oncotomskСибирский онкологический журналSiberian journal of oncology1814-48612312-3168Tomsk National Research Medical Сепtеr of the Russian Academy of Sciences10.21294/1814-4861-2017-16-1-91-97oncotomsk-497Research ArticleОБЗОРЫREVIEWSНОЗОКОМИАЛЬНЫЕ ИНФЕКЦИИ У ОНКОЛОГИЧЕСКИХ БОЛЬНЫХ: ПРОБЛЕМА НАРАСТАЮЩЕЙ РЕЗИСТЕНТНОСТИ ГРАМОТРИЦАТЕЛЬНЫХ МИКРООРГАНИЗМОВNASOCOMIAL INFECTOIONS IN CANCER PATIENTS: PROBLEM OF GRAM-NEGATIVE BACTERIAL RESISTANCEГригорьевскаяЗ. В.GrigorievskayaZ. V.

доктор медицинских наук, старший научный сотрудник лаборатории микробиологической диагностики и лечения инфекций в онкологии

SPIN-код: 4416-5191.

MD, DSc, Senior Researcher

SPIN-code: 4416-5191

zlatadoc@list.ruПетуховаИ. Н.PetukhovaI. N.

доктор медицинских наук, ведущий научный сотрудник лаборатории микробиологической диагностики и лечения инфекций в онкологии

SPIN-код: 1265-2875.

MD, DSc, Leading Research Scientist

SPIN-code: 1265-2875.

irinapet@list.ruБагироваН. С.BagirovaN. S.

доктор медицинских наук, ведущий научный сотрудник лаборатории микробиологической диагностики и лечения инфекций в онкологии

SPIN-код: 3189-8188

MD, DSc, Leading Research Scientist

SPIN-code: 3189-8188.

nbagirova@mail.ruШильниковаИ. И.ShilnikovaI. I.

доктор медицинских наук, старший научный сотрудник лаборатории микробиологической диагностики и лечения инфекций в онкологии

SPIN-код: 9400-6222.

MD, DSc, Senior Researcher

SPIN-code: 9400-6222

iish54@mail.ruТерещенкоИ. В.TereshchenkoI. V.

научный сотрудник лаборатории микробиологической диагностики и лечения инфекций в онкологии

Research fellow

in.ter68@inbox.ruГригорьевскийЕ. Д.GrigorievskyE. D.

студент 5-го курса лечебного факультета

5-th year student

mrjake916@gmail.comДмитриеваН. В.DmitrievaN. V.

доктор медицинских наук, профессор, руководитель лаборатории микробиологической диагностики и лечения инфекций в онкологии

SPIN-код: 8217-2448.

MD, DSc, Professor, Head of the Laboratory of Microbiological Diagnostics and Management

SPIN-code: 8217-2448.

prof.ndmitrieva@mail.ruФГБУ «Российский онкологический научный центр им. Н.Н. Блохина» МЗ РФ, г. МоскваРоссияLaboratory of Microbiological Diagnostics and Management of Infections in Cancer Patients, N.N. Blokhin Russian Cancer Research CenterRussian FederationФГБОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» МЗ РФ, г. МоскваРоссияI.M. Sechenov First Moscow State Medical University, MoscowRussian Federation2017220320171619197Copyright © Григорьевская З.В., Петухова И.Н., Багирова Н.С., Шильникова И.И., Терещенко И.В., Григорьевский Е.Д., Дмитриева Н.В., 20172017Григорьевская З.В., Петухова И.Н., Багирова Н.С., Шильникова И.И., Терещенко И.В., Григорьевский Е.Д., Дмитриева Н.В.Grigorievskaya Z.V., Petukhova I.N., Bagirova N.S., Shilnikova I.I., Tereshchenko I.V., Grigorievsky E.D., Dmitrieva N.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.siboncoj.ru/jour/article/view/497

Проблема профилактики и лечения нозокомиальных (госпитальных) инфекций в течение многих столетий волнует прогрессивные умы человечества. Риск и частота развития госпитальных инфекций во всем мире постоянно увеличиваются. Бороться с ними все сложнее. Особое внимание заслуживают нозокомиальные инфекции, вызванные резистентными грамотрицательными микроорганизмами. Эта проблема актуальна для клиник всех стран. В большинстве стран разработаны национальные программы по предотвращению развития резистентности и распространения устойчивых штаммов. Онкологические больные представляют особую группу больных. Инфекционные осложнения развиваются у них чаще и протекают тяжелее, чем у пациентов общего профиля. Чаще всего инфекционные осложнения у этих пациентов вызваны ассоциациями внутрибольничных микроорганизмов. Особенно опасны осложнения, вызванные резистентными грамотрицательными микроорганизмами: P. aeruginosa, A. baumannii, K. рneumoniaе. Лечение таких пациентов становится непростой задачей, требующей слаженной работы микробиологов и клиницистов.

 

The problem of prevention and treatment of hospital-acquired (nosocomial) infections excites progressive minds of humanity for centuries. The risk and incidence of nosocomial infections are constantly increasing. It becomes harder and harder to fight with them. Special attention is paid to nosocomial infections caused by resistant gram-negative organisms. This is a problem for clinics in all countries. National programs for the prevention of the development and spread of resistant strains have been developed in the majority of countries. Infectious complications develop more frequently and more severe in cancer patients than in non-cancer patients. Infectious complications in these patients are mainly associated with hospital-acquired infections. Complications caused by resistant gram-negative microorganisms, such as P. aeruginosa, A. baumannii and K. rneumoniae are especially dangerous complications. The clinical management of these patients is difficult and requires teamwork of microbiologists and clinicians.

онкологические больныеP. aeruginosaA. baumanniiK. pneumoniaерезистентные грамотрицательные микроорганизмынозокомиальные инфекциилечение инфекцийантибиотикиcancer patientsP. aeruginosaA. baumanniiK. рneumoniaеresistant gram-negative microorganismsnosocomial infectionstreatment of infectionsantibioticsReferencesГригорьевская З.В. Стратегия лечения нозокомиальных инфекций, вызванных резистентными микроорганизмами, в онкологической клинике [дис... докт. мед. наук]. [Москва]; 2015. 252 с.Grigorievskaya Z.V. Treatment strategy for nosocomial infections caused by resistant microorganisms in cancer clinics. [Doctoral thesis]. [Moscow]; 2015. 252 p. [in Russian]Григорьевская З.В. Актуальность проблемы госпитальных инфекций в онкологической клинике. Вестник РОНЦ им. Н.Н. Блохина РАМН. 2013; 24 (3–4): 46–49.Grigorievskaya Z.V. Problem of hospital-acquired infections in cancer clinics. Вестник РОНЦ им. Н.Н. Блохина РАМН. 2013; 24 (3–4): 46–49. [in Russian]Григорьевская З.В., Петухова И.Н., Дьякова С.А., Дмитриева Н.В. Особенности течения инфекционных осложнений, вызванных панрезистентными Acinetobacter baumanii у онкологических больных. Сибирский онкологический журнал. 2011; 6: 14–18.Grigorievskaya Z.V., Petukhova I.N., Dyakova S.A., Dmitrieva N.V. Infectious infections caused by Acinetobacter baumanii in cancer patients. Siberial Journal of Oncology. 2011; 6: 14–18. [in Russian]Cидоренко С.В., Резван С.П., Еремина Л.В., Поликарпова С.В., Карбак В.И., Меньшикова Е.Д., Тишков В.И., Черкашин Е.А., Белобородов В.Б. Этиология тяжелых госпитальных инфекций в отделениях реанимации и антибиотикорезистентность среди их возбудителей. Антибиотики и химиотерапия. 2005; 2–3 (50): 33–41.Sidorenko S.V., Rezvan S.P., Eremina L.V., Polikarpova S.V., Karbak B.I., Menshikova Е.D. Etiology of severe hospital-acquired infections in intensive care departments and antibiotic resistance among pathogens. Antibiotics and chemotherapy. 2005; 2–3 (50): 33–41. [in Russian]Сидоренко С.В., Тишков В.И. Молекулярные основы резистентности к антибиотикам. Успехи биологической химии. 2004; 44: 263–306.Sidorenko S.V., Tishkov V.I. Molecular bases of resistance to antibiotics. Advances in biological chemistry. 2004; 44: 263–306. [in Russian]Dent L.L., Marshall D.R., Pratap S. Multidrug resistant Acinetobacter baumannii: a descriptive study in a city hospital. BMC Infect Dis. 2010 Jul 7; 10: 196. doi: 10.1186/1471-2334-10-196.Dent L.L., Marshall D.R., Pratap S. Multidrug resistant Acinetobacter baumannii: a descriptive study in a city hospital. BMC Infect Dis. 2010 Jul 7; 10: 196. doi: 10.1186/1471-2334-10-196.Esposito S., Leon S. Antimicrobial treatment of infections in intensive care units. Role of infectious disease. Int J Antimicr Agents. 2007; 29: 494–500.Esposito S., Leon S. Antimicrobial treatment of infections in intensive care units. Role of infectious disease. Int J Antimicrob Agents. 2007; 29: 494–500.WHO Global Strategy for Containment of Antimicrobial Resistance. World Health Organization. Geneva. 2001; 90.WHO Global Strategy for Containment of Antimicrobial Resistance. World Health Organization. Geneva. 2001; 90.Center for Disease Control and Prevention [cited 01.11.2016]. Available from: www.cdc.gov.Center for Disease Control and Prevention [cited 01.11.2016]. Available from: www.cdc.gov.Белоцерковский Б.З., Гельфанд Е.Б., Попов Т.В., Краснов В.Г. Проблемные госпитальные микроорганизмы. Acinetobacter spp – возбудитель или свидетель. Инфекции в хирургии. 2008; 1 (6): 18–24.Belotserkovsky B.Z., Gelfand Е.B., Popov T.V., Krasnov V.G. Hospital-acquired microorganisms. Infections in surgery. 2008; 1 (6): 18–24. [in Russian]Давыдов М.И., Дмитриева Н.В. Инфекции в онкологии. М., 2009; 472 с.Davydov М.I., Dmitrieva N.V. Infections in oncology. Moscow. 2009; 472 p. [in Russian]Bowers D.R., Liew Y.X., Lye D.C., Kwa A.L., Hsu L.Y., Tam V.H. Outcomes of appropriate empiric combination versus monotherapy for P.aeruginosa bacteremia. Antimicrob Agents Chemother. 2013 Mar; 57 (3): 1270–4. doi: 10.1128/AAC.02235-12.Bowers D.R., Liew Y.X., Lye D.C., Kwa A.L., Hsu L.Y., Tam V.H. Outcomes of appropriate empiric combination versus monotherapy for P. aeruginosa bacteremia. Antimicrob Agents Chemother. 2013 Mar; 57 (3): 1270–4. doi: 10.1128/AAC.02235-12.Mandel G.L. Principles and Practice of Infections Diseases. 16th ed. Elsevier Churchill Livingstone, 2010; 4320 р.Mandel G.L. Principles and Practice of Infections Diseases. 16th ed. Elsevier Churchill Livingstone, 2010; 4320 р.Wang C.Y., Jermg J.S., Cheng K.Y. Pandrug-resistant Pseudomonas aeruginosa among hospitalized patients: clinical features, risk-factors and outcomes. Clinical Microbiology and Infection. 2006; 12: 63–64.Wang C.Y., Jermg J.S., Cheng K.Y. Pandrug-resistant Pseudomonas aeruginosa among hospitalized patients: clinical features, risk-factors and outcomes. Clinical Microbiology Infection. 2006; 12: 63–64.Руднов В.А., Зубарев А.С. Инфекции в отделениях реанимации и интенсивной терапии, вызванные P.aeruginosa и Acinetobacter spp. Consilium medicum. 2008; 1: 37–44.Rudnov V.А., Zubarev А.S. Infections caused by P. aeruginosa и Acinetobacter spp in intensive care unit. Consilium medicum. 2008; 1: 37 44. [in Russian]Gootz T.D., Marra A. Acinetobacter baumannii: An Emerging Multidrug-resistant Threat: Overview of Antibiotic-resistance mechanism. Expert Review of Anti-infective Therapy. 2008; 6 (3): 309–325.Gootz T.D., Marra A. Acinetobacter baumannii: An Emerging Multidrug-resistant Threat: Overview of Antibiotic-resistance mechanism. Expert Review of Anti-infective Therapy. 2008; 6 (3): 309–325.Peleg A.Y., Seifert H., Paterson D.L. Acinetobacter baumannii: emergence of a successful pathogen. Clin Microbiol Rev. 2008 Jul; 21 (3): 538–82. doi: 10.1128/CMR.00058-07.Peleg A.Y., Seifert H., Paterson D.L. Acinetobacter baumannii: emergence of a successful pathogen. Clin Microbiol Rev. 2008 Jul; 21 (3): 538–82. doi: 10.1128/CMR.00058-07.Abbott I., Cerqueira G.M., Bhuiyan S., Peleg A.Y. Carbapenem Resistance in Acinetobacter baumannii. Expert Rev Anti Infect Ther. 2013 Apr; 11 (4): 395–409. doi: 10.1586/eri.13.21.Abbott I., Cerqueira G.M., Bhuiyan S., Peleg A.Y. Carbapenem Resistance in Acinetobacter baumannii. Expert Rev Anti Infect Ther. 2013 Apr; 11 (4): 395–409. doi: 10.1586/eri.13.21.Adams M.D., Nickel G.C., Bajaksouzian S., Lavender H., Murthy A.R., Jacobs M.R., Bonomo R.A. Resistance to Colistin in Acinetobacter baumannii Associated with Mutations in the PmrAB Two-Component System. Antimicrob Agents Chemother. 2009 Sep; 53 (9): 3628–34. doi: 10.1128/AAC.00284-09.Adams M. D., Nickel G.C., Bajaksouzian S., Lavender H., Murthy A.R., Jacobs M.R., Bonomo R.A. Resistance to Colistin in Acinetobacter baumannii Associated with Mutations in the PmrAB Two-Component System. Antimicrob Agents Chemother. 2009 Sep; 53 (9): 3628–34. doi: 10.1128/AAC.00284-09.Bonomo R.A., Szabo D. Mechanisms of Multidrug Resistance in Acinetobacter species and Pseudomonas aeruginosa. Clinical Infectious Diseases. 2006; 43 (2): 49–56. doi: 10.1086/504477.Bonomo R.A., Szabo D. Mechanisms of Multidrug Resistance in Acinetobacter species and Pseudomonas aeruginosa. Clinical Infectious Diseases. 2006; 43 (2): 49–56. doi: 10.1086/504477.Cai Y., Chai D., Wang R., Liang B., Bai N. Colistin resistance of Acinetobacter baumannii: clinical reports, mechanisms and antimicrobial strategies. J Antimicrob Chemother. 2012 Jul; 67 (7): 1607–15. doi: 10.1093/jac/dks084.Cai Y., Chai D., Wang R., Liang B., Bai N. Colistin resistance of Acinetobacter baumannii: clinical reports, mechanisms and antimicrobial strategies. J Antimicrob Chemother. 2012 Jul; 67 (7): 1607–15. doi: 10.1093/jac/dks084.Chiu C.H., Lee H.Y., Tseng L.Y., Chen C.L., Chia J.H., Su L.H., Liu S.Y. Mechanisms of resistance to ciprofloxacin, ampicillin/sulbactam and imipenem in Acinetobacter baumannii clinical isolates in Taiwan. Int J Antimicrob Agents. 2010 Apr; 35 (4): 382–6. doi: 10.1016/j. ijantimicag.2009.12.009Chiu C.H., Lee H.Y., Tseng L.Y.,Chen C.L.,Chia J.H., Su L.H., Liu S.Y. Mechanisms of resistance to ciprofloxacin, ampicillin/sulbactam and imipenem in Acinetobacter baumannii clinical isolates in Taiwan. Int J Antimicrob Agents. 2010 Apr; 35 (4): 382–6. doi: 10.1016/j. ijantimicag.2009.12.009Gordon N.C., Wareham D.W. Multidrug-resistant Acinetobacter baumannii: mechanisms and resistance. Int J Antimicr Agents. 2010; 35 (3): 219–22.Gordon N.C., Wareham D.W. Multidrug-resistant Acinetobacter baumannii: mechanisms and resistance. Int J Antimicrob Agents. 2010; 35 (3): 219–22.Kim Y.J., Hong K.W., Wie S.H., Park Y.J., Jeong H., Kan M.W. Carbapenem-resistant Acinetobacter baumannii: diversity of resistant mechanisms and risk factors for infection. Epidemiol Infect. 2012 Jan; 140 (1): 137–45. doi: 10.1017/S0950268811000744.Kim Y.J., Hong K.W., Wie S.H., Park Y.J., Jeong H., Kan M.W. Carbapenem-resistant Acinetobacter baumannii: diversity of resistant mechanisms and risk factors for infection. Epidemiol Infect. 2012 Jan; 140 (1): 137–45. doi: 10.1017/S0950268811000744.Lee H.Y., Chen C.L., Wang S.B., Su L.H., Chen S.H., Liu S.Y., Wu T.L., Lin T.Y., Chiu C.H. Imipenem heteroresistance induced by imipenem in multidrug-resistant Acinetobacter baumannii: mechanism and clinical implications. Int J Antimicrob Agents. 2011 Apr; 37 (4): 302–8. doi: 10.1016/j.ijantimicag.2010.12.015Lee H.Y., Chen C.L., Wang S.B., Su L.H., Chen S.H., Liu S.Y., Wu T.L., Lin T.Y., Chiu C.H. Imipenem heteroresistance induced by imipenem in multidrug-resistant Acinetobacter baumannii: mechanism and clinical implications. Int J Antimicrob Agents. 2011 Apr; 37 (4): 302–8. doi: 10.1016/j.ijantimicag.2010.12.015Дмитриева Н.В., Григорьевская З.В., Дьякова С.А., Ключникова И.А., Петухова И.Н. Разработка стратегических подходов терапии инфекций, вызванных мультирезистентными Acinetobacter baumanii. Сибирский онкологический журнал. 2012; 4: 11–19.Dmitrieva N.V., Grigorievskaya Z.V., Dyakova S.А., Klyuchnikova I.А., Petukhova I.N. Therapeutic strategies against infections caused by multiresistant Acinetobacter baumanii. Siberian Journal of Oncology. 2012; 4: 11–19. [in Russian]Falagas M.E., Bliziotis I.A., Siempos I.I. Attributable mortality of Acinetobacter baumannii infections in critically ill patients: a systematic review of matched cohort and case-control studies. Critical Care. 2006; 10: 48.Falagas M.E., Bliziotis I.A., Siempos I.I. Attributable mortality of Acinetobacter baumannii infections in critically ill patients: a systematic review of matched cohort and case-control studies. Critical Care. 2006; 10: 48.Monaghan K. Strategic Implications of Global Health. National intelligence council Washington DC. 2008; ICA-2008-10D.Monaghan K. Strategic Implications of Global Health. National intelligence council Washington DC. 2008; ICA-2008-10D.Poirel L., Potron A., Nordmann P. OXA-48-like carbapenemases: the phantom menace. J Antimicrob Chemother. 2012 Jul; 67 (7): 1597–606. doi: 10.1093/jac/dks121.Poirel L., Potron A., Nordmann P. OXA-48-like carbapenemases: the phantom menace. J Antimicrob Chemother. 2012 Jul; 67 (7): 1597–606. doi: 10.1093/jac/dks121.Guidance for Control of Carbapenem-Resistant Enterobacteriaceae [cited 01.11.2016).]. Available from: www.cdc.gov.Guidance for Control of Carbapenem-Resistant Enterobacteriaceae [cited 01.11.2016).]. Available from: www.cdc.gov.Poirel L., Schrenzel J., Cherkaoui A., Bernabeu S., Renzi G., Nordmann P. Molecular analysis of NDM-1-producing enterobacterial isolates from Geneva, Switzerland. J Antimicrob Chemother. 2011 Aug; 66 (8): 1730–3. doi: 10.1093/jac/dkr174.Poirel L., Schrenzel J., Cherkaoui A. , S. Bernabeu, G. Renzi, P. Nordmann. Molecular analysis of NDM-1-producing enterobacterial isolates from Geneva, Switzerland. J Antimicrob Chemother. 2011 Aug; 66 (8): 1730–3. doi: 10.1093/jac/dkr174.Шабанова В.В., Краснова М.В., Божкова С.А., Агеевец В.А., Лазарева И.В., Рукина А.Н., Сидоренко С.В. Первый случай выявления в России Klebsiella Pneumoniae ST147, продуцирующий NDM-1 карбапенемазу в травматолого-ортопедическом стационаре. Травматология и ортопедия России. 2015; 2 (76): 90–98.Shabanova V.V., Krasnova М.V., Bozhkova S.А., Ageevets V.А., Lazareva I.V., Rukina А.N., Sidorenko S.V. The first case of detection of Klebsiella Pneumoniae ST147 in Russia, producing NDM-1 carbapenemases in trauma and orthopedic hospital. Traumatology and Orthopedics. 2015; 2 (76); 90–98. [in Russian]European Centre for Disease Prevention and Control. Antimicrobial resistance surveillance in Europe 2015. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). Stockholm: ECDC; 2017.European Centre for Disease Prevention and Control. Antimicrobial resistance surveillance in Europe 2015. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). Stockholm: ECDC; 2017.Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery. American Journal of Health-System Pharmacy. 2013; 70: 195–283.Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery. American Journal of Health-System Pharmacy. 2013; 70: 195–283.Snitkin E.S., Zelazny A.M., Thomas P.J., Stock F., NISC Comparative Program Group, Henderson D.K., Palmore T.N., Seqre J.A. Tracking a Hospital Outbreak of Carbapenem-Resistant Klebsiella pneumoniae with Whole-Genome Sequencing. Sci Transl Med. 2012 Aug 22; 4 (148): 148ra116. doi: 10.1126/scitranslmed.3004129.Snitkin E.S., Zelazny A.M., Thomas P.J., Stock F., NISC Comparative Program Group, Henderson D.K., Palmore T.N., Seqre J.A. Tracking a Hospital Outbreak of Carbapenem-Resistant Klebsiella pneumoniae with Whole-Genome Sequencing. Sci Transl Med. 2012 Aug 22; 4 (148): 148ra116. doi: 10.1126/scitranslmed.3004129.Kumarasamy K.K., Toleman M.A., Walsh T.R., Bagaria J., Butt F., Balakrishnan R., Chaudhary U., Doumith M., Giske C.G., Irfan S., Krishnan P., Kumar A.V., Maharjan S., Mushtaq S., Noorie T., Paterson D.L., Pearson A., Perry C., Pike R., Rao B., Ray U., Sarma J.B., Sharma M., Sheridan E., Thirunarayan M.A., Turton J., Upadhyay S., Warner M., Welfare W., Livermore D.M., Woodford N. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infect Dis. 2010 Sep; 10 (9): 597–602. doi: 10.1016/S1473-3099(10)70143-2.Kumarasamy K.K., Toleman M.A., Walsh T.R., Bagaria J., Butt F., Balakrishnan R., Chaudhary U., Doumith M., Giske C.G., Irfan S., Krishnan P., Kumar A.V., Maharjan S., Mushtaq S., Noorie T., Paterson D.L., Pearson A., Perry C., Pike R., Rao B., Ray U., Sarma J.B., Sharma M., Sheridan E., Thirunarayan M.A., Turton J., Upadhyay S., Warner M., Welfare W., Livermore D.M., Woodford N. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infect Dis. 2010 Sep; 10(9): 597 602. doi: 10.1016/S1473-3099(10)70143-2.Yong D., Toleman M.A., Giske C.G., Cho H.S., Sundman K., Lee K., Walsh T.R. Characterization of a new metallo-beta-lactamase gene, blandm-1, and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicr Agents Chemother. 2009; 53: 5046 54.Yong D., Toleman M.A., Giske C.G., Cho H.S., Sundman K., Lee K., Walsh T.R. Characterization of a new metallo-beta-lactamase gene, blandm-1, and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrob Agents Chemother. 2009; 53: 5046–54.Chen Y., Lin A., Siu L.K., Koh T.H. Sequence of Closely Related Plasmids Encoding bla (NDM-1) in Two Unrelated Klebsiella pneumoniae Isolates in Singapore. PLoS One. 2012; 7 (11): e48737. doi: 10.1371/ journal.pone.0048737.Chen Y., Lin A., Siu L.K., Koh T.H. Sequence of Closely Related Plasmids Encoding bla (NDM-1) in Two Unrelated Klebsiella pneumoniae Isolates in Singapore. PLoS One. 2012; 7 (11): e48737. doi: 10.1371/ journal.pone.0048737.Kallen A., Guh A. United states centers for disease control and prevention issue updated guidance for tackling carbapenem-resistant enterobacteriaceae. Eurosurveillance. 2012; 17(Issue 26): 27.Kallen A., Guh A. United states centers for disease control and prevention issue updated guidance for tackling carbapenem-resistant enterobacteriaceae. Eurosurveillance. 2012; 17 (Issue 26): 27.Григорьевская З.В., Петухова И.Н., Дмитриева Н.В. Вспышка внутрибольничной инфекции, вызванной мультирезистентными (MDR) штаммами K. pneumoniae. Сибирский онкологический журнал. 2014; 2: 5–8.Grigorievskaya Z.V., Petukhova I.N., Dmitrieva N.V. An outbreak of nosocomial infections caused by multiresistant (MDR) strains of K.pneumoniae. Siberian Journal of Oncology. 2014; 2: 5–8. [in Russian]

The authors declare that there are no conflicts of interest present.