COVID-19 pandemic is a pandemic of antimicrobial therapy.

The article presents a critical analysis of antibiotic usage tactics in the treatment of patients with COVID-19 existing in Russian and foreign healthcare, and discusses the possible causes of unjustified antibiotic aggression in this category of patients. The potential negative consequences of the widespread use of antibiotics in patients carrying a new coronavirus infection are analyzed: life-threatening cardiotoxicity in patients with the simultaneous administration of such a "popular" candidate etiologic therapy as a combination of azithromycin and hydroxychloroquine, the potential development of other serious adverse drug reactions (in particular, the development of an antibiotic-associated pseudomembranous colitis, etc.), the expected dramatic increase in the secondary drug resistance of potentially pathogenic microorganisms to widely and often prescribed antibiotics.Copyright © 2021, Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy. All rights reserved.

Clinical aspects of diarrhea during the pandemia of COVID-19.

The aim. To investigate the clinical peculiarities of adult patients with diarrheal syndrome, associated with coronavirus infection COVID-19. The materials and methods. There has been carried out the analysis of 56 patients aged 26-81 years, hospitalized with acute enteric infection at the Municipal Infectious Diseases Hospital 8 (not reprofiled as hospital for the treatment of coronavirus infection COVID-19 patients) in the course of August 2020 - February 2021 and the patients with cause-effect relationship with COVID-19. There have been used the routine diagnostic methods, the analysis of feces for causative agents of diarrhea was tested by the methods of bacteriological and immunoenzymatic analysis, the analysis of feces for toxins A and B Clostridium difficile was tested method of immunochromatographic assay;the blood serum was tested by method of immunoenzymatic analysis and the analysis of nasopharyngeal swabs was tested by immunochromatographic assay and PCR test for markers SARS-COV-2. The statistical material treatment has been done using Statistical Package of IBM SPSS Statistics-22. The results. There have been registered 51,8% of cases - diarrhea as one of the clinical manifestations of COVID-19 in adult patients (the first group of patients), in 48,2% of cases - diarrhea as a result of recently treated COVID-19 and a massive course of antibiotics (the second group of patients). In the second group 12 patients have been diagnosed with clostridial infection, 15 patients - with antibiotic-associated diarrhea. There has been registered the main severity of clinical manifestations in patients with clostridial infection. The disease being characterized by severity of colitis syndrome, the blood sedimentation rate increasing, hyperleukocytosis in haemogram, hypoproteinemia and hypoalbuminemia. The aggravating factors are combined comorbidity and patients aged over 55 years. The conclusion. There should be used the differential approach for diarrheal syndrome in patients with coronavirus infection. Taking into account the massive course antibiotics' side effects, the analysis of feces for pathogenic flora must be included into the medical examinations such as Clostridium difficile and the course of probiotic and anticlostridial medicines should be done.Copyright © 2022 Authors. All rights reserved.

Clinical aspects of diarrhea during the pandemia of COVID-19

The aim. To investigate the clinical peculiarities of adult patients with diarrheal syndrome, associated with coronavirus infection COVID-19. The materials and methods. There has been carried out the analysis of 56 patients aged 26-81 years, hospitalized with acute enteric infection at the Municipal Infectious Diseases Hospital №8 (not reprofiled as hospital for the treatment of coronavirus infection COVID-19 patients) in the course of August 2020 – February 2021 and the patients with cause-effect relationship with COVID-19. There have been used the routine diagnostic methods, the analysis of feces for causative agents of diarrhea was tested by the methods of bacteriological and immunoenzymatic analysis, the analysis of feces for toxins A and B Clostridium difficile was tested method of immunochromatographic assay;the blood serum was tested by method of immunoenzymatic analysis and the analysis of nasopharyngeal swabs was tested by immunochromatographic assay and PCR test for markers SARS-COV-2. The statistical material treatment has been done using Statistical Package of IBM SPSS Statistics-22. The results. There have been registered 51,8% of cases – diarrhea as one of the clinical manifestations of COVID-19 in adult patients (the first group of patients), in 48,2% of cases – diarrhea as a result of recently treated COVID-19 and a massive course of antibiotics (the second group of patients). In the second group 12 patients have been diagnosed with clostridial infection, 15 patients – with antibiotic-associated diarrhea. There has been registered the main severity of clinical manifestations in patients with clostridial infection. The disease being characterized by severity of colitis syndrome, the blood sedimentation rate increasing, hyperleukocytosis in haemogram, hypoproteinemia and hypoalbuminemia. The aggravating factors are combined comorbidity and patients aged over 55 years. The conclusion. There should be used the differential approach for diarrheal syndrome in patients with coronavirus infection. Taking into account the massive course antibiotics' side effects, the analysis of feces for pathogenic flora must be included into the medical examinations such as Clostridium difficile and the course of probiotic and anticlostridial medicines should be done. © 2022 Authors. All rights reserved.

Clinical aspects of diarrhea during the pandemia of COVID-19.

The aim. To investigate the clinical peculiarities of adult patients with diarrheal syndrome, associated with coronavirus infection COVID-19. The materials and methods. There has been carried out the analysis of 56 patients aged 26-81 years, hospitalized with acute enteric infection at the Municipal Infectious Diseases Hospital 8 (not reprofiled as hospital for the treatment of coronavirus infection COVID-19 patients) in the course of August 2020 - February 2021 and the patients with cause-effect relationship with COVID-19. There have been used the routine diagnostic methods, the analysis of feces for causative agents of diarrhea was tested by the methods of bacteriological and immunoenzymatic analysis, the analysis of feces for toxins A and B Clostridium difficile was tested method of immunochromatographic assay;the blood serum was tested by method of immunoenzymatic analysis and the analysis of nasopharyngeal swabs was tested by immunochromatographic assay and PCR test for markers SARS-COV-2. The statistical material treatment has been done using Statistical Package of IBM SPSS Statistics-22. The results. There have been registered 51,8% of cases - diarrhea as one of the clinical manifestations of COVID-19 in adult patients (the first group of patients), in 48,2% of cases - diarrhea as a result of recently treated COVID-19 and a massive course of antibiotics (the second group of patients). In the second group 12 patients have been diagnosed with clostridial infection, 15 patients - with antibiotic-associated diarrhea. There has been registered the main severity of clinical manifestations in patients with clostridial infection. The disease being characterized by severity of colitis syndrome, the blood sedimentation rate increasing, hyperleukocytosis in haemogram, hypoproteinemia and hypoalbuminemia. The aggravating factors are combined comorbidity and patients aged over 55 years. The conclusion. There should be used the differential approach for diarrheal syndrome in patients with coronavirus infection. Taking into account the massive course antibiotics' side effects, the analysis of feces for pathogenic flora must be included into the medical examinations such as Clostridium difficile and the course of probiotic and anticlostridial medicines should be done.Copyright © 2022 Authors. All rights reserved.

Evaluation of the Rationality of Antibiotic Therapy of Nosocomial Infections in Resuscitation and Intensive Care Patients with COVID-19: a Retrospective Analysis.

The overall incidence of healthcare-associated infections (HAIs) in patients with COVID-19 is lower than 15%. However, in critical COVID-19 patients, the incidence of HAIs may reach 50%, and the mortality rate may exceed 50%. This makes effective antibiotic therapy in this category of patients extremely important. The aim of the study was to assess the rationality of antibiotic therapy in critically ill COVID-19 patients with HAIs, as well as analyse the timeliness and sufficiency of microbiological and laboratory diagnostic testing in these patients. Material(s) and Method(s): the study comprised a retrospective analysis of medical records of the patients with COVID-19 complicated by HAIs who had been admitted to an intensive care unit of Moscow City Clinical Hospital 4 from 27.04.2020 to 01.11.2020. Antibacterial therapy was analysed in accordance with the principles set forth in the Strategy for the Control of Antimicrobial Therapy (antimicrobial stewardship) and the current Interim Guidelines on the Prevention, Diagnosis and Treatment of Novel Coronavirus Infection (COVID-19) of the Russian Ministry of Health. Statistical significance was evaluated using Student's unpaired t-test. The qualitative comparison of independent groups was made using the chi2 test. Result(s): HAIs developed in 138 (20.8%) of 664 patients admitted to the intensive care unit. The authors considered empirical antibiotic therapy irrational in 53.6% of these cases (74/138 patients) due to nonconformity to the current clinical recommendations. Empirical antimicrobial therapy was rational in 68.6% of survivors and 33.3% of non-survivors (p < 0.001). It was corrected based on the results of microbiological testing in 56.9% of survivors and 30.2% of non-survivors (p = 0.005). Procalcitonin levels, as a marker of bacterial infection, were determined in 74.5% survivors and 48.3% of non-survivors (p = 0.003). Conclusion(s): Antibiotic therapy was rational in less than 50% of critically ill COVID-19 patients with HAIs. Having demonstrated a significant mortality decrease in the category of studied patients with rational antibiotic therapy, the study suggests that it is necessary to follow the current recommendations more carefully. The success of therapy also largely depends on its timely correction based on the results of HAI pathogen identification and other diagnostic measures, in particular, procalcitonin biomarker tests.Copyright © 2022 Obstetrics, Gynecology and Reproduction. All rights reserved.

Bacterial Co-Infection and Empirical Antibacterial Therapy in Patients With COVID-19.

BACKGROUND: The rate and composition of bacterial co-infection in patients with coronavirus disease 2019 (COVID-19) were evaluated when microbiological testing was conducted on the majority of patients. We also evaluated whether the use of empirical antibacterials was associated with mortality. METHODS: In this retrospective study, all of the adult patients with COVID-19 hospitalized in a single tertiary hospital in South Korea between February 2020 and December 2021 were included. Bacterial co-infection was assessed by sputum cultures, blood cultures, and molecular testing, including polymerase chain reaction sputum testing and urinary antigen tests. Mortality was compared between patients who received empirical antibacterials and those who did not. RESULTS: Of the 367 adult patients admitted during the study period, 300 (81.7%) had sputum culture results and were included in the analysis. Of these 300 patients, 127 (42.3%) had a history of antibiotic exposure. The co-infection rate within 48 hours was 8.3% (25/300): 6.4% (11/173) of patients without prior antibiotic exposure and 11% (14/127) of patients with prior antibacterial exposure. The co-infected bacteria were different according to antibacterial exposure before admission, and multi-drug resistant pathogens were detected exclusively in the antibacterial exposed group. Among the patients without positive results for the microbiological tests, empirical antibacterials were used in 33.3% of cases (100/300). Empirical antibacterial therapy was not significantly related to the 30-day mortality or in-hospital mortality rates in the study cohort before or after the propensity score-matching. CONCLUSION: In this study including only patients underwent microbiological testing, bacterial co-infection was not frequent, and the co-infected organisms varied depending on previous antibacterial exposures. Given the rarity of co-infection and the lack of potential benefits, empiric antibacterial use in COVID-19 should be an important target of antibiotic stewardship.

Evaluation of the Rationality of Antibiotic Therapy of Nosocomial Infections in Resuscitation and Intensive Care Patients with COVID-19: a Retrospective Analysis

The overall incidence of healthcare-associated infections (HAIs) in patients with COVID-19 is lower than 15%. However, in critical COVID-19 patients, the incidence of HAIs may reach 50%, and the mortality rate may exceed 50%. This makes effective antibiotic therapy in this category of patients extremely important. The aim of the study was to assess the rationality of antibiotic therapy in critically ill COVID-19 patients with HAIs, as well as analyse the timeliness and sufficiency of microbiological and laboratory diagnostic testing in these patients. Material(s) and Method(s): the study comprised a retrospective analysis of medical records of the patients with COVID-19 complicated by HAIs who had been admitted to an intensive care unit of Moscow City Clinical Hospital 4 from 27.04.2020 to 01.11.2020. Antibacterial therapy was analysed in accordance with the principles set forth in the Strategy for the Control of Antimicrobial Therapy (antimicrobial stewardship) and the current Interim Guidelines on the Prevention, Diagnosis and Treatment of Novel Coronavirus Infection (COVID-19) of the Russian Ministry of Health. Statistical significance was evaluated using Student's unpaired t-test. The qualitative comparison of independent groups was made using the chi2 test. Result(s): HAIs developed in 138 (20.8%) of 664 patients admitted to the intensive care unit. The authors considered empirical antibiotic therapy irrational in 53.6% of these cases (74/138 patients) due to nonconformity to the current clinical recommendations. Empirical antimicrobial therapy was rational in 68.6% of survivors and 33.3% of non-survivors (p < 0.001). It was corrected based on the results of microbiological testing in 56.9% of survivors and 30.2% of non-survivors (p = 0.005). Procalcitonin levels, as a marker of bacterial infection, were determined in 74.5% survivors and 48.3% of non-survivors (p = 0.003). Conclusion(s): Antibiotic therapy was rational in less than 50% of critically ill COVID-19 patients with HAIs. Having demonstrated a significant mortality decrease in the category of studied patients with rational antibiotic therapy, the study suggests that it is necessary to follow the current recommendations more carefully. The success of therapy also largely depends on its timely correction based on the results of HAI pathogen identification and other diagnostic measures, in particular, procalcitonin biomarker tests. Copyright © 2022 Obstetrics, Gynecology and Reproduction. All rights reserved.

Epidemiological, Clinical and Anatomopathological Analysis in Sars_ Cov_2 Infection in Arad

Objective. The year 2020 radically changed the therapeutic approach in patients of Romanian hospitals, and intensive care units (ICUs) were sometimes used over capacity;our goal was to establish the success rate in Covid 19 patients assisted in 2020 in Arad. Material and methods. Were analyzed 450 Covid 19 cases hospitalized between 28.03-25.05.2020, regarding the demographic characteristics, symptomatology, comorbidities, hospitalisation length, treatment regimens and success rates. Results. Patients ranged in age from 19 to 99 years, with a mean of 56.75 for women and 56.11 for men, with hospitalization averaging 12 days for women and 17 days for men, who had also a higher risk for severe forms compared to women (RR 1.4483, 95% CI 1.0012-2.095, P = 0.0493);Odds ratio OR in men was increased but without statistical validation (OR 1.5023, 95% CI 10.9175-2.46, P = 0.1057). The death rate was increased in cases with hypertension associated to diabetes (OR 26.6049, P = 0.0353). Isolation of associated bacterial agents was performed in only 5.55% of cases (n = 25) but antibiotic regimens targeted 54.66% (n = 246) of cases. Multidrug resistance of circulating strains in 2020 in this hospital has increased despite the decrease in the number of patients discharged and specimens, compared to 2019. Conclusions. Antibiotic therapy in Covid 19 is not justified in the absence of a proven secondary bacterial infection, contributing to the increase in the selection of multidrug resistant bacterial strains, which is a fact already ascertained. Copyright © 2022 Romanian Society of Legal Medicine.

NEW CORONOVIRAL INFECTION (COVID-19) IN PATIENTS OF THE ELDERLY AND SENILE AGE

The review is devoted to the peculiarities of the course of a new coronavirus infection (COVID-19) in elderly and senile patients. Data on the epidemiology, pathogenetic mechanisms of development, clinical manifestations, course and prognosis of the disease among geriatric patients are presented. The role of comorbid pathology in the course and prognosis of a new coronavirus infection in the elderly is shown. Recommendations for the treatment of patients with an emphasis on the need to comply with strict indications for prescribing antibacterial drugs in this category of patients are discussed. Copyright © 2022 Stavropol State Medical University. All rights reserved.

COVID-19 in children and adolescents with cystic fibrosis

Patients with cystic fibrosis (CF) are a risk group for a severe course of respiratory viral diseases. In this regard, the European Cystic Fibrosis Society has developed the ECFS-COVID-19 surveillance program to collect information on the characteristics of COVID-19 in patients with cystic fibrosis, aimed at providing them with the necessary medical care. This article presents part of a study of Russian patients. Objective. To assess the prevalence and course of COVID-19 in Russian patients with CF and in the general Russian population. Materials and methods. From the beginning of the pandemic to December 31, 2020, 35 cases of COVID-19 in Russian children and adolescents with CF and 347,749 cases in the general population of children and adolescents were analyzed (findings from the Central Research Institute of Epidemiology of Rospotrebnadzor). Results. The proportion of children with COVID-19 in the Russian Federation was 11.3% of all reported cases, and the proportion of CF patients with COVID-19 - 10.1 per 1,000 pediatric CF patients. The main symptoms of COVID-19 in children with CF were fever, cough, rhinorrhea, abdominal pain syndrome, and no loss of smell. Most CF patients had asymptomatic or mild form of COVID-19, and hospitalization was more frequent compared to the general pediatric population. Conclusion. The study resulted in determination of prevalence of SARS-CoV-2 in CF patients and its clinical characteristics. Copyright © 2022, Dynasty Publishing House. All rights reserved.

Diagnostics and antimicrobial therapy of the infections caused by multiresistant microorganisms (update 2022)

Strains of microorganisms characterized by resistance to antimicrobial drugs used in medical organizations continue to spread In most regions of the world including Russia. It is clear that it affects both the effectiveness of antimicrobial therapy and tactics and strategy of its use not only in adults patients but also in children. The pandemic of coronavirus infection, in addition, highlighted the growing problems in treatment of invasive mycoses, the dose adjustment of antibiotics during sorption and dialysis therapy methods. These circumstances made it necessary to make adjustments to Guidelines on Diagnostics and Antimicrobial Therapy of Infections Caused by Multiresistant Strains of Microorganisms, which were prepared by a group of leading Russian experts in 2020 [1]. The submitted version of the recommendations was approved on 25.03.2022 at a joint meeting of the working group with representatives of public organizations: Association of Anesthesiologists-Intensivists, the Interregional Non-Governmental Organization Alliance of Clinical Chemotherapists and Microbiologists, the Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy (IACMAC), and NGO Russian Sepsis Forum. These recommendations reflect an interdisciplinary consensus opinion on approaches to the diagnosis and antimicrobial therapy of infections caused by multiresistant microorganisms. They are based on data from publications obtained from randomized trials as well as based on international clinical guidelines with a high degree of evidence. It is rational to use the Guidelines for determining the tactics of empirical and etiotropic therapy of the most severe infections. © 2022 by the authors.