Antimicrobial resistance of Haemophilus influenzae clinical isolates in Russia: the results of multicenter epidemiological study «PEHASus 2014–2017»

Background Antimicrobial reistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action. Objectives To review AMR in Russia and any initiatives addressing it. Identifying any areas where more information is required will provide a call to action to minimize any further rise in AMR within Russia and to improve patient outcomes. Methods National AMR initiatives, antibiotic use and prescribing, and availability of susceptibility data, in particular for the key community-acquired respiratory tract infection (CA-RTI) pathogens Streptococcus pneumoniae and Haemophilus influenzae, were identified. National and international antibiotic prescribing guidelines commonly used locally for specific CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) were also reviewed, plus local antibiotic availability. Insights from both a local clinician and a local clinical microbiologist were sought to contextualize this information. Conclusions Russia launched a national strategy in 2017 to prevent the spread of AMR and the WHO reports that as of 2020–21, it is being implemented and actively monitored. Reports suggest outpatient antibiotic use of antibiotics is high and that non-prescription access and self-medication are very common. Antibiotic susceptibility studies in Russia include PeHASus, a multicentre epidemiological study focusing on susceptibilities of community-acquired respiratory pathogens and international studies such as Survey of Antibiotic Resistance (SOAR), Antimicrobial Testing Leadership and Surveillance (ATLAS) and SENTRY Antimicrobial Surveillance Program. International guidelines are used to support the development of local guidelines in Russia, and for the common CA-RTIs Russian clinicians use of several country-specific local antibiotic prescribing guidelines. A standardized inclusive approach in developing local guidelines, using up-to-date surveillance data of isolates from community-acquired infections in Russia, could make guideline use more locally relevant for clinicians. This would pave the way for a higher level of appropriate antibiotic prescribing and improved adherence. This would, in turn, potentially limit AMR development and improve patient outcomes.

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“…These data demonstrate the importance of using β-lactam+β-lactamase inhibitor combinations to treat H. influenzae infections (Figure 2 ). 11 …”

Section: Surveillancementioning

confidence: 99%

Country data on AMR in Russia in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome

Torumkuney

Kozlov

Сидоренко

et al. 2022

Journal of Antimicrobial Chemotherapy

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“…Среди респираторных изолятов Haemophilus influenzae, выделенных в 2014-2017 гг. устойчивость к амоксициллину/клавуланату составляла 3,3%, к цефтибудену -2,7%, к цефиксиму -3,3%, к левофлоксацину -5,4% [7]. При отсутствии устойчивости к бета-лактамным антибиотикам, 12,1% штаммов Streptococcus pyogenes в 2014-2017 гг.…”

Section: Introductionunclassified

In vitro activity of cefpodoxime against Russian clinical isolates of Haemophilus influenzae, Streptococcus pneumoniae and Streptococcus pyogenes

Kozlov,

Ivanchik,

Skleenova

et al. 2023

CMAC

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Objective. To determine in vitro activity of oral III generation cephalosporin cefpodoxime against clinical isolates of Haemophilus influenzae, Streptococcus pneumoniae and Streptococcus pyogenes isolated from patients with community-acquired respiratory tract infections in different regions of the Russian Federation. Materials and Methods. The study included isolates of bacterial pathogens of community-acquired respiratory tract infections isolated from outpatients and hospitalized patients in different regions of the Russian Federation. A total of 558 isolates were included in the study, including 184 isolates of H. influenzae, 186 isolates of S. pneumoniae and 188 isolates of S. pyogenes. Species identification was performed using the MALDI-TOF mass spectrometry (Bruker Daltonics, Germany), for S. pneumoniae identification was also performed taking into account the morphology of colonies on blood agar, the presence of α-hemolysis, negative catalase reaction, sensitivity to optochin and positive results of latex-agglutination using DrySpot kit (OXOID, UK). Antimicrobial susceptibility to cefpodoxime and comparative antimicrobials was determined using broth microdilution method; interpretation of susceptibility testing results was performed in accordance with the recommendations of EUCAST, v.13.0. Data analysis and visualization were performed using the online platform AMRcloud. Results. Despite the generally low incidence of antibiotic resistance in the tested H. influenzae isolates, cefpodoxime, to which all tested isolates were susceptible, was superior to all other oral antibiotics in terms of in vitro activity: aminophenocillins (R – 8.7%), amoxicillin/clavulanate (R – 1.1%), co-trimoxazole (R – 31.5%), levofloxacin (R – 3.8%), moxifloxacin (R – 3.8%), tetracycline (R – 11%), cefixime (R – 2.2%), ceftibuten (R – 3.3%). Among the studied S. pneumoniae isolates, 81.7% were susceptible to cefpodoxime. All isolates resistant to penicillin, amoxicillin and ceftriaxone were also resistant to cefpodoxime. Cefpodoxime was inferior to levofloxacin (R – 0%), moxifloxacin (R – 0%), linezolid (R – 0%), vancomycin (R – 0%), ertapenem (R – 8.6%), ceftaroline (R – 2.3%), and chloramphenicol (R – 3.2%) in terms of in vitro activity against S. pneumoniae. However, all these drugs are either not available in oral form or have a less favorable safety profile compared to cefpodoxime. When compared with other III generation oral cephalosporins cefixime and ceftibuten, the activity of cefpodoxime against S. pneumoniae was significantly higher based on MIC50/90 values (cefixime – 0.125⁄8 mg/l, ceftibuten – 2/≥ 128 mg/l, cefpodoxime – 0.06/4 mg/l) and MICs range (cefixime – 0.06/≥ 128 mg/l, ceftibuten – 0.06/≥ 128 mg/l, cefpodoxime – 0.03/32 mg/l). No strains resistant to β-lactam antibiotics were detected among the tested S. pyogenes isolates. Based on the MIC50/90 values and the range of MIC values, the in vitro activity of cefpodoxime was higher than that of ceftibuten and comparable to that of cefixime. Conclusions. According to the results of our study, as well as in view of its pharmacokinetic profile, high safety and compliance, cefpodoxime can be considered as one of the options for oral therapy of community-acquired bacterial upper and lower respiratory tract infections.

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“…Исключения составляют экспресс-тесты на COVID-19 и грипп. Если говорить об антибактериальной терапии нозокомиальной пневмонии, то клиницисты должны быть осведомлены о спектре местных патогенов, особенно если они лечат пациентов в центре, где наиболее распространены полирезистентные патогены [12][13][14].…”

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Antibacterial Therapy for Pneumonia: What Everyone Should Know

et al. 2023

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В настоящее время проблема резистентности к антибактериальным препаратам носит глобальный характер. Развитие устойчивости микроорганизмов к действию антибактериальных препаратов приводит к увеличению срока госпитализации, повышению финансовых затрат и иногда к летальным исходам. Социальная значимость проблемы определяется распространением устойчивых штаммов микроорганизмов во внебольничной среде, что обусловливает низкую эффективность антибиотикотерапии инфекционных заболеваний, в том числе и пневмоний. Рациональное использование антибиотиков – это попытка улучшить то, как антибиотики назначаются и используются медицинскими работниками. Хотя антибиотики не действуют против таких вирусов, как SARS-CoV-2, данные препараты часто назначались пациентам с COVID-19 во время пандемии. Самыми назначаемыми антибиотиками были азитромицин, левофлоксацин. Коллектив авторов работает над продвижением надлежащего использования антибиотиков, помогая практикующим врачам назначать правильный в правильной дозе c правильной продолжительностью и в нужное время, а также сокращая их ненужное использование. Понимание того, как мы назначаем и используем антибиотики, или управление антибиотиками, имеет решающее значение для эффективного лечения инфекций, защиты пациентов от вреда, вызванного их ненужным использованием, а также для борьбы с устойчивостью к ним. Эти рекомендации предназначены для использования медицинскими работниками, оказывающими помощь пациентам с внебольничной пневмонией, а также пациентам с нозокомиальной пневмонией, включая специалистов по инфекционным заболеваниям, пульмонологов, врачей ОРИТ, хирургов и других клиницистов, которые осуществляют лечение пациентов с пневмониями. Currently, the problem of resistance to antibacterial drugs is global. The development of resistance of microorganisms to the action of antibacterial drugs leads to an increase in the duration of hospitalization, an increase in financial resources, and, sometimes, to death. The social significance of the problem is determined by the spread of resistant strains of microorganisms in the out-of-hospital environment, which leads to the low effectiveness of antibiotic therapy for infectious diseases, including pneumonia. Antibiotic prudent use is an attempt to improve how antibiotics are prescribed and used in all healthcare settings. Although antibiotics do not work against viruses such as SARS-CoV-2, these drugs have often been prescribed to patients with COVID-19 during the pandemic. The most prescribed antibiotics were azithromycin, levofloxacin. The team of authors works to promote the proper use of antibiotics by helping medical practitioners use the right antibiotic at the right dose, for the right duration and at the right time, and by reducing the unnecessary use of antibiotics. Understanding how we prescribe and use antibiotics or "antibiotic stewardship" is critical to effectively treating infections, protecting patients from the harm caused by unnecessary antibiotic use, and combating antibiotic resistance. These guidelines are to be used by healthcare profession treating patients with community-acquired pneumonia, as well as patients with nosocomial pneumonia, including infectious disease specialists, pulmonologists, intensive care physicians, surgeons, and other clinicians who treat patients with pneumonia.

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Antimicrobial resistance of Haemophilus influenzae clinical isolates in Russia: the results of multicenter epidemiological study «PEHASus 2014–2017»

Cited by 15 publications

References 8 publications

Country data on AMR in Russia in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome

Country data on AMR in Russia in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome

In vitro activity of cefpodoxime against Russian clinical isolates of Haemophilus influenzae, Streptococcus pneumoniae and Streptococcus pyogenes

Antibacterial Therapy for Pneumonia: What Everyone Should Know

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