Method for estimating effectiveness of inhalation antibacterial therapy of hospital-aquired pneumonia caused by gram-negative flora

FIELD: medicine.

SUBSTANCE: method is ensured by the double evaluation of total endotoxin (LPS) of gram-negative bacteria: prior to the beginning of the inhalation antibacterial therapy and one hour after the first antibiotic inhalation. It involves controlling the total endotoxin of the gram-negative bacteria in patient's blood serum by activated particle method. Double and higher endotoxin increase as compared with the reference testifies to a bactericidal action of the antibiotic and proves the effectiveness of the conducted antibacterial therapy.

EFFECT: using the method enables the early estimation of the effectiveness of the antibacterial therapy.

1 ex

 

The method relates to the field of medicine, namely intensive care critical States.

Currently starting antibiotic therapy is empirical, taking into account the localization of lesions, the nature of the probable causative agents of disease, as well as retrospective analysis of the microbial flora and sensitivity to antibiotics for a particular medical institutions or the Department. So far, the evaluation of the effectiveness of antibiotic therapy based on clinical signs (body temperature, leukocytosis, WBC, somatic status of the patient), available analysis and evaluation not earlier than within 48-72 hours from the start of antibiotic therapy (2). However, these parameters are fundamental for the evaluation of the effectiveness of therapy and serve as a prototype. After the start of antibiotic therapy within the first day is the suppression of growth and reproduction of sensitive microorganisms, then in response to the reduction of intoxication appear first positive symptoms in clinical condition, the reaction temperature and laboratory indicators, therefore clinically to assess the initial effect from the appointed antibiotic can be no earlier than 48 hours. The main performance criteria in these terms is to reduce body temperature, in which oxical and respiratory failure (3). Methods of early identification of the pathogen with definition of sensitivity to antibiotics are not widely available due to the high cost of analyzers and consumables. Lipopolysaccharide (LPS) of gram-negative bacteria is the main pathogenetic factor in the development of gram-negative infections, as well as in the development of the syndrome of endogenous intoxication. LPS (endotoxin, O-antigen) is a required structural element of all gram-negative bacteria (1). The destruction of the bacterial cell wall of gram-negative bacteria leads to increased levels of endotoxin (5). Bactericidal action of aminoglycosides bacterial cell, consisting in the breach of protein synthesis in ribosomes and, as a consequence, the destruction of the cytoplasmic membrane and cell wall, can lead to increased levels of LPS in the blood (4). In recent years publications examples of efficient use of inhaled tobramycin for the treatment of nosocomial pneumonia caused by gram-negative microflora, as well as the uniformity of distribution of the antibiotic in the lung parenchyma, regardless of the source of ventilation-perfusion abnormalities (6).

The aim of the invention is the early determination of the effectiveness of inhaled antibiotic therapy of nosocomial mo is vmoney, caused by gram-negative bacteria.

The aim is achieved by a double determination of total endotoxin (LPS) of gram-negative bacteria by the method of activated particles (MAH) in the blood serum of the patient's blood diagnostic set "MAH-Endotox spp".

The method is implemented as follows. Carry out the determination of the total endotoxin (LPS) of gram-negative bacteria by the method of activated particles (MAH) in the blood serum of the patient's blood before inhaled antibiotic therapy. Re-determination of the total endotoxin (LPS) of gram-negative bacteria in the blood serum of the blood is performed within 1 hour after the end of the first inhaled antibiotic.

The criterion for the effectiveness of antibiotic therapy consider increasing the level of endotoxin from the original 2 times or more.

Clinical example.

Patient M., 24 years. Diagnosis: open craniocerebral injury, fracture of base of skull, subdural hematoma of the right fronto-temporal region, subdural hematoma of the left parieto-temporal area. Brain injury severe. Injury in both lungs. Operation: decompressive craniotomy on the left to the right, the removal of subdural hematomas. The early postoperative period was complicated by the development of right-sided pneumonia with severe manifestations of Yateley failure. In this regard, the patient in addition to used intravenous antibiotics (Meronem 1 g 3 times daily) started a course of tobramycin (inhalation form of TOBI 300 mg 2 times a day with an interval of 12 hours). Results: the results of the determination of the total endotoxin (LPS) of gram-negative bacteria by the method of activated particles (MAH) in serum arterial blood diagnostic set "MAH-Endotox spp" patient immediately before the first inhalation of tobramycin, the General level of endotoxin was 4 PG/ml Re-determination of the total endotoxin (LPS) of gram-negative bacteria by the method of activated particles (MAH) in the blood serum of the patient's blood occurred within 1 hour after inhalation, the General level of endotoxin was 16 PG/ml 6 hours after inhalation of tobramycin level dropped to 4 PG/ml

Unchanged values of procalcitonin, biochemical parameters and results of bacteriological blood culture against inhalation therapy with tobramycin indirectly indicate the absence of the damaging action of the drug and endotoxin levels in the tissues of the body. On day 7 of antibiotic therapy was performed control multislice spiral computed tomography of the lungs, the conclusion is positive dynamics in the form of a resolution of pneumonia. In sputum decreased concentration of sod is Rania microbial bodies (Acinetob. calcoaceficus) with 106up to 102.

Sources of information

1. Mayansky A.N. Microbiology for physicians. N.N.: The Nizhniy Novgorod state medical Academy, 1999. - 41 S., - 127 C.

2. Beloborodov V.B. have been Practical recommendations for the diagnosis and treatment of nosocomial pneumonia: what's new? // Infection and antimicrobial therapy No. 2-2005. - 46 S.

3. Beloborodov, NV Algorithms for antibiotic therapy of severe infections. M., 1998.

4. Yakovlev V.P., Yakovlev S.V., I.A. Alexandrova Rational antimicrobial therapy. M: Littera, 2007.

5. Alicia M. Mohr, Ziad C. Sifri, Helen S. Horng, Ragui Sadek. Use of Aerosolized Aminoglycosides in the Treatment of Gram-Negative Ventilator-Associated Pneumonia. // SYRGICAL INFECTIONS, Volume 8, Number 3, 2007.

6. Milena Baptistella Grotta, Elba Cristina de Sa Camargo Etchebere, Antonio Fernando Ribeiro, Juliana Romanato. Pulmonary deposition of inhaled tobramycin prior to and after respiratory therapy and use of inhaled albuterol in cystic fibrosis patients colonized with Pseudomonas aeruginosa. // J Bras Pneumol. 2009; 35 (1): 35-43.

A method of evaluating the effectiveness of inhaled antibiotic therapy of nosocomial pneumonia caused by gram-negative flora, including the definition of leukocytosis and leukocyte formula, characterized in that before the start of inhaled antibiotic therapy and after 1 h after the first inhaled antibiotic conduct monitoring of endotoxin of gram-negative bacteria in the blood serum of the patient's blood by the method of activated particles; registration of the increase of the level of endotoxin in 2 times or more of the original is vidualistic on the bactericidal action of antibiotics and the effectiveness of antibiotic therapy.



 

Same patents:

FIELD: medicine.

SUBSTANCE: invention describes a method for prediction of reduced transport function of band-3 protein of red-cell membranes of newborns delivered by mothers suffered aggravated herpes viral infection in the third trimester of pregnancy wherein newborn's peripheral blood is examined for the TNFa content; band-3 protein is detected in the newborn's red-cell membranes by disk electrophoresis in polyacryl amide gel (10%) with sodium dodecyl sulphate; a discriminant function is calculated by formula Df=(5.167×band-3)+(2.196×TNFα), wherein Df is the discriminant function, band-3 is red-cell membrane stromal protein, TNFα is newborn's blood interleukine, and if Df is more than 218.67, reduced transport anion function by protein band-3 through newborn's red-cell membranes is predicted.

EFFECT: invention provides detecting the effect of herpes viral infection on the content of protein band-3 in newborn's red-cell membranes.

1 ex

FIELD: medicine.

SUBSTANCE: peripheral venous blood of the patients with autoimmune thyroiditis is examined for the absolute transferring receptor (CD71+) T-lymphocyte count and the interleukin-2 (IL-2) concentration. If the CD71+ T-lymphocyte count exceeds 0.3×109 cell/l, and the IL-2 concentration is less than 25 pg/ml, a favourable clinical course of the disease is predicted, while the CD71+ T-lymphocyte count less than 0.3×109 cell/l and the IL-2 concentration exceeding 25 pg/ml shows an unfavourable clinical course of autoimmune thyroiditis.

EFFECT: method provides more accurate and objective prediction with using the material, reagents and research methods widely applied in common clinical-laboratory practise.

3 ex

FIELD: medicine.

SUBSTANCE: patient's peripheral blood is examined for the content of cytotoxic lymphocytes, %: (CD8/CD16), (CP8/GranzymeB), (CP16/GranzymeB), (CDS), (CD16/CD56) and (CD8/HLA DR). It is conmbined with determining cytotoxic activity (CTA), %. It is followed by calculating a RA activity index (AI) by formula: If observing the condition 11.8%<AI≤18.2%, a moderate degree of rheumatoid arthritis activity is diagnosed. If observing the condition AI>18.2%, a high degree of rheumatoid arthritis activity is diagnosed.

EFFECT: using the technique enables high-reliability differential diagnosis of the degree of rheumatoid arthritis activity.

2 ex

FIELD: medicine.

SUBSTANCE: there are involved recording clinical and laboratory manifestations of a CNS injury during the first days of the disease that is followed by the calculation of total diagnostic coefficients related to the detected graduation levels of pathognomonic signs of the disease. Total (+)7 points and more is related to predicting the developing mixed tick-borne encephalitis and borreliosis infection. Total (-)8 points and less shows the developing potential monoinfection of tick-borne encephalitis. If deriving the intermediate values of total diagnostic coefficients when none of said limits is reached, the prognosis is uncertain.

EFFECT: using the method for stating basic tendencies of the developing pathological process at the early stages of the developing disease.

1 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: with using indirect immunofluorescence and monoclonal antibodies, the patients suffering gastric ulcer (GU) are examined for an expression level of CD8, CDDR markers by peripheral blood lymphocytes with the CD8 level exceeding 24.5% and the CDDR level exceeding 15% enabling diagnosing a severe clinical course of GU.

EFFECT: use of the offered diagnostic technique provides high information value in diagnosing the severe clinical course of gastric ulcer, well-timed prediction of the severe clinical course of GU, instant diagnosing, provides well-timed and adequate complex of therapeutic measures.

1 tbl, 1 ex

FIELD: medicine.

SUBSTANCE: method involves the peripheral blood analysis for T-lymphocyte count with receptor expression in relation to CD3+ and CD25+ cells by cell count in 1 mcl of blood before the beginning of treatment and 10 days after. If observing the count increased 7% and more in comparison with the reference, a therapeutic effect in non-psychotic versions of psycho-organic syndrome is predicted to be positive.

EFFECT: use of the method enables more precise prediction of the clinical effectiveness in the given disease that promotes selecting an adequate therapy and reducing length of treatment.

1 ex

FIELD: medicine.

SUBSTANCE: invention describes a method of detecting the decreased phosphatidyl ethanolamine content in red-cell membranes in a pregnant woman suffered aggravated herpes-virus infection in their third trimester of pregnancy with underlying increasing peripheral blood TNFα, characterised by the fact that peripheral blood of the pregnant woman is analysed for the TNFα content to detect phosphatidyl ethanolamine in red-cell membranes by two-dimensional thin-layer chromatography, and a discriminant equation is presented. Df=+1.743×TNFα+(-1.079×phosphatidyl ethanolamine), and if Df is more than a boundary value 78.86, the decreased phosphatidyl ethanolamine content in red-cell membranes is detected.

EFFECT: higher red-cell membrane stability in peripheral blood of the pregnant woman.

1 ex

FIELD: medicine.

SUBSTANCE: invention describes a method for prediction of developing suppurative complications of acute pancreatitis involving laboratory blood analysis wherein the patients are examined for the kinetics of leukocyte chemiluminescence with using an activated suspension of clinical strains Acinetobacter baumannii or Pseudomonas aeruginosa or methicillin-resistant Staphylococcus aureus - MRSA and combining maximisation time - T max more than 1400.0 sec., maximum intensity - 1 max less than 5131.5 standard units, light sum - S less than 144000.0 standard units for the reaction initiated by Acinetobacter baumannii, and combining the values T max>1435.0 sec., I max<4708.0 standard units, S<118000.0 standard units for the reaction initiated by Pseudomonas aeruginosa, or combining the values T max>3520.0 sec., I max<4257.0 standard units, S<169000.0 standard units for the reaction initiated by MRSA enables predicting developing suppurative complications.

EFFECT: higher sensitivity and reduced time of prediction of suppurative complications of acute pancreatitis ensured by enabled assessment of the specific properties of patient's phagocytic response to etiologically significant activators.

1 ex, 4 tbl

FIELD: medicine.

SUBSTANCE: invention describes a method of assessment of the effect of arginine dehydrogenase activity on the blood histamine level in pregnant women suffered aggravated herpes viral infection with herpes antibody titre 1:12800 in the third trimester of gestation wherein syncytiotrophoblast of placental villi are examined with a histochemical reaction; section regions are photographed, entered in the computer and cytophotometried; observing increasing arginine dehydrogenase activity up to 48.7±2.9 standard units enables stating increasing the peripheral blood histamine level of the pregnant woman up to 1.44±0.09 mcmole/l that exacerbates foetoplacental deficiency in pregnant women.

EFFECT: method allows assessing the effect of arginine dehydrogenase activity on the blood histamine level of the pregnant women suffered aggravated herpes viral infection in the third trimester of gestation.

1 ex

FIELD: medicine.

SUBSTANCE: pre-therapy blood plasma is analysed for immunoglobulin E, adrenocorticotrophin and endorphin, the index SCORAD dynamics is determined by formula: Dsk=1.34147-0.000820741*IgE-0.00382642*ACTP+0.0209401*endorphin wherein IgE is the level of acute blood plasma immunoglobulin E mIU/ml; ACTP is the level of acute blood plasma adrenocorticotrophin ng/l. If observing the Dsk value exceeding 1.18, a prognosis of improving clinical dynamics of recovery is favourable; the conventional therapy is considered to be sufficient. The Dsk value being equal to 1.18 or less, the improving clinical dynamics of recovery is unfavourable, the intensified therapeutic scheme for atopic dermatitis is considered to be preferential.

EFFECT: higher prediction accuracy.

FIELD: medicine, ophthalmology.

SUBSTANCE: in lacrimal liquid one should detect the content of interleukin 8 (IL-8) and that of interleukin 1 beta (IL-1β) to calculate prognostic coefficient (PC) due to dividing the first value by the second one by the following formula: At PC value being below 10.0 one should predict favorable disease flow, and at PC value being above 10.0 - unfavorable flow.

EFFECT: higher accuracy of prediction.

2 ex

FIELD: medicine, medicinal microbiology.

SUBSTANCE: method involves growing microorganism culture to be studied in solid nutrient medium followed by preparing microbial suspension and its incubation in the presence of lactoferrin. Control sample is prepared in parallel series. Control and experimental samples are incubated, supernatant is removed from bacterial cells and lactoferrin concentration is determined in supernatant of experimental and control sample by immunoenzyme analysis. Then anti-lactoferrin activity is calculated by difference of concentrations of residual lactoferrin in experimental and control samples. This method provides enhancing the sensitivity and precision in carrying out the quantitative evaluation of anti-lactoferrin activity in broad spectrum of microorganisms that is urgent in diagnosis and prognosis of diseases with bacterial etiology. Invention can be used in determination of persistent indices of microorganisms for assay of their etiological significance in pathological processes.

EFFECT: improved assay method.

3 tbl, 3 ex

FIELD: medicine, biology.

SUBSTANCE: invention relates to nutrient medium used for accumulation of cells for the following cytological and/or immunocytochemical analysis carrying out. Invention relates to medium containing salts NaCl, KCl, anhydrous CaCl2, MgSO4 x 6 H2O, MgCl2 x 6 H2O, Na2HPO4 x 2 H2O, KHPO4, NaHCO3, and also glucose and Henx's solution, 10% albumin solution and polyglucin taken in the ratio 1:1:1. Invention provides enhancing the preservation of cells.

EFFECT: improved an valuable properties of nutrient medium.

3 ex

FIELD: medicine, cardiology.

SUBSTANCE: in peripheral blood one should detect the level of CD95(+) and CD16(+) neutrophilic granulocytes and at combination of increased level of CD95(+) neutrophilic granulocytes by 4 times and more and CD16(+) neutrophilic granulocytes by 0.6 times against the norm with ECG signs of myocardial infarction one should predict lethal result of large-focal myocardial infarction.

EFFECT: higher accuracy of prediction.

FIELD: medicine, parasitology.

SUBSTANCE: one should carry out immunoenzymatic assay to detect diagnostic optic density and that of labeled immune complex in a plot's hole with tested serum measured in conventional units at wave length being 492 nm. One should calculate coefficient of antibodies concentration measured in conventional units by the following formula: CAC = (Odtsh - Odd) x 100, where CAC - coefficient of antibodies concentration, Odtsh - optic density of the hole with tested serum, Odd - diagnostic value of optic density, 100 - coefficient of serumal dilution. By CAC value one should detect the titer of antibodies to Lamblia intestinalis antigens to interpret results of the trial. The method enables to study the dynamics of disease flow.

EFFECT: higher efficiency and accuracy of diagnostics.

1 ex, 1 tbl

FIELD: medicine.

SUBSTANCE: the present innovation deals with studying and treating diseases of inflammatory, autoimmune and degenerative genesis. One should perform sampling of heparinized blood followed by its sedimentation to obtain blood plasma with leukocytes and centrifuging to isolate the latter which are washed against erythrocytic and serumal admixtures, and, also, it deals with calculating the number of cells in samples out of leukocytic suspension after incubation (B) for 1.5 h at 37 C in holes of plastic microplotting board, out of leukocytic suspension one should additionally prepare two samples, one should be applied to calculate total number of leukocytes before incubation (A), the second sample undergoes incubation at the same mode at addition of autoserum to calculate the number of cells remained after incubation (C). One should state upon adhesive properties of leukocytes by the index of spontaneous adhesion (D), where D=(A-B)/B.100%, and effect for enhanced cellular adhesion under the impact of autoserum should be detected by the value of K=(B-C)/C.100% at K ≥ 30%, where B - C - the number of cells undergone additional adhesion after addition of autoserum. The present innovation widens functional possibilities of the suggested method due to obtaining additional values depicting adhesive properties of blood leukocytes.

EFFECT: higher accuracy of detection.

FIELD: medicine, immunology.

SUBSTANCE: one should carry out reaction of blast-transformation, detect proliferation of T-lymphocytes activated with antibodies to CD3 in the presence of interleukin-7 (ACT IL-7) and in the presence of interleukin-7 and dexametazone (ACT IL-7 D), calculate the index for dexametazone action as the ratio of ACT IL-7 to ACT IL-7 D, moreover, the value of dexametazone action index being above 1.2 indicates increased production of cytokins that suppress T-lymphocytes in neonatals. The method enables to detect functional defect of immune system that characterizes neonatal period.

EFFECT: higher efficiency of detection.

2 ex

FIELD: medicine.

SUBSTANCE: method involves measuring forced exhalation volume per 1 s (FEV1) in l, full right ventricle evacuation time (RVE) in ms and angiotensin II value (AII) in ng/l. Discriminant relationship is built as D=0.504·RVE+3.038·FEV1 - 2.0·AII. D being less than 83.88, pulmonary hypertension occurrence is predicted within 1 year. D being equal to or greater than 83.88, no pulmonary hypertension is predicted to occur.

EFFECT: enhanced accuracy of prediction.

FIELD: medicine, medicinal immunology.

SUBSTANCE: method involves determination of heterophilic antibodies in human serum blood by the Paul-Bunnel's method relatively the level of circulating immune complexes, complement-activating properties of heterophilic antibodies by incubation of standardized ram erythrocytes with 0.8% serum for 30 ± 5 min and the following measurement of the erythrocytes lysis degree. The measurement of the effector function coefficient of heterophilic antibodies is carried out by the complement system Keff.f.h.a.-c.s. by the formula: Keff.f.h.a.-c.s. = Y/Tg.a. wherein Y means a lysis degree, %; Tg.a. means a reverse titer of heterophilic antibodies to ram erythrocytes. The damage assay is carried out by comparison of the immune status with the relative level of circulating immune complexes in serum. Method provides detection of preclinic from of immunodeficiency and autoimmune diseases that opens the possibility for their prophylaxis at most early stages of development. Invention can be used for assay of damage in the immune status in human serum blood.

EFFECT: improved method for assay.

5 tbl, 1 ex

FIELD: medicine.

SUBSTANCE: method involves concurrently examining anti-inflammatory IL-4 level in blood serum and lacrimal fluid. The value being within the limits of 60-70 pg/l in blood serum and 5-15 pg/l in lacrimal fluid, disease prognosis is considered to be unfavorable. The IL-4 concentration being within the limits of 90-100 pg/l in blood serum and 20-30 pg/l in lacrimal fluid, disease prognosis is considered to be favorable.

EFFECT: high accuracy of diagnosis.

Up!