Empirical antimicrobial therapy of purulent-septic complications in surgical coloproctology
https://doi.org/10.25199/2408-9613-2019-6-2-17-23
Abstract
Object. to optimize antibacterial therapy in patients with coloproctological profile with purulent-septic complications.
Materials and methods. A one-center intervention study with historical control was conducted. The intervention began in January 2017, when in the hospital FSBI «N. I. Pirogov National Medical Surgical Center» Russian Ministry of Health introduced strict monitoring of compliance with the protocols of empirical antimicrobial therapy. The study included 62 patients who underwent antibacterial therapy after operations on the colon and rectum in 2016–2017. Patients were divided into two groups with respect to the beginning of the intervention: 2016 – comparison group (A), 2017 – main group (B).
Results. There was a slight decrease in the total consumption of antibacterial drugs in coloproctological patients from 823.0 to 691.0 Defined Daily Dose (DDD, established daily dose), as well as the average consumption of antibiotics per patient from 26.5 to 22.3 DDD. An increase in the number of cases of compliance with the approved protocol of empirical antimicrobial therapy (AMT) was revealed from 32.3 % in group A to 67.7 % in group B, p = 0.01. The frequency of adequate empirical antibiotic prescribing increased from 71.0 to 93.5 %, p = 0.042. A significant increase in the frequency of de-escalation of AMT was revealed from 3.2 % in group A to 25.8 % in group B, p = 0.026.
Conclusion. Monitoring compliance with empirical AMT protocols allowed to increase the number of cases of adherence to approved protocols, which positively affected the frequency of adequate appointment of empirical AMT, and also led to increase the number of cases of de-escalation of AMT.
About the Authors
Yu. M. Stoiko
FSBI «N. I. Pirogov National Medical Surgical Center» Ministry of Health of Russia
Russian Federation
70, Lower Pervomayskaya Str., Moscow, 105203, Russia
Russian Federation
70, Lower Pervomayskaya Str., Moscow, 105203, Russia
V. G. Gusarov
FSBI «N. I. Pirogov National Medical Surgical Center» Ministry of Health of Russia
Russian Federation
70, Lower Pervomayskaya Str., Moscow, 105203, Russia
Russian Federation
70, Lower Pervomayskaya Str., Moscow, 105203, Russia
A. L. Levchuk
FSBI «N. I. Pirogov National Medical Surgical Center» Ministry of Health of Russia
Russian Federation
70, Lower Pervomayskaya Str., Moscow, 105203, Russia
Russian Federation
70, Lower Pervomayskaya Str., Moscow, 105203, Russia
A. V. Maksimenkov
FSBI «N. I. Pirogov National Medical Surgical Center» Ministry of Health of Russia
Russian Federation
70, Lower Pervomayskaya Str., Moscow, 105203, Russia
Russian Federation
70, Lower Pervomayskaya Str., Moscow, 105203, Russia
D. A. Kolozyan
FSBI «N. I. Pirogov National Medical Surgical Center» Ministry of Health of Russia
Russian Federation
70, Lower Pervomayskaya Str., Moscow, 105203, Russia
Russian Federation
70, Lower Pervomayskaya Str., Moscow, 105203, Russia
References
1. The strategy and tactics of using antimicrobial agents in hospitals in Russia: Russian national recommendations / ed. V. S. Saveliev, B. R. Gelfand, S. V. Yakovleva = Strategiya i taktika ispol'zovaniya antimikrobnykh sredstv v LPU Rossii : Rossiyskiye natsional'nyye rekomendatsii / pod red. V. S. Savel'yeva, B. R. Gel'fanda, S. V. Yakovleva. M.:[b. i.], 2012. 94 s. (In Russ).
2. Surgical infections of the skin and soft tissues : Russian national recommendations / ed. B. R. Gelfand, V. A. Kubyshkina, R. S. Kozlova, N.N. Khachatryan = Khirurgicheskiye infektsii kozhi i myagkikh tkaney : Rossiyskiye natsional'nyye rekomendatsii / pod red. B. R. Gel'fanda, V. A. Kubyshkina, R. S. Kozlova, N. N. Khachatryan. M.: [b. i.], 2015. 109 s. (In Russ).
3. Gusarov V. G., Lashenkova N. N., Petrova N. V., et al. Protocols of empirical antimicrobial therapy as a tool to improve the quality of emergency medical care for patients with infection in a multidisciplinary surgical hospital = Gusarov V. G., Lashenkova N. N., Petrova N. V. i dr. Protokoly empiricheskoy antimikrobnoy terapii kak instrument uluchsheniya kachestva neotlozhnoy meditsinskoy pomoshchi patsiyentam s infektsiyey v mnogoprofil'nom khirurgicheskom statsionare // Meditsinskiy alfavit. 2016. T. 4, № 33. S. 24-28 (In Russ).
4. Abdominal surgical infection : Russian national recommendations / ed. B. C. Saveliev, B. R. Gelfand = Abdominal'naya khirurgicheskaya infektsiya : Rossiyskiye natsional'nyye rekomendatsii / red. B. C. Savel'yeva, B. R. Gel'fanda. M.: Borges, 2011. 98 s. (In Russ).
5. Gusarov V. G., Zamyatin M. N., Teplykh B. A., et al. Antibiotic resistance: ways to solve the problem in a multidisciplinary hospital = Gusarov V. G., Zamyatin M. N., Teplykh B. A. i dr. Antibiotikorezistentnost': puti resheniya problemy v mnogoprofil'nom statsionare // Vestnik Natsional'nogo mediko-khirurgicheskogo Tsentra im. N. I. Pirogova. 2014. T. 9, № 3. S.108–112 (In Russ).
6. The SKAT program (Antimicrobial Therapy Control Strategy) for inpatient care : Russian Clinical Recommendations / ed. S. V. Yakovleva, N. I. Briko, S. V. Sidorenko, D. N. Protsenko = Programma SKAT (Strategiya Kontrolya Antimikrobnoy Terapii) pri okazanii statsionarnoy meditsinskoy pomoshchi : Rossiyskiye klinicheskiye rekomendatsii / pod red. S. V. Yakovleva, N. I. Briko, S. V. Sidorenko, D. N. Protsenko. – M.:Izdatel'stvo «Pero», 2018. – 156 s. (In Russ).
7. Zamyatin M., Gusarov V., Petrova N., Lashenkova N., Dementienko M., Shilkin D., Nesterova E. Results of antimicrobial stewardship program implementation in multidisciplinary hospital // ICU Management & Practice. 2018. Vol. 18, № 2. P. 125–127.
8. The strategy and tactics of using antimicrobial agents in hospitals in Russia: Russian national recommendations / ed. V. S. Saveliev, B. R. Gelfand, S. V. Yakovleva = Strategiya i taktika ispol'zovaniya antimikrobnykh sredstv v LPU Rossii : Rossiyskiye natsional'nyye rekomendatsii / pod red. V. S. Savel'yeva, B. R. Gel'fanda, S. V. Yakovleva. M.:[b. i.], 2012. 94 s. (In Russ).
9. Khachatryan N. N., Karsotyan G. S., Isaev A. I., Dibirov T. M. Postoperative infectious complications: prevention and treatment in conditions of increasing resistance of microorganisms = Khachatryan N. N., Karsot'yan G. S., Isayev A. I., Dibirov T. M. Posleoperatsionnyye infektsionnyye oslozhneniya: profilaktika i lecheniye v usloviyakh narastayushchey rezistentnosti mikroorganizmov // Infektsii v khirurgii. 2017. T. 15, № 1. S. 41–49 (In Russ).
10. Gusarov V. G., Lashenkova N. N., Petrova N. V., et al. Protocols of empirical antimicrobial therapy as a tool to improve the quality of emergency medical care for patients with infection in a multidisciplinary surgical hospital = Gusarov V. G., Lashenkova N. N., Petrova N. V. i dr. Protokoly empiricheskoy antimikrobnoy terapii kak instrument uluchsheniya kachestva neotlozhnoy meditsinskoy pomoshchi patsiyentam s infektsiyey v mnogoprofil'nom khirurgicheskom statsionare // Meditsinskiy alfavit. 2016. T. 4, № 33. S. 24-28 (In Russ).
11. Tacconelli E., De Angelis G., Cataldo M. A., et al. Does antibiotic exposure increase the risk of methicillinresistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis // J. Antimicrob. Chemother. 2008. Vol. 61. P. 26–38.
12. Gusarov V. G., Zamyatin M. N., Teplykh B. A., et al. Antibiotic resistance: ways to solve the problem in a multidisciplinary hospital = Gusarov V. G., Zamyatin M. N., Teplykh B. A. i dr. Antibiotikorezistentnost': puti resheniya problemy v mnogoprofil'nom statsionare // Vestnik Natsional'nogo mediko-khirurgicheskogo Tsentra im. N. I. Pirogova. 2014. T. 9, № 3. S.108–112 (In Russ).
13. Epidemiological surveillance of infections associated with the provision of medical care: Federal clinical guidelines / ed. B. I. Aslanova, L. P. Zueva, A. V. Lyubimova et al. = Epidemiologicheskoye nablyudeniye za infektsiyami, svyazannymi s okazaniyem meditsinskoy pomoshchi: Federal'nyye klinicheskiye rekomendatsii / pod red. B. I. Aslanova, L. P. Zuyevoy, A. V. Lyubimova i dr. M.: [b. i.], 2014. 60 c. (In Russ).
14. Zamyatin M., Gusarov V., Petrova N., Lashenkova N., Dementienko M., Shilkin D., Nesterova E. Results of antimicrobial stewardship program implementation in multidisciplinary hospital // ICU Management & Practice. 2018. Vol. 18, № 2. P. 125–127.
15. Khachatryan N. N., Karsotyan G. S., Isaev A. I., Dibirov T. M. Postoperative infectious complications: prevention and treatment in conditions of increasing resistance of microorganisms = Khachatryan N. N., Karsot'yan G. S., Isayev A. I., Dibirov T. M. Posleoperatsionnyye infektsionnyye oslozhneniya: profilaktika i lecheniye v usloviyakh narastayushchey rezistentnosti mikroorganizmov // Infektsii v khirurgii. 2017. T. 15, № 1. S. 41–49 (In Russ).
16. Tacconelli E., De Angelis G., Cataldo M. A., et al. Does antibiotic exposure increase the risk of methicillinresistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis // J. Antimicrob. Chemother. 2008. Vol. 61. P. 26–38.
17. Epidemiological surveillance of infections associated with the provision of medical care: Federal clinical guidelines / ed. B. I. Aslanova, L. P. Zueva, A. V. Lyubimova et al. = Epidemiologicheskoye nablyudeniye za infektsiyami, svyazannymi s okazaniyem meditsinskoy pomoshchi: Federal'nyye klinicheskiye rekomendatsii / pod red. B. I. Aslanova, L. P. Zuyevoy, A. V. Lyubimova i dr. M.: [b. i.], 2014. 60 c. (In Russ).
Review
For citations:
Stoiko Yu.M., Gusarov V.G., Levchuk A.L., Maksimenkov A.V., Kolozyan D.A. Empirical antimicrobial therapy of purulent-septic complications in surgical coloproctology. Wounds and wound infections. The prof. B.M. Kostyuchenok journal. 2019;6(2):17-23. (In Russ.) https://doi.org/10.25199/2408-9613-2019-6-2-17-23
Views:
1033
Email this article 