Uzročnici pneumonije udružene sa ventilatornom potporom bolesnika i njihova rezistencija na antibiotike u pulmološkoj jedinici intenzivnog lečenja

  • Vlada V Injac Hemofarm AD, Research and Development Department, Belgrade, Serbia
  • Uroš Batranović Institute for Pulmonary Diseases of Vojvodina, Clinic for Urgent Pulmonology, Intensive Care Unit, Sremska Kamenica, Serbia
  • Jovan Matijašević Institute for Pulmonary Diseases of Vojvodina, Clinic for Urgent Pulmonology, Intensive Care Unit, Sremska Kamenica, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia
  • Marija Vukoja Institute for Pulmonary Diseases of Vojvodina, Clinic for Urgent Pulmonology, Center for Pathophysiology of Breathing and Sleep Medicine, Sremska Kamenica, Serbia
  • Mirjana Hadnadjev Institute for Pulmonary Diseases of Vojvodina, Clinic for Urgent Pulmonology, Center for Microbiology, Virology and Immunology, Sremska Kamenica, Serbia
  • Zoran Bukumirić University of Belgrade, Faculty of Medicine, Institute for Medical Statistics and Informatics, Belgrade, Serbia
  • Goran Trajković University of Belgrade, Faculty of Medicine, Institute for Medical Statistics and Informatics, Belgrade, Serbia
  • Slobodan Janković University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
DOI: https://doi.org/10.2298/VSP151216270I
Ključne reči: pneumonia||, ||pneumonija, cross infection||, ||infekcija, intrahospitalna, anti-bacterial agents||, ||antibiotici, drug resistance, bacterial||, ||lekovi, rezistencija bakterija, respiration, artificial||, ||disanje, mehaničko, mortality||, ||mortalitet,

Sažetak


Uvod/Cilj. Incidencija pneumonije udružene sa ventilatornom potporom bolesnika (VAP), njeni uzročnici i njihova rezistencija razlikuju se između zemalja i jedinica intenzivne nege (JIN). U Evropi je u poslednjih deset godina došlo do progresivnog porasta rezistentnih bakterija. Međutim, ne postoji dovoljno podataka za JIN u Srbiji. Ciljevi rada bili su da se ispita etiologija i rezistencija uzročnika VAP na antibiotike u JIN, da se ispita da li postoji razlika između uzročnika ranog i kasnog VAP i da se utvrdi letalitet kod bolesnika sa VAP nakon 30 i 60 dana hospitalizacije. Metode. Retrospektivno kohortno ispitivanje je bilo sprovedeno u pulmološkoj JIN. Bili su uključeni svi odrasli bolesnici sa dijagnostikovanim VAP od 2009. do 2014. godine. Rezultati. Glavni uzročnici VAP bili su gram negativne bakterije (80,3%). Najčešće je bio izolovan Acinetobacter spp (59,8%). Zabeležen je statistički značajan porast incidencije oboljevanja usled Klebsiella pneumoniae (8,9% vs 25,6%; p = 0,019). Najzastupljeniji su bili ekstremno rezistentni (XDR) sojevi bakterija (78,7%). Kasni VAP je dijagnostikovan kod 81,1% bolesnika bez razlike u patogenima u poređenju sa ranim VAP. Acinetobacter spp je bio osetljiv na tigeciklin i kolistin uz statistički značajan porast rezistencije na ampicilin/sulbaktam (30,2% vs 58,6%; p = 0,01). Rezistencija Pseudomonas aeruginosa i Klebsiella pneumoniae na karbapeneme iznosila je 38%, odnosno 11%. Kod meticilin-rezistentnog Staphylococcus aureus nije postojala rezistencija na vankomicin i linezolid. Nisu utvrđene razlike u letalitetu između bolesnika sa ranim i kasnim VAP posle 30 i 60 dana hospitalizacije. Zaključak. Gram negativne bakterije bile su glavni uzročnici VAP, od kojih je najzastupljeniji bio XDR soj Acinetobacter spp. Bolesnici sa ranim i kasnim VAP imali su iste uzročnike. Nije bilo razlike u letalitetu između te dve grupe bolesnika tokom 60 dana hospitalizacije.

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Objavljeno
2017/10/27
Broj časopisa
Vol. 74 Br. 10 (2017)
Rubrika
Originalni članak