Evaluation of the Rationality of Antibiotic Therapy of Nosocomial Infections in Resuscitation and Intensive Care Patients with COVID-19: a Retrospective Analysis

Autor: K. I. Karnoukh, N. B. Lazareva
Jazyk: ruština
Rok vydání: 2022
Předmět:
Zdroj: Безопасность и риск фармакотерапии, Vol 10, Iss 3, Pp 269-282 (2022)
Druh dokumentu: article
ISSN: 2312-7821
2619-1164
DOI: 10.30895/2312-7821-2022-278
Popis: The overall incidence of healthcare-associated infections (HAIs) in patients with COVID-19 is lower than 15%. However, in critical COVID-19 patients, the incidence of HAIs may reach 50%, and the mortality rate may exceed 50%. This makes effective antibiotic therapy in this category of patients extremely important.The aim of the study was to assess the rationality of antibiotic therapy in critically ill COVID-19 patients with HAIs, as well as analyse the timeliness and sufficiency of microbiological and laboratory diagnostic testing in these patients.Materials and methods: the study comprised a retrospective analysis of medical records of the patients with COVID-19 complicated by HAIs who had been admitted to an intensive care unit of Moscow City Clinical Hospital 4 from 27.04.2020 to 01.11.2020. Antibacterial therapy was analysed in accordance with the principles set forth in the Strategy for the Control of Antimicrobial Therapy (antimicrobial stewardship) and the current Interim Guidelines on the Prevention, Diagnosis and Treatment of Novel Coronavirus Infection (COVID-19) of the Russian Ministry of Health. Statistical significance was evaluated using Student’s unpaired t-test. The qualitative comparison of independent groups was made using the χ2 test.Results: HAIs developed in 138 (20.8%) of 664 patients admitted to the intensive care unit. The authors considered empirical antibiotic therapy irrational in 53.6% of these cases (74/138 patients) due to nonconformity to the current clinical recommendations. Empirical antimicrobial therapy was rational in 68.6% of survivors and 33.3% of non-survivors (p < 0.001). It was corrected based on the results of microbiological testing in 56.9% of survivors and 30.2% of non-survivors (p = 0.005). Procalcitonin levels, as a marker of bacterial infection, were determined in 74.5% survivors and 48.3% of non-survivors (p = 0.003).Conclusions: Antibiotic therapy was rational in less than 50% of critically ill COVID-19 patients with HAIs. Having demonstrated a significant mortality decrease in the category of studied patients with rational antibiotic therapy, the study suggests that it is necessary to follow the current recommendations more carefully. The success of therapy also largely depends on its timely correction based on the results of HAI pathogen identification and other diagnostic measures, in particular, procalcitonin biomarker tests.
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