“The end of the era of antibiotics” — myth or reality: what the past COVID-19 pandemic has shown
- Authors: Mitrokhin S.D.1, Mironov A.Y.2,3, Aleshkin A.V.2, Galitskiy A.A.1, Suranova T.G.3, Mironova A.V.2
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Affiliations:
- City Clinical Hospital No. 67 named after L.A. Vorokhobova
- G.N. Gabrichevsky Research Institute for Epidemiology and Microbiology
- Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies
- Issue: Vol 29, No 1 (2024)
- Pages: 29-39
- Section: ORIGINAL STUDIES
- URL: https://rjeid.com/1560-9529/article/view/623450
- DOI: https://doi.org/10.17816/EID623450
- ID: 623450
Cite item
Abstract
BACKGROUND: During the coronavirus disease 2019 pandemic, the sale of antimicrobials (AMPs) in the pharmacy network and their purchases by healthcare facilities of the Russian Federation have significantly increased. Microbiological monitoring conducted at the City Clinical Hospital No. 67 named after L.A. Vorokhobov of the Moscow Health Department in 2020–2021 revealed an urgent problem: gram-negative bacteria, which are dominated by multidrug-resistant (MDR) strains, are now mainly isolated from patients with healthcare-associated infections (HAIs). Pharmacoeconomic studies have shown that the cost of one course of targeted antibiotic therapy for HAIs can increase by 6–12 times compared with a similar course of therapy in the absence of nosocomial MDR and extensively drug-resistant (XDR) pathogens.
AIM: To increase the effectiveness of preventive measures aimed at preventing the spread of hospital-acquired pathogen strains in the intensive care unit (ICU) using effective bacteriophages against MDR strains of Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, and Acinetobacter baumannii, which were selected in accordance with an individualized algorithm.
MATERIALS AND METHODS: The study included two groups, totaling 20 patients, who were on prolonged mechanical ventilation in the ICU of City Clinical Hospital No. 67 named after L.A. Vorokhobov of the Moscow Health Department in 2022. The second group received 20 mL of bacteriophages via an intragastric tube for five consecutive days. The concept of a personalized approach to phage therapy for various forms of HAIs caused by nosocomial MDR pathogens in patients of a multidisciplinary hospital has been proposed and tested.
RESULTS: With this medical technology, the effectiveness of phage therapy for various nosological forms of HAIs caused by nosocomial MDR and XDR strains increased by 30%, and the effectiveness of the initial antibiotic therapy regimen was ≥70%. The economic effect of the combination of antibiotic therapy and phage therapy (booster therapy) amounted to more than 3 million rubles compared with the use of AMP alone for treating patients with HAIs caused by nosocomial MDR/XDR strains.
CONCLUSIONS: Booster therapy as a variant of IIB therapy reduces the cost of treatment of AMPs of various forms of HAIs by ≥2.5 times compared with AMPs alone.
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About the authors
Sergey D. Mitrokhin
City Clinical Hospital No. 67 named after L.A. Vorokhobova
Email: s_mitrokhin60@mail.ru
ORCID iD: 0000-0001-5127-1060
SPIN-code: 4306-9304
MD, Dr. Sci. (Med.), Professor
Russian Federation, MoscowAndrey Yu. Mironov
G.N. Gabrichevsky Research Institute for Epidemiology and Microbiology; Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies
Email: andy.60@mail.ru
ORCID iD: 0000-0002-8544-5230
SPIN-code: 9225-1560
Scopus Author ID: 37038042300
MD, Dr. Sci. (Med.), Professor
Russian Federation, Moscow; MoscowAndrey V. Aleshkin
G.N. Gabrichevsky Research Institute for Epidemiology and Microbiology
Email: ava@gabri.ru
ORCID iD: 0000-0002-0532-1378
SPIN-code: 2224-7471
MD, Corresponding Member of the Russian Academy of Sciences, Dr. Sci. (Med.), Professor of the RAS
Russian Federation, MoscowAnton A. Galitskiy
City Clinical Hospital No. 67 named after L.A. Vorokhobova
Email: a.galitskiy@67gkb.ru
ORCID iD: 0000-0001-5022-1475
SPIN-code: 6967-9964
MD
Russian Federation, MoscowTatyana G. Suranova
Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies
Author for correspondence.
Email: suranovatatiana@mail.ru
ORCID iD: 0000-0003-3411-1027
SPIN-code: 7326-5273
MD, Cand. Sci. (Med.), Associate Professor
Russian Federation, MoscowAnna V. Mironova
G.N. Gabrichevsky Research Institute for Epidemiology and Microbiology
Email: annamir_88@mail.ru
ORCID iD: 0000-0001-8840-850X
SPIN-code: 7596-2992
MD
Russian Federation, MoscowReferences
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