Klin Farmakol Farm. 2004;18(1):6-10

Vliv selekčního tlaku vybraných antibiotik na rezistenci nejčastěji se vyskytujících gramnegativních bakteriálních kmenů na jednotkách intenzivní péče ve Fakultní nemocnici v Hradci Králové

Petra Matoulková1, Věra Klemerová1, Jiří Vlček1, Pavel Čermák2, Vladimír Černý3, Miroslav Měšťan4, Václav Dostál5, Luboš Sobotka6, Ladislav Žabka7
1 Katedra sociální a klinické farmacie, Farmaceutická fakulta, Univerzita Karlova, Hradec Kralové
2 Ústav klinické mikrobiologie FN a LF UK Hradec Králové
3 Klinika anesteziologie a resuscitace LF UK a FN Hradec Králové
4 I. interní klinika Fakultní nemocnice v Hradci Králové
5 Infekční klinika Fakultní nemocnice Hradec Králové
6 Klinika gerontologická a metabolická, FN Hradec Králové
7 Neurochirurgická klinika, LF UK a FN, Hradec Králové

Keywords: antibiotics, antibiotic selective pressure, gram-negative bacteria, intensive care units, drug resistance.

Published: December 31, 2004  Show citation

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Matoulková P, Klemerová V, Vlček J, Čermák P, Černý V, Měšťan M, et al.. Vliv selekčního tlaku vybraných antibiotik na rezistenci nejčastěji se vyskytujících gramnegativních bakteriálních kmenů na jednotkách intenzivní péče ve Fakultní nemocnici v Hradci Králové. Klin Farmakol Farm. 2004;18(1):6-10.

ÚČEL STUDIE: Analyzovat vztah mezi expozicí antibiotikům (gentamicin, amikacin, netilmicin, cefotaxim, ceftazidim, ciprofloxacin) a rezistencí nejčastěji se vykytujících gramnegativních bakterií na jednotkách intenzivní péče ve Fakultní nemocnici.

POUŽITÉ METODY: Jedná se prospektivní, observační studii. Sběr dat (spotřeba antibiotik a podíl bakteriálních kmenů rezistentních vůči vyšetřovaným antibiotikům) byl prováděn v období od 1. 1. 1998 do 31. 12. 1999. Spotřeba antibiotik byla vyjádřena v definovaných denních dávkách vztažených na 100 ošetřovacích dnů - lůžkodnů (DDD/100 lůžkodnů). Pro stanovení celkového podílu rezistentních kmenů byly do studie pro jednu hospitalizaci jednoho pacienta zahrnuty pouze odlišné fenotypy. Závislost četnosti rezistentních kmenů na expozici antibiotikům byla analyzována pomocí linearní regrese.

VÝSLEDKY: Statisticky významná lineární závislost byla zjištěna mezi relativní roční spotřebou ciprofloxacinu a rezistencí kmenů Enterobacter spp. (r=0,800; p=0,005). Statisticky významná negativní korelace byla zjištěna mezi expozicí gentamicinu a rezistencí kmenů Klebsiella pneumoniae (r=-0,693; p=0,026).

ZÁVĚR: V prostředí intenzívní péče bylo zjištěno, že snížení selekčního tlaku ciprofloxacinu znamená rovněž snížení výskytu kmenů Enterobacter spp. rezistentních k tomuto antibiotiku. Paradoxně byl většinou na odděleních s nízkou spotřebou gentamicinu pozorován vysoký podíl kmenů Klebsiella pneumoniae rezistentních vůči gentamicinu.

An influence of selective pressure of antibiotics on gram-negative bacterial flora resistance in the Intensive Care Units at the Teaching Hospital, Hradec Kralove, Czech Republic

OBJECTIVE: Aim of the study was to evaluate the relationship between usage of antimicrobial agents intended to treat infections caused by gram-negative bacteria (gentamicin, amikacin, netilmicin, cefotaxime, ceftazidime, ciprofloxacin) and resistance of those bacteria in the intensive care units in the University Hospital.

METHODS Design: Observational, prospective study. Data has been collected from 1. 1. 1998 to 31. 12. 1999. Antibiotic usage data were obtained by chart extraction. Microbiology data were consecutively collected. Non-duplicate strains isolated from ICU inpatients were tested for their susceptibility by the disk diffusion test. Setting: 5 intensive care units at the university-affiliated teaching hospital Hradec Králové, Czech Republic. Patients and participants: All patients in the general admitted to the intensive care units within 2 years. Interventions: None.

RESULTS: A relationship between relative one-year consumption (expressed in DDD/100bed-days) and rates of resistance for selected gram-negative bacteria was evaluated by the means of linear regression. We identified statistically significant positive correlation for ciprofloxacin usage and Enterobacter spp. resistance to ciprofloxacin (r=0.800; p=0.005). Statistically significant negative correlation was found for usage of gentamicin and Klebsiella pneumoniae resistance (r=-0.693; p=0.026).

CONCLUSSION: In the ICU setting a decrease of selective pressure of ciprofloxacin entailed a decrease of Enterobater spp. strains resistant to ciprofloxacin. Paradoxly high resistance of Klebsiella pneumoniae strains to gentamicin was observed at the ICU wards with low consumption of gentamicin.

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