CMAC
Official Journal of Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy (IACMAC)

ISSN 1684-4386

Journal name for citation — Kliničeskaâ mikrobiologiâ i antimikrobnaâ himioterapiâ



Clinical Microbiology and Antimicrobial Chemotherapy vol. 20, № 2

Clinical Guidelines

Review of updated clinical practice guidelines of the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) for Clostridium difficile infection in adults and children

Kozlov R.S., Shelygin Yu.A., Veselov A.V., Dekhnich A.V., Zubareva N.A., Ershova O.N., Kulabukhov V.V., Popov D.A., Reshedko G.K., Yakushin S.B.

An update on 2010 clinical practice guideline on Clostridium difficile infection (CDI) by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) was published in March 2018. This new version of guideline not only includes significant changes in the management of this infection and reflects the evolving controversy over best methods for diagnosis and threatment of CDI but has also incorporated recommendations for children. This document currently is the most complete and up to date source of information on CDI. In the present article we reviewed this new IDSA/SHEA guideline and compared it with existing European and Russian guidelines.


Diseases and Pathogens

Biofilm formation by Candida spp. isolated from blood culture in patients with or without hematological malignancies

Malchikova A.O., Klyasova G.A.

Objective: To evaluate the biofilm formation by isolates of Candida spp. obtained from blood culture in patients with or without hematological malignancies.

Materials and methods: Biofilm formation by Candida spp. was determined by the method of Pierce C. and Tumbarello M. Isolates with optical density (OD) >0.1 were considered as biofilmforming.

Results: A total of 109 isolates of Candida spp. (C. albicans [n=22], C. parapsilosis [n=22], C. tropicalis [n=22], C. krusei [n=21], C. glabrata [n=22]) obtained from patients with or without hematological malignancies (55 and 54 isolates, respectively) were studied. Biofilm formation was determined in 54% of Candida spp. isolates (n=59). Biofilm production was observed more often in non albicans species compared to C. albicans (60% versus 32%, p=0.02). The incidence of biofilm formation was significantly higher in isolates of C. tropicalis (82%) and C. krusei (81%) compared to isolates of C. parapsilosis (50%), C. albicans (32%), and C. glabrata (27%) (p<0.05). The leading biofilmforming species were C. tropicalis and C. krusei in the both patient cohorts. Biofilm production was more frequent in C. parapsilosis isolated from patients with hematological malignancies compared to patients without hematological malignancies (73% versus 27%, p=0.03). The lowest incidence of biofilm formation was found in C. albicans (18%) isolated from patients with hematological malignancies and C. glabrata (18%) isolated from patients without hematological malignancies.

Conclusions: Biofilm formation varied among the Candida spp., with the highest incidence in C. tropicalis (82%) and C. krusei (81%). There were differences in the biofilm formation incidence among Candida spp. isolated from patients with or without hematological malignancies.


Antimicrobials

The role of antimicrobial therapy stewardship in intensive care service

Rudnov V.A., Kolotova G.B., Bagin V.A., Nevskaya N.N., Belsky D.V., Ivanova N.A., Gayfutdinov E.A.

An analysis of current trends in the prevalence of nosocomial infections, their etiology and antibiotic resistance in pathogens was performed. Social and economic consequences of antimicrobial resistance as well as a medical community's response were shown. A role of the AMRmap Internet resource in monitoring antibiotic resistance in Russia was demonstrated. The results of our own approaches to the antimicrobial therapy stewardship in the intensive care service of a large hospital were evaluated.


Antimicrobial Resistance

Antimicrobial resistance of nosocomial Enterococcus spp. isolated from blood culture in patients with hematological malignancies

Klyasova G.A., Fedorova A.V., Frolova I.N., Khrulnova S.A., Vetokhina A.V., Kaporskaya T.S., Skorobogatova E.V., Molchanova I.V., Pospelova T.I., Krainova L.E., Shushurina S.E., Khoreva O.E., Zvyozdkina N.N, Kutsevalova O.Yu.

Objective. To evaluate antimicrobial susceptibility of Enterococcus spp. isolated from blood culture in patients with hematological malignancies.

Materials and methods. Antimicrobial susceptibility of 427 Enterococcus spp. collected from 10 hospitals in 8 cities of Russia in 2002-2016 as part of the multicenter study was tested by the broth microdilution method [CLSI 2015].

Results. Among bloodstream pathogens there was a prevalence of E. faecium (78.2%), followed by E. faecalis (19.7%) and other Enterococcus spp. (2.1%). A total of 50 (15%) vancomycinresistant E. faecium (Vancomycinresistant Enterococcus — VRE) was detected, of them 33 (66%) were harboring vanA gene, 17 (34%) — vanB gene. In 2012 one linezolid resistant E. faecium (MIC = 16 μg/mL) was detected. Linezolidresistant E. faecium contained the G2576T 23S rRNA mutation. All VRE faecium including the one linezolidresistant isolate were susceptible to daptomycin. All E. faecium were susceptible to tigecycline, 78.7% — to chloramphenicol, 74.9% — to tetracycline. Proportion of E. faecium with high level resistance to gentamicin was 85%, to streptomycin — 60%, to both aminoglycosides — 45%. All E. faecalis were susceptible to linezolid, teicoplanin and tigecycline; 97.6% — to ampicillin. One isolate of E. faecalis (1.2%) with intermediate susceptibility to vancomycin (MIC = 16 μg/mL) harboring vanD gene and one isolate of E. gallinarum resistant to vancomycin, carrying vanC1 and vanB genes were detected.

Conclusions. Isolates of E. faecalis had more favorable profile of antimicrobial susceptibility comparing to E. faecium. A total of 15% E. faecium were vancomycin resistant and one of them had resistance to linezolid. In this study one E. faecalis and one E. gallinarum isolates were non-susceptible to vancomycin.


Personal Experience

Etiology of communityacquired pneumonia in the military personnel

Speranskaya E.V., Brusnigina N.F., Efimov E.I., Dobrotina I.S., Samokhina L.P

Objective. To assess the etiology of community-acquired pneumonia (CAP) in the army recruits using a polymerase chain reaction (PCR) assay.

Materials and methods. Sputum, blood, bronchoalveolar lavage samples and oropharyngeal swabs collected from 255 hospitalized army recruits with radiographically confirmed diagnosis of CAP were tested by PCR assay. The comparator group included 270 otherwise healthy recruits. Detection of Streptococcus pneumoniae, Haemophilus influenzaċ, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Chlamydophila psittaci, Legionella pneumophila, adenoviruses, Herpes simplex virus I/II, cytomegalovirus was performed by PCR using commercial AmpliSens kits and GenPak DNA PCR test.

Results. The specific causative agent of CAP was determined in 94.1% of the enrolled military personnel. S. pneumoniae was a predominant pathogen of CAP. The high S. pneumoniae carriage rate (86.3%) among the military personnel was found. The incidence rates of M. pneumoniae and C. pneumoniae were 14.5±2.2% and 13.7±2.2%, respectively. The highest rates of C. pneumoniae and M. pneumoniae were observed in patients with non-severe CAP (16.2±2.6% and 16.7±2.7%, respectively) compared to significantly lower rates in patients with severe CAP (5.3±3.0% and 7.0±3.4%, respectively; p<0.05). The significance of L. pneumophila and C. psittaci as a cause of CAP in the military personnel was negligible. The adenoviruses were detected in 14.1±2.2% of patients, particularly those with severe CAP (36.8±6.4%). There was found the high incidence of associations between bacterial and bacterial or viral pathogens.

Conclusions. PCR is a highly effective method for determining CAP etiology in military personnel, especially during the periods of increased morbidity. The high S. pneumoniae carriage rate among military personnel and its predominant role in the CAP etiology indicate a need for pneumococcal immunization of recruits. The significant proportion of M. pneumoniae and C. pneumoniae among pathogens causing CAP confirms a need to include these pathogens in the algorithm for examination of patients with CAP.

 

Impact of the 10valent pneumococcal conjugate vaccine on the incidence of respiratory and ENT diseases and antibiotic consumption in children under 5 years of age in Barnaul

Kozyanova Yu.À., Safyanova T.V.

Objective. To evaluate epidemiological efficacy of the 10-valent pneumococcal conjugated vaccine (PCV10) as assessed by the number of episodes of respiratory tract and ENT diseases and by the number of antibiotic courses prescribed for those diseases in children under 5 years of age in Barnaul.

Materials and methods. At the end of 2016, a total of 312 children under 60 months of age were enrolled into a retrospective cohort epidemiological study and divided into 2 cohorts (156 children each). The first cohort consisted of the children who received at least 2 doses of PCV10; the second cohort consisted of the age-matched children who didn’t receive any pneumococcal vaccines. Reporting and assessment of any episodes of acute respiratory diseases, rhinitis, tonsillitis, adenoiditis, pharyngitis, tracheitis, bronchitis, pneumonia, acute otitis media, and sinusitis as well as any antibiotic courses administered for those conditions were performed in the both cohorts by a review of the children’s medical records. The quartile method was used to assess data distribution. The differences in the incidence of respiratory tract and ENT diseases and antibiotic consumption between the two cohorts were assessed using chi-square test.

Results. Comparative analysis of morbidity and incidence of antibiotic prescriptions showed significant differences between vaccinated and non-vaccinated children (p<0.05). The PCV10 efficacy as assessed by reduction in the number of antibiotic courses was 52.7% (95% CI: 43.7-61.6) and reduction in the incidence of the respiratory tract and ENT diseases was 34.1% (95% CI: 31.1-37.0).

Conclusions. The use of PCV10 in children is associated with reduced incidence of respiratory tract and ENT diseases and reduced antibiotic consumption administered for those diseases.



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