COVID-19 大流行后医院感染的抗菌治疗问题及解决方法

A. A. Galitsky, S. D. Mitrokhin, A. S. Shkoda, O. E. Orlova, S. Bochkareva, I. A. Kiseleva, M. Anurova, A. V. Aleshkin
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摘要

目的:通过使用对肺炎克雷伯氏菌、铜绿假单胞菌、金黄色葡萄球菌和鲍曼不动杆菌的多重耐药菌株具有活性的噬菌体,提高旨在预防重症监护病房医院病原体循环的预防和治疗措施的有效性。研究在莫斯科医疗保健部第 67 医院(L.A. Vorohobov City Clinical Hospital No. 67)第 2 重症监护室进行。噬菌体的个性化选择是在 G.N. Gabrichevsky 莫斯科流行病学和微生物学研究所的基础上进行的。研究包括两组患者,共 20 人,他们都在重症监护室接受长期机械通气。在所有使用噬菌体的病例中,患者均未发现中毒和过敏反应。使用噬菌体后,血液生化指标未出现病理变化。60%的病例完全根除了病原体。由于使用了个性化的噬菌体疗法,由医院病原体的MDR菌株引起的各种HAI的治疗效果提高了30%,起始抗生素治疗方案的效果提高了70%以上。
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Problems of antibacterial therapy of hospital infections in the post-pandemic period of COVID-19 and ways to solve them
Due to the coronavirus pandemic in Russia, a significant increase in the emergence of strains of microorganisms with multiple drug resistance was noted.Objective: improvement of the effectiveness of prophylactic and therapeutic measures aimed at prevention of hospital pathogens circulation in the intensive care unit by using bacteriophages active against multidrug-resistant strains of Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, and Acinetobacter baumannii.Materials and methods. The study was conducted on the basis of the Intensive Care Unit No. 2 of L.A. Vorohobov City Clinical Hospital No. 67 of Moscow Healthcare Department. Personalized selection of bacteriophages was carried out on the basis of G.N. Gabrichevsky Moscow Research Institute of Epidemiology and Microbiology. The study included two groups of patients, a total of 20 people, who were on prolonged mechanical ventilation in the intensive care unit.Results. No toxic and allergic reactions were detected from the patients in all cases of bacteriophages application. Pathological changes of blood biochemical parameters were not observed in connection with the use of bacteriophages. Complete eradication of pathogens occurred in 60 % of cases.Conclusion. The effectiveness of treatment of various nosological forms of HAIs caused by MDR strains of hospital pathogens increased by 30%, and the effectiveness of the starting antibiotic therapy regimen was 70% and more as a result of the use of personalized phage therapy.
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