Enterococci are common causative agents in a broad range of human infections. Although formerly considered to be of low virulence, in recent years they have emerged as important pathogens, particularly in the hospital environment. Enterococci are not only intrinsically resistant to several antibiotics, but are also characterised by a potent and unique ability to exchange genetic material. With the increasing prevalence of strains resistant to ampicillin, aminoglycosides and glycopeptides, serious therapeutic difficulties have become more common. Epidemiological aspects, the mechanisms of action, the detection of antibiotic resistance, and the situation of enterococci in Sweden are discussed in the article.
Most mucocutaneous surfaces of humans harbor a rich indigenous microbial flora with predominance of anaerobes. Anaerobic infections are usually endogenous indicating that they originate from the host's own flora. Important exceptions are botulism, tetanus, food poisoning by Clostridium perfringens, some cases of gas gangrene and cases of hospital-acquired C. difficile-induced diarrhea. Endogenous anaerobic infections often occur in adjacent to the mucosal surfaces. Other organs are infected by penetration or hematogenous spread. A predisposing condition to anaerobic infections is a low redox potential resulting from tissue destruction, foreign bodies, malignancy or vascular insufficiency. A mixed anaerobic-aerobic infection is often found in abscesses or tissue necrosis. Antimicrobial therapy must take into account that anaerobic infections are often associated with aerobic bacteria.
A comprehensive study was undertaken to examine morbidity due nosocomial pneumonia. An epidemiological survey demonstrated a growth in morbidity and mortality from this disease among the adult population of the Republic of Tatarstan. Pharmacological and epidemiological survey indicated that antibacterial therapy was in conformity with the federal protocols in 43.9% of cases, revealed the optimization of the use of antibacterial agents after introduction of the federal standards. At the same time the low social status of patients dying from pneumonia was accompanied by their appeal for medical aid, which leads to late hospitalization and untimely intensive therapy.
Early in 1983 an epidemic of a Pseudomonas aeruginosa resistant to aminoglycosides, carbenicillin, ureidopenicillins, ceftazidime, cefsulodin and imipenem occurred in a cystic fibrosis centre. Most of the epidemic could be attributed to a specific nosocomial strain by means of O-grouping and phage-typing. This strain was present in the centre at a low frequency in 1973 and developed resistance during courses of chemotherapy. The epidemic was stopped by isolating patients with the resistant strains. Restrictive and selective use of antibiotics have not been sufficient to eradicate the resistant strains, which persist in 42% of the patients. The extensive use of the third generation cephalosporins in the clinic is probably responsible for inducing and selecting for the resistant strains. Clustering of patients in the centre has facilitated the spread. First-line use of older beta-lactam antibiotics, close bacteriological monitoring and prompt isolation of patients with resistant strains are recommended.
The article is based on an analysis of results of complex treatment of 497 patients with pancreatonecrosis at the period from 2010 to 2014. All patients were admitted to the surgical departments of Republican hospital No 2 and Centre of Emergency Medicine of Republic of Sakha (Yakutia). The investigation allowed adaptation and development of antibiotic prophylaxis and therapy management in pancreatonecrosis in multifield surgical hospital. More than 80% of patients avoided a contamination of necrotic destruction zones. The level of lethality was reduced in group of patients with infectious complications of pancreatonecrosis from 45.8% to 37.7%.
A study was carried out on 1523 urinary isolates obtained at The Toronto Hospital, Canada's largest tertiary care establishment, over three 1-month periods in 1986, 1987 and 1990. Escherichia coli was the most frequently isolated organism, with Enterococcus spp. the second most common isolate in 1986 and 1987, and Streptococcus spp. in 1990. Pseudomonas aeruginosa isolates were found to be resistant to many of the antimicrobial agents tested. Resistance patterns were found to commonly prescribed ampicillin, co-trimoxazole and, to some extent, the new fluoroquinolones, ciprofloxacin and norfloxacin. These results are relevant to the treatment and management of urinary tract infections in patients attending a tertiary care hospital.
The microbiological tests of 769 blood samples from 220 patients, treated in 4 intensive care units of the N.V. Sklifosovsky Research Institute for Emergency Medical Service within a period from January 2009 to June 2010, were analysed. Etiologically significant microorganisms were detected in 323 samples (42%). 253 isolates were used in the analysis. Grampositive and gramnegative pathogens were detected in 47 and 42% of the cases respectively. Candida and anaerobic organisms were isolated in 8 and 3% of the cases respectively. Staphylococcus aureus and enterococci were isolated in 24 and 15% of the cases respectively. Nonfermenting gramnegative bacteria and enterobacteria were revealed in 25 and 17% of the cases respectively. Differences in the spectrum of the sepsis pathogens depending on the patients contingent were shown. The maximum summary susceptibility of the grampositive cocci was observed with respect to vancomycin and linezolid and that of the gramnegative bacteria was stated with respect to imipenem and meropenem.