Оптимизация стартовой эмпирической антибактериальной терапии у больных ВИЧ-инфекцией – пациентов специализированного стационара

Objective: to analyze the adequacy of the scheme of empirical antibiotic therapy in patients with complicated forms of HIV infection in a specialized hospital and propose a set of measures for its optimization.Materials and methods: Clinical and demographic characteristics, results of bacteriological studies, risk factors of infection with resistant and multiresistant pathogens were studied in patients with HIV infection at the stage of progression with infectious complications of bacterial etiology, and the adequacy of empirical antibiotic therapy was evaluated. Results: The analysis of bacterial infectious complications in 21 HIV-infected patients with advanced stages of the disease was carried out. It was established that the profiles of the starting ABT only in 47% of cases coincide with the results of the antibiogram. To increase the effectiveness of empirical antibacterial therapy, stratification of risk groups for the detection of multiresistant bacterial pathogens has been developed. The basis of stratification: the severity of immunodeficiency, the presence of previously conducted antibacterial therapy, the period and place of detection of infectious complications, the localization of the infectious process.Conclusion: the use in clinical practice of a differentiated approach to the appointment of antibacterial drugs for starting empirical therapy in patients with HIV infection can improve the quality of treatment of infectious complications in patients with immunosuppression.Цель: провести анализ адекватности схемы эмпирической антибактериальной терапии у больных с осложненными формами ВИЧ-инфекции в специализированном стационаре и предложить комплекс мероприятий по ее оптимизации.Материалы и методы: у больных ВИЧ-инфекцией в стадии прогрессирования с инфекционными осложнениями бактериальной этиологии изучены клинико-демографическая характеристика, результаты бактериологических исследований, факторы риска инфицирования резистентными и полирезистентными возбудителями, проведена оценка адекватности эмпирической антибактериальной терапии.Результаты: проведен анализ бактериальных инфекционных осложнений у 21 ВИЧ-инфицированного с поздними стадиями заболевания. Установлено, что профили стартовой АБТ только в 47% случаев совпадают с результатами антибиотикограммы. Для повышения эффективности эмпирической антибактериальной терапии разработана стратификация групп риска выявления полирезистентных бактериальных возбудителей. В основе стратификации: выраженность иммунодефицита, наличие ранее проводимой антибактериальной терапии, период и место выявления инфекционного осложнения, локализация инфекционного процесса.Заключение: использование в клинической практике дифференцированного подхода к назначению антибактериальных препаратов для стартовой эмпирической терапии у больных ВИЧ-инфекцией может повысить качество лечения инфекционных осложнений у пациентов с иммуносупрессией

Optimization of starting empirical antibacterial therapy in patients with HIV infection – specialized hospital patients

Objective: to analyze the adequacy of the scheme of empirical antibiotic therapy in patients with complicated forms of HIV infection in a specialized hospital and propose a set of measures for its optimization.Materials and methods: Clinical and demographic characteristics, results of bacteriological studies, risk factors of infection with resistant and multiresistant pathogens were studied in patients with HIV infection at the stage of progression with infectious complications of bacterial etiology, and the adequacy of empirical antibiotic therapy was evaluated. Results: The analysis of bacterial infectious complications in 21 HIV-infected patients with advanced stages of the disease was carried out. It was established that the profiles of the starting ABT only in 47% of cases coincide with the results of the antibiogram. To increase the effectiveness of empirical antibacterial therapy, stratification of risk groups for the detection of multiresistant bacterial pathogens has been developed. The basis of stratification: the severity of immunodeficiency, the presence of previously conducted antibacterial therapy, the period and place of detection of infectious complications, the localization of the infectious process.Conclusion: the use in clinical practice of a differentiated approach to the appointment of antibacterial drugs for starting empirical therapy in patients with HIV infection can improve the quality of treatment of infectious complications in patients with immunosuppression