ANALYSIS OF THE RESULTS OF ANTIBIOTIC THERAPY OF BURN SEPSIS IN ADULTS
DOI:
https://doi.org/10.11603/2414-4533.2024.4.15073Keywords:
sepsis, antibiotic therapy, ESCAPEAbstract
The aim of the work: to analyze the frequency of burn sepsis and the effectiveness of initial antibiotic therapy in adult patients.
Materials and Methods. An analysis of the incidence of sepsis in patients of the Department of Combustiology of the Khmelnytskyi Regional Hospital during 2023–2024 was carried out, as well as the determination of pathogens, as well as the timing and effectiveness of antibiotic therapy.
Results and Discussion. The sensitivity of these pathogens has changed significantly over the years, as resistant strains are being selected. In 14 cases, patients were prescribed a combination of meropenem and vancomycin, in 8 cases piperacillin / tazobactam and tobramycin, in 6 cases aztreonam and tobramycin, and in 2 cases no antibiotic therapy replacement was performed: ceftazidime and amikacin, and cefoperazone / sulbactam and amikacin. The antibiotic therapy scheme was revised after 48 hours and subsequently, after the condition stabilized, de-escalation was carried out. As a result of treatment, mortality in the groups was: meropenem and vancomycin – 3 patients (10 %), piperacillin / tazobactam and tobramycin – 3 patients (10 %), aztreonam and tobramycin – 1 patient (3.3 %) with total mortality in the described groups patients – 23.33 %.
Conclusions. Monitoring of the «microbial landscape» of departments of combustiology indicates a significant presence of microorganisms of the ESCAPE group in 77.1 % and a decrease in the sensitivity of isolates to the main groups of antibacterial drugs during 2021–2023, a high representation of polyresistant strains of A. baumanii in 18.48 %, Kl. Pneumoniae in 11.5 %, and Ps. aeruginosa in 9.6 % of cases.
References
Pro zatverdzhennia Standartu medychnoi dopomohy «Opiky» [About the approval of the Medical Care Standard "Care]. Nakaz MOZ Ukrainy vid 09.10.2023 № 1767. Available from: https://moz.gov.ua/uploads/10/50393-dn_1767_09102023_dod.pdf. Ukrainian.
Kovalenko OM. Suchasni mozhlyvosti likuvannia opikovoho shoku [Modern opportunities for the burn shock]. Surgery of Ukraine. 2019; (1): 84-90. DOI: 10.30978/su2019-1-84. Ukrainian. DOI: https://doi.org/10.30978/SU2019-1-84
Kovalenko ОM, Kovalenko AO, Osadcha OI, Boyarska AM. Alhorytm diahnostyky i likuvannia opikovoho sepsysu[Аlgoritm of diagnostic and treatment of burn sepsis]. Hospital surgery. 2013; 3:65-67. Available from: https://ojs.tdmu.edu.ua/index.php/surgery/article/view/1803. Ukrainian.
Sorokina OYu, Koval MG. Skryninh i diahnostyka sepsysu pry vazhkykh ozhohakh [Screening and diagnosis of sepsis in severe burns]. Emergency medicine. 2021; 16(1):16-23. DOI: 10.22141/2224-0586.16.1.2020.196925. Ukrainian. DOI: https://doi.org/10.22141/2224-0586.16.1.2020.196925
Granholm A, Munch MW, Meier N, Sjövall F, Helleberg M, Hertz FB, et al. Empirical meropenem versus piperacillin/tazobactam for adult patients with sepsis EMPRESS trial: Protocol. Acta Anaesthesiologica Scandinavica. 2024; 68(8):1107-19. DOI: 10.1111/aas.14441. DOI: https://doi.org/10.1111/aas.14441
Helset E, Cheng V, Sporsem H, Thorstensen C, Nordøy I, Gammelsrud KW, et al. Meropenem pharmacokinetic/pharmacodynamic target attainment and clinical response in ICU patients: A prospective observational study. Acta Anaesthesiologica Scandinavica. 2024; 68(4):502-11. DOI: 10.1111/aas.14376. DOI: https://doi.org/10.1111/aas.14376
Sartelli M, Kluger Y, Ansaloni L, Carlet J, Brink A, et al. A Global Declaration on Appropriate Use of Antimicrobial Agents across the Surgical Pathway. Surgical Infections. 2017; 18(8):846–53. DOI: 10.1089/sur.2017.219. DOI: https://doi.org/10.1089/sur.2017.219
De Waele JJ, Lipman J, Akova M, Bassetti M, Dimopoulos G, Kaukonen M, et al. Risk factors for target non-attainment during empirical treatment with β-lactam antibiotics in critically ill patients. Intensive Care Medicine. 2014; 40(9):1340-51. DOI: 10.1007/s00134-014-3403-8. DOI: https://doi.org/10.1007/s00134-014-3403-8
Boehm D, Menke H. Sepsis in Burns–Lessons Learnt from Developments in the Management of Septic Shock. Medicina. 2021; 58(1):26. DOI: 10.3390/medicina58010026. DOI: https://doi.org/10.3390/medicina58010026
D’Abbondanza JA, Shahrokhi S. Burn Infection and Burn Sepsis. Surgical Infections. 2021; 22(1):58–64. DOI: 10.1089/sur.2020.102. DOI: https://doi.org/10.1089/sur.2020.102
Kanoore Edul VS, Ince C, Dubin A. What is microcirculatory shock? Current Opinion in Critical Care. 2015; 21(3):245-52. DOI: 10.1097/mcc.0000000000000196. DOI: https://doi.org/10.1097/MCC.0000000000000196
Kara A, Akin S, Ince C. Monitoring microcirculation in critical illness. Current Opinion in Critical Care. 2016; 22(5):444-52. DOI: 10.1097/mcc.0000000000000335. DOI: https://doi.org/10.1097/MCC.0000000000000335
Li AT, Moussa A, Gus E, Paul E, Yii E, Romero L, et al. Biomarkers for the Early Diagnosis of Sepsis in Burns. Annals of Surgery. 2021; 275(4):654-62. DOI: 10.1097/sla.0000000000005198 DOI: https://doi.org/10.1097/SLA.0000000000005198
Meza-Escobar LE, Rehou S, Jeschke MG. Sepsis Definitions in Burns. Surgical Infections. 2021; 22(1):28-36. DOI: 10.1089/sur.2020.297. DOI: https://doi.org/10.1089/sur.2020.297
Lübbert C, Rodloff AC, Laudi S, Simon P, Busch T, Mössner J, et al. Lessons learned from excess mortality associated with Klebsiella pneumonia carbapenemase 2-producing pneumonia in liver transplant recipients. Liver Transplantation. 2014; 20(6): 736-8.DOI: 10.1002/lt.23858. DOI: https://doi.org/10.1002/lt.23858
Guarino M, Perna B, Cesaro AE, Maritati M, Spampinato MD, Contini C, et al. 2023 Update on Sepsis and Septic Shock in Adult Patients: Management in the Emergency Department. Journal of Clinical Medicine. 2023; 12(9):3188. DOI: 10.3390/jcm12093188. DOI: https://doi.org/10.3390/jcm12093188
Mahmoud S, Shen C. Augmented Renal Clearance in Critical Illness: An Important Consideration in Drug Dosing. Pharmaceutics. 2017; 9(3):36. DOI: 10.3390/pharmaceutics9030036. DOI: https://doi.org/10.3390/pharmaceutics9030036
Montravers P, Tubach F, Lescot T, Veber B, Esposito-Farèse M, et al. Short-course antibiotic therapy for critically ill patients treated for postoperative intra-abdominal infection: the DURAPOP randomised clinical trial. Intensive Care Medicine. 2018; 44(3):300-10. DOI: 10.1007/s00134-018-5088-x. DOI: https://doi.org/10.1007/s00134-018-5088-x
Morrissey I, Hackel M, Badal R, Bouchillon S, Hawser S, Biedenbach DA. Review of Ten Years of the Study for Monitoring Antimicrobial Resistance Trends (SMART) from 2002 to 2011. Pharmaceuticals. 2013; 6(11):1335-46. DOI: 10.3390/ph6111335. DOI: https://doi.org/10.3390/ph6111335
Nordmann P, Cuzon G, Naas T. The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. The Lancet Infectious Diseases. 2009; 9(4):228-36. DOI: 10.1016/s1473-3099(09)70054-4. DOI: https://doi.org/10.1016/S1473-3099(09)70054-4
Noskin GA. Vancomycin-resistant enterococci: Clinical, microbiologic, and epidemiologic features. Journal of Laboratory and Clinical Medicine. 1997; 130(1):14-20. DOI: 10.1016/s0022-2143(97)90054-8. DOI: https://doi.org/10.1016/S0022-2143(97)90054-8
Pezzilli R, Zerbi A, Campra D, Capurso G, Golfieri R, Arcidiacono PG, et al. Consensus guidelines on severe acute pancreatitis. Digestive and Liver Disease. 2015; 47(7):532-43. DOI: 10.1016/j.dld.2015.03.022. DOI: https://doi.org/10.1016/j.dld.2015.03.022
Packialakshmi B, Stewart IJ, Burmeister DM, Chung KK, Zhou X. Large animal models for translational research in acute kidney injury. Renal Failure. 2020; 42(1):1042-58. DOI: 10.1080/0886022x.2020.1830108. DOI: https://doi.org/10.1080/0886022X.2020.1830108
Pandompatam G, Kashani K, Vallabhajosyula S. The role of natriuretic peptides in the management, outcomes and prognosis of sepsis and septic shock. Revista Brasileira de Terapia Intensiva. 2019; 31(3). DOI: 10.5935/0103-507x.20190060. DOI: https://doi.org/10.5935/0103-507X.20190060
Piccioni A, Saviano A, Cicchinelli S, Valletta F, Santoro MC, de Cunzo T, et al. Proadrenomedullin in Sepsis and Septic Shock: A Role in the Emergency Department. Medicina. 2021; 57(9):920. DOI: 10.3390/medicina57090920. DOI: https://doi.org/10.3390/medicina57090920
Sartelli M, Catena F, Ansaloni L, Coccolini F, Di Saverio S, Griffiths EA. Duration of Antimicrobial Therapy in Treating Complicated Intra-Abdominal Infections: A Comprehensive Review. Surgical Infections. 2016; 17(1):9-12. DOI: 10.1089/sur.2015.130. DOI: https://doi.org/10.1089/sur.2015.130
Sartelli M, Weber DG, Ruppé E, Bassetti M, Wright BJ, Ansaloni L, et al. Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA). World Journal of Emergency Surgery. 2016;11(1). DOI: 10.1186/s13017-016-0089-y. DOI: https://doi.org/10.1186/s13017-016-0089-y
Sartelli M, Coccolini F, Kluger Y, Agastra E, Abu-Zidan FM, Abbas AES, et al. WSES/GAIS/SIS-E/WSIS/AAST global clinical pathways for patients with intra-abdominal infections. World Journal of Emergency Surgery]. 2021; 16(1). DOI: 10.1186/s13017-021-00387-8. DOI: https://doi.org/10.1186/s13017-021-00387-8
Yin Z, Beiwen W, Zhenzhu M, Erzhen C, Qin Z, Yi D. Characteristics of bloodstream infection and initial antibiotic use in critically ill burn patients and their impact on patient prognosis. Scientific Reports. 2022; 12(1). DOI: 10.1038/s41598-022-24492-z. DOI: https://doi.org/10.1038/s41598-022-24492-z
Zhou Y, Wang G, Zhao Y, Chen W, Chen X, Qiu Y, et al. Efficacy and safety of different polymyxin-containing regimens for the treatment of pneumonia caused by multidrug-resistant gram-negative bacteria: a systematic review and network meta-analysis. Critical Care. 2024; 28(1). DOI: 10.1186/s13054-024-05031-w. DOI: https://doi.org/10.1186/s13054-024-05031-w
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