PHENOTYPIC PREDICTORS AND BIOMARKERS FOR FORECASTING THE EFFECTIVENESS OF ANTIMICROBIAL THERAPY

Аннотация

In order to assess the forecast of the effectiveness of antimicrobial therapy, phenotypic predictors characterizing the seriousness of the inflammatory process and the level of beta-lactamase activity (BLA) of blood serum were studied in 55 patients with exacerbation of chronic obstructive pulmonary disease and 40 patients with hospital-acquired pneumonia. According to the results, it was found that the serum beta-lactamase activity level is determined by phenotypic and clinical variables: age over 60 years, severe respiratory pathology, fever over 380, peripheral blood leukocyte level over 10x109, C-reactive protein over 40 mg/L and saturation less than 93%, correlating with an increase in UAV levels, and are predictors of low efficacy of treatment with beta-lactam antibiotics. A direct correlation was revealed between the level of serum beta-lactamase activity and the duration of antimicrobial therapy during the year (r=+0.86, p=0.001), the number of antimicrobial drugs prescribed simultaneously (r=+0.69, p=0.001), the fact of receiving beta-lactam reserve antibiotics – cefepime, imipenem, meropenem (r=+0.71, p=0.001), the fact of prescribing reserve antibiotics not related to the beta-lactam series – rifampicin, azithromycin, vancomycin, linezolid, levofloxacin (r=+0.59, p=0.001). Predicting the effectiveness of successful treatment with antibacterial drugs of the first-line beta-lactam group in the framework of evidence-based medicine, the need to determine the level of beta-lactamase activity of biological substrates is justified. Assessment of the level of beta-lactamase activity before the start of antibiotic therapy will reduce the unjustified use of beta-lactam antibiotics by up to 30%.