The article presents current approaches to medical care delivery in children with primary ciliary dyskinesia. The genetic heterogeneity of the disease causes the variability of pathological symptoms in clinical practice. The most common clinical manifestation in children is the frequent inflammatory diseases of the upper and lower respiratory tract which are registered in the majority of patients, especially in young children. However, the diagnosis is often untimely due to the low disease awareness among medical specialists. The article describes the algorithm for differential diagnostic search in detail, presents approaches to the treatment and management of pediatric patients with primary ciliary dyskinesia. The material is based on clinical recommendations developed and approved by the professional association «Union of Pediatricians of Russia»; recommendations were updated in 2018.

The article is devoted to bronchiectases issue in children and reflects the most actual approaches to the diagnosis and management of patients with this pathology. Information on the true prevalence of bronchiectases both abroad and in Russia varies. Wherein, bronchiectases can be either an independent disease or a manifestation of another pathology, which necessitates an integrated multidisciplinary approach not only for diagnosis but also for patient management with this pathology. The material presented by the authors is based on clinical guidelines developed and approved by the profile association of the Union of Pediatricians of Russia and aimed at raising awareness of specialists providing medical care to children.

After the introduction of the conjugated 7-valent pneumococcal vaccine (PCV7) the incidence of infections, caused by non-vaccine serotypes of S. pneumoniae, especially by 19А serotype, significantly increased. But in few countries similar phenomenon was observed before the vaccine introduction. In the present study we evaluated retrospective collection of non-invasive S. pneumonia strains of 19А-serotypes (n=49), isolated in Russia during 2002-2013. Majority (80%) of isolates were represented by four global clonal complexes: СС156, СС230, СС320, and СС663. During 2010-2013 isolates of 19А serotype were mainly represented by СС230 and СС320 (70%), replacing previously predominant СС156 and СС663. All CC156, CC320 and CC663 isolates demonstrated penicillin MIC of ≥1 mg/l, at the same time CC230 isolates had lower penicillin MICs and were fully susceptible to amoxicillin and ceftriaxone. This finding suggests that susceptibility to beta-lactams in pneumococci of 19А serotype is clone-associated.

The article is devoted to bronchiectases issue in children and reflects the most actual approaches to the diagnosis and management of patients with this pathology. Information on the true prevalence of bronchiectases both abroad and in Russia varies. Wherein, bronchiectases can be either an independent disease or a manifestation of another pathology, which necessitates an integrated multidisciplinary approach not only for diagnosis but also for patient management with this pathology. The material presented by the authors is based on clinical guidelines developed and approved by the profile association of the Union of Pediatricians of Russia and aimed at raising awareness of specialists providing medical care to children.

Background. Pneumococci (Streptococcus pneumoniae) represent major pathogens that cause acute infections in children. Objective. Our aim was to analyze dynamics of the distribution of nasopharyngeal pneumococcal serotypes and their antimicrobial susceptibility in children. Methods. A retrospective cohort study was conducted. We examined nasopharyngeal pneumococci isolated from children getting care at the National Medical Research Center of Children’s Health (Moscow) in 2010–2016. Serotyping was performed using specific antisera and/or by molecular typing employing PCR. Susceptibility to oxacillin (OXA), erythromycin (ERY), clindamycin (CLI), trimethoprim/sulfamethoxazol, chloramphenicol and tetracycline was tested by the disk diffusion method. In 2013–2016, penicillin (PEN), amoxicillin (AMX), ERY and CLI minimal inhibitory concentrations (MIC) were measured. Results. A total of 1,111 pneumococcal isolates were examined; the sample was obtained from children with a median age of 4 years (P25–P75, 2.4–6.5 years). We identified 48 pneumococcal serotypes; six leading serotypes were serotypes 3, 6А, 6В, 14, 19F and 23F aggregating a proportion of 63.2% in the overall distribution. From 2010 to 2016, the distribution of serotypes has not changed. Wherein, 13-valent pneumococcal conjugate vaccine covered 74% of serotypes in children under 5 years. The five leading serotypes (6А, 6В, 14, 19F, 23F and serotype 19A) had the highest resistance rate. Within 2010–2016, the proportion of OXA- and ERY-resistant pneumococci grew from 21.3% to 35.9% and from 24.5% to 36.9%, respectively. The majority (81.3%) of ERY-resistant isolates possessed an MLSB-phenotype, i. e. were resistant to macrolides, lincosamides, and streptogramin B. In 2013–2016, the rate of PEN- and AMX-resistant pneumococci was 34.6% and 3.5%, respectively. Conclusion. Within the seven year study period, no major shifts in the nasopharyngeal pneumococcal serotype distribution were observed. The pneumococci remained highly susceptible to AMX, but activity of macrolides was significantly reduced. Considering the leading mechanism of macrolide resistance, the use of any macrolides or lincosamides for empiric treatment of pneumococcal infections in children is questionable.

The article presents the most modern positions of healthcare delivery for children with primary ciliary dyskinesia. Symptoms of this pathology in clinical practice vary that is conditioned by genetic heterogeneity of the disease. The most common disease manifestation in children is frequent inflammatory diseases of the upper and lower respiratory tract. They are recorded in most patients, especially in young children, and the diagnosis is often determined untimely due to a low awareness of specialists about this nosology. Differential diagnostic approach is described in detail, peculiarities of treatment and management of children with this nosology are specified. The material is based on clinical guidelines developed and approved by the professional association «Union of Pediatricians of Russia».

: The paper using the analysis of international experience of bicycle infrastructure development proposes a concept of bicycle monitoring system for Moscow. The system is based on a set of “hard” (normed) and “soft” (perceived) indicators. Soft indicators ensure that the citizens’ views on various aspects of the development of Cycling infrastructure are taken into account through the identification of the perceived quality of infrastructure. Using deviations of the real indicators from the planned levels there may be developed programs and projects portfolios, as well as the decisions about possible directions to improve the city bicycle infrastructure may be taken.

The frequency and mechanisms of resistance to macrolides in Streptococcus.pyogenes isolated within 3 periods: 2011-2012 (246 strains), 2013-2014 (273 strains) and from January to November of 2015 (120 strains) were studied. The strains of S.pyogenes (639) were isolated from 17107 nasopharyngeal, vaginal and middle ear discharge smears of children on their visits to physiciants or hospitalization at somatic hospital departments. The susceptibility was tested by the disk diffusion method and E-test strips. Identification of the mechanisms of resistance to macrolides and lincosamides included phenotypic and molecular genetic methods. PCR was used to determine ermB and mef genes in 23 erythromycin resistant isolates. As compared to 2011-2012, resistance of S.pyogenes to macrolides increased from 5 to 16% in 2015 and that to clindamycin from 2 to 10%. Among 23 erythromycin resistant strains 6 (26.1%) belonged to the M phenotype, 3 (13.0%) belonged to the iMLS(b) phenotype and 14 (60.9%) belonged to the cMLS(b) pheno-type. The results of detecting the macrolide resistance genes in S.pyogenes showed that only 26.1% of the isolates expressed the mefA gene. The predominant share (65.2%) of the erythromycin resistant isolates possesed the ermB gene as a determinant and in 4.3% of the isolates the ermB gene was associatied with the mefgene. No resistance genes were detected 1 isolate. Therefore, the main mech- anism that determined resistance of S.pyogenes to macrolides was methylation of ribosomes mediated by the ermB gene.

Objective. Streptococcus pneumoniae (pneumococcus) is the leading cause of acute otitis media (AOM) in children. Hereby, we describe antibiotic susceptibility, clonality, and serotype distribution of pneumococci isolated from the middle ear fluid (MEF) in children with AOM. Materials and Methods. MEF specimens from children ≤5 years of age with AOM were collected in 4 pediatric hospitals in Moscow in 2011–2013. Isolation and identification of pneumococcus was performed using standard microbiological procedures. Antibiotic susceptibility was tested by means of the disk diffusion method, minimal inhibitory concentration (MIC) for penicillin and amoxicillin was determined by the E-test. Serotyping was performed using pneumococcal antisera from the Staten Serum Institut (Denmark). For the multilocus sequence typing, a conventional protocol was used. Results. A total of 107 pneumococcal isolates were analyzed. Penicillin nonsusceptibility (MIC >0.06 µg/L) was found in 45% (48/107) isolates, macrolide resistance had 34% (36/107) pneumococci. The vast majority of macrolide-resistant isolates (92%, 33/36) carried the ermB gene conferring a constitutive MLSB-phenotype, i.e. simultaneous resistance to all macrolides, lincosamides, streptogramin B. A multidrug resistant (MDR) phenotype displayed 30% (32/107) pneumococci, however all isolates were susceptible to amoxicillin (MIC ≤2 µg/mL). Ten of 32 (31%) MDR isolates belonged to clonal complex (CC) 320, the rest were distributed among 7 different CC. In the serotype distribution, isolates with serotype 19F (27%), 3 (12%), 6B (11%), 14 (11%), 19A (9%), and 23F (8%) predominated. Available polysaccharide pneumococcal conjugated vaccines (PCV) cover the majority of AOM serotypes (PCV7, 66%; PCV10, 67%; PCV13, 93%). Conclusions. AOM pneumococci circulating in Moscow are characterized by a substantial reduction in antimicrobial susceptibility and pronounced clonality. Pneumococcal serotype distribution suggests advantage of a PCV with the extended coverage.

Nasopharyngeal colonization with Streptococcus pneumoniae is a source of respiratory mucosal and invasive infections. For effective vaccine prophylaxis of these diseases the national monitoring of the circulating serotypes and antimicrobial resistance of Streptococcus pneumoniae is required. Objective: To analyze serotype diversity and antimicrobial resistance of S. pneumoniae in the nasopharyngeal carriage in children under 5 years. Methods and patients: The study included orphanage, nursery and children not attending preschool institutions (unorganized children) without respiratory infections and not receiving antibiotic therapy. Conducted microbiological analysis of nasopharyngeal flora, serotyping of pneumococcus, assess their sensitivity to antibiotics. Results: Nasopharyngeal carriage of S. pneumoniae was found in 23%, Moraxella catarrhalis - in 23%, Haemophilus influenzae - 16% of the 246 children included in the study. Serotype was determined in 54 pneumococcal isolates: predominant serotypes 19F (21%), 6B (15%), 23F (14%), 14 (8%). The coincidence of the spectrum obtained with serotypes members of the PCV7 pneumococcal conjugate vaccines and PKV10, was 81% in PKV13 - 90%. The proportion of strains sensitive to clindamycin, 31%, to macrolides - 40% to trimethoprim / sulfamethoxazole - 60%. Multiple resistance was observed in 37% of the identified pneumococcal serotypes. In erythromycin-resistant strains resistance was caused by the presence of ermB-gene (in 74% of cases) or mef-dependent efflux pump as the sole determinant (9%), in 17% of cases – with its association. Maximum antibiotic resistance is observed in pneumococcal vaccine serotypes. Conclusions: The results of the study comparing with previously obtained data shows stability over the past decades the spectrum of pneumococci circulating in the Russian population of children. A substantial increase in pneumococcal resistance to (especially vaccine serotypes) antibiotic penicillin, macrolides, clindamycin is observed.

The pneumococcus (Streptococcus pneumoniae) is a common bacterial pathogen responsible for various infections, especially in children below 5 years of age. The severity of pneumococcal infections varies from self-limiting mucosal infections, including acute otitis media, sinusitis, and noninvasive pneumonia, to life-threatening invasive disease like bacteremia and meningitis. A high incidence of pneumococcal infections is combined with a constantly growing antibiotic resistance of this pathogen. The growing resistance is thought to be associated with misuse of antibiotics and emerging of resistant clones that may spread throughout the entire population. Pneumococcal polysaccharide conjugate vaccines (PCV) contain an assortment of pneumococcal capsular polysaccharides (from 7 to 13) that produce serotype-specific protective antibodies. Since early 2000's, the introduction of PCV into national immunization programs has been shown to substantially decrease the incidence of invasive pneumococcal disease and pneumococcal carriage associated with vaccine-type pneumococci in many countries. In 2014, PCV vaccination was included in the Russian national calendar of prophylactic vaccination. The present article reviews the current literature on serotype prevalence, antibiotic susceptibility, and PCV effect on the evolution of pneumococcus.

Nosocomial infections and their rational antibiotic treatment represent a major challenge for the healthcare nowadays. In this context, gramnegative bacteria including Pseudomonas aeruginosa, Acinetobacter baumanii and Enterobacteriaceae spp. are etiologically important and characterized by a significant level of antibiotic resistance. To examine dynamics of the respiratory tract colonization by hospital flora, tracheal aspirates obtained at three time points from 69 children with severe craniocerebral trauma during their stay in ICU were analysed. Colonization was observed on the 4th day of the ICU stay with predomination of K.pneumoniae (45%) and A.baumanii (27-37%). P.aeruginosa was detected after the 8th day of the ICU stay with the isolation rate of 33%. Substantial proportions of P.aeruginosa (61%), A.baumanii (78%) and K.pneumoniae (25%) were resistant to carbapenems. In 65 carbapemen resistant isolates, the presence of carbapenemases was examined using PCRs. OXA-48 carbapenemase was detected in 11 out of 14 (78%) K.pneumoniae isolates. Among the A.baumanii isolates, 30/31 (97%) carried OXA-40 and 1/31 (3%) had OXA-23 carbapenemases. None of the examined A.baumanii and K.pneumoniae isolates produced metallo-betalactamases (MBL). In contrast, all 20 car-bapenem resistant P.aeruginosa isolates produced a MBL, and in 12 out of 20 (60%) of theme VIM-2 was detected. Thus, gramnegative nosocomial microflora rapidly colonizes ICU patients and has a high level of resistance to antibiotics, including carbapenems.

to investigate changing of Candida species (C. spp) distribution and expenditure for antimicrobial drugs in the intensive care unit (ICU). from 1.01.11 to 30.07.13 there were 200 patients with Candida spp positive samples in the ICU. We followed up antifungal drugs susceptibility of different C. spp. and evaluated expenditure for antifungal drugs. C spp was detected in 200 patients (12,2% of ICU microbiota). In 2011: 47 (19,3%); in 2012: 50 (9,3%); in 2013: 103 (12,1%) patients. The predominant species, detected during period of investigation was Candida albicans (C. a. ), which was isolated in 21 (44,7%), 21 (42%) and 52 (50,5%) patients in 2011,2012 and 2013 accordingly. Candida parapsilosis (C. p. ) was on second place and frequency of this fungus detecting increased: 1 (2,1%); 12 (24%); 31 (30,1%) patients. Candida tropicalis (C. t. ) was detected: in 5 (10,6%); 6 (12%); 10 (9,7%) patients. Candida glabrata (C. g. ): in 9 (19,1%); 3 (6%); 2 (1,9%). Candida krusei (C. k. ): in 6 (12,8%); 1 (2%); 1 (1%). Candida lusitaniae (C. l. ): in 2 (4,3%); 2 (4%); 3 (2,9%). Fluconazole susceptibility was: for C. a.: 100%; 89%; 97%; C. t. 82%; 94%, 92%, C. g 18%; 46%; 0% in 2011,2012 and 2013 accordingly; for C. p.: in 2012; 29%: in 2013: 23%. Changing of C. spp species distribution led to increasing of expenditure for antifungal drugs in ICU: 52% of expenditure for antimicrobial drugs in 2011; 72% in 2012; 78% in 2013. Echinocandines determined 44%; 65% and 70% of ICU expenditure for antimicrobial drugs in 2011; 2012; 2013 accordingly. Our data coordinate with modern tendency in C. spp changing in ICUs. Increasing of C. spp proportion, resistant to fluconazole requires more frequent echinocandines use, that leads to rise of hospital expenditure.

A difficult problem of Pseudomonas infection antibacterial treatment in patients with cystic fibrosis and its historical aspects are discussed in this article. Different medicinal forms of antibiotics are compared; the dosages for treatment in cystic fibrosis are shown. Efficacy and safety of inhalation form of tobramycin solution in patients with cystic fibrosis and chronic Pseudomonas infection are considered. Appropriateness of its administration in order to eradicate Pseudomonas aeruginosa as soon as it is found in the sputum, as well as in chronic persistence of this pathogen to prevent relapses of bronchopulmonary process and improvement of pulmonary function and microbiological stability is shown. The authors demonstrate their own data on usage of this drug, confirming its high tolerability and clinical effect.

Introduction. Biclotymol [bis(chloro-4-thymol)methyl] is a biphenol derivative used for local treatment of pharyngeal inflammatory diseases. It is an antiseptic drug with bacteriostatic and bactericidal effects. Objective: evaluation of the drug’s antibacterial activity towards opportunistic and normal oropharyngeal microflora and identification of its minimum bactericidal concentration for the main bacterial pathogens of the upper respiratory tract. Results: we revealed that antibacterial effect of biclotymol on mouth cavity microbiota manifests itself with elimination of such species and genera of opportunistic microflora as Staphylococcus aureus, Streptococcus pyogenes, Haemophilus spp. and anginosus streptococci. We also revealed antibacterial activity of biclotymol against normal microbiota representatives, which included viridans streptococci. Out of this group of streptococci, only 1/3 of the initial amount of Streptococcus salivarius remained in place. Alongside identification of the minimum inhibitory concentration (MIC) of biclotymol against opportunistic microflora we revealed the most sensitive bacteria requiring the lesser drug concentration for the antibacterial effect to take place – Streptococcus pneumoniae and Haemophilus influenzae; intermediate – Moraxella catarrhalis, S. pyogenes and S. aureus; and resistant – non-pathogenic Neisseria species. Among the strains that survived biclotymol exposure, MIC was the highest in Neisseria spp. – 20 mg/ml after a 30‑minute-long exposure. Conclusions: results of a study of antibacterial effect of a topical antiseptic containing biclotymol demonstrated that the drug’s bactericidal activity is primarily aimed at gram-positive cocci represented both by opportunistic and non-pathogenic microbes. Non-pathogenic Neisseria species abundantly inhabiting mouth cavity mucosae and gram-negative rod-like microbes, which are uncharacteristic of the biotope under study, appeared to be resistant to bactericidal effect of biclotymol. Preservation of these microbes may somewhat prevent oropharyngeal colonization by undesirable pathogenic species.