Intraabdominal infections and resistance of their causative agents towards antibiotics in surgical stationaries in the City of Kуiv
Objective. To study clinical and microbiological peculiarities of intraabdominal infections (IАI), аs well as resistance towards antibiotics of their causative agents, extracted from the patients, who were admitted to surgical stationaries in the City of Kiev.
Маterials and methods. There were investigated 1622 intraperitoneal isolates, which were bacteriologically confirmed as IAI and obtained from 662 patients, ageing 22-84 yrs old, who were treated in surgical departments of 7 hospitals in City of Kiev from Jan. 2014 yr till Dec. 2016 yr. Identification and determination of sensitivity of the cultures obtained towards 20 аntibiotics were conducted with the help of automated analizer Vitek 2 Compact. Kirby - Bauer disc-diffusion method was applied in some tests. The sensitivity towards antibiotics results were estimated in accordance to recommendation of the Institute of clinical and laboratory standards of the USA.
Results. Among 662 patients in 468 (70.7%) the extramural infections were observed, while in 194 (29.3%) - nosocomial infections. Mortality index in admitted to hospital patients have constituted 10.3% - for extramural infections and 14.4% - for nosocomial. Concurrent diseases and the severity indices were observed more frequently in nosocomial infections, than in extramural. The peritonitis type and localization were different in nosocomial and extramural infections. Distribution of microorganisms, depending on the infection origin (extramural and nosocomial) was different as well. In the patients, who suffered nosocomial infections, increase of the stationary aerobic bacteria was observed, including Enterococcus faecalis - 34.7% and Pseudomonas aeruginosa - 12.9% comparing with extramural infections - 21,6 and 5%, accordingly were observed. While in the patients, suffering nosocomial infections, the proportions of Escherichia coli - 52% and strains of streptococcus - 31%, was lower, than in the patients with extramural infections - 72 and 50%, accordingly. Among antibiotics tested, carbapenems (imipenem and ertapenem) and amicacin were mostly active against Enterobacteriaceae: both - in extramural and nosocomial infections. Against P. aeruginosa аmicacin, imipenem, ceftazidim have appeared mostly active in extramural infections, while imipenem, cefepim and amicacin - in nosocomial infections.
Vancomicin and teycoplanin were mostly active against gram-positive bacteria, both - towards nosocomial, as well as in nosocomial infections, including strains of E. faecium. Against anaerobic bacteria the largest activity was revealed by imipenem and ertapenem, in extramural as well as nosocomial peritonitis.
Conclusion. The tactics for antibiotics application ought to be established in every surgical stationary, depending on local data for resistance towards them. Taking into account the constant changes and essential differences of the strains resistance, which are specific in different regions, it is necessary to conduct a constant monitoring in every surgical stationary, and, basing on the local data obtained, to elaborate the hospital formulary for antibiotics.
2.Guyatt G, Gutterman D, Baumann MH, Addrizzo-Harris D, Hylek EM, Phillips B, et al. Grading strength of recommendations and quality of evidence in clinical guidelines: report from an American College of Chest Physicians task force. Chest. 2006;129:174-81. doi: 10.1378/chest.129.1.174.
3. Sartelli M, Abu-Zidan FM, Catena F, Griffiths EA, Di Saverio S, Coimbra R, et al. Global validation of the WSES Sepsis Severity Score for patients with complicated intraabdominal infections: a prospective multicenter study (WISS Study) World J Emerg Surg. 2015;10:61. doi: 10.1186/s13017-015-0055-0.
4. Salmanov AG, Vdovychenko YuP, Nychytailo MYu, Andriuschenko DV, Verner OM. Incidence of Surgical Site Infections and Antimicrobial Resistance their Pathogens in Ukraine. International Journal of Antibiotics and Probiotics. 2018 Mar; 2(1):18-29. doi: https://doi.org/10.31405/ijap.2-1.18.02.
5. Sartelli M, Catena F, Abu-Zidan FM, Ansaloni L, Biffl WL, Boermeester MA, et al. Management of intra-abdominal infections: recommendations by the WSES 2016 consensus conference. World J Emerg Surg. 2017 May 4;12:22. doi: 10.1186/s13017-017-0132-7.
6. Paul M, Shani V, Muchtar E, Kariv G, Robenshtok E, Leibovici L. Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis. Antimicrob Agents Chemother. 2010;54:4851-63.
7. Bodmann KF. Complicated intra-abdominal infections: pathogens, resistance. Recommendations of the Infectliga on antbiotic therapy. Chirurg. 2010 Jan;81(1):38-49. doi: 10.1007/s00104-009-1822-9. [Article in German].
8. Mazeh H, Mizrahi I, Dior U, Simanovsky N, Shapiro M, Freund HR, et al. Role of antibiotic therapy in mild acute calculus cholecystitis: a prospective randomized controlled trial. World J Surg. 2012;36:1750-9. doi: 10.1007/s00268-012-1572-6.
9. Regimbeau JM, Fuks D, Pautrat K, Mauvais F, Haccart V, Msika S, et al. Effect of postoperative antibiotic administration on postoperative infection following cholecystectomy for acute calculous cholecystitis: a randomized clinical trial. JAMA. 2014;312:145-54. doi: 10.1001/jama.2014.7586.
10. Sawyer RG, Claridge JA, Nathens AB, Rotstein OD, Duane TM, Evans HL, et al. Trial of short-course antimicrobial therapy for intraabdominal infection. N Engl J Med. 2015;372:1996-2005. doi: 10.1056/NEJMoa1411162.
11. Blot S, De Waele JJ, Vogelaers D. Essentials for selecting antimicrobial therapy for intra-abdominal infections. Drugs. 2012;72:17-32. doi: 10.2165/11599800-000000000-00000.
12. Mishra SP, Tiwary SK, Mishra M, Gupta SK. An introduction of tertiary peritonitis. J Emerg Trauma Shock. 2014;7:121-3. doi: 10.4103/0974-2700.136872.]
13. Sartelli M, Catena F, di Saverio S, Ansaloni L, Coccolini F, Tranà C, Kirkby-Bott J. The Challenge of Antimicrobial Resistance in Managing Intra-Abdominal Infections. Surg Infect (Larchmt). 2015 Jun;16(3):213-20. doi: 10.1089/sur.2013.262.
14. Salmanov AG. Antimicrobial resistance and healthcare-associated infections in Ukraine. Epidemiological report of the multicenter study (2010-2014). Kyiv: AgrarMediaGroup; 2015. 452 p. [In Ukrainian].
15. European Centre for Disease Prevention and Control. Surveillance of antimicrobial resistance in Europe 2016. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). Stockholm: ECDC; 2017. Available from: https://ecdc.europa.eu/sites/portal/files/documents/AMR-surveillance-Europe-2016.pdf
16. World Health Organization (WHO). Antimicrobial resistance: global report on surveillance 2014. WHO: Geneva; 2014. Available from: http://apps.who.int/iris/bitstream/10665/112642/1/9789241564748_eng.pdf .
17. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing: Eighteenth Informational Supplement M100-S18. Wayne, PA, USA: CLSI; 2008.
18. Paterson DL, Rossi F, Baquero F, Hsueh PR, Woods GL, Satishchandran V, et al. In vitro susceptibilities of aerobic and facultative Gram-negative bacilli isolated from patients with intra-abdominal infections worldwide: the 2003 Study for Monitoring Antimicrobial Resistance Trends (SMART). J Antimicrob Chemother. 2005 Jun;55(6):965-73. doi: 10.1093/jac/dki117.
19. Rossi F, Baquero F, Hsueh PR, Paterson DL, Bochicchio GV, Snyder TA, et al. In vitro susceptibilities of aerobic and facultatively anaerobic Gram-negative bacilli isolated from patients with intra-abdominal infections worldwide: 2004 results from SMART (Study for Monitoring Antimicrobial Resistance Trends). J Antimicrob Chemother. 2006 Jul;58(1):205-10. doi: 10.1093/jac/dkl199.
20. Roehrborn A, Thomas L, Potreck O, Ebener C, Ohmann C, Goretzki PE, Röher HD. The microbiology of postoperative peritonitis. Clin Infect Dis. 2001 Nov 1;33(9):1513-9. doi: 10.1086/323333.
21. Sotto A, Lefrant JY, Fabbro-Peray P, Muller L, Tafuri J, Navarro F, et al. Evaluation of antimicrobial therapy management of 120 consecutive patients with secondary peritonitis. J Antimicrob Chemother. 2002 Oct;50(4):569-76. PMID: 12356803.
22. Seguin P, Laviolle B, Chanavaz C, Donnio PY, Gautier-Lerestif AL, Campion JP, Mallédant Y. Factors associated with multidrug-resistant bacteria in secondary peritonitis: impact on antibiotic therapy. Clin Microbiol Infect. 2006 Oct;12(10):980-5. doi: 10.1111/j.1469-0691.2006.01507.x.
23. Baquero F, Hsueh PR, Paterson DL, Rossi F, Bochicchio GV, Gallagher G, et al. In vitro susceptibilities of aerobic and facultatively anaerobic gram-negative bacilli isolated from patients with intra-abdominal infections worldwide: 2005 results from Study for Monitoring Antimicrobial Resistance Trends (SMART). Surg Infect (Larchmt). 2009 Apr;10(2):99-104. doi: 10.1089/sur.2008.0020.
24. Montravers P, Dupont H, Gauzit R, Veber B, Auboyer C, Blin P, Hennequin C, Martin C. Candida as a risk factor for mortality in peritonitis. Crit Care Med. 2006 Mar;34(3):646-52. doi: 10.1097/01.CCM.0000201889.39443.D2.
25. Montravers P, Dupont H, Chalfine A, Gauzit R, Lepape A, Marmuse JP, et al. Clinical and therapeutic features of nonpostoperative nosocomial intra-abdominal infections. Ann Surg. 2004 Mar;239(3): 409-416. doi: 10.1097/01.sla.0000114214.68169.e9.
26. Sitges-Serra A, López MJ, Girvent M, Almirall S, Sancho JJ. Postoperative enterococcal infection after treatment of complicated intra-abdominal sepsis. Br J Surg. 2002 Mar;89(3):361-7. doi: 10.1046/j.0007-1323.2001.02023.x.
27. Dalfino L, Bruno F, Colizza S, Concia E, Novelli A, Rebecchi F, et al. Cost of care and antibiotic prescribing attitudes for community-acquired complicated intra-abdominal infections in Italy: a retrospective study. World J Emerg Surg. 2014;9:39. doi: 10.1186/1749-7922-9-39
28. Cattan P, Yin DD, Sarfati E, Lyu R, De Zelicourt M, Fagnani F. Cost of care for inpatients with community-acquired intra-abdominal infections. Eur J Clin Microbiol Infect Dis. 2002 Nov;21(11):787-93. doi: 10.1007/s10096-002-0834-x.
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