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I. ДИАГНОСТИКА И ЛЕЧЕНИЕ
RESEARCH EXPERIENCE OF ANTIBIOTIC RESISTANCE OF MICROORGANISMS IN THE SURGICAL HOSPITAL
УДК 615.859:617089:579:615.33-078
Abdilova G.B., Kataeva H.T., Nurakhova A.D.
National Scientific Surgery Center under the name of A.N.Syzganov, Almaty Kazakh Medical University Continuing Education, Almaty
ABOUT THE AUTHORS
Abdilova Gulnur Bekmurzaevna -Head of the CDL, e-mail address: [email protected], telephone 87019911346 Nurakhova Alma Dandybaevna -PhD, doctor-laboratory CDL, e-mail address: [email protected], telephone 87776850298
Summary
The results of the monitoring of antibiotic resistance of microorganisms held in National Scientific Surgery Center under the name of A.N.Syzganov in 2015. The obtained data are actual as introduction in clinical practice of a significant number of modern antibiotics and the emergence of new mechanisms of antibiotic resistance in microorganisms require more strict standardization of testing procedures, the development of new approaches to the interpretation of the results, the use of advanced internal quality control system at every stage of research.
Хирургиялык стационарда микроорганизмдер антибиотикорезистенттшпн зерттеу тэж1рибес
Абдилова Г.Б., Катаева Х.Т., Нурахова А.Д.
А. Н. Сызранов атындаш улттык, шлыми хирургия орталыш, Алматы, К,азак,стан Казак, медициналык, уздшз 6rniMi беру университет!, Алматы к.
Ацдатпа
Макалада «А.Н.Сызганов атындат YFXO-да» 2015 жылы жасалган микроорганизмдер антибиотикорезистентт!л1г1н1н мониторингi нэтижелер! келпршген. Алыман деректер езекл болып табылады, ейткенi замануи антибиотиктерд!н елеулi саны клиникалык тэж!рибеге енуi жэне микроорганизмдер антибиотикорезистентт!л!г!н!н жана тет!ктер!н!н пайда болуы тестлеу рэс!м!н, нэтижелердi тужырымдауга жана кезкарасты эз!рлеу, зерттеудн эр кезен!нде сапа-сын íwkí бакылау бойынша замануи жуйесн енпзу катандау стандарттауын талап етед '1.
Keywords:
antibiotic resistance, microorganisms, surgical hospital.
АВТОРЛАР ТУРАЛЫ
Абдилова Гулнур Бекмурзакызы
- А.Н.Сызганов атындагы YFXO клиникалык-диагностикалык зертханасынын менгерушю, электрон адресi: [email protected], телефон 87019911346 Нурахова Алма Дандыбайкызы
- м.г.к., КДЗ лаборант-дэ^е^, электрон адреа: [email protected], телефон 87776850298
Туйш сездер
антибиотикорезистенттЫк, микроорганизмдер, хирургиялык стационар.
Опыт исследования антибиотикорезистентности микроорганизмов в хирургическом стационаре
Абдилова Г.Б., Катаева Х.Т., Нурахова А.Д.
Национальный научный центр хирургии им. А.Н. Сызганова, Алматы, Казахстан Казахский медицинский университет непрерывного образования, г. Алматы
Аннотация
В статье приведены результаты мониторинга антибиотикорезистентности микроорганизмов, проведенного в ННЦХ им. А.Н.Сызганова за 2015 год. Полученные данные являются актуальными, так как внедрение в клиническую практику значительного количества современных антибиотиков и появление новых механизмов антибиотикорезистентности у микроорганизмов требует более строгой стандартизации процедуры тестирования, разработки новых подходов к интерпретации результатов, внедрения современной системы внутреннего контроля качества на каждом этапе исследования.
ОБ АВТОРАХ
Абдилова Гульнур Бекмурзаевна -Заведующая КДЛ, электронный адрес: [email protected], телефон 87019911346
Нурахова Алма Дандыбаевна - к.м.н., Врач-лаборант КДЛ, электронный адрес: [email protected], телефон 87776850298
Ключевые слова:
антибиотикорезистентность, микроорганизмы, хирургический стационар.
Abstract
The results of the monitoring of antibiotic resistance of microorganisms held in National Scientific Surgery Center under the name of A.N.Syzganov in 2015. The obtained data are actual as introduction in clinical practice of a significant number of modern antibiotics and the emergence of new mechanisms of antibiotic resistance in microorganisms require more strict standardization of testing procedures, the development of new approaches to the interpretation of the results, the use of advanced internal quality control system at every stage of research.
In recent years, around the world there is a significant increase in the sustainability of community-acquired pathogens and nosocomial infections antimicrobic preparations. The emergence of antimicrobial resistance is a natural biological response to the use of the antibiotics, which create a selective pressure that promotes the selection, the survival and reproduction of resistant strains of microorganisms.
Resistance to the antibiotics has a great socioeconomic importance in the developed countries of the world is seen as a threat to national security. Infections caused by resistant strains, characterized by longer duration, often require hospitaliza-tion and increase the length of hospital stay, worsen the prognosis of patients. With the inefficiency of the drugs of choice have to use the means of the second or third row, which often are more expensive, less safe and are not always available. All this increases the direct and indirect economic costs, but also increases the risk of the spread of drug-resistant strains in the community.
There are several levels of resistance to antibiotics - global, regional and local. First of all, it is necessary to take into account the global tendencies in the development of resistance. Examples of microorganisms that are in the world rapidly develop resistance to existing antibiotics are staphylococci, pneumococci, gonococci, Pseudomonas aeruginosa, and others. It should be remembered that antibiotic resistance is not an all-out does not apply to all micro-organisms and the antibiotics.
However, despite the importance of taking into account the global picture when planning antibiotic treatment policy more rationally based on data obtained in a particular country (regional data). There is no doubt that in Kazakhstan there are significant variations in territorial spread of antimicrobial resistance. In connection with this undeniable importance of the territorial monitoring of resistance and bringing the results to doctors of various specialties.
Each health care setting should have local data on resistance. This primarily refers to offices with a
high frequency of use of the antibiotics: Intensive care unit, burn, urological and other information about the resistance should be given differentiated for various offices and micro-organisms [5, 6, 7].
The aim of the work was to analyze antibiotic resistance of strains of Gram-positive - Staphylococcus aureus and gram-negative microorganisms Klebsiella pneumonia isolated in 2015 at the clinical diagnostic laboratory of National Scientific Surgery Center under the name of A.N.Syzganov.
Material and methods
In work are analysed microorganisms isolated from biological materials of patients treated in National Scientific Surgery Center under the name of A.N.Syzganov in 2015. We investigated strains 1115 of Staphylococcus aureus and 691 strain of Klebsi-ella pneumonia. We studied the biological materials such as urine, sputum, swabs tracheostomy, swabs from the throat and nose swabs from wound swabs from other organs and blood. Samples for analysis were collected from all central offices. Identification of microorganisms was performed a classical microbiological way. Antibiotic resistance was assessed disk diffusion method on meat-peptone agar (disks with antibiotics firms Haymedia, India), in accordance with existing regulations, followed by statistical processing.
Results and discussion
Resistance was investigated Staphylococcus aureus and Klebsiella pneumonia antimicrobials such as gentamicin, meropenem, ciprofloxacin, amikacin, amoxicillin, ceftriaxone, erythromycin, ceftazidime, clarithromycin, ampicillin, and others. The obtained results are shown in the graphs.
As follows from the figure, for example, in the first half of 2015 the highest resistance of Staphylococcus aureus was observed to gentamicin, amikacin and ceftriaxone. The most active agents against this microorganism were erythromycin (0.1% resistance) and meropenem (resistance of 0.16%).
Meanwhile ciprofloxacin (resistance 0.2%) and ceftazidime (resistance 0.2%) were more effective in the treatment of infections caused by Klebsiella pneumonia. The studied strains of Klebsiella pneumonia were the most resistant to gentamicin, meropenem, ciprofloxacin and amikacin.
During the second half of 2015 marked resistance of Staphylococcus aureus to the following drugs: gentamicin, meropenem, ciprofloxacin, amikacin, amoxicillin, ceftriaxone, ceftazidime, and erythromycin.
Also in the specified time period the more pronounced resistance Klebsiella pneumonia, in particular gentamicin, meropenem, ciprofloxacin, amikacin, erythromycin.
12
ВЕСТНИК ХИРУРГИИ КАЗАХСТАНА № 3-2016
35 30 25 20 15 10
1
1 1 1 - - l-ll 1-J.L^... -Jl —I__
I Gentamicin I Meropenem Ciprofloxacin I Amikacin I Amoxicillin Ceftriaxone Erythromycin Ceftazidime Clarithromycin Ampicillin
January February March April
The introduction into clinical practice of a significant number of modern antibiotics and the emergence of new mechanisms of antibiotic resistance in microorganisms require more strict standardization of testing procedures, the development of new approaches to the interpretation of the results, the use of advanced internal quality control system at every stage of research. According to existing medical and economic standards, the appointment of antimicrobial agents does not provide for the preliminary determination of the pathogen antibiotic resistance to this antimicrobial compound and the objectification of the results of the therapy [3, 4]. However, successful treatment of inflammatory diseases, particularly severe, it is impossible without taking into account the local microbiological monitoring.
In the context of the rise of antibiotic resistance, when the development of new drugs do not have
30
May
June
Figure 1.
Dynamics of antibiotic resistance (%) Staphylococcus aureus in surgical hospital in the first half 2015 year
time to make up for the needs of the health system, the monitoring program with the use of antibiotics interventional component and «feedback» is one of the main ways to contain pathogens resistance [1, 2]. Implementation of any strategy to optimize the use of the antibiotics must precede pharmaco-epidemiological study on the hospital level to ensure maximum adaptation of a set of measures to local needs by identifying the main problems of antibiotic therapy within the therapeutic and prophylactic institutions treatment-and-prophylactic establishment (TPE), and finding the best solutions. In order to optimize the treatment of antibiotics in a hospital of pharmacoepidemiological studies can be used to:
• assess the feasibility and cost of choice for optimization of drug procurement measures;
• rationalization of the distribution of the antibiotics between the departments of health care facilities;
I Gentamicin Meropenem Ciprofloxacin I Amikacin Amoxicillin Ceftriaxone Erythromycin Ceftazidime Clarithromycin Ampicillin
Figure 2.
The dynamics of antibiotic resistance (%) Klebsiella pneumoniae in surgical hospital in the first half 2015 year
January February March April
May
June
Figure 3. 18
Dynamics of antibiotic
resistance (%) Staphylo- 16
coccus aureus in surgical
hospital in the second half 14
2015 year
12
10
8
6
4
2
0
Figure 4. 16
Dynamics of antibiotic
resistance (%) Klebsiella 14
pneumoniae in surgical
hospital in the second half 12
2015 year
10
8
6
4
2
0
July
August September October November December
I Gentamicin I Meropenem Ciprofloxacin I Amikacin I Amoxicillin Ceftriaxone Erythromycin Ceftazidime Clarithromycin Ampicillin
I Gentamicin Meropenem Ciprofloxacin I Amikacin Amoxicillin Ceftriaxone, Erythromycin Ceftazidime Clarithromycin Ampicillin
July
August September October November December
planning and local adaptation measures to optimize the use of the strategy of the antibiotics in the hospital;
evaluating the efficiency of the current program and correct strategy to optimize the use of the antibiotics;
reducing the risk of selecting resistant to antibiotics nosocomial microflora by reducing the selective pressure on the «target» organisms, as well as minimize the «parallel damage»; improve patient safety by reducing the use of outdated, ineffective and unsafe drugs, as well as the incidence of this complication influence antimicrobial therapy as Clostridium difficile-associated diarrhea.
In addition, a promising introduction to spe-
cialist hospitals such as clinical pharmacologist. It demanded figure, his advisory and information activities are highly valued, regardless of the profile of health facilities. The main reason for treatment to clinical pharmacology - the problem of antibiotic therapy. Reserve increasing demand for clinical pharmacologist seems to actively cooperate with the doctors in a broader aspect of the problems, and for specialized hospital - the development of a more detailed information of the corresponding profile. Also, in every health care setting must have local data on the resistance (resistance passport). resistance passport must be set out in writing and should be regularly, at least once a year to update. Conveniently, it is the publication as an annex to the formulary guide.
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BECTHMK XMPyPfMM KA3AXCTAHA № 3-2016
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