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V B Beloborodov

Publications and source records attributed to V B Beloborodov.

At least 19 recordsLinked to original sources
PubMed2005

[Etiology of severe hospital infections in intensive care units and antibiotic resistance of pathogens].

The leading pathogens of severe infections in intensive care units were the following: respiratory tract infections--bacteria of the famility of Enterobacteriaceae (33.8%), Pseudomonas spp. (24.9%), Acinetobacter spp. (18.1%), Staphylococcus aureus (16.0%), blood flow infections--coagulase negative staphylococci (33.6%), S. aureus (26.1%), Enterobacteriaceae (17.6%), wound infections--Enterobacteriaceae (35.7%), coagulase negative staphyloccocci (17.8%), Pseudomonas spp. (14.3%). As for various species of Enterobacteriaceae, susceptibility was preserved in 91-100% of the isolates to meropenem, in 72-100% to cefoperazone/sulbactam, in 51-65% to cefepime, in 72-86% to amikacin, and in less than 50% to cephalosporins and fluoroquinolones. As for P.aeruginosa, 28% of the isolates was resistant to all the antibacterials, except polymyxin. The highest susceptibility to cefoperazone/sulbactam and meropenem was revealed in the isolates of Acinetobacter baumannii. Oxacillin resistance was detected in 64.9% of the S.aureus isolates. The oxacillin resistance as a rule was associated with resistance to macrolides, aminoglycosides and fluoroquinolones. As for coagulase negative staphylococci, oxacillin resistance was stated in 75.6% of the isolates. All the isolates of the Staphylococcus spp. preserved their susceptibility to vancomycin and linezolid.

Cross Infection↗
PubMed2004

[A clinical and pathothysiological study of protein C in patients with generalized meningococcosis].

The clinical-and-pathogenetic significance of protein C was dynamically investigated within the infection processes in 23 patients (mean age 44 years) with meningococcemia. A reliably lower concentration of protein C in blood plasma (mean 37.8%) was registered versus the normal parameters (N = 70-130%) at exacerbation irrespective of a disease outcome. Leyden mutation was detected in 30.5% of patients. The presence of the above genetic defect denoted a predisposition to a severe disseminated intravascular coagulation (DIC) syndrome in patients of the studied group. A lower concentration of protein C was detected in blood plasma of patients with meningococcemia; it correlated with severity of the infection process and with the development of organic malfunction. The study of the concentration of protein C enabled an evaluation of the functional condition of anticoagulation mechanisms in the DIC development and can be regarded as an important extra criterion for the evaluation of thrombohemorrhagic syndrome in patients with meningococcemia.

Adolescent↗
PubMed1999

[Prognosis in meningococcal disease: methodology and practice].

78 patients with systemic meningococcal disease admitted to the Intensive Care Unit of the 2nd Moscow Hospital for Infectious Diseases were studied and the composite prognostic score was developed to estimate the risk of lethal outcome. The stepwise variable selection procedure for the multiple logistic regression was applied to 30 potential clinical and laboratory risk factors and markers. Five factors were selected for the score, namely the platelet count (< 150 x 10(6)/ml), the presence of hemorrhages into the eye or mucosal tissue, the interval from the last urination before admission (> 4 h), the respiration rate (> 170% of age-adjusted normal value) and age (< 2 or > 65 years) with regression coefficients 0.3, 0.2, 0.2 and 0.1, respectively. Both for the source clinical group and for the additional test group (64 patients), the scale was able to classify correctly 95% of cases using the data collected at admission. Ten prognostic scores proposed previously by foreign investigators were tested in the same patients and the best four scores were selected (GMSPS, Gedde-Dahl, Niklasson, Kahn); the scores classified correctly 85-90% of cases. This study is an example of methodological approaches to prognostic score construction in medicine.

Adolescent↗
PubMed1999

[The interconnection between the severity of meningococcal infection and the endotoxicity levels and patient's blood complement].

Seventy-eight patients with severe systemic meningococcal disease admitted to the Intensive Care Unit of the Second Moscow Hospital for Infectious Diseases were divided into four groups by complications of their disease: patients with refractory septic shock (RSS)--group 1; patients with early septic shock (ESS)--group 2; patients without shock but with severe mental disorders--group 3; patients without any of these complications--group 4. The LPS concentration in plasma was assessed by chromogenic method. Initial LPS levels in plasma of group 3 or group 4 patients (170 ng/l, median value and 360 ng/l, respectively) were greater than those of healthy donors (LPS < 15 ng/l). LPS concentration was significantly greater in group 2 (920 ng/l) or group 1 (12,400 ng/l). LPS levels declined exponentially in all the patients. The half-life was calculated to be 1.4 (+) -0.3 h. In group 2 and 1, respectively, the classical pathway complement activity in patients' serum was 50 and 10% of normal control values. To estimate significant prognostic factors for fatality in our patients, specificity and factor fatality difference of various clinical and laboratory factors were calculated. The cut-off LPS value for development of ESS was 600 ng/l and that for development of RSS and death was 8000 ng/l. For the prediction of fatality using the former cut-off value of LPS, sensitivity was 84% and specificity 100%. Using plasma complement activity (cut-off--15% of normal value) for prediction, sensitivity was 75% and specificity was 100%. Other factors (platelet and WBC count, blood pH, BP, etc.) had lower predictive power. Thus to date plasma endotoxin level and complement activity are the best prognostic factors in meningococcal disease.

Adolescent↗
PubMed1999

[Clinical features of meningococcal infection in subjects with deficient terminal components of complement].

AIM: To evaluate clinical characteristics of meningococcal disease (MD) in individuals with terminal complement component deficiency (TCCD) who are thousands times more susceptible to MD than complement-sufficient persons. MATERIALS AND METHODS: 61 cases of MD in TCCD patients and 200 randomly selected cases of MD in complement-sufficient patients were analyzed. RESULTS: Meningitis without meningococcemia accounted for 17% of the MD episodes in the control group of complement-sufficient patients but none in individuals with TCCD who had meningococcemia (10%) or meningococcemia with meningitis (90%). Moderate disease predominated in patients with TCCD (70%) and no episodes of fatal disease were noted, whereas severe disease was more common in the control group which had an 8% case fatality rate and frequent complications such as endotoxic shock (15% of episodes) and brain edema (26%). The severity of the disease in TCCD patients did not differ between the first and subsequent episodes, between males and females, between episodes caused by serogroup A and B meningococci, etc. CONCLUSION: In comparison to complement-sufficient persons, the course of the disease in patients with TCCD is statistically less severe.

Adolescent↗
PubMed1999

[The results of a multicenter study of the comparative activity of cefepime and other antibiotics against the causative agents of severe hospital infections (the Micromax program)].

A multicentre trial was performed on the activity of cefepime in comparison with ceftazidime, ceftriaxone, piperacillin/tazobactam, imipenem and ciprofloxacin against severe hospital infection pathogens in intensive care units. The isolates of Escherichia coli and Proteus spp. from the majority of the centres were highly susceptible to the antibiotics (90 to 100 per cent of the isolates). In some centres up to 40 per cent of the isolates produced ESBL. The isolates of Klebsiella spp. were characterized by lower susceptibility, in some centres the frequency of the strains producing ESBL exceeded 90 per cent, by the MIC geometric mean cefepime was superior to the third generation cephalosporins, the frequency of resistance to ciprofloxacin ranged from 0 to 31 per cent, no resistance to imipenem was recorded. The frequency of resistance to the third generation cephalosporins and piperacillin/tazobactam in Enterobacter spp., Serratia spp., Citrobacter spp., Morganella spp., and Providencia spp. ranged from 10 to 52 per cent, the resistance to cefepime equaled 0-11 per cent, 0 to 17 per cent of the isolates were resistant to ciprofloxacin, some isolates were resistant to imipenem. As for the nonfermenting microorganisms their resistance to all the antibiotics tested was comparatively high and markedly differed in various centres. As a whole, 7 per cent of all the isolates of the nonfermenting organisms was resistant to cefepime, 10 per cent was resistant to imipenem, 17 per cent was resistant to ceftazidime, 21 per cent was resistant to piperacillin/tazobactam and 36 per cent was resistant to ciprofloxacin.

Acute Disease↗
PubMed1996

How partial C7 deficiency with chronic and recurrent bacterial infections can mimic total C7 deficiency: temporary restoration of host C7 levels following plasma transfusion.

An apparently completely complement C7-deficient patient with refractory otitis media and two episodes of meningococcal disease was given therapeutic plasma transfusions in 1992 and 1994. Following these transfusions unexpected changes were found in C7 levels. Immediately after transfusion the serum C7 levels failed to rise to the expected levels but then rose to 5-10% of the normal mean during the next 5 days and remained at that level for more than 2 weeks before eventually returning to zero. The patient's DNA genotyped C7 M, and therefore C7 N donor plasma was selected for the second transfusion to allow identification of the source of the C7 circulating post-transfusion. This C7 phenotyped C7 M, demonstrating it to be of recipient origin. Therefore, the apparently completely C7-deficient patient was able to secrete some C7. By a combination of DNA typing and isoelectric focusing of the C7 appearing after transfusion, it was demonstrated that the patient was heterozygous for combined subtotal C6/C7 deficiency (inherited from his father) and a different, so far uncharacterized, subtotal C7 deficiency (inherited from his mother). The low amount of C7 secreted appeared to be constantly consumed, probably by generation of C5b6 as a result of his chronic infection. He had been shown to have circulating C5b6 most of the time, and thus only when sufficient exogenous C7 was given to consume the free C5b6 did his own C7 appear in circulation.

Bacterial Infections↗
PubMed1995

Definition of a new score for severity of generalized Neisseria meningitidis infection.

Neisseria meningitidis infection may present as meningitis or as severe, fulminant sepsis. In order to classify individual patients early according to the expected course of the disease, we developed a score named Neisseria sepsis index [NESI]. The NESI was defined using the parameters heart rate, mean arterial blood pressure, base excess and presence of acute subcutaneous bleeding and/or skin necroses (minimal value [= no evidence for sepsis] NESI 0; maximum value [= most severe sepsis] NESI 8). Seventeen patients with documented, systemic N. meningitidis infection were prospectively assessed for the terminal complement complex (TCC), serum tumour necrosis factor alpha (TNF alpha) levels (as laboratory parameters for severity of sepsis) and NESI score. The evaluation was immediately performed when the patients were admitted to the hospital. The 17 patients showed the following distribution of data: NESI 0 (n = 4), NESI 1 (n = 6), NESI 2 (n = 0), NESI 3 (n = 1), NESI 4 (n = 2), NESI 5 (n = 2), NESI 6 (n = 0), NESI 7 (n = 1), NESI 8 (n = 1). Mortality was 4/17 patients, all had NESI > or = 5. TCC values ranged from 647-6461 ng/ml (normal range: 130-360 ng/ml); and was not correlated to NESI. TNF alpha values ranged from 10-910 pg/ml and were correlated to NESI (r2 = 0.71, n = 17, P < 0.001). In patients with fatal outcome, TNF alpha was 600 +/- 160 pg/ml (mean +/- SEM) and in surviving patients 130 +/- 50 pg/ml (mean +/- SEM). TNF alpha was increased in 15/17 patients when compared to normal controls (< 27 pg/ml). CONCLUSION. The NESI is based on few clinical, objective data, that are available in every hospital. NESI appears to offer an instrument: (1) for making decisions in regard to appropriate monitoring and treatment of vital organ function; and (2) for assessing the quality of care for this life-threatening infection.

Adolescent↗
PubMed1995

Vaccination of patients deficient in a late complement component with tetravalent meningococcal capsular polysaccharide vaccine.

Eighteen patients with late complement component deficiency (LCCD) were immunized with meningococcal capsular polysaccharide vaccine. The LCCD patients had experienced one-to-five meningococcal infections before vaccination, but their immunological and clinical status was normal at the time of immunization. Serum samples from vaccinated complement-sufficient relatives of the LCCD patients and healthy Russian male adults were used as controls. Total and immunoglobulin-specific concentrations of antibodies to group A, C, W135, and Y capsular polysaccharides were determined by enzyme immunoassay in serum samples taken before and 1-108 weeks after immunization. The individual preimmunization and post-immunization antibody concentrations varied greatly. The median antibody concentrations of the LCCD patients increased significantly after vaccination, and were not significantly different from those of the control groups. The antibody concentrations remained elevated for at least 1 year after vaccination. The post-immunization antibody concentrations correlated with the number of meningococcal infections within 10 years before vaccination. In spite of the vaccination two LCCD patients experienced a meningococcal disease 9 and 12 months, respectively, after vaccination.

Adolescent↗
PubMed1993

Meningococcal disease in patients with late complement component deficiency: studies in the U.S.S.R.

The purpose of this study was to examine the occurrence of late complement component deficiency (LCCD) states in the USSR. Thirty deficient individuals were detected: 27 with C8 beta and 3 with C7 deficiency. Among individuals with a first episode of meningococcal infection, about 1% had LCCD, whereas among patients with recurrent bacterial meningitis the prevalence of LCCD rose to approximately 50%. This corresponds to a prevalence for LCCD of approximately 12 per 100,000 in the general population. The individuals with LCCD identified in this study experienced about 77 episodes of meningococcal disease and acute bacterial meningitis. Mathematical analysis of the morbidity from meningococcal disease in individuals with LCCD demonstrated that the probability of disease did not change with the age of the patient and was not affected by prior episodes of infection. This finding suggest that in contrast to the situation in the general population, prior infection fails to protect the deficient individual from recurrent disease. In comparison to complement-sufficient persons, the course of disease in individuals with LCCD is less severe, as shown by a reduction in the number of episodes of endotoxic shock and mortality as well as their more rapid recovery. These findings suggest that exuberant complement activation and concomitant formation of membrane attack complexes during meningococcal infection in complement-sufficient patients plays an important role in the activation and injury of peripheral blood cells and endothelial cells during endotoxic shock.

Adolescent↗
PubMed1992

Immunological evaluation of late complement component-deficient individuals.

The possible contribution of additional immunologic variables to the susceptibility of late complement component-deficient individuals to meningococcal disease has not been systematically examined in previous studies. Thus, we studied three groups of patients: (1) 24 healthy individuals, (2) 8 complement-sufficient individuals with a history of recurrent bacterial meningitis, and (3) 19 complement-deficient individuals with prior meningococcal infection. No statistical differences were noted among the three groups for the following parameters: the absolute number and the percentage of lymphocytes; CD3+, CD4+, CD8+, CD20+, and CD16+ cells; and the CD4+/CD8+ ratio. The concentration of C4 and circulating immune complexes was also similar among the groups. The concentrations of IgG, IgM, and IgA were slightly, but significantly, decreased in the complement-deficient individuals. Of interest, the coefficient of spontaneous and lipopolysaccharide-stimulated activation of neutrophils was significantly depressed in the deficient individuals. We hypothesize that the terminal complement components may participate in maximal neutrophil activation.

Adolescent↗
PubMed1990

[Characteristics of blood circulation disorders in meningococcal meningoencephalitis].

Studies of liquorologic, hemodynamic, electrophysiologic, and biochemical characteristics of the blood, carried out over the course of the disease in 110 patients with purulent meningoencephalitis of meningococcal etiology, complicated by development of high intracranial hypertension, have revealed a hypokinetic type of circulation, characterized by reduced heart performance and elevated afterload, in the majority of the examinees during the acute period of the disease. Among the causes contributing to the formation of the hypokinetic type are inflammatory and dystrophic changes in the myocardium, deterioration of the blood rheology (of the high blood viscosity syndrome type), and vasopressor effect of elevated intracranial pressure (Cushing's phenomenon) resultant from brain edema developing in the majority of patients. The findings evidence the leading role of intracranial pressure elevation in the origin of increased tone of resistive vessels and in the development of macro- and microcirculatory disorders in the acute phase of the disease.

Adolescent↗
PubMed1989

[Hemosorption in infectious pathology].

Hemosorption was used for the treatment of 152 patients with purulent meningitis, sepsis complicated by shock, virus hepatitis and leptospirosis. A favorable effect of hemosorption in infections was based on highly effective correction of microcirculatory disorders as a result of the removal of high molecular substances of microbic and endogenous origin.

Hemoperfusion↗
PubMed1986

[Role of hemosorption in the therapy of infectious toxic shock and the multiple-organ failure syndrome in a fulminating form of meningococcemia].

Hemoperfusion was applied to the treatment of 20 patients with fulminant meningococcemia complicated by the infectious-toxic shock, stage III, and the polyorgan insufficiency syndrome. Ten patients recovered while the remaining 10 died mainly because of irreversible lesions of the vitally important organs: kidneys, adrenals, heart and brain. In the deceased patients, the prehospital stage had lasted two times longer than in the convalescents. All the patients had received antishock therapy: correction of acidosis, artificial ventilation of the lungs, dopamine, pharmacological doses of steroids and protease inhibitors as well as moderate infusion therapy. Hemoperfusion was instituted immediately after elimination of arterial hypotension. The use of hemoperfusion promoted the abatement of systemic toxicosis and neurotoxicosis, the recovery and stabilization of the hemodynamics, improvement of rheological properties of the blood, the recovery of effective tissue perfusion, the lowering of specific antigenemia and blood toxicity, and elimination of the pathological protein complexes from the circulating blood.

Adolescent↗