Objective. To evaluate the results of the implementation of antimicrobial stewardship (AMS) program in a multidisciplinary hospital. Materials and Methods. A retrospective intervention study was performed in the 600-bed multidisciplinary hospital of the Pirogov National Medical and Surgical Center (Moscow, Russia). The study included a number of sequential interventions, aimed at improving the prevention, diagnosis and treatment of infections, with an assessment of the following indicators dynamics: the structure of microorganisms isolated in the hospital, the level of resistance to antimicrobial drugs (AMD) among the pathogens of the ESKAPE group, the structure of prescribed AMD, as well as an assessment of clinical and economic consequences of antimicrobial resistance changes. For a comprehensive assessment of trend in antibiotic resistance and its connection with consumption of antibiotics, the drug resistance index (DRI) was used. DRI is based on the ratio of the level of resistance of the microorganism and the frequency of administration of AMD, potentially effective against this pathogen. The intervention started in 2013, so the data of 2012 (pre-intervention period) and 2022 were compared in this study. Results. The implementation of AMS program measures helped to reduce the relative frequency of ESKAPE group microorganisms in the structure of nosocomial infection pathogens in the hospital from 36.5% to 22% (p < 0.0001). The proportion of gram-negative (Gr-) isolates resistant to meropenem decreased from 32.4% to 10.9% (p < 0.0001). As a result of the introduction of AMS program, DDDh has been reduced almost three times: from 48.1 to 17.2 DDDh. The median duration of the AMT course in a specialized intensive care unit for the treatment of patients with nosocomial infections decreased from 12 to 8 days (p < 0.0001), the number of AMT days per 1 patient decreased from 7.7 to 4.2 (p < 0.0001). The proportion of ESKAPE pathogens in the structure of bloodstream infections in the hospital decreased from 53.1% to 26% (p < 0.0001), which led to decrease in mortality from 28.4% to 12.8%, (p = 0.012) and length of hospital stay from 31 to 22 days (p < 0.001) in this group of patients. Conclusions. The implementation of AMS program in a multidisciplinary hospital helps to reduce the frequency of inappropriate use of antimicrobial drugs and reduces the consumption of antibiotics, decrease the level of antimicrobial resistance, and in such way improves the results of treatment of patients with nosocomial infections.

BACKGROUND: Despite the proven importance of secondary bacterial infections influencing the severity of viral respiratory diseases, their etiology is still not well understood. There is a gap in knowledge about the nature, frequency, and antimicrobial resistance profiles of bacterial pathogens in the current COVID-19 pandemic. AIM: To describe the species spectrum of microorganisms in patients of the COVID-19 Hospital on the basis of a multidisciplinary federal medical institution. MATERIALS AND METHODS: Clinical samples (blood, lower respiratory tract discharge, urine, other biological materials) from patients with COVID-19 who were treated at the COVID-19 Hospital at a multidisciplinary federal medical institution were obtained and processed. RESULTS: The bacteriological laboratory received 1821 samples of biomaterial from 452 patients, microorganisms were isolated from 620 (38.0%) samples. Most of the biomaterial was represented by blood 35.9% and discharge from the lower respiratory tract 31.7%. The structure of microorganisms was dominated by Candida albicans 19.7%, Staphylococcus aureus 10.2%, Klebsiella pneumoniae 10.1%, Enterococcus faecalis 7.9%. At the beginning of the period of operation of the Hospital, the most frequently identified microorganisms were S. aureus and Haemophilus influenzae 19.7% and 7.9%, respectively, while in the final period there was a change in the spectrum of microorganisms to nosocomial ESKAPE -pathogens with multiple drug resistance, the structure was dominated by Acinetobacter baumannii 24.3%. Antibiotic consumption in the hospital increased from 18.3 DDD/100 patient days in 2019 to 28.8 DDD/100 patient days in 2020. CONCLUSION: Significant colonization of various loci of patients with COVID-19 by fungi of the genus Candida was revealed. There has been a change in the microbial spectrum of infectious agents from community-acquired (H. influenzae and S. pneumoniae) to nosocomial ESKAPE pathogens with multiple drug resistance. The consumption of antibiotics has increased significantly.

Objective. To create local antibiotic resistance surveillance system using the AMRcloud online platform to provide evidence base for activity of antimicrobials (AM) and antimicrobial resistance (AMR) epidemiology. Materials and Methods. This study was conducted at the Pirogov National Medical and Surgical Center (Moscow, Russia). The study is prospective, with two evaluations of the local AMR surveillance system (before and after the implementation of the AMRcloud online platform). Separately, the effects of implementing the AMRcloud platform were evaluated and the most frequent scenarios of using this system in hospital were studied. Results. With the help of the AMRcloud platform, which acts as one of the central links in the AMR surveillance process, a local AMR surveillance system was formed, providing continuity of historical data and evidence base on local AMR epidemiology with real-time access and bringing together specialists of various profiles. Conclusions. Implementation of the AMRcloud online platform into multidisciplinary hospital operations enables the creation of a local evidence base on AM activity and AMR epidemiology, as well as reducing the labor costs of several crucial stages of AMR surveillance – data storage, analysis and exchange.

A retrospective analysis of the medical data of 12 patients with COVID-19 was performed. For the diagnosis of invasive aspergillosis the international criteria ECMM/ISHAM 2020 were used. We analyzed the scientific literature data on the diagnosis and treatment of invasive aspergillosis in patients with COVID-19.Results. Among the 12 examined patients with a severe course of COVID-19, invasive aspergillosis was diagnosed in 5 patients. Four patients (80%) were treated in the ICU. Steroids or interleukin-6 inhibitors were used in 80% patients. Severe lymphocytopenia was in 80% patients, neutropenia 20%. A fever refractory to antibiotic therapy was noted in 80% patients, an increase in respiratory failure – 60%, acute respiratory distress syndrome – 60%. All patients showed negative dynamics of changes in the chest CT scan. Invasive aspergillosis was confirmed with a positive test for galactomannan in bronchoalveolar lavage and / or serum in 100% of cases. All patients received antifungal therapy with voriconazole and/or caspofungin. The overall 12-week survival rate was 80%.Conclusion. In ICU patients with severe COVID-19 and progressive pulmonary symptoms invasive aspergillosis should be excluded. Examination of substrates from the lower respiratory tract (BAL, tracheal aspirate, or nonbronchoscopic lavage) is necessary. Laboratory examination should include microscopy, culture and test for galactomannan. Voriconazole and isavuconazole are drugs of choice for the treatment of invasive aspergillosis in patients with COVID-19.

The analysis of the current state of antimicrobial resistance was performed and used as the basis for the implementation of modern tools of antimicrobial stewardship program in hospital practice. As a result, the structure of nosocomial pathogens and the prevalence of resistant isolates in a hospital were affected. Antibiotic consumption and economic burden of antimicrobial resistance have decreased, and treatment quality indicators for nosocomial infections have changed.

The protocol of empirical antimicrobial therapy (AMT) in the National Medical & Surgical Center n. a. N. I. Pirogov is a part of antimicrobial stewardship program, implemented in 2013. The protocol is based on local antimicrobial resistance data, takes into account features of the hospital and contains the decision-making process for risk stratification of antibiotic-resistant microorganisms, for start, choice, removal of AMT and its results assessment, as well as differentiated algorithms of empirical antibiotic therapy for respiratory tract infections, skin and soft tissues infections, urinary tract infections, bloodstream infections, intra-abdominal infections, periprosthetic joint infection, central nervous system infection, infections in neutropenic patients, treatment regimens for antibiotic-associated colitis. The protocol is updated annually, the fourth edition of the protocol is presented.