Инструкция по эксплуатации;pdf

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Guerrant et al. Clin Infect Dis 2001; 32:331-50
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, 6,8
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:
>6
$
: 11,6
, 2008-2010
.
CFR (case-fatality rate) –
Schmid et al. Journal of International and Public Health 2014; 7:133
,
• Campylobacter spp. Riddle et al. Dig Dis Sci 2013; 58:3242
(Salmonella spp.,
Shigella spp., Campylobacter spp., Yersinia spp.):
2,7, 95%
2,1-3,6)
1,3, 95%
1,0-1,9)
1,6, 95%
1,3-2,0)
1,6, 95%
1,4-1,8)
Porter et al. BMC Gastroenterology 2013; 13:46
(
– Campylobacter spp. – 9
– Salmonella spp. – 12
– Shigella spp. – 12
:
1000
1000
1000
Ajene et al. J Health Popul Nutr 2013; 31:299
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,
)
–
,
,
,
,
,
,
,
,
,
:
Vibrio cholerae
Salmonella spp.
E.coli
E.coli
Vibrio parahaemolyticus
Yersinia spp.
:
Clostridium perfringens
Clostridium difficile
Staphylococcus aureus
Bacillus cereus
:
Norovirus
Rotavirus
Adenovirus
Astrovirus
Calicivirus
:
Giardia lamblia
Cryptosporidium
Isospora spp.
Cyclospora spp.
Hatchette et al. CMAJ 2011; 183:339
:
Shigella spp.
Campylobacter spp.
E.coli
E.coli
Aeromonas spp.
Yersinia spp.
Salmonella spp.
:
Entamoeba histolytica
Balantidium coli
Hatchette et al. CMAJ 2011; 183:339
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Hatchette et al. CMAJ 2011; 183:339
:
– Salmonella spp., Shigella spp., Campylobacter spp., EHEC
(STEC) +
C.difficile
30
(
E.coli)
:
– Yersinia spp.
E.coli (EIEC, ETEC, EPEC,
EAEC)
– Vibrio spp., Aeromonas spp., Plesiomonas spp., Edwardsiella
tarda, S.aureus
Baron et al. Clinical Infectious Diseases 2013; 57:485
(
Shigella spp.
,
Salmonella spp.,
.–
)
–
)
(
)
:
,
«3
»
>3
,
(Campylobacter spp., Salmonella spp., Shigella
spp.
.)
:
> 65
,
,
,
)
– Clostridium difficile
Guerrant et al. Clin Infect Dis 2001; 32:331
>48
> 3/
,
,
,
,
,
:
–
–
–
–
C.difficile
Norovirus, Rotavirus
Salmonella spp. (non-typhoidal)
Cryptosporidium spp. (
)
Bobo et al. Crit Care Med 2010; 38:S324
:
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,
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)
EHEC O157:H7
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.
.
.
Jernberg et al. Microbiology 2010; 156:3216
3
:
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Guerrant et al. Clin Infect Dis 2001; 32:331
DuPont HL. N Engl J Med 2009; 361:1560
Hill et al. BMJ 2008; 337:a1746
!
,
E.coli O157:H7
(?)
-
E.coli O157:H7,
< 20
,
, 129
• 66
EHEC O157
:
3
(
12.4; 95%
1.4-110.3)
(
18.0; 95%
1.9-170.9)
7
Smith et al. Pediatr Infect Dis J 2012;31:37
E.coli O157:H7,
,6
3
Safdar et al. JAMA 2002; 288:996
EHEC O104:H4?
• 24
EHEC O104:H4
,7
,
(
2011
,
,
)
EHEC O104:H4,
,
• 4/7
,
,
2/5
,
17/19
( =0,043)
, 15/17
( =0,12)
,
,
,
;
,
,
Geerdes-Fenge et al. Infection 2013; 41:669
,
,
EHEC O157
1-3
• 5
24
Tarr et al. Lancet 2005; 365:1073
Holtz et al. Gastroenterology 2009;136: 1887
,
:
–
II
:
500
2
400
400
2
2
: 3-5
:
10
per os
per os
per os
1
–
3
III
:
1,0
1
,
5
–
,
:
<6
> 65
(
,
,
,
,
)
(
(
,
.)
.)
Guerrant et al. Clin Infect Dis 2001; 32:331
DuPont HL. N Engl J Med 2009; 361:1560
, 12
, 767
,
2
Salmonella spp.
(
1,96, 95%
1
1,29-2,98)
Onwuezobe et al. Cochrane Database of Systematic Reviews 2012; 11: CD001167
:
:
200
4
II
7
:
500
2
400
400
2
2
:3
:
10
per os
per os
per os
1
3
–
1,0
1
III
,
3
:
,
,
spp., E.coli
5-
Salmonella spp., Shigella spp., Yersinia
.
,
,
Buisson et al. Therapie 1989; 44: 123
Bulbulovic-Telalbasic S. Med Arh 1991; 45:105
• 88
2,09
3,26
(p=0,004)
24
Bouree et al. Gastroenterol Clin Biol 1989; 13:469
C.difficile(
)
,
12
48
1/3
Wilcox et al. The Journal of Antimicrobial Chemotherapy 2008; 62:388
–
65%
42%
1,5%
,
6
,
,
26%
Bauer et al. Clinical Microbiology and Infection 2009; 15:1087
C.difficile:
,
(WBC<15.000,
< 1,5
500
3
per os 10-14
,
1,5
):
(WBC>15.000,
)
125
4
per os 10-14
,
,
,
,
)
+
125-500
500
4
per os
3
Cohen et al. Infect Control Hosp Epidemiol 2010; 31:431
Surawicz et al. Am J Gastroenterol 2013; 108:478
,
,
vs
3
(36,1
vs
43,6 , =0,163),
(9% vs 12%, =0,841)
Hong et al. Gut Liver 2010;4:357-362
,
Shiga(Stx) EHEC O157:H7
,
Stx
,
EHEC 0157:H7
,
,
(
,
,
)
• 20-50%
3-14
(
3-5
)
1-5
– ETEC, EAEC,
, EPEC
– ETEC, EAEC, Salmonella spp.,
Shigella spp.
– Campylobacter spp.,
EPEC, Salmonella spp.,
Vibrio spp.
– ETEC, Norovirus, Shigella, EPEC
Shah et al. . Am J Trop Med Hyg 2009; 80:609
:
• 509
:
14
,
-
McGregor et al. Transactions of the Royal Society of Tropical Medicine and Hygiene 2012; 106: 549
1-2
Cochrane Database Syst Rev. 2000;(3):CD002242
:
.
(
).
Hatchette et al. CMAJ 2011; 183:339
:
,
3-
:
,
:
750
per os
> 24 :
500
2
1000
per os
;
3
500
1
3
200
3
3
(
)
200
4
3
Shah et al. . Am J Trop Med Hyg 2009; 80:609
, 176
• 3
:
1000
500
500
(
+
4
,
,
16
2
)
+
(11 vs 34 , =0,0002)
(1,2 vs 3,4,
<0,0001)
Ericsson et al. Journal of Travel Medicine 2007; 14: 312
• 75
, 39 –
, 36 –
(9/39 vs 21/36, <0,01)
Bouree et al. Transactions of the Royal Society of
Tropical Medicine and Hygiene 1987; 81:859
,
–
200
3
3
(33 vs 68 , <0,005),
(6,5 vs 8,6, <0,0001)
(77% vs 61%, =0,01)
DuPont et al. J Travel Med 2007; 14:16
• Salmonella spp. (
)–
II,
III
• Shigella spp. II,
• Campylobacter spp. –
(
),
II,
;
III,
• E.coli –
II,
III
• Yersinia spp. –
II,
• Vibrio cholerae –
,
,
,
• Aeromonas spp., Plesiomonas spp. –
II
III
,
III
,
,
Guerrant et al. Clin Infect Dis 2001; 32:331
(I+R)
Salmonella
spp.,
.
,
, 2013 ., n=659)
0,0%
0,0%
92,2%
37,3%
0,0%
0,0%
13,3%
564 – S.enteritidis, 49 – S.typhimurium, 46 –
Shigella spp. (
, 1998-1999
,
.)
,
,
,
.
.
2000; 2: 65
:
in vivo
in vitro
,
,
III
in vitro
Shigella spp.,
(
)
,
63
(
, 8014
,
24
)
• Lactobacillus rhamnosus GG, Lactobacilus acidophilus,
Saccharomyces boulardii, Enterococcus LAB SF68....
Allen et al. Cochrane Database of Systematic Reviews 2010; 11: CD003048
,
,
.
Saccharomyces boulardii
:
Dinleyici et al. Expert Opin Biol Ther 2012; 12:395
Kotzampassi et al. International Journal of Antimicrobial Agents 2012; 40:288
:
C.difficile(
)
(
,
)
• .......
Kotzampassi et al. International Journal of Antimicrobial Agents 2012; 40:288