[Antibiotic Resistance of MRSA in the Russian Federation].

The results of the multicentre trial on estimation of MRSA antibiotic susceptibility to 17 antibiotics are presented. 474 nonrepeting isolates of MRSA (mecA+), collected in 2011-2014 in 10 cities of the Russian Federation were used in the trial. The antibiotic susceptibility was determined by the method of serial microdilutions in broth with estimation of the MICs in accordance with the international standards CLSI 2014 and EUCAST 2014. The highest levels of the MRSA resistance were stated against ciprofloxacin--92%(MIC50 32 mcg/ml), gentamicin--85% (MIC50 128 mcg/ml), erythromycin--54% (MIC50 32-mcg/ml) and clindainycin - 45% (MIC50 0.03 mcg/ml), as well as against rifampicin--38% (MIC50 0.06 mcg/ml). The frequency of MRSA isolated at the vancomycin dose of 2 mcg/ml equaled 26%. No correlation of the decrease in susceptibility to vancomycin and rifampicin was observed. In 5% of MRSA isolated from infected surgical wounds in patients with bone infection or sepsis, there was observed a decrease in the susceptibility to ceftarolin (MIC 2-4 mcg/ml). Co-trimoxasole, fusidic acid (MIC50 0.06 mcg/ml) and mupirocin (MIC50 0.5 mcg/ml) showed high antibacterial activity, 93-98% of the isolates being susceptible to the drugs. No resistance to linezolid and tigecycline was detected. By the associate resistance spectrum, most of the MRSA isolates were characterized by resistance to drugs of 3-7 groups (56%). The phenotypes with simultaneous resistance to drugs of 8-10 groups amounted to 6%. As a whole, 70 variants of associate resistance combinations were detected.

[Estimation of MRSA susceptibility to oxacillin, cefoxitine, vancomycin and daptomycin].

Prevalence and therapy of infections due to MRSA remain one of the most serious problems in the world. Therefore, correct laboratory identification of the MRSA phenotype based on the use of the marker antibiotic cefoxitine, as a more susceptibile one vs. oxacillin, is of great importance. There is lately being observed a tendency towards emergence of strains with lower susceptibility to the last reserve drugs protecting from MRSA, i. e. vancomycin and daptomycin. Susceptibility of MSRA to these drugs was not investigated in Russia and there are no data on the prevalence of the VISA and hVISA phenotypes. The results of our study on estimation of susceptibility of 316 MRSA isolates from several regions of Russia to oxacillin, cefoxitine, vancomycin and daptomycin are presented herein. It was shown that the ranges of the oxacillin MIC were extremely wide, i. e. 0.5 to 512 mcg/ml, while 2.2 +/- 1% of the isolates was susceptible by the phenotype to oxacillin, in spite of the mecA gene presence. As for cefoxitine, the MRSA isolates were rather resistant to it at the MIC > 16 mcg/ml. The tests with serial microdilutions revealed that 30.7 +/- 7% of the isolates had a critical level of susceptibility to vancomycin at the MIC 2 mcg/ml. The E-tests revealed 1.3 +/- 1% of the isolates which were susceptible at the MIC 2-4 mcg/ml. The MRSA isolates were highly susceptible to daptomycin, while high levels of the MIC (2 mcg/ml) were characteristic of 2.8 +/- 1% of the isolates. Cross reduction of the susceptibility to vancomycin and daptomycin was observed.

[Susceptibility of gramnegative carbapenemase-producing bacteria to various group antibiotics].

The study involved 25 isolates of gramnegative carbapenemase-producing bacteria. 17 isolates of Klebsiella pneumonia produced carbapenemase NDM-1 and were highly resistant to cephalosporins (MIC>128 mcg/ml), carbapenems (MIC>16 mcg/ml), aminoglycosides and fluoroquinoiones, while among them 4 isolates preserved susceptibility to azthreonam and all of them were susceptible to tigecycline and polymyxin. 2 isolates of Acinetobacter genomospecies 13 produced NDM-1 and were resistant to all the beta-lactams and amikacin, while preserved susceptibility to gentamicin, co-trimoxazole, tigecycline and polymyxin, the susceptibility to ciprofloxacin being lowered. Carbapenemase VIM-4 was produced by 2 isolates of Enterobacter cloacae, which were highly resistant to cephalosporins and azthreonam, significant synergism being observed between cefepim and clavulanate. The resistance of the isolates to carbapenems was low (MIC 0.5-4.0 mcg/ml), they also being resistant to aminoglycosides and ciprofioxacin and susceptible to tigecycline and polymyxin. Carbapenemases KPC-2 were detected in 2 isolates of K.pneumoniae and in 1 isolate of E.cloacae. The above isolates were resistant to all the beta-lactams, ciprofloxacin, aminoglycosides and co-trimoxazole. I isolate of E.cloacae showed resistance to tigecychine and I isolate of K.pneumoniae was resistant to polymyxin. Carbapenemase OXA-48 was detected in 1 isolate of K.pneumoniae. It was resistant to all the beta-lactams, ciprofloxacin and co-trimoxazole and susceptible to aminoglycosides, tigecycline and polymyxin.