Comparative Analysis of the Effectiveness of Enteral and Parenteral Antibacterial Drugs in Sepsis of Patients with Brain Damage

The aim of the study was to analyze the effectiveness of microbiological studies and the use of parenteral and enteral forms of antibacterial drugs in sepsis of patients with brain damage of various etiologies. Material and methods. The study included 40 patients (23 men, 17 women, average age 50.43±2.84). In patients who survived and died from sepsis, the type, duration, as well as the total amount of parenteral and enteral antibiotics, were assessed. The prognostic value of microbiological parameters of urine, tracheobronchial aspirate, venous blood, cerebrospinal fluid, and intravenous fragment of the central venous catheter was studied, with the absolute and relative number of cases of positive and negative microbiological culture determined. Results. In all 40 examined patients, 22 microbiological cultures were isolated from urine and the tracheobronchial tree, venous blood, cerebrospinal fluid, and the intravenous segment of the central venous catheter, of which 17 species were found in tracheobronchial aspirate, 10 in urine, 10 in venous blood, 8 in cerebrospinal fluid, and 10 in the intravenous segment of the central venous catheter. Of the 22 microorganisms, 9 (40.9%) isolates were representatives of enterobacteria. The patients were given 23 types of parenteral antibiotics and 10 types of enteral and inhalation antibacterial drugs. Conclusion. Detection of Providencia stuartiiin bronchial aspirate and Acinetobacter baumanii, Escherichia coli in urine was reliably associated with the group of deceased patients, which can be considered an unfavorable prognostic factor. Administration of amikacin sulfate intravenously with long-term use, as well as fosfomycin and ciprofloxacin with enteral administration, increase the survival of patients with sepsis.

1. Gunsolus I. L., Sweeney T. E., Liesenfeld O., Ledeboer N. A. Diagnosing and managing sepsis by probing the host response to infection: advances, opportunities, and challenges. J Clin Microbiol. 2019 Jun 25; 57 (7): e00425–19. doi: 10.1128/JCM.00425-19.

2. Rothe K., Wantia N., Spinner C. D., Schneider J., Lahmer T., Waschulzik B. et al. Antimicrobial resistance of bacteraemia in the emergency department of a German university hospital (2013–2018): potential carbapenemsparing empiric treatment options in light of the new EUCAST recommendations. BMC Infect Dis. 2019; 19 (1): 1091. Published 2019 Dec 30. doi: 10.1186/s12879-019-4721-9.

3. Friedman N. D., Temkin E., Carmeli Y. The negative impact of antibiotic resistance. Clin Microbiol Infect. 2016 May; 22 (5): 416–422. doi: 10.1016/j.cmi.2015.12.002.

4. Caraballo C., Jaimes F. Organ dysfunction in sepsis: an ominous trajectory from infection to death. Yale J Biol Med. 2019; 92 (4): 629–640.

5. Miller W. D., Keskey R., Alverdy J. C. Sepsis and the microbiome: a vicious cycle. J Infect Dis. 2020 Dec 17: jiaa682. doi: 10.1093/infdis/jiaa682.

6. Moron R., Galvez J., Colmenero M., Anderson P., Cabeza J., RodriguezCabezas M. E. The Importance of the microbiome in critically ill patients: role of nutrition. Nutrients. 2019 Dec 7; 11 (12): 3002. doi: 10.3390/nu11123002.

7. Dobson R., McGuckin C., Walker G., Lucas C., McGrogan P., Russell R. K. et al. Cycled enteral antibiotics reduce sepsis rates in paediatric patients on long-term parenteral nutrition for intestinal failure. Aliment Pharmacol Ther. 2011 Oct; 34 (8): 1005–11. doi: 10.1111/j.1365-2036.2011.04826.x.

8. Kleif J., Rasmussen L., Fonnes S., Tibæk P., Daoud A., Lund H. et al. Enteral antibiotics are non-inferior to intravenous antibiotics after complicated appendicitis in adults: a retrospective multicentre non-inferiority study. World J Surg. 2017 Nov; 41 (11): 2706–2714. doi: 10.1007/s00268-017-4076-6.

9. Falagas M. E., Vouloumanou E. K., Samonis G., Vardakas K. Z. Fosfomycin. Clin Microbiol Rev. 2016; 29 (2): 321–347. doi: 10.1128/CMR.00068-15.

10. Cebrero-Cangueiro T., Labrador-Herrera G., Pascual Á., Díaz C., Rodríguez-Baño J., Pachón J. et al. Efficacy of fosfomycin and its combination with aminoglycosides in an experimental sepsis model by carbapenemase-producing Klebsiella pneumoniae clinical strains. Front Med (Lausanne). 2021 Mar 26; 8: 615540. doi: 10.3389/fmed.2021.615540.

11. Kane Z., Gastine S., Obiero C., Williams P., Murunga S., Thitiri J. et al. IV and oral fosfomycin pharmacokinetics in neonates with suspected clinical sepsis. J Antimicrob Chemother. 2021 Jun 18; 76 (7): 1855–1864. doi: 10.1093/jac/dkab083.

12. Williams P. C. Potential of fosfomycin in treating multidrug-resistant infections in children. J Paediatr Child Health. 2020 Jun; 56 (6): 864–872. doi: 10.1111/jpc.14883.