Rezistenţa culturilor bacteriene în secţia de terapie intensivă

Abstract

Introducere: Rezistenţa bacteriilor la antibiotice reprezintă o problemă majoră în sistemul medical. Antibioticoterapia excesivă reduce biodiversitatea bacteriană, favorizând colonizarea gazdei umane cu germeni rezistenţi la diverse antimicrobiene. Material şi metode: Analiza retrospectivă a examinărilor bacteriologice în perioada 1 ianuarie 2016 – 31 decembrie 2017 în Spitalul Clinic Municipal nr. 1, Chişinău, probe prelevate din Secţia de terapie intensivă. Pentru definirea multidrog-rezistenţei au fost utilizate criteriile European Centre for Disease 2012. Rezultate: Au fost cercetate 530 de rezultate microbiologice, în 497 de cazuri au fost depistate tulpini bacteriene. Au fost analizate tulpinile muldidrog-rezistente. Tulpinile de P. aeruginosa au prezentat nivele de rezistenţă la: Piperacillin –tazobactam (2016 – 13%; 2017 – 100%); Levofloxacin (2016 – 53%; 2017 – 55%); Tobramicin (2016 – 33%; 2017 – 59%); Meropenem (2016 – 100%; 2017 – 69%). Tulpinile de S. aureus au prezentat nivele de rezistenţă la: Doxycycline (2016 – 0%; 2017 – 100%); Erytromicin (2016 – 39%; 2017 – 50%); Clindamycin (2016 – 31%; 2017 – 43%). Tulpinile de Enterococcus spp. au prezentat nivele de rezistenţă la: Meropenem (2016 – 100%; 2017 – 100%); Gentamicin (2016 – 80%; 2017 – 75%); Doxycycline (2016 – 67%; 2017 – 62%). Tulpinile de Enterobacteriaceae au prezentat nivele de rezistenţă la: Cefuroxime (2016 – 100%; 2017 – 100%); Cefepime (2016 – 67%; 2017 – 90%); Gentamicin (2016 – 45%; 2017 – 62%); Meropenem (2016 – 100%; 2017 – 73%). Concluzii: Tulpinile izolate au înregistrat nivele înalte de rezistenţă la aminoglicozide, cefalosporine şi tetracicline. Analiza patternurilor de MDR la cele 3 tulpini izolate au demonstrat nivele înalte de rezistenţă pentru toate 3 tulpinile. Nu au fost identificate tulpini cu rezistenţă extinsă (XDR) şi pan-rezistenţă (PDR) conform criteriilor European Centre for Disease.

Background: Antibiotic resistance is recognized as a major problem of the medical system. Excessive antibiotic therapy reduces bacterial biodiversity by favoring colonization of the human organism with germs resistant to various antimicrobials. Material and methods: Retrospective analysis of bacteriological examinations during January 1, 2016 – December 31, 2017, collected in the ICU, Municipal Clinical Hospital Nr. 1, Chisinau. The criteria for the European Center for Disease 2012 were used to define multidrug resistance. Results: 530 analyses were investigated and were obtained 497 cases of bacterial strains. The following MDR strains were identified: a) P. aeruginosa strains showed resistance levels to: Piperacillin-tazobactam (2016 – 13%, 2017 – 100%); Levofloxacin (2016 – 53%, 2017 – 55%); Tobramycin (2016 – 33%, 2017 – 59%); Meropenem (2016 – 100%, 2017 – 69%). b) S. aureus strains showed resistance levels to: Doxycycline (2016 – 0%, 2017 – 100%); Erythromycin (2016 – 39%, 2017 – 50%); Clindamycin (2016 – 31%, 2017 – 43%). c) Enterococcus spp. showed resistance levels to: Meropenem (2016 – 100%, 2017 – 100%); Gentamicin (2016 – 80%, 2017 – 75%); Doxycycline (2016 – 67%, 2017 – 62%). d) Enterobacteriacae showed levels of resistance to: Cefuroxime (2016 – 100%, 2017 – 100%); Cefepime (2016 – 67%, 2017 – 90%); Gentamicin (2016 – 45%, 2017 – 62%); Meropenem (2016 – 100%, 2017 – 73%). Conclusions: 1) Isolated strains recorded high levels of resistance to aminoglycosides, cephalosporins and tetracyclines. 2) Analysis of MDR patterns in the isolates showed high resistance levels for all strains. 3) Strains with extended resistance (XDR) and pan-resistance (RDP) were not identified according to the criteria of the European Center for Disease.