ANTIBIOTSKA REZISTENCIJA UZROČNIKA INFEKCIJA URINARNOG TRAKTA KOD PACIJENATA INSTITUTA ZA JAVNO ZDRAVLJE KRAGUJEVAC
Sažetak
Uvod/Cilj: Urinarne infekcije su među najčešćim u primarnoj zdravstvenoj zaštiti. Cilj ovog rada je bila mikrobiološka analiza urina ambulantnih pacijenata u Institutu za javno zdravlje u Kragujevcu u periodu od šest meseci (01.11.2020. - 30.04.2021.).
Metode: Retrospektivno, na osnovu prikupljenih rezultata, vršena je identifikacija uzročnika urinarnih infekcija i određivanje njihove osetljivosti na antibiotike metodom antibiograma.
Rezultati: Šestomesečna analiza uzoraka urina ambulantnih pacijenata obuhvatila je 4809 uzoraka urina. Od svih testiranih uzoraka pozitivno na patogene mikroorganizme je bilo 1218 (25,3%). Najzastupljeniji patogeni urinarnog trakta u ispitivanom periodu bili su: Escherichia coli 842 (69,1%), Klebsiella spp. 252 (20,7%), Pseudomonas aeruginosa 71 (5,8%) i Enterococcus grupa 53 (4,4%). Bakterija E. coli je bila češća od žena (82,7%), a Pseudomonas aeruginosa kod muškaraca (76,1%). Klebsiella spp. i Enterococcus spp. su se skoro podjednako javljale kod oba pola. Lekovi prvog izbora u terapiji urinarnih infekcija bi bili sledeći: za E. coli amikacin (aminoglikozid) i fosfomicin, a za Klebsiella spp. meropenem (karbapenem) i takođe amikacin. Što se tiče P. aeruginosa, najefikasnijim su se pokazali takođe meropenem, kao i penicilinski antibiotik piperacilin-tazobaktam.
Zaključak: S obzirom na to da uropatogeni poseduju mehanizme za razvoj rezistencije, potrebno je u terapiji koristiti antibiotike u zavisnosti od rezultata antibiograma.
Reference
1. Matic S, Ninkovic V, Arsovic A, Obrenovic N, Baskic D. Sensitivity of urinary pathogens to antimicrobial therapy in patients in primary healthcare. Medical Journal (Kragujevac) 2012; 46(3):126-31. doi: 10.5937/mckg46-1899
2. Djordjevic Z, Folic M, Jankovic S. Community-acquired urinary tract infections: causative agents and their resistance to antimicrobial drugs. Vojnosanit Pregl (Belgrade) 2016; 73(12):1109–1115. doi:10.2298/VSP150122218D
3. Dijkmans AC, Zacarías NV, Burggraaf J, Mouton JW, Wilms EB, Nieuwkoop C, et.al. Fosfomycin: Pharmacological, Clinical and Future Perspectives. Antibiotics 2017; 6 (4):24. doi:10.3390/antibiotics6040024.
4. Knezevic-Vukcevic J, Nikolic B, Beric T, Vukovic-Gacic B, Stankovic S. Microbiology. University of Belgrade, Faculty of Biology: Belgrade; 2020.
5. Ministry of Health of Montenegro. Section of Microbiologists of the Society of Physicians of Montenegro. Laboratory diagnostics in clinical bacteriology. National guidelines for good clinical practice. Ministry of Health of Montenegro: Podgorica, Montenegro; 2016
6. ClSi. Performance standards for antimicrobial susceptibility testing; twenty-first informational supplement, 2011. Available at: https://clsi.org/about/press-releases/clsi-publishes-m100-performance-standards-for-antimicrobial-susceptibility-testing-31stedition/
7. The European Committee on Antimicrobial Susceptibility Testing Breakpoint tables for interpretation of MICs and zone diameters. Version 9.0, 2019. Available at: http://www.eucast.org
8. De Backer D, Christiaens T, Heytens S, De Sutter A, Stobberingh EE, Verschraegen G. Evolution of bacterial susceptibility pattern of Escherichia coli in uncomplicated urinary tract infections in a country with high antibiotic consumption: a comparison of two surveys with a 10 years interval. J Antimicrobial Chem 2008; 62:364–8. doi: 10.1093/jac/dkn197
9. Beyene G, Tsegaye W. Bacterial uropathogens in urinary tract infection and antibiotic susceptibility pattern in jimma university specialized hospital, southwest Ethiopia. Ethiop J Health Sci 2011; 21: 141–6. doi: 10.4314/ejhs.v21i2.69055
10. Okesola AO, Aroundegbe TI. Antibiotic resistance pattern of uropathogenic Escherichia coli in South West Nigeria. Afr J Med Med Sci 2011; 40: 235–8.
11. Lalosevic V, Jarak M, Vidic B, Pasic S, Ukropina-Mihajlovic M, Jelesic Z, et al. Microbiology for students of veterinary medicine. Faculty of Agriculture in Novi Sad, Department for Veterinary Medicine: (Novi Sad); 2011.
12. Maeda Y, Goldsmith CE, Coulter WA, Mason C, Dooley JS, Lowery CJ, Moore JE. The viridans group streptococci. Rev Med Microb 2010; 21(4), 69-79. doi: 10.1097/MRM.0b013e32833c68fa
13. Djekic-Malbasa J. Risk factors and the impact of bloodstream, infections caused by multi-drug resistant bacteria Acinetobacter spp. On public health (Doctoral dissertation), University of Novi Sad, Faculty of Medicine:Novi Sad; 2017.
14. Flannagan SE, Chow JW, Donabedian SM, Brown WJ, Perri MB, Zervos MJ, Clewell DB. Plasmid content of a vancomycin-resistant Enterococcus faecalis isolate from a patient also colonized by Staphylococcus aureus with a VanA phenotype. Antimicrob Agents Chemother 2003; 47(12): 3954-3959. doi: 10.1128/AAC.47.12.3954-3959.2003
15. Huycke MM, Sahm DF, Gilmore MS. Multiple-drug resistant enterococci: the nature of the problem and an agenda for the future. Emerg Infect Diseas 1998; 4(2): 239-249. doi: 10.3201/eid0402.980211