Impact of implementation of elements of antibacterial therapy control strategy on the properties of the causative agents of infectious complications in HIV-infected hospital patients

The aim: to evaluate the effectiveness of implementing elements of the antimicrobial therapy control strategy in the hospital of the AIDS Center using epidemiological criteria.
Materials and methods. The results of identification of 2025 isolates isolated in 2013–2019 were analyzed. from samples of clinical material from 1103 inpatients at the AIDS Center. A Protocol for initial antibacterial therapy has been developed, including the results of data analysis on local microflora resistance to antibiotics and stratification of patients according to the risk of the presence of antibiotic-resistant pathogens. Using epidemiological criteria, an assessment was made of two time periods before and after the implementation of the Protocol with an interval of 12 months between them: the first quarter of 2018 and the first quarter of 2019. Statistical analysis of the results included calculations of exact 95% Clopper-Pearson confidence intervals for qualitative indicators. If two intervals did not have common values, differences between groups were considered significant at a level of less than 0.05. Analyzes were performed using SAS statistical system version 9.0 (SAS Institutes Inc., Cary, NC).
Results and discussion. It was established that during the study period, 10 microorganisms predominated in the spectrum of pathogens of non-AIDS-indicative bacterial infections in patients with HIV infection, the share of which ranged from 82.1% in 2014. up to 74.7% in 2019 Among them, the leaders were K. pneumoniae (18.4%), E. coli (12.6%) and S. aureus (14.9%). The use of the Initial Antibacterial Therapy Protocol made it possible to reduce the proportion of gram-negative bacteria from 65.5.5% to 50.9% (p=0,0286), reduce the detection rate of K. pneumoniae from 31.8% to 16.0% (p=0,0067), reduce the frequency of isolation of carbapenem-resistant strains of K. pneumoniae and cephalosporin-resistant isolates of enterobacteria from 44.8% to 36.4%. The proportion of methicillin-resistant staphylococcus decreased from 8.3% to 4,8%.
Conclusion. The introduction of elements of the antimicrobial therapy control strategy made it possible to change the spectrum and properties of pathogens causing infectious complications in HIV-infected patients in a specialized hospital

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