Употреба на антибиотици и евалуација на бактериска резистенција кај хоспитализирани деца

Abstract

Antibiotics are drugs used to prevent and treat bacterial infections. Resistance of the bacteria is a natural biological phenomenon in their struggle for survival and occurs either as an inherent (natural) resistance or occurs when the bacterium changes in response to the use of a particular antibiotic (acquired resistance). In a global WHO analysis of 2015, the state of bacterial resistance suggests a weak response to the fight against antimicrobial resistance (AMR). Bacterial resistance is a global issue that needs to be addressed locally. The volume of data on the use of antibiotics and the phenomenon of bacterial resistance in the Republic of North Macedonia is limited, and the existing data is obsolete, especially when it comes to bacterial resistance in hospitalized children. The aim of this study is to correlate the data on the scope of antibiotic use and the condition of bacterial resistance in hospitalized pediatric patients. A prospective observational pharmacoepidemiological study was carried out in the PHI UK for Children's Diseases in Skopje (a tertiary healthcare facility with 177 hospital beds) over a period of one year. Consumption of antibiotics is processed through the statistical unit DDD / 100IBD, which is a degree of the scope of use of the analyzed antibiotic at quarterly level. The state of resistance and multi-resilience of microorganisms to particular antibiotics and classes of antibiotics is monitored and statistically processed through the WHONET software developed by the WHO and used to monitor antimicrobial resistance. The total consumption of antibacterial drugs with ATC code J01 for one year is 30.03 DDD/100OBD. The most commonly used antibiotics in the cephalosporin group are 16.36 DDD/100OBD, and third generation parenteral cephalosporins with 14.76 DDD/100OBD, followed by aminoglycosides 3.58 DDD /100OBD and carbapenem 3.45 DDD/100OBD. Half of the total antibiotic consumption (50%) is due to antibiotics from the cephalosporin group. The most commonly used medication is ceftriaxone with 11.46 DDD/100OBD, then amikacin with 3.39 DDD/100OBD and meropenem 2.65 DDD/100OBD. All three antibiotics are used parenterally. The number of antibiotics used in winter is 25% higher than in summer. The largest consumption of antibiotics is in the department of pulmonology, intensive care and infant department, metabolism and cystic fibrosis. The most common bacteria in the microbiological findings are: Staphylococcus aureus (20.8%). Escherichia coli and Pseudomonas aeruginosa (19.6%) Klebsiella sp. (10.2%) and Acinetobacter spp. (4.5%). From hemoculture specimens, most commonly isolated coagulase negative Staphylococcus spp, from respiratory tract - Staphylococcus aureus, Pseudomonas aeruginosa, and from urine - E.coli. S. aureus is resistant to penicillin 94% and to cephalosporins in the interval of 37.5% - 45.4%. (Ceftriaxone 45.4%, cefotaxime 45% and cefoxitin 37.5%) The MRSA is 8%. E. coli is resistant to penicillins (96%), cefuroxime 71%, ceftriaxone 65%, ceftazidime 63% and cefepime 61%. Beta lactam / inhibitor has 69% resistance. Escherichia coli ESBL (Extended Spectrum Beta-Lactamase) producers is isolated in 38 samples. Pseudomonas spp is resistant to carbapenem 55%. Coagulase negative Staphylococcus spp resistance to penicillins 100% and flucoxacillin 88.2%. Cephalosporins: cefotaxime 90.9%, ceftriaxone 84.6%, cefoxitin 80%. Clarithromycin 64.3%, Erythromycin 72.2%, azithromycin 69.2%. Klebsiella spp have statistically significant resistance to penicillins of 98% (ampicillin and amoxicillin), cefuroxime 79%, ceftriaxone 74%, ceftazidime 73% and cefepim 66%, gentamycin 57%, piperacillin / tazobactim 54%. Acinetobacter spp with a high degree of multi-resistance: resistance to penicillins (96%) cephalosporins (79%) and over 50% carbapenem resistance. The resistance profile of PHI UK for children's diseases in Skopje indicates the most common identification of multidrug-resistant strains of K. pneumoniae, Acinetobacter spp and E. coli. In the most commonly used antibiotic (ceftriaxone) there is a very strong positive correlation (r = 0.93) between the consumption expressed in DDD / 100IBD and the occurrence of resistance (R%). As consumption increases, so does the resilience. It has been shown that there is a direct correlation between the resistance of isolated bacteria to ceftriaxone and the extent of its use. It can be concluded that frequent use of this antibiotic affects the appearance of increased resistance to it. The relationship between antibiotic resistance to the most commonly isolated bacteria correlates with the extent of use of the most commonly used antibiotics (ceftriaxone, amikacin and meropenem). The study indicates that continuous monitoring of the scope of antibiotic use and bacterial resistance is needed, enabling prescribing the most appropriate therapy and identifying and defining further steps and procedures for identifying and correcting the factors affecting bacterial resistance and bacterial resistance.