jofinЖурнал инфектологииJournal Infectology2072-6732IPO “АIDSSPbR"10.22625/2072-6732-2020-12-5-21-28jofin-1140Research ArticleОригинальные исследованияOriginal ResearchЧастота инфекционных осложнений и особенности системного воспалительного ответа у больных с длительным нарушением сознанияFrequency of infectious complications and features of systemic inflammatory response in patients with prolonged disorders of consciousnessДрягинаН. В.DryaginaN. V.

заведующая клинико-диагностической лабораторией с экспресс-группой, 

к.м.н.,

Санкт-Петербург

Saint-Petersburg

nvdryagina@mail.ruКондратьеваЕ. А.KondratyevaE. A.

невролог, ведущий научный сотрудник, руководитель группы по изучению «малого сознания»,  к.м.н.,

Санкт-Петербург

Saint-Petersburg

eak2003@mail.ruКондратьевС. А.KondratyevS. A.

невролог отделения анестезиологии и реанимации, к.м.н.,

Санкт-Петербург

Saint-Petersburg

3773717@mail.ruМарковкинаИ. А.MarkovkinaI. A.

врач клинической лабораторной диагностики КДЛ с экспресс-группой,

Санкт-Петербург

Saint-Petersburg

i.a.stepanova@yandex.ruПотемкинаЕ. Г.PotemkinaE. G.

врач-рентгенолог рентгеновского отделения с ангиографическим кабинетом и кабинетом ультразвуковой диагностики, д.м.н.,

Санкт-Петербург

Saint-Petersburg

Potemkina25@rambler.ruКондратьевА. Н.KondratyevA. N.

анестезиолог-реаниматолог, научный руководитель отделения анестезиологии и реанимации, д.м.н., профессор,

Санкт-Петербург

Saint-Petersburg

neuro@rambler.ruРоссийский научно-исследовательский нейрохирургический институт им. профессора А.Л. Поленова – филиал Национального медицинского исследовательского центра им. В.А. АлмазоваРоссияRussian Research Neurosurgical Institute named after professor A.L. Polenov – Branch of National Medical Research Centre named after V.A. AlmazovRussian Federation2020180120211252128Copyright © Дрягина Н.В., Кондратьева Е.А., Кондратьев С.А., Марковкина И.А., Потемкина Е.Г., Кондратьев А.Н., 20212021Дрягина Н.В., Кондратьева Е.А., Кондратьев С.А., Марковкина И.А., Потемкина Е.Г., Кондратьев А.Н.Dryagina N.V., Kondratyeva E.A., Kondratyev S.A., Markovkina I.A., Potemkina E.G., Kondratyev A.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.niidi.ru/jofin/article/view/1140Цель

Цель: изучить эпидемиологию инфекционных осложнений, интенсивность антибактериальной терапии и особенности системного воспалительного ответа у больных с длительным нарушением сознания.

Материалы и методы

Материалы и методы: проведен ретроспективный анализ историй болезни 102 пациентов с длительным нарушением сознания, проходивших лечение в отделении анестезиологии-реанимации Российского научноисследовательского нейрохирургического института им. профессора А.Л. Поленова с 2010 по 2019 г.

Результаты

Результаты: у всех пациентов (100%) за время госпитализации присутствовали признаки трахеобронхита, у 86 больных (84,3%) была обнаружена инфекция мочевыводящих путей, у 34 (33,3%) – пневмония, у 10 (9,8%) – менинговентрикулит, у 9 (8,8%) – сепсис. Выявленные бактериальные осложнения потребовали назначения интенсивной антибактериальной терапии. При продолжительности пребывания больного в стационаре в среднем 51±42 дня продолжительность антибактериальной терапии составила в среднем 37±41 день. Однокомпонентная терапия проводилась в половине случаев (54%), чуть реже (43,2%) лечение состояло из двух антибактериальных препаратов, в отдельных случаях состояние больного требовало назначения трех антибактериальных препаратов (2,8%). Даже в отсутствие очага инфекции температура и лабораторные маркеры воспаления в крови у больных с длительным нарушением сознания были выше референсных показателей. СРБ увеличивался при присоединении всех бактериальных осложнений. Количество лейкоцитов достоверно повышалось только с развитием пневмонии и сепсиса. Прокальцитониновый тест был положительным в 16,6% случаев инфекций мочевыводящих путей, 30,4% пневмоний и 28% менинговентрикулитов.

Заключение

Заключение: наиболее информативным провоспалительным маркером в диагностике бактериальных осложнений у больных с длительным нарушением сознания оказался С-реактивный белок. Слабо выраженная лейкоцитарная реакция может объясняться иммуносупрессией у длительно болеющих пациентов. Ограниченная ценность прокальцитонина обусловлена недостаточной чувствительностью полуколичественного метода с пороговым уровнем 0,5 нг/мл, а также сниженным провоспалительным ответом на локальную инфекцию у пациентов с длительным нарушением сознания в результате массивной антибактериальной терапии, колонизации условно-патогенной флоры, наличия симпатикотонии (неинфекционной системной воспалительной реакции). 

Objective

Objective: investigate epidemiology of infectious complications, intensity of antibacterial therapy, and features of the systemic inflammatory response in patients with prolonged disorders of consciousness.

Materials and methods

Materials and methods: retrospective case histories analysis of 102 patients with prolonged disorders of consciousness who were treated in the department of anesthesiology and intensive care of Polenov Neurosurgical Institute from 2010 to 2019.

Results

Results: during hospitalization all patients (100%) had signs of tracheobronchitis, 86 patients (84,3%) had urinary tract infection, 34 (33,3%) pneumonia, 10 patients (9,8%) meningoventriculitis, and in 9 (8,8%) cases sepsis was diagnosed. Identified bacterial complications required systemic antibacterial therapy. With an average length of hospital stay of 51±42 days, duration of antibiotic therapy was 37±41 days. One-component therapy was applied in half of the cases (54%), slightly less often (43,2%) treatment consisted of two antibiotics, in some cases patient’s condition required prescription of three antibiotics (2,8%). Even in the absence of a focus of infection, temperature and laboratory markers of inflammation in blood samples of patients with prolonged disorders of consciousness were higher than the reference values. CRP was increased with addition of any bacterial complications. Count of white blood cells significantly increased only in case of pneumonia and sepsis. Procalcitonin test was positive in 16,6% observations of urinary tract infection, 30,4% of pneumonia, and 28% of meningoventriculitis.

Conclusion

Conclusion: most informative proinflammatory marker of bacterial complications in patients with prolonged disorders of consciousness was CRP. Mild leukocyte response can be explained by immunosuppression in long-term ill patients. Limited value of procalcitonin test may be due to the insufficiency of the semi-quantitative method sensitivity with a threshold level of 0,5 ng/ml, as well as reduced proinflammatory response to local infection in patients with prolonged disorders of consciousness as a result of massive antibacterial therapy, colonization of opportunistic microflora and presence of sympathicotonia (non-infectious systemic inflammatory reaction). 

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