BACKGROUND: In the structure of childhood traumatism, thoracic trauma occurs in less than 10% of cases, but it is the second most likely cause of death in children. A bronchial rupture that disrupts adequate ventilation of the lungs can be the culprit of the fatal outcome. The purpose of our publication is to demonstrate a rare clinical observation of successful endoscopic treatment of an intermediate bronchus rupture in a 4-year-old child with polytrauma. CLINICAL CASE DESCRIPTION: A 4-year-old boy was injured in a traffic accident as a pedestrian. During the first three days, he was treated for multiple injuries (Injury Severity Score 41) in a local hospital where, because of emergency indications, drainage of the right pleural cavity with two drains for tension pneumothorax and laparotomy for intra-abdominal bleeding due to liver rupture were done. Because of patient’s relative stabilization by the 3rd post-trauma day, he was transferred to our clinic (level 1 trauma center). We could stabilize his hemodynamics; however, air blowing through the drains was maintained, complete straightening of the parenchyma of the right lung was not reached, and blood gas composition remained subcompensated. On day 5 of the post-traumatic period, laryngotracheobronchoscopy was performed, and the rupture of intermediate bronchus measuring 3×9 mm was diagnosed. Its occlusion with a positive effect was done. After 7 days, laryngotracheobronchoscopy was repeated, and blockers were removed. After that, complete straightening of the right lung was reached; no recurrence of bronchopulmonary fistula. Long mechanical ventilation and long hospital stay were results of severe traumatic brain injury. At the follow-up visit in a year, no pathology in respiratory organs was detected at clinical laboratory, radiological and endoscopic examination. CONCLUSION: Bronchial rupture may be a cause of inadequate ventilation and aggravation of the post-traumatic period in a polytrauma patient. The present observation demonstrates that intraluminal endoscopy allows to timely detect the rupture of the large bronchus and to perform a minimally invasive surgical treatment. Such a tactics ensured further positive dynamics in child's condition and favorable outcomes after polytrauma, as a whole.

Introduction: A duplication cyst (DC) of the gastrointestinal (GI) tract is a rare developmental anomaly of the digestive system. The latency and variability of clinical manifestations hamper the physician's ability to make the correct diagnosis, often leading to a marked delay in diagnosing the disease. The patient in the current report repeatedly sought medical help for four years before the correct diagnosis was made. Case presentation: A 14-year-old boy was admitted to the emergency department complaining of abdominal pain and repeated vomiting. A more thorough history revealed that similar pain accompanied by vomiting of gastric contents had been periodically noted for the last four years. According to the parents, the boy has had a poor appetite throughout the period, resulting in minor weight loss. On physical examination, the patient's abdomen was not distended and could be examined with only moderate pain on deep palpation in the epigastric and right mesogastric regions. To exclude perforation of a hollow organ and intestinal obstruction, plain abdominal radiography in two standing projections was performed, which showed no free air under the diaphragm and no features characteristic of intestinal obstruction. Ultrasonography of the abdomen, in the area of the major curve of the stomach near the head and body of the pancreas, revealed a cystic mass with echogenic contents 40 x 30 mm in size. The patient underwent an esophagogastroduodenoscopy (EGD). In the antrum, along the posterior gastric wall, there was an ovoid-shaped mass measuring about 40 x 30 mm and covered with smooth pink mucosa. According to the MRI, there was a clearly outlined cystic mass, 38 x 36 x 40 mm in size. A complete examination allowed for the diagnosis of a gastric DC and a decision was made to perform laparoscopic surgery. The laparoscopy was performed under general anesthesia using the threeport technique. The duplication cyst in the stomach was removed laparoscopically. The course of the postoperative period was smooth. Conclusion: The latency and variability of clinical manifestations of gastric DC in children complicate the correct diagnosis and lead to a delay in definitive diagnosis. Modern imaging techniques allow for diagnosing rare GI pathology before surgery. Minimally invasive surgical techniques facilitate the early recovery of patients.

Aim: to identify the medical and epidemiological hallmarks of eye damage in children with complex and multiple injuries in a specialized surgical department. Patients and Methods: this study included 403 children aged 1 month to 18 years with eye injuries associated with multiple or complex injuries of varying severity on the day before hospital admission. All children were admitted between 2014 and 2020. The following data were evaluated: patient's age, gender, severity of complex trauma based on the ISS score, cause of trauma, combination of anatomical areas involved. Results: among children with mechanical complex eye injuries, 255 (63%) were boys and 148 (37%) were girls. The mean age of boys was 10.2±0.34 years, and the mean age of girls was 8.5±0.42 years. Furthermore, more than half (67.5%) of those included in the study were school-aged children and adolescents. The most common types of injuries were those resulting from falls from height, school, sports, gunshot/mine blast, and street incidents. In more than half of the children (n=227, 56.4%), orbital traumas affecting the walls and/or content were reported. The most common type of eye damage was a complex damage to the orbit and ocular adnexa (most often as a periorbital hematoma). The percentage of children with multiple fractures of the orbital walls increases with an increase in the severity of polytrauma. Conclusions: children most often received mechanical complex eye injuries as a result of road traffic accidents. The percentage of children with minor, moderate, and severe complex injuries (assessed by the ISS) was 47.1%, 18.4%, and 33.5%, respectively. Orbital fractures are the most common surgical entities in children with complex mechanical eye injuries. Unilateral orbital fractures were diagnosed in 56.4% of cases, while bilateral orbital fractures were diagnosed in 17.9%. In the majority of instances, mechanical complex eye injuries are associated with traumatic brain injury (99%). KEYWORDS: complex eye injuries, multiple injury, combined injury, mechanical complex eye injury, orbital fracture, orbital injury, morbidity pattern, damage to eye. FOR CITATION: Arzhimatova G.Sh., Karaseva O.V., Koroleva E.A., Chernakova G.M. Multiple and complex eye injuries in children. Russian Journal of Clinical Ophthalmology. 2024;24(2):78–82 (in Russ.). DOI: 10.32364/2311-7729-2024-24-2-6.

Introduction. Inflammation and activation of the immune system are the main cause of secondary injuries in traumatic brain injury (TBI). Given the central role of nitric oxide (NO) in the neuronal Glu cascade with significant changes in the content of ATP in neurons, as well as the presence of GluRc NMDA-type in lymphocytes, it is relevant to determine the effect of NO on the lymphocytes’ adenosine triphosphate (ATP) content. The aim of the work was to determine the effect of different concentrations of NO-generating compounds (NaNO2 and S-nitrosocysteine) on the content of intra- (hcATP) and extracellular ATP (ecATP) in human lymphocytes and to establish links between NO formed during TBI and the initiation of autoimmune processes in children with TBI of varying severity. Materials and methods. Blood samples from 36 TBI children were used for analysis. Lymphocytes were isolated in a ficol gradient according to a standard procedure. The ATP concentration in the tris-acetate buffer (pH 7.76) was determined on a Lucy-1 luminometer using luciferin luciferase (Promega). The ATP concentration was expressed in nmol/mg of protein, which was determined by the Bradford method using Fluka kits. Results. An increase in the level of ATP in lymphocytes immediately after TBI was found to be a positive factor reflecting the activation of lymphocytes. At the same time, a higher level of autontibodies (aAT) to GluRc immediately after severe TBI is a favourable sign for the TBI outcome and coincides with an increase in CGAP in lymphocytes. Prolonged negative trend in ATP content in lymphocytes with similar changes in serum ATP concentrations in severe TBI is an indicator of an unfavourable outcome of severe TBI in children. Conclusion. A moderate increase in NO in the blood immediately after TBI contributes to an increase in CGAP in lymphocytes and aAT to GluRc, which activates the immune response and protects the brain from hypoxic damage.

Introduction. Carbapenemase-producing Klebsiella pneumoniae (CP-Kp), which are international high-risk clones, have become a problem of utmost importance. CP-Kps, adapting to the hospital environment, evolve into convergent pathotypes. Such variants combine traits of two genetic lineages: multidrug resistant (MDR) and hypervirulent. The pathotypes, along with MDR K. pneumoniae, pose an exceptional threat to young patients during systemic infection. The objective of this study is the detailed molecular genetic analysis of MDR isolates of K. pneumoniae detected during the monitoring of resistant Gram-negative bacteria at the National Medical Research Center for Children’s Health in 2014–2021. Materials and methods. Whole-genome sequencing with a subsequent bioinformatics analysis of eight MDR isolates from the bloodstream and cerebrospinal fluid. Results. MDR isolates belonged to 4 sublineages (SL): SL307, SL395, SL29 and SL1198. In the genomes of 6 pangrug-resistant (PDR) isolates, genes associated with resistance to all categories of antibiotics recommended for Enterobacteriaceae therapy were identified. Plasmids were present in all genomes. In 6 isolates, plasmids contained heavy metal ion resistance operons in addition to antibiotic resistance genes. Prophages within the plasmids were also involved in the transfer of resistance genes. The ST395 isolate from the cerebrospinal fluid belonged to the convergent pathotype in terms of resistance and virulence. Comparison of genomes within SLs revealed recombination events in the K- and O-locus regions and the Yersiniabactin operon. Conclusion. Thus, in a sample of resistant K. pneumoniae isolated from bloodstream and cerebrospinal fluid, 6 PDR isolates were detected, one of which belongs to the convergent pathotype ST395.

Introduction. Foreign bodies in the gastrointestinal tract (GIT) is a serious problem in pediatric surgery. In recent years, the incidence of cases when children swallow magnets has increased significantly. Foreign bodies in the stomach, small and large intestines can cause their perforation.Purpose. To demonstrate a successful endoscopic removal of multiple magnetic foreign bodies which were in the stomach of a 2–yearold child for a long time.Description of clinical observation. Boy, 2 y.o., was admitted by the ambulance to the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma in Moscow with suspected presence of multiple magnetic foreign bodies in the stomach and complaints of melena during the last 2 months, about which his parents repeatedly consulted their pediatrician. Two days before the admission, the parents found several magnetic balls in child's faeces and decided to visit the pediatrician for the second time. This time the child had X-ray examination and was transferred to the hospital. At the survey radiography and ultrasound examination of the abdominal cavity, the diagnosis of multiple foreign bodies in the stomach was confirmed. Esophagogastroduodenoscopy revealed a conglomerate of multiple magnetic foreign bodies that filled ½ of the stomach lumen. Under general anesthesia, 209 pieces of magnetic beans were endoscopically removed. Postoperative course was uneventful.Conclusion. If there is the slightest suspicion of a foreign body in the gastrointestinal tract and if there is a clinical picture of gastrointestinal bleeding, the child must be sent to surgical hospital for further examination and, if possible, for endoscopic management.

The development of multiple organ failure and septic complications increases the cumulative risk of mortality in children with severe injury. Clinically available biochemical markers have shown promise in assessing the severity and predicting the development of complications and outcomes in such cases. This study aimed to determine informative criteria for assessing the severity and outcome prediction of severe injury in children based on levels of mid-regional proadrenomedullin (MR-proADM) procalcitonin (PCT), neuron-specific enolase (NSE), and protein S100. Biomarker levels were measured in 52 children with severe injury (ISS ≥ 16) on the 1st, 3rd, 7th, and 14th days after admission to the ICU. The children were divided into groups based on their favorable (n = 44) or unfavorable (n = 8) outcomes according to the Severe Injury Outcome Scale, as well as their favorable (n = 35) or unfavorable (n = 15) outcomes according to the Glasgow Coma Outcome Scale (GOS). The study also evaluated the significance of biomarker levels in predicting septic complications (with SC (n = 16) and without SC (n = 36)) and diagnosing and stratifying multiple organ failure (with MOF (n = 8) and without MOF (n = 44)). A comprehensive assessment of MR-proADM and PCT provided the highest diagnostic and prognostic efficacy for early diagnosis, risk stratification of multiple organ failure, and outcome prediction in severe injury cases involving children. Additionally, the inclusion of the S100 protein in the study allowed for further assessment of brain damage in cases of traumatic brain injury (TBI), contributing to the overall prognostic model.

Introduction. Serratia marcescens is an opportunistic gram-negative microorganism, currently has been detected with increasing frequency in various clinical biomaterials from sick persons is the causative agent of nosocomial infections. The aim of the work is to determine microbiological and clinical features of S. marcescens in bloodstream infections in children. Materials and methods. Nineteen isolates of S. marcescens were isolated from blood cultures. Antibiotic sensitivity was determined by broth microdilution method. Carbapenemase gene were determined using real-time polymerase chain reaction. Biofilm formation was studied on abiotic surfaces using polystyreneplates. Population diversity was determined by multilocus genotypic analysis. Results. Carbapenems, fosfomycin and biseptol showed the highest antimicrobial activity in vitro. Resistance to aminoglycosides, aztreonam, cefepime, and ticarcillin/clavulanate was over 50%. According to PCR data, only OXA-48 carbapenemases were found in 11% of isolates, NDM — in 5%, and a combination of carbapenemases — in 15%. Biofilms of moderate intensity were formed in 13 (68%) isolates, and weak biofilms — in 6 (32%). According to the genotypic analysis, a large proportion of isolates with multiple resistance were included in one group. All of them were singled out over one year from one department — perhaps there was a single source. In 3 cases, patients were diagnosed with sepsis, 1 of them had an unfavourable outcome. Bacteremia occurred on the 3rd day after the initial isolation of S. marcescens. An unfavourable outcome occurred on the 10th day of bacteremia. S. marcescens in this case had multiple resistance and a combination of resistance genes, also belonged to genotypic group I, which is often found in our work. Conclusion. S. marcescens in bloodstream infections is a serious problem for pediatric patients. Natural resistance to polymyxins, as well as acquired resistance to carbapenems and aminoglycosides, cause particular alertness and attention to this microbial agent.

Introduction. Torsion of the appendix is a rare pathology with unclear pathogenesis. The article describes clinical manifestations, diagnostics and surgical management of the distorted appendix in a child. Observation. A 10-year-old boy was admitted to the hospital with pain in the right iliac region and repeated vomiting. During examination, acute appendicitis was diagnosed. At laparoscopy, appendix torsion was revealed; its detorsion and laparoscopic removal were performed. Intraoperatively, it was found out that the mesentery had narrow base , while the process length was about 7 cm; such a combination under developing inflammatory changes in the process could contribute to its torsion. Conclusion. Torsion of the appendix in children has a clinical, laboratory and echographic picture of the destructive appendicitis. Laparoscopy allows to timely clarify the pathology nature and to timely perform appendectomy.

Severe mechanical injury is among the main reasons of disability and mortality in pediatric patients. The imbalance between the states of inflammation and immune suppression during the critical period of post-traumatic injury bears an elevated risk for infectious complications and/or multiple organ failure. The present study aimed to determine the informative immunological criteria in order to evaluate severity and prognosis for clinical outcomes in children from the severe injury group (SInj, ISS 16, n = 87); mild/moderate injury group (MInj, ISS 16, n = 34), as based on assessment of helper T cells (Th) ratios, i.e., Th17/Treg, T127hi/ Treg, and Th17/T127hi. The patients with severe injuries were classified by their outcomes (favorable, n = 47; unfavorable, n = 40), presence of infectious complications (IC, n = 16) and the development of multiple organ failure (MOF, n = 11). Th ratios were studied on the 1st, 3rd, 5th, 7th, 14th day after injury. For the Sinj group, a pronounced increase of Th17/Treg ratio in the acute post-traumatic period with a decrease by 14 days was revealed. The indices of T127hi/Treg ratio on the first day for the patients from Minj group corresponded to the values of control group and significantly differed from patients with SInj in the 3rd to 5th day. There are different kinetics of Th subset ratio in peripheral blood of children with severe injuries over time in different groups, as well as with/without MOF, in presence, or absence of infectious complications and different clinical outcomes. Significant differences in T127hi/Treg ratio level were found in group with IC from 1st to 3rd day and from 7th to 14th day. Significant differences in Th17/Treg ratio level were found in IC group (7th day), in MOF group on 14th day post-injury. The patients with MOF had lower median concentrations of Th17/Treg and T127hi/Treg than patients without MOF. The results of the study indicate that the levels of Th17/Treg and T127hi/Treg ratio in children may be used to predict outcome of the traumatic disease and assess the risk of infectious complications and multiple organ dysfunction syndrome.

Klebsiella pneumoniae is one of the most significant and life-threatening pathogen of nosocomial infections. This opportunistic microorganism can cause infections of the bloodstream, respiratory tract, urinary tract, skin and soft tissues, inflammation of meninges of the brain and spinal cord, leading to elevated hospital mortality. The purpose of our study was a retrospective analysis of molecular genetic characteristics of K. pneumoniae isolated from blood and liquor samples as well as to describe clinical features in bacteremia and CNS infections. According to the results of assessed clinical data, K. pneumoniae isolates were selected from 64 children suffered from surgical pathology (congenital heart defects — 30%, abdominal pathology — 39%, severe combined trauma — 12%) and somatic diseases accompanied by antibacterial and/or glucocorticosteroid therapy — 14%. The minimum suppressive concentrations of antibiotics were determined by the broth micro-dilution method. Carbapenemases were detected by real time polymerase chain reaction. Virulence genes and capsule serotypes K1/K2 were assessed by multiplex PCR. Biofilms were grown using flat-bottomed polystyrene plates, followed by coloring, fixation, elution and data detection. The population diversity was assessed by multilocus sequence typing. Bacteremia and CNS infections associated with K. pneumoniae were fatal in 25% of cases. A substantial portion of the isolates demonstrated the phenotype of extremely drug resistance (XDR) — 43%, the phenotype of multidrug resistance (MDR) was shown in 16% of the isolates. The blaCTX-M cephalosporinase gene was found in 85% of the strains. The main determinant of resistance to carbapenems was the blaOXA-48 gene (33%); the blaNDM gene was detected in 9% of strains. The combination of blaOXA-48 and blaNDM was found in 7% of isolates. The study of biofilm production showed that moderate ability to form biofilms was shown in 61%, strong — 21%, and weak — 15% isolates. Two isolates (3%) did not form biofilms. The virulence genes entB and mrkD were detected in 100% of isolates, ybtS — in 78%. The iutA gene was found in 18% of the strains. Two isolates showed the presence of the kfu gene. Seven isolates belonged to the K2 serotype. 27 different genotypes were found in K. pneumoniae isolates examined. The most common were: ST307 — 21%, ST395 — 12%, ST48 — 7%, ST39 — 6% and ST29 — 6%. Infections of the bloodstream and central nervous system associated with K. pneumoniae have great importance in clinical practice. This microorganism is able to long persist on biotic and abiotic surfaces, has a wide natural and acquired resistance to antibiotics.

Introduction. Currently, the conservative treatment of ileocecal intussusception (ICI) has proven its effectiveness; indications for surgical treatment are increasingly narrowing and do not depend on disease duration and child’s age. And yet, there are situations when conservative treatment is ineffective, and surgical intervention is a must.Purpose. To analyze reasons leading to ineffective conservative treatment of ileocecal intussusception in children and, accordingly, to specify current indications for surgical treatment.Material and methods. 160 children with ICI, who were treated in the Clinical and Research Institute of Emergency Pediatric Surgery and Trauma (CRIEPST) in Moscow from 2011 to 2021, were taken in the trail. Boys prevailed and amounted to 67.5% (108), girls – to 32.5% (52). Average age of patients was 2.9±2.02. 81.2% (130 children ) were older than one year. If the disease was diagnosed for the first time and if there were no complications, patients with ICI had hydrocolonoscopy (HCS), regardless of child’s age and disease duration. If HCS was ineffective, laparoscopy was done. Laparoscopy was also made in case of disease recurrence. If laparoscopic disinvagination was ineffective or impossible, laparotomy was performed. In case of effective laparoscopic disinvagination but in disease relapse and in the absence of intra-abdominal anatomical problems in the postoperative period, colonoscopy was made to rule out intraluminal anatomical pathologies. In the present trial, the researchers assessed causes of ineffective HCS: anatomical problems including volumetric lymphadenopathy, invaginate necrosis and disease relapses. Types of surgical intervention and their effectiveness were also analyzed. Additionally, the authors compared studied parameters obtained in the hospital earlier when HCS protocol (n=160; 2011–2021) and laparoscopic disinvagination protocol were used (n =40, 2007–2010).Results. Surgical intervention by HCS protocol was made in 9.4% (15); HCS effectiveness was as high as 90.6%. Laparoscopy was performed in 6 children (3.75%) after ineffective HCS and in 9 children (5.6%) after disease relapse. Laparoscopic disinvagination was effective in 60.0% of cases (9) from the surgical group; laparoscopy was changed for laparotomy in 6 patients (40%). Anatomical problems accounted for 73.3% (11) in the surgical group and for 6.9% in the study group, respectively. In the rest of patients (4–26.7%), ineffectiveness of conservative disinvagination was caused by severe lymphoid hyperplasia of the ileocecal angle. In early disease relapses, 42.9% of such patients had anatomical problems. In the surgical group, invaginate necrosis was registered in 20% (3), and bowel resection with anastomosis was made in 26.7% (4); in the study group, these indexes were 1.9 and 2.5%, respectively.Conclusion. The basic reason for ICI conservative treatment failure was an anatomical problem which is a leadpoint of disease pathogenesis that causes both intussusception necrosis and intussusception relapses. Currently, the main indications for surgical ICI management are ineffectiveness of conservative treatment and ICI relapses regardless of child’s age and disease duration.

Severe mechanical injury is one of the main reasons behind children’s disability and mortality. Severe injury induces a complex host immune response to tissue injury, a parallel pro- and anti-inflammatory state, bearing an elevated risk for infectious complications (IC) and/or multiple organ failure (MOF). This study aimed to determine the informative immunological criteria of traumatic injury severity and prognosis outcome in children (severe injury group (SInj, ISS ≥ 16), n = 87; mild/moderate injury group (MInj, ISS < 16), n = 34) based on the assessment of absolute cell count (abs) and percentage of such T helper subpopulations as regulatory T lymphocytes – CD4+CD127lowCD25high(Treg), Th17 lymphocytes – CD4+CD161+ and CD4+CD127higtCD25high T cells(T127hi) in severe injury cases grouped by the outcome (favorable, n = 47; unfavorable, n = 40) and depending on IC (n = 16) and the development of MOF (n = 11) on the 1st, 3d , 5th, 7th, 14th day after injury. The control group was comprised of 80 apparently healthy children comparable in age and sex. An inverse relationship between severity of injury, degree of blood loss and outcome of injury was revealed with the abs of all Th populations, but for Th abs and Treg abs the most significant correlation was found (Spearman’s R ≤ -0,70, p < 0.00001). For SInj group, a pronounced decrease of Th abs, Treg abs, T127hi abs and Th17 abs, in the acute post-traumatic period with an increase to 14 days was revealed. The values of in the first day for indicators of patients with MInj group correspond to the values of control group and significantly differ from SInj group. There are different kinetics of percentage Th subpopulations in peripheral blood of children with severe injuries. The Th17%CD4+ and T127hi%CD4+ significant increase in 1st-3d and 3d -7th days after injury respectively in comparation with сontrol and MInj groups. There were no differences between groups in terms of Treg%CD4+. The lower-level Treg abs in trauma patients admitted to the ICU is significantly associated with develop the infectious complications and outcome of trauma. The Th17 abs is significantly reduced in 3-7th days after the injury in the SInj group with MOF. The results of the study indicate that in children levels of Treg, T127hi and Th17 is significantly associated with severity of injury and may be used to predict outcome of trauma and assess the risk of IC and MOF.

Acinetobacter baumannii is a representative of the peak priority nosocomial pathogens capable of causing infections with high mortality and economic treatment costs. The purpose of our study was to determine a role of A. baumannii in blood-borne and central nervous system infections in children. We conducted a retrospective study of A. baumannii associated cases of bacteremia and CNS infection in children. A. baumannii strains were isolated from 17 children followed up with surgical pathology (congenital heart defects 24%, abdominal pathology 29%, severe combined trauma 29%) and with somatic diseases accompanied by antibacterial and/or glucocorticosteroid therapy 18%. The minimum inhibitory concentrations of antibiotics were determined by the broth microdilution method. Carbapenemase genes were detected by real time polymerase chain reaction. Biofilm formation genes were determined by PCR. Biofilms were grown using flat-bottomed polystyrene tablets, followed by coloring, fixation, elution and detection. Population diversity was assessed by the multilocus sequence typing. About a quarter of cases of bacteremia and central nervous system infection caused by A. baumannii had an unfavorable outcome. Resistance to carbapenems, aminoglycosides, fluoroquinolones was more than 70%. Carbapenemases of the OXA-23 (24%) and OXA-40 (41%) groups were identified. The study of biofilm production showed that A. baumannii isolates formed biofilms of varying intensity: weak biofilms (59%), moderate (35%) and strong (6%). During determining the sensitivity to meropenem for biofilm and planktonic forms of cultures, it was determined that the minimum inhibitory concentrations of meropenem were significantly higher for biofilms than for planktonic forms. The minimum inhibitory concentrations of meropenem for plankton cells ranged from 0.5 to 512 mg/l. While in biofilms the same microorganisms had in vitro minimum inhibitory concentrations of meropenem within 128 to 512 mg/l and higher. All isolates bore biofilm formation regulating genes: bfmR, bap and katE. The ompA gene was found in 94% strains, and the csuA/B gene was found in 88%. The population pattern of A. baumannii isolated from blood and cerebrospinal fluid of children was represented by nine different sequence types. Most of the isolates were represented by genotypes: ST944Oxf, ST1550Oxf, ST1104Oxf belonging to the international clonal line ICL6, and ST450Oxf, ST2063Oxf and ST1102Oxf of the international clonal line ICL2. Blood-borne and central nervous system infections associated with A. baumannii have a great importance in clinical practice. This microorganism is able to persist for a long time on biotic and abiotic surfaces, has a wide natural and acquired antibiotics resistance.

Introduction. Infections associated with carbapenem-resistant (Carba-R) Klebsiella pneumoniae (KP) are a serious public health problem because they lead to an increase in hospital stays, treatment costs, and an increase in patient morbidity and mortality. Aim to characterize antimicrobial resistance, virulence factors and genotypes of Carba-R KP strains isolated from patients in intensive care and surgical units. Materials and methods. In total, 455 KP strains that were resistant to meropenem and/or imipenem, or susceptible to meropenem and/or imipenem at increased exposure were collected in 20182020. For further analysis, total 90 KP strains isolated from clinically significant sites blood/сerebrospinal fluid/urine/lower respiratory tract/wounds/abdominal cavity of patients in intensive care and surgical units were selected. Antibiotic susceptibility was determined using the broth microdilution method. Carbapenemase genes were detected by real-time PCR. The virulence genes and K1/K2 capsular serotypes were determined by multiplex PCR. Sequence types (ST) were determined using multilocus sequence typing. Results. Most of the selected isolates (97%) were recognized as extensively drug-resistant pathogens, three isolates were classified as multidrug-resistant pathogens. The major determinant of carbapenem resistance was blaOXA-48-like (53%), blaNDM-group was detected in 13% strains, a combination of blaNDM-group and blaOXA-48-like genes was found in 31% isolates. Two isolates harbored blaKPC-group. Most of the isolates had the virulence genes entB (100%), mrkD (99%), and ybtS (78%). The iutA gene was found in 16% strains. Four isolates had kfu gene and four strains carried rmpA gene. The K2 capsule type was determined in 13% isolates. Four ST dominated in the studied population: ST395 (26%), ST2975 (19%), ST198 (12%) and ST307 (11%). Conclusion. Carba-R KP isolates had a high level of resistance not only to carbapenems, but also to antibiotics of other classes. Carbapenem resistance was mainly associated with OXA-48 carbapenemase. The entB, mrkD and ybtS genes were the main determinants of virulence. The epidemically successful clones CG395 and CG307 were the predominant genetic lines. Resistance to antimicrobials was combined with the presence of various virulence factors. The data obtained are important for the epidemiological surveillance of the spread of KP and have important clinical implications.

Introduction. Since the middle of the last century, the conservative treatment of ileocecal intussusception (ICI) has dominated in children. However, questions on choosing a technique for conservative treatment and indications for surgical treatment remain open. Purpose. To assess the effectiveness of hydroechocolonoscopy (HEC) for ICI in children regardless of their age and disease duration. Material and methods. 160 children with confirmed ICI were enrolled in the study. All children, who had developed uncomplicated ICI for the first time, had HEC regardless of their age and disease duration. Failed hydrostatic disinvagination and disease relapse after HEC were indications for surgical management (laparoscopy, colonoscopy, laparotomy). To evaluate the effectiveness of conservative treatment at different age groups and at different terms of disease duration, two comparable trials were performed: 1 – stratification of patients by age: main group (n=130) - children older than one year, comparison group (n=30) – children younger than one year; 2 – stratification of patients by disease duration: main group (n=107) – more than 12 hours, comparison group (n=53) – up to 12 hours. To assess outcomes, the following parameters were analyzed: HEC effectiveness and complications, incidence of early relapses after HEC, causes of HEC failure and relapses after HEC, frequency and surgical techniques applied for treating ICI. Results. In the groups stratified by age, HEC effectiveness was 95.4% in the main group and 93.3% in the comparison group, p=0.216. Early relapses occurred in 10.3% in the main group and in 3.3% in the comparison group, p=0.128. In the groups stratified by the disease duration, HEC effectiveness was 93.5% in the main group and 98.1% in the comparison group, p=0.204. Early relapses occurred in 10.3% (11) in the main group and in 11.3% (6) of cases in the comparison group, p=0.841. There were no any complications during HEC procedure. Basic reasons for the conservative treatment failure were anatomical ones; for relapses – lymphoid hyperplasia of the abdominal cavity and anatomical reasons. Thus, HEC was effective in 95% of cases; relapses after HEC amounted up to 10.6%. Surgical interventions ( in 15.6%) were started with laparoscopy; laparoscopic disinvagination was effective in 68% of cases. Colonoscopy after successful laparoscopic disinvagination was performed in 5.6%, conversion to laparotomy was in 5% of the total number of observations. Conclusion. HEC is a highly effective and safe option for HEC conservative management in children regardless of child’s age and disease duration. Indications for surgical treatment for uncomplicated ICI are hydrostatic disinvagination failure and disease relapse.

The article discusses the literature data on the relationship of modified albumin by ishemia (IMA) and nitrosative stress (nitroalbumin/nitrotyrosine) to the ischemic/hypoxic damage of the brain and other organs. Data on the association of an increase in the content of IMA with a violation of the binding of serum albumin of metals, which is observed in processes accompanied by oxidative oxygen and nitrosative stress, are presented.

Objective - assessment of RT-PCR for the detection of carbapenem-resistance genes in gram-negative bacteria. A total, 499 strains of gram-negative microorganisms isolated in two pediatric hospitals in 2019-2020 were studied. Species identification was performed using MALDI-ToF mass-spectrometry (Bruker Daltonics, Germany). Meropenem and imipenem minimal inhibitory concentration (MIC) was determined by E-test method (BioMerieux, France). The presence of acquired carbapenemase genes of IMP, NDM, VIM, KPC, OXA-48, OXA-23, OXA-40, OXA-58-groups was determined by RT-PCR. Klebsiella pneumoniae (34%), Escherichia coli (4%), Serratia marcescens (6%) and other members of Enterobacterales (6%), also gram-negative non-glucose-fermenting bacteria Acinetobacter baumannii (14%), Pseudomonas aeruginosa (36%) were found among selected strains. Carbapenemase production was found in 385 isolates (77%). The main mechanism determining carbapenem resistance in P. aeruginosa was the production of blaVIM (100%). A. baumanii strains harbored OXA-23 (55%) and OXA-40 (45%) carbapenemases. The major determinant of carbapenem resistance in K. pneumoniae isolates was OXA-48 carbapenemase, detected in 63% strains, 13% of the strains possessed blaNDM-group, 16% isolates had a combination of blaNDM-group and blaOXA-48-like. Carbapenemase of KPC-group was found in 8% K. pneumoniae strains. OXA-48 carbapenemase prevailed (95%) among S. marcescens strains. Most of E. coli isolates harbored metallo-beta-lactamase NDM (89%). Other members of Enterobacterales most often had OXA-48 carbapenemase (57%), 39% of the isolates carried blaNDM-group. In one strain, a combination of blaNDM-group and blaOXA-48-like was discovered. RT-PCR is a fast and reliable method for the detection of acquired carbapenemases and can be recommended for routine use in bacteriological laboratories.

Introduction. Infections of the bloodstream and central nervous system (CNS) caused by Pseudomonas aeruginosa are associated with a serious patient conditions and are often accompanied by high mortality.Aim. Molecular genetic characterization of P. aeruginosa isolated from positive samples of blood cultures and cerebrospinal fluid of patients under 18 years of age from intensive care units of hospitals.Materials and methods. We conducted a retrospective study of bacteremia and CNS infection cases associated with P. aeruginosa from 2014 to 2021. 24 clinical isolates of P. aeruginosa from positive blood cultures and CSF were analyzed. MICs of antibiotics were determined by serial microdilution in broth. Identification of the genes of carbapenemase was carried out using real-time PCR. Virulence genes were determined by PCR. Population diversity was assessed by MLST.Results. More than 70% of isolates showed resistance to carbapenem antibiotics. The phenotype of multiple drug resistance had 25% of the isolates. Extreme resistance was shown by 54% of isolates. The detection rate of metallo-β-lactamases (MBL) was 54%. Based on PCR data, 33% of the strains were found to have the ExoU type, and 67% had the ExoS type. According to MLST, 16 genotypes were identified. The structure was dominated by two sequence types ST654 (29%) and ST235 (12.5%). The structure of patients was dominated by children with surgical pathology — 16 cases, and there were eight somatic patients. Fatal outcome was observed in 28% of cases with bacteremia and CNS infection associated with P. aeruginosa.Conclusion. P. aeruginosa isolates from positive blood cultures and CSF samples are highly resistant to antibiotics; virulence genes were found in all isolates. Strains of high epidemic risk prevailed in the studied sample. More than a quarter of the described clinical cases had an unfavorable outcome.