Opasnosti antibiotske rezistencije kod pacijenata sa stalnim urinarnim kateterom: bakterijski spektar, učestalost infekcija i pojava multirezistentnih i ekstenzivno rezistentnih sojeva
Sažetak
Obiminost antibiotske rezistencije predstavlja globalnu opasnost i prema najnovijim izveštajima Svetske zdravstvene organizacije 21. vek može da označi i kraj antibiotske ere. Urinarne infekcije povezane sa kateterizacijom su vodeći uzrok nozokomijalnih bakterijemija i glavni izvor rezistentnih Gram negativnih organizama. Ovaj rad se fokusira na antibiotskoj rezistenciji bakterija izolovanih iz urina bakteriuričnih pacijenata. U ovoj studiji ispitivane su urinokulture pacijenata sa permanentnim urinarnim kateterom hospitalizovanih zbog operativnog lečenja kod kojih postoji povećani rizik od pojave rezistentnihpatogena. Analizirani su i primarna oboljenja, komorbiditeti i faktori rizika za nastanak infekcija u nastojanju da se dovedu u vezu sa stopama rezistencije. Testovi osetljivosti izvedeni na uzorcima pozitivnih urinokultura otkrili su visoke stope rezistencije na inhibitore beta-laktamaze, cefalosporine treće generacije, fluorohinolone i trimetoprim-sulfametoksazol kao i kombinovanu rezistenciju na cefalosporine treće generacije, fluorohinolone i aminoglikozide. Multirezistentni sojevi izolovani su nezavisno od prisustva simptoma i znakova infekcije pri čemu je trajanje kateterizacije dominantni faktor rizika u poređenju sa težinom osnovne bolesti i komorbiditetima. Primenjena empirijska terapija pokazala se neadekvatnom u lečenju izolovanih patogena. Kriza antibiotske rezistencije je na vrhuncu i zahteva brz i odlučan odgovor. Kateterizacija prema strogo određenim indikacijama, smanjenje vremena trajanja kateterizacije i izbor antibiotika po antibiogramu trenutno su najbolje strategije kako u prevenciji tako i terapiji.
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