MICROBIOLOGICAL MONITORING IN THERAPY OF PATIENTS WITH IATROGENIC ESOPHAGEOTRACHEAL FISTULA

Abstract

The results of the microbiological diagnosis of infective inflammatory complications in patients with iatrogenic esophageotracheal fistula and the tactics of their antibacterial prophylaxis and therapy within a 9-year observation period (2003-2011) were analysed. The main organisms colonizing the tracheobronchial tree in the patients were S.epidermidis, S.aureus, enteric bacteria, P.aeruginosa and Candida. An increase of the S.epidermidis resistance to rifampicin, moxifloxacin and especially ciprofloxacin was observed. The resistance of S.aureus did not significantly change. Within the observation period, high susceptibility of all the Staphylococcus isolates to vancomycin and linezolid remained stable. Among the nonfermenting gramnegative bacteria, the P.aeruginosa isolates were the most frequent and characterized by a lower portion of the isolates with preserved susceptibility to the agents (except polymyxin B) known earlier as antipyocyanic antibiotics, i.e. to imipenem and cefepim. Since the proportion of P.aeruginosa in the etiology of pyoinflammatory processes in the region of esophageotracheal fistula ranged within 9.3 to 17.5%, the fact should be considered in the antibiotic therapy. There was observed an increase in the frequency of infectious complications due to other nonfermenting gramnegative bacteria (acinetobacters) and first of all A.baumannii. Various Candida isolates were characterized by dependence of the susceptibility on the selective pressure of nonrational therapy, as well as their species (the presence of such species as C.Krusei and C.glabrata with natural resistance), that required not only the species identification but also determination of the Candida isolates resistance in every particular case.