RÉSUMÉ
Profiles and mechanisms of resistance to beta-lactam antibiotics of isolates of Gram-negative microorganisms, which are causative agents of infections in Intensive Care Unit of hospital surgery department, were studied. Two hundred and ten clinical isolates were studied: Pseudomonas aeruginosa--86 strains (40.9%), Acinetobacter baummanii--45 strains (21.4%), Klebsiella pneumoniae--52 strains (24.8%), Escherichia coli--23 strains (11%), Enterobacter spp.--4 strains (1.9%). Profiles of antibiotic resistance were studied by the method of serial microdilutions; detection of most widespread and clinically significant genes of beta-lactamases of Gram-negative bacteria was performed by polymerase chain reaction. Carbapenems and cefoperazone/sulbactam were the most active antibiotics. Local features of distribution of beta-lactamase coding genes (TEM, SHV, CTX) in K. pneumoniae and E. coli isolates were revealed. Eleven strains of P. aeruginosa resistant to carbapenems and possessing genetic determinants of VIM-group, which codes metallo-beta-lactamases, were isolated. Obtained data allows to assess the parameters of resistance to beta-lactam antibiotics and to reveal the main mechanisms of such resistance in etiologic agents of nosocomial infections, that, in its turn, allows to choose preparations for etiotropic therapy.
Sujet(s)
Antibactériens/pharmacologie , Infection croisée/microbiologie , Bactéries à Gram négatif/effets des médicaments et des substances chimiques , Bactéries à Gram négatif/génétique , Infections bactériennes à Gram négatif/microbiologie , bêta-Lactames/pharmacologie , Protéines bactériennes/génétique , Carbapénèmes/pharmacologie , Céfopérazone/pharmacologie , Résistance bactérienne aux médicaments , Gènes bactériens , Humains , Unités de soins intensifs , Tests de sensibilité microbienne , Moscou , Sulbactam/pharmacologie , Résistance aux bêta-lactamines/génétique , bêta-Lactamases/génétiqueRÉSUMÉ
Etiological structure, patterns and antibiotic resistance mechanisms of gramnegative nonfermenting pathogens of nosocomial infections isolated from patients in intensive care units and surgical departments were investigated. One hundred thirty one clinical isolates, including 86 (65.6%) isolates of Pseudomonas aeruginosa and 45 (34.4%) isolates of Acinetobacter baumannii were tested. Carbapenems and cefoperazone/sulbactam showed the highest activity against the tested isolates. Eleven carbapenem resistant strains of P. aeruginosa were detected. The strains were found to possess genetic determinants of the VIM group encoding metal beta-lactamases.
Sujet(s)
Antibactériens/pharmacologie , Infection croisée/épidémiologie , Infections bactériennes à Gram négatif/épidémiologie , Unités de soins intensifs , Épidémiologie moléculaire , Département hospitalier de chirurgie , Acinetobacter baumannii/effets des médicaments et des substances chimiques , Adolescent , Carbapénèmes/pharmacologie , Céfopérazone/pharmacologie , Enfant , Enfant d'âge préscolaire , Résistance microbienne aux médicaments , Gènes bactériens/génétique , Humains , Nourrisson , Tests de sensibilité microbienne , Moscou/épidémiologie , Pseudomonas aeruginosa/effets des médicaments et des substances chimiques , Pseudomonas aeruginosa/génétique , Sulbactam/pharmacologie , bêta-Lactamases/génétiqueRÉSUMÉ
The review deals with one of the most actual problems of modern medicine, i.e. nosocomial infections. Criteria, epidemiology, pathogenesis and etiology of nosocomial infections are discussed. Up-to-date approaches to prophylaxis and control of nosocomial infections are indicated with special attention to the advantages and disadvantages of some widely used methods. Data on structure of nosocomial infections and their specific features in multipurpose hospitals are indicated. General principles of antimicrobial chemotherapy of nosocomial infections are formulated. The importance on multicentre studies of resistance of hospital pathogens in accordance with internationally recognised methodology is emphasised.