The article describes a clinical observation of a 3 months old patient with ALK-positive histiocytosis complicated by sepsis caused by Lactobacillus paracasei. A pure culture of the microorganism was obtained by seeding on blood agar, and its identification was performed using MALDI-TOF technology, using Autof MS 1000 mass-spectrometer. An analysis of the literature data on the possible causes of microbial intestinal translocation with the development of lactobacillary sepsis is also provided.
Objective. To assess the categorization of antimicrobial susceptibility testing results using aggregated data from microbiology laboratories in the Russian Federation for 2023 and 2024, considering interpretation standards, their versions, microorganisms, and federal districts. Materials and Methods. A retrospective descriptive study of aggregated microbiology laboratory data for 2023 and 2024 was performed. Data from 494 laboratories in 2023 and 520 laboratories in 2024 were included. We assessed the use and recency of interpretation standards, the proportion of errors/inaccuracies among tested results, and their distribution by type, microorganism, federal district, and standard recency group. Year-to-year comparisons included absolute differences in proportions, 95% confidence intervals, paired analysis of comparable laboratories, and a multivariable quasi-binomial generalized linear model. Results. In 2023, errors/inaccuracies accounted for 125,435 of 1,694,993 tested results (7.4%); in 2024, they accounted for 244,461 of 2,506,844 results (9.8%). In both years, the highest proportion was observed in laboratories using only MUK 4.2.1890-04: 31.3% in 2023 and 41.0% in 2024. In the aggregated comparison, the 2024 proportion was higher by 2.35 percentage points; however, paired analysis of 377 laboratories did not demonstrate a statistically significant unidirectional change. In the multivariable model, higher proportions remained independently associated with the “only MUK 4.2.1890-04” group and with standards of unknown version year. Conclusions. The frequency of errors/inaccuracies in routine laboratory reporting is determined by the combined influence of interpretation standards, their recency, microorganisms, and regional data structure. The findings support systematic quality control of AST result categorization, including review of expected resistance, rare phenotypes, and cases where interpretive criteria are absent.
Candidozyma auris (Candida auris before 2024) is a fungus included in the list of priority fungal pathogens by the World Health Organization and characterized by high resistance to antifungal drugs. Proven deepseated invasive candidiasis caused by C. auris and meeting the EORTC/MSGERC 2020 and FUNDICU 2024 criteria is poorly characterized in the literature, and clinical data on rezafungin in this setting remain extremely scarce. Rezafungin is a next-generation echinocandin with a prolonged half-life, approved by the US FDA (March 2023) and the European Medicines Agency (December 2023) for the treatment of candidemia and invasive candidiasis in adults; the drug is not registered in the Russian Federation. We describe a 46-year-old patient with disseminated renal cell carcinoma who underwent multiple surgical interventions for tumour-related complications and subsequently developed candidemia and proven deepseated invasive candidiasis caused by C. auris with disseminated abdominal involvement (splenic-bed abscess, hepatic abscesses, peritonitis) and colonization of several non-sterile sites. Despite prolonged combination antifungal therapy with caspofungin, amphotericin B lipid complex, and anidulafungin together with staged surgical source control, the infection progressed with formation of new fluid collections and abscesses. Given disease progression and exhaustion of available antifungal options, rezafungin was administered on a compassionate-use basis after approval by the institutional medical commission and the local ethics committee. With rezafungin (400 mg intravenously on day 1, then 200 mg once weekly) the patient achieved clinical and laboratory stabilization and microbiological eradication of C. auris from monitored sites; the total rezafungin course lasted 12 weeks and was well tolerated. To the best of the authors’ knowledge, this is the first published clinical observation of rezafungin use for the treatment of invasive mycosis in the Russian Federation.
Three clinical cases of treatment of patients with disseminated mycobacteriosis caused by M. avium using the drug bedaquilin have been described. The criteria for prescribing bedaquiline were M. avium resistance to two drugs in the regimen (primarily to clarithromycin) and/or adverse events leading to drug withdrawal. Regimen of the bedaquiline administration: 400 mg once daily for the first 14 days, from day 15 until the end of the course of therapy – 200 mg 3 times a week. The main criteria for treatment efficacy were: normalization of temperature, relief of clinical manifestations, cessation of isolation of nontuberculous mycobacteria. All patients had involvement of the intra-abdominal lymph nodes, lungs, and intestines. There was also involvement of the intrathoracic lymph nodes, peripheral lymph nodes, and bone marrow. Duration of the bedaquiline therapy ranged from 14 to 17 months and depended on the timing of the cessation of bacterial excretion. During the bedaquiline therapy there was no adverse events that required discontinuation of the drug. Upon completion of therapy no relapses were recorded during 2 years observation. We conclude, that use of bedaquiline in the treatment regimens of disseminated mycobacteriosis caused by M. avium in HIV-infected patients helped to stabilize the condition, the cessation of bacterial excretion and improve immunological parameters, including an increase in CD4 T-lymphocyte count. The results obtained require further study of the use of bedaquiline in this category of patients.
Objective. To conduct an in-depth analysis of the competence structure in rational antimicrobial therapy (AMT) among healthcare professionals and students to identify typical knowledge profiles and determine priorities for Antimicrobial Stewardship (AMS) educational programs. Materials and Methods. The study employed a two-stage statistical analysis of survey data. The first stage used the k-means clustering method to stratify respondents based on their knowledge structure. The second stage involved a correlation analysis of responses to assess the internal connectivity ("architecture") of key knowledge domains and identify integrative nodes. Results. A total of six discrete competence clusters (profiles) were identified, differing qualitatively not only in overall proficiency but also in internal structure. Professional status was not a guarantee of systemic knowledge: the cluster with a total deficit included practicing physicians, while clusters of "limited expertise" demonstrated high performance in narrow areas alongside weak foundational principles. Correlation analysis identified questions concerning the principles of rational antimicrobial combinations and dosing as key integrative nodes, with low performance on these nodes observed in most clusters. The successful profile (Cluster 1) was characterized by strong interconnections between these nodes, reflecting a formed systemic knowledge model. Conclusions. Competencies in AMT are heterogeneous, mosaic, and structurally dependent. The findings justify a transition from uniform training programs to stratified and targeted educational interventions within AMS frameworks. A strategic priority is reinforcing key integrative nodes (principles of antimicrobial combinations and dosing), which has a multiplicative effect on the overall knowledge architecture. The proposed methodology provides a tool for diagnosing structural deficits, planning personalized educational strategies, and evaluating their effectiveness based on the analysis of qualitative shifts in competence profiles.
