Single-point multicenter survey of using antimicrobial drugs in the ICUs of Russian multidisciplinary hospitals: results of the Global-PPS 2022 project

Introduction. The marked increase in the resistance of infectious disease pathogens to antimicrobial drugs (AMDs), especially in intensive care units (ICUs), poses a threat to healthcare systems worldwide. This leads to adverse consequences: medical, social and economic. The objective was to evaluate the practice of AMDs using in the ICUs of Russian multidisciplinary hospitals based on its compliance with quality indicators.

Materials and Methods. Single-point survey of AMDs using was conducted in 37 ICUs of various types in 12 multidisciplinary hospitals in different cities of the Russian Federation (Krasnoyarsk, Moscow (4 centres), Omsk, Saratov, Smolensk (2 centres), Tomsk, Yakutsk and Yaroslavl). The study was conducted in accordance with the protocol of international Global-PPS project from September to December 2022. The object of the study was the medical records of patients who received systemic AMDs for preventive or curative purposes. The practice of AMDs using was studies as well as the assessment of the prescription compliance with the quality indicators.

Results. The survey included 501 patients of whom 314 (62.7%) received systemic AMDs. The frequency of AMDs prescription ranged from 24% in cardiac ICUs to 86.9% in surgical ICUs and reached 100% in paediatric departments. The vast majority of drugs were used for therapeutic purposes (74.3%–89.3%) and were prescribed for the treatment of nosocomial infections (71.6% on the average). Carbapenems (20.6%), third-generation cephalosporins (13.1%) and fluoroquinolones (11.6%) prevailed in the structure of prescriptions.

Conclusion. The following accuracies in AMDs using were identified during our study: low frequency of etiotropic therapy, inappropriate duration of perioperative antibiotic prophylaxis and relatively low frequency of planning the duration of therapy. These accuracies provide an opportunity to optimize the practice of using drugs of this group in ICUs of hospitals participating in the study.

1. WHO. Global Action Plan on Antimicrobial Resistance. – WHO, 2016. URL: http://apps.who.int/iris/bitstream/10665/254884/1/9789244509760-rus.pdf?ua=1 (accessed: 07.12.2024). (In Russ.).

2. Action plan for 20192024 for the implementation of the Strategy for preventing the spread of antimicrobial resistance in the Russian Federation for the period up to 2030 Approved by Decree of the Government of the Russian Federation dated March 30, 2019 № 604P. URL: http://government.ru/docs/29477/ (accessed: 07.12.2024). (In Russ.).

3. Belotserkovskiy B. Z., Kruglov A. N., Ni O. G. et al. Etiological structure of infections in patients of the surgical intensive care unit in the post-covid era. Clinical Microbiology and Antimicrobial Chemotherapy, 2024, vol. 26, no. 2, pp. 124–140. (In Russ.). https://doi.org/10.36488/cmac.2024.2.124-140.

4. Zakharenkov I. A., Rachina S. A., Kozlov R. S., Belkova Yu. A. Consumption of systemic antibiotics in the Russian Federation in 2017-2021. Clinical Microbiology and Antimicrobial Chemotherapy, 2022, vol. 24, no. 3, pp. 220–225. (In Russ.). https://doi.org/10.36488/cmac.2022.3.220-225.

5. Perfileva D. Yu., Miroshnichenko A. G., Kulikov E. S. et al. Nosocomial infections: a look at the problem in the context of the global threat of antibiotic resistance (review). The Siberian Journal of Clinical and Experimental Medicine, 2024, vol. 39, no. 1, pp. 28–37. https://doi.org/10.29001/2073-8552-2024-39-1-28-37.

6. Rachina S. A., Fedina L. V., Alkhlavov A. A. et al. Difficulties in choosing antibacterial therapy regimen for nosocomial pneumonia in intensive care units: clinical observations. Clinical Microbiology and Antimicrobial Chemotherapy, 2024, vol. 26, no. 1, pp. 104–112. https://doi.org/10.36488/cmac.2024.1.104-112.

7. Rudnov V. A., Belsky D. V., Dekhnich A. V., ROIRITA Study GrouP. Infections in Russian ICUs: Results of the Nationwide Multicenter Study. Clinical Microbiology and Antimicrobial Chemotherapy, 2011, vol. 13, no. 4, pp. 294–303.

8. Rudnov V. A., Kolotova G. B., Bagin V. A. et al. The role of antimicrobial therapy stewardship in intensive care unit. Clinical Microbiology and Antimicrobial Chemotherapy, 2018, vol. 20, no. 2, pp. 132–140. https://doi.org/10.36488/cmac.2018.2.132-140.

9. Edelstein M. V., Shaidullina E. R., Ivanchik N. V. et al. Antimicrobial resistance of clinical isolates of Klebsiella pneumoniae and Escherichia coli in Russian hospitals: results of a multicenter epidemiological study. Clinical Microbiology and Antimicrobial Chemotherapy, 2024, vol. 26, no. 1, pp. 67–78. https://doi.org/10.36488/cmac.2024.1.67-78.

10. Yakovlev S. V., Suvorova M. P., Beloborodov V. B. et al. Multicentre Study of the Prevalence and Clinical Value of Hospital-Acquired Infections in Emergency Hospitals of Russia: ERGINI Study. Antibiotics and Chemotherapy, 2016, vol. 61, no. 5–6, pp. 32–42.

11. New Global-PPS leaflet, English version. URL: www.global-pps.com/wp-content/uploads/2023/03/GLOBAL-PPS-FLYER-2023-UPDATE-FINAL-1.pdf (accessed: 10.12.2024).

12. New Global PPS leaflet, English version. URL: www.globalpps.com/wpcontent/uploads/2023/03/GLOBAL-PPS-FLYER-2023-UPDATE-FINAL-1.pdf (accessed: 01.12.2024).

13. Political Declaration of the UN General Assembly High-Level Meeting on antimicrobial resistance 2024. URL: https://www.un.org/pga/wp-content/uploads/sites/108/2024/09/FINAL-Text-AMR-to-PGA.pdf (accessed: 16.12.2024).

14. Surveillance of health care-associated infections at national and facility levels: practical handbook. Geneva: World Health Organization; 2024. Licence: CC BY-NC-SA 3.0 IGO. URL: https://iris.who.int/bitstream/handle/10665/379248/9789240101456-eng.pdf?sequence=1 (accessed: 16.12.2024).

15. WHO Collaborating Centre for Drug Statistics Methodology, Guidelines for ATC classification and DDD assignment, 2024. Oslo, 2024. URL: https://atcddd.fhi.no/filearchive/publications/2024_guidelines__final_web.pdf (accessed: 23.09.2024).

16. Avdeev S., Rachina S., Belkova Y. et al. Antimicrobial Prescribing Patterns in Patients with COVID-19 in Russian Multi-Field Hospitals in 2021: Results of the Global-PPS Project. Tropical Medicine Infectious Disease, 2022, vol. 75, no. 7, pp. 12. https://doi.org/10.3390/tropicalmed7050075.

17. Barriere S. L. Clinical, economic and societal impact of antibiotic resistance. Expert Opinion on Pharmacotherapy, 2015, vol. 16, no. 2, pp. 151–153. https://doi.org/10.1517/14656566.2015.983077.

18. Brink A. J., Richards G. Best practice: Antibiotic decision-making in ICUs. Current Opinion in Critical Care, 2020, vol. 26, no. 5, pp. 478–488. https://doi.org/10.1097/MCC.0000000000000752.

19. Calbo E., Boix-Palop L., Garau J. Clinical and economic impact of bacterial resistance: an approach to infection control and antimicrobial stewardship solutions. Current Opinion in Infectious Disease, 2020, vol. 33, no. 6, pp. 458–463. https://doi.org/10.1097/QCO.0000000000000694.

20. Chatterjee A., Modarai M., Naylor N. R. et al. Quantifying drivers of antibiotic resistance in humans: a systematic review. The Lancet Infectious Diseases, 2018, vol. 18, no. 12, pp. e368–e378. https://doi.org/10.1016/S1473-3099(18)30296-2.

21. de Jonge S. W., Boldingh Q. J., Solomkin J. S. et al. Effect of postoperative continuation of antibiotic prophylaxis on the incidence of surgical site infection: A systematic review and meta-analysis. The Lancet Infectious Diseases, 2020, vol. 20, no. 10, pp. 1182–1192. https://doi.org/10.1016/S1473-3099(20)30084-0.

22. Denny K. J., De Wale J., Laupland K. B. et al. When not to start antibiotics: Avoiding antibiotic overuse in intensive care unit. Clinical Microbiology and Infection, 2020, vol. 26, no. 1, pp. 35–40. https://doi.org/10.1016/j.cmi.2019.07.007.

23. Jacoby T. S., Kuchenbecker R. S., Dos Santos R. P. et al. Impact of hospital-wide infection rate, invasive procedures use and antimicrobial consumption on bacterial resistance inside an intensive care unit. Journal of Hospital Infection, 2010, vol. 75, no. 1, pp. 23–27. https://doi.org/10.1016/j.jhin.2009.11.021.

24. Kollef M. N., Sherman G., Ward S. et al. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest, 1999, vol. 115, no. 2, pp. 462–474. https://doi.org/10.1378/chest.115.2.462.

25. Langford B. J., So M., Raybardhan S. et al. Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis. Clinical Microbiology and Infection, 2021, vol. 27, no. 4, pp. 520–531. https://doi.org/10.1016/j.cmi.2020.12.018.

26. Macera M., Calò F., Onorato L. et al. Inappropriateness of Antibiotic Prescribing in Medical, Surgical and Intensive Care Units: Results of a Multicentre Observational Study. Life (Basel), 2021, vol. 11, no. 6, pp. 475. https://doi.org/10.3390/life11060475.

27. Rachina S., Belkova Y., Kozlov R. et al. Longitudinal Point Prevalence Survey of Antimicrobial Consumption in Russian Hospitals: Results of the Global-PPS Project. Antibiotics (Basel), 2020, vol. 9, no. 8, pp. 446. https://doi.org/10.3390/antibiotics9080446.

28. Rafa E., Wałaszek M. Z., Wałaszek M. J. et al. The Incidence of Healthcare-Associated Infections, Their Clinical Forms, and Microbiological Agents in Intensive Care Units in Southern Poland in a Multicentre Study from 2016 to 2019. International Journal of Environmental Research and Public Health, 2021, vol. 18, no. 5, pp. 2238. https://doi.org/10.3390/ijerph18052238.

29. Trejnowska E., Deptuła A., Tarczyńska-Słomian M. et al. Surveillance of Antibiotic Prescribing in Intensive Care Units in Poland. The Canadian Journal of Infectious Diseases and Medical Microbiology, 2018, vol 2018, pp. 7. https://doi.org/10.1155/2018/5670238.

30. Versporten A. Antimicrobial use and HAI rates in Adult ICU’s. International Symposium on Intensive Care and Emergency Medicine (ESICEM), Brussels, 2019.

31. Vincent J. L., Rello J., Marshall J. et al. International study of the prevalence and outcomes of infection in intensive care units. Journal of Americal Medical Association, 2009, vol. 302, no. 21, pp. 2323–2329. https://doi.org/10.1001/jama.2009.1754.

32. Vincent J. L., Sakr Y., Singer M. et al. Prevalence and Outcomes of Infection Among Patients in Intensive Care Units in 2017. Journal of American Medical Association, 2020, vol. 323, no. 15, pp. 1478–1487. https://doi.org/10.1001/jama.2020.2717.

33. Winroth A., Andersson M., Fjällström P. et al. Automated surveillance of antimicrobial consumption in intensive care, northern Sweden: an observational case study. Antimicrobial Resistance & Infection Control, 2024, vol. 13, no. 1, pp. 67. https://doi.org/10.1186/s13756-024-01424-2.

34. Zarb P., Goossens H. European Surveillance of Antimicrobial Consumption (ESAC): value of a point prevalence survey of antimicrobial use across Europe. Drugs, 2011, vol. 71, no. 6, pp. 745–755. https://doi.org/10.2165/11591180-000000000-00000.