clinvestКачественная клиническая практикаKachestvennaya Klinicheskaya Praktika = Good Clinical Practice2588-05192618-8473ООО «Издательство ОКИ10.37489/2588-0519-2023-4-4-14clinvest-684Research ArticleФАРМАКОЭПИДЕМИОЛОГИЯPHARMACOEPIDEMIOLOGYАнализ структуры и показателей антибиотикорезистентности возбудителей инфекций у пациентов в отделениях интенсивной терапии многопрофильного стационараAnalysis of the infectious agent’s structure and antibiotic resistance parameters in patients in intensive care units of a multidisciplinary hospitalhttps://orcid.org/0000-0001-7729-2169БутрановаО. И.ButranovaO. I.

Бутранова  Ольга Игоревна, к. м. н., доцент кафедры общей и клинической фармакологии; н. с.

Москва

Olga I. Butranova, PhD, Cand. Sci. (Med.), Associate Professor of the Department of General and Clinical Pharmacology; Researcher

Moscow

butranova-oi@rudn.ruhttps://orcid.org/0000-0002-6348-6867ЗыряновС. К.ZyryanovS. K.

Зырянов  Сергей Кенсаринович, д. м. н., профессор, зав. кафедрой общей и клинической фармакологии; гл. н. с.; заместитель главного врача

Москва

Sergey K. Zyryanov, PhD, Dr. Sci. (Med.), Professor, Head of the Department of General and Clinical Pharmacology; Chief Researcher; Deputy Chief physician

Moscow

ГорбачеваА. А.GorbachevaA. A.

Горбачева  Анастасия Андреевна, аспират 1 года кафедры общей и клинической фармакологии; инженер-исследователь

Москва

Anastasia A. Gorbacheva, aspirate of 1 year of the Department of General and Clinical Pharmacology; research engineer

Moscow

ПуцманГ. А.PutsmanG A.

Пуцман Глеб  Александрович, инженер-исследователь; врач-клинический фармаколог 

Москва

Gleb A. Putsman, research engineer; doctor-clinical pharmacologist

Moscow

ФГАОУ ВО «Российский университет дружбы народов имени Патриса Лумумбы»; ФГБУН Институт физической химии и электрохимии им. А.Н. Фрумкина РАНРоссияPeoples' Friendship University of Russia named after Patrice Lumumba; Frumkin Institute of Physical Chemistry and Electrochemistry Russian Academy of SciencesRussian FederationФГАОУ ВО «Российский университет дружбы народов имени Патриса Лумумбы»; ФГБУН Институт физической химии и электрохимии им. А.Н. Фрумкина РАН; ГБУЗ «Городская клиническая больница № 24 Департамента здравоохранения города Москвы»РоссияPeoples' Friendship University of Russia named after Patrice Lumumba; Frumkin Institute of Physical Chemistry and Electrochemistry Russian Academy of Sciences; City Clinical Hospital No. 24 of the Moscow City Health DepartmentRussian FederationФГБУН Институт физической химии и электрохимии им. А.Н. Фрумкина РАН; ГБУЗ «Городская клиническая больница № 24 Департамента здравоохранения города Москвы»РоссияFrumkin Institute of Physical Chemistry and Electrochemistry Russian Academy of Sciences; City Clinical Hospital No. 24 of the Moscow City Health DepartmentRussian Federation20232702202404414Copyright © Бутранова О.И., Зырянов С.К., Горбачева А.А., Пуцман Г.А., 20242024Бутранова О.И., Зырянов С.К., Горбачева А.А., Пуцман Г.А.Butranova O.I., Zyryanov S.K., Gorbacheva A.A., Putsman G.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.clinvest.ru/jour/article/view/684

Актуальность.  Нозокомиальные инфекции являются распространённым осложнением, возникающим у пациентов, проходящих лечение в условиях отделения реанимации и интенсивной терапии (ОРИТ). Микроорганизмы, характеризующимися множественной лекарственной устойчивостью, являются одним из значимых факторов риска летального исхода у данной категории больных. Цель. Изучение структуры возбудителей инфекций у пациентов в ОРИТ и параметров их антибиотикорезистентности. Материалы и методы. Ретроспективное фармакоэпидемиологическое исследование медицинской документации взрослых пациентов с диагностированной в ОРИТ инфекцией, проходивших лечение в ГКБ № 24 ДЗМ в период 20.08.2022 — 31.07.2023 (199 историй болезни, ИБ). В анализ (пол, возраст пациентов, локализация инфекционного процесса, данные о структуре возбудителей и чувствительности к антибактериальным препаратам) включали ИБ с данными о бактериальном посеве (n=141).  Результаты.  В структуре возбудителей инфекций у пациентов в ОРИТ преобладает грамотрицательная микрофлора (54 %). Среди возбудителей с  клинически значимым ростом основными являлись  K. pneumoniae (22 %),  Candida spp. (20 %) и Staphylococcus  spp. (19  %). K. pneumoniae характеризовалась резистентностью к бета-лактамам, аминогликозидам, левофлоксацину, наибольшая чувствительность отмечалась к колистину, 88,9 %. Кандиды были в абсолютном большинстве чувствительными ко всем использованным препаратам. Среди стафилококков чаще всего встречался  S. aureus  (70 % резистентность к ампициллину и цефокситину). Заключение. В структуре возбудителей инфекций у пациентов в ОРИТ было выявлено доминирование таких представителей ESKAPE (наиболее прогностически важных микроорганизмов:  Enterococcus faecium,  Staphylococcus aureus ,  Klebsiella pneumoniae ,  Acinetobacter baumannii ,  Pseudomonas aeruginosa ,  Enterobacter  spp.), как  K. pneumoniae ,  S. aureus ,  A. baumannii,  P. aeruginosa. Для всех указанных микроорганизмов за исключением стафилококков был продемонстрирован высокий уровень антибиотикорезистентности.

Introduction.  Nosocomial infections are a common complication in patients treated in the intensive care unit (ICU). Microorganisms with multidrug resistance are one of the significant risk factors for death in this category of patients. Aim. To study structure of infectious agents in ICU patients and parameters of their antibiotic resistance.  Materials and methods. Retrospective pharmacoepidemiological study of medical records of adult patients with infections diagnosed in ICU who were treated in City Clinical Hospital No. 24 of the Department of Health (Moscow, Russian Federation) in the period 08/20/2022 — 07/31/2023 (n=199). The analysis (gender, age of patients, localization of the infectious process, data on the structure of pathogens and sensitivity to antibacterial drugs) included records with data on bacterial culture ( n=141). Results. In the structure of pathogens detected in ICU patients, gram-negative microflora predominated (54 %). Among the pathogens with a clinically significant growth, leaders were  K. pneumoniae (22 %), Candida spp. (20 %) and  Staphylococcus  spp. (19 %). K. pneumoniae was characterized by resistance to beta-lactams, aminoglycosides, and levofloxacin, the highest susceptibility was reported to colistin, 88.9 %.  Candida  spp. was overwhelmingly susceptible to all drugs used. Among Staphylococ caceae, S. aureus  was the most common (70 % resistance to ampicillin and cefoxitin).  Conclusion.  In the structure of infectious agents detected in ICU patients, a predominance of ESKAPE pathogens (the most prognostically important microorganisms: Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp.) was observed, including K. pneumoniae, S. aureus, A. baumannii, P. aeruginosa.  For all these microorganisms, except for Staphylococcaceae, a high level of antibiotic resistance was demonstrated.

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