THE CONCEPT OF MODERN NOSOCOMIAL INFECTION FROM THE STANDPOINT OF A RATIONAL APPROACH TO ANTIMICROBIAL PHARMACOTHERAPY

Abstract

Background. Systemic antimicrobial pharmacotherapy of modern nosocomial infections involving antibiotic-resistant gram-negative bacteria does not always comply with the principle of rationality, thereby reducing the quality and clinical effectiveness of their treatment. Klebsiella pneumoniae, Streptococcus pneumoniae, Escherichia coli, Proteus mirabilis, Enterobacter cloacae, Pseudomonas aeruginosa and Acinetobacter baumannii are the leading gram-negative pathogens of modern nosocomial infections in many hospitals, the clinical strains of which are characterized by high-level of associated and cross-drug resistance.

Material. 770 patients aged 3 days to 92 years with documented nosocomial infection involving antibiotic-resistant gram-negative aerobic and facultative anaerobic bacteria were examined. The patients were hospitalized in intensive care units, surgical, somatic, gynaecological, pediatric and neonatology departments of the Multidisciplinary Clinic of the Tashkent Medical Academy.

Results. At the same time, there is a correlation between the frequency of isolation of these bacterial species and the age of patients, their sex, as well as the nature of the origin of clinical material for microbiological research. The use of most drugs of the beta-lactam class in the pharmacotherapy of modern nosocomial infections involving antibiotic-resistant gram-negative bacteria is associated with a high risk of treatment failure due to the wide distribution of beta-lactam products among hospital strains of microbes. The polymicrobial nature of modern nosocomial surgical infections, in contrast to nosocomial urinary infections, determines the appointment of targeted empirical combination antibiotic therapy.

Conclusion. Rational empirical antimicrobial pharmacotherapy of nosocomial infections should consider the results of monitoring the modern etiological structure of infectious pathology and current local data on the pharmacodynamic activity of antibiotics against potential pathogens in each individual hospital of a medical institution. At the same time, systemic empirical antimicrobial pharmacotherapy of modern nosocomial infections should include the universal use of regimens with the widest possible coverage of potential pathogens and considering their likely multiple antibiotic resistance.