To determine diagnostic value of neutrophil CD64 index (iCD64n) in the diagnosis of postoperative infectious complications after colorectal resections.Seventy-three patients underwent colorectal surgery for the period from January to December 2018. These patients were included into a single-center study. Peripheral blood samples were taken on 3 and 6 postoperative days (POD) to check iCD64n level. We analyzed incidence of postoperative infectious complications, sensitivity (Se) and specificity (Sp) of postoperative iCD64n level on the 3rd and 6th POD.Postoperative infectious complications developed in 10 (13.7%) patients. Median iCD64n was significantly higher (p=0.0017 for POD 3; p=0.018 for POD 6) in patients with infectious complications (1.6 on POD 3; 1.3 on POD 6) compared to those without complications (1.1 on POD 3; 0.9 on POD 6). Area under curve (AUC) on the 3rd POD was 0.8 with the cut-off value of 1.4, Se - 70%, Sp - 93.7% (p=0.002). On the 6th POD, AUC was 0.91 with cut-off value of 1.23, Se - 80%, Sp - 93.7% (p<0.001).Neutrophil CD64 index is a valuable predictor for the diagnosis of postoperative infectious complications after colorectal resections. It is a useful tool to ensure a safe early discharge.The study is registered on the website «clinictrials.gov» (registration number NCT03559335).Хирургические вмешательства на толстой кишке ассоциированы с высоким риском развития послеоперационных инфекционных осложнений, которые ухудшают результаты лечения, увеличивают его стоимость, удлиняют время пребывания в стационаре. Биологические маркеры являются одним из инструментов ранней диагностики инфекционных осложнений, однако наличие разнородных данных в мировой литературе о диагностической ценности каждого из них требует продолжения поиска наиболее информативного для использования в клинической практике.Определить значимость индекса CD64-нейтрофилов (iCD64n) как предиктора инфекционных осложнений после резекций толстой кишки.В одноцентровое исследование (январь—декабрь 2018 г.) вошли 73 пациента, перенесших оперативные вмешательства на толстой кишке. Для определения уровня iCD64n на 3-й и 6-й послеоперационные дни (ПОД) брали образцы периферической крови, определяли частоту инфекционных осложнений и оценивали чувствительность, специфичность iCD64n.Инфекционные осложнения диагностированы у 10 (13,7%) больных. Медиана iCD64n статистически значимо выше (p=0,0017 для 3-го ПОД; p=0,018 для 6-го ПОД) у пациентов с инфекционными осложнениями (1,6 на 3-й ПОД; 1,3 на 6-й ПОД) по сравнению с пациентами без осложнений (1,1 на 3-й ПОД; 0,9 на 6-й ПОД). Площадь под ROC-кривой на 3-й ПОД составила 0,8 при точке отсечения 1,4, чувствительность — 70%, специфичность — 93,7% (p=0,002). На 6-й ПОД площадь под ROC-кривой была равна 0,91, чувствительность — 80%, специфичность — 93,7% при точке отсечения 1,23 (p<0,001).Индекс CD64-нейтрофилов является ценным предиктором инфекционных осложнений после резекций толстой кишки и может служить критерием безопасной ранней выписки пациента из стационара.Исследование зарегистрировано на сайте clinicaltrials.gov (регистрационный номер NCT03559335).
The aim of the review is to show possible links between intestinal microbiota and colorectal carcinogenesis, to describe the procarcinogenic properties of microorganisms associated with the development or proliferation of colorectal cancer. The gut microbiota plays a leading role in metabolism, providing important metabolites to the macroorganism. In humans, there is a spatial variability in the qualitative and quantitative microbiota composition. The intestinal microbiota provides the colony resistance, protecting it from colonization by opportunistic and pathogenic microorganisms. There is more and more data on the role of the gut microbiota in the development of colorectal cancer. The profound study of the gut microbiome in various populations is required, which will allow to identify other microorganisms associated with the development or proliferation of colorectal cancer. It can be used as biomarkers for colorectal cancer screening and predicting the response to immunotherapy.
Aim: to imply a method of Clostridium (Clostridioides) difficile-associated infection treatment based on lactobacilli autostrains. Materials and methods: Toxin-producing vancomycin-resistant C. difficile and three types of lactobacilli in different titers were isolated from the translucent feces of a patient with recurrent C. difficile-associated infection. According to the results of the study, the strain Lactobacillus zeae was detected, which showed high antagonistic activity against C. difficile. Within 48 hours, biomass of L. zeae was accumulated. The patient was administered a suspension of lactobacilli per rectum (in the form of microclysters) every other day. Results: in a patient with severe pseudomembranous colitis, a persistent remission of the underlying disease was achieved against the background of regular injections of a suspension of Lactobacillus zeae autostrains with a high antagonistic activity against C. difficile, isolated in this patient. Conclusion: Lactobacillus transplantation is an effective and promising treatment for recurrent clostridial infection resistant to antibiotic therapy.
Introduction. The increasing bacterial contamination of water bodies requires an increase in water quality control’s reliability to ensure epidemic safety against waterborne infections. Therefore, researchers in both Russia and Europe came to the conclusion that it is necessary to search for indicator microorganisms that can more accurately suggest the presence of pathogens. microorganisms in water than traditional indicators. The aim of the study was to justify the introduction of indicator indices of fecal contamination “generalized coliform bacteria” and Escherichia coli to assess the safety of drinking water Material and methods. The article provides an analysis of domestic and international regulatory documents and literary materials regulating the quality of drinking water in terms of sanitary and microbiological indicators and assessment criteria. The results of many years of experimental and field research carried out by research organizations and practical organizations of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare are presented. Results. On the territory of Russia, “general coliform bacteria,” is one of the indicator indices chosen according to the fermentation of lactose, determine the safety of drinking water. The water does not take into account pathogenic bacteria (Salmonella, Shigella) and a number of lactose-negative opportunistic bacteria, causative agents of intestinal infections. The study of microorganisms isolated from the feces of patients confirms the frequency of occurrence of lactose-negative microorganisms to varying from 20 to 100% of strains. With an annual trend towards a decrease in the percentage of non-standard drinking water samples in terms of microbiological indices, general intestinal infections (GII) of unknown etiology increase, i.e. risk of GII. If the quality of drinking water does not correspond to thermotolerant coliform bacteria (TCB), 95% of samples contain E. coli. Therefore, the determination of E. coli more reliably indicates the intake of fresh fecal contamination and provides efficiency in taking measures to eliminate an unfavorable situation than TCB. Conclusion. Reasons are given for the introduction of more reliable microbiological indicators of water safety control, such as - “generalized coliform bacteria” with the preservation of the abbreviation GCB, combining both lactose-positive and lactose-negative bacteria, determined by the sign of glucose fermentation, negative oxidase test and negative stain according to Gram and E. coli as an indicator of recent faecal contamination, which will allow the assessment of water quality for a wide range of bacteria of the order Enterobacterials, corresponding to the modern taxonomy of Enterobacteriaceae NCBI, will ensure harmonization with international requirements and the safety of drinking water for the population.
Aim. To develop an optimal algorithm for laboratory diagnosis of C. difficile associated diarrhea in context of obtaining the most reliable analysis results. Materials and methods. 211 patients with clinically significant C. difficile associated diarrhea participated in the study. Luminal faeces were analysed by immunological (immune chromatographic assay, ICA; ELISA) bacteriological and molecular (GENEexpert rtPCR system, Cepheid, USA) methods. Results. We isolated 126 C. difficile strains from 211 samples of luminal faeces. We identified glutamate dehydrogenase (GDH) in 54% of cases (n=68) by means of immune ICA, and in 11.1% of cases (n=14) by means of ELISA. The increase of bacterial concentration is associated with the growth of sensitivity of GDH detection by immunological tests (p
Introduction. The work is devoted to evaluating the results of our own research of sanitary-microbiological monitoring of environmental objects in diversified treatment-and-prophylactic institutions of stationary type and of the analysis both of domestic and foreign data in order justify of the list of priority controlled sanitary-microbiological indices of air and surfaces to ensure the safety of hospital environment, medical organizations stationary type, regardless of their functional purpose. Material and methods. The survey was conducted in various premises in the medical-prophylactic institutions of stationary type for two years. Studies included determination of microbial contamination of the air environment, working surfaces, hands of personnel with the detection of bacteriological, virological, and mycological parameters, followed by macroscopic and microscopic identification of microorganisms and identification using automated systems with the method of time-of-flight matrix-assisted laser mass spectrometry platform MALDI-TOF, based on the study of the mass spectra of ribosomal proteins in the range of 1000-10000 Daltons and bioinformatic comparison of the obtained spectrum with database reference spectra and PCR. Results. As a result, the research of surface washings in the premises of a multidisciplinary clinic revealed microbial contamination with conditionally pathogenic gram-positive cocci, including S.aureus, gram-positive and gram-negative bacteria posing a serious epidemiological danger to patients in these wards regardless of the MOST profile and requires mandatory monitoring taking into account of the used disinfectants. Conclusion. Our own research and analysis of domestic and foreign literature showed that it is not enough to monitor the air in the MOST premises only in terms of total microbiological contamination. In the operating, procedural and dressing blocks, as well as in the wards, physiotherapeutic, diagnostic, laboratory rooms and auxiliary units, it is also necessary to take into account other sanitary and microbiological indices: total microbes count, gram-positive rods and cocci, including S.aureus, fungi, adeno-, entero-, astroviruses, coliphages.
Bacillus cereus sensu lato comprises genetically, morphologically, and physiologically similar gram-positive spore-forming bacterial species with high pathogenic potential, such as B. anthracis, B. cereus, and B. thuringiensis. Toxin-producing strains of B. cereus s.I. pose a major threat to human health. The high degree of similarity between these species makes it very difficult to identify them and to take adequate measures to treat the diseases they cause. Previously, we characterized the clinical isolate CCGC 19/16 belonging to B. cereus s.l. that exhibited features of both B. cereus and B. cytotoxicus. In the present work, CCGC 19/16 was identified as B. cytotoxicus using multilocus sequence typing (MLST) and mass spectrometric analysis. It was also shown that, unlike other representatives of the B. cytotoxicus species, strain CCGC 19/16 is not thermotolerant. Unlike B. cereus, strain CCGC 19/16 is sensitive to most antibiotics and shows increased motility. Like B. cereus strain CCGC 19/16 forms β-hemolysis zones in blood agar. In addition, it has been shown that prolonged storage of samples prior to analysis can lead to misidentification of the isolate. Our results indicate that "rapid methods" of analysis using single genes have insufficient resolving power in the identification of B. cereus s.l. species. The combination of MLST analysis with MALDI-TOF MS provides sufficient resolution.
AIM: to work out the algorithm for diagnosis and treatment of non-healing postoperative wounds of the perineum and anal canal. PATIENTS AND METHODS: the prospective cohort study included 119 people which underwent surgery for chronic anal fissure, hemorrhoids and anal fistula. The main group included 63 patients with long-term non-healing chronic wounds (46-159 days after surgery, mean 106.0 ± 44.8 days). The control group included 56 patients, whose postoperative period was uneventful and whose wounds healed on the 38.0 ± 10.4 days (p = 0.001).The wound healing and possible deviations in its course were assessed in all the patients using clinical, microbiological, cytological, pathomorphological pathophysiological tests, as well as molecular diagnostics (PCR). The main and control groups of the patients were homogenous in the main parameters (age, sex, the nature of surgical treatment), with the exception of the history of the disease. In the patients with a history of non-healing postoperative wounds, the incidence of sexually transmitted infections (STI) and inflammatory diseases of the pelvic organs, possibly caused by STI, was 44.4%, and in the patients of the control group — 10.7%, (p = 0.002). RESULTS: in all patients of the main group at the time of admission and in 85.7% of the control group on the 30th day after the surgery, the wounds were contaminated with various microorganisms during bacteriological examination. Clinically significant microorganisms were found in 71.4% of the patients in the main group and in 12.5% of the control group (p = 0.0001). Associations of microorganisms were found in 73.0% in the main group and only in 33.9% in the controls (p = 0.01). During PCR in wounds of the perineum and anal canal STI were found in 34.9% in the main group, while in the control — 7.1% (p = 0.003). Histological examination of tissues taken from the area of non-healing wounds revealed papillomavirus infection (koilocytosis) in 11 (17.5%) patients. The patients with non-healing wounds were treated depending on the isolated pathogen and sensitivity to antibiotics, as well as appropriate treatment if an STI was detected. In 6.3% in the main group, the wounds did not heal and a spasm of the internal sphincter was detected. These patients got injection of botulinum toxin type A (BTA) into the internal sphincter (40 U). After 9.4 days after the BTA complete wound healing was noted. A control test (profilometry) on the 7th day after the BTA showed no spasm of the internal sphincter in all cases. CONCLUSION: healing processes in patients after anal surgery may slow down due to the presence of infectious agents, opportunistic pathogens and STI, which support the inflammatory wound reaction in the postoperative period, as well as due to spasm of the anal sphincter. It is necessary to carry out targeted diagnostics, to prescribe appropriate treatment, and in the presence of anal sphincter spasm, to eliminate it.
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