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2013, vol. 5, br. 2, str. 27-41
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Prevalenca i stepen rezistencije uzročnika infekcija urinarnog trakta kod pacijenata lečenih u Kliničkom centru Kragujevac u periodu 2009-2011.
Profile of urinary tract infections pathogens and their antimicrobial resistance patterns during three-year period (2009-2011) in the Clinical center Kragujevac
aUniverzitet u Kragujevcu, Fakultet medicinskih nauka, Srbija
bKlinički centar Kragujevac, Služba za kliničku farmakologiju, Srbija
cKlinički centar Kragujevac, Klinika za infektivne bolesti, Srbija
Sažetak
Infekcije urinarnog trakta su čest uzrok propisivanja antibiotske terapije. Poznavanje vrste patogena i njihove rezistencije na antibiotike može pomoći pri odabiru adekvatne terapije. U ovoj studiji su ispitivani prevalenca i stepen rezistencije uzročnika infekcija urinarnog trakta hospitalizovanih pacijenata. Sprovedena je studija preseka u bolničkim uslovima. Uzeto je ukupno 662 uzoraka urina pacijenata sa infekcijom urinarnog trakta koji su analizirani standardnom procedurom. Korišćena je disk difuziona metoda na Miler-Hinton agaru, a procena antimikrobne osetljivosti je izvršena prema Clinical and Laboratory Standards Institute smernicama. Najčešći izolovani patogeni su bili Klebsiella spp. (219 izolata, tj. 33,1%), zatim Proteus mirabilis (107 izolata, tj. 16,2%), Enterobacter (86 izolata, tj. 13%), Escherichia coli (82 izolata, tj. 12,4%), Pseudomonas aeruginosa (70 izolata, tj. 10,6%), Enterococcus spp (39 izolata, tj. 5,9% ) i Proteus vulgaris (38 izolata, tj. 5,7%). Grupa bolesnika starijih od 65 godina je bila najbrojnija (426 pacijenata, tj. 64,4%). Gram negativne bakterije su pokazale najviši stepen rezistencije (92,3% - 100%) na peniciline (ampicilin, amoksicilin, amoksicilin + klavulanska kiselina) i cefalosporine treće generacije (cefotaksim, ceftriakson i ceftazidim) (88,3% - 98, 4%), dok je gram pozitivni Enterococcus spp bio najviše rezistentan na aminoglikozide (gentamicin i amikacin) (96,8% - 100%) i fluorohinolon ciprofliksacin (100%). Najniži stepen rezistencije gram negativni patogeni su pokazali na karbapeneme (imipenem i meropenem) i piperacilin / tazobaktam (6,9% - 35,5%), dok je za gram pozitivni Enterococcus spp utvrđen najmanji stepen rezistencije na glikopeptidne antibiotike (vankomicin i teikoplanin ) (3,0% - 3,3%). Pri izboru antibiotika treba uzeti u obzir farmakokinetiku i farmakodinamiku antibiotika, stanje bubrega i jetre, neželjene reakcije sa drugim lekovima, kao i rezultate antibiograma. Prema našim podacima, kada su izazivači infekcija urinarnog trakta Klebsiella spp, Proteus mirabilis, Enterobacter, Escherichia coli, Pseudomonas aeruginosa i Proteus vulgaris empirijski izabrani antibiotici bi trebalo da budu karbapenemi ili piperacilin / tazobaktam, a kada je izazivač Enterococcus spp, empirijski treba izabrati glikopeptidne antibiotike.
Abstract
Urinary tract infections are common bacterial diseases and also a frequent reason for prescribing antibiotics. Knowledge about the type of pathogens and their resistance patterns may help the clinician to choose the correct treatment. In this study, the prevalence and the resistance pattern of the main bacteria responsible for urinary tract infections of hospitalized patients in Clinical centar Kragujevac was evaluated throughout a tree-year period. Cross-sectional study in the hospital settings was conducted and urine samples were collected from 662 patients with urinary tract infections and tested using standard procedures. The diskdiffusion method on Mueller-Hinton agar according to Clinical and Laboratory Standards Institute guidelines (CLSI) was performed for assessment of antimicrobial susceptibility. The most frequently isolated pathogen were Klebsiella spp. (219 isolates, i.e. 33.1%), Proteus mirabilis (107 isolates, i.e. 16.2%), Enterobacter (86 isolates, i.e. 13%), Escherichia coli (82 isolates, i.e. 12.4%), Pseudomonas aeruginosa (70 isolates, i.e. 10.6%), Enterococcus spp (39 isolates, i.e. 5.9% ) and Proteus vulgaris (38 isolates, i.e. 5.7%). Group of patients older than 65 years was the largest one 426 (64.4%). Gram negative bacteria showed the highest degree of resistance (92.3% - 100%) to penicillins (ampicillin, amoxicillin, amoxicillin + clavulanic acid) and third-generation cephalosporins (cefotaxime, ceftriaxone and ceftazidime) (88.3% - 98, 4%), while Gram positive Enterococcus spp showed the highest degree of resistance to aminoglycosides (gentamicin and amikacin) (96.8% - 100%) and fluoroquinolone ciprofliksacin (100%). The lowest resistance rate of the studied Gram negative pathogens was to carbapenems (imipenem and meropenem) and piperacillin / tazobactam (6.9% - 35.5%), while the lowest level of resistance of gram positive Enterococcus spp was found to glycopeptide antibiotics (vancomycin and teicoplanin) (3.0% - 3.3%). When choosing antibiotics, the pharmacokinetics and pharmacodynamics, renal and liver function, adverse reactions with other drugs, as well as the results of susceptibility testing should be taken into consideration. According to our data, empiric treatment for Klebsiella spp, Proteus mirabilis, Enterobacter, Escherichia coli, Pseudomonas aeruginosa and Proteus vulgaris should include carbapenems or piperacillin / tazobactam, and when it comes to Enterococcus spp, glycopeptide antibiotics are appropriate choice.
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Reference
|
|
 
|
Bergman, M., Nyberg, S., Huovinen, P., Paakkari, P., Hakanen, A., Finnish Study Group for Antimicrobial Resistance (2009) Association between Antimicrobial Consumption and Resistance in Escherichia coli. Antimicrobial Agents And Chemotherapy, (March): 912-917
|
|
|
Cantón, R., Loza, E., Aznar, J., i dr. (2011) Antimicrobial susceptibility of Gram-negative organisms from intraabdominal infections and evolution of isolates with extended spectrum β-lactamases in the SMART study in Spain (2002-2010). Rev Esp Quimioter, 24(4): 223-232
|
|
|
CLSI. (2011) Performance standards for antimicrobial susceptibility testing. Twenty-first informational supplement
|
|
|
Dada-Adegbola, H.O., Muili, K.A. (2010) Antibiotic susceptibility pattern of urinary tract pathogens in Ibadan, Nigeria. Afr J Med Med Sci, 39(3): 173-9
|
|
|
Falagas, M.E., Rafailidis, P.I., Kofteridis, D., Virtzili, S., Chelvatzoglou, F.C., Papaioannou, V., Maraki, S., Samonis, G., Michalopoulos, A. (2007) Risk factors of carbapenem-resistant Klebsiella pneumoniae infections: a matched case control study. Journal of antimicrobial chemotherapy, 60(5): 1124-30
|
|
3
|
Farrell, D.J., Morrissey, I., De, R.D., Robbins, M., Felmingham, D. (2003) A UK multicentre study of the antimicrobial susceptibility of bacterial pathogens causing urinary tract infection. Journal of infection, 46(2): 94-100
|
|
|
Feglo, K.P., Gbedema, Y.S., Armar, Q.N.S., Adu-Sarkodie, Y., Opoku-Okrah, C. (2010) Occurrence, species distribution and antibiotic resistance of Proteus isolates: A case study at the Komfo Anokye Teaching Hospital (KATH) in Ghana. International Journal of Pharma Sciences and Research, 1(9): 347-352
|
|
|
Gasink, L., Edelstein, P., Lautenbach, E., Synnestvedt, M., Fishman, N. (2009) Risk Factors and Clinical Impact of Klebsiella pneumonia Carbapenemase-Producing K. pneumonia. Infect Control Hosp Epidemiol, 30(12): 1180-1185
|
|
|
Ghadiri, H., Vaez, H., Khosravi, S., Soleymani, E. (2012) The antibiotic resistance profiles of bacterial strains isolated from patients with hospital-acquired bloodstream and urinary tract infections. Critical care research and practice, 2012: 890797
|
|
|
Giamarellou, H. (2010) Multidrug-resistant Gram-negative bacteria: how to treat and for how long. International Journal of Antimicrobial Agents, 36S: -S50-S54
|
|
|
Jankovic, S. (2009) Rational Use Of Antibiotics In Clinical Practice. Racionalna terapija, 1(1): 1-6
|
|
|
Johnson, P.D.R., Ballard, S.A., Grabsch, E.A., Stinear, T.P., Seemann, T., Young, H.L., Grayson, L.M., Howden, B.P. (2010) A sustained hospital outbreak of vancomycin-resistant Enterococcus faecium bacteremia due to emergence of vanB E. faecium sequence type 203. Journal of infectious diseases, 202(8): 1278-86
|
|
|
Kahlmeter, G. (2003) An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO-SENS Project. J Antimicrob Chemother, 51(1): 69-76
|
|
1
|
Kahlmeter, G., Poulsen, H.O. (2012) Antimicrobial susceptibility of Escherichia coli from community-acquired urinary tract infections in Europe: the ECO·SENS study revisited. International journal of antimicrobial agents, 39(1): 45-51
|
|
|
Karlowsky, J.A., Lagace-Wiens, P.R., Simner, P.J., i dr. (2011) Antimicrobial Resistance in Urinary Tract Pathogens in Canada from 2007 to 2009: CANWARD Surveillance Study. Antimicrob Agents Chemother, 55(7): 3169-3175
|
|
|
Linhares, I., Raposo, T., Rodrigues, A., Almeida, A. (2013) Frequency and antimicrobial resistance patterns of bacteria implicated in community urinary tract infections: a ten-year surveillance study (2000--2009). BMC Infectious Diseases, 13: -19
|
|
|
Livermore, D.M., Pearson, A. (2007) Antibiotic resistance: location, location, location. Clinical microbiology and infection, 13 (Suppl 2): 7-16
|
|
|
Magliano, E., Grazioli, V., Deflorio, L., i dr. (2012) Gender and Age-Dependent Etiology of Community-Acquired Urinary Tract Infections. Scientific World Journal, -349597
|
|
|
Nicoletti, J., Kuster, S.P., Sulser, T., Zbinden, R., Ruef, C., Ledergerber, B., Weber, R. (2010) Risk factors for urinary tract infections due to ciprofloxacin-resistant Escherichia coli in a tertiary care urology department in Switzerland. Swiss Med Wkly, 140: -w13059
|
|
|
Potic, M., Ignjatovic, I. (2009) Catheter-associated and nosocomial urinary tract infections: antibiotic resistance and influence on commonly used antimicrobial therapy. Int Urol Nephrol, 41(3): 461-464
|
|
|
Pramodhini, S., Niveditha, S., Umadevi, S., i dr. (2012) Antiobiotic resistance pattern of biofilm forming uropathogens isolated from catheterised patients in Pondicherry, India. Australasian Medical Journal, 5(7): 344-348
|
|
|
Ronald, A.R., Nicolle, L.E., Stamm, E., Krieger, J., Warren, J., Schaeffer, A., Naber, K.G., Hooton, T.M., Johnson, J., Chambers, S., Andriole, V. (2001) Urinary tract infection in adults: research priorities and strategies. International journal of antimicrobial agents, 17(4): 343-8
|
|
|
Salem-Bekhit, M.M., Moussa, I.M.I., Muharram, M.M., Alanazy, F.K., Hefni, H.M. (2012) Prevalence and antimicrobial resistance pattern of multidrug-resistant enterococci isolated from clinical specimens. Indian journal of medical microbiology, 30(1): 44-51
|
|
|
Sreeja, S., Babu, S.P.R., Prathab, A.G. (2012) The Prevalence and the Characterization of the Enterococcus Species from Various Clinical Samples in a Tertiary Care Hospital. Journal of Clinical and Diagnostic Research, 6(9): 1486-1488
|
|
2
|
Tabibian, J.H., Gornbein, J., Heidari, A., Dien, S.L., Lau, V.H., Chahal, P., Churchill, B.M., Haake, D.A. (2008) Uropathogens and host characteristics. Journal of clinical microbiology, 46(12): 3980-6
|
|
|
Tan, T.Y., Hsu, L.Y., Koh, T.H., Ng, L.S.Y., Tee, N.W.S., Krishnan, P., Lin, R.T.P., Jureen, R. (2008) Antibiotic resistance in gram-negative bacilli: a Singapore perspective. Annals of the Academy of Medicine, Singapore, 37(10): 819-25
|
|
|
Thierfelder, C., Keller, P.M., Kocher, C. (2012) Vancomycin-resistant Enterococcus. Swiss Med Wkly, 142(May)
|
|
|
Tumbarello, M., Trecarichi, E.M., Fiori, B., Losito, A.R., D'Inzeo, T., Campana, L., Ruggeri, A., Di, M.E., Liberto, E., Fadda, G., Cauda, R., Spanu, T. (2012) Multidrug-resistant Proteus mirabilis bloodstream infections: risk factors and outcomes. Antimicrobial agents and chemotherapy, 56(6): 3224-31
|
|
|
Zilberberg, M.D., Chen, J., Mody, S.H., Ramsey, A.M., Shorr, A.F. (2010) Imipenem resistance of Pseudomonas in pneumonia: a systematic literature review. BMC pulmonary medicine, 10: 45
|
|
|
|
|