STRUCTURE OF MICROFLORA AND ANTIBIOTIC RESISTANCE TRENDS IN INTENSIVE CARE UNIT OF A MULTIDISCIPLINE INSTITUTION

Abstract

Objective. To study dynamics of structure and antibiotic resistance of microflora in the intensive care unit depending on the amount of used antibiotics. Methods. 41375 isolates were studied in the intensive care unit of a multidisciplinary hospital from 2015 to early 2021. Bacteriological examination of clinical samples on basis of Republican Scientific and Practical Center “Infection in Surgery” has been performed. The primary treatment of results with the analysis of sensitivity of microorganisms to antibiotics was carried out by means of International Computer Program (WHONET). Antibiotic sensitivity was determined by disk-diffusion method, suspended in Mueller-Hinton broth and semi-automatic analyzer ATB Expression (BioMerieux, France). The analysis of consumption of antibacterial drugs in the intensive care unit was carried out according to data of pharmacy which operates at the medical institution where the research itself was carried out. Results. From 2015 to 2017 the analysis of microflora composition permitted to establish the prevalence of P. aeruginosa (22,74%), Acinetobacter spp. (22,25%) and K. pneumoniae (16,11%) which occurred 1,6 folds more often than other microorganisms while in general structure of multidisciplinary hospital S. aureus was most common (20,96% and 20,05%). Since 2018 carbapenem-resistant K. pneumonia has dominated (23,01%). Tigecycline and colistat were not effective against 4,3% and 5,7% of K. pneumoniae isolates in 2019, 10,2% and 13,7% of isolates in 2020, 37,3% and 39,6% - from January to May 2021 which was associated with a growth of tigecycline and colistat consumption. Conclusion. Since 2018 prevalence of carbapenem-resistant K. pneumoniae has been observed in microflora of the intensive care unit which is associated with a growth of consumption of antibacterial drugs which caused appearance of K. pneumoniae isolates resistant to colistin and tigecycline. What this paper adds The relation tendency between the consumed antibacterial agents and the growth of resistance to them in the intensive care intensive care unit of a multidisciplinary institution has been firstly analyzed. The predominance of carbapenem-resistant isolates of K. pneumoniae was established starting from 2018 which led to an increase in the use of tigecycline and colistin in the treatment of patients in the intensive care unit accompanied by the appearance of isolates resistant to them at the end of 2020.