[Show abstract][Hide abstract] ABSTRACT: The results of microbiological tests of 2382 blood specimens from 698 patients of three ICUs of the N. V. Sklifosovsky Research Institute of Emergency Service were analysed for a period of 2009 to 2012. No microbial growth was detected in 1160 specimens (48.7%). In the subsequent tests 816 isolates were used. The quota of grampositive isolates in the pathogen pattern decreased from 51.68 to 35.9% and that of gramnegative isolates increased from 38.26 to 48.1%. The number of the Candida isolates increased from 7.38 to 15.2%. The frequency of the S. aureus and Enterococcus spp. isolates lowered from 26.2 to 13.3% and from 15.4 to 11.5% respectively. The quota of K. pneumoniae isolates and Acinetobacter spp. increased from 8.1 to 18.9% and from 14.1 to 17.4% respectively. Most of the S. aureus isolates were methicillin resistant. All the staphylococcal isolates were susceptible to vancomycin and linezolid. All the strains of K. pneumoniae isolated in 2009-2012 produced extended spectrum beta-lactamases. In 2012 7.8% the K. pneumoniae isolates were resistant to carbapenems. In 2012 25.5% of the Acinetobacter spp. isolates were susceptible to carbapenems and 70.2% were susceptible to cefoperazon/sulbactam.
No preview · Article · Apr 2014 · Antibiotiki i khimioterapii͡a = Antibiotics and chemoterapy [sic] / Ministerstvo meditsinskoĭ i mikrobiologicheskoĭ promyshlennosti SSSR
[Show abstract][Hide abstract] ABSTRACT: The aim of the study was to investigate the role of early multiple organ failure in 152 patients with severe acute pancreatitis admitted to the intensive care unit for the period from 2002 to 2009. The group of patients with early progressive multiple organ failure had high early (29%) and overall mortality (45%) rate, infectious complications rate (39%) and long intensive care unit stay (median - 8 (5; 18) days). Based on the statistical analysis of data the criteria to predicted risk progression of multiple organ failure on admission were: APACHE II score ≥12, SOFA score ≥4, failure >2 organs/systems, Ranson score ≥7.
[Show abstract][Hide abstract] ABSTRACT: Regardless of modern achievements in intensive therapy the mortality from severe acute pancreatitis progressed to a polyorganic insufficiency reaches 60%. Analysis of mortality structures shows that more than 50% of patients die from severe acute pancreatitis in first 72 hours, which is indicated as early severe pancreatitis. In the recent years the experimental and clinical studies proved that continuous vein to vein hemifiltration in the early stage allowes to lower the severity of poliorgan insufficiency and early death. The aim of the study was to measure the efficiency of vein to vein hemifiltration in the complex treatment of early severe acute pancreatitis. The retrospective analysis consisted of 106 patients, which were divided into 2 groups. 1st with vein to vein hemifiltration in the dose of less than 30ml/kg/h (n = 45) and more than 30 ml/kg/h (n = 20) respectively, the 3rd group did not receive vein to vein hemifiltration (n = 41). The study showed the decrease of early mortality (14 days) in the 2nd group (p = 0.022) and a tendency of decrease in the 2nd group (p = 0.093) compared to the 3rd group. The median interval from admission to death in the first two groups was 14 days while in the 3rd group it was only 5 days. The use of vein to vein hemifiltration in complex therapy of early severe acute pancreatitis patients allows to lower the early mortality. The best results were reached in the 2nd group.
No preview · Article · Jan 2011 · Anesteziologiia i reanimatologiia
[Show abstract][Hide abstract] ABSTRACT: 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.
No preview · Article · Jan 2011 · Antibiotiki i khimioterapii͡a = Antibiotics and chemoterapy [sic] / Ministerstvo meditsinskoĭ i mikrobiologicheskoĭ promyshlennosti SSSR
[Show abstract][Hide abstract] ABSTRACT: Severe sepsis and septic shock remain the most serious problem of critical care medicine today with a mortality of 25-80%. Bacterial endotoxin is of considerable importance in the pathogenesis of sepsis. A selective hemosorbent in which endotoxin adsorption is accomplished via its binding to a synthetic peptide (LPS-A) has been recently designed in Sweden. The purpose of the study was to evaluate the efficiency of using the LPS-A in the complex treatment of patients with severe sepsis. Eight patients in whom the course of the underlying disease was complicated by the development of gram-negative sepsis in the postoperative period were examined. The patients had an APACHE II score of 20.4 +/- 4.5 LPS-A was performed using the hemosorbent Alteco LPS (Lund, Sweden) and an Aquarius hemoprocessor (Edwards Lifesciences) (U.S.A.). The use of LPS-A caused a significant reduction in endotoxin levels by 2.9 times. The level of procalcitonin was increased in all patients; after a LPS-A session, it was significantly decreased by 1.9 times. The use of LPS-A resulted in diminished tachycardia, elevated blood pressure and could reduce the doses of vasopressor amines. There was an improvement in lung gas exchange parameters. A study of the effect of LPS-A on the immune system showed a significant reduction (36.6%) in neutrophil oxygen-dependent metabolism according to the data of the spontaneous HCT test, a 2.4-fold decrease in large circulating immune complexes, and a rise in the count of mononuclear cells that died both by necrosis and apoptosis, the count of the cells significantly increased by 5.3 times in late apoptosis. A LPS-A session caused a significant drop in the blood level of endotoxin and procalcitonin and it was accompanied by a trend toward better hemodynamics and lung gas exchange and alleviated organ dysfunction. At the same time LPS-A showed the ambiguous effect on immune system parameters, which calls for further study.
No preview · Article · Sep 2010 · Anesteziologiia i reanimatologiia
[Show abstract][Hide abstract] ABSTRACT: The study was undertaken to evaluate the immunomodulatory effects of various methods of extracorporeal hemocorrection in septic patients. Thirty-two patients in whom the course of the underlying disease was complicated by the development of sepsis were examined. A package of therapeutic measures involved debridement of an infection focus, de-escalation antibacterial therapy, nutritional support, and immunomodulatory therapy. All the patients underwent procedures of plasma filtration and continuous venovenous hemofiltration; granulocytopheresis was carried out in 5 patients. Granulocytopheresis was shown to eliminate dead leukocytes from the bloodstream within a few hours, which contributed to clinical improvement. Plasmafiltration in patients with sepsis resulted to a reduction in the degree of a systemic inflammatory reaction, to normalization of coagulation homeostasis, which indirectly affected immunological parameters. Continuous venovenous hemofiltration made it possible to make continuous elimination of the low and average molecular-weight substances, corrected liquid balance, and well affected gas exchange in the lung.
[Show abstract][Hide abstract] ABSTRACT: Apoptosie of mononuclear cells, dead leukocyte and CD95+ lymphocytes content in venous blood of 15 patients were evaluate by flow cytometry within 2-3 day after diagnosis of sepsis. The number of CD95+ lymphocytes increased in 40% of the cases and that of lymphocytes expressmg Fas receptor decreased in 27%.The mononuclear cells in venous blood increased 7 times compared with physiological norm; this rise was a reliable predictor of the unfavourable outcome of the disease. Elimination of dead leukocytes by granulocytophoresis produced good therapeutic result.
[Show abstract][Hide abstract] ABSTRACT: Sepsis with 18-to-33% mortality also remains the most serious problem of modem medicine today. Forty-five patients treated at the N. V. Sklifosovsky Research Institute of Emergency Care in June 2006 to February 2008 were examined. Twenty-seven primary blood donors were examined to determine the physiological concentration of dead leukocytes. Two groups of patients were formed according to the signs of a systemic inflammatory reaction (SIR). A study group included 29 patients in whom the course of the underlying disease was complicated by the development of sepsis. All the patients from the study group underwent extracorporeal hemocorrection techniques (EHT): plasma filtration (PF) and continuous venovenous hemofiltration (CVVHF). A granulocytopheresis procedure was performed in 4 patients. A control group comprised 16 patients without clinical signs of SIR. The blood taken from patients with sepsis showed the significant increase in the levels of dead leukocytes as compared with both the physiological normal values and the values obtained in patients without signs of systemic inflammation, which significantly correlates with the severity of organ dysfunction. The elevated content of dead leukocytes is an independent risk factor for a poor outcome. Plasma filtration used in sepsis patients facilitates a significant reduction in the blood concentration of dead leukocytes. The first experience with granulocytopheresis in patients with severe sepsis, a leukemoid reaction and high absolute concentrations of dead leukocytes is indicative of its clinical effectiveness, which is manifested itself by the elimination of dead leukocytes.
[Show abstract][Hide abstract] ABSTRACT: Acute purulent mediastinitis (APM) is one of the most complicated forms of surgical infection, showing a high incidence of sepsis--from 45 to 100%, mortality rates of 17 to 80%. Sixty-eight patients with APM admitted to the N. V. Sklifosovsky Research Institute of Emergency Care in October 2002 to March 2007 were examined. Postoperatively, all the patients received extracorporeal hemocorrection techniques (EHT): plasmapheresis (PA) via filtration and continuous venovenous hemofiltration (CVVHF). According to the time of initiation of EHT, the patients were divided into 2 groups: 1) 34 patients in whom EHT was initiated within the first 24 hours after surgery; 2) 34 patients in whom it was started on postoperative day 2. The efficiency of early use of EHT in the complex therapy of APM was evaluated. The early initiation of EHT (PA and CVVHF) caused a reduction in endogenous intoxication and the magnitude of a systemic inflammatory reaction, which resulted in the rapidest restoration of the size of major populations and subpopulations of lymphocytes and prevented the development of immune system incompetence. The early use of EHT caused a significant reduction in hospital mortality (11.8 and 35.3% in the early and late EHT use groups, respectively).
No preview · Article · May 2008 · Anesteziologiia i reanimatologiia
[Show abstract][Hide abstract] ABSTRACT: Acute purulent mediastinitis (APM) is one of the most difficult forms of surgical infection with severe clinical course and lethality from 17 to 80%. Overall 80 patients with APM were treated; plasmapheresis in postoperative period was used at 66 of them. The main criteria of negative prognosis at the patients with APM were elderly age, high score on APACHE-2, SAPS-2 and SOFA scales, higher level of creatinine and urea serum concentration, hyperglycemia, leucopenia. Early application of plasmapheresis was associated with lower lethality (12.5% at the group with early beginning of plasmapheresis, 35.3% at the group with late beginning, 36.2% at the control group). Plasmapheresis promotes normalization of hemostasis, microcirculation and immune parameters, reduction of intoxication and systemic inflammation syndrome.
[Show abstract][Hide abstract] ABSTRACT: The parameters of endogenous intoxication (EI) were studied in patients with purulent mediastinitis (PM). The integral index of EI - the coefficient CEI that included the relative indices (as to the normal values) of the total and effective concentrations of albumin, medium molecular-weight peptides, leukocytic intoxication index, and malonic dialdehyde, was developed. The values multiplied together are CEI and reflect the manifestation of EI. The level of EI in patients with PM was ascertained to be much increased on postoperative days 1 and 3. Extracorporeal hemocorrection (plasmapheresis, prolonged venovenous hemofiltration) used in complex therapy diminishes the degree of EI by several times, on day 10 after surgery in particular. The use of CEI, is shown to considerably increase the diagnostic sensitivity of the early stage of EI, to prescribe adequate detoxifying therapy in time, and to evaluate its efficiency.