Respiratory tract infections are the most common among all diseases of the population of Ukraine, among which community-acquired pneumonia is one of the main causes of mortality from infectious diseases [1]. In the etiology of bronchitis and pneumonia, a certain role is played by the normal microbiota of the upper respiratory tract, whose representatives with increased virulence are able to cause the development of an inflammatory reaction, even with minimal violations of protective mechanisms, in case of penetration into the respiratory tract of the lungs. Mixed infection is often noted in adult patients with lower respiratory tract infections (in 10-15% of cases). Treatment schemes for bronchitis and pneumonia of bacterial etiology are based on antimicrobial therapy. Currently, the global threat to society is the widespread resistance of bacteria to antibiotics. Among the reasons for the development of antibiotic resistance, the uncontrolled use of antibiotics is of particular concern. In addition, many antibiotics under clinical development belong to existing families of compounds, and their antibacterial activity may therefore decrease due to the rapid development of resistance in clinical strains [3].
The aim of the work: analysis of the results of microbiological monitoring of antibiotic resistance of staphylococci and streptococci isolated from patients with bronchitis and community-acquired pneumonia.
Material and methods. The researches used the results of the study of microorganisms isolated from patients with respiratory tract pathology who were treated at the Lung Health Center in Lviv. Sputum, exudate, washing water obtained during bronchoalveolar lavage were used as clinical material. Identification of isolated cultures and determination of sensitivity of bacteria to antibiotics were carried out using an automatic bacteriological analyzer Vitec-2 compact bioMarieux (France).
Results and discussion. When analyzing the etiological structure of infectious diseases of the organs of the lower respiratory tract, it was found that gram-positive cocci, namely S. pneumoniae (1353 strains), group B streptococci (1322 strains), S. aureus (622 strains), S. epidermidis (290 strains) and S. haemolyticus (64 strains) were the most common.
The study of the sensitivity of the isolated bacteria to antibiotics showed that the bacteria of both genera were characterized by a high frequency of resistant isolates. The highest resistance of S. pneumoniae was observed to levofloxacin - 63% of isolates. In addition, pneumococcus was resistant to teicoplanin in 45% of cases, benzylpenicillin in 39%, vancomycin in 31%, clindamycin in 25%, and clarithromycin in 22%. Streptococcus resistance to gentamicin, imipenem, ciprofloxacin, and linezolid ranged from 10 to 15%. In 8% of cases, S. pneumoniae was resistant to cefepime and 3% of resistant isolates were found to cefoperazone. Only amikacin was effective against all tested pneumococcal strains. Group B streptococci are hemolytic bacteria, and a representative of this serogroup, Streptococcus agalactiae, together with other microorganisms, can cause pneumonia [4]. The resistance of these bacteria to antibiotics also reached high values. The greatest resistance was observed to levofloxacin (51%), teicoplanin (49%), vancomycin (39%), benzylpenicillin (36%), and clindamycin (24%). Resistance to gentamicin, imipenem, amikacin, and cefepime was noted in the range of 6-9%. The highest sensitivity of streptococci was observed to cefoperazone and ciprofloxacin (only 3% of isolates were resistant). In S. aureus, the greatest resistance was observed to benzylpenicillin (76%), teicoplanin (41%), clindamycin (39%), vancomycin (34%). Resistance to gentamicin, cefepin, and cefoperazone was shown by 4% of the isolated strains. 6-8% of strains had resistance to imipinem, levofloxacin and ciprofloxacin, 15% to clarithromycin. Staphylococcus aureus was the most sensitive to amikacin (2% of resistant isolates). S. haemolyticus and S. epidermidis had the highest level of resistance to benzylpenicillin (67% and 57%, respectively). Epidermal staphylococcus was also highly resistant to teicoplanin (65%) and clindamycin (64%). A third of S. epidermidis strains were resistant to vancomycin and linezolid, and resistance to fluoroquinolones varied between 25-35%. S. haemolyticus showed the greatest resistance among all tested bacterial strains to clarithromycin (46%), ciprofloxacin (22%), cefoperazone (20%) and imipinem (17%). Only linezolid and amikacin were effective against all strains of S. haemolyticus.
Thus, the most common representatives of opportunistic microflora isolated from patients with bronchitis and community-acquired pneumonia, staphylococci and streptococci, were characterized by a high level of resistance to benzylpenicillin, vancomycin, teicoplanin, clindamycin, levofloxacin, clarithromycin. The greatest effectiveness was registered for cefepime, cefoperazone, and amikacin in relation to all studied species of staphylococci and streptococci. The formation of resistance to antibiotics in representatives of the normal microbiota of the respiratory tract will complicate the choice of drugs for empiric therapy of diseases of bronchopulmonary localization.
References
1.Андреева И. В. Инфекции дыхательных путей: новый взгляд на старые проблемы / И. В. Андреева, О. У. Стецюк // Клин. Микробиол. Антимикроб. Химиотер. – 2009. – Т. 11, № 2. – С. 143-51.
2.Наказ МОЗ України №1614 від 03.08.2021 Про організацію профілактики інфекцій та інфекційного контролю в закладах охорони здоров’я та установах/ закладах надання соціальних послуг / соціального захисту населення. – К., 2021.
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