Rational antibiotic therapy of basic microbial pathogens in intensive care units

M.V. Bondar, M.M. Pylypenko, I.A. Kuchynska


The article presents the results of a 10-year study of the evolution of the microbial landscape in the intensive care units (IT) of a general profile in Kyiv. It has been established that the main reason for the selection of pathogenic microflora in IT departments is the formation of antibiotic resistance to the basic microbial pathogens as a result of the widespread use of antibiotic therapy. Today, the leading microbial pathogens in the general IT departments are Klebsiella pneumoniae, Acinetobacter baumannii, Enterococcus faecalis, Enterococcus faecium, and Pseudomonas aeruginosa. The morphological features of these microorganisms and the mechanisms of their pathogenic action on the human body are described. The results of our own studies of the sensitivity of these microorganisms to antibiotics with the definition of optimal antibiotic therapy programs are presented. Based on the analysis of the world literature, the question of the advisability of using antimicrobial therapy against the basic microbial pathogens in the IT departments using the antibiotics most effective to the above microbial pathogens was considered.


basic microbial pathogens in intensive care units; antibiotic resistance; rational antibiotic therapy; reserve antibiotics; colomycin; fosfomycin; gentamicin; tobramycin; amikacin; protected penicillins; protected cephalosporins; glycopeptides


Терещенко О. Антибіотикорезистентність як глобальна проблема: фокус на респіраторні інфекції. Здоров’я України. 2017. 19(416). 3.

Лоскутов О.А., Бондар М.В., Овсієнко Т.В. Десятирічна еволюція мікробного пейзажу та сучасні тенденції формування антибіотикорезистентності у відділеннях ІТ загального профілю м. Києва. Медицина невідкладних станів. 2018. 2(89). 102-109.

Montefour K., Frieden J., Hurst S., Helmich C., Headley D., Martin M. Acinetobacter baumannii: an emerging multidrug-resistant pathogen in critical care. Crit. Care Nurse. 2008. 28. 15-25.

Rice L.B. Federal funding for the study of antimicrobial resistance in nosocomial pathogens: no ESKAPE. J. Infect. Dis. 2008. 197. 1079-81. doi: 10.1086/533452.

Report of the consensus conference on antibiotic resistance; prevention and control. Clin. Infect. Dis. 2005. 11. 938-54.

Шагинян И.А., Чернуха М.Ю. Неферментирующие грамотрицательные бактерии в этиологии внутрибольничных инфекций: клинические, микробиологические и эпидемические особенности. Клиническая микробиология и антимикробная химиотерапия. 2005. 7(3). 271-285.

Hoenigl M., Drescher М., Feierl G. et al. Successful management of nosocomial ventriculitis and meningitis caused by extensively drug-resistant Acinetobacter baumannii in Austria. J. Infect. Dis. Med. Microbiol. 2013 Autumn. 24(3). Е88-90.

Fischetti V.A., Novick R.P., Ferretti J.J. et al. Gram-Positive Pathogens. 2006. 2. 849.

Ryan K.J., Ray C.G. Sherris Medical Microbiology. 2004. 4. 294-5.

Vincent J.L., Rello J., Marshall J. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009. 302(21). 2323-2329.

Paul-Ehrlich-Gesellschaft für Chemotherapie Resistenzstudie 2013. Abschlussbericht Teilprojekt H — Epidemiologie und Resistenzsituation beiklinisch wichtigen Infektionserregern aus dem Hospitalbereich gegenüber Antibiotika. 2015. Available at:

Allerberger F., Klare I. In-vitro activity of fosfomycin against vancomycin resistant enterococci. J. Antimicrob. Chemother. 1999. 43. 211-7.

Maraki S., Samonis G., Rafailidis P.I. et al. Susceptibility of urinary tract bacteria to fosfomycin. Antimicrob. Agents Chemother. 2009. 53. 4508-10.

Falagas M.E., Kastoris A.C., Kapaskelis A.M. et al. Fosfomycinfor the treatment of multidrug-resistant, including extended-spectrum blactamaseproducing, Enterobacteriaceae infections: a systematic review. Lancet Infect. Dis. 2010. 10. 43-50.

Pfausler B., Spiss H., Dittrich P. et al. Concentrations of fosfomycin in the cerebrospinal fluid of neurointensive care patients with ventriculostomy-associated ventriculitis. J. Antimicrob. Chemother. 2004. 53. 848-52.

Kuhnen E., Pfeifer G., Frenkel C. Penetration of fosfomycin into cerebrospinal fluid across non-inflamed and inflamed meninges. Infection. 1987. 15. 422-4.

Schintler M.V., Traunmüller F., Metzler J. et al. High fosfomycin concentrations in bone and peripheral soft tissue in diabetic patients presenting. J. Antimicrob. Chemother. 2009. 64(3). 574-8. doi: 10.1093/jac/dkp230. Epub 2009 Jul 3.

Matzi V., Lindenmann J., Porubsky C. et al. Extracellular concentrations of fosfomycin in lung tissue of septic patients. J. Antimicrob. Chemother. 2010. 65. 995-8.

Legat F.J., Maier A., Dittrich P. et al. Penetrationof fosfomycin into inflammatory lesions in patients wich cellulitis ordiabetic foot syndrome. Antimicrob. Agents Chemother. 2003. 47. 371-4.

Parker S.L., Frantzeskaki F., Wallis S.C. et al. Population pharmacokinetics of fosfomycin in critically ill patients. Antimicrob. Agents Chemother. 2015. 59. 6471-6.

Río A., Gasch O., Moreno A. et al. Efficacy and safety of fosfomycin plus imipenem as rescue therapy for complicated bacteremia and endocarditis due to methicillin-resistant Staphylococcusaureus: a multicenter clinical trial. Clin. Infect. Dis. 2014. 59. 1105-12.

Grabein B. et al. Intravenous fosfomycin-back to the future. Systematic review and meta-analysis of the clinical literature. Clinical Microbiology and Infection. 2016.

Samonis G., Maraki S., Karageorgopoulos D.E. et al. Synergy of fosfomycin with carbapenems, colistin, netilmicin, and tigecycline against multidrug-resistant Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa clinical isolates. European Journal of Clinical Microbiology and Infectious Diseases. Springer Nature, Jan 1, 2011.

Mukherjee D.N., Agarwal L., Nayyar I. Intravenous fosfomycin therapy in critically ill patients infected with colistin-resistant enterobacteriacae. Crit. Care. 2015. 19(Suppl. 1). 119.

Pontikis K., Karaiskos I., Bastani S. et al. Outcomes of critically ill intensive care unit patients treated with fosfomycin for infections due to pandrug-resistant and extensively drug-resistant carbapenemase-producing Gram-negative bacteria. International Journal of Antimicrobial Agents. 2014. 43(1). 52-59. doi: 10.1016/j.ijantimicag.2013.09.010.

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