DOI: https://doi.org/10.22263/2312-4156.2022.3.69
E.G. Antonova, I.V. Zhyltsou, I.I. Stakhovich
Antibacterial therapy of hospital infections caused by carbapenemase-producing strains of K. pneumoniae
Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus
Vestnik VGMU. 2022;21(3):69-76.
Abstract.
The wide prevalence of carbapenemase-producing strains of K. pneumoniae is a major public health problem in most countries of the world. Such pathogens are able to show resistance not only to β-lactam antibiotics, but also to other groups of antimicrobial drugs, that until recently were classified as reserve ones.
Objectives. To detect the production of the main molecular classes of carbapenemases by nosocomial strains of
K. pneumoniae, to determine the resistance of such pathogens to colistin and tigecycline, and to analyze the provided antibiotic therapy of the infections that they cause.
Material and methods. We have studied the antimicrobial resistance of 132 strains of K. pneumoniae isolated from the biomaterial of patients treated at the departments of the Vitebsk Regional Clinical Hospital in the period from 2018 to 2021. For isolates of K. pneumoniae with resistance to meropenem, the minimum inhibitory concentrations (MICs) of colistin and tigecycline were determined. Carbapenemase genes (blaKPC, blaOXA-48, blaNDM, blaVIM, blaIMP) were detected for 73 strains of K. pneumoniae by real-time PCR.
Results. It has been found that carbapenem-resistant isolates of K. pneumoniae were insensitive to colistin in 49.6% of cases and had a fairly high level of resistance to tigecycline (MIC50 made up 2 μg/ml, and MIC90 was 16 μg/ml). All studied carbapenem-resistant strains of K. pneumoniae had the main carbapenemase genes, both serine and metallo-β-lactamases. In 24.7% of cases, coproduction of two serine carbapenemases OXA-48 and KPC was detected by one strain, in other cases serine and metallo-β-lactamases of various classes (NDM, VIM, IMP) were found simultaneously. Carbapenem resistance for K. pneumoniae was not associated with prior antibiotic therapy.
Conclusions. Identification of different molecular classes of carbapenemases for strains of K. pneumoniae can contribute to the choice of the most effective regimen of the antibiotic etiotropic therapy for severe nosocomial infections.
Keywords: K. pneumoniae, antibiotic resistance, carbapenemases, colistin, tigecycline, antimicrobial therapy.
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Information about authors:
E.G. Antonova – senior lecturer of the Chair of General and Clinical Pharmacology with the course of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University, https://orcid.org/0000-0002-1293-7023
Е-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Elena G. Antonova;
I.V. Zhyltsou– Doctor of Medical Sciences, professor, head of the Chair of Evidence-Based Medicine and Clinical Diagnostics of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University, https://orcid.org/0000-0002-4912-2880
I.I. Stakhovich – head of Clinical Diagnostic Laboratory, Clinic of Vitebsk State Order of Peoples’ Friendship Medical University.
