Наукові праці. Кафедра інфекційних хвороб, дитячих інфекційних хвороб, фтизіатрії та пульмонології
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Item Effect of adequacy of empirical antibiotic therapy for hospital-acquired bloodstream infections on intensive care unit patient prognosis: a causal inference approach using data from the Eurobact2 study(Elsevier B.V., 2024) Loiodice, Ambre; Bailly, Sebastien; Ruckly, Stephane; Buetti, Niccolo; Barbier, François; Staiquly, Quentin; Tabah, Alexis; Timsit, Jean-François; Sokhan, A.; Burma, Ya.Objectives: Hospital-acquired bloodstream infections (HA-BSI) in the intensive care unit (ICU) are common life-threatening events. We aimed to investigate the association between early adequate antibiotic therapy and 28-day mortality in ICU patients who survived at least 1 day after the onset of HA-BSI. Methods: We used individual data from a prospective, observational, multicentre, and intercontinental cohort study (Eurobact2). We included patients who were followed for - 1 day and for whom time-to appropriate treatment was available. We used an adjusted frailty Cox proportional-hazard model to assess the effect of time-to-treatment-adequacy on 28-day mortality. Infection- and patient-related variables identified as confounders by the Directed Acyclic Graph were used for adjustment. Adequate therapy within 24 hours was used for the primary analysis. Secondary analyses were performed for adequate therapy within 48 and 72 hours and for identified patient subgroups. Results: Among the 2418 patients included in 330 centres worldwide, 28-day mortality was 32.8% (n ¼ 402/1226) in patients who were adequately treated within 24 hours after HA-BSI onset and 40% (n ¼ 477/1192) in inadequately treated patients (p < 0.01). Adequacy within 24 hours was more common in young, immunosuppressed patients, and with HA-BSI due to Gram-negative pathogens. Antimicrobial adequacy was significantly associated with 28-day survival (adjusted Hazard Ratio (aHR), 0.83; 95% CI, 0.72e0.96; p 0.01). The estimated population attributable fraction of 28-day mortality of inadequate therapy was 9.15% (95% CI, 1.9e16.2%). Discussion: In patients with HA-BSI admitted to the ICU, the population attributable fraction of 28-day mortality of inadequate therapy within 24 hours was 9.15%. This estimate should be used whenItem The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections(Springer Verlag, 2024-06) Buetti, Niccolò; Tabah, Alexis; Setti, Nour; Ruckly, Stéphane; Barbier, François; Akova, Murat; Aslan, Abdullah Tarik; Leone, Marc; Bassetti, Matteo; Morris, Andrew Conway; Arvaniti, Kostoula; Paiva, José‑Artur; Ferrer, Ricard; Qiu, Haibo; Montrucchio, Giorgia; Cortegiani, Andrea; Kayaaslan, Bircan; De Bus, Liesbet; De Waele, Jan J.; Timsit, Jean‑François; Sokhan, A.; Burma, Ya.Purpose: The primary objective of this study was to evaluate the associations between centre/country-based factors and two important process and outcome indicators in patients with hospital-acquired bloodstream infections (HABSI). Methods: We used data on HABSI from the prospective EUROBACT-2 study to evaluate the associations between centre/country factors on a process or an outcome indicator: adequacy of antimicrobial therapy within the frst 24 h or 28-day mortality, respectively. Mixed logistical models with clustering by centre identifed factors associated with both indicators. Results: Two thousand two hundred nine patients from two hundred one intensive care units (ICUs) were included in forty-seven countries. Overall, 51% (n=1128) of patients received an adequate antimicrobial therapy and the 28-day mortality was 38% (n=839). The availability of therapeutic drug monitoring (TDM) for aminoglycosides everyday [odds ratio (OR) 1.48, 95% confdence interval (CI) 1.03–2.14] or within a few hours (OR 1.79, 95% CI 1.34–2.38), surveillance cultures for multidrug-resistant organism carriage performed weekly (OR 1.45, 95% CI 1.09–1.93), and increasing Human Development Index (HDI) values were associated with adequate antimicrobial therapy. The presence of intermediate care beds (OR 0.63, 95% CI 0.47–0.84), TDM for aminoglycoside available everyday (OR 0.66, 95% CI 0.44–1.00) or within a few hours (OR 0.51, 95% CI 0.37–0.70), 24/7 consultation of clinical pharmacists (OR 0.67, 95% CI 0.47–0.95), percentage of vancomycin-resistant enterococci (VRE) between 10% and 25% in the ICU (OR 1.67, 95% CI 1.00–2.80), and decreasing HDI values were associated with 28-day mortality. Conclusion: Centre/country factors should be targeted for future interventions to improve management strategies and outcome of HABSI in ICU patients.Item Psychological features of rehabilitation of HIV-infected patients(Georgian Association of Business Press, 2024) Lantukh, I.; Kucheriavchenko, V.; Yurko, K.; Bondarenko, A.; Merkulova, N.; Mohylenets, O.; Gradil, G.; Bondar, O.; Bodnia, I.; Burma, Ya.; Tsyko, O.; Tkachenko, V.The human immunodeficiency virus (HIV) is one of the major medical problems in the world. For almost forty years, it has had catastrophic effects on the body of infected people with variable pathogenesis of mortality. The purpose of the work is to analyse the importance of psychological assistance for the social adaptation of HIV-infected patients. Materials and methods: The empirical basis of the study was the analysis of 30 medical records of inpatients. The majority were patients of working age, namely 25 people (83.3%), while the average age of the patients was (28.5±5.5) years old. During the study, patients were divided into groups depending on the receipt of psychological help, psychoemotional disorders, and signs of social maladjustment. Results: The first group of patients consisted of 10 (33.3%) patients who refused psychological help. The second group, namely 20 (66.7%) patients, consisted of patients who received psychological help immediately after the diagnosis of HIV infection and had milder disorders. During the research, a set of methods was used: clinical and anamnestic method; to assess the presence of depression in patients, the Montgomery-Asberg Depression Rating Scale (MADRS) was used; the Spielberger-Khanin anxiety questionnaire was used to determine the level of anxiety in patients; patients' adherence to treatment was determined using the Morisky-Goin compliance assessment scale. Conclusions: The issue of adaptation of HIV-infected patients in society is a significant problem caused by the low level of awareness of HIV infection and the ways of its transmission. The obtained results indicate the need for psychological assistance to HIV-infected persons at every stage, both at the time of the announcement of the diagnosis (prevention of the development of depression, suicidal intentions), and during drug treatment (debriefing of the methodology, creation of peer-to-peer support groups), thanks to which the social adaptation of patients and the effectiveness of medical treatment are accelerated.