Sensitivity to antibiotics, antiseptical nosocomial strain of Pseudomonas aeruginosa, isolated in urological patients

Анотація

Introduction. Given the active introduction into clinical practice of new groups of antibiotics and antiseptics, the problem of treatment of purulent-inflammatory complications after prostatectomy and today is relevant. Of particular concern belated cases of diagnosis and treatment of postoperative complications in urological practice patients receiving antibiotic therapy. The use of traditional antibiotics is not prevents the development of infection, because the problem of resistance of microorganisms to antibiotics and antiseptics remains relevant. The solution to the problem of development of infectious complications and prevent the formation of resistant clinical strains largely depends on the isolated pathogen, susceptibility to antimicrobial agents based on its bioavailability , ability to spread and penetrate into cells and tissues, selection of dose, interval, and route of administration to maintain minimum bactericidal concentration. Material and methods. The study involved 145 patients who were treated in the urology Department of the Vinnytsia regional clinical hospital named of M. I. Pirogov. Patients underwent the surgical treatment of benign hypertrophic prostate. Material for bacteriological studies of purulent-inflammatory diseases were urine, pieces of the prostate, remote operationally, urinary catheters, through which conducted irrigation of the bladder. Specimen collection, transportation was carried out in accordance with modern requirements. Identification was done by morphological, cultural and biochemical properties. The definition of antibiotic resistance were performed according to "guidelines for the definition of sensitivity of microorganisms to antibiotics by the method of diffusion in agar using discs" (No. 2675-83, Kiev, 2007) 12 .]. Evaluation of the results of determining the sensitivity of microorganisms to antibiotics was carried out on the basis of the determination of the zone of growth (mm) of the studied cultures around the disks with antibiotics. To explore sensitivity to antiseptics used commercial samples drug Decesan® (decamethoxin) of 0.02% solution ("YURI-PHARM", Ukraine), Miramistin® 0.01% solution (benzyldimethyl-myristoylation-Propylamine chloride monohydrate) (ZAO Pharmaceutical firm "Darnitsa") and Chlorhexidine (chlorhexidine digluconate) 0.05% solution (PJSC "Monfarm"). Comparative evaluation of sensitivity of microorganisms to the test preparations was determined by the minimum bactericidal concentration (MBsC) standard method, serial dilutions of the drug in a liquid medium (µg⁄ml). Results and discussion. Just received 20 nosocomially strains of P. аeruginosa. Isolated strains had the typical morphology polymorphic thin sticks, gramnegative on dense nutrient media formed a rounded, translucent colonies with a smooth edge, with a blue-green pigment. The biochemical properties referenceusa gram-negative bacteria were determined using Neverlast-24 (PLIVA – Lachema a. s. Brno, Czech Republic). The results of the determination of antibiotics susceptibility of tested strains P. aeruginosa. The greatest activity against the studied strains of P. аeruginosa had Meropenem, amikacin, ceftazidime and imipenem. Nimensa frequency of resistant strains identified to Meropenem were insensitive to 10% of strains of P. aeruginosa. From resistant to Meropenem 6 strains had perekhresne resistance to imipenem. The second activity with β-lactam antibiotics were identified ceftazidime. Insensitive to it were 5%. Antoniniani penicillins were less active than the carbapenems and ceftazidime.So resistant to Pirillo/tazobactam were 30% of the isolates. The most frequent combinations of stability were gentamicin – piperacillin 55,3%, gentamicin – piperacillin – piperacillin/tazobactam 35%. One strain of P. aeruginosa possessed simultaneously resistant to all antibiotics. Decesan and Miramistin had the same sensitivity P. aeruginosa (62.5± 8.94 μg∕ ml and 62.5±16,04 μg∕ ml) For chlorhexidine MBsC 125 ± 8,88 μg∕ ml. Conclusion. Resistance nosocomial strains of P. aeruginosa at the present time is a serious clinical problem. Of all the antibiotics, the lowest level of resistance was determined to Meropenem. Antibacterial drugs, active against P. aeruginosa - Meropenem > amikacin > ceftazidime > imipenem > ciprofloxacin > piperacillin/tazobactam > piperacillin > gentamicin. Found that antibiotic-resistant strains of the Pseudomonas had a low level of sensitivity to antiseptics.