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[Hospital infections caused by Pseudomonas aeruginosa. Significance in intensive therapy]
Abstract:
The significance of P. aeruginosa as an agent of hospital infections in intensive care departments is determined by high prevalence of this microorganism, its natural and acquired resistance to antibiotics of various groups, and severity of the infection it induces. The resistance of P. aeruginosa to antibiotics is different in different regions. Among the strains isolated in Moscow in intensive care wards for newborns 9% were resistant to meropenem, 10% to amicacine, 15% to imipramine, 16% to cefepime, 37% to ceftasidime, 45% to piperacylline/tasobactam, 45% to ciprofloxacine, and 60% to gentamicin; 1.5% of these strains were resistant to all tested antibiotics. High prevalence of antibiotic resistance among P. aeruginosa impedes the choice of drugs for empirical antibiotic therapy and increases the significance of microbiological diagnosis. Even if an agent is sensitive to such antibiotics as semisynthetic penicillines and aminoglycosides, their use as monotherapy in infections caused by P. aeruginosa is ineffective. Carbapenemes, III- IV generations cefalosporines, and fluoroquinolones can be used as mono therapy.
Insights
Pseudomonas aeruginosa causes severe hospital infections in intensive care units due to widespread antibiotic resistance. Microbiological diagnosis is crucial for effective treatment, as monotherapy with some antibiotics is ineffective against these resistant strains.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Clinical Pharmacy
Background:
- Pseudomonas aeruginosa is a significant pathogen in hospital-acquired infections, particularly in intensive care settings.
- High rates of antibiotic resistance in P. aeruginosa complicate treatment strategies and increase patient morbidity.
- Regional variations in antibiotic resistance patterns necessitate localized surveillance and treatment guidelines.
Purpose of the Study:
- To determine the prevalence of antibiotic resistance in P. aeruginosa strains isolated from neonatal intensive care units in Moscow.
- To evaluate the effectiveness of different antibiotic classes for treating P. aeruginosa infections.
Main Methods:
- Antimicrobial susceptibility testing of P. aeruginosa isolates.
- Analysis of resistance rates to various antibiotic classes including carbapenemes, cephalosporins, fluoroquinolones, aminoglycosides, and beta-lactam/beta-lactamase inhibitors.
Main Results:
- High resistance rates were observed for gentamicin (60%), ciprofloxacin (45%), and piperacillin/tazobactam (45%).
- Lower but significant resistance was noted for ceftazidime (37%), cefepime (16%), imipenem (15%), amikacin (10%), and meropenem (9%).
- 1.5% of isolates exhibited pan-resistance to all tested antibiotics.
Conclusions:
- The high prevalence of antibiotic resistance in P. aeruginosa strains in Moscow ICUs poses a significant challenge for empirical antibiotic therapy.
- Microbiological diagnosis is essential for guiding appropriate treatment selection.
- While some antibiotics like carbapenems, third/fourth-generation cephalosporins, and fluoroquinolones may be suitable for monotherapy, others like semisynthetic penicillins and aminoglycosides are ineffective as monotherapy.