Spektrum mikrobiologiczne oraz lekowrażliwość bakterii izolowanych od pacjentów z zakażeniem wewnątrzbrzusznym
[Microbiologic spectrum and susceptibility of bacteria isolated from patients with intra-abdominal infection]

Zakażenia wewnątrzbrzuszne (IAIs) stanowią wyzwanie diagnostyczne i terapeutyczne. Występowanie oporności na antybiotyki stwarza ryzyko niepowodzenia terapii empirycznej. Profil wrażliwości bakterii wywołujących IAIs na antybiotyki wymaga stałego monitorowana zarówno w szpitalu jak i w skali regionu i świata. Wyniki analiz powinny być implementowane do programów nadzoru epidemiologicznego i ustalenia algorytmów leczenia.

ABSTRACT

Introduction: With their multiple etiologies, IAIs have always been a diagnostic and therapeutic challenge. Development of drug resistance, and possibly multiple drug resistance, by the causative pathogens may pose difficulties in empirical treatment selection. The aim of the study was to analyze the etiology of bacterial intra-abdominal infections (IAIs) in patients hospitalized in surgical wards and to evaluate the mechanisms of antibiotic resistance. Methods: The evaluated biological samples (fluids from abdominal cavity and bile) were obtained from patients with suspected or confirmed IAIs, hospitalized at a teaching hospital in Poland. Routine microbiological diagnostic tests were performed. Results: The proportions of Gram-positive and Gram-negative bacteria isolated from the analyzed peritoneal fluid and bile specimens were comparable. Multiple bacterial species were significantly more common in bile isolates than in peritoneal fluid isolates. A total of 61,7% of aerobic Gram-negative bacillus isolates obtained from peritoneal fluid and bile produced ESBL. The proportions of vancomycin-resistant enterococci (VRE) and enterococci exhibiting high level aminoglycoside resistance (HLAR) were 32,6% and 43,5%, respectively. Ertapenem-resistant K. pneumoniae was detected in 22,2% of peritoneal fluid cultures and 71,4% of biliary cultures. Methicillin resistance was detected in 85,7% of staphylococcal isolates. The proportion of anaerobes detected in peritoneal fluids was relatively high at approximately 17% and included predominantly Gramnegative species. All Gram-negative anaerobes showed resistance to benzylpenicillin. Conclusions: Etiologies and susceptibility pattern of IAIs must be monitored on a ward, hospital, regional, and world-wide scale and the findings implemented into epidemiologic surveillance programs and proposed treatment protocols.