Зміни ротоглоткового мікробіому у хворих на вірусно-бактеріальну пневмонію, асоційовану із сovid-19 на фоні терапії антибіотиками та моніторинг антибіотикорезистентних штамів

Abstract

The relevance of the infection caused by COVID-19 today is beyond doubt. According to the Protocol “Provision of medical care for the treatment of coronavirus disease (COVID-19)” approved by the order of the Ministry of Health of Ukraine dated April 2, 2020 № 762, antibacterial drugs are prescribed only in the presence of confirmed bacterial co-infection ( after receiving positive bacteriological results) blood and / or sputum analysis). But given that the results of the analysis must wait a few days, antibiotics, under certain indications, can be prescribed empirically. The aim of our work was to analyze the structure of the oropharyngeal microbiome, patients with viral and bacterial pneumonia who received antibiotics, to determine clinically significant strains and their sensitivity to antibacterial agents. In the structure of the oropharyngeal microbiome, fungi of the genus Candida significantly prevailed, which were found in 50 (45.6%) subjects, in second place in terms of frequency of detection were S. pneumoniae – 29 (26.4%). Much less often from the oropharynx of patients with viral-bacterial pneumonia associated with COVID-19 were isolated K. pneumoniae – 13 (11.8%), S. aureus – 11 (10.0%) and E. coli – 7 (6.4 %). Among the isolated S. pneumoniae, the maximum number of resistant strains was detected for such fairly new antibiotics as ceftriaxone – 37.9% and azithromycin – 31.0%. Among fungi of the genus Candida resistant to nystatin and amphotericin were 38.5% and 26.9%, respectively. Therefore, the administration of antibacterial agents, taking into account the sensitivity of clinically significant strains, will guarantee effective treatment, prevent the development of antibiotic resistance, prevent the development of oropharyngeal and intestinal dysbiosis, and thus reduce the cost of treatment of antibiotic side effects, including probiotics.