Elaboration of Treatment Modality for Patients with Burns infected with Multiresistant Gram-Negative Microorganisms
https://doi.org/10.25016/2541-7487-2015-0-1-71-77
Abstract
About 7–8 million fires occur annually where over 70–80 thousand people die. 10,548 people died and 11,076 people were injured in 152.9 thousand registered fires in Russia in 2013. One of the most frequent causes of injuries during fires is skin and airway burns of various severity. Long-term treatment of patients with burns is associated with infections, i.e. hospital-acquired pneumonias, cystitis, ingress of infection into the wound surface. Infectious agents are multiresistant Gram-negative bacteria. One of the main mechanisms of antibiotic resistance in Gram-negative microorganisms is enzymatichydrolysis with beta-lactamases (so-call beta-lactamases of an expanded range and metal-beta-lactamases). Strengthening carbapenem activity is possible via combination with beta-lactamase inhibitors, irrespective of enzyme genotype or localization (for example, among antiseptics and complexones allowed for clinical application). For the first time, our research has shown that meropenem or imipenem combined with subbactericidal concentrations of an antiseptic "Prontosan®" or biphosphonates "Xydifon" and "Bonefos" has 128- to 512-fold higher activity. This effect is revealed for medicinal preparations allowed for practical application, but at doses much less than clinical ones. The combined application of local antiseptics, antibiotics and systemic complexones will allow clinicians to effectively treat severe infections caused by Gram-negative bacteria with high resistance against carbapenems, irrespective of genotypes of their plasmid or chromosomal carbapenemases.
About the Authors
T. M. Voroshilova
The Nikiforov Russian Center of Emergency and Radiation Medicine EMERCOM of Russia
Russian Federation
Russian Federation
head of the Laboratory of Bacteriologic Studies, the Nikiforov Russian Center of Emergency and Radiation Medicine, EMERCOM of Russia (Russia, 194044, St.-Petersburg, Academica Lebedeva Str., 4/2)
G. G. Rodionov
The Nikiforov Russian Center of Emergency and Radiation Medicine EMERCOM of Russia
Russian Federation
Russian Federation
Dr. Med. Sci., associate professor, head of the Research Laboratory of Toxicology and Drug Monitoring, the Nikiforov Russian Center of Emergency and Radiation Medicine, EMERCOM of Russia (Russia, 194044, St.-Petersburg, Academica Lebedeva Str., 4/2)
Y. N. Filippova
The Nikiforov Russian Center of Emergency and Radiation Medicine EMERCOM of Russia
Russian Federation
Russian Federation
PhD Biol. Sci., head of the Research Laboratory of Molecular-Genetic Diagnostics of Infections, the Nikiforov Russian Center of Emergency and Radiation Medicine, EMERCOM of Russia (Russia, 194044, St.-Petersburg, Academica Lebedeva Str., 4/2)
A. G. Afinogenova
Saint-Petersburg State University
Russian Federation
Russian Federation
Dr. Biol. Sci. Prof., Department of Maxillofacial Surgery and Surgical Odontology, the Saint-Petersburg State University (Russia, 199034, St.-Petersburg, University str. 7/9)
References
1. Gosudarstvennyi doklad o sostoyanii zashchity naseleniya i territorii Rossiiskoi Federatsii ot chrezvychainykh situatsii prirodnogo i tekhnogennogo kharaktera v 2013. MChS Rossii [State Report on Protection of Population and Territory of the Russian Federation from Natural Disasters and Industrial Accidents in 2013. EMERCOM of Russia]. Moskva. 2014. 343 p. (In Russ.)
2. Opredelenie chuvstvitel'nosti mikroorganizmov k antibakterial'nym preparata : metodicheskie ukazaniya N 4.2.1890-04 [Determining Microorganisms Sensitivity to Antibacterial medications: Recommended Practices N 4.2.1890-04]. Moskva. 2004. 74 p. (In Russ.)
3. Ob unifikatsii mikrobiologicheskikh (bakteriologicheskikh) metodov issledovaniya, primenyaemykh v klinikodiagnosticheskikh laboratoriyakh lechebno-profilakticheskikh uchrezhdenii : prikaz Minzdrava SSSR ot 22.04.1985 N 535 [About Unification of Microbiological (Bacteriological) Tests in Clinical and Diagnostic Laboratories of Medical Centers: Order of Ministry of Health Care of the USSR dated April 22, 1985 N 535]. Moskva. 1985. 78 p. (In Russ.)
4. Rukovodstvo po meditsinskoi mikrobiologii. Obshchaya i sanitarnaya mikrobiologiya [Textbook on Medical Microbiology. General and Sanitary Microbiology ]. Eds.: Labinskaya A.S., Volina E.G. Moskva. 2008. Bk. 1. 1080 p. (In Russ.)
5. Sidorenko S.V., Partina I.V., Ageevets V.A. Imipenem: 30 let terapii [Imipenem: 30 Years of Therapy]. Antibiotiki i khimioterapiya [Antibiotics and chemotherapy]. 2013. Vol. 58, N 5/6. Pр. 55–61. (In Russ.)
6. Shevchenko O.V., Edel’shtein M.V., Stepanova M.N. Metallo-beta-laktamazy: znachenie i metody vyyavleniya u gramotritsatel’nykh nefermentiruyushchikh bakterii [Metal-beta-lactamases: Significance and Methods of Detection in Non-Fermenting Gram-Negative Bacteria]. Klinicheskaya mikrobiologiya i antimikrobnaya khimioterapiya [Clinical microbiology and antimicrobial chemotherapy]. 2007. Vol. 9, N 3. Pр. 211–219. (In Russ.)
7. Mouton J.W., Touw D.J., Horrevorts A.M. [et al.]. Comparative pharamacokinetiks of the carbapenems: clinical implications. Clin. Pharmacokinet. 2000. N 39. Pр. 185–201.
8. Watanabe M., Iyobe S., Inoue M., Mitsuhashi S. Transferable imipenem resistance in Pseudomonas aeruginosa. Antimicrob. Agents Chemother. 1991. N 35. Pр. 147–151.
Review
For citations:
Voroshilova T.M., Rodionov G.G., Filippova Y.N., Afinogenova A.G. Elaboration of Treatment Modality for Patients with Burns infected with Multiresistant Gram-Negative Microorganisms. Medicо-Biological and Socio-Psychological Problems of Safety in Emergency Situations. 2015;(1):71-77. (In Russ.) https://doi.org/10.25016/2541-7487-2015-0-1-71-77
Views:
321
Email this article 