Dynamics of Acquires Resistance in the Main Gramnegative Pathogens of Surgical Infections to Beta-Lactams in 2004-2008

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 3^rd 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.

nosocomial gramnegative pathogens, resistance, beta-lactams

1. Pool K. Resistance to beta-lactam antibiotics. Cell Mol Life Sci 2004; 61: 2200-2223.

2. Bush K., Jacoby G., Medeiros A. A functional classification scheme for /З-lactamases and its correlation with molecular structure. Antimicrob Agents Chemother 1995; 39: 1211-1233.

3. NCCLS. 2000. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. Approved standard M7-A5, 5th ed. NCCLS, Wayne, Pa.

4. Эйдельштейн М. В. Выявление /З-лактамаз расширенного спектра у грамотрицательных бактерий с помощью фенотипических методов. Современные методы клинической микробиологии. Выпуск 1. 2003; 104.

5. Скала Л. 3., Сидоренко С. В., Нехорошева А. Г. и др. Практические аспекты современной клинической микробиологии. Выпуск 1. 2003; 312.

6. National Committee for Clinical Laboratory Standarts 2001. M 100-S11(M2). Disk Diffusion Eleventh informational Suppl. NCCLS.

7. Решедько Г. Κ., Рябкова Е. Л., Фаращук А. H., Страчунский Л. С. Неферментирующие грамотрицательные возбудители нозокомиальных инфекций в ОРИТ России: проблемы антибиотикорезистентности. Клин микробиол антимикроб химиотер 2006; 8: 243-257.

8. Queenan A. M., Shang W., Bush K., Flamm R. Hydrolysis parameters for doripenem, meropenem, and imipenem tested with β-lactamases of molecular classes A to D. In: Program and Abstracts of the 18th European Congress of Clinical Microbiology and Infectious Diseases, April 19-22, 2008, Barcelona, Spain.

9. El Amin N., Giske C. G., Jalal S. et al. Carbapenem resistance mechanisms in P.aeruginosa alterations of porin OprD and efflux proteins do not fully explain resistance patterns observed in clinical isolates. APMIS 2005; 113: 187-196.

10. Эйдельштейн М. В., Страчунский Л. С., исследовательская группа РОСНЕТ. Динамика распространенности и чувствительности БЛРС-продуцирующих штаммов энтеробактерий к различным антимикробным препаратам в ОРИТ России. Клин микробиол антимикроб химиотер 2005; 7: 323-336.

11. National Committee for Laboratory Standards, Perfomance standards for antimicrobial susceptibility testing: 14th informational supplement NCCLS document M100-S14. 2004. National Committee for Clinical Laboratory Standards, Wayne, PA.

12. Livermore D. M. Beta-Lactamases in laboratory and clinical resistance. Clin Microbiol Rev 1995; 8: 557-584.

13. Paterson D. L. Recommendation for treatment of severe infection caused by Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBLs). Clin Microbiol Infect 2000; 6: 460-463.

14. Maglio D., Ong C., Banevicius M. A. et al. Determination of the in vivo pharmacodynamic profile of cefepime against extended-spectrum-beta-lactamase-product Escherichia coli at various inocula. Antimicrob Agents Chemother 2004; 48: 1941-1947.

15. Ромашов О. М., Яковлев С. В., Сидоренко С. В., Березин А. Г. Эффективность цефепима при лечении нозокомиальных инфекций, вызванных энтеробактериями - продуцентами бета-лактамаз расширенного спектра. Инфекц антимикроб тер 2003; 5.