ISSN 1866-8836
Клеточная терапия и трансплантация

PI-08. Antimicrobial control in real clinical practice

Yulia V. Sveshnikova, Dmitry A. Mazein, Olga A. Markina, Alevtina V. Dzhapakova, Tatyana S. Konstantinova

Sverdlovsk Regional Clinical Hospital No. 1, Yekaterinburg, Russia

Contact: Dr. Yulia V. Sveshnikova, e-mail:

doi 10.18620/ctt-1866-8836-2020-9-3-1-152



Infectious complications are among main problems in the treatment of patients with hematological malignancies, including hematopoietic stem cell transplantation (HSCT). To achieve optimal results of therapy, reduce mortality, it is necessary to implement a complex of organizational, methodological and sanitary-epidemiological measures, optimal laboratory support, and a sufficient set of antibacterial drugs. The aim of the work was to analyze the impact of antimicrobial control measures at our Department of Hematology.

Materials and methods

The Hematology Center at the Regional hospital provided diagnostics and treatment of patients with hematological malignancies living in the Sverdlovsk Region (4.31 million people) and residents of Yekaterinburg, including patients with indications for HSCT. On average, 1240-1280 patients received therapy at inpatient department annually including 55-60 with de novo diagnosed acute leukemia, 400 courses of intensive chemotherapy are carried out, with a period of agranulocytosis of more than 7 days. Autologous HSCT had been performed since 1997, allogeneic HSCT since 2002, including haploidentical and unrelated. To detect and identify the infectious pathogens, VITEK-2 Compact was used. To determine the antibiotics sensitivity, standard methods were used, including the E-test. Mycological and virological studies were carried out using standard methods. Recently, taking into account the high incidence of ESBL strains, the study of rectal smears had become a mandatory practice.


The results of blood cultures were most significant for the study of local epidemiology and implementation of antimicrobial control. The informativity of blood cultures for episodes of fever had increased over the years from 11-15% in 2011-2015 up to 25-28% 2016-2019. The percentage of pathogens detected from the blood was low, thus being typical to patients with hematological malignancies, and it is comparable to published data. Over the past 10 years, Gram(+) flora prevailed in blood cultures in the Department (from 63.5% in 2017 to 73.3% in 2016), as the main cause of bacteremia. In 2019, the ratio of Gram(+) and Gram(-) flora changed, becoming 42.6% and 57.4%, respectively, towards Gram(-). The number of MRS/MRSA strains had remained consistently high over past decade, thus demanding availability for antibiotics with anti-MRSA activity. In addition, the incidence of Enterobacteriaceae ESBL strains did not change significantly, reaching a level of 78-82%, which requires a sufficient amount of carbapenems in the stores of the department. In 2010-2011, pan-resistant Pseudomonas aeruginosa was the main problem at the department of hematology. Due to a complex of anti-epidemic and therapeutic measures, the detection rates of this pathogen from in blood were significantly decreased (from 12.8% to 3.2%), and pan-resistant forms had not been revealed over recent years. On the contrary, the number of cases of K.pneumoniae blood culture, including carbapenemase producers, was increased since 2017, which is currently the main problem and requires administration of multiple antibacterial drug regimens, including “reserve” antibiotics. Over the past 10 years, the number of hospitalizations had not changed significantly, but the proportion of patients with newly diagnosed diseases was growing. The number of HSCT was gradually increasing, and the percentage of intensive chemotherapy courses remains stably high. The number of episodes of infectious complications in hospitalized patients during treatment reached 56.7%, whereas the percentage of mortality from infection had been increased since 2017 (from 43.6% in 2016 with a total mortality of 4.2% to 65.8% in 2016 with a total mortality of 6.0%), due to the changed spectrum of infectious agents and emergence of poly- and pan-resistant K.pneumoniae. In 2019, the percentage of mortality from infection was 61.7% of the total mortality of 4.9%.


The implementation of antimicrobial control measures resulted in the significantly decreased detection rates of poly- and pan-resistant P.aeruginosa by 2013. Despite the increasing mortality in 2017-2018 (from 3.8% in 2015 to 6.0% in 2018), in 2019 we managed to reduce mortality to 4.9% due to revised approach to administration of antibiotics, by including multi-component treatment regimens at the early stages, as well as new “reserve” antibiotics, updating the list of diagnostic examinations. However, additional measures are required to prevent the spread of infections with poly- and pan-resistant K.pneumoniae strains.


Antimicrobial control, infections, hematology, bone marrow transplantation, local epidemiology.

Volume 9, Number 3

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doi 10.18620/ctt-1866-8836-2020-9-3-1-152

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