ABSTRACT
Objective. Development of local clinical protocols for antibacterial therapy of COVID-19-associated bacterial pneumonia in the therapeutic department of the city clinical hospital based on an analysis of the treatment process in patients with COVID-19-associated pneumonia. Materials and methods. A retrospective analysis of 1382 cases of hospitalization in the therapeutic department of patients with COVID-19-associated pneumonia for the period from 2020 to 2021 was carried out. The structure of etiotropic therapy, the frequency and timing of microbiological studies of the biomaterial, the manifestations of the main markers of bacterial infection during dynamic monitoring of clinical and laboratory parameters in patients prescribed antibiotic therapy, as well as statistics of the stay of patients in the therapeutic department of the hospital were assessed. Based on the results obtained in the course of microbiological studies, an assessment was made of the microbial landscape of the lower respiratory tract of patients with an analysis of the sensitivity of strains of the leading microflora to a wide range of antibiotics. Results. The study found that the dominant flora in COVID-19-associated pneumonia in hospitalized patients was gram-negative bacteria - K. pneumoniae, P. aeruginosa and A. baumannii - their proportion was more than 50%. Among K. pneumoniae strains, 89.4% were ESBL producers, 63.5% of the strains were resistant to carbapenems, which with a high probability allows them to be considered carbapenemase-producing strains. Among the strains of P. aeruginosa, the proportion of strains resistant to carbapenems and with a high degree of probability being strains - producers of carbapenemase was 41.1%. Among strains of Acinetobacter spp. these were 76.4%, and associated resistance to fluoroquinolones and aminoglycosides was also demonstrated. Gram-positive microorganisms were found in 34.3% of cases and were mainly represented by strains of S. aureus (74.9%), only 26.4% of strains of this pathogen were methicillin-resistant. Conclusions. Microbiological monitoring conducted in 2020-2021 revealed the presence, among the pathogens of viral-bacterial pneumonia, at an early stage of hospitalization, a significant proportion of gram-negative bacteria with resistance of the MDR and XDR types. Based on the obtained microbiological data, starting empirical schemes for antibacterial therapy of secondary viral and bacterial pneumonia, which complicated the course of a new coronavirus infection COVID-19 caused by the SARS-CoV-2 virus, were developed and proposed.Copyright © 2022, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy. All rights reserved.
ABSTRACT
Objective. Development of local clinical protocols for antibacterial therapy of COVID-19-associated bacterial pneumonia in the therapeutic department of the city clinical hospital based on an analysis of the treatment process in patients with COVID-19-associated pneumonia. Materials and methods. A retrospective analysis of 1382 cases of hospitalization in the therapeutic department of patients with COVID-19-associated pneumonia for the period from 2020 to 2021 was carried out. The structure of etiotropic therapy, the frequency and timing of microbiological studies of the biomaterial, the manifestations of the main markers of bacterial infection during dynamic monitoring of clinical and laboratory parameters in patients prescribed antibiotic therapy, as well as statistics of the stay of patients in the therapeutic department of the hospital were assessed. Based on the results obtained in the course of microbiological studies, an assessment was made of the microbial landscape of the lower respiratory tract of patients with an analysis of the sensitivity of strains of the leading microflora to a wide range of antibiotics. Results. The study found that the dominant flora in COVID-19-associated pneumonia in hospitalized patients was gram-negative bacteria – K. pneumoniae, P. aeruginosa and A. baumannii – their proportion was more than 50%. Among K. pneumoniae strains, 89.4% were ESBL producers, 63.5% of the strains were resistant to carbapenems, which with a high probability allows them to be considered carbapenemase-producing strains. Among the strains of P. aeruginosa, the proportion of strains resistant to carbapenems and with a high degree of probability being strains – producers of carbapenemase was 41.1%. Among strains of Acinetobacter spp. these were 76.4%, and associated resistance to fluoroquinolones and aminoglycosides was also demonstrated. Gram-positive microorganisms were found in 34.3% of cases and were mainly represented by strains of S. aureus (74.9%), only 26.4% of strains of this pathogen were methicillin-resistant. Conclusions. Microbiological monitoring conducted in 2020–2021 revealed the presence, among the pathogens of viral-bacterial pneumonia, at an early stage of hospitalization, a significant proportion of gram-negative bacteria with resistance of the MDR and XDR types. Based on the obtained microbiological data, starting empirical schemes for antibacterial therapy of secondary viral and bacterial pneumonia, which complicated the course of a new coronavirus infection COVID-19 caused by the SARS-CoV-2 virus, were developed and proposed. © 2022, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy. All rights reserved.
ABSTRACT
We evaluated humoral immunity (presence of specific IgM and IgG) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among healthcare professionals providing inpatient care for individuals with COVID-19. Objective. To detected and measure the level of anti-SARS-CoV-2 antibodies in healthcare professionals and to identify how many of them contacted with COVID-19 patients, including those who had asymptomatic or subclinical disease. Materials and methods. Anti-SARS-CoV-2 antibodies were detected using enzyme-linked immunosorbent assay (ELISA) with the ‘SARS-CoV-2-ELISA-Vector’ kit for IgG (State research Center of Virology and Biotechnology ‘Vector’) and ‘SARS-CoV-2-IgG- ELISA-BEST’ and ‘SARS-CoV-2-IgМ-ELISA-BEST’ kits for IgM and IgG (Vector-Best LLC). Samples were collected in several healthcare institutions of Moscow and in G.N.Gabrichevskiy Moscow Research Institute of Epidemiology and Microbiology. A total of 24,373 serum specimens from 74 healthcare institutions were tested. All study participants filled in special questionnaires. Results. Among 24,373 healthcare professionals tested in this study, 5,382 people were IgG-positive to SARS-CoV-2 (seroprevalence index 22.1%). The seropositivity rate was 21.5% in senior medical staff, 22.2% in nursing professionals, and 22.8% in medical assistants/technicians. We found that the proportion of SARS-CoV-2 seropositive individuals had changed over time, gradually increasing from 17.9% in April 2020 to 37.6% in December 2020. The proportion of SARS-CoV-2 seropositive people doubled among senior medical staff and nursing professionals during the year. The proportion of individuals with asymptomatic or subclinical COVID-19 was 13.8%. Conclusion. The methodological approaches used in this study allowed us to assess the humoral immunity to SARS-CoV-2 among healthcare professionals in Moscow. Our findings can be used for further improvement of anti-epidemic measures in healthcare institutions. © 2021, Dynasty Publishing House. All rights reserved.