No 3 (2015)

Natural focal tick-transmitted infections are worldwide distributed. When bitten by a tick, the man can be infected with one or several causative agents. In the Yaroslavl Region, Lyme disease caused by Ixodes tick is the most common tick-borne infection, but tick-borne encephalitis remains more dangerous because of fatal outcomes. The infections are chiefly transmitted; tick-borne encephalitis is also transmitted by the alimentary or, less commonly, transcutaneous route. The main contingent of patients with tick-borne infections is urban dwellers who come into the natural foci when the carriers show their high activity. Both men and women equally fall ill with Lyme disease; there is a male predominance among the patients with tick-borne encephalitis. Laboratory tests are used to determine the contamination of the ticks by various causative agents in the region. The Borrelia, tick-borne encephalitis virus, Anaplasma, and Ehrlichia infection rates of carriers are 17.6-35.4, 0.25-15, 0.54, and 3.8%, respectively. The region’s population is vaccinated to prevent tick-borne encephalitis. Anti-tick immunoglobulin is used for emergency disease prevention. Antibiotics are prescribed to prevent Lyme disease, anaplasmosis, and ehrlichiosis when laboratory tests identify their causative agents.

Objective. To analyze the prevalence, etiological pattern, and profile of antibiotic resistance in the causative agents of healthcare-associated infections (HCAI) in the septic surgery unit, intensive care unit one (ICU-1), and urology unit, Saint Ioasaf Belgorod Regional Clinical Hospital, over time from 2013 to 2014. Materials and methods. The results of a clinical observation of pyoinflammatory infections and complications were analyzed in the patients from the purulent surgery, ICU-1, and urology units over the last two years. Conventional microbiological methods were applied to isolate the pure culture of a causative agent and to determine its antibiotic sensitivity by the disk-diffusion method. Data of the qLIS laboratory information system containing information about the causative agents of nosocomial infections over time from 2013 to 2014 were used. Results. The microflora of patients from the septic surgery unit showed a preponderance of gram-positive organisms (54.7%); the proportion of gram-negative organisms was 45.3%. In the etiological pattern of nosocomial infections, there was a predominance of the representatives of the Micrococcaceae (41.3%), Enterobacteriaceae (35.8%), and Pseudomonadaceae (9.5%) families. The microflora of clinical materials from ICU-1 patients displayed an increase in the proportion of gram-negative bacteria of the Enterobacteriaceae and Pseudomonadaceae families by 17.6 and 13.7%, respectively; at the same time, the proportion of gram-positive bacteria of the Micrococcaceae family declined by 22.1%. In the urology unit, the total number of the isolated microbial strains remained virtually unchanged (463 in 2013 versus 493 in 2014). Over the last two years, the pattern of nosocomial infections exhibited a preponderance of gramnegative organisms (94.8-93.5%), among which the representatives of the Enterobacteriaceae family (83.8-84.6%) were prominent. The isolated microbial strains were found to be multidrug resistant to most antimicrobial agents used at hospital. Conclusions. The number of registered HCAI cases in the septic surgery, ICU-1, and urology units is much lower than that of microorganisms isolated from the clinical materials, which suggests the incomplete registration of HCAI and requires the optimization of active epidemiological surveillance of its cases in these units. Due to the higher proportion of microorganisms that are multidrug resistant to antibiotics, a range of treatment and preventive agents against infectious diseases, including HCAI, gradually decreases. In this connection, the primary task is to use additional agents to control infectious diseases, which may be bacteriophages.

The review shows the role of genetic markers of predilection for a certain (good or poor) tuberculosis therapy outcome. Pharmacogenetics studies relationships between differences in genes and the way a medication is converted and it acts in the body. When prescribing a drug, it is necessary to take into account the features of a patient’s genome. Genomic variations may cause a change in gene expression, processing of gene products or impairment of protein functional activity. The authors describe the role of gene polymorphisms at the stages of biotransformation as predictors when evaluating the efficiency and safety of anti-TB therapy.

The paper comparatively analyzes the frequency and clinical manifestations of adverse events after injection of combined vaccines containing whole-cell (DTwP) or acellular (Infanrix, Pentaxim) pertussis components. The incidence of the adverse events after administration of the combined vaccines with a whole cell or acellular pertussis component is not found to differ (DTwP (0.8%), Infanrix (0.6%), Pentaxim (0.4%)). Short-term moderate health problems developed after injection of the vaccines in most (80 -98%) cases. Administration of the whole-cell vaccine significantly more frequently caused serious undesirable events from vaccination as a local abscess (21 cases), suggesting the higher safety profile of preparations containing an acellular pertussis component. By considering the complex vaccination schedule for children of the first year of life in the national immunization calendar of the Russian Federation, Pentaxim is the vaccine of choice in reducing an injection load.

The paper gives data on the epidemiology, clinical course, and diagnosis of imported rickettsial diseases detected in Moscow among the tourists returning from the endemic regions.