Monitoring the antibiotic resistance in the intensive care unit of a multidisciplinary hospital

Abstract

Background. Infectious complications remain a serious post-transplant problem and make a major cause of poor outcome. Given the active development of transplant services at a regional level, the problem of infectious complications becomes increasingly important and requires monitoring of the etiological structure and level of antibiotic resistance in each hospital dealing with this problem.The purpose was to analyze the changes over time in the structure and antimicrobial resistance of the most common pathogens in various nosology, including in patients after organ transplantation, regardless gender and age.Material and methods. The study included 37,103 patients, of whom 8,091 (21.8%) were treated in the Intensive Care Unit (ICU) of the Vitebsk Regional Clinical Hospital (VRCH) for the period from 2015 to 2017; infectious complications after organ transplantation made 3%. The clinical samples were studied for bacteriology in the Republican Scientific and Practical Center "Infection in Surgery"; 20,280 clinical isolates were investigated.Results. Staphylococcus aureus (20.96%) dominated in the general structure of microorganisms cultured mainly from the wound surface in thermal burns; meanwhile, in the ICU, gram-negative microflora dominated and was presented with Acinetobacter spp. (22.75%) and Pseudomonas aeruginosa (22.74%) in the majority of cases. By 2017, there had been an increase in resistant isolates of Klebsiella spp. (22.87%) and Acinetobacter spp. (23.09%) and a reduction of P. aeruginosa (13.31%) and S. aureus (18.88%) seeding. The protocol of the antibacterial therapy initiation was set up in the ICU of Vitebsk Regional Clinical Hospital, based on the obtained results demonstrating that all S. aureus isolates were sensitive to linezolid, vancomycin and teicoplanin, while P. aeruginosa was sensitive to colistin. All isolated Acinetobacter spp. were sensitive to colistin and 80% of the isolates were sensitive to sulbactam. More than 95% of K. pneumonia isolates were sensitive to colistin and tigecycline.Conclusion. The current epidemiology is characterized by the prevalence of S. aureus (20.96%) in the overall structure of microorganisms, while Acinetobacter spp. (22.25%) and P. aeruginosa (22.74%) dominate in the ICU. Based on the microbiology study results, the protocol of antibacterial therapy initiation was established in the ICU of Vitebsk Regional Clinical Hospital. It is necessary to monitor the resistance of common microorganisms to certain antibiotics in order to develop algorithms for rational antibacterial treatment in each hospital.