2) and a repletion of exhausted protective factors (such as AT-III, Protein C, ADAMTS-13) could be observed in the TPE but not in the SOC group. Significant NE reduction (> 50% from baseline) upon TPE occurred more often in patients with 1) a pulmonary focus of infection, 2) profound respiratory failure (pO2/FiO2<150 mmHg), 3) critical hemodynamic instability (NE > 0.6 μg/kg/min and lactate >0.4 mmol/l) as well as 4) substantial degree of organ failure (SOFA Score > 16) at randomization. Patients with a pulmonary focus of infection had a 28-day mortality of 15% in the TPE group while it was 42% in the SOC group. Conclusions: Adjunctive TPE is associated with the removal of injurious mediators and repletion of consumed protective factors altogether leading to preserved hemodynamic stabilization in refractory septic shock. It is We identified potential response predictors (lung focus, PF ratio < 150, higher SOFA score etc.) that might guide future designing of large RCTs that will further evaluate TPE with regard to hard endpoints. Trial registration: Retrospectively registered 18th January 2020 at clinicaltrials.gov (Identifier: NCT04231994), https://clinicaltrials.gov/ct2/show/NCT04231994?term=NCT04231994&draw=2&rank=1

THE USE OF A DIODE LASER IN THE TREATMENT OF DRUG-ASSOCIATED OSTEONECROSIS OF THE JAW (CLINICAL CASE)

Object of research. Drug-associated osteonecrosis of the jaw is a complication of therapy with osteo-modifying agents. Several theories of its pathogenesis have been deduced, but there is no uniform treatment plan that would reduce the risk of relapse and allow timely prevention. The research aims to demonstrate the effectiveness of the intraoperative use of a diode laser in the treatment of drug-associated osteonecrosis of the jaw. Methodology. The article presents the case of treatment of 60-year-old patient with drug-associated osteonecrosis of the jaw. The underlying medical condition is Bence-Jones myeloma, Stage III on the Durie-Salmone Staging System, with the Th1 – Th12, L1 – L5 involvement. A laser surgical device with a diode laser with a wavelength of 980 nm, power of 0.1-20 W, with a continuous pulse type was used intraoperatively for ablation of residual granulations. An APRF clot was placed at the bottom of the wound. On the 5th and 10th days, autologous plasma injections were performed in the area of surgical treatment. Results. Low pain syndrome during the postoperative period, immediate agglutination, no relapse a month after surgery, closure of the cortical plates according to the control CT scan results. Conclusion. Thus, the first case of clinical use of a diode laser in the treatment of drug-associated osteonecrosis of the jaw has demonstrated its effectiveness. It cannot completely replace the traditional methods, but diode laser is an important auxiliary instrument which contributes to the rehabilitation of the focus of infection, stimulates reparative processes both in the mucous membrane and in the bone. Its future application in the treatment of drug-associated osteonecrosis of the jaw is promising and might prove its effectiveness in reducing the frequency of relapses.

Enterococcus faecalis bloodstream infection: does infectious disease specialist consultation make a difference?

Purpose To evaluate the relationship between mortality or relapse of bloodstream infection (BSI) due to Enterococcus faecalis and infectious diseases specialist consultation (IDC) and other factors potentially associated with outcomes. Methods In a tertiary-care center, consecutive adult patients with E. faecalis BSI between January 1, 2016 and January 31, 2019, were prospectively followed. The management of E. faecalis BSI was evaluated in terms of adherence to evidence-based quality-of-care indicators (QCIs). IDC and other factors potentially associated with 90-day-mortality or relapse of E. faecalis BSI were analyzed by multivariate logistic regression. Results A total of 151 patients with a median age of 68 years were studied. IDC was performed in 38% of patients with E. faecalis BSI. 30 cases of endocarditis (20%) were diagnosed. All-cause in-hospital mortality was 23%, 90-day mortality was 37%, and 90-day relapsing E. faecalis BSI was 8%. IDC was significantly associated with better adherence to 5 QCIs. Factors significantly associated with 90-day mortality or relapsing EfB in multivariate analysis were severe sepsis or septic shock at onset (HR 4.32, CI 2.36e7.88) and deep-seated focus of infection (superficial focus HR 0.33, CI 0.14e0.76). Conclusion Enterococcus faecalis bacteremia is associated with a high mortality. IDC contributed to improved diagnostic and therapeutic management.

Incidence of neutropenic fever and sepsis in patients receiving induction chemotherapy in acute leukemia

Background: Acute leukemias are treated with intensive chemotherapy protocols which are associated with increased risk of infections. The objective of this study was to determine the incidence of febrile neutropenia and sepsis in acute leukemia patients during induction chemotherapy.Methods: In this prospective study we analysed the data of febrile neutropenia of forty-four patients of acute leukemia treated with intensive chemotherapy protocols. Study was conducted in hemato-oncology unit of Government Medical College, Kozhikode from January 2018 to December 2018. Events of the first month of induction were assessed, data entered in Microsoft excel and analysed with SPSS software.Results: Febrile neutropenia developed in all patients with AML induction therapy and 21.4% patients with ALL induction therapy. Causative organism was identified in 41.6% of febrile neutropenia episodes. Major focus of infection was lower respiratory tract followed by gastrointestinal tract. Fungal infection was identified in 6.8% cases. Mortality in AML induction was 31% and that of ALL induction was 3.57%. Infection was the most common cause of mortality. No clinical or laboratory parameters were found significant to predict outcome during induction chemotherapy in acute leukemia.Conclusions: Neutropenic fever and sepsis are the major cause of mortality in acute leukemia during induction chemotherapy. Early initiation of appropriate antibiotics will help to improve outcome in the treatment of leukemia.

The Application of Terahertz Time-Domain Spectroscopy to Identification of Potato Late Blight and Fusariosis

Fusarium and late blight (fungal diseases of cereals and potatoes) are among the main causes of crop loss worldwide. A key element of success in the fight against phytopathogens is the timely identification of infected plants and seeds. That is why the development of new methods for identifying phytopathogens is a priority for agriculture. The terahertz time-domain spectroscopy (THz-TDS) is a promising method for assessing the quality of materials. For the first time, we used THz-TDS for assessing the infection of seeds of cereals (oats, wheat and barley) with fusarium and potato tubers of different varieties (Nadezhda and Meteor) with late blight. We evaluated the refractive index, absorption coefficient and complex dielectric permittivity in healthy and infected plants. The presence of phytopathogens on seeds was confirmed by microscopy and PCR. It is shown, that Late blight significantly affected all the studied spectral characteristics. The nature of the changes depended on the variety of the analyzed plants and the localization of the analyzed tissue relative to the focus of infection. Fusarium also significantly affected all the studied spectral characteristics. It was found that THz-TDS method allows you to clearly establish the presence or absence of a phytopathogens, in the case of late blight, to assess the degree and depth of damage to plant tissues.