Clinical Microbiology and Antimicrobial Chemotherapy. 2025; 27(2):124-133
To assess prevalence, etiology, antimicrobial prescribing practices and treatment outcomes of infections in intensive care units in Russia.
A two-stage (the first stage – October 18, 2022, the second stage – November 18, 2022) multicenter prospective one-day observational study involved 111 intensive care units (ICUs) of 67 centers from 25 cities of the Russian Federation. Each patient was included in the study only once. Data from the medical records of all patients in the ICU on the day of the study were entered by the attending physician into a single electronic individual case report form. Patients were monitored throughout their hospital stay until transfer from the ICU and discharge from the hospital.
The study included data on 1274 patients, of whom 896 (70.3%) had signs of infection (in 73% of cases, the infection was associated with healthcare – HAI). The most common localization of infection was the respiratory system (32.6%), abdominal cavity (13.6%) and skin/soft tissues (9.6%); in 17.6% of cases, the source of infection was not identified. Among patients with HAI, 29.2% developed sepsis, and 10.4% developed septic shock. Artificial ventilation was an independent risk factor for respiratory infections (OR = 3.06 [95% CI 2.35–3.99]; p < 0.001), the presence of a urinary catheter was a risk factor for urinary tract infections (OR = 4.54 [95% CI 1.41 – 14.65]; p = 0.006). Mortality in patients with infection was 24.7%, while according to the treating physicians, 52.9% of patients died directly from infectious causes. The SOFA index had a significant impact on mortality (OR = 1.25; 95% CI 1.17–1.33; p < 0.001). Mortality was higher among patients admitted for emergency indications and among surgical patients. The presence of a localized infection increased the risk of death by 1.5 times, sepsis – by 1.8 times. Gram-negative bacteria were the leading causative agents of infections (67.4% of all cases, 74.4% in the structure of bacterial pathogens); Gram-positive bacteria in the general etiological structure accounted for 23.3%. The three most common pathogens were Klebsiella pneumoniae (26.7%), Acinetobacter baumannii (15.3%) and Pseudomonas aeruginosa (10%). Microorganisms that are not characteristic of the corresponding loci of infection were often indicated as causative agents, so 13.5% of all microorganisms reported in respiratory infections were Candida spp., coagulase-negative staphylococci, enterococci and non-diphtheria corynebacteria. In total, antimicrobial drugs were prescribed to 56.1% of patients in monoand combination therapy regimens. The most frequently prescribed drugs were cephalosporins (all – 24.6%, cephalosporins III – 7.8%, ceftazidime/avibactam – 1.4%) and carbapenems (23.1%). The frequency of prescribing glycopeptides was 8.1%, inhibitor-protected penicillins – 7.7%, aminoglycosides – 6.4%, fluoroquinolones – 6.2%, polymyxins – 5.1%, oxazolidinones – 4.1%, metronidazole – 3.5%, tigecycline – 3.3%, antifungal drugs – 2%.
The study demonstrates a high proportion of patients with infections in the intensive care units of Russia, the majority of which are nosocomial infections. The etiological structure of infectious agents reflects the global trend of the spread of poly- and extremely resistant Gram-negative microorganisms. The structure of the prescribed antimicrobial therapy does not fully correspond to the profile of pathogens and their resistance. The data obtained indicate the need for measures to strengthen epidemiological surveillance, implement and monitor adequate infection control protocols, revise the practice of microbiological diagnostics and develop algorithms for prescribing antimicrobial drugs based on local resistance monitoring data.