Present Strategy and Tactics of Antibacterial Therapy for Hospital Infections: Lessons Learned from the COVID-19 Pandemic

S. D. Mitrokhin, A. V. Aleshkin, A. A. Galitskiy, A. S. Shkoda
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Abstract

A significant increase in sales of antibacterial drugs in pharmacies and their purchases by medical institutions of the Russian Healthcare System was observed against the background of the past pandemic of a novel coronavirus infection in Russia. Microbiological monitoring that was carried out at City Clinical Hospital No. 67 named after. L. A. Vorokhobov (Moscow) in 2020–2021, revealed a pressing problem — primarily gram-negative bacteria, with a predominance of multidrug-resistant (MDR) strains, were isolated from patients with healthcare-associated infections (HAIs). As shown by pharmacoeconomic studies conducted by the authors, the cost of one course of targeted antibacterial therapy for HAI in this case could increase by 6–12 times compared to a similar course of therapy in the absence of both MDR strains and XDR strains of hospital pathogens. In order to achieve a reduction in the cost of antibacterial therapy developed and used by the authors, in addition to the development of effective antibacterial therapy regimens for HAIs caused by MDR/XDR pathogens, another study was carried out as a continuation of the work on creating and improving biotherapy regimens for HAIs, namely the development of personalized phage therapy regimens for patients with hospital-acquired pneumonia caused by MDR bacterial strains. Based on the data obtained, the concept of a personalized approach to phage therapy of various nosological forms of HAIs caused by hospital-acquired MDR pathogens in patients of a multidisciplinary hospital was proposed and tested. As a result of this approach, the effectiveness of phage therapy for various nosological forms of HAIs caused by MDR and XDR strains of hospital pathogens in City Clinical Hospital No. 67 named after. L. A. Vorokhobov increased by 30%, and the effectiveness of the initial antibiotic regimen was 70%. The economic effect of the combination of antibiotic therapy and phage therapy («booster therapy») amounted to 3,000,000 rubles, compared with the use of antibiotics alone in the treatment of patients with HAIs caused by MDR/XDR strains of hospital pathogens.
医院感染抗菌疗法的当前战略和战术:从 COVID-19 大流行中汲取的经验教训
在俄罗斯新型冠状病毒感染大流行的背景下,药店的抗菌药物销售量和俄罗斯医疗系统医疗机构的抗菌药物采购量都出现了大幅增长。以Л.А. 沃罗霍夫命名的第 67 市临床医院进行了微生物监测。2020-2021 年,以 L. A. Vorokhobov(莫斯科)命名的第 67 市临床医院进行的微生物监测发现了一个紧迫的问题--从医疗相关感染(HAIs)患者中分离出的细菌主要是革兰氏阴性菌,其中耐多药(MDR)菌株占多数。作者进行的药物经济学研究表明,在这种情况下,针对 HAI 的抗菌治疗一个疗程的费用可能会比在医院病原体中没有 MDR 菌株和 XDR 菌株的情况下类似疗程的费用增加 6-12 倍。为了降低作者开发和使用的抗菌疗法的成本,除了为 MDR/XDR 病原体引起的 HAI 开发有效的抗菌疗法方案外,还开展了另一项研究,作为创建和改进 HAI 生物疗法方案工作的延续,即为 MDR 菌株引起的医院获得性肺炎患者开发个性化的噬菌体疗法方案。根据所获得的数据,提出并测试了针对一家多学科医院患者中由医院获得的 MDR 病原体引起的各种 HAI 的个性化噬菌体疗法概念。由于采用了这种方法,噬菌体疗法对以Л.А. 沃罗赫命名的第67市临床医院中由医院病原体的MDR和XDR菌株引起的各种HAI的治疗效果显著。Vorokhobov 命名的第 67 市临床医院的噬菌体疗法对 MDR 和 XDR 医院病原体菌株引起的各种 HAI 的疗效提高了 30%,而初始抗生素方案的疗效为 70%。与单独使用抗生素治疗由医院病原体的 MDR/XDR 菌株引起的 HAIs 患者相比,抗生素疗法和噬菌体疗法("强化疗法")的组合产生了 300 万卢布的经济效益。
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