Pharmacoepidemiological analysis of the consumption of antibacterial drugs for the treatment of patients with nosocomial infections associated with previous hospitalization in multidisciplinary hospitals in the Tomsk region

BACKGROUND: Healthcare-associated infections (HAIs) are one of the common complications associated with patients’ stay in a medical organization. An urgent practical problem is the choice of antibiotic therapy for the treatment of patients with nosocomial infections because these infections are caused by antibiotic-resistant strains. HAIs associated with previous hospitalization (HAPH) manifest in patients after discharge from the hospital, and their risk of isolating resistant strains often remains unrecognized by specialists. Thus, more studies are required to examine the structure of HAPH pathogens and patterns of consumption of antibacterial drugs for the treatment of HAPH to further determine antibiotic therapy in these patients.

AIMS: To analyze the use of antibiotic therapy for the treatment of HAPH with known etiological agents and the level of antibiotic resistance.

MATERIALS AND METHODS: The study analyzed the results of a multicenter descriptive retrospective study based on the Clinics Siberian State Medical University and the State Clinical Hospital No. B.I. Alperovich (Tomsk). A total of 108 HAPH cases were examined according to the medical records of inpatients (Form 003/y). For pharmacoepidemiological analysis, the anatomical therapeutic chemical/defined daily dose (DDD) methodology was used, and antibiotic intake was assessed using the number of established daily doses. The etiological structure of HSV microorganisms was evaluated using the AMRcloud online platform. Quantitative and qualitative indicators were presented as shares (%) and absolute numbers.

RESULTS: In total, 116 isolates from patients with HAPH were assessed. Klebsiella pneumoniae, Klebsiella oxytoca, Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli were the dominant pathogens causing HAPH in the overall distribution of pathogens. For the treatment of these patients, a wide range of drugs was used, including 13 groups of antibiotics. In most cases, the parenteral route of drug administration was used: intravenous route, 56.0%; intramuscular, 28.0%; and oral, 16.0%. The DDD analysis showed that antibiotic intake for the treatment of patients with HAPH was 137.8 NDDD/100 bed-days; surgical infection, 48.2 NDDD/100 bed-days (35.0%); and pneumonia, 89.6 NDDD/100 bed-days (65.0%). Cephalosporins were the most commonly used group of antibiotics for both surgical infection and pneumonia, mainly third-generation cephalosporins.

CONCLUSION: Etiological agents of HAPH are phenotypically similar to nosocomial strains. Among antibacterial drugs, cephalosporins and fluoroquinolones were mainly consumed, and HAPH isolates had unfavorable resistance profiles to these drugs.