Диагностика и антибактериальная терапия нозокомиальной пневмонии у взрослых: от рекомендаций к реальной практике - Журнал Терапевтический архив №11 Инфекционные болезни 2023

Диагностика и антибактериальная терапия нозокомиальной пневмонии у взрослых: от рекомендаций к реальной практике

Рачина С.А., Федина Л.В., Сухорукова М.В., Сычев И.Н., Ларин Е.С., Алхлавов А.А. Диагностика и антибактериальная терапия нозокомиальной пневмонии у взрослых: от рекомендаций к реальной практике. Терапевтический архив. 2023;95(11):996–1003. DOI: 10.26442/00403660.2023.11.202467

© ООО «КОНСИЛИУМ МЕДИКУМ», 2023 г.

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Rachina SA, Fedina LV, Sukhorukova MV, Sychev IN, Larin ES, Alkhlavov AA. Diagnosis and antibiotic therapy of nosocomial pneumonia in adults: from recommendations to real practice. A review. Terapevticheskii Arkhiv (Ter. Arkh.). 2023;95(11):996–1003. DOI: 10.26442/00403660.2023.11.202467

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Аннотация

Нозокомиальная пневмония (НП) представляет собой инфекцию, связанную с оказанием медицинской помощи, которая характеризуется значительными последствиями для пациента и системы здравоохранения. Эффективность лечения в значительной степени зависит от своевременности и адекватности режима антибактериальной терапии. Рост устойчивости грамотрицательных возбудителей НП к антибиотикам повышает риск назначения неадекватной эмпирической терапии, что ухудшает результаты лечения пациентов. Выявление факторов риска инфицирования микроорганизмами с множественной лекарственной устойчивостью, тщательный локальный микробиологический мониторинг с детекцией механизмов устойчивости, реализация стратегии контроля антимикробной терапии и применение рациональных комбинаций антибактериальных препаратов имеют огромное значение. Кроме того, необходимо понимать важность использования новых препаратов с активностью в отношении карбапенеморезистентных штаммов, в том числе цефтазидима/авибактама. В обзоре изложены современные данные об этиологии НП, особенности диагностики и принципы антибактериальной терапии НП.

Ключевые слова: нозокомиальная пневмония, пневмония, ассоциированная с искусственной вентиляцией легких, антибиотики, микробиологическая диагностика

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Nosocomial pneumonia is a healthcare-associated infection with significant consequences for the patient and the healthcare system. The efficacy of treatment significantly depends on the timeliness and adequacy of the antibiotic therapy regimen. The growth of resistance of gram-negative pathogens of nosocomial pneumonia to antimicrobial agents increases the risk of prescribing inadequate empirical therapy, which worsens the results of patient treatment. Identification of risk factors for infection with multidrug-resistant microorganisms, careful local microbiological monitoring with detection of resistance mechanisms, implementation of antimicrobial therapy control strategy and use of rational combinations of antibacterial drugs are of great importance. In addition, the importance of using new drugs with activity against carbapenem-resistant strains, including ceftazidime/aviabactam, must be understood. This review outlines the current data on the etiology, features of diagnosis and antibacterial therapy of nosocomial pneumonia.

Keywords: nosocomial pneumonia, ventilator-associated pneumonia, antibiotics, microbiological diagnosis

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12. Petrov A, Quintana W, Mosquera P, et al. Etiology of nosocomial pneumonia in multidisciplinary hospital. Eur Respir J. 2018;52:PA1963.
DOI:10.1183/13993003.congress-2018.PA1963
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15. Choby JE, Howard-Anderson J, Weiss DS. Hypervirulent Klebsiella pneumoniae – clinical and molecular perspectives. J Intern Med. 2020;287(3):283-300. DOI:10.1111/joim.13007
16. Antunes LC, Visca P, Towner KJ. Acinetobacter baumannii: evolution of a global pathogen. Pathog Dis. 2014;71(3):292-301. DOI:10.1111/2049-632X.12125
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18. Arzanlou M, Chai WC, Venter H. Intrinsic, adaptive and acquired antimicrobial resistance in Gram-negative bacteria. Essays Biochem. 2017;61(1):49-59. DOI:10.1042/EBC20160063
19. Karakonstantis S, Kritsotakis EI, Gikas A. Treatment options for K. pneumoniae, P. aeruginosa and A. baumannii co-resistant to carbapenems, aminoglycosides, polymyxins and tigecycline: an approach based on the mechanisms of resistance to carbapenems. Infection. 2020;48(6):835-51. DOI:10.1007/s15010-020-01520-6
20. Sun S, Gao H, Liu Y, et al. Co-existence of a novel plasmid-mediated efflux pump with colistin resistance gene mcr in one plasmid confers transferable multidrug resistance in Klebsiella pneumoniae. Emerg Microbes Infect. 2020;9(1):1102-13. DOI:10.1080/22221751.2020.1768805
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Авторы

С.А. Рачина*¹, Л.В. Федина^2,3, М.В. Сухорукова⁴, И.Н. Сычев^2,3, Е.С. Ларин⁵, А.А. Алхлавов¹

¹ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия;
²ГБУЗ «Городская клиническая больница им. С.С. Юдина» Департамента здравоохранения г. Москвы, Москва, Россия;
³ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
⁴ФГАУ «Национальный медицинский исследовательский центр нейрохирургии им. акад. Н.Н. Бурденко» Минздрава России, Москва, Россия;
⁵ГБУЗ «Госпиталь для ветеранов войн №3» Департамента здравоохранения г. Москвы, Москва, Россия
*Svetlana.Ratchina@antibiotic.ru

________________________________________________

Svetlana A. Rachina*¹, Ludmila V. Fedina^2,3, Marina V. Sukhorukova⁴, Igor N. Sychev^2,3, Egor S. Larin⁵, Abdulbari A. Alkhlavov¹

¹Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia;
²Yudin City Clinical Hospital, Moscow, Russia;
³Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
⁴Burdenko National Medical Research Center for Neurosurgery, Moscow, Russia;
⁵Hospital for War Veterans №3, Moscow, Russia
*Svetlana.Ratchina@antibiotic.ru

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