antibioticsАнтибиотики и ХимиотерапияAntibiot Khimioter = Antibiotics and Chemotherapy0235-2990ООО «Издательство ОКИ»10.37489/0235-2990-2026-71-5-6-97-110KNUQYPantibiotics-1378Research ArticleОБЗОРЫREVIEWSАнтибактериальная терапия при сепсисе с диссеминированным внутрисосудистым свертыванием: аналитический обзорAntibacterial therapy in sepsis complicated by disseminated intravascular coagulation: analytical reviewГабдулхаковР. М.GabdulkhakovR. M.

Габдулхаков Раиль Мунирович - д.м.н., профессор, Башкирский государственный медицинский университет, Уфа, Российская Федерация

Rail M. Gabdulkhakov - MD, Dr. Sci. (Med.), Professor, Bashkir State Medical University, Ufa, Russian Federation

https://orcid.org/0009-0005-0963-1823ТакаловаА. Р.TakalovaA. R.

Такалова Алия Рамилевна - ординатор, Башкирский государственный медицинский университет, Уфа, Российская Федерация

Aliya R. Takalova - Resident, Bashkir State Medical University, Ufa, Russian Federation

takalova.bgmu@mail.ruhttps://orcid.org/0009-0001-4236-0202ТупикинаЭ. А.TupikinaE. A.

Тупикина Эльвира Алексеевна - ассистент, Башкирский государственный медицинский университет, Уфа, Российская Федерация

Elvira A. Tupikina - Assistant, Bashkir State Medical University, Ufa, Russian Federation

https://orcid.org/0009-0003-3903-9658НурматовМ. М.NurmatovM. M.

Нурматов Муинджон Мухамаджонович - ординатор, Башкирский государственный медицинский университет, Уфа, Российская Федерация

Muinjon M. Nurmatov - Resident, Bashkir State Medical University, Ufa, Russian Federation

https://orcid.org/0009-0002-6208-4660ХотамовИ. Б.KhotamovI. B.

Хотамов Ихтиёр Бахтиёрович - ординатор, Башкирский государственный медицинский университет, Уфа, Российская Федерация

Ikhtiyor B. Khotamov - Resident, Bashkir State Medical University, Ufa, Russian Federation

https://orcid.org/0009-0002-1831-3892АкатьеваМ. А.AkatyevaM. A.

Акатьева Маргарита Александровна - ординатор, Башкирский государственный медицинский университет, Уфа, Российская Федерация

Margarita A. Akatyeva - Resident, Bashkir State Medical University, Ufa, Russian Federation

https://orcid.org/0009-0004-9680-2290ПулатовЛ. О.PulatovL. O.

Пулатов Лоикшо Орифджонович - ординатор, Башкирский государственный медицинский университет, Уфа, Российская Федерация

Loiksho O. Pulatov - Resident, Bashkir State Medical University, Ufa, Russian Federation

https://orcid.org/0009-0004-2868-7948ТиллоевФ. И.TilloevF. I.

Тиллоев Фаридун Илхомович - ординатор, Башкирский государственный медицинский университет, Уфа, Российская Федерация

Faridun I. Tilloev - Resident, Bashkir State Medical University, Ufa, Russian Federation

https://orcid.org/0009-0006-6503-5302МухаммадалиеваР. Н.MukhamadalievaR. N.

Мухаммадалиева Рухшона Нозимджоновна - ординатор, Башкирский государственный медицинский университет, Уфа, Российская Федерация

Rukhashona N. Mukhamadalieva - Resident, Bashkir State Medical University, Ufa, Russian Federation

https://orcid.org/0009-0001-1339-2571ШамсиевУ. А.ShamsievU. A.

Шамсиев Урал Альбертович - ординатор, Башкирский государственный медицинский университет, Уфа, Российская Федерация

Ural A. Shamsiev - Resident, Bashkir State Medical University, Ufa, Russian Federation

https://orcid.org/0009-0006-4985-1465ЖаворонковаВ. М.ZhavoronkovaV. M.

Жаворонкова Валерия Максимовна - ординатор, ФГБВОУ ВО «Военно-медицинская академия имени С.М. Кирова» Минобороны России, Санкт-Петербург, Российская Федерация

Valeriya M. Zhavoronkova - Resident, Military Medical Academy named after S.M. Kirov, Saint Petersburg, Russian Federation

https://orcid.org/0009-0003-0354-576XЩербаковаА. М.ShcherbakovaA. M.

Щербакова Альбина Максимовна - ординатор, ФГБОУ ВО Иркутский государственный медицинский университет Минздрава России, Иркутск, Российская Федерация

Albina M. Shcherbakova - Resident, Irkutsk State Medical University, Irkutsk, Russian Federation

https://orcid.org/0009-0005-3403-8394НиконороваД. А.NikonorovaD. A.

Никонорова Дарья Андреевна - ординатор, ФГБВОУ ВО «Военно-медицинская академия имени С.М. Кирова» Минобороны России, Санкт-Петербург, Российская Федерация

Daria A. Nikonorova - Resident, Military Medical Academy named after S.M. Kirov, Saint Petersburg, Russian Federation

https://orcid.org/0009-0009-1824-1180МариничеваВ. П.MarinichevaV. P.

Мариничева Виктория Павловна - ординатор, ФГБВОУ ВО «Военно-медицинская академия имени С.М. Кирова» Минобороны России, Санкт-Петербург, Российская Федерация

Viktoriia P. Marinicheva - Resident, Military Medical Academy named after S.M. Kirov, Saint Petersburg, Russian Federation

https://orcid.org/0009-0002-9008-3163АракчааК. А.ArakchaaK. A.

Аракчаа Кристина Александровна - ординатор, ФГБВОУ ВО «Военно-медицинская академия имени С.М. Кирова» Минобороны России, Санкт-Петербург, Российская Федерация

Kristina A. Arakchaa - Resident, Military Medical Academy named after S.M. Kirov, Saint Petersburg, Russian Federation

https://orcid.org/0009-0000-1744-2233АмайяП. Ф.PeñuelaF. A.

Амайя Пеньуэла Фелипе - ординатор, ФГБОУ ВО «Санкт-Петербургский государственный университет», Медицинский институт, Санкт-Петербург, Российская Федерация

Felipe Amaya Peñuela - Resident, Saint Petersburg State University, Medical Institute, Saint Petersburg, Russian Federation

Башкирский государственный медицинский университет, Уфа, Российская ФедерацияРоссияBashkir State Medical University, Ufa, Russian FederationRussian FederationФГБВОУ ВО «Военно-медицинская академия имени С.М. Кирова» Минобороны России, Санкт-Петербург, Российская ФедерацияРоссияMilitary Medical Academy named after S.M. Kirov, Saint Petersburg, Russian FederationRussian FederationФГБОУ ВО Иркутский государственный медицинский университет Минздрава России, Иркутск, Российская ФедерацияРоссияIrkutsk State Medical University, Irkutsk, Russian FederationRussian FederationФГБОУ ВО «Санкт-Петербургский государственный университет», Медицинский институт, Санкт-Петербург, Российская ФедерацияРоссияSaint Petersburg State University, Medical Institute, Saint Petersburg, Russian FederationRussian Federation20222107202600Принято в печать97110Copyright © ООО «Издательство ОКИ», 20222022ООО «Издательство ОКИ»ООО «Издательство ОКИ»https://www.antibiotics-chemotherapy.ru/jour/about/submissions#copyrightNoticehttps://www.antibiotics-chemotherapy.ru/jour/article/view/1378

Сепсис остаётся одной из ведущих причин летальности в отделениях интенсивной терапии, а его течение часто осложняется сепсис-индуцированной коагулопатией и диссеминированным внутрисосудистым свёртыванием, значимо ухудшающими прогноз. Цель обзора - систематизировать современные представления о роли антибактериальной терапии в комплексном ведении пациентов с сепсисом, осложнённым коагулопатией. Антибактериальная терапия рассматривается как обязательный компонент лечения, направленный на устранение инфекционного триггера тромбовоспаления. Наиболее обоснованным остаётся требование раннего инфекционного контроля при высокой вероятности бактериального сепсиса или септическом шоке, включая адекватную эмпирическую терапию и устранение источника инфекции. Вместе с тем степень влияния антибиотиков именно на динамику коагулопатии остаётся менее изученной, поскольку большинство исследований не стратифицирует пациентов по коагуляционному статусу и источнику инфекции. Обсуждается диагностическая роль биомаркеров: прокальцитонина, пресепсина, С-реактивного белка, внеклеточной свободной ДНК, показателей комплемента, активности антитромбина и фибриногена. Показано, что они могут помочь в оценке инфекционной нагрузки, риска диссеминированного внутрисосудистого свёртывания и прогноза, однако ни один из них не должен использоваться как автономный критерий назначения или отмены антибиотиков и антикоагулянтов. Органоспецифичность сепсис-ассоциированного диссеминированного внутрисосудистого свёртывания дополнительно демонстрирует, что источник инфекции влияет на прогноз, возможность контроля очага, исходную активность антитромбина и потенциальную применимость антикоагулянтных вмешательств. Сформулирована клиническая рамка, основанная на ранней адекватной антибактериальной терапии, параллельной оценке коагуляционного статуса, активном контроле источника инфекции, индивидуализации доз антибиотиков при органной дисфункции и экстракорпоральной поддержке, а также на рассмотрении антикоагулянтной терапии только после оценки коагуляционного фенотипа, источника инфекции и риска кровотечения. Подчёркивается необходимость проспективных исследований, стратифицированных по коагуляционному статусу и источнику инфекции, для уточнения оптимальных терапевтических стратегий.

Sepsis remains one of the leading causes of mortality in intensive care units, and its course is frequently complicated by sepsis-induced coagulopathy and disseminated intravascular coagulation, which substantially worsen prognosis. The aim of this review is to systematize current concepts regarding the role of antibacterial therapy in the comprehensive management of patients with sepsis complicated by coagulopathy. Antibacterial therapy is regarded as an essential component of treatment directed at eliminating the infectious trigger of thromboinflammation. The most strongly supported requirement remains early infection control when there is a high probability of bacterial sepsis or septic shock, including adequate empiric therapy and source control. At the same time, the extent to which antibiotics specifically influence the dynamics of coagulopathy remains less well studied, as most investigations do not stratify patients by coagulation status or source of infection. The diagnostic role of biomarkers-namely procalcitonin, presepsin, C-reactive protein, extracellular free DNA, complement markers, antithrombin activity, and fibrinogen-is discussed. Evidence indicates that these may assist in assessing infectious burden, the risk of disseminated intravascular coagulation, and prognosis; however, none should be used as an autonomous criterion for initiating or discontinuing antibiotics and anticoagulants. The organ-specific nature of sepsis-associated disseminated intravascular coagulation further demonstrates that the source of infection influences prognosis, the feasibility of source control, baseline antithrombin activity, and the potential applicability of anticoagulant interventions. A clinical framework is proposed, founded on early adequate antibacterial therapy, concurrent assessment of coagulation status, active source control, individualized antibiotic dosing in the presence of organ dysfunction and extracorporeal support, and the consideration of anticoagulant therapy only after evaluation of the coagulation phenotype, source of infection, and bleeding risk. The need for prospective studies stratified by coagulation status and source of infection is underscored in order to refine optimal therapeutic strategies.

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The authors declare that there are no conflicts of interest present.