Monocytosis in rational empirical antibacterial therapy in moderate forms of COVID-19

Microbiologically confirmed bacterial co-infection occurs in 1.2%–7% of hospitalized patients with COVID-19. The study of rational approaches to empirical antibacterial therapy (ABT) of SARS-CoV-2 virus-induced pneumonia continues. Glucocorticoid (GCS) therapy, the main method for pathogenetic treatment of moderate forms of CОVID-19, can lead to the development of neutrophilic leukocytosis. The criterion for the differential diagnosis of leukocytosis could be determining the quantity of peripheral blood monocytes. Assessing the significance of identifying the monocyte quantity can serve as an additional criterion for assigning empirical ABT in the treatment of pneumonia caused by the new coronavirus infection. The aim of the study was to identify the characteristics of glucocorticoid-induced leukocytosis in patients with moderate COVID-19. The study included 86 patients with a confirmed diagnosis of COVID-19 (ICD codes: U07.1, U07.2) of moderate severity. The patients were divided into 2 groups. The comparison group consisted of 40 patients who were prescribed ABT after the manifestation of leukocytosis on the background of glucocorticoid therapy. The control group included 46 people who were not prescribed ABT after the manifestation of leukocytosis on the background of glucocorticoid therapy and until the end of their stay in the hospital. We compared the parameters of the clinical blood tests (the absolute number of white blood cells, neutrophils and monocytes (×109/L)) on days 3, 6 and 9 from the start of GCS therapy. As a result, on the 3rd day, both groups had neutrophilic leukocytosis (>9.0×109/L) and absolute monocytosis (>0.8×109/L). There was a statistically signif icant decrease in the absolute number of white blood cells, neutrophils and monocytes by days 6 and 9, compared with day 3 from the start of glucocorticoid therapy. When comparing blood parameters between the groups, there was no statistically significant difference in the number of cells on the 3rd, 6th and 9th day of GCS therapy (p>0.05). Glucocorticoid-induced leukocytosis is associated with absolute monocytosis. The administration of ABT in response to the occurrence of leukocytosis in this study did not affect the change in the level of white blood cells. At the same time, a likely factor in reducing these indicators was a decrease in the daily dosage of corticosteroids.

Predicting peritoneal contamination with enterobacteria producing extended-spectrum beta-lactamases and choosing empirical antibacterial therapy for postoperative peritonitis in cancer patients

Relevance: Enterobacteriaceae family microorganisms, specifically E. coli and K. pneumoniae isolates, are the most common activators of postoperative peritonitis in oncology. Many of these microorganisms produce extended-spectrum beta-lactamases (ESBL). The deemed resistance of ESBL-producing enterobacteria to all β-lactam antibiotics, except for carbapenems, leads to the ineffectiveness of empiric antibiotic therapy. The purpose of the study was to define the risk factors of peritoneal contamination with ESBL-producing enterobacteria for choosing optimal empirical antibacterial therapy on the example of a specific cancer patient with postoperative peritonitis. Results: Independent risk factors of peritoneal contamination with ESBL-producing enterobacteria included “the administration of antibiotics for more than three days” (OR 106, 95% CI 21.0-537, p<0.001), “two or more repeated laparotomies” (OR 2.66, 95% CI 1.32-5.34, p=0.006), and “postoperative preventive antibiotic treatment” (OR 0.17, 95% CI 0.04-0.75, p=0.02). The obtained prognostic model allowed predicting the infection with ESBL-producing enterobacteria before establishing the postoperative peritonitis microbial etiology. The model sensitivity was 94.7%, overall predictive accuracy was 73.1. Conclusion: Prolonged administration of antibiotics (3rd-generation cephalosporins and/or fluoroquinolones) after cancer surgery to prevent surgical infections is the main independent risk factor of peritoneal contamination with ESBL- producing enterobacteria.

Predicting peritoneal contamination with enterobacteria producing extendedspectrum beta-lactamases and choosing empirical antibacterial therapy for postoperative peritonitis in cancer patients

Enterobacteriaceae family microorganisms, specifically E. coli and K. pneumoniae isolates, are the most common activators of postoperative peritonitis in oncology. Many of these microorganisms produce extended-spectrum beta-lactamases (ESBL). The deemed resistance of ESBL-producing enterobacteria to all β-lactam antibiotics, except for carbapenems, leads to ineffectiveness of empiric antibiotic therapy. Purpose of the study: To define the risk factors of peritoneal contamination with ESBL-producing enterobacteria for choosing optimal empirical antibacterial therapy on the example of a specific cancer patient with postoperative peritonitis. Results: Independent risk factors of peritoneal contamination with ESBL-producing enterobacteria included “the administration of antibiotics for more than three days” (OR 106, 95% CI 21.0-537, p<0.001), “two or more relaparotomies” (OR 2.66, 95% CI 1.32-5.34, p =0.006), and “postoperative preventive antibiotic treatment” (OR 0.17, 95% CI 0.04-0.75, p =0.02). The obtained prognostic model allowed predicting the infection with ESBL-producing enterobacteria before establishing the postoperative peritonitis microbial etiology. The model sensitivity was 94.7%, overall predictive accuracy was 73.1. Conclusion: Prolonged administration of antibiotics (3rd-generation cephalosporins and/or fluoroquinolones) after cancer surgery to prevent surgical infections is the main independent risk factor of peritoneal contamination with ESBL- producing enterobacteria.

Antibiotic resistance: a modern view of the problem by the example of a multi-profile hospital

Relevance. Conducting microbiological monitoring allows controlling hospital-acquired infections and making timely strategic decisions for epidemiologists and clinical pharmacologists. Objective of the work is to determine the tendency of prevailing problem microflora and to develop a strategy of empirical antibacterial therapy for severe nosocomial infections and inflammatory processes. Materials and methods. The article analyzes the main groups of pathogens of hospital infections in dynamics for the first quarter of 2018, 2019 and 2020. The relation of positive cultures to the total number of investigated samples was taken for the analysis. Antibiotic sensitivity was isolated, identified and determined using conventional mass spectrometry methods. The results. The stable sowing rate of Acinetobacter baumannii and Klebsiella pneumoniae in the intensive care and surgical departments was noted for the analyzed periods. To solve the issue of antibiotic resistance in the inpatient department, a strategy to contain it has been developed.

Regional Features of the Course of Pneumonia at the Present Stage

The article discusses the regional features of the diagnosis, course, and treatment of community-acquired pneumonia (CAP). The cohort of patients with CAP was dominated by males in the age group of 70 years or older, who had many concomitant diseases. Staphylococcal flora was found to be the main pathogen. Empirical antibacterial therapy was mainly carried out, which does not always correspond to the real picture of the microflora of the patient.

Carbapenems Utilization Evaluation in Neutropenic Patients of a Teaching Hospital

Background: Carbapenems is frequently prescribed for treatment or prophylaxis in neutropenic patients. It is cleared that antimicrobial misuse can cause poor patient outcomes, through raise of antibiotic resistance, increased adverse events, and prolonged length of hospital stay. To evaluate the rational use of Imipenem- Cilastatin and Meropenem for empirical antibacterial therapy in neutropenic patients based on IDSA guideline. Methods: Through this cross-sectional study, we assessed the appropriateness of administration of Carbapenems in neutropenic patients admitted in hematology–oncology and bone marrow transplant wards in Namazee hospital, Shiraz, Iran, from March 2012 to May 2013. Results: Total of 90 patients was enrolled. Drug therapy duration was appropriate in 69.6% of Imipenem-Cilastatin and 75% of Meropenem groups. Sampling time of culture was appropriated in 59.1% of Imipenem-Cilastatin and 78.3% of Meropenem group, interval of drug administration was correct in 74.5% at initiation and 79.4% during therapy in Imipenem-Cilastatin group. For dosing these values were 74.5% and 72.2%, respectively. These values were evaluated in patients who received Meropenem too, interval was correct in 89.5% at initiation and 90.3% during therapy, dosing was correct in 12.3% both at initiation and during therapy. Conclusion: These finding suggest that attention to correct dose, correct interval, renal dose adjustment, logical indication for administration of Carbapenem should be considered by health care system. J Pharm Care 2019; 7(4): 106-111.

Treatment of widespread infected wounds of different etiology

Background. The infections problem of the surgical departments is increasing due to resistance of pathogens to antibiotics, so it becomes an important issue to develop new regimens for the treatment of common infected wounds. The aim of the study was expanding the possibility of treating infected wounds with the use of infusion therapy with reosorbylact, decasan antiseptic, and braxone and leflocin antibiotics. Materials and Methods. 55 patients with infected wounds of different etiology were included in the study. The mean patients age was 43.4 ± 4.7 years. Decasan antiseptic used in the treatment of infected wounds in patients of the main group, the antibiotics braxon (tobramycin) and leflocin 750 (levofloxacinum) is intended simultaneously for empirical antibiotic therapy, reosorbylact solution is included in the infusion therapy. Results. Intoxication syndrome was observed in patients with widespread infected wounds. The initial level of urea blood exceeded 1.6–1.7 times after the patient admission. Creatinine level decreased by 23 % from baseline for 5–7 days of treatment, in patients of the main group during infusion detoxication therapy with Reosorbylact, it remained raised to 9–11 days in patients of the comparison group. Leukocytosis, TGN, and LII decreased in case of empirical antibacterial therapy with braxone (tobramycin) and leflосin 750. The number of microbial associations decreased to 1.6 ± 0.3 using decasan for wound treatment up to 9 days. Bacterial contamination of wounds decreased to a level suitable for effective auto graft (<104 per 1 g of tissue). Conclusions. The complex program of treatment for patients with infected wounds contributed to the reduction of intoxication syndrome, faster reduction of the number of microorganisms in the wound, preparation of wounds for skin graft, shortening the treatment time by 4.3 days.

The results of monitoring the dynamics and antibiotic resistance of microflora when performing split-skin grafting in a general surgical hospital

Relevance. One of the effective ways to close chronic wounds according to many authors is split-skin grafting. To obtain good results of plastic operations, a constant monitoring of the structure of microbiological associations of chronic wounds and their sensitivity to antimicrobial agents is necessary. Aim. Analysis of the structure and properties of pathogens of wound infections when performing split-skin grafting and optimizing the choice of drugs for starting empirical antibacterial therapy. Materials and methods. A retrospective analysis of the results of microbiological studies was conducted in 86 patients who underwent split-skin grafting. For statistical processing of the data obtained, the computer program Statistica 6.0 was used. Results. Microbial contamination in patients on admission to hospital was (Me [Q1; Q3]) 106 [102; 108] CFU/ml. Unsatisfactory results of split-skin grafting were noted in 15 patients (17%). In this group of patients, strains of non-fermenting gram-negative bacteria - Pseudomonas aeruginosa (in 6 cases) and Acinetobacter baumannii (in 4 cases), which retained sensitivity to carbapenems in 65% of cases, were most often detected. Conclusions. Non-fermenting gram-negative microorganisms sharply reduce the likelihood of good results of plastic operations. If found in the recipient wound after split-skin grafting signs of an infectious process, it is advisable to use carbapenems.