ssmuБюллетень сибирской медициныBulletin of Siberian Medicine1682-03631819-3684Siberian State Medical University, the Ministry of Healthcare of the Russian Federation10.20538/1682-0363-2023-1-121-131ssmu-5143Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEW AND LECTURESДиагностика бактериальной инфекции у больных COVID-19: так ли все просто? (обзор литературы)Diagnosis of bacterial infection in patients with COVID-19: is it a simple task? (literature review)https://orcid.org/0000-0002-7464-826XКаролиН. А.KaroliN. A.

Кароли Нина Анатольевна – доктор медицинских наук, профессор кафедры госпитальной терапии

410012, г. Саратов, ул. Б. Казачья, 112

112, Bolshaya Kazachya Str., Saratov, 410012

nina.karoli.73@gmail.comhttps://orcid.org/0000-0002-3463-7734РебровА. П.RebrovA. P.

Ребров Андрей Петрович – доктор медицинских наук, профессор, зав. кафедрой госпитальной терапии

410012, г. Саратов, ул. Б. Казачья, 112

112, Bolshaya Kazachya Str., Saratov, 410012

andreyrebrov@yandex.ruСаратовский государственный медицинский университет им. В.И. РазумовскогоРоссияSaratov State Medical University named after V.I. RazumovskyRussian Federation202321042023221121131Copyright © Кароли Н.А., Ребров А.П., 20232023Кароли Н.А., Ребров А.П.Karoli N.A., Rebrov A.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://bulletin.ssmu.ru/jour/article/view/5143

Проблема диагностики бактериальной инфекции у больных новой коронавирусной инфекцией (НКИ) представляет не такую простую задачу, как выглядит на первый взгляд. Имеющиеся данные свидетельствуют, что бактериальная инфекция у больных COVID-19 встречается редко и составляет менее 10%. При этом данные отдельных исследований и систематических обзоров свидетельствуют, что более 70% пациентов с НКИ получали антибактериальную терапию, преимущественно препараты широкого спектра и часто эмпирически, нередко до получения подтверждения НКИ. Таким образом, это широко распространенное эмпирическое использование антибиотиков не подтверждается данными о необходимости их применения.

В статье обсуждаются литературные данные о значимости общепринятых методов диагностики бактериальной инфекции с акцентом  на  лабораторное подтверждение ее наличия/отсутствия. В повседневной практике сочетание клинического течения болезни и результатов стандартных лабораторных исследований, данных методов визуализации являются ведущими в оценке вероятности бактериальной коинфекции у пациентов с COVID-19. Однако в условиях развития тропной к респираторной системе вирусной инфекции такой подход не всегда позволяет с достаточной степенью достоверности диагностировать бактериальную коинфекцию. Помочь в этом могут имеющиеся современные тест-системы, использование комбинации признаков или дополнительных лабораторных критериев (например, прокальцитонина), а также анализ врачом общей клинической картины заболевания с использованием знаний о группах риска пациентов.

Diagnosing bacterial infection in patients with novel coronavirus infection (COVID-19) is not an easy task. Available data suggest that bacterial infection in patients with COVID-19 is rare and occurs in less than 10% of cases. At the same time, data of individual studies and systematic reviews indicate that more than 70% of patients with COVID-19 receive mainly empirical antimicrobial therapy with broad-spectrum antibiotics often before the diagnosis of COVID-19 has been verified. Therefore, this widespread empirical use of antibiotics is not supported by data on the need for their use.

The article discusses the literature data on the significance of commonly accepted methods for diagnosing bacterial infection, with an emphasis on laboratory presence / absence tests. In everyday practice, the likelihood of bacterial coinfection in patients with COVID-19 is assessed by clinical presentation of the disease and the results of standard laboratory tests and imaging methods. However, when viral respiratory infection develops, this approach does not always allow to diagnose bacterial coinfection with sufficient significance. This issue may be handled by available modern test systems, the use of a combination of signs or additional laboratory criteria (for example, procalcitonin), and the analysis of the overall clinical presentation by the doctor using knowledge about patient risk groups.

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