Значение экспресс-методов идентификации возбудителей и механизмов антибиотикорезистентности для оптимизации антибиотикотерапии: нарративный обзор

Антибиотикорезистентность остаётся одной из наиболее значимых проблем современной клинической практики, поскольку ассоциирована с ростом летальности, увеличением продолжительности госпитализации и повышением экономической нагрузки на систему здравоохранения. Особое значение данная проблема имеет при инфекциях, вызванных ESKAPE-патогенами, карбапенеморезистентными бактериями семейства Enterobacteriaceae, Acinetobacter baumannii и Pseudomonas aeruginosa, для которых своевременный выбор рациональной антибактериальной терапии влияет на прогноз. Целью настоящего обзора является обобщение современных данных о значении экспресс-методов идентификации возбудителей и выявления механизмов антибиотикорезистентности для оптимизации проведения антибиотикотерапии. Поиск литературы проводился в PubMed/MEDLINE, eLibrary, CyberLeninka, Google Scholar, Springer Link и ScienceDirect, в анализ включено 70 публикаций. Рассмотрены возможности мультиплексных ПЦР-панелей, MALDI-TOF MS, быстрых фенотипических методов определения чувствительности, метагеномного секвенирования и вспомогательных маркеров. Продемонстрировано, что экспресс-диагностика позволяет сократить время до назначения адекватной терапии, ускорить эскалацию при выявлении резистентных штаммов, способствовать деэскалации и снижать необоснованное применение антибиотиков. Наиболее выраженный клинический эффект достигается при интеграции быстрых диагностических тестов в программы рационального управления антимикробной терапией с участием микробиологов, клинических фармакологов и инфекционистов. Вместе с тем данные о влиянии экспресс-диагностики на летальность, продолжительность госпитализации и экономические затраты остаются неоднородными, что связано с различиями в локальной эпидемиологии AMR, доступности диагностических платформ, организации лабораторного процесса, маршрутизации результатов и качестве клинической интерпретации.

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