Антибиотики и Химиотерапия (May 2020)
Dynamics of Acquires Resistance in the Main Gramnegative Pathogens of Surgical Infections to Beta-Lactams in 2004-2008
Abstract
Resistance of 2134 clinical isolates of etiologically significant species of gramnegative bacteria to 5 beta-lactam antibiotics, i. e. cefepime, piperacillin/tazobactam, cefoperazone/sulbactam, imipenem and ceftazidime (the 3rd generation cephalosporin) as the reference drug was investigated for the period of 5 years (2004-2008). In total, 554 strains of E.coli, 578 strains of P.aeruginosa, 255 strains of Acinetobacter spp., 161 strains of Proteus mirabilis, 359 strains of Klebsiella pneumoniae and 227 strains of Enterobacter cloacae were assayed in dynamics. The comparative analysis of the frequency of the antibiotic resistant isolates from the patients treated within 2004-2008 with often and long-term use of cefoperazom-sulbactam, meropenem and imipenem revealed an increase in development of resistance to all beta-lactams, including the inhibitor-protected ones. It least of all concerned imipenem, still isolation of 39.5% of the imipenem resistant strains of P.aeruginosa was in favour of the tendency. A dramatic 3-5-fold rise of resistance in 2007 and 2008 in the isolates of K.pneumoniae, E.cloacae and Acinetobacter spp. to both the inhibitor-protected beta-lactams, that averaged 56 and 45%, 45 and 35% and 26 and 30% respectively, deserved attention. It was assumed that the main mechanism of resistance in the isolates to the inhibitor-protected beta-lactams was hyperproduction of beta-lactamase of type CTX-M. The large part of the cefepime resistant isolates of K.pneumoniae and Acitetobacter spp. (76.8 and 62.2% respectively) was in favour of the assumption. It was concluded that periodical reversion of the policy of preventive antibiotic prophylaxis was necessary, since such a prophylaxis is a reliable barrier to development of postoperative complications and at the same time it promotes selection of nosocomial strains with some other mechanisms of antibiotic resistance under hospital conditions.
