DOI: https://doi.org/10.22263/2312-4156.2018.1.50
Tapalski D.V.1, Bonda N.A.2, Lagun L.V.1
Microbiological monitoring system of extensively drug-resistant and pandrug-resistant bacterial pathogens determining the sensitivity to antibiotic combinations
1Gomel State Medical University, Gomel, Republic of Belarus
2Gomel Regional Center of Hygiene, Epidemiology and Public Health, Gomel, Republic of Belarus
Vestnik VGMU. 2018;17(1):50-58.
Abstract.
Objectives. To organize the system of microbiological monitoring based on the detection of epidemiologically significant antibiotic-resistant isolates and determination of their sensitivity to antibiotics and their combinations.
Material and methods. Carbapenemases genes detection by means of real-time PCR method and determination of minimal inhibitory antibiotic concentrations with the help of twofold serial broth dilutions method were carried out for 130 extensively drug-resistant Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii clinical strains isolated in 2016-2017 years in 21 health care institutions of Gomel Region. In addition, for each microorganism sensitivity to 11 double antibiotic combinations was determined by testing the bactericidal activity of various concentrations.
Results. 8 isolates (9,8%) with resistance to all antibiotics (with colistin MIC of 4 and more mcg/ml) and 72 isolates (87,2%) sensitive only to colistin were detected among 82 extensively drug-resistant P.aeruginosa isolates. Most of the strains of A.baumannii and K.pneumoniae included in the study remained sensitive only to colistin and tigecycline. The carbapenemases production was detected in 11,0% of the P.aeruginosa isolates (metallo-β-lactamase VIM); all isolates of A.baumannii (carbapenemase OXA-23 – in 2,7% of the isolates, carbapenemase OXA-40 – in 97,3% of the isolates); 30,6% of the K.pneumoniae isolates (carbapenemase OXA-48 – in 25,0% of the isolates, metallo-β-lactamase NDM – in 5,6% of the isolates). The bactericidal activity of all combinations with the inclusion of colistin for the majority of the investigated strains of K.pneumoniae and A.baumannii has been revealed. The combinations of meropenem-colistin and imipenem-colistin demonstrated the greatest activity against P.aeruginosa (bactericidal activity was detected for 82,9% and 89,0% of the isolates).
Conclusions. It has been shown that the extensive antibiotic resistance of A.baumannii and K.pneumoniae is associated with the production of carbapenemases. Antibiotic combinations, effective against extensively antibiotic-resistant microorganisms have been found.
Key words: Klebsiella, Pseudomonas, Acinetobacter, antibiotic resistance, antibiotic combinations, carbapenemases.
References
1. Tapal'skiy DV, Osipov VA, Zhavoronok SV. Сarbapenemases of gram-negative pathogens: spread and methods of detection. Med Zhurn. 2012;(2):10-5. (In Russ.)
2. Woodford N, Turton JF, Livermore DM. Multiresistant Gram-negative bacteria: the role of high-risk clones in the dissemination of antibiotic resistance. FEMS Microbiol Rev. 2011 Sep;35(5):736-55. doi: http://dx.doi.org/10.1111/j.1574-6976.2011.00268.x
3. Zavascki AP, Bulitta JB, Landersdorfer CB. Combination therapy for carbapenem-resistant Gram-negative bacteria. Expert Rev Anti Infect Ther. 2013 Dec;11(12):1333-53. doi: http://dx.doi.org/10.1586/14787210.2013.845523
4. D'Souza BB, Padmaraj SR, Rekha PD, Tellis RC, Prabhu S, Pothen P. In vitro synergistic activity of colistin and ceftazidime or ciprofloxacin against multidrug-resistant clinical strains of Pseudomonas aeruginosa. Microb Drug Resist. 2014 Dec;20(6):550-4. doi: http://dx.doi.org/10.1089/mdr.2014.0006
5. Aaron SD, Ferris W, Henry DA, Speert DP, Macdonald NE. Multiple combination bactericidal antibiotic testing for patients with cystic fibrosis infected with Burkholderia cepacia. Am J Resp Crit Care Med. 2000 Apr;161(4 Pt 1):1206-12. doi: http://dx.doi.org/10.1164/ajrccm.161.4.9907147
6. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012 Mar;18(3):268-81. doi: http://dx.doi.org/10.1111/j.1469-0691.2011.03570.x
7. GOST R ISO 20776-1-2010. Clinical laboratory studies and diagnostic test systems in vitro. Study of the sensitivity of infectious agents and evaluation of functional specifications for the study of sensitivity to antimicrobial means. Part 1. Reference method laboratory studies of the activity of antimicrobial agents against rapidly growing aerobic bacteria causing infectious diseases. Vved 2012-03-01. Moscow, RF: Standartinform; 2011. 23 р. (In Russ.)
8. The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. V. 6.0 [Electronic resource]. 2016. Mode of access: http://www.eucast.org/ast_of_bacteria/previous_versions_of_documents/.
Information about authors:
Tapalski D.V. – Candidate of Medical Sciences, associate professor, head of the Chair of Medical Microbiology, Virology and Immunology, Gomel State Medical University;
Bonda N.A. – doctor-bacteriologist of the Microbiological Laboratory, Gomel Regional Centre of Hygiene, Epidemiology and Public Health;
Lagun L.V. – Candidate of Medical Sciences, associate professor of the Chair of Medical Microbiology, Virology and Immunology, Gomel State Medical University.
Correspondence address: Republic of Belarus, 246050, Gomel, 5 Lange str., Gomel State Medical University, Chair of Medical Microbiology, Virology and Immunology. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Dmitry V. Tapalski.
