Acinetobacter species on shkіrі in newborns. Infections, with acinetobacter infection: disease, symptoms

Microorganisms in the genus Acinetobacter are celomorphic gram-negative sticks, which are easily linked with microorganisms in the genus Neisseria. Important infections, infections with microorganisms, including meningitis, bacterial endocarditis, pneumonia, bacteremia, should be described with an increasing frequency.

Ethiology

A. calcoaceticus variant Iwoffi with descriptions of DeBord as Mima polymorpha in 1939, one of two good varieties of Acinetobacter. Інshim є A. calcoaceticus variant anitratus, a collection of the names of Herella vaginicola. Microorganisms, described as Bacterium anitratum and B5W, may be synonymous with Acinetobacter. The microorganisms are pleomorphic, intermittent, unruly, gram-negative. It’s good to grow on simple, lively middle-class, fancy beads, opuchs, smooth colonies. The middle of microbes, which have grown on the midsection, overcame the diplococcal form; Palichkopodіbnі and thread-like options of the witch often appear in the native middle. The type of identification of enterobacteriaceae is based on negative reactions with nitrates, and of the representatives of the genus Neisseria, which smell can be nagaduvati by morphology, - by the middle of non-palpitations, to live food-like reactions.

Epidemiology and pathogenesis

Microorganisms of the genus Acinetobacter are widened everywhere. Smells є normal sackcloths of curvatures in 25% healthy people... In the case of the potential participation of Acinetobacter in bacteria, it takes a long time to develop at the patient's internal catheters, the main entrance gate of the infection is the main entrance gate of the infection. The incidence of Acinetobacter pneumonia, which is the primary cause, has grown as a result of superinfection, and it is also a sign of morbidity that mental health can serve as an important gateway to infection. Generally, microorganism, an extravagant commensal, but Volodya is visibly low in virulence, which more often than not I think about bacteriologicalism, which is more common in the development of infections. Enemies occur, as well as ailments, Acinetobacter wicks, grows in individuals, unsuccessfully grows from internal gram-negative infection. Important infections develop in the minds of reduced resistance to macroorganism, in case of instrumental involvement, or for trivial antimicrobial therapy with drugs wide rangeдії. The bulo is attributed to an imperceptible increase in the frequency of infections with Acinetobacter and infectious diseases. Participation of the whole microorganism in the ethology of conjunctivitis, vaginitis and urethritis in the general public.

show

Before important infections, Acinetobacter infection, there should be meningitis, food preparation and state bacterial endocarditis, pneumonia, infections sečovyh noblesі bacterієmiya. Name the clinical manifestation and symptoms of a common infection do not appear as such in case of similar illnesses, who have suffered from illnesses. Inodi Acinetobacter can cause bliscavic bacteremia with swelling fever, vertebral collapse, petechiae, massivimi pediatric hemorrhages, I do not appear to be meningococcemic. More often, however, bacteria are associated with obvious infections through the venous system, growth through venous catheters, surgical wounds or surface detection. You can also develop writing instrumental engagement on a seeding machine in some areas. In key cases of such ailments there are dominant endotoxemia, and the prognosis of their unpleasantness.

diagnostics

Diagnostics of infection, Acinetobacter infection, can be accelerated by the team, but the staff of the laboratory of clinical bacteriology has little knowledge of microorganisms, so that it can be misinterpreted to achieve results. Plutanin, who is spared in the taxonomic classification of microorganisms, also does not lie down. A practical plan is to see Acinetobacter in blood, spinal cord Mokrotinnya, sich or pus guilty roztsinuvatisya yak little klinichne meaning, as there is no proof of one-hour explicitness of any kind of zealot. In a practical plan, there is a need for differentiation of Acinetobacter and Neisseria, since they are persistent to penicillin, and others are sensitive.

lykuvannya

The sensitivity of some Acinetobacter strains to antibiotics varies, but most of them are attributed to gentamicin, tobramicin, amicacin and ureidopenicilin, such as pperacylin. Sensitivity to tetracycline is not transmissible, and a large number of strains are resistant to penicilin, ampicilin, cephalosporins, erithromicin and levomycetin. In case of important systemic infections, it is necessary to use an antibiotic, as a rule, along with a number of aminoglycosides. In case of localized abscesses, which are affected by microorganisms, it is necessary to fix the surgical procedure.

Infections, Acinetobacter baumannii: factors of risk, diagnostics, treatment, approach to prophylaxis /

Bilorussian State Medical University NDI Antimicrobial Chemotherapy Smolensk State Medical Academy, Russian Federation

Gorbich U.L., Karpov I.A., Krechikova O.I.

Infections, induced byAcinetobacter baumannii: risk factors, diagnostics, treatment, prevention approaches

Nosocomial infections (lat. nosocomium- lykarnya, walnut. nosocmeo- Likarnya, watch out for ailments) - the price of infection, which developed at the patient not less than 48 years later, after the hospitalization, for thinking that, when it was necessary to the stationary, the infection did not overwhelm; Infections, which has become a legacy in front of the front hospital, as well as Infectious diseases medical workers, Pov'yazanі from їkh professional activity.

According to the data of young authors, the number of patients, who develop nosocomial infections, number from 3 to 15% ?. Of these, 90% may be bacterially less likely; Viruses, fungi, fungi and the most simple ones develop significantly earlier.

From the ear of antibiotics to the 60s of the XX century. Approximately 65% ​​of internal infections (VLI) are malignant in nature. I will appear in the arsenal of drugs penicillinazostabilnyh antibacterial drugs stinks entered into another plan, giving up the leadership of infections, vicious gram-negative bacteria.

In this hour, the ethological role of gram-positive microorganisms and fungi, such as diseases of nosocomial infections, with the help of gram-negative microorganisms, is becoming resistant to many resistance problems. According to a number of authors, the frequency varies from 62 to 72% of all nosocomial infections. Most relevant teachers of all VLI (including angiogenic) and sepsis and microorganisms of the family Enterobacteriaceae and non-fermentative bacteria, before which are introduced Pseudomonasaeruginosaі Acinetobacterspp. .

Most importantly significant species in the genus Acinetobacterє Acinetobacter baumannii(Genomovid 2), which is 2-10% of gram-negative infections in Europe and the United States, up to 1% of all nosocomial infections.

Riziku factories

In yakosti out-of-the-box factors rizyk of infections, viclikanikh A. baumannii, See:

To become a cholovicha;

Pohiliy vіk;

frankness fellow sickness(Malignant blood loss, heart-vascular or mental deficiency, desemination of internal vascular blood loss);

The triviality of the treatment of invasive methods of treatment and monitoring probe; tracheostomy; catheterization of the cuticle, central vein, artery, promptly involved);

Trial of the knowledge in the hospital or the provision of reanimation and intensive therapy (VRIT);

Anterior antibacterial therapy with cephalosporins, fluoroquinolones or carbapenemi.

Prior to the hospitalization of the VRIT surgical procedure, the adjustment of information is approximately 5 times.

Yak factor rizikuinfіkuvannya carbapenem-resistant strain A. baumannii for those who are older at the moment of description: a great size for the stationary (more than 500 lizhok); hospitalization in VRIT or hospitalization for executions shown; trivial transfer to the stationary; temporarily the number of patients from CRAB in the ward; to become a person; immunosuppression; ShVL, catheterization of secular nobles or arteries, carrying out hemodialysis; recently promptly involved; pulse lavage wounds; in front of meropennem, imipenem or ceftazidime.

In the Republic of Bilorus as a factor in the risk of colonization / infection of nosocomial isolate Acinetobacter baumannii, Stiff up to carbapenemic antibiotics, bullets of vision in front of the "antipseudomonal" carbapenems, catheterization of secular paths, hospitalization before the release of a non-therapeutic profile.

Table 1 Risk factor of colonization / infection with carbapenem-resistant strain A. baumannii in the hospital they have health protection organizations m Minsk(Personal unpublished data)

* Stated chances (HS) - start as a chance of chance in one before the chance of chance in one, or as a chance of chance of coming, before the chance of not coming; ** meropenem, imipenem, doripenem.

Atsinetobacterassociation

інфекції

A. baumannii in a large number of vypadkiv wiklikє sick with gravely ill, immunocompromised patients. Denmark microorganism can be the cause of infections dikhalnyh nobles(Sinusitis, tracheobronchitis, pneumonia), blood flow (sepsis, endocarditis of natural and piece valves), secular pathways, early and surgical infections, infectious diseases, and some small tissues (including nervous system(Meningitis, ventriculitis, brain abscess), intra-abdominal (abscesses of localization, peritonitis), musculoskeletal apparatus (osteomyelitis, arthritis).

According to the data of the authorities, held in 15 health care organizations in Minsk, in the structures A. baumannii-associated infections prevail in the bloodstream, storage is 39.4% of all infections that have been registered by these children. Another place is occupied by infections of mental health (35.4%), and the third (19.7%) - infections of children and soft tissues (including infections of surgical wounds). Osteomyelitis was diagnosed in 4.7% of cases, in infections of secular nobles - 0.8% of cases.

bloodstream infections. Klinichny show bloodstream infection, A. baumannii, Varying from a transitory bacterium to a very important illness with a high rate of mortality. The gates of infection are the most frequent way, however, in the primary development of the septic process, the main role is to play the internal vascular catheter. Before the entrance gates to serve the most important ways, shkira and m'yak_ fabric, Opіkovі wounds, organ black empty and the central nervous system. Internal carnial sepsis, viklicaniy A. baumannii, In 73% of vypadkіv develop on the 15th day of hospitalization. Septic shock develops in about 30% of patients with acinetobacteriosis sepsis. At the same hour, ailments with bacteria tied to internal vascular catheters, are characterized by a shorter prognosis, in addition to the fact that infections can become more severe when the catheter is seen.

Risik factors in the development of infections in the bloodstream, viclikanikh A. baumannii, Є ekstrena hospitalization, trivial transfer to the hospital, before the colonization of acinetobacter, a high rate of invasive procedures carried out by SHVL, abduction vik for less than 7 days, less than 1500 g (for newborns), immunosuppression, malaise, heart-and-heart deficiency, nirkova lack There is a dysfunctional lack of prescription for an hour in BPIT, a history of sepsis, developing in BPIT, before antibacterial therapy (especially ceftazidime or imipenem).

Infectious diseases A. baumannii, order s Pseudomonas aeruginosa, Stenotrophomonasmaltophiliaі MRSA, є (developed more than 5 days from the moment of hospitalization) of the disease nosocomial pneumonia. Before the hour of the manifestation of the infection, there is also an antibacterial therapy and hospitalization for the last 60 days.

Nosocomial pneumonia is most often polysegmental. It may be possible to promote the formation of empty spaces in the legends, pleural manifestations, and illumination of bronchopleural fistula.

Independent factors in the development of Rizik, VAP, Wiklikano A. baumannii, Є anterior antibacterial therapy and manifestation of a severe respiratory distress syndrome. Poperednіy epіzod sepsis, vikoristannya antibakterіalnih preparatіv to rozvitku іnfektsії (osoblivo imipenem ftorhіnolonіv that tsefalosporinіv III pokolіnnya, pіperatsilіn / tazobactam), trivalіst SHVL bіlshe dnіv 7, reіntubatsіya, trivalіst perebuvannya in statsіonarі viznachenі yak factorization riziku rozvitku VAP viklikanoї on multiresistant strains A. baumannii .

A. baumanniiє the third for the frequency of the cause of nosocomial tracheobronchitis (NTB) in patients with high-speed ventilation, 13.6% and 26.5% of NTB types in patients with surgical and therapeutic pathologies are evident. The development of NTB reliably led to an increase in the term of transferring to VRIT and the triviality of carrying out SHVL in vapors, since the patients did not develop nosocomial pneumonia later.

Infections of children and soft fabrics A.baumanniiє a significant pathogen in traumatic ears, opіk, as well as schoodo infectious diseases from the operative wounds. Infections of children and soft tissues, due to A. baumannii, In most cases, bacteremia accelerates.

Acinetobacterium bacteria are infectious during the insertion of an intravenous catheter, which can only be reached as soon as possible.

Infections of the nervous system. Acinetobacter baumannii zdatniy viklicati vnutrіshnyolіkarnyani menіngіti, abscesses to the brain. Meningit can grow as a state of the art ear. Petechial visip can be promoted on the curved slopes (up to 30% of the vapors). Spinal changes during meningitis, viclikan A. baumannii There is no evidence of any kind of change in case of changes in etiology and presentation: pleuocytosis with replenished neutrophils, increased levels of protein and lactic acid, decreased glucose.

The factor of risk of development of atinetobacteric meningitis include: extra neurosurgical treatment;

Infections of the secular nobles (IMP). Uninvolved in the frequent colonization of the lower types of secular paths of acinetobacterium is a relatively ethological agent of IMP. Acinetobacter spp... seen in 1-4.6% of nosocomial IMPs.

Risk factors of atinetobactero-bacterial IMP are the presence of a catheter in the dissection and nephrolithiasis.

Інші інфекції. Acinetobacteriosis peritonitis in patients who are on a trivial outpatient peritoneal dialysis; as well as cholangitis on aphids of transhepatic cholangiography or drainage of young women. Osteomyelitis and arthritis, wiklican A. baumannii, Pov'yazany z vvadzhennyam piece implants or trauma. Described is also an antibacterial improvement of the eyes, tied with the contamination of the eyes contact lines(Flipping and cutting out the horns). Mossy development of those who have a problem with the organ from conjunctivitis to endophthalmitis.

Diagnostics and value

sensitivity to antimicrobial drugs

V CLINIC PRACTICEінфекції, wiklikanoї A. baumannii, Before the colonization of shkirny crooks, dichny and secular nobles, shlunkovo-intestinal tract patients. significant extension A. baumannii how to colonize the microorganism in the process of an active assessment of the situation when seen from the biological material of the patient. At the same hour, it means that you see Acinetobacterspp. how to colonize microorganism є predictively significant for the value of etiology of sub-nosocomial infections (positive / negative predictive value - 94/73% for VAP, 43/100% for blood flow infections).

Diagnostics of nosocomial infections, incl. A. baumannii-associated, from key positions cleverly subdivided into 4 stages:

1. Pick up and transport of key material.

2. Identification of the teacher.

3. The value of the ethological significance of the vision of the microorganism.

4. The value of sensitivity to antimicrobial drugs and interpretation of the results.

The correct selection and transportation of key material is allowed to bring up to a minimum and the number of incomplete results laboratory dosages And also, і change the "inadequate" sign of antimicrobial drugs.

General rules for the collection of clinical material on microbiological data (with changes):

1. Taking, if possible, it is necessary to carry out antibacterial therapy before the ear. If I have ailments, I’ll reject antibacterial therapy, then clinics niy material slid brothers bezposeredno before the introduction of the drug.

2. Material for bacteriological pre-lactation must be taken directly from the department of infection. In case of ill-will - vicoristovuvati is the most important biologically significant material.

3. Suvoro dotrimuvatisya rules of asepsis, do not allow contamination to the material of third-party microflora.

4. To take a vision from a wound, smears from mucous membranes, from an eye, a nose, a nose, a sore, a cervical canal, a pichvi, an anal opening, a sterile cotton swab. For blood, pus, liquor and exudates - sterile syringes and special transport means; for sputum, chaff, feces - sterile containers should be closed.

5. The amount of material is sufficient for carrying out further education.

6. Native material shall be delivered to the laboratory in the shortest possible term (no more than 1.5-2 years after being taken away). It is allowed to take the material in the refrigerator at 4 ° C (except for biological material, from sterile in the norm loci: liquor, blood, inner corner and pleural origin). In case of vicarious transport means, essential material can be taken for 24-48 years.

7. Rare biological material can be transported without the middle in a syringe, on the tip of a sterile container, or it is bent underneath the head.

Identification of the teacher. rid Acinetobacter(family Moraxellaceae) Build up from strict aerobic, mild gram-negative lactose-nonenzymatic oxidase-negative, catalapositive coccobacteria with a size of 1-1.5 x 1.5-2.5 microns, and then oxidize glucose until acidic in the presence of acidity. On the healthy, lively middles of the colonies are smooth, opaque, sometimes they are less than the size, not the representatives of enterobacteria.

Typical morphological forms and microorganisms can be seen in smears, crumbled from clinical material, or from wild lively midst. When growing on the middle midst, in the presence of antibiotics, bacterium smears may form sticks. Deyakі іsolatiya acinetobacter can overlap the crystalline violet, filthy impatiently when farbuvannya behind Gram, to produce up to їkh pompous interpretations of how gram-positive bacteria.

interpretation of results(With changes and additions). On a large scale, there is a change of authors, reliable criteria of infection, related to intellectually pathogenic internal microcarnial microflora, including Acinetobacter baumannii, Є seeing the culture from sterile dzherel.

Shelter. The material for the advancement is necessary to have a minimum of two peripheral veins in a small bottle. It is not allowed to take blood from a venous catheter for a vignette of vipadkiv, if only for a catheter-assisted infection. When we take two blood samples from the catheter, take from the catheter and peripheral venous diseases, and take them by the small method, reject the growth of colonies from the catheter, so that we change the number of identical blood colonies in case of venous diseases by 5-10 times.

Liquor. vision A. baumannii in low concentrations, an accelerated interpretation of the results, especially among children, microorganisms often colonize children. The vitality of its ethiological significance is significant to develop in the form of seeing an acinetobacter from the liking of patients with an already obvious infection, a vicious A.baumannii, Posture by the central nervous system (so the titles of secondary meningitis), when conducting neurosurgery, in patients with penetrating ears of the skull, especially on the most obvious factors.

Interpretation of the clinical meaning of acinetobacter, seen from non-sterile loci, is a complex factorial process, which is based on the qualifications of a clinician, microbiologist, a patient. Bring the lower criterion to the singing world є clear up, or at the same hour allow the adjustment of the correct interpretation of the seen microorganism, like colonizing an agent of an infectious disease.

Sputum. Vidіlennya acinetobacter in number ³ 10 6 CFU / ml (from bronchial serums ³ 10 4 CFU / ml) є diagnostically significant for understanding the rules of sputum collection. However, the values ​​are not absolute, as in the case of antibacterial therapy, the number of causally significant bacteria in sputum decreases and, navpaki, increases the concentration of colonization of microflora.

When sputum is present, bacterioscopy is obovasovyu, which allows you to judge the quality of the material taken. The presence in one field with a small increase in more than 10 epithelial cells and / or less than 25 polymorphic-nuclear leukocytes, in the case of contamination of the brain, which is further down to the lack of material. In such a case, sputum should be taken repeatedly from the same sampling rules.

Material for early infection. Slide to exclude the possibility of contamination to the material of the isolates A. baumannii from the surface of the shkiri, especially with vicorian tampons. In the event of a change in cultures, a change is made to microorganisms, to a greater concentration.

Slashing. Diagnostically significant є seeing bacteria in a concentration of ³ 10 5 KUO / ml in case of symptoms of illness. When a cut is taken from a cross section without catheterization, the appearance of acinetobacter in any title is significant. The presence of three and more types of microorganisms in great concentrations is caused by contamination before the hour of collecting, or at the wrong time.

Dodatkovym marker of ethiological significance Acinetobacter baumanniiє positive dynamics of the patient's zagalny camp on the same anti-bacterial therapy.

Interpretation of antibioticograms(With changes and additions). If the results of the test for sensitivity to antibacterial drugs are rejected, it is not formalized to indicate etiotropic therapy; Sensitivity to the body prior to that of antimicrobial drug in vitro don’t wait for your activity in vivo... It can be linked with individual features of pharmacokinetics and / or pharmacodynamics of a drug in a given particular patient, as well as with errors in the methodology of admission, as vicarious materials, etc.

When analyzing antibiotics, I respect the animals not for any specific drug (s), but for the whole picture as a whole. At the same time, the resistance of acinetobacter to the actual data is allowed, having introduced the imovir phenotype, but rather the latter, having eliminated by themselves the sign of poorly effective drugs.

Zokrema, for the identification of strains, which produce beta-lactamases of an extended spectrum of diy (ESBL), I respect the sensitivity of the animal to cefoxitin and aztreonam. Although the ESBL product is isolated, cefoxitin has a high activity, while the aztreones are not active. In general, it is necessary to isolate the isolate, as it is resistant to all cephalosporins of the 1st-4th generations and to aztreonam just in the actual results of antibioticograms. Yaksho strain is stable to cefoxitin, sensitive to aztreonam, vin є producer of chromosomal beta-lactamases. In general, the IV generation of cephalosporin can take over their activity.

At the difference in sensitivity to one of the "antipseudomonal" carbapenems, not to assess the sensitivity of those by analogy with them. The representatives of carbapenems are not the same world of schilia until they have the same mechanism of resistance. A. baumannii, Resistant, for example, to meropenem, you can gain sensitivity to impenem and / or Doribax and navpaki.

When a strain resistant to colistin is detected, it is necessary to take care of such a result and re-emphasize sensitivity to parallel tests of control strains.

Evidently aminoglykozid_interpretational assessment of antibiotic-gram in the region is steep and the number of aminoglykozidmod_sidіvnyh enzymes and variable professional substrates. Therefore, for aminoglycosides, let us assume all the sensitivity to the same sensitivity / resistance in the middle class.

Most of the clinical isolates A. baumannii resistance to fluoroquinolones and chloramphenicol, for which it is necessary to protect the choice of these drugs in the capacity of ethiotropic for the treatment of cytobacterial infections, which does not affect the result of the antibiotic Besides, appreciate the sensitivity Acinetobacter baumannii to chinolones, next to vrahovuvati, the fact that for the formation of resistance to non-fluorinated quinolones there is enough one mutation in the gene, either DNA-gyrazi (gyrA) or topoisomerase IV (parC). For the development of resistance to fluoroquinolones, mutations are required in both genes. That is, with the results of antibiotics rejected, it is possible to apply the sensitivity of the strain to nalidixic or pipemic acid in case of one-hour resistance to fluoroanimic chinoloniv, then in the extreme skeptical goes to the given antibioticogram.

When interpreting antibiotic-gram, it is also necessary to Acinetobacterspp... in general, it can be naturally resistant to cephalosporins of the 1st and 2nd generation, natural to aminopenicylin, trimethoprim, phosphamides.

To characterize resistance Acinetobacter baumannii it is recommended to vikoristovuvati such a witness:

resistant ( resistant) Acinetobacterbaumannii- insensitive to one antimicrobial drug;

multi-resistant ( multidrug- resistant - MDR) Acinetobacterbaumannii- insensitive up to ³ 1 drug in ³ 3 classes, pererahovanih in the table. 2;

Table 2. Antimicrobial drugs that are used for classification Acinetobacter spp. beyond the level of resistance

Extensively resistant ( extensivelydrug- resistant - XDR) Acinetobacterbaumannii- insensitive up to ³ 1 drug in ³ 8 classes, pererahovanih in the table. 2;

panrestent ( pandrug- resistant - PDR) Acinetobacterbaumannii- insensitivity to all overinsurance in the table. 2 antimicrobial drugs.

When analyzing antibiotics, the value is not less important, there is no interpretation of the characteristics of resistance, there is little estimate of the minimum important concentration (MIC). In a number of types, especially as microorganism є intermediate-resistant (that is, the value of the MIC is the threshold of sensitivity, but not reaching the threshold of maximum doseі / abo vikorstannі prolonged introduction mode. Zokrema, for the given randomized control, until the concentration of the drug is reached in syrovatz with uninterrupted introduction, 5.8 times overshoots the minimum concentration, as it can be reached in the intermittent mode. And in the preliminaries D. Wang in case of acute vascular disease in a dose of 1 g of skin 8 years intravenously with a stretch of one-hour infusion and in a dose of 0.5 g of skin for 6 years with a duration of triple infusion of pneumonia in cases of multimodality A. baumannii, Bulo was established, that the concentration of the drug in the syrovattsi blood overshadowed the IPC with a stretch of 54 and 75.3% per hour and was introduced as a matter of fact; The part of antibacterial therapy was significantly 1.5 times lower than in the other group. Table. 3 the criteria for the interpretation of sensitivity for the IPC and for the general zone and for the growth of microorganisms on the solid The European Committee on Antimicrobial Susceptibility Testing - EUCAST).

Table 3 Criteria for Interpretation of Sensitivity Acinetobacter spp... to antimicrobial drugs according to MIC and growth areas (EUCAST)

* It is filthy to diffundu in the solid living middle. Viklyuchno viznachennya IPC!

lykuvannya

Therapy of nosocomial infections Acinetobacter baumannii, Conducted according to the general rules for the conduct of infections, associations of diseases medical aid(Fig. 1). The empirical assessment of anti-bacterial therapy in adolescence on the development of nosocomial infections is justified in quiet organizations for the protection of health. structural components, de A. baumanniiє one of the provincial doctors of infections, of the urinary factors of the disease.

The assessment of the effectiveness of the therapy is carried out in 48-72 years after the ear is right on the basis of the fact that the therapy was prescribed empirically, as if the child was seen. Vona is guilty of basing on the dynamism of the clinical picture and the results of microbiological studies (including repeated ones), moreover, an overwhelming factor for the assessment is to serve the critical picture.

Unimportant for a number of days, but consider the possibility of changing the triviality of antibiotic therapy, not the speed of feeling the triviality of antimicrobial therapy for infections, patients A. baumannii... So, in a multicenter randomized prescription, it was revealed that the rapidity of terms in antibacterial therapy of VAP, viclican non-enzymatic gram-negative microorganisms, from 15 to 8 days, was associated with recurrent growth rates.

In case of vibration therapy, it is possible to use the most active antibacterial drugs. A. baumanniiє sulbactam, carbapenemi, aminoglycosidi, polymixini, tigecycline and minotsiklin. However, the vibir of a specific antimicrobial drug, which can be used as vicoristas for empirical therapy A. baumannii-associated infections, guilty of grounding on local data for the organization of health protection, develops nosocomial infection.

In this case, as antimicrobial therapy is indicated by the appearance of an antibiotic from pathological material, the vibration of antibiotics is guilty of being based on an antibiogram, with the help of an interpretative analysis of the results

Sulbactam. Sulbactam in Danish hour є with a Vibor preparation for the treatment of acinetobacteriological infections. The Republic of Belarus, before the given antimicrobial drug, is sensitive 84.8% of hospital patients A. baumannii.

Sulbactam has internal antimicrobial activity against A. baumannii, Yak does not lie behind it in the combination of beta-lactamic preparation.

In experimental studies on food, the effectiveness of sulbactam bula is consistent with the effectiveness of carbapenems, which are probably carbapenesensitive acinetobacters. In clinical preschool patients, the combination of sulbactams / beta-lactams showed similar efficacy in terms of carbapenems for VAP and sepsis, vicious multi-drug resistant isolates A. baumannii... The results of the treatment of sepsis with a multidrug-resistant strain A. baumannii The sulbactam was not susceptible to any results that were susceptible to antibacterial drugs for sepsis, nonresistant A. baumannii .

With parenteral administration, the concentration of sulbactam in the blood is 20-60 mg / l, in the tissues - 2-16 mg / l. The optimal dosage regimen for sulbactam is 2 g in a 30-year-old infusion in 6 years, or 1 g in a 3-year infusion in 6-8 hours. diarei, visipu, urazhennya nirok.

As a result, a number of doslidzhen established a synergistic diet of sulbactam with meropenem, imipenem, rifampicin, cefpir, amicacin.

Carbapenemi. For the detection of important infections, A. baumannii, You can vikoristovuvatisya іmіpenem, meropenem і dorіpenem. Ertapenem is not active against Acinetobacterspp. as a whole.

In relation to the increase in the number of carbapenem-resistant strains A. bauma-nnii In addition, in the Republic of Bilorus, the administration of carbapenemic antibiotics for the treatment of acinetobacteriological infections in monotherapy regimes in the Danish hour is not adequate. The winyat is to become a licensed organization of health protection, de due to the data of local monitoring of antibiotic resistance of hospital pathogens, there is an absolute greater amount of residual sensitivity to carbapenems.

Doslidzhennyakh in vitro established a synergistic or additive action of a combination of imipenem + amikacin + colistin, doripenem + amikacin, doripenem + colistin, meropenem + sulbactam, meropenem + colistin; in vivo- imipenem + tobramicin.

Stagnation of the combination of carbapenem + beta-lactam / sulbactam for the elimination of infections in the bloodstream A. baumannii To help reduce the results of the treatment, not to get rid of the carbapenem monotherapy or to add carbapenem + amikacin. However, the addition of imipenem with sulbactam was associated with a higher low frequency of survival on the model of pneumonia in mice with a combination of imipenem + rifampicin.

When choosing a drug from this class for the elimination of acinetobactero-bacterial infections, it is necessary to use it, but in the Republic of Bilorus, imipenem is often more active as a result of nosocomial infections. A. baumannii in some cases with meropenem (44.1% and 38.6% of sensitive strains, apparently). Activity of Doribax overtakes activity of impenem and meropenem only A. baumannii, Also the OXA-58 gene, the activity of imipenem is that of OXA-23-producing strains A. baumannii... However, in the Republic of Bilorus, OXA-40 is predominantly used to produce acinetobacter, but it is not allowed to talk about the overdose of the given drug in front of the other representatives of the class in the infected infection A. baumannii.

Aminoglikosidi. Aminoglycosides often become vicious in infections, as well as gram-negative microorganisms, however, in hospital A. baumannii May a high level of stiffness up to the given class of antibacterial drugs. In the Republic of Bilorus, 64.4% are resistant to gentamicin, and 89% are resistant to amikacin. A. baumannii... An alarmingly low level of resistance to gentamicin of newer dressings due to a decrease in the growth of antimicrobial drug in the organization of protecting health for a number of remaining rocks.

The assignment of a given class of drugs can only be used in combinations with more active antibiotics as well as acinetobacter antibiotics on the basis of local reports about the sensitivity of the child.

Rifampicin. I will look at the manifestation of sensitivity in hospital strains of acinetobacter to rifampicin, and the drug can be added to therapy for infections that have multi-resistant strains. A number of authors have shown the effectiveness of rifampicin in monotherapy regimes, as well as in combination with imipenem or sulbactam. Synergism is also characteristic for the combination of rifampicin with colistin. The effectiveness of rifampicin and the combination of rifampicin with colistin was shown in case of meningitis, in case of malignant infection with imipenem-resistant isolate A. baumannii .

Given a number of advances in the process of elimination, resistance to rhyphocyte is shown to develop in case of stagnation in the monotherapy regime, as well as in the case of imipenem, however, in case of acute combination of rhyphenitis + colitis

Tetracycline. Tetracycline (minocyclin, doxycycline, tetracycline) in dosage invitro may be active against A. baumannii . most active showing minocyclin (not registered in the Republic of Bilorus), which is also active, apparently isolates, resistant to the lowest tetracyclines. In general, experimental and clinical data, which characterize vicious tetracycline in case of infections, vicious A. baumannii, In the edge of the unnumbered. To that the recognition of the drugs in this class was primed only on the display with antibiotics when there was an alternative.

Polimixini. From five different drugs in the given class (polymixin A-E) for clinical trials, only polymixin B and polymixin E (colistin) are available in Danish hours. There are two forms of colostin sulphate: colistin sulfate (for intestinal decontamination and for muscle congestion in cases of infection of small tissues; sometimes for internal administration) and sodium hydrochloride (for steaming) Colistimetate sodium (an inactive alternator of colistin) reduces toxicity and antibacterial activity in proportion to colysteine ​​sulfate.

Polіmіxini mayut high activity against strains A. baumannii, Includes multi-resistant and carbapenem-resistant isolates. According to the data of recent years, the level of clinical efficiency of the colostin becomes 20-83%, microbiological 50-92%. According to the pharmacokinetic dosages, the concentration of colostin in the blood plasma from the internal introduction is in the range of 1-6 mg / l, in the liquor - 25% of the syrovatous concentration.

Vnaslіdok rotten proniknennya through gіstogematichnі bar'єri in patsієntіv of іnfektsіyami nizhnіh dihalnih shlyahіv polіmіksini bіlsh perevazhno priznachati іngalyatsіyno, while lіkuvannі іnfektsіy tsentralnoї nervovoї systems - іntraventrikulyarno abo іntratekalno in poєdnannі їh parenteral administration of ABO SYSTEM vikoristannyam іnshih antimіkrobnih preparatіv.

The frequency of development of nephrotoxicity in case of stagnation of polymixin, according to the data of the present day, can be adjusted from the other classes of antibacterial drugs and become 0-37%. Rizik the development of nephrotoxicity in case of stagnation of polymixin є dose-delayed. At the same time, the frequency of the development of side effects from the side of the child was spared in the patients with the previously damaged functions, however, the lack of development of the turnover was developing.

For dany doslіdzhen in vitro the synergy of colostin with zrifampicin, imipenem, minocycline and ceftazidime is indicated; polymixin In with imipenem, meropenem and rifampicin.

In the current hour, parenteral forms of polymixins have not been registered for storage in the Republic of Bilorus.

Tigecycline. Tigecycline is bacteriostatic and bactericidal for A. baumannii, Not strong to the mechanisms of resistance, characteristic of tetracycline.

According to the results of a number of advanced tigecycline, it is possible to secure the activity of relatively low-resistance, low-resistance, colostin-resistant, multi-resistant strains. A. baumannii .

Tigecycline can be a great problem for the growth and high concentration in the tissues of the body, including Legeneva, however, according to a number of authors, the concentration of the drug in the blood and spinal cord in the case of the recommended regimen of administration is suboptimal. Because of low concentrations of the drug in the section, it is not recommended to use vicoristovuvati tigecycline in case of IMP.

The experts of the Food and Drug Administration (USA) have brought the effectiveness of the cyclin for the treatment of important intra-abdominal infections, patients with MSSA and VSE, important infections of the pneumonic and medical tissues. At the same hour, the treatment of nosocomial pneumonia (especially VAP) is associated with an increase in the risk of a lethal result in important patients. The Republic of Bilorus does not have the drug in the given hour of registration.

Table 4. Doses of antibacterial drugs and frequency of administration

with lіkuvannі A. baumannii-associated infections

* The drug is not registered in the territory of the Republic of Bilorus.

Prospects for the therapy of infections, which A. baumannii is suffering from. Doslidzhennyakh in vitro described the effectiveness of a new cephalosporin - ceftobiprol? against Acinetobacterspp... The activity of ceftobiprol outperforms the activity of ceftazidime and cefepime in the presence of a low expression of genes, which are indicative of the synthesis of ADC-beta-lactamases. British author in doslijenni invitro showed the activity of a new monobact BAL30072 with 73% CRAB at a concentration of 1 mg / l and 89% at 8 mg / l.

Doslidzhenni invivo The models of opiate lesions on misha show the effectiveness of photodynamic therapy for the treatment of localized infections, those with multiresistant A. baumannii .

Among principally new drugs in potential activity against A. baumannii May the ingibitorium of the efflux pump, the ingibitorium of the enzyme in the biosynthesis of bacterial fatty acids (FabI- and FabK-ingibitorium), the ingibitorium of the peptide deformylase and of the metalloenzymes, the antimicrobial peptides (-buforin II, the lactobiotic peptides (buforin II) Doslidzhenni invitro demonstrates the ability of the experimental drug NAB741 to avenge a cyclic polypeptide fragment identical to the analogous polypeptide fragment B, increasing sensitivity Acinetobacterbaumannii before preparations, for those who are not well-trained, the membrane is an effective bar. In іnshomu invitro the efficacy of vancomycin is shown before A. baumannii with vicorian technology of fusogenic liposomes for their delivery to the Periplasm. Described the capacity of speech, how to run bioplastics (zokrem, based on 2-aminoimidazole), and the sensitivity of multiresistant antibiotics to antibiotics. It is possible to discuss the possibility of developing the so-called "antigens", which are linked to the attribution of genes, which lead to the formation of mechanisms of resistance; active and passive immunization. In a number of robots, the activity of vitamins and extracts from roslin, secretions of food and multi-resistant acinetobacter was shown. Zocrema, oil Helichrysumitalicum, Tanning and ellagic acid and significantly lower the level of resistance A. baumannii to antibacterial drugs for the preparation of Efflux.

Lysis of acinetobacter is shown in a number of doslidzhen bulo invitro, As well as the effectiveness of the storage of bacteriophages in the history of experimental infections, Acinetobacter spp., At tvarins.

prophylaxis

I will look at the temple resistance Acinetobacterbaumannii to antimicrobial drugs, as well as the development of a microorganism quickly and efficiently by the mechanisms of stiffness; A. baumannii-associated infections in the organization of health protection, which are based on the principles and norms of infection control.

A. baumannii Zdatnі colonizuvati zvіchіt sterile ob'єkti, vizhivati ​​yak in dry, as well as in the minds of the hospital center. Colonization get in touch with things to feel sick (food in the pillows, mattresses, bedside, food, bedside tables, bedside tables, sour and water-supplied faucets, water to look after him, to control his stance, to take care of his political maneuvers. In the middle of objects, how to be victorious for a glance and the health of political maneuvers A. baumannii see from apartments piece ventilation lungs and mechanical forms, also can colonize objects, tied with an internal vascular access (infusomati, vimiryuvachi vise, systems for trivial hemophilia, vascular catheter). In the middle of the colony setup, there can be gurneys for transporting ailments, medical gloves, dressing gowns, tonometer cuffs, flow measurements, pulse oximetry, laryngoscope blades, ventilation and air conditioning systems. Establishments of the building are in the middle of the world A. baumannii contaminated with anti-inflammatory drugs, including those of disinfectants (furacilin, rivanol). The items of the hospital center often come into contact with the staff (door handles, computer keys, history of ailments, tables on medical gardens, sinks and picking equipment) A. baumannii .

Every hour of internal carnival sleepers in infectious diseases A. baumannii, medical management You can also be tied with the broadens of the teacher, in the main for the rakhunok of the contamination of the victorious materials. Such manipulations can be hydrotherapy or pulse lavage of wounds, surgical intervention, catheterization, tracheostomy, spinal puncture.

For adequate health of the infectious control of nosocomial A. baumannii-associated infectious diseases need to be permanently taken into account, direct on the transmission of the driver from the patient to the patient (Fig. 2), so as the main reservoir A. baumannii in the stationary for colonization / information of patients.

For vinyatkom vischevkazanih zahodіv, vazhlive values ​​Got zaprovadzhennya zhorstkih indications for priznachennya antimіkrobnih preparatіv is outside the pershit lіnіyu antimіkrobnoї terapії (napriklad, karbapenemіv, tsefalosporinіv i ftorhіnolonіv IV pokolіnnya that іn.) Scho znizhuє frequency inadequate priznachennya antibіotikіv in lіkarnyanіy organіzatsії receptionists Zdorov'ya as a whole, as inherits, equal resistance of hospital isolates, including A. baumannii.

In general, then say, scho Acinetobacter baumannii, Є in the Danish hour, a "problematic" child of nosocomial infections, so that the drug is hostile to an important patient, good adaptations before living in the hospital middle and volodya is highly resistant to high resistance. When antibacterial therapy is indicated, it is directed to A. baumannii, Slid obov'yazkovo vrahovuvati local data about their sensitivity in the specific organization of health protection, and even more beautifully, in the specific skin.

Medical news. - 2011. - No. 5. - S. 31-39.

Uwaga!The article is addressed to lykar-fakhivtsy. Before the hand of the given statty or fragments in the Internet without a hyperpower on the first look like a violation of copyright.

Part 4. "Problems" of gram-negative microorganisms: synogniyny stick and acinetobacter "title ="
Synopsis of a clinical clinician and a microbiologist
Part 4. "Problems" of gram-negative microorganisms: synogniina stick and acinetobacter">!}!}

Є a number of microorganisms (MO), which are prone to high levels of resistance, are considered to be problematic. Up to such a middling disease of organisms, methicilin of staphylococcus aureus and representatives of gram-negative flora - Pseudomonas aeruginosa, P. aeruginosa, a number of Acinetobacter spp. pneumoniae). This statistic will include P. aeruginosa and Acinetobacter spp.

T.A. Pertseva, Department of Faculty Therapy and Endocrinology, Dnipropetrovsk State Medical Academy, Ukraine; R.A. Bontsevich, Labitnangskaya Central Miska Bagatoprofilna Likarnya, Russia

Entry

Sinyogniina palichka is known to microbiologists as a pathogen of young roslin, which protects against it, it’s good for people to get sick. In a large number of P. aeruginosa species є for humans, mentally pathogenic MO. Vona is not hostile to the health of non-smart fabrics. At the same time, whether tissue is on the body, P. aeruginosa can be detected in the case of a decrease in the amount of macroorganism functions (immunodeficiency). To this infection, P. aeruginosa enlargement, є to enlarge the manifestation, especially in the internal minds, if the part of the given MO is quickly swollen with polyresistance.

According to the data of the American Center for Ailment Control (CDC), the total share of infections that have been increased by P. aeruginosa, in US pharmacies, is close to 0.4%. Tsei MO, being the fourth most populous middle nosocomial pathogens, is close to 10.1% of all internal infections. According to the last data, P. aeruginosa is the cause of 28.7% of all hospital infections, 20-40% of all of the infections of nosocomial pneumonia. P. aeruginosa is most susceptible to cancer, opioid and SNID-ailments, in those who can suffer bacteremia, with a mortality rate of 50%.

Acinetobacter spp. є water і soil, stench is often seen from waste waters. Tsі MO incoming to warehouse mіkroflori shkіri health osіb (chastіshe kolonіzuyut dіlyanki mіzh finger nіg i in pahovіy oblastі, Especially in prozhivayuchih in hot i vologomu klіmatі) shlunkovo-kishkovogo i urogenіtalnogo traktіv i vіdnosyatsya to malopatogennih mіkroorganіzmam however nayavnіst Pevnyi vlastivostey spriyaє pіdvischennyu vіrulentnostі Acinetobacter spp. ...

The most significant MOs in the genus Acinetobacter spp. vvazhayutsya vidi A. baumannii, nabagato rіdsche є zhvoryuvan A. lwoffii. To that, when there is a miscarriage of bacterial infections in the first place, rely on the respect of A. baumannii.

In important ailments (intensive therapy wards, reanimation wards) A. baumannii can suffer from pneumonia, tracheobronchitis, infection of the bloodstream, cutaneous tract, catheter-associative and wound infections (June 2005). In the period of intensive therapy (IT) in the USA in 2003, Acinetobacter spp. becoming the cause of 6.9% of the increase in the number of pneumonia, 2.4% of the bloodstream infections, 2.1% of the infectious region surgical engagement and 1.6% of infectious diseases of the secular system. Acinetobacter spp. The importance of pneumonia can be increased (Houang et al., 2001). In addition, the acinetobacter is very good at being sick and sick for the hour of spontaneous hard times.

The mortality rate with acinetobacter infection is 20-60%, the attributive lethality is close to 10-20% (Joly-Guillou, 2005).

The incidence of acinetobacter infection of growth. In the UK, the number of bacteraemias associated with Acinetobacter increased by 6% between 2002 and 2003, and had 1087 cases (Health Protection Agency, 2004). A serious problem is the increase in the frequency of bacteremia, vicious multi-resistant strains of Acinetobacter spp. - more than 300% more from 2002 to 2003 (7 and 22 types of populations) (Health Protection Agency, 2004). In the US WIT, the level of Acinetobacter pneumonia has moved from 4% in 1986 to 7% in 2003 (Gaynes and Edwards, 2005).

In the last hour, the most recent period is the growth of the polyresistance of these microorganisms, they are developed with the help of stems that are resistant to all the main antimicrobial drugs (AMP). Through the tse MO they figuratively baptized with the "gram-negative MRSA".

In some regions, the problem of nosocomial acinetobacter infection occurs at a given position. So, in Israel, according to the site antibiotic.ru, in the last ten years Acinetobacter spp. becoming a provincial cause of ventilator-associated pneumonia and bacteria. Expansion of this zbudnik grew rapidly. For 7-8 years, in Israel there were no infections, Acinetobacter spp. Vicissitudes, and the present-day people in Tel Aviv routinely reestablish nearly 500 infections, 50 years later with the result. As a result of a retrospective cohort follow-up, which included 236 patients, it was established that polyresistant strains of A. baumannii were infected, and they were successfully treated as a less successful result. In a group of patients, in those who were seen with polyresistant strains, the lethality became 36%, and for those with non-resistant strains - 21% (p = 0.02). Acinetobacteria is even more important to be happy. At that hour, come by MRSA and Clostridium difficile in medical institutions Tel Aviva bully successful, fit in with Acinetobacter spp. without reaching. E. Harris (USA), in his pre-condition, stating that it is necessary to enter the prophylaxis and new drugs for drug use this year. Necessary new antibiotics, active gram-negative antibiotics, if in this hour no more drugs are distributed.

characterization of the culprit

P. aeruginosa and Acinetobacter spp. to be applied to gram-negative non-enzymatic microorganisms.

P. aeruginosa ("synogniina stick") - gram of bacterium bacterium rod-shaped form, oblastny aerob. The size is 0.5-0.8 microns in thickness and 1.5-3 microns in thickness. It is referred to the genus Pseudomonas (there are 140 species of bacteria) of the Pseudomonadaceae family (pseudomonads). Superbly stiffening up to a large amount of antibiotics for rakhunok bar'era, folded liposaccharides of the zonal membrane, as well as forming bioplastics, also the role of the viconu. Use the pieces, which are practically not the same as for different antibiotics.

The large number of MOs of the Pseudomonadaceae family is important, they are baggy in the ground and in the water, they may not be of great importance (with the blame B. mallei and B. pseudomallei - the glanders and small doses are evident). In the bogey minds of the synogniyn, the stick is built to colonize the cakelnous surface, hammering into the sewing and setting up the biofuel, due to which it infuses standard disinfectant into it.

In P. aeruginosa licarns, they can be transferred to the surface of other objects and possession, as well as in reservoirs with ridges. It is often carried from contaminated water or water, as well as in transit through toilets, sinks, handles of faucets for water, objects, especially vologues (for example, towels), which can spontaneously cure ailments, with average contact with bacteria through the hands of medical personnel. .NS. ...

The pathogenicity of P. aeruginosa is high, and the pathogenicity of P. aeruginosa is more pronounced in some cases of pseudomonads associated with a number of factors of virulence, which are responsible for the colonization of human tissue. The factors of adhesion, infection and cytotoxicity are attributed to the determinants of virulence.

Locally i systemically dіyu on organіzm ssavtsіv nadayut fosfolіpaza C ekzotoksin A ekzoenzіm S, elastaza, leykotsіdіn, pіgment pіotsіanіn (scho obumovlyuє Shinyo green zabarvlennya seredovischa at viroschuvannі mіkroorganіzmu in kulturі abo gnіynih vidіlen іnfіkovanih wounds), lipopolysaccharide (іnduktor sistemnoї zapalnoї reaktsії) , capsular polysaccharide alginate (develop in patients with chronic infections), for example, in cystic fibrosis; alginate sprays on the surface of the food, as it will inadvertently prevent a pathogen from becoming resistant to organisms

P. aeruginosa is characterized by the versatility of the mechanisms of regulation of the expressive factors of virulence, which is aimed at promoting the adaptation of the microorganism to the smallest minds of living. When the MO is transferred to the outer middle, the virulence factor does not synthesize, when the inner middle food gets in, the organisms of the fellow workers will have to repair intensive synthesis of proteins, so that the development of the process is developing.

A number of important factors, such as the regulation of the synthesis of virulence factors on the same level of microbial cells, in P. aeruginosa, the regulation is on the basis of the population. One is looking about the phenomenon of "cooperative sensitivity" or "feeling a quorum" (quorum sensing), which is growing in the accumulated in the microbial population of low molecular weight spoluks (homoserine lactones), as well as being able to sing along with the concentration of blue In such a rank, the expression of the genie of virulence appears to be a fallow form of the fertility of the microbial population. Biological sensation of the phenomenon, imovirno, dressings with a coordinated ear, the synthesis of factors of virulence only when the microbial population reaches the singing level of proficiency. Regulation on the level of cooperative sensitivity in P. aeruginosa has a strong expression of greater factors in virulence and secondary metabolism.

Acinetobacter genus is common gram-negative (it is not bad for alcohol when it is farmed for a gram). Suvor aerobi, oxidase negative and catalase positive.

A. baumannii is an aquatic organism that lives in individual and natural waters. At the same hour, they will be able to see the bacteria on a dry surface for up to 1 month.

In the minds of the stationary A. baumannii often colonize the decision for the final, internal and parenteral bagatorazovanny. MO is low on virulence. Often it is possible to see from shkiri and phlegm ailments, wounds, wounds, scho, as a rule, it is not about infection, but about colonization.

The development of acinetobacter infection is atypical, more typical for immunocompromised ailments. Infection is more tropic to tissue and organs great together ridini (respiratory and sevidial tracts, liquor, shelter, peritoneal ridina). To be found in vigorous nosocomial pneumonia, infections, associated with trivial peritoneal dialysis, catheter-associated infections.

The knowledge of the MO in the respiratory secrets of intubated patients is practical to know about colonization. Pneumonia can be epidemiologically linked to the colonization of respiratory possession, including pleurisy, drainage systems, sepsis, catheters and other infusional possession and development.

The characteristics of the colonization and incidence of bacterial infections are presented in Table 1.

vision of MO

In microbial synonyms, the stick is unimaginable, it grows on small, single-breasted centers (Endo, Kligler, Koda, Levina, etc.) greenish colora with a licorice smell. In a smear prepared from pure culture, sticks can be roasted one at a time, or in pairs, or short lances. The specific power of P. aeruginosa is the phenomenon of "raid lisis", as well as the appearance of an intensively farbuvati medium (often in blue-green colori). For help serological diagnostics in a relatively short term, it is possible to develop antigenic infection, as well as antigen, which is violated in response to antigenic stimulation of the immune system.

Є native to P. aeruginosa MO, such as S. maltophilia and B. cepacia, which require correct microbiological identification differential diagnosis... It is linked to thymus, but S. maltophilia is naturally resistant to carbapenems, B. cepacia is preaminoglycosides, and P. aeruginosa is naturally sensitive to them (if resistance can be added).

Cultivate Acinetobacter in the midst of a wide range of temperatures 20-30 ° C, with an optimum growing temperature of 33-35 ° C; ci MO does not require growth factors, does not build up to denitrification. Most of the strains grow on the mineral middles, so that they can be substituted in the form of a single dzherel in carbon and energy ethanol, acetate, pyruvate, lactate, and as dzherelo nitrogen - salts of ammonia and nitrate.

Identification. In the minds of practical laboratories for the identification of bacteria of the genus Acinetobacter and differentiation of these from the other gram-negative MOs, to complete the victorious set of tests. When tsomu viznachalnimi Find our employees: a form klіtin (coca abo drіbnі palichki) vіdsutnіst ruhlivostі, character i zdatnіst growth in seredovischі MakKonkі (laktozootrіtsatelnie kolonії drіbnih i serednіh rozmіrіv) vіdsutnіst for Change koloru іndikatora on polіuglevodnom agarі Klіglera i grassing seredovischa negatively tsіtohromoksіdaznoy test. To differentiate Acinetobacter spp. from the largest oxidase-free non-enzymatic bacteria of the vicious test. The type of identification of Acinetobacter is significantly more flexible, as a rule, it is not carried out in routine practice.

P. aeruginosa resistance to AMP

Prior to the main groups of antibiotics, which are clinically significant antipseudomonal activity, β-lactates, aminoglycosides and fluorocholoni are recognized. On the other hand, P. aeruginosa has the powerlessness of the mechanisms of speed variation:

• preaminoglykozidiv - enzymatic activation, decrease in penetration, modification of the target;
• up to β-lactamic AMP - change in the structure of the porinovy ​​channel (decrease in penetration), hydrolysis by β-lactamases, active wikid with the participation of the OprM protein, modification of the target for the PSB, change in the structure of the porinovie O;
• before fluorochinolones - change in the structure of the target (DNA-hyrase), activation of the system and vivennya (MexA-MexB-OprM), decrease in membrane penetration.

It is especially important that in 30-50% of patients the polyresistance of P. aeruginosa develops during monotherapy.

Resistance of Acinetobacter spp. to AMP

MO can be used to adapt to antibacterial drugs, which can be found in a variety of forms and accessories. Shtami, otrimanі from ailments, more stirs to antibiotics, nіzh bacteria, іsolyovany from medical personnel, but the resistance of A. baumannii can be in 10-20 times the concentration of lacquers A. lwoffii. Important is the large number of clinical isolates, up to penicilin at a dose of 100 OD / ml, as well as up to macrolides, linkosamids, chloramphenicol, cephalosporins of I-II generations. The hospital staff builds up resistance to a wide range of antibacterial drugs, or they become noticeably sensitive to carbapenems and amikacin.

Resistance of Acinetobacter spp. to β-lactamic AMP is linked to the production of plasmid and chromosomal β-lactamases, a decrease in the penetration of the surface structures of cellini and a change in the structure of penicillin-binding proteins.

The potency of Acinetobacter isolates to aminoglycosides is enriched in all three groups of aminoglycosidmodifying enzymes: aminoacetyltransferase, adenoacetyltransferase genes, adenyltransferase controllersaminoses

Resistance to fluoroquinolones in vinicas due to modification of DNA-lymphocytes by bacteria, as a result of changes in the structure of the cellular membrane and a decrease in the penetration of the drug into the middle of the clitini.

Sensitivity value to AMP

The first series of drugs for antibiotic sensitivity of Pseudomonas spp. i Acinetobacter spp. є Most importantly, it is due to the greatest natural activity.

ceftazidime- one of the main AMPs, vikoristovuvanih for the treatment of infections, zooming given by a group of microorganisms.

Cefepim in case of porous with ceftazidime of equal natural activity in a number of vipads, the activity of MO, persistent to ceftazidime, is suspected.

Gentamicin, amikacin... Aminoglycosides for monotherapy of infections, which are affected by a given group of bacteria, do not get stagnant, protects in bagatech vypadki є a necessary component of combined therapy regimens.

ciprofloxacin in the middle of fluorochinolones to be infused with a Vibor preparation in case of elimination of this group of infections.

Meropenem, іmіpenem. Meropenem is characterized by the highest level of activity, which is given by the Ministry of Education, and it is impenetrable to do so. The completeness of the inclusion of both carbapenems is explained by the daytime between them in some types of cross-resistance.

Additional preparations for the level of natural activity, as a rule, are used against antibiotics of the first row, protects in bagatokh vypadki, persh for all economical worlds, can be used in therapy. In addition, it is a bit of a matter of non-fermenting bacteria, and it’s worth pursuing the level of natural sensitivity to AMP.

Aztreonam, cefoperazone for the main authorities close to ceftazidime.

Cefoperazone / sulbactam, ticarcilin / clavulanate. Stagnation in the therapy of antibiotics does not increase the activity of higher β-lactamases, which is synthesized by P. aeruginosa, due to which the combination of the drug does not seem to be overwhelming in the development of antibiotic antibiotics. At the same hour, cefoperazone / sulbactam, as well as ampicilin / sulbactam, can be highly effective in the treatment of acinetobacter infections for sulbactam.

Carbenicilin. I will look at the toxicity and high incidence of carbenicillin intake for the treatment of infections, P. aeruginosa is susceptible to infection, which is considered to be insufficient.

Oscillations of important infections, pseudomonads, are indicated for the recognition of combined therapy, especially in case of the results of microbiological indications in the class of the most effective points of combination therapy.

Vimogues before material collection and microbiological diagnostics of guidance in the statute “Clinically significant educators of infectious diseases. Synopsis of a clinical physician and a microbiologist. Part 1. Pneumococcus "(div. No. 3 (04), 2006).

Risk factors and specialties of infections

As a result, P. aeruginosa has no factors in virulence of infection, accumulation of cysts of MO, potentially more insecure, less susceptible to intellectually pathogenic microorganisms.

Dzherelom infected in Pershu Cherga є ailments from the synognious infection, as well as service personnel. An absolute factor in the widening of the synagogue infection can serve as a service to infected objects and pobutu, razchini, hand creams, towels for exposure, genitalia, shaving brush, etc. Prior to rare factors, it is necessary to introduce an increase in the infection through tools, to add the equipment, as the disinfection was given, as it turned out to be ineffective.

Sinyogniyna stick is hostile in the main people with weakening immunity: hospitalized ailments with fellow illnesses, especially a kidnapped child. A number of stanіv, such as cystic fibrosis, opіki, leukemia, sechoam'yana ailment, perebuvannya on piece ventilation legends (SHVL), є are independent factors friendly to rhizik. The overlap of the stanis, which is screwed up to the development of the infection, is shown in table 2.

Most serious diseases of nosocomial infections are caused by SHVL-associated pneumonia. Prior to the risk of development of such pneumonia, P. aeruginosa infection, there should be anterior therapy with cephalosporins of the 3rd generation, hospitalization or obstructive lesions. Letalnіst at bakterіologіchno pіdtverdzhenoї SHVL-asotsіyovanoї pnevmonії (zabrudnenіst materіalu, otrimanogo of nizhnіh vіddіlіv dihalnih shlyahіv for dopomoga spetsіalnih schіtok, zahischenih od kontamіnatsії in verhnіh dihalnih Shlyakhov, Hope TEM 103 / ml) becoming 73%, and at kolonіzatsії nizhnіh dihalnih shlyahіv P. aeruginosa (material obstruction less 103 KUO / ml) - 19%.

If there is a localization of the primary infection, P. aeruginosa zooming, the potential growth of bacteria, the prognosis of the disease is often lost. According to the data of the European center SENTRY, the frequency of bacteremia, P. aeruginosa infections, becomes 5%. At the same time, the indicators of mortality become 40-75%, attributive - 34-48%.

The role of P. aeruginosa in the etiology of post-carnial infections is small.

Before viniknennya atsіnetobakternoy kolonіzatsії (i Zgoda - іnfektsії) privertayut under study is gospіtalіzatsіya abo antimіkrobnu terapіya (Especially AMP s nizkoyu aktivnіstyu to atsіnetobakter) znahodzhennya in vіddіlennі іnshih patsієntіv, kolonіzovanih danimi MO, and Minds VІT - vikoristannya respіratornogo abo catheter obladnannya іnvazivnogo nature.

The yak was also known as a whistle, Acinetobacter spp. hostile to immunocompromised patients. Most often, the Ministry of Defense is subject to nosocomial infections. A lot of them may have a very hopeful character, however, the stench is superbly stiff before therapy.

lykuvannya

The problem of the treatment of synagogue and acinetobacter infections with cutaneous fissure is becoming more and more relevant in increasing the frequency of population, increasing the resistance of MO and in response to a decrease in the effectiveness of therapy. In pulmonology, the problem of medical treatment of medical conditions is often associated with such nosologies as nosocomial pneumonia and cystic fibrosis, and, more recently, with chronic nasal bronchitis, pleurisy and post-carnial pneumonia.

In the last few years, there is a robotic process of anti-Pseudomonas aeruginosa vaccines, biofilm ingibitories and "feeling a quorum". More recently, the standard of therapy for synovial infection with the combination of ciprofloxacin with ceftazidime and carbenicillin with gentamicin, often in conjunction with Piperacilin. However, the present data show that there is an increase in resistance to two remaining drugs, as well as to carbapenems. The most effective treatment for the disease is the following therapy schemes:

• ciprofloxacin + amikacin;
• ceftazidime + amikacin;
• ceftazidime + ciprofloxacin + amikacin.

In addition, it is necessary to remember about the need for routine monitoring of local sensitivity and the introduction of any correctives in the therapy scheme.

Vibir of antibiotics for the treatment of vicious Acinetobacter spp. hospital infections as well as іmіpenem, meropenem, amіkacin in combination with effective β-lactam and ciprofloxacin. For the treatment of lung infections, you can use effective ampicilin / sulbactam, the first for all for the development of self-activity sulbactam. However, Vibor is used in the treatment of important and moderate infections and combinations of antibiotic cefoperazone / sulbactam. Sulbactam increases the activity of cefoperazone and broadens the spectrum of acinetobacter (> 128 g / l), and the MIC of Acinetobacter strains that are resistant to cefoperazone (> 128 g / l) decreases to 12.5 g / l. Yogo klinic efficiency has been brought to a whole series of richly-centered dosages.

If necessary, you can use the following combinations:

• cefoperazone / sulbactam + amikacin;
• carbapenem + amikacin.

Drugs that also have anti-bacterial activity, according to data from Go and Cunha (1999), є colistin, polymixin B, rifampicin, mino- and tetheciclin.

In the case of infections that have accumulated P. aeruginosa and Acinetobacter spp., In the remaining hour the possibility of ingestion of new fluoroquinolones is actively observed. Levofloxacin is the most commonly used inoculation, as well as recommendations in a number of standard therapy regimens in the Russian lands.

Yak butt is a guided scheme for the treatment of nosocomial pneumonia from our recent statistics and a scheme for the treatment of important pneumonia with the risk of syngene damage according to the American protocol of treatment post-carnial pneumonia ASCAP 1 -2005 (Table 3,).

visnovok

P. aeruginosa and Acinetobacter spp. In pulmonary and therapeutic practice, stench is significant in such important camps as nosocomial and ventilator-associated pneumonia, cystic fibrosis. Tsi MO is characterized by a significant breadth of natural stiffness, ale, scho naygolovnіshe, rapidly developing іvnem pribanoi resistance. With a whole number of strains, resistance to all major AMP groups is determined one hour (multi-resistance). A number of vypadkіv cars find themselves in a dead end situation through the visibility of the choice.

Tse obgruntovano viklikaє velichezne zanepokoєnnya in Naukova medichnomu suspіlstvі, vimagaє velikoї i skoordinovanoї robots of monіtoringu will chutlivostі, stvorennya formulyarіv i standartіv zastosuvannya ILA rozrobtsі novih antimіkrobnih zasobіv vaccines i preparatіv of іnshimi mehanіzmami dії, SSMSC zmogli b virіshiti problem polіrezistentnih Gram nefermentuyuchih mіkroorganіzmіv, such as synogniina stick and acinetobacteria.

1 Antibiotic Selection and Outcome-Effective Management of Community-Acquired Pneumonia (ASCAP).

The list of literature is in the editorial office

I go,
Dytina ailment from the flow of flowing rock: a sprinkle of nozzles, through a few days a temperature of 39 and a cough (fever, coughing too much), more angina, more cough without angina, because of the new fever for robotic angina. - they zapped the food. Have become lіkuvati in a cough. Analysis was done (shelter, slaughter, nasal swab and ziva). Zivu analysis: Acinetobacter baumannii complex (10 * 7 KUO, Klebsiella pneumoniae 10 * 7 KUO, Viridans Streptococcus Group 10 * 7 KUO). All smears were given in a paid clinic. For the results of the analysis, we were told to turn up to the infectious disease. We returned within the framework of the compulsory medical insurance right before the infectious disease - we were told that they didn’t need to get such an analysis at once, since we didn’t need to pass the infection itself. What are we doing?

Have a nice day!

We took out the annual results of the smear from the beginning of the child of 4 rocks, de bula viyavlena was given to the guide: Acinetobacter baumanii 10 * 5.

The ENT didn’t give me a chance, saying that I don’t know such a “beast”, but looking back, without a second smear, said that they had already managed to do it (because of the tidy obrob with Candid). I'm naturally in Google, the information about the bacterium is not so rich, Russian language, at least. And besides, I’ve already read it, I’ve already come to the roster.
Be a weasel, hto, having already stuck to such a point, I ask you to share the thoughts of your politicians: is it not safe, and why should you still be liking?

Nosocomial infections. Zagalna characteristic... Results of the conducted doslіdzhen.

Gorbich Yu.L., Karpov I.A., Krechikova O.I.

Bilorus State Medical University, Republic of Bilorus.

NDI Antimicrobial Chemotherapy of Smolensk State Medical Academy, Russian Federation.

Nosocomial infections (lat. Nosocomium - medicine, Greek. Nosocmeo - medicine, to look for ailments) - the price of infection, which rose from the patient not less than 48 years later, when the hospital was sent to the hospital overflow in the incubation period; Infectious diseases, which has become a legacy in front of the front hospitalization, as well as infectious diseases of medical workers, dressings, from their professional activities.

According to the data of the young authors, the number of patients who develop nosocomial infections is from 3 to 15%. Of these, 90% may be bacterially less likely; Viruses, fungi, fungi, and the most simple ones develop significantly earlier.

From the ear of antibiotics to the 60s of the XX century. Approximately 65% ​​of internal infections (VLI) are malignant in nature. With the appearance of penicillinase-resistant anti-bacterial drugs in the arsenal of drugs, the stench entered the second plan, giving up the leadership of infectious diseases and gram-negative bacteria.

In a given hour, the ethological role of gram-positive microorganisms and fungi as educators of nosocomial infections, with the help of the grammar-maker-of-them-grows the ethiological role of the anti-microorganisms and fungi For a number of cars, the frequency varies from 62 to 72% of all nosocomial infections. Most actual diseases of all ILI (including angiogenic) and sepsis, microorganisms of the Enterobacteriaceae family and nonenzymatic bacteria, including Pseudomonasaeruginosa and Acinetobacterspp. ...

A most important species of the genus Acinetobacter є Acinetobacter baumannii (genomovid 2), which is 2-10% of gramophobic infections in Europe and the United States, up to 1% of all nosocomial infections.

Riziku factories

In addition to the external factors in the risk of infections, infections of A. baumannii, see:

• • how many to become;

• • abduction of vik;

•  the presence of a concomitant ailment (malignant incontinence of blood, heart-vascular or dichal deficiency, desemination of intravascular coagulation of blood);

• Triviality of invasive methods of treatment and monitoring (SHL for more than 3 days; injection of drug drugs; insertion of a probe; tracheo-stoma; catheterization of the cutaneous cavity, arthrocyte);

•  Trivial knowledge in the hospital or from the day of reanimation and intensive therapy (VRIT);

•  anterior antibacterial therapy with cephalosporins, fluoroquinolones or carbapenemi.

Prior to the hospitalization of the VRIT surgeons, the infection rate is approximately 5 times.

Yak factor rhizik іnfіkuvannya carbapenem-resistant strain A. baumannii for grown-ups at the moment of description: great size of stationary (more than 500 ko-ek); hospitalization in VRIT or hospitalization for executions shown; trivale perebuvannya in

stationary; temporarily the number of patients from CRAB in the ward; to become a person; immunosuppression; SHVL, ka-teterizatsiya sechivividnyh nobles or arteries, carrying out hemodialysis; recently promptly involved; pulse lavage wounds; Pereduyut-niy vicoristannya meropenem, imipenem or ceftazidime.

In Respublіtsі Bіlorus in yakostі faktorіv riziku kolonіzatsії / іnfіkuvannya nozokomіalnih s-lyatom Acinetobacter baumannii, stіykim to car-bapenemnim antibіotikіv, boules vidіlenі to-go vikoristannya "pseudomonas" karbapenemіv, kateterizatsіya sechovivіdnih Pu-Tei gospіtalіzatsіya to vіddіlen neterapevtіche-skogo profіlyu i vіk up to 40 rock_v (tab. 1).

Atinetobacteriological infection

A. baumannii in a large number of cases of sickness in severely ill patients with immunocompromising patients. Denmark microorganism can be the cause of infections of mental tissues (sinusitis, tracheo-bronchitis, pneumonia), blood flow (sepsis, endocarditis of natural and piece valves), myocardial diseases, early necrotizing fasciitis), the nervous system (me-Ning, ventriculitis, abscess to the brain), intra-abdominal (abscesses of localization, peri-tonitis), musculoskeletal apparatus (osteoma lith, arthritis).

According to the data of the authorities, it was carried out in 15 medical institutions for the protection of health in Minsk, in the structures of A. baumannii-associated infections prevailing in the bloodstream, and in the storage of 39.4% of the infections Another place is occupied by infections of mental health (35.4%), and the third (19.7%) - infections of children and soft tissues (including infections of surgical wounds). Osteomy-ELIT was diagnosed in 4.7% of cases, infectious diseases - 0.8% of cases.

Infections in the bloodstream. Clinical manifestations of infection in the bloodstream, A. baumannii vyklikanich, are varied from a transient bacterium to a very important discomfort with a high level of death. The gates of infection are the most frequent ones, however, in the primary pink-ni septic process, the main role is to play the internal vascular catheter. Before the entrance gates to serve as secular paths, shkira and myaky fabrics, wounds, organelle cavity and central nervous system. Internal-lycarnic sepsis, A. baumannii, in 73% of cases develop during the 15th day of the hospital. Septic shock develops in about 30% of patients with acinetobacteriosis sepsis. At the same hour, ailments with bacteria, tied with internal vascular catheters,

characterized by a shorter prognosis, allowing for the fact that the infection can get worse when the catheter is seen.

Risk factors for the development of infectious blood flow, patients A. baumannii, for men of state hospitalization, trials in hospital systems, before the colonization of bacterial infections, high procedures 1500 g (for neonates), immunosuppression, malignant disease, heart-related deficiency, nirkoval deficiency, mental deficiency for every hour in BPIT, apparent in the anamnesis-anamnesis, in case of sepsis ...

Infectious diseases A. baumannii, the order of Pseudomonas aeruginosa, Stenotrophomonasmaltophilia and MRSA, є can be a wake-up call (it develops within 5 days from the moment of hospitalization) in cases of nosocomial pneumonia. Before the hour of the manifestation of the infection, there is also an antibacterial therapy and hospitalization in the last 60 days.

Nosocomial pneumonia is most often polysegmental. It is possible to promote the formation of empty spaces in the legends, pleural symptoms, illumination of bronchopleural fistula.

Indirect factors in the development of VAP, A. baumannii viclikan, є antibacterial therapy and the manifestation of a hostile respiratory distress syndrome. Poperednіy epіzod sepsis, vikoristannya antibakterіalnih preparatіv to rozvitku іn-fektsii (osoblivo imipenem ftorhіnolonіv that tsefalosporinіv III pokolіnnya, pіperatsіllі-on / tazobactam), trivalіst SHVL bіlshe 7 dnіv, reіntubatsіya, trivalіst perebuvannya in statsіonarі viznachenі yak factorization riziku rozvitku VAP viklikanoї multiresistant strain A. baumannii.

A. baumannii is the third most frequent cause of nosocomial tracheobronchitis (NTB) in patients with high-speed ventilation, increasing 13.6 and 26.5% of NTB types in patients with surgical and medical pathology. The development of NTB reliably led to an increase in the term of being transferred to VRIT and the triviality of the SHVL to be carried out in patients, even if the patients had not developed nosocomial pneumonia.

Infections of children and soft fabrics A. baumannii is a significant pathogen in traumatic ears, opioids, and also in infectious delayed surgical wounds. Infections of children and soft tissues, viral infections of A. baumannii, are more likely to be accelerated by bacteremia.

Acinetobacterium bacteria are infectious during the insertion of an internal catheter, which can only be reached as soon as you can see it.

Infections of the nervous system. Acinetobacter baumannii is a permanent infection of internal carnial meningitis, abscesses of the brain. Me-Ning can grow very or rather a cob. Petechial visip can be promoted on the curved slopes (up to 30% of the vapors). The changes in the spinal cord in case of me-Ning, in women who suffer from A. baumannii, do not appear from any of the changes in the development of changes in other ethiology and presentation:

Factors of risk of development of atinetobacter Menin-Gita include: extra neurosurgery in hand, call for ventriculostomy (especially for 5 days), manifestation of cerebrospinal neuropsychiatric disease

Infections of the secular nobles (IMP). It is not invasive for the frequent colonization of the lower types of bacteria of acinetobacteria that are rarely an ethological agent of IMP. Acinetobacter spp. seen in 1-4.6% of nosocomial IMPs.

Risk factors of atinetobactero-bacterial IMP are the presence of a catheter in the dissection and nephrolithiasis.

Інші інфекції. Acinetobacteria viklikayut peritone in patients, who perebuyut on trivial outpatient peritoneal dialysis; as well as cholangitis on aphids of transhepatic cholangiography or drainage of young women. Osteomyelitis and arthritis, A. baumannii wicclicks, tied with single-piece implants or trauma. Described is also the acinetobacteras-socialization of the eyes, tied with the con-tamination of soft contact lines (twisting and tearing of the horns). Mossy development of іnshh urazheni organ zoru from conjunctivitis to en-dophthalmitis.

Diagnostics and assessment of sensitivity to antimicrobial drugs

In clinical practice of infection, A. baumannii, the colonization of shkirnyh pokriviv, mental and secular paths, intestinal tract of patients. A significant extension of A. baumannii as a colonization of the microorganism in the process of an active assessment of the situation in the case of a patient's biological material. At the same hour, it means that Acinetobacterspp has seen it. as a colonization of microorganism є predictively significant for the value of the etiology of sub-nosocomial infection (positive / negative predictive value - 94/73% for VAP, 43/100% for blood flow infections)

Diagnostics of nosocomial infections, incl. A. baumannii-association, from key positions it is cleverly divided into 4 stages:

• 1. Pick up and transport of key material.

• 2. Identification of the teacher.

• 3. Appraisal of ethological significance in relation to microorganism.

• 4. The value of sensitivity to anti-micro-drugs and interpretation of the results.

The correct selection and transportation of clinical material will allow the production of incomplete laboratory results to a minimum, as well as the change "inadequately" for antimicrobial drugs.

General rules for the collection of clinical material on microbiological data (with health care):

• 1. Taking, if possible, it is necessary to carry out antibacterial therapy before the ear. As soon as I have ailments, I’ll reject antibacterial ti-rapia, then the key material went by my brothers without a medication before the drug was introduced.

• 2. Material for a bacteriological patient must be taken away from the department of infection. In case of ill-will - vicoris-tovuvati is the most important biological material.

• 3. Suvoro dotrimuvatisya rules of asepsis, not admitting contamination of the material of third-party microflora.

• 4. To take a vision from a wound, smears from mucous membranes, from an eye, a nose, a nose, a sore, a cervical canal, a pichvi, an anal opening, a sterile cotton swab. For blood, pus, liquor and exudates - sterile syringes and special transport means; for sputum, chaff, feces - sterile containers are closed.

• 5. The amount of material is sufficient for carrying out further education.

• 6. Native material shall be delivered to the laboratory in the shortest possible term (no more than 1.5-2 years after it has been removed). Allow the material to be stored in the refrigerator at 4 ° C (except for biological material, taken from sterile in the normal locus: liquor, blood, inner corner and pleural lines). In case of vicarious transport means, essential material can be taken for 24-48 years.

• 7. Ridky biological material can be transported without the middle in a syringe, on the tip of a container a sterile box is or is bent underneath the head.

Identification of the teacher. The genus Acinetobacter (family Moraxellaceae) is composed of strict aerobic, non-sound gram-negative lacto-enzyme oxidase-negative, catalase-positive coccobacteria with a size of 1-1.5 x 1.5-2.5 microns, glucose on zychaynyh lively middlings. On the hospitable, lively midst of the colony

smooth, opaque, sometimes less for size, less representatives of enterobacteria.

Typical morphological forms of microorganisms can be seen in smears, broken down from clinical material, or from wild lively midst. When growing on the middle midst, in the presence of antibiotics, bacterium smears may form sticks. Deyakin izolatiya acinetobacter can hold the crystalline violet, blooming badly when farbuvannya behind Gram, so that it can lead to the gram-positive interpretations of gram-positive bacteria.

Interpretation of results (with changes and pre-employment). On a large scale, the authors reconsider, a reliable criterion of infection, related to intellectually pathogenic internal microcarnial microflora, including Acinetobacter baumannii, is a type of culture.

Shelter. The material for the advancement is necessary to have a minimum of two peripheral veins in a small bottle. It is not allowed to take blood from a venous catheter for a vignette of vipadkiv, if only for a catheter-assisted infection. When two blood samples are taken from the catheter, peripheral veins are taken from the catheter, and the blood is taken by the small method, the growth of colonies is rejected from the catheter, and the number of identical blood colonies is changed by 5-10 times the number of identical blood colonies when the veins occur. catheter.

Liquor. The appearance of A. baumannii in low concentrations accelerates the interpretation of results, especially in children, microorganisms are often colonized by children. Vіrogіdnіst Yogo etіologіchnoї znachuschostі considerable-telno pіdvischuєtsya in razі vidіlennya atsіneto-bakterіy of lіkvoru in patsієntіv s already nayavnoyu іnfektsієyu, viklikanoї A. baumannii, pose central-noї nervovoї system (the so titles vtorinny menіngіt) Venue of pіslya neyrohіrurgіchnih vtruchan have patsієntіv of pronikayuchimi on-damage to the skull, especially on the smallest factors in the risk of atinetobacterial infections.

Interpretation of the clinical meaning of antibacterials, visions from non-sterile loci, is a complex factorial process that can be found in the quality of a clinician, microbiologist, teacher for-Bira Lower the criterion of the singing world to be clearer, or at the same hour allow for an adequate interpretation of the microorganism, like colonizing an agent of an infectious disease.

Sputum. The appearance of atinetobacter in the number of ³106 KUO / ml (from bronchial serums ³104 KUO / ml) є diagnostically significant for understanding the rules of sputum collection. However, the values ​​are not absolute, as on the other antibacterial therapy, the number of causally significant bacteria in the sputum decreases and, navpaki, the growth of the concentration of colonic microflora.

When the sputum is present, the bacterioscopy is ligamentous, as it allows you to judge the quality of the material taken. The presence in one field with a small increase in the amount of more than 10 alimentary cells and / for less than 25 polymorphic-nuclear leukocytes, in order to contaminate the image with a sludge, which is far from the later In such a case, the phlegm should be taken again and again from the dotrimanі-yum we used the sampling rules.

Material for early infection. It is necessary to exclude the possibility of contamination of the previously reported material of A. baumannii isolates from the surface of the skin, especially with vicious tampons. When changing cultures are seen, the overwhelming should be given to microorganisms, seen in greater concentration.

Slashing. Diagnostically significant є seen bacteria in a concentration of ³105 KUO / ml in the presence of symptoms of discomfort. When taking a slice from a bezposeredno slice michur without a catheter, attaching the secular paths, the appearance of acineto-bacteria in any title is significant. The appearance of three and more types of microorganisms in great concentrations in the case of Kontamina-tsіyu-tsіyu o'clock in the gathering of the battle, for on the wrong sberіgannya.

A supplemental marker of the ethiological significance of Acinetobacter baumannii the load of the dynamism of the patient's back on the anti-bacterial therapy.

Interpretation of antibiotics (with changes and additions). Pislya otrimannya

the results of the test for sensitiveness to antibacterial drugs, do not mean etiotropic Forman-poklik therapy, spiraling deprivation of antibiotic gram. Sensitivity to an organism prior to the in vitro antimicrobial drug does not depend on its in vivo activity. It can be linked with individual features of pharmacokinetics and / or pharmacodynamics of pre-Paraty for a given patient, as well as being flexible in the methodology of preliminaries, such as vicarious materials, etc.

When analyzing antibiotics, one should pay respect not to any particular pre-Paraty (s), to which (their) origin is sensitive / resistant, but to the whole picture as a whole. It is not allowed, having put in the imovirny phenotype of the stent-nosty acinetobacter with the actual data, it is faster to remain, having eliminated by themselves the sign of poorly effective drugs.

Zokrema, for the detection of strains that produce beta-lactamases with an extended spectrum of dey-nasic (ESBL), should be noted for the sensitivity of the plant to cefoxitin and AZT-rheonam. Although the ESBL product is isolated, cefoxy-tin has an activity, and the aztreones do not. In general, it is necessary to isolate the isolates, as they are stent until all cephalosporins of the 1st-4th generations, and the aztreonam is right from the actual results of antibiotics. Yaksho strain is resistant to cefoxitin, sensitive to aztreonam, vin is a producer of chromosomal beta-lactamases. In general, the cephalosporin of the 4th generation can take over its activity.

At the difference in sensitivity to one of the "antipseudomonal" carbapenems, not to assess the sensitivity of those by analogy with them. The representatives of the Carbapenems are not the same world of schilia until they have the same mechanism of resistance. A. baumannii, resistant, for example, to mero-penem, can be sensitive to them-penem and / or Doribax and navpaki.

When a strain is detected that is resistant to the amount of Wall, it is necessary to put such a result to safety and re-value sensitiveness from parallel tests of con-control strains.

Evidently aminoglykozidіv іnterpretatsіynі evaluation of antibiotic-gram in the region is steep and the number of aminoglykozіdmodі-fіtsііvіvіy enzymіvіvіvіy profіkh sublyuch. Therefore, for aminoglycosides, let us assume all the sensitivity for the same sensitiveness / resistance in the middle class.

The greater the number of clinical isolates of A. baumannii resistance to antiphlogistic and chloramphenicol, which is necessary for the protection of the vibration of these drugs in the capacity of ethiotropic for the elimination of the results of antibacterial In addition, the assessment of the sensitivity of Acinetobacter baumannii to chinolones, followed by vrahovuvati, is the fact that for the formation of resistance to non-fluorinated quinolones, only one mutation in the gene of abnormal DNA hyrazomes (gyrAsera) is sufficient. For the development of resistance to fluoroquinolones, mutations are required in both genes. To that, with the results of antibiotics, indicating the sensitivity of the strain to the presence of pipemic acid, with the one-hour resistance to fluorine chinolones, the antibiotic goes to the edge with skepticism and goes to the given

When interpreting antibiotic gram, it is also necessary to use Acinetobacterspp. in general, it is naturally resistant to cephalos-porins I and II generation, natural and aminopenicillin, trimethoprim, phosphamides.

To characterize the resistance of Acinetobacter baumannii, it is recommended to use the following witnesses:

• • resistant Acinetobacterbaumannii - insensitive to one antimicrobial drug;

•  multidrug-resistant (MDR) Acinetobacterbaumannii - insensitive up to ³1 to the drug in ³3 classes, perahovanih in table. 2;

•  Extensivelydrug-resistant (XDR) Acinetobacterbaumannii - Hі-sensitive up to ³1 to the drug in ³8 classes, overwhelmed in the table. 2;

• Pandrug-resistant (PDR) Aci-netobacterbaumannii - insensitivity up to

• all pererahovanim in table. 2 anti-microbial

• drugs.

When analyzing antibiotics, no less important is the value, no interpretation of the characteristics of resistance, there is little estimate of the minimum important concentration (MIC). In a number of types, especially as microorganism є intermediate-resistant (so that the value of the IPC changes the threshold of sensitivity, but does not reach the threshold of the maximum dose and / or the prolonged regime of introduction. Zokrem, for the given randomized control, until the concentration of the drug can be reached in syrovatz with uninterrupted administration, 5.8 times overshoots the minimum concentration that can be reached during intermittent mode. And in the preliminaries of D. Wang in case of vascular infection of meropenem in a dose of 1 g of the skin 8 years internally with a stretch of at once infusion and in a dose of 0.5 g of the skin 6 years in the flow of trigonal pneumonia in case of multiple with strains of A. baumannii, it was established that the concentration of the drug in the syrovatz blood overshadowed the IPC for 54 and 75.3% of the time when introduced as a matter of fact; The variability of antibacterial therapy is reliably 1.5 times lower than in the other group. Table. 3 Criteria for the Interpretation of Sensitivity for the MIC and the Criteria for the Growth of Microorganisms on a Solid, Resilient Center have been established, according to the recommendations of the European Committee of the European Committee for the value of an anti-sensitivity

Therapy of nosocomial infections, vicious Acinetobacter baumannii, is carried out according to the general rules of administration of infections, association with medical aid (Fig. 1). The empirical significance of antibacterial therapy in case of adolescence on the development of nosocomial infections is justified in the quiet organization of health protection, and in the case of structural diseases of the disease, in some A. baumannii

The assessment of the effectiveness of therapy should be carried out in 48-72 years after the ear is right on the basis of the fact that the therapy was prescribed.

piricheski for the vision of the teacher. Vona is guilty of basing on the dynamism of the classic picture and the results of microbiological slides-dzhen (including repeated ones), moreover, the transforming factor for the assessment is to serve the classic picture.

Uninvolved for a number of days, it might be possible to change the triviality of antibiotic therapy, not to speed up the duration of antimicrobial therapy for infections caused by A. baumannii. So, in the multicenter early-domizirovanny pre-sluggish, it was revealed that the rapidity of the terms of antibacterial therapy of VAP, vicyclic non-enzymatic gram-negative microorganisms, from 15 to 8 days in connection with the frequency of recurrence of growth

In the case of vibration therapy, the most active antibacterial drugs, such as A. baumannii, are sulbactam, carbapenemi, aminoglycosidi, polymixin, tigecyclic and microin. However, the vibration of a specific antimicrobial drug, which can be used for the empirical therapy of A. baumannii-associated infections, is guilty of grounding on local data for the purpose of organizing and protecting health

In that case, as antimicrobial therapy is recognized as a result of the appearance of an antibiotic from pathological material, the antibiotic vibration is guilty of basuvatis on an antibiogram, due to the deterioration of an antibiotic test result.

Sulbactam. Sulbactam in Danish hour is a Vibor preparation for the treatment of acineto-bacteriological infections. In the Republic of Belarus, 84.8% of A. baumannii hospitals are sensitive to the antimicrobial drug given.

Sulbactam has an internal antimicrobial activity against A. baumannii, but it does not depend on it in a combination of beta-lactam preparations.

In experimental studies on food, the effectiveness of sulbactam bula is due to the effect of carbapenems, which is probably carbapene-insensitive acinetobacter. In clinical pretreatments, the combination of sulbactams / beta-lactams has shown similar efficacy in terms of carbapenems in VAP and sepsis, vicious multi-drug resistant A. baumannii isolates. The results of the treatment of sepsis, accumulated on the multi-resistant strain of A. baumannii, did not show the results of the treatment of sulbactam from the results of the treatment, as they are susceptible to the treatment of the other anti-bacterial, non-bacterial preparations of the septicemia baumannii.

With parenteral administration, the concentration of sul-bactam in the blood is 20-60 mg / l, in the tissues - 2-16 mg / l. The optimal dosage regimen for sulbactam dosage is є 2 g in a 30-year-old infusion in 6 years, or 1 g in a 3-year infusion in 6-8 hours. lykarskih reactions in vі-de dіareі, visipu, urazhennya nirok.

As a result, a number of dosages have been established with a si-energetic dose of sulbactam with meropenem, imipenem, rifampicin, cefpir, amika-Tsin.

Carbapenemi. For the detection of important infections, such as A. baumannii, you can vicoristovuvatya іmіpenem, meropenem and doripenem. Ertapenem is not active against Acinetobacterspp. as a whole.

In connection with the increase in the number of carbapenemresis-stent strains of A. bauma-nnii, including in the Republic of Bylorus, the number of carbapenem-resistant antibiotics for the treatment of antibacterial antibiotic regimens in particular It is essential to establish the basic organization of health protection, because of the data of local monitoring of antibiotic resistance of hospital pathogens, there is an absolute greater degree of remaining sensitivity to carbapenems.

In pre-adolescents in vitro, a synergistic or additive action of the combination of imipenem + amikacin + colistin, doripenem + amikacin, dopenem + colistin, meropenem + sulbactam, meropenem + colistin was established; in vivo - imipenem + tobramicin.

Stagnation of the combination of carbapenem + beta-lactam / sulbactam for the treatment of infectious blood flow, suffering from multidrug-resistant A. baumannii, is associated with the shortening of the results of treatment, lowering of carbapenem monotherapy + antihypertensive treatment for carbapenem. However, the addition of imipenem with sulbactam was associated with a higher low frequency of survival on a pneumonia model in mice with a combination of imipenem + rifampicin.

When a drug is vibrated from the given class for the treatment of acinetobactero-dissociative infections), it is necessary to take measures (in the Republic of Bilorus, imipenem is usually more active than it is in the republic of Bilorus). ... The activity of Doribax transplants the activity of imipenem and meropenem only from A. baumannii isolates, but the OXA-58 gene may be present, the activity of imipenem is to produce OXA-23 strains of A. baumannii. However, in the Republic of Bilorus, OXA-40 -produce acinetobacter stamps prevails, but it is not allowed to talk about the overdose of this pre-Paraty in front of the other representatives of the class in the infectious diseases, A. baumannii.

Aminoglikosidi. Aminoglycosides are often vicarious in diseases of the drug, but they are literally microorganisms, however, the state-fundamental diseases of A. baumannii may have a high level of resistance to the class of antibiotics. In the Republic of Bilorus, 64.4% are resistant to gentamicin, and 89% of pre-mature strains of A. baumannii to amikacin. An apparently low level of resistance to Gentamycin is more effective in dressings due to a decrease in the use of antimicrobial drug in the organization of protecting health in a number of remaining rocks.

The assignment of a given class of drugs can only be used in combinations with antibiotics, which are more active in the form of acetyl bacteria, based on local data on the sensitivity of the pathogen.

Rifampicin. I will look at the manifestation of sensitivity in hospital strains of acineto-bacteria to rifampicin, and the drug can be added to therapy for infections, vicious multi-resistant strains. A number of authors have shown the effectiveness of rifampicin in monotherapy modes, as well as in combination with imipenem and sulbactam. Synergism is also characteristic for the combination of rifampicin from coli-Wall. The effectiveness of rifampicin and the combination of rifampicin with colistin in meningitis and in the treatment of immunosuppressive A. baumannii isolates was shown.

Given a number of advances in the process of elimination, resistance to rhyphampycin is shown to develop in case of stagnation in monotherapy, as well as in combination with imipenem, however, in case of vicious combination of rhyphenitis + colitis

Tetracycline. Tetracycline (minocyclin, doc-cyclin, tetracycline) in vitro are active against A. baumannii. The most active is the manifestation of mino-cyclines (not registered in the Republic of Belarus), which is also active, apparently, of isols resistant to the lowest tetracyclines. For a gale of experimental and clinical data, it characterizes the reaction of tetracycline in infections, A. baumannii, in small numbers. To that the recognition of the drugs in this class was primed only on the display with antibiotics when there was an alternative.

Polimixini. From five different drugs in the given class (polymixin A-E) for clinical trials, only polimixin B and polymixin E (colistin) are available in this hour. There are two forms of colistin sulphate: colistin sulphate (for intestinal decontamination and for muscular congestion in case of infections of small tissues); Colistimetate sodium (an inactive alternator of colistin) reduces toxicity and antibacterial activity in proportion to colysteine ​​sulfate.

Polymixini may be highly active against A. baumannii strains, including multiresis-stent and carbapenem-resistant isolates. According to the data of recent years, the level of clinical efficiency of the colostin is 20-83%, microbiological 50-92%. For pharmacokinetic data

Concentration of colostin in blood plasma for internal introduction is in the pre-right 1-6 mg / l, in liquor - 25% of sivoro-exact concentration.

Vnaslіdok rotten proniknennya through gіstoge-matic bar'єri in patsієntіv of іnfektsіyami nizhnіh dihalnih shlyahіv polіmіksini bіlsh perevazhno priznachati іngalyatsіyno, while lіkuvannі іnfektsіy tsentralnoї nervovoї systems - іntraventrikulyarno abo іntratekalno in spoluchennya-vannі їh parenteral administration of ABO-it systems vikoristannyam іnshih antimіkrobnih preparations.

The frequency of development of nephrotoxicity in case of stagnation of polymixin, according to the data of the present day, it is possible to compare with the other classes of antibacterial drugs and to become 0-37%. Rizik the development of nephrotoxicity in case of stagnation of polymixin є doseavi-sym. At the same time, the frequency of the development of side effects from the side of the child was spared in the patients with the previous breakdown of their functions, however, the development of the lack of quality of the turnover was developing.

Synergy-Gizmo colostin with zrifampicin, imipenem, mi-nociclin and ceftazidime is indicated for in vitro dosage data; polymixin In with imipenem, meropenem and rifampicin.

In the current hour, parenteral forms of poly-Mixini have not been registered for storage in the Republic of Bilorus.

Tigecycline. Tigecycline is bacteriostatic and bactericidal against A. baumannii, which is not resistant to the mechanisms of resistance of nosti, characteristic of tetracycline.

According to the results, a number of advanced tigecycline can be more active in relatively short-lived, non-resistant, non-resistant, multi-resistant strains of A. baumannii.

Tigecyclin is a great problem for the growth of high concentrations in the tissues of the organisms, including Legenevu, however, on the thought of a number of authors, the concentration of the drug in the blood and spinal cord during the recommended regime of administration is not suboptimal. Because of low concentrations of the drug in the section, it is not recommended to use vicoristovuvati tigecycline in case of IMP.

The experts of the Food and Drug Administration (USA) have brought the effectiveness of the cyclin for the treatment of important intra-abdominal infections, patients with MSSA and VSE, important infections of the pneumonia, and myagic tissues. At the same hour, the treatment of nosocomial pneumonia (especially VAP) is associated with an increase in the risk of a lethal result in important patients. The Republic of Bilorus does not have the drug in the given hour of registration.

Table 4. Doses of antibacterial drugs and frequency of administrations for administration of A. baumannii-associated infections

Prospects for the therapy of infections, which A. baumannii is suffering from. The effectiveness of a new cephalosporin - ceftobiprol? against Acinetobacterspp., Proteins of clinical dosages throughout the day. The activity of ceftobiprol outperforms the activity of ceftase-dime and cefepime during the daytime or low ex-press genes, which are indicative of the synthesis of ADC-beta-lactamases. The British authoritatively showed the activity of the new monobact BAL30072 at 73% CRAB at a concentration of 1 mg / l and 89% at 8 mg / l.

In preliminarily in vivo models of opioid lesions on mishas, ​​the effectiveness of photo-todynamic therapy for the treatment of localized infections and multi-resistant A. baumannii has been shown.

Among the fundamentally new drugs in the potential activity against A. baumannii, the inhibitors of the efflux pump, the inhibitors of the enzymes in the biosynthesis of bacterial fatty acids (FabI- and FabK-peptiforms), , іngіbіtory beta-lactamases class D based on boronic acid. In the tested in vitro, the ability of the experimental drug NAB741 was demonstrated, a similar tri-cyclic polypeptide fragment identical to the analogous polymixin B, the sensitivity of Acinetobacterbaumannii was increased. In the last in vitro, the efficacy of A. baumannii vancomycin was shown in the use of fusogen liposomes for their delivery in the periplasmic space. Described the quality of ve-wines, how to run biodiesel (zokrem, based on 2-aminoimidazole), and the sensitivity of multi-drug resistant bacteria to antibiotics. It is possible to discuss the possibility of marketing the so-called "antigen-niv", which are linked to the driven genes, which are responsible for the formation of mechanisms of resistance; active and passive immunization. In a number of robots, the activity of knots and ex-tracts was shown in roslin, secretions of tvarin in the put-bath of multi-resistant acinetobacter. Zokrema, Helichrysumitalicum oil, du-bile and ellagic acid significantly reduce the level of resistance of A. baumannii to antibacterial drug for boiling down with ef-flux.

Lysis of bacteriophages in vitro has been shown in a number of dosage bulo, as well as the effectiveness of primi-vati bacteriophages in patients with experimental infections, Acinetobacter spp.

prophylaxis

W looking around at Visoko rezistentnіst Acinetobacter baumannii to antimіkrobnih preparatіv and takozh zdatnіst tsogo mіkroorganіzmu Shvydko virobok-yut mehanіzmi stіykostі, bike zna-nya nabuvaє profіlaktika A. baumannii-asotsіyovanih іnfektsіy in organіzatsії sensibly-receptionists in osnovі yakoї on the principle of normalization i іnfektsіynogo Control ...

A. baumannii grow up colonize in a healthy way, see it in dry or in the minds of the hospital center. Co-lonizatsii allow you to add objects that are too sick (food in pillows, mattresses, according to Tiln bilizna, frankincense, bedside tables, tables and bedside tables, sour and water supply to the faucets, water, ), as well as vikoriz-zaz-zaz-z-z-z-z-z for him, control of his perebryuyu-nya, health of political manipulations. In the middle of objects, where one can see and carry out political manipulations of A. baumannii, one can see from the apparatus of a piece ventilator, legends and mechanical views, one can also colonize, , systems for trivial hemofiltration, vascular catheter). Among the sieve of the equipment for colonization, there can be gurneys for transporting ailments, medical gloves, dressing gowns, tonometer cuffs, pulse meters, pulse oximetry, laryngoscope blades, ventilation and air conditioning systems. Establishments of health and wellness in A. baumannii culture contaminate most of the developmental problems, including the lack of disinfection (furacilin, rivanol). Items of the hospital center that are often in contact with the staff's hands (door handles, computer keyboard, history of ailments, tables at Medi-Tsinsk posts, sinks and food storage tanks), baumannii.

During the hour of internal carnial sleepers in infections, A. baumannii infections, medical maneuvers, they can also be linked with the extended driver's wake-up call. Such manipulations can be hydrotherapy or pulse-lavage of wounds, surgical intervention, catheterization, tracheostomy, spinal puncture.

For adequate health of infection control of nosocomial A. baumannii-associa-tional infection in A. nі / іnfіkovanі paciєnti.

For the blame of anti-microbial drugs, it is more important that the anti-microbial drugs are not included in the first line of anti-microbial drugs (for example, carbapenems, generations of cephalosporins and diseases). Licarious organization of health protection as a whole, as inherited, of equal resistance of hospital-based isolates, including A. baumannii.

In general, as a matter of fact, Acinetobacter baumannii, є in the Danish hour of "problems-nim", the originator of nosocomial infections, it is important for the patients to know about being in an important middle-class country, kindly adapt to the state of tuvati until living resistant to great antiseptic and antimicrobial drugs. When antibacterial therapy is recognized, straightening on A. baumannii, it follows that there are local data about this sensitivity in the specific organization of health protection, and even more beautifully, in the specific skin appearance.

The given article is taken from the journal "Medicni novini", No. 5, 2011.