DISTRIBUCIJA UZROČNIKA INFEKCIJA URINARNOG TRAKTA I NIVOA NJIHOVE REZISTENCIJE U KLINIČKOM CENTRU KRAGUJEVAC U PERIODU OD TRI GODINE (2009- 2011)

Radiša T Pavlović; Slobodan M Janković; Zorana Đorđević

doi:10.5937/racter5-3385

Radiša T Pavlović Fakultet Medicinskih nauka
Slobodan M Janković Fakultet medicinskih nauka Služba Kliničke farmakologije, Klinički centar Kragujevac
Zorana Đorđević Klinika za infektivne bolesti, Klinički centar Kragujevac

DOI: https://doi.org/10.5937/racter5-3385

Ključne reči: Drug Resistance||, ||Rezistencija, Anti-bacterial agents||, ||Antibiotik, Infection||, ||Infekcija, Urinary tract||, ||Urinarni trakt,

Sažetak

Infekcije urinarnog trakta su česte infekcije i čest uzrok propisivanja antibiotske terapije. Poznavanje vrste patogena i njihovih rezistencija može pomoći pri odabiru adekvatne terapije. U ovoj studiji je ispitivana prevalenca i stepen rezistencije uzročnika infekcija urinarnog trakta hospitalizovanih pacijenata.

Sprovedena je studija preseka u bolničkim uslovima. Uzeto je ukupno 662 uzorka urina pacijenata sa infekcijom urinarnog trakta koji su testirani standardnim procedurama. Korišćena je disk difuziona metoda na Mueller Hinton agaru, a procena antimikrobne osetljivost je izvršena prema CLSI smernicama.

Najčešći izolovani patogen je bila Klebsiella spp. 219 (33,1%), zatim Proteus mirabilis 107 (16,2%), Enterobacter 86 (13%), Escherichia coli 82 (12,4%), Pseudomonas aeruginosa 70 (10,6%), Enrerococcus spp 39 (5,9% ) i Proteus vulgaris 38 (5,7%). Grupa bolesnika starijih od 65 godina je bila najbrojnija 426 (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 Enrerococcus 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 Enrerococcus 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 Enrerococcus spp, empirijski treba izabrati glikopeptidne antibiotike.

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