Utjecaj primjene antimikrobne terapije na selekciju mikroorganizama koji produciraju beta-laktamaze proširenog spektra (AmpC i ESBL) i ishod liječenja bolesnika [The impact of antimicrobial consumption on the selection of extended-spectrum beta-lactamases producing (ESBL, AmpC) strains and on patients outcomes]

Erdeljić, Viktorija (2012) Utjecaj primjene antimikrobne terapije na selekciju mikroorganizama koji produciraju beta-laktamaze proširenog spektra (AmpC i ESBL) i ishod liječenja bolesnika [The impact of antimicrobial consumption on the selection of extended-spectrum beta-lactamases producing (ESBL, AmpC) strains and on patients outcomes]. PhD thesis, Sveučilište u Zagrebu.

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Abstract

There is an increase in infections caused by extended-spectrum beta-lactamases (ESBL) producing strains of Escherichia coli and Klebsiella pneumoniae, especially in intensive care units (ICUs). The aim of this study was to identify local risk factors for ESBL infection, with emphasis on defining the position of antibiotics. This study was conducted in 3 ICUs at 3 levels: 2) case-control study; 1) ecological study, and 3) isolate genotipization. Ecological study demonstrated that the use of fluroquinolones and 3rd generation cephalosporins was significantly associated with the increase in frequency of ESBL strains isolation with a delay of 2 months. The use of carbapenems, piperacillin/tazobactam, cephalosporins, aminoglicosides, glycopeptides and clindamycin was also significantly associated with the frequency of ESBL KP/EC isolates, without delay. Risk factors for ESBL infection identified in the case-control study were: duration of ICU stay, previous antimicrobial therapy, number of prescribed antibiotics, previous use of macrolides and fluoroquinolones. Mortality and inadequate antimicrobial therapy were more frequent in the ESBL group. Isolate genotipization revealed that both selection pressure and horizontal transfer are important factors for ESBL infection. This study confirms that antibiotic consumption is the main risk factor for ESBL infection. Rational use of antibiotics, especially fluoroquinolones, is needed in the control of ESBL infections in ICUs, as well as strict adherence to infection control measures.

Abstract in Croatian

Bilježi se značajno povećanje učestalosti infekcija sojevima Escherichia coli i Klebsiella pneumoniae koje produciraju beta-laktamaze proširenog spektra (ESBL), posebno u jedinicama intenzivne skrbi (JIL). Cilj ove studije bio je utvrditi lokalne čimbenike rizika za infekciju ESBL sojem, s naglaskom na definiranje uloge antibiotika . Studija je provedena u 3 JIL na 3 razine: 2) studija slučajeva s kontrolama; 1) ekološka studija, i 3) genotipizacija reprezentativnog uzorka izolata. Ekološka studija utvrdila je povezanost učestalosti izolacije ESBL sojeva s primjenom fluorokinolona i cefalosporina 3.generacije s vremenskim odmakom od 2 mjeseca. Potrošnja karbapenema, cefalosporina, aminoglikozida, glikopeptida i klindamicina također je bila značano povezana s prevalencijom ESBL izolata, bez vremenskog odmaka. Čimbenici rizika utvrđeni u studiji slučajeva s kontrolama bili su: dužina hospitalizacije u JIL, prethodna antibiotska terapija, broj propisanih antibiotika te prethodna primjena makrolida i fluorokinolona. Mortalitet i učestalost primjene neadekvatne antibiotske terapije bili su veći u grupi bolesnika s ESBL infekcijom. Genotipizacija izolata utvrdila je da su i selekcijski pritisak primjene antibiotika i horizontalni prijenos važni čimbenici rizika za infekciju ESBL sojem KP i EC. Rezultati ove studije potvrđuju da je primjena antibiotika najvažniji čimbenik rizika za ESBL infekciju, naglašavaju važnost i potrebu za racionalnom primjenom antibiotika, posebno fluorokinolona, uz strogo pridržavanje mjera kontrole infekcije.

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