Резюмета на публикациите на Доц. Емма Едмонд Кьолеян
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на Доц. Емма Едмонд Кьолеян от публикуваните научни трудове след хабилитацията
ABSTRACT Establishment of a rational antibiotic policy (RAP) is a key issue for both better care of patients and combating antimicrobial resistance [1–5]. The problem of rational antibiotic use is complex [6,7] and requires co-ordination of the activities of healthcare authorities, institutions and individual practitioners. Furthermore, on a community basis, it involves restriction of non-human usage of antibiotics [8] and awareness of society about both the useful and harmful effects of antibiotics [9] and, on a national basis, participation of governmental [10] and non-governmental [11] organizations in collaboration with European and international medical societies [12–14]. The rational use of antibiotics should be established in both hospital and ambulatory settings [10]. Institutional, regional, national and global aspects of antibiotic policies should be considered [2].
ABSTRACT In Bulgaria, as in other countries, the emergence and dissemination of antimicrobialresistance has been recognized as a major obstacle in antimicrobial chemotherapy, as well as an event with wide biological significance. The first Bulgarian publications on this issue date from the 1960s. Today we can cite several positive examples of hospital antibiotic policies, e.g. Allexander’s UH, Military Medical Academy, Queen Ioanna UH. The National data of antibiotic cosumptions show a decrease in prescribing of tetracyclines and aminoglycosides and improvement of antibiotic prophylaxis in surgery. Sciantists contribute substantially in detection of mechanisms and epidemiology of resistance, publishing and presenting their results on scientific forums. Educational activities are addressed to practicionners, providers and consumers of antibiotics. Post-graduated educational courses are organized on a regular basis by the Medical University of Sofia and the National Center for Infectious and Parazitic Diseases. The International cooperation and support are explored and reconized: through common scientific projects and educational activities, e.g. WHO/CDC External Quality Assurance Programme, the APUA small grants program for the chapters affiliated, the EU projects Tempus, PHARE, the ESCMID’ EARSS project etc. In conclusion, this experience is on a small scale. Curbing antimicrobial resistance will take more knowledge, work, education and funds. 3. Keuleyan E.(in Study group*; удостоверение от МУ – София): Bouza E, San Juan R, Minoz P, Voss A and Kluytmans J on behalf of the Co-operative Group of the European Study Group on Nosocomial Infections (ESGNI).. A European perspective on nosocomial urinary tract infections I. Report on the microbiology workload, etiology and antimicroial susceptibility (ESGNI-003 study). Clin Microbiol Infect, 7, 2001, 10, 523 – 531 (24МП) ABSTRACT
OBJECTIVES: To obtain information on the microbiology workload, etiology and antimicrobial susceptibility of urinary tract infection (UTI) pathogens isolated in European hospitals.MATERIALS AND METHODS:We collected data available in the microbiology units of a large sample of European hospitals regarding the laboratory workload, diagnostic criteria, and etiology and antimicrobial resistance of the urinary isolates collected on one day (the study day). RESULTS:Data were received from a total of 228 hospitals from 29 European countries. The average rate of urine samples cultured per 1000 admissions in 1999 was 324. The criteria to consider a positive urine culture as significant were quite variable; > or =10(4) colony-forming units (CFU)/mL for bacteria or > or =10(3) CFU/mL in the case of yeasts were the most used cut-off points. On the study day, a total of 607 micro-organisms from 522 patients with nosocomial UTI were isolated. The six most commonly isolated micro-organisms were, in decreasing order: Escherichia coli (35.6%), Enterococci (15.8%), Candida (9.4%), Klebsiella (8.3%), Proteus (7.9%) and Pseudomonas aeruginosa (6.9%). Pseudomonas was isolated more frequently in non-EU countries. The study data reveal high rates of antimicrobial resistance in UTI pathogens, especially in non-EU countries, where Pseudomonas aeruginosa presented rates of aminoglycoside resistance as high as 72% to gentamicin, 69.2% to tobramycin and 40% to amikacin. CONCLUSIONS:Nosocomial UTI accounts for an important proportion of the workload in microbiology laboratories. A consensus on the practice and interpretation of urine cultures in Europe is needed. The levels and patterns of resistance of UTI pathogens must be a serious cause for concern and a clear reason for stricter guidelines and regulations in antimicrobial policy. 4. Markovska R, Strateva T, Gergova G, Keuleyan E. Nasopharyngeal carriage of penicillin-resistant, macrolide-resistant and multiply-resistant Streptococcus pneumoniae in day-care centers in Sofia, Bulgaria. Clin Microbiol Infect. 2001, 7, 1:42-46 (25МП) ABSTRACT
5. Bijev A, Nankov A, Keuleyan E, Markovska R, Daneva E. Synthesis and preliminary antimicrobial evaluation of new 7-(N-pyrrolyl) derivates of cephalosporins. Arzneimittelforschung, 54, 2004, 2, 119 – 24 (26МП) ABSTRACT A series of seven new cephalosporins was prepared for preliminary microbiological evaluation by N-acylation of 7-aminocephalosporanic acid with substituted N-pyrrolylcarboxylic acids via mixed anhydrides. The chemical structure of the compounds were confirmed by IR, 1H-NMR and mass spectral data. The 7-(N-pyrrolyl) cephalosporin derivatives were tested in vitro by the disc diffusion method upon 3 strains and subsequent determination of the minimal inhibitory concentration (MIC) of the most active ones upon 29 strains. The products of the series exhibited antibacterial activity. They showed selective potency against gram-positive and were practically inactive against gram-negative microorganisms. The compound 3-[(acetyloxy)methyl]-7-([2-[3-(ethoxycarbonyl)-2-methyl-5-phenyl-1H-1-pyrrolyl]acetyl]amino)-6-oxo-7,7a-dihydro-2H,6H-aceto[2,1-b][1,3]thiazine-4-carboxylic acid (4a) was outlined as more active than the reference cefazolin (CAS 23325-78-2) in regard to S. pyogenes and some strains of S. aureus, the MIC of 4a against S. pyogenes were at least 4-fold lower. The toxicological evaluations of the starting N-pyrrolylcarboxylic acids showed no acute toxicity. 6. Markovska R, Schneider I, Keuleyan E, Bauernfeind A. Extended Spectrum Beta-Lactamase (ESBL) CTX-M-15 producing E. coli and K. pneumoniae in Sofia, Bulgaria. Clin Microbiol Infect,10, 2004, 8, 752-754 (27МП) ABSTRACT
During a survey of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae in Bulgaria in 2001-2002, three isolates from Sofia (two Escherichia coli, one Klebsiella pneumoniae) showed cefotaxime MICs that were decreased in the presence of clavulanate and were 2-8-fold higher than those of ceftazidime. Resistance was transferred to a sensitive recipient strain of E. coli. Both wild-type and transconjugant strains produced a cefotaxime-hydrolysing beta-lactamase of pI 8.8. Sequencing of the PCR product obtained with oligonucleotide primers binding outside the coding region identified this beta-lactamase as CTX-M-15. To our knowledge, this is the first report of CTX-M-15 in Bulgaria. 7. Cizman M, Beovic B, Krcmery V, Barsic B, Tamm E, Ludwig E, Pelemis M, Korovski K, Grzesiovski P, Gardovska D, Valokha A, Keuleyan E, Strachounski L, Dimitru C, Titov LP, Usonis V, Dvorak P. Antibiotic policies in Central Eastern Europe. Int J Antimicrob Agents, 24, 2004,199-204 (28МП) ABSTRACT To assess the antibiotic policies in Central Eastern European (CEE) countries, a questionnaire on the prevalence of resistance, antibiotic consumption data for ambulatory and hospital care and antibiotic policies, was mailed to national representatives. Data on antibiotic resistance and consumption of antibiotics at national levels are limited and vary considerably among countries. The importance of surveillance data in altering perceptions of the prevalence of resistance is shown by the comparison of surveillance data and interview data. Interview data without surveillance data produced the widest range of estimates of the prevalence of resistance in streptococcus pneumonia -5% in Lithuania and 82% in Belarus. The average consumption of antibiotics in ambulatory care in eight CEE countries in 2001 was 19.35 defined daily doses (DDD)/1000 inhabitants per day, (range 13.1 - 24.8 DDD) and in hospitals in six CEE countries was 2.2 DDD/1000 inhabitants per day (range 1.3-4.5). Over the counter sales of antibiotics are available in some countries. Antibiotic policy interventions do not exist or only apply to specific problems or interventions. Better implementation of antibiotic interventions and education on antibiotic use should be a high priority in this region. An effective strategy requires close co-operation, consultations and partnership at national and international level in particular, via existing international organisations. 8. Markovska R, Rachkova K, Schneider I, Keuleyan E, Bauernfeind A. Multiresistant SHV-2-producing Salmonella enterica Serotype Corvallis in Bulgaria. J Chemother. Oct;17 . 2005 (5): 568-9 (29МП) ABSTRACT We characterize a strain from a 45-day old baby suffered from gastroenteritis, isolated in Thracian University Hospital – Stara Zagora in 2002- Salmonella enterica Serotype Corvalis SZ 5-1. It was resistant to amoxicillin, piperacillin, cefotaxime, gentamicin, tobramycin and chloramphenicol, and was susceptible to combinations of cefotaxime and ceftazidime with sulbactam. The resistance plasmid was transferred by conjugation to E. coli K12. In Isoelectric focussing the transconjugants presented pI at 5.4 (probable TEM-1) and pI 7.6. Using SHV-type specific primers, PCR products of expected size of about 300 bp were obtained. Sequencing of the entire coding region of blaSHV and comparative analysis with published sequences (accession no. X53433) revealed the presence of bla SHV-2. This is the first report of the occerence of SHV-2 in S. enterica Serotype Corvalis in Bulgaria. 9. Markovska R, Keuleyan E, Schneider I, Markova B, Rachkova K, Sredkova M, Bauernfeind A. CTX-M-3 Extended Spectrum Beta-Lactamase producing K. pneumoniae and dissemination of the plasmidic bla CTX-M-3 in Bulgaria. Eur J Clin Microbiol Infect Dis. 2006, 25:123-125 (30МП) ABSTRACT
In this study we report another type of cefotaximases (ESBLs), CTX-M-3 in Bulgaria, after the first described type, CTX-M-15. We randomly selected by four isolates of K. pneumoniae from the four participated centers. We investigated the ESBL production by V. Jarlier double disc synergy test, by CLSI confirmatory method; performed conjugational plasmid transfer to E. coli K12:W3110 Rif lac- and subjected the transconjugants to Isoelectric focussing and Bioassay. Whole-cell DNA preparations were used as template in specific PCRs with universal primers defined using the nucleotide sequence of 18 bla CTX-M genes, incl CTX-M-3. PCR amplification products of the bla CTX-M genes of the transconjugants were obtained with oligonucleotides binding to the flanking regions of the genes P1C and P2C and subjected to automatic sequencing. ESBLs of pls 8.4 and PCR products of the expected size of 585 bp were obtained from all strains. CTX-M-3 producing strains appeared in Bulgaria in 2002 and 2003. Epidemiological typing with RAPD revealed no relatedness among the strains tested. 10. Keuleyan E. “Dual-Use” Life-Sciences Research – a View from Bulgaria. International Round-Table on Dual Use Life-Sciences Research, 25-27 February 2007, Bethesda, MD. US Government & WHO. Conference Book. 2007. USG (DHHS) & WHO (31МП) ABSTRACT How does Bulgaria perceive “dual-use” life-sciences research problem? For more than 25 years Bulgaria has signed the CBW. Now the country is on the way to coordinate its safeguards with those of NATO and EU. Bulgarian participation in NATO science program includes Defense against bio-terrorism: rapid detection of biological weapons, rapid diagnosis of their effects, novel and rapid methods of detection, physical protection-, -medical countermeasures. In an interview Prof. B. Petrunov, Director of the National Centre for Infectious and Parasitic Diseases, and Bulgarian expert with the UN, said, that “Dual-use” life-sciences research is important and complex, both for the science and politics. In recent years, pursuant to the appeal to strengthen the awareness of scientists, the Ethics Code of the Bulgarian Scientists for Preventing and Fighting Bioterrorism has been developed. The Code was published in several mass-media. The current practice is the research project to be reviewed by institutional scientific/ethic committee: what are the goals, methods, strains, the level, then analyzing if the results might have potential “dual use”. The stock and dynamics of strains are according to the international rules. We consider that safeguard measures should be developed to prevent the eventual misuse. Special bodies should be created to develop Guidelines and to control their implementation in every country. The role of the scientist in controlling the prevention of malevolent application of the research should be supported. The Ethics Code of scientists, which criminalizes the bio-terrorist use, should be regarded as the scientist Hypocrath oath to society. In international plan: - a specialized chapter with the WHO/UN should co-ordinate the global preventive activities. The countries should promote the trust and should work together, sharing their experience for the general welfare.
ABSTRACT Taking into account: the natural disaster epidemics, the emerging and re-emerging diseases, the huge potential of organisms and toxins that may be used as bio-weapons, the liberty to decide on dual use biomedical research is an acknowledged necessity: Let we continue research implementing preventive measures and develop bio-preparedness on national and international level. 12. Schneider I, Markovska R, Keuleyan E, Sredkova M, Rachkova K, Mitov I, Bauernfeind A. Dissemination and persistence of a plasmid-mediated TEM-3-like beta lactamase, TEM-139, among Enterobacteriaceae in Bulgaria. Int J Antimicrob Agents. 2007, 29, 6:710-714 (33МП) ABSTRACT
During a survey of extended-spectrum beta-lactamases (ESBLs) in Bulgaria from 1996 to 2003, a TEM-3-like ESBL was detected in strains of Klebsiella pneumoniae, Escherichia coli, Citrobacter freundii and Klebsiella oxytoca from three centres in three different towns. The nucleotide sequence of the cloned gene was identical to that of TEM-3, except for one substitution (C347A) causing an amino acid exchange at position 49 from leucine to methionine. This TEM-3 variant with both a unique nucleotide and amino acid sequence was designated TEM-139. Transformants producing TEM-3 or TEM-139 expressed identical beta-lactam resistance phenotypes. TEM-139 was the only TEM-type ESBL detected in the surveyed hospitals (seven centres in three towns). TEM-139 is a natural variant of TEM-3 with an amino acid exchange without informational content, detectable only by molecular procedures, e.g. a nucleotide-specific polymerase chain reaction. 13. Markovska R, I. Schneider, E. Keuleyan, M. Sredkova, D. Ivanova, B. Markova, G. Lazarova, E. Dragijeva, E. Savov, I. Haydouchka, N. Hadjieva, L. Setchanova, I. Mitov, A. Bauernfeind. Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Bulgarian Hospitals. Microbial Drug Res. 14, 2008: 2, 119-128 (34МП) ABSTRACT The aim of the study was to describe the emergence, the spread, and the prevalence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae in Bulgaria. Over eight years (1996-2003), 442 ESBL-screen-positive isolates were collected in nine medical institutions in four Bulgarian towns. Class A ESBLs of the SHV, TEM, and CTX-M groups were identified in seven species. SHV-type enzymes persisted during the whole study period, TEM-ESBLs appeared first in 1999, and CTX-M-types appeared first in 2001. The rate of CTX-M enzyme producers increased rapidly between 2001 and 2003, while the rate of SHV producers decreased. Six different ESBL-types were identified, namely, SHV-2, -5, and -12, CTX-M-3 and -15, and a new TEM-3-like variant (TEM-139). The most widespread enzymes were SHV-12, CTX-M-15, and CTX-M-3 found in seven centers. TEM-139 was identified mainly in one center. A trend for strains harboring more than one ESBL gene, for example, CTX-M + SHV, was observed since 2002. Plasmid fingerprinting and random amplified polymorphic DNA analysis typing revealed wide dissemination of identical plasmids among different bacterial species and hospitals, as well as clonal spread of ESBL producers. Our data contribute to clarify the dynamics in the prevalence of ESBLs in Bulgaria and demonstrate the importance of molecular procedures for their analysis. 14. Schneider I, E. Keuleyan, R. Rasshofer, R. Markovska, A.M. Queenan, A. Bauernfeind. VIM-15 and VIM-16, Two New VIM-2-Like Metallo- β-Lactamases in Pseudomonas aeruginosa Isolates from Bulgaria and Germany. Antimicrob Agents Chemother. 52, 2008: 8, 2977-2979 (35МП) ABSTRACT
Two Pseudomonas aeruginosa urine isolates from Bulgaria and Germany produced two new VIM-2 variants. VIM-15 had one amino acid substitution (Tyr218Phe) which caused a significant increase in hydrolytic efficiency. The substitution Ser54Leu, characterizing VIM-16, showed no influence on enzyme activity. Both genes were part of class I integrons located in the chromosome. 15. Keuleyan E. Current perceptions about the problem of “dual-use” life sciences research and its management in Bulgaria. International Round-Table “Sustaining Progress in the Life Sciences: Strategies for Managing Dual Use Research of Concern”, November 4-6, 2008, Bethesda, MD, USA. Conference Book. USG (DHHS) & WHO. 2008. (36МП) ABSTRACT Like in other countries, Bulgarian scientists would like to contribute to the management of the problem of “dual-use” life sciences research. The Code of Conduct of Bulgarian scientists has been prepared by the scientists from the Bulgarian Academy of Sciences. Raising Awareness about DURC was done during scientific conferences and via publications and participation in International activities.The Expert Committee on Biological Defense with the Council of Ministers was a specialized commission on biological threats to humans, animals and plants. The tasks of committee were: to perform scientific projects, to prepare guidelines and to advise on particular issues. The Center for Research on National Security and Defense with BAS supports, coordinates and organizes the research within BAS and according to the International programs (EC, NATO etc). Another important institution is the Ministry of Health (http://www.mh.government.bg). In conclusions, Bulgarian scientists are willing to work together with the other scientists to achieve better health, a higher quality of life and prosperity, but with necessary preventive measures for security. 16. Yovchevski, Pl H, E. E. Keuleyan, N. P. Smilov. Re: Daily Cranberry Juice for the Prevention of Asymptomatic Bacteriuria in Pregnancy: A Randomized, Controlled Pilot Study. J Urol, Vol. 181, 2008, 3, 1503-1504, 2009; PMID: 19157436, DOI: 10.1016/j.juro.2008.11.040 (American Urological Association) (37МП) ABSTRACT
We read with great interest the recent randomized, controlled pilot study on the potential beneficial effect of cranberry juice for the prevention of asymptomatic bacteriuria and symptomatic urinary tract infections (UTIs) during pregnancy by Wing and colleagues [1]. In respect to asymptomatic bacteriuria the authors found about two times greater frequency reduction in the daily consuming cranberry juice cocktail group as compared to these drinking placebo. This led the authors to the first part of their conclusion that there may be a protective effect of cranberry ingestion against asymptomatic bacteriuria. Intuitively, we would also like to agree with the second part of the conclusion, namely that cranberry ingestion decreasing asymptomatic bacteriuria during pregnancy lead to a decrease in symptomatic UTIs. But intuition is of course no substitute for results of a well-conducted study, and asymptomatic bacteriuria is not the only factor predisposing to upper UTIs. The results of the study show that only pregnant women drinking cranberry juice had symptomatic bacteriuria. Frequency of pyelonephritis (PN) in them was 2.4%, given that generally PN occurs in 1.4% percent of pregnant women [2]. There was no incidence of PN in the group drinking placebo. As by the reduction of asymptomatic bacteriuria a reduction of PN is targeted, the presented results are not sufficient to validate the use of cranberry for prevention of UTIs in pregnancy. This may be due to some differences in the pathogenic mechanisms of PN development in pregnant women. Capability of adherence of P-fimbricated Escherischia coli to uroepithelial-cell surfaces, which is inhibited by proanthocyanidin extracts from cranberries [3] is not the only factor for the developing of pyelonephritis. There are several other factors like urinary stasis and the presence of vesicoureteral reflux, which predispose pregnant women to upper UTIs and acute PN. Cranberries have a complex phytochemical profile which includes 3 classes of flavonoids (flavonols, anthocyanins, and proanthocyanidins), catechins, hydroxycinnamic and other phenolic acids, and triterpenoids [4]. We suppose that some of the key phytochemicals can negatively affect tonic relaxation of ureters. So, in spite of the inhibition of adherence of Escherischia coli to uroepithelial-cell and the reduction in the frequency of asymptomatic bacteriuria the risk of acute pyelonephritis is not decreased. Thus, considering the results of this pilot study a more appropriate conclusion would be that although cranberry juice consumption reduces the frequency of asymptomatic bacteriuria during pregnancy, it does not reduce the incidence of symptomatic urinary tract infections. 17. Keuleyan E.E. and K.G. Kirilov. Comment on: Aminoglycoside drugs in clinical practice: an evidence-based approach. J Antimicrob Chemother. 63, 2009: 5, 1081-1082 (38МП) ABSTRACT
We would like to raise several points: (i) ‘Resistant bacteria have renewed our interest in the aminoglycoside drugs’ - while this is partly true, we would argue that interest has never diminished as these drugs are widely used, regarded as being effective asmonotherapy and in combination, and are being increasingly seen as a treatment and surgical prophylactic alternative to many beta-lactam antibiotics, which are more potent initiators of Clostridium difficile. (ii) There is interest in aminoglycoside use for Gram-negative infections that are resistant to ‘more efficacious and less toxic drugs’. We would question which drugs are more efficacious? (iii) As Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella spp. are resistant to β-lactams – the authors say - the alternatives are usually aminoglycosides, colistin and ( potentially) tigecycline. As far as we know, Acinetobacter spp. are inherently resistant to aminoglycosides. (iv) Regarding infective endocarditis, the authors recommend to use published guidelines, taking into account the fact that combination treatment is not supported by evidence’. They cite trials with small numbers of patients were in favour of monotherapy (without aminoglycosides), but they ‘did not reach statistical significance’. It would be a brave clinician who deviates from internationally agreed guidelines that aim to provide the optimum care for the patient within a framework of ‘best practice’. (v) Similarly, the authors argue against combination therapy with aminoglycosides for Gram-negative infections, stating that combinations do not improve efficacy and add side effects. However, in severe systemic infections, aminoglycosides in combination are a widely used and reliable therapeutic intervention, especially for empirical treatment of sepsis, systemic inflammatory response syndrome and septic shock - to achieve a rapid synergistic bactericidal effect, to broaden the spectrum of activity and to prevent emergence of resistance. In our own practice, we use aminoglycoside combinations except when the main antibiotic is a carbapenem. (vi) A final comment is whether meta-analysis is the best method to draw evidence-based conclusions. How can such a variety of trials involving diverse settings, different patient populations, different antibiotics and dosage regimens, different timings of the appropriate therapy and different microorganisms with their virulence factors and specific mechanisms of resistance, and performed over a long period of time (25–30 years) be assessed and provide meaningful comparative conclusions? 18. Schneider I, A.M. Queenan, R. Markovska, B. Markova, E. Keuleyan, A. Bauernfeind. New variant of CTX-M Type Extended – Spectrum β-Lactamases, CTX-M-71, with a Gly238Cys Substitution in a Klebsiella pneumoniae Isolate from Bulgaria. Antimicrob Agents Chemother. 53, 2009: 10, 4518-4521 (39МП) ABSTRACT A single Klebsiella pneumoniae strain isolated in a Bulgarian hospital was found to produce CTX-M-71, a new CTX-M variant characterized by one amino acid substitution from glycine to cysteine at position 238 in comparison to CTX-M-15. This exchange decreased the hydrolytic activity of the β-lactamase for cefotaxime, ceftazidime, and cefepime. 19. Keuleyan E. 2010. Liberty to decide on dual use biomedical research: an acknowledged necessity. Sci Eng Ethics, 2010, 16 (1), 43-58 (40МП) ABSTRACT
О. Keuleyan E. Bulgaria APUA – Chapter. APUA 2010 (www.apua.org) ABSTRACT
Since its foundation in 1998, APUA-Bulgaria Chapter has two main goals: 1. Containment of Antimicrobial Resistance and 2. Rational Antibiotic Policies/Antibiotic stewardship. Among the APUA-Bulgaria Chapter greatest achievements are: 1. The participation in Expert Committee with the Ministry of Health (2000-2003) to create a National Policy for Antimicrobial Resistance Surveillance and Rational antibiotic policies, 2. The conference “Rational Antibiotic Policy” 3-5 June, 2005, Sofia, jointly co-organized with BSMM, BAM and ESGAP, 3. The work on APUA small grants program-supported project on resistance surveillance, 4. The International cooperation: projects ARPAC, EARSS, ESAC (ESCMID) and the work in the ESCMID Study Groups: ESGAP, ESGARS and others, 5. The Inquiry on Antibiotics and Antibiotic policies, performed on the occasion of the second “antibiotic day” (ECDC, WHO), 18.11.2009 among patients and medical personnel. 20. Keuleyan E., G. Kirov, M. Kondarev, I. Lozev, D. Vezeva, S. Toujarov, N. Smilov. Surgical personnel’ adherence to antibiotic policies. Journal of IMAB, 2010, 16, 3: 83-89 (41МП) ABSTRACT - Objectives. This work aimed at studying the adherence of personnel of the Surgery clinic of our institute to antibiotic policies in place. - Methods. Antimicrobial resistance surveillance of the alert resistant microorganisms (Staphylococcus aureus (MRSA), Enterobacteriaceae (ESBL-producing), Pseudomonas aeruginosa, MDR); Antibiotic consumption calculation (ABC calc, D. Monnet); Audits of antibiotic prescriptions, and Inquiries – were performed. - Results. Current antibiotic policies in the Surgery clinic (50-bed) were prepared, discussed and introduced in 2003. Since then, five 3-month audits of antibiotic prescriptions took place. During the last four years (2006-2009), the problem resistant organisms were: MRSA, 10-36 %; ESBL-producing Enterobacteriaceae, 14-23 %; MDR P. aeruginosa, 30-47 % and carbapenem-resistant, 0-35 %. Antibiotic consumption was between 47.9 and 61.9 DDD/100 bed-day, and first generation cephalosporins were the top used antibiotics (29.5-35.2 DDD/100 bed-day). Two inquiries (2007 and 2009) revealed: - a good compliance with the policies, with the exception of the duration of antibiotic prophylaxis, - and a comprehensive knowledge on antibiotics and antibiotic resistance. - Conclusion. With one exception (the duration of antibiotic prophylaxis) this study revealed good adherence to antibiotic policies, as well as professional attitudes towards the rational use of antibiotics. 21. Keuleyan E and R. Vatcheva-Dobrevski. (Enhancing Infection Control with Antibiotic Stewardship – APUA Chapter Reports). APUA-Bulgaria. APUA Newsletter, 2011, vol. 29, No 3 (http://www.tufts.edu/med/apua/news/news-newsletter-vol-29-no-3-5.shtml#APUA-bulgaria) (42МП) ABSTRACT
The incidence of health-associated infections (HAIs) in Bulgaria dropped from 12.7 to 1000 in 2007 to 11.2 0/00 in 2008 and 10.2 0/00 in 2009. From 1999 to 2009, the incidence increased approximately 10 % (21.1 0/00 to 10.2 0/00. In a point prevalence survey conducted in 2008among 23 acute-care hospitals, the overal prevalence rate of HAI was 2.43 %. The highest prevalence rates were found in intensive care units: (15.2 %) and surgical wards (4.1 %). Their distribution was as follow: surgical site infections (43.18 %) > pneumonia (27.27 %) > urinary tract infections (20.45 %) > blood-stream infections (9.09 %). The Ministry of Health, the National Center for Infectious and Parasitic Diseases (NCIPD), the National Reference Center for Healthcare-Associated Infections (NRC-HAI), and the National Centre for Public Health and Information (NCPHI) are responsible for infection control activities, together with professional organizations. Bulgaria has also participated in a series of ECDC surveys of HAIs, such as the European Clostridium difficile infection surveillance network project (ECDIS-net), as well as in other national and international programs. 22. Markovska R, Schneider I, Ivanova D, Keuleyan E, Stoeva T, Sredkova M, Markova B, Bojkova K, Gergova R, Bauernfeind, Mitov I. High Prevalence of CTX-M-15-Producing 025b-ST131 Escherichia coli Clone in Bulgarian Hospitals. Microb Drug Res. 2012, 18, 4:390-5 (43МП) ABSTRACT According to the European Antimicrobial Resistance Surveillance System project results, Bulgaria has become one of the European countries with dramatically increasing rates of extended-spectrum beta-lactamase (ESBL) producers. The aim of this work was to investigate the epidemiology of ESBL-producing Escherichia coli clinical isolates in Bulgaria, collected from seven clinical centers in three towns, during two study periods: 2002-2003 and 2006-2009. For 193 ESBL-producing E. coli isolates random amplified polymorphic DNA (RAPD) analyses, phylogenetic typing, and screening for O25b-ST131 isolates were carried out. Antimicrobial susceptibility, ESBL-type and transferability of resistance determinants were analyzed. Four different ESBL-types, namely TEM-139, SHV-12, CTX-M-3, and CTX-M-15 were found. CTX-M-15 dominated, being found in 88% of the isolates. RAPD-typing revealed 35 types, among which type A dominated, comprising 65% of the isolates. Sixty-eight percent of the 193 isolates belonged to the O25b-ST131 clone, to the phylogenetic group B2, mostly showed RAPD-type A (92%) and were found in all participating hospitals. O25b-ST131 isolates predominantly produced CTX-M-15 (96%), and less SHV-12 (n=3) or TEM-139 (n=2). In conclusion, this study demonstrated for the first time the country-wide dissemination of a highly resistant B2 O25b-ST131 CTX-M-15 producing E. coli clone in Bulgaria. 23. Keuleyan E. Antibiotic stewardship in Bulgaria – achievements and further needs. The APUA Newsletter. 2012, 30, 20-21 (44МП) ABSTRACT Каталог: rdonlyres rdonlyres -> Областна дирекция на мвр – р а з г р а д районно управление на мвр – р а з г р а д rdonlyres -> Република българия министерство на вътрешните работи а н а л и з rdonlyres -> Стара Загора Дата Време rdonlyres -> „развитие на човешките ресурси” Ч rdonlyres -> Дипломна работа за получаване на образователно-квалификационна степен „Магистър" по специалността „Стратегическо ръководство и управление на сигурността и обществения ред" rdonlyres -> Наредба за условията и реда за функциониране на националната система за ранно предупреждение и оповестяване на органите на изпълнителната власт и населението при бедствия и за оповестяване при въздушна опасност rdonlyres -> Решение за откриване на процедура за възлагане на обществена поръчка rdonlyres -> Закон за движението по пътищата в сила от 01. 09. 1999 г. Отразена деноминацията от 05. 07. 1999 г rdonlyres -> Наредба №8121з-968 от 10 декември 2014 Г. За правилата и нормите за пожарна безопасност при извършване на дейности в земеделските земи Изтегляне 0.75 Mb. Сподели с приятели:
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