STAPHYLOCOCCAL INFECTION — group of the infectious diseases caused by stafilokokka.
According to the International classification of diseases, injuries and causes of death of the ninth review (1975) allocate the following main nosological forms, at to-rykh etiol. a factor is staphylococcus: a) diseases of skin and hypodermic cellulose; from them the most widespread diseases at newborns are pyoderma (see), vezikulopustulez, a pempigus (see. Pemphigus ), exfoliative dermatitis of Ritter (see. Rittera dermatitis exfoliative ), at more senior children and adults — abscess (see), furuncle (see), hydradenites (see), felon (see), multiple abscesses at children (see. Pseuofurunculosis ), etc.; b) diseases of a respiratory organs, from to-rykh are most frequent quinsy (see), pleurisy (see), pneumonia (see); c) diseases of a nervous system and sense bodys — meningitis (see), otitis (see), conjunctivitis (see), dacryocystitis (see), etc.; d) diseases of digestive organs — stomatitis (see), peritonitis (see), paraproctitis (see), enteritis (see), coloenteritis (see), staphylococcal food intoxication (see. Toxicoinfections food ); e) diseases of a musculoskeletal system and connecting fabric — arthritises (see), osteomyelitis (see), periostitis, etc.; e) diseases of the blood circulatory system — endocarditis (see), pericardis (see), phlebitis (see), etc.; g) diseases of urinogenital bodies — a pyelitis, cystitis (see), urethritis (see), mastitis (see), an endometritis (see. Metroendometritis ), an orchitis (see), etc.; h) staphylococcal sepsis (see) — primary or developing against the background of the existing suppurative focuses.
Causative agents of a staphylococcal infection belong to the sort Staphylococcus this. Micrococcaceae and, according to the decision of Subcommittee on taxonomy of stafilokokk and micrococci (1976), include three look: Staphylococcus aureus, S. epidermidis, S. saprophyticus (see. Stafilokokki ). The main role in inf. pathology of the person possesses S. aureus. Growth of incidence of S. and., observed in 60 — the 70th of the current century, connect first of all with the broad and often insufficiently reasonable use of antibiotics which brought into force of high biological ductility of stafilokokk (see) to selection and wide dissimination of antibiotiko-resistant strains. Among allocated from sick S. and. strains of staphylococcus of 70 — 80% are steady to Benzylium-penicillin, it is frequent at simultaneous tetracycline, streptomycin resistance, to levomycetinum and other antibiotics, i.e. formation and growth of number of polyresistant strains of staphylococcus is characteristic (see. Medicinal stability of microorganisms ).
Page and. is high on the list among intrahospital infections (see) and its emergence is possible in a hospital of any profile (surgical, burn, urological, etc.), however the biggest danger of S. and. represents for maternity homes (see) where newborn children for the first time face staphylococcus. At disturbances of the sanitary and hygienic and anti-epidemic modes in hospitals (density, lack of regular cleaning, disturbance at a sterilization of instruments, etc.), and also insufficient discipline of personnel of S. and. can arise at the child from the first days of his life.
Intrahospital S.'s sources and. patients with are erased a wedge, forms of a staphylococcal purulent infection or carriers of stafilokokk (see the Carriage of contagiums), and also medical staff (doctors, nurses, nurses) or mothers (generally in obstetric hospitals and departments for children of early age) with similar forms C. and. The greatest danger as a source of an infection (see) represents medical staff (especially in obstetric, surgical, children's hospitals), to-ry can be the carrier of the strains of staphylococcus, with a certain constancy circulating in hospital conditions and which are characterized by polyresistance to antibiotics (so-called hospital strains). According to the International classification (the report of Committee of WHO experts, 1967) distinguish constant carriers, at to-rykh at crops from a nasal cavity golden staphylococcus is always found (perhaps, and various fagotip), and the alternating carriers — golden staphylococcus (the same strain is more often) at them is allocated from time to time. G. N. Chistovich (1969) suggested to allocate still group of so-called resident (malicious) carriers, i.e. persons, to-rye carry constantly in a significant amount same fagotip golden staphylococcus. It is shown that resident carriers allocate staphylococcus to the environment even at quet breathing.
Ways and factors of transfer of an intrahospital staphylococcal infection are various (see. Mechanism of transmission of infection ). Leading role in distribution of activators C. and. belongs to an airborne way of transfer. The contact and household way of transfer of stafilokokk (through hands of personnel, objects of patient care and linen), especially in obstetrical institutions is important. In S.'s emergence and. in surgical and urological hospitals, burn departments not disinfected tools, solutions, a suture and dressing material, and also various devices and devices used during operations and medical procedures can play a large role. S.'s transfer and. to the newborn it can be carried out also in the food way — through solutions for drink, the milk used for a dokorm through breast milk of mother in a case of her mastitis.
Features of epidemiology of intrahospital S. and. are defined by opportunistic character of the activator and are characterized by the following: infection of newborns and patients with so-called hospital strains of stafilokokk, a possibility of a long carriage, existence of a large number of possible sources of an infection and a variety of ways and factors of transfer of the activator, presence of the persons who are characterized by reduced nonspecific resistance of an organism. So, e.g., the reasons promoting S.'s emergence and. at newborn children are: existence at mother of pathology during pregnancy, childbirth or a puerperal period (see. Puerperal diseases ), existence at the child of various intercurrent diseases, low level of an immune responsiveness of the child.
Producing various exotoxins (hemolysins, leukocidins, eksfoliatina, enterotoxins), enzymes (a plazmokoagulaza, fibrinolysin, a letsitovitellaza, a nuclease, hyaluronidase) and other biologically active agents, staphylococcus influence various cellular structures of an organism, break protective barriers, than and the possibility of penetration and their reproduction in various bodies and systems of the person is caused (see Toxins, Enzymes). Entrance gate of contagiums are the injured skin and mucous membranes of a respiratory, intestinal and urogenital path. Development of the pyoinflammatory centers on site of entrance gate is characteristic, and also generalized it is purulent - septic processes (see Sepsis). As a rule, S. and. develops at persons with the lowered nonspecific resistance, against the background of various inf. diseases, especially virus etiology, in the presence of chronic patol. states, at the immunodepressants receiving massive doses, antibiotics, a roentgenotherapy. There are data on a certain predisposition of nek-ry people to S. and., what is shown by repeated cases of diseases. Immunity after the postponed S. and. unstable.
S.'s diagnosis and. the wedge, pictures and results a lab is based on data. researches. Opportunistic character of the activator, a wide spread occurance of stafilokokk in microflora of almost healthy faces (see. Mikroflora of the person ) and in the environment complicates assessment etiol. the importance of the stafilokokk allocated from patol. material, especially open cavities. Allocation of staphylococcus in pure growth, frequency of allocation of the same fagotip, the loudspeaker of immunological specific indicators allows to assume a staphylococcal etiology of a disease.
Lab. S.'s diagnosis and. includes bacterial. and serol. methods of a research. By bacteriological methods (see. Bacteriological techniques ), to-rye are the main, allocate the activator, identify it to a look and type (option) and define if necessary sensitivity to antibiotics for what investigate blood, urine, pus, slime (from a nose, a pharynx, etc.). The studied material sow on the dense elective shggatelny environment — 1,8% a beef-extract agar (pH 7,0 — 7,2) containing 7,5% of sodium chloride, 1% of egg yolk and 10% of milk. Blood is previously sowed in the broth containing 1% of glucose; the grown culture is oversown on the dense elective environment. At the culture which grew in the form of separate colonies on the dense environment register existence of a pigment and letsitovitellaza, determine morphology of cells (in the smear painted but to Gram) and existence of a catalase (test from 3% by solution of hydrogen peroxide). Then reveal ability of a strain to ferment 1% solution of glucose in the semi-fluid environment of Gis-sa (see Giss of the environment) covered with a layer of a liquid paraffin and also existence at it of a plazmokoagulaza and thermostable DNA-ase. The first sign characterizes belonging of a strain to the sort Staphylococcus, two last — to a type of S. aureus. At the strains of this look allocated at food intoxication (see Toxicoinfections food), define availability of enterotoxins in biol. or immunol. tests. The cultures of S. aureus which are marked out from people in epid. S.'s centers and., first of all subject to a lysotypy by means of 22 phages of the international set for carrying out epidemiol. the analysis (for identification of a source of an infection). Belonging of strains to koagu-lazonegativny types of S. epidermidis and S. saprophyticus establishes by definition at them of resistance to 2 mkg/ml of novobiocin, on availability of phosphatase and ability to oxidize 1% mashsht and trehalose. Sensitivity of stafilokokk to antibiotics is checked by means of standard disks or method of serial delution. Tentative data on identification of stafilokokk can be obtained in 1 — 2 days Serol. researches at the infection caused by S. aureus are applied by hl. obr. when it is not possible to allocate the activator. Most often apply definition in blood serum of patients of level of An-tialfatoksina in reaction of braking of hemolysis across Vygodchikov to this purpose (in foreign terminology — the ASTA-test). In some cases apply titration of antibodies to ribitteykhoyevy to - those are to one of components of a cell wall S. aureus or reaction of an autoagglyutination. Titration of antibodies is carried out in dynamics.
Treatment is defined by features a wedge, forms C. and. However the general principles of treatment are based on the complex therapy providing the combined use of antibacterial and specific immunodrugs, sanitation of suppurative focuses, and also actions for increase in nonspecific resistance of an organism (good nutrition, vitamin therapy, a nonspecific immunotherapy etc.).
Considering high antibacterial drugs resistance of stafilokokk, define sensitivity of the isolated stafilokokk to antibiotics. At impossibility of the directed antibiotic treatment it is necessary to give preference to semi-synthetic to penicillin (see), possessing penitsillinazoustoychivostyo (Methicillinum, Oxacillinum, etc.). From immunodrugs for treatment anti-staphylococcal plasma, immunoglobulin human antistaphylococcal, staphylococcal anatoxin, a staphylococcal vaccine can be used; the staphylococcal bacteriophage is recommended (see. Immunization , Phagotherapy ). Appointment biol is reasonable. the drugs recovering normal microflora of an organism and increasing its nonspecific resistance that is especially shown to newborn children and children of early age (bifidumbacterium, bifikol, etc.). Use of drugs like levamisole, Prodigiosanum, nucleinate of sodium, etc. for increase in nonspecific resistance of an organism is possible. The specified drugs demand careful use and reasonable preliminary estimate of a condition of humoral and cellular immunity of the patient.
Prevention Page and. it is carried out in the direction of all three links of epidemic process: a source of an infection, ways of transfer, a susceptible organism (see. Anti-epidemic actions ). From the actions directed to a source of an infection, importance have daily survey of medical staff for the purpose of S.'s identification and. and discharges from work of persons with a pyoinflammatory disease (quinsy, a pyoderma, a felon, etc.), and also early and full detection of sick S. and. among patients in hospitals and their isolation in special department or chamber. After the postponed S. and. the medical staff can be allowed to work only at total disappearance of all a wedge, displays of a disease. Carrying out inspections of medical staff on a carriage of golden staphylococcus in upper respiratory tracts and identification epidemic of dangerous group of resident carriers is necessary. It has to be for this purpose carried out triple bacterial. inspection with an interval of 7 — 10 days. Allocation at each inspection of the same fagotip of golden staphylococcus allows to carry this carrier to resident carriers and to carry out its sanitation. For sanitation of carriers various drugs can be used; the most effective of them are a staphylococcal bacteriophage, hlorofillipt, Ectericidum, a lysozyme. Sanitation by antibiotics of carriers of stafilokokk is inadmissible.
As a contraindication to work in a maternity home serves existence of the suppurative chronic inflammatory focuses in upper respiratory tracts, an oral cavity and others hron. diseases of a staphylococcal etiology. Resident carriers shall not be employed, directly connected with service of children.
One of measures of prevention of intrahospital S. and. reduction of terms of stay of patients in hospitals, in particular in surgical hospitals is during the carrying out planned operations that is reached by inspection and preoperative training of patients in the conditions of policlinics. The early extract of newborns from obstetric hospitals is important, and also wider use of maternity homes of system mother — the child, at a cut mother is in one chamber with the child and services it. S., perspective for prevention, and. at newborns early applying of the child to a breast for breastfeeding is (during the first hours after the birth).
The measures directed to suppression of ways of transfer of S. and., provide the organization strict a dignity, - a gigabyte. the mode in hospitals of various profile: sterile linen for newborns, effective remedies for disinfecting of hands of medical staff, systematic disinfecting of air of rooms, processing of bedding in disinfection chambers; the organization centralized sterilizing, a high security of sterilization, control of sterility of surgical material and tools (see. Disinfection , Sterilization ). The great value in maternity homes is attached to a high security of sterilization, pasteurization and storage of breast milk.
In S.'s prevention and. the important part is assigned to the actions directed to increase in nonspecific resistance of an organism, especially children of the first year of life, to-rye are carried out in hospitals.
Natrium nucleinicum, trypsin, fibrinolysin (plasmin), B12 vitamin, bifidumbacterium, bifikol and some other means can be for this purpose used.
Increase in specific antistaphylococcal immunity is reached by use of staphylococcal anatoxin, antistaphylococcal plasma and antistaphylococcal gamma-globulin. These drugs are effective for prevention of staphylococcal diseases in surgical hospitals (see. Immunization ). The question of expediency of use of staphylococcal anatoxin for immunization of pregnant women for the purpose of prevention of staphylococcal diseases at newborns remains debatable so far.
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H. B. Mordvinova, H. A. Syomina; A. K. Akatov (lab. diagnosis).