CC BY
0ANTIBIOTIC RESISTANCE DYNAMICS OF ACINETOBACTER
SPP. IN ICU
1Ibadov Ravshan Alievich, 2Shanieva Zulfiya Aymurzaevna, 3Ibragimov Sardor
Khamdamovich
1,2,3 State Institution "Republican Specialized Scientific and Practical Medical Center for Surgery named after academician V.Vakhidov", Tashkent, Uzbekistan https://doi. ors/10.5281/zenodo. 10700638
Abstract. Objective: to analyze the dynamics of antibiotic resistance of Acinetobacter spp. isolatedfrom patients in ICU. To identify effective antibiotics against isolated strains. Material and methods. We analyzed the isolated strains and analyzed the results of determining the sensitivity of Acinetobacter spp. to antibacterial drugs. The pathogens were isolated from ICU patients in 2008-2019. Clinical material for microbiologic examination included wound secretions, bronchoalveolar lavage, abdominal cavity exudate, abscess contents, bile, urine, and blood. Microbiological studies were carried out in the laboratories of microbiological of the State Institution "RSSPMCfor surgery named after V. Vakhidov"
Results. Due to the introduction of recommended protocols for antibacterial prophylaxis and treatment, methods of monitoring the effectiveness of antimicrobial therapy, the introduction of forecasting methods (identification of risk groups and more targeted antibiotic prophylaxis of nosocomial infections), effective criteria for ventilator modes, approaches to pathogenetic therapy, nutritional support, etc. since 2012, there is a decrease in the frequency of purulent-septic complications, so that in 2012-2019 in the cardiac block, it was from 1.5-1.3 to 0.3-0.1%, in the abdominal block - from 1.0-1.9 to 0.5-0.2%, in the thoracic block - from 0.7-0.5 to 0.03-0.02%.
Conclusion. The increasing antibiotic resistance of Acinetobacter spp. causes the necessity to study antibiotic grams of all strains isolated from patients for adequate choice of means of effective antibiotic therapy. The obtained data were used to optimize empirical antibiotic therapy in patients with purulent-septic complications in ICU.
Keywords: antimicrobial therapy, Acinetobacter spp., agents of suppurative and septic complications, resistance, nosocomial infections, intensive care unit.
INTRODUCTION
The development of infectious complications in patients with a high risk of sepsis in ICU (severe acute pancreatitis, bleeding, acute respiratory distress syndrome, PON) is the leading cause of mortality. Knowledge of the etiologic structure and antibiotic resistance of the main pathogens is essential for timely adequate antibiotic prophylaxis and empirical antibiotic therapy.
The main problematic pathogens of nosocomial infections in terms of antibiotic resistance are MRSA, MRSE, Ps. aeruginosa, Kl.pneumoniae, E. coli, Acinetobacter spp. etc. The most relevant causative agents of all hospital-acquired infections (except angiogenic infections) and sepsis are microorganisms of the Enterobacteriaceae family and non-fermenting bacteria, which include Ps. aeruginosa and Acinetobacter spp. (Wong D, 2017). Acinetobacter strains prior to 1970 very rarely caused infections in humans, infections were successfully treated with ampicillin, gentamicin, and carbenicillin; in 1975, reports of resistant strains appear; in 1990, Acinetobacter strains resistant to all ABs except carbapenems were isolated in Germany. In Hong Kong, the most frequent pathogens were Acinetobacter johnsonii and Acinetobacter lwoffi. In most countries of
the world, including Russia, Acinetobacter baumannii is becoming the main causative agent. Until 2004, Acinetobacter spp. - was the second most frequent causative agent of nosocomial infections in ICU among NSAIDs in Europe, from 2006 to 2007 it was the first most frequent pathogen in 7 leading ICUs among NSAIDs (Salzer H.J., 2009).
The following risk factors for carbapenem-resistant Acinetobacter infection have been described so far: large size of the hospital (more than 500 beds), prolonged hospitalization in ICU, immunosuppression, ventilator, catheterization, recent surgical intervention, aggravated antibiotic history (recent use of ceftazidime, meropenem, imipenem). MATERIAL AND METHODS.
We analyzed the isolated strains and analyzed the results of determining the sensitivity of Acinetobacter spp. to antibacterial drugs. The pathogens were isolated from ICU patients in 20082019. Clinical material for microbiologic examination included wound secretions, bronchoalveolar lavage, abdominal cavity exudate, abscess contents, bile, urine, and blood. Identification of isolated microorganisms was performed using test kits of "Hi-Media" company, India, Interpretation of results was performed according to NCCLS/CLSI guidelines. Determination of antibiotic sensitivity of strains was performed by disk-diffusion method on Mueller-Hinton medium in accordance with CLSI (formerly NCCLS) standards. RESULTS.
A total of 486 cultures were isolated, of which Acinetobacter spp. - 131 (27%). Acinetobacter spp. strains were isolated mainly from trachea (patients on PIVL) - 77%, drainage secretions - 15%, from blood - 8%. High level of resistance of Acinetobacter spp. to cephalosporins in 2008-2011 amounted to 85%, in 2012-2019 - 100%, to fluoroquinolones - 100%. - 100%, to fluoroquinolones in 2008-2011 amounted to 85%, in 2012-2019 - 100%, to aminoglycosides spp.
- 100%, to aminoglycosides in 2008-2011 amounted to 85%, in 2012-2019. - 70%, in 2012-2019.
- 100%, to carbapenems in 2008-2011. - 25%, in 2012-2019. - 70%.
Table 1. Results of biological field samples (%)
Biomaterial type 00 o On O 0 0 0 - 0 2 0 3 0 4 0 5 0 6 0 7 0 8 0 9 0
(N (N (N 2 2 2 2 2 2 2 2 2
Surgical wound 3,7 0,6 2,6 - - - - - - - - -
Blood 10,4 11 14 5,4 3,8 2,7 - 0,6 1,2 0,4 0,2 -
From abdominal 1,5 0,6 2,2 1,3 0,6 - 0,3 0,6 2,2 0,6 0,2 0,4
cavity
From pleural 0,4 0,3 0,9 2 - - - 0,3 - 0,3 - -
cavity
From drainage 6,3 5,3 4,8 6,7 3,7 4,3 2,4 3,8 5,6 2,6 5,3 2,1
From trachea 10 7,3 9,6 11 19 17 10 14 19 10 17 19
From bronchi 4 1 - 0,6 - - - 0,6 1 - 0,6 0,2
Urine 0,4 - - 2 - - - - 0,6 - 0,2 -
These data demonstrate the leading position o severe infections.
respiratory diseases in the structure o
Table 2. Acinetobacter spp. resistance in ICU (%)
Antibiotics on Cf. CD fs rfl ■ï- in r- en Cf.
o o CD CD CD CD CD CD CD CD CD CD
r-1 r 1 rl rl r 1 r-1 rl r 1 ri rl rl r 1
Ampicillin 100 100 100 100 100 100 100 100 100 100 100 100
¿sulbactam
Amoxicillin 100 100 100 100 100 100 100 100 100 100 100 100
Piperacillin - - - 82 76 100 100 100 100 100 100 100
. Tazcbactam
Imipenetu 0 11,7 21 11,7 13 21 43 85 100 100 100 100
Meropenem 11,7 41 41 60 66,6 76 87 100 100 100 100 100
Ertapenem - - - - - 100 100 100 100 100 100 100
Cefazoliue 100 100 100 100 100 100 100 100 100 100 100 100
100 100 100 100 100 100 100 100 100 100 100 100
100 100 100 100 100 100 100 100 100 100 100 100
100 100 100 100 100 100 100 100 100 100 100 100
Ceftriaxone 100 100 100 100 100 100 100 100 100 100 100 100
■_ _ Î -— - ■- - ■ ■- -i - 100 100 100 100 100 100 100 100 100 100 100 100
66,6 34 81 66,6 73 85 100 100 100 100 100
¿sulbactam
100 100 100 100 100 100 100 100 100 100 100 100
Gentamicin S3 se 7S S6 as 90 100 100 100 100 100 100
Amikacin 86 78 90 90 90 90 100 100 100 100 100 100
Tetracycline 66 +6 17,6 17,6 26 6S 66 70 100 100 100 100
52 41 16 11,7 16 52 50 50 100 100 100 100
Ofloxacin 66,6 7S 90 76 90 100 100 100 100 100 100 100
Ciprofloxacin 100 100 100 100 100 100 100 100 100 100 100 100
Levofloxacin - - 7S 100 - 100 100 100 100 100 100 100
■_TLLt 1 il ■- . - - - - - 100 100 100 100 100 100 100
0 0 0 0 0 0 0 4 5 3 4 4
Note: "-" - the study was not conducted
Fig.1. Cultivability of the most important pathogens of purulent-septic complications in ICU
Fig.2. Frequency of purulent-septic complications in ICU (%)
cardiac surgery abdominal surgery thoracic surgery
°'50S 04 04
0,04 0,03 0,02 0,Ö3 O.Ö5 (
2008 2009 2010 2011 2012 2013 2014 201S 2016 2017 2018 2019
Analysis of microbiological monitoring data and antibiotic resistance in ICU shows that during the studied period (2008-2019), in patients undergoing PIVL, there is a tendency of prevalence of Gram-negative microflora isolation and expansion of the spectrum of isolated cultures, namely: Klebsiella pneumonia (17.0-29.0%), Ps. aeruginosa (14.0-20.5%) and Candida (4.2-10.0%) were dominant in 2008-2012. The drugs active against them were meropenem (60.0-30.0%S), polymyxin B (100.0-95.0%S), cefoperazone/sulbactam (72.0-58.0%), amikacin (72.064.0%), ofloxacin (69.0-56.0%). St.aureus and Enterococcus spp. occurred in 4.0-2.0% of cases.
Subsequent 2012-2019 among the most "topical" pathogens of hospital infections were Acinetobacter spp. (26.0-39.0%), E. coli (27.6-11.0%), gr.r.Candida (11.0-18.5%). The range of perorates active against them was extremely limited: polymyxin B (97.0-95.0%S), imipenem (90.0-30.0%S). Moreover, out of 50 tracheobronchial aspirate samples in 25 cases - were isolated associated. The problem was the development and progression of renal insufficiency when using amikacin in patients with PON.
RESULTS.
The effective reduction of purulent-septic complications frequency (despite the annual increase in the number of hospitalized patients) was the isolation of patients with high risk of infection with nosocomial strains, high level of SRB - 70 mg/l and more, protocols of resuscitation in case of purulent-septic complications, timely adequate antibiotic therapy. The achieved results indicate the effectiveness of the applied monitoring system, despite the high resistance of pathogens; the need for continuous control of the microbial landscape.
Due to the introduction of recommended protocols for antibacterial prophylaxis and treatment, methods of monitoring the effectiveness of antimicrobial therapy, the introduction of forecasting methods (identification of risk groups and more targeted antibiotic prophylaxis of nosocomial infections), effective criteria for ventilator modes, approaches to pathogenetic therapy, nutritional support, etc. since 2012, there is a decrease in the frequency of purulent-septic complications, so that in 2012-2019 in the cardiac block, it was from 1.5-1.3 to 0.3-0.1%, in the abdominal block - from 1.0-1.9 to 0.5-0.2%, in the thoracic block - from 0.7-0.5 to 0.03-0.02% (Fig.2).
CONCLUSION
In the structure of pathogens of nosocomial infections in ICU - Acinetobacter spp. is the leading one, which has high resistance to all groups of antibacterial drugs. Over the last 12 years, the increase in the isolation rate of this pathogen amounted to: 5.4 - 39%, i.e., an increase of 7 times. Acinetobacter is capable of causing infections of any localization. The increasing antibiotic resistance of Acinetobacter spp. causes the necessity to study antibiotic grams of all strains isolated from patients for adequate choice of means of effective antibiotic therapy. The obtained data were used to optimize empirical antibiotic therapy in patients with purulent-septic complications in ICU.
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