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PubMed | The Burdenko Neurosurgery Institute, Schlossberg Klinik for Early Neurological Rehabilitation, Innsbruck Medical University, O. Landeskrankenhaus Hochzirl and 10 more.
Type: Journal Article | Journal: European journal of trauma and emergency surgery : official publication of the European Trauma Society | Year: 2016

Epidemiology in Europe shows constantly increasing figures for the apallic syndrome (AS)/vegetative state (VS) as a consequence of advanced rescue, emergency services, intensive care treatment after acute brain damage and high-standard activating home nursing for completely dependent end-stage cases secondary to progressive neurological disease. Management of patients in irreversible permanent AS/VS has been the subject of sustained scientific and moral-legal debate over the past decade.A task force on guidelines for quality management of AS/VS was set up under the auspices of the Scientific Panel Neurotraumatology of the European Federation of Neurological Societies to address key issues relating to AS/VS prevalence and quality management. Collection and analysis of scientific data on class II (III) evidence from the literature and recommendations based on the best practice as resulting from the task force members expertise are in accordance with EFNS Guidance regulations.The overall incidence of new AS/VS full stage cases all etiology is 0.5-2/100.000 population per year. About one third are traumatic and two thirds non traumatic cases. Increasing figures for hypoxic brain damage and progressive neurological disease have been noticed. The main conceptual criticism is based on the assessment and diagnosis of all different AS/VS stages based solely on behavioural findings without knowing the exact or uniform pathogenesis or neuropathological findings and the uncertainty of clinical assessment due to varying inclusion criteria. No special diagnostics, no specific medical management can be recommended for class II or III AS treatment and rehabilitation. This is why sine qua non diagnostics of the clinical features and appropriate treatment of AS/VS patients of AS full, remission, defect and end stages require further professional training and expertise for doctors and rehabilitation personnel.Management of AS aims at the social reintegration of patients or has to guarantee humanistic active nursing if treatment fails. Outcome depends on the cause and duration of AS/VS as well as patients age. There is no single AS/VS specific laboratory investigation, no specific regimen or stimulating intervention to be recommended for improving higher cerebral functioning. Quality management requires at least 3 years of advanced training and permanent education to gain approval of qualification for AS/VS treatment and expertise. Sine qua non areas covering AS/VS institutions for early and long-term rehabilitation are required on a population base (prevalence of 2/100.000/year) to quicken functional restoration and to prevent or treat complications. Caring homes are needed for respectful humane nursing including basal sensor-motor stimulating techniques. Passive euthanasia is considered an act of mercy by physicians in terms of withholding treatment; however, ethical and legal issues with regard to withdrawal of nutrition and hydration and end of life discussions raise deep concerns. The aim of the guideline is to provide management guidance (on the best medical evidence class II and III or task force expertise) for neurologists, neurosurgeons, other physicians working with AS/VS patients, neurorehabilitation personnel, patients, next-of-kin, and health authorities.


PubMed | The Burdenko Neurosurgery Institute and State Research Center for Applied Microbiology and Biotechnology
Type: | Journal: Annals of clinical microbiology and antimicrobials | Year: 2015

The spread of carbapenemase-producing Enterobacteriaceae (CPE) is a great problem of healthcare worldwide. Study of the spread for bla OXA-48-like genes coding epidemically significant carbapenemases among hospital pathogens is important for the regional and global epidemiology of antimicrobial resistance.Antibacterial resistant isolates of Klebsiella pneumoniae (n=95) from 54 patients, P. mirabilis (n=32) from 20 patients, Enterobacter aerogenes (n=6) from four patients, and Enterobacter cloacae (n=4) from four patients were collected from January, 2013 to October, 2014 in neurosurgical intensive care unit (ICU) of the Burdenko Neurosurgery Institute, Moscow. Characteristics of the isolates were done using susceptibility tests, PCR detection of the resistance genes, genotyping, conjugation, DNA sequencing, and bioinformatic analysis.Major strains under study were multi drug resistant (MDR), resistant to three or more functional classes of drugs simultaneously-98.9% K. pneumoniae, 100% P. mirabilis, one E. aerogenes isolate, and one E. cloacae isolate. Molecular-genetic mechanism of MDR in K. pneumoniae and P. mirabilis isolates were based on carrying of epidemic extended-spectrum beta-lactamase bla CTX-M-15 gene (87.2 and 90.6% accordingly), carbapenemase bla OXA-48-like gene (55.3 and 23.3% accordingly), and class1 (54.8 and 31.3% accordingly) and class 2 (90.6% P.mirabilis) integrons. The bla OXA-48-like-positive K.pneumoniae were collected during whole two-year surveillance period, while P.mirabilis and Enterobacter spp. carrying bla OXA-48-like genes were detected only after four and 18months after the research start, respectively. The bla OXA-48-like gene acquisition was shown for P.mirabilis isolates collected from five patients and for E.cloacae isolate collected from one patient during their stay in the ICU, presumably from bla OXA-48-like-positive K.pneumoniae. The source of the bla OXA-244 gene acquired by E.aerogenes isolates and the time of this event were not recognized.The expanding of CPE in the surveyed ICU was associated with the spread of bla OXA-48 and bla OXA-244 carbapenemase genes documented not only among K. pneumoniae, well-known bacterial host for such genes, but among P. mirabilis, E. aerogenes, and E.cloacae.

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