| Abstract | Cilj istraživanja: Cilj istraživanja je prikazati epidemiološke i mikrobiološke osobitosti
karbapenem-rezistentnih izolata Klebsiella pneumoniae koji su dokazani iz uzoraka donjih
dišnih puteva u Kliničkom bolničkom centru (KBC-u) Split u razdoblju od 1. siječnja do 31.
prosinca 2022. godine.
Materijali i metode: U ovom retrospektivnom, opažajnom istraživanju analizirani su podatci
o svim izolatima K. pneumoniae koji su bili rezistentni na karbapeneme i izolirani iz uzoraka
donjih respiratornih puteva, bolničkih i izvanbolničkih pacijenata, u Kliničkom zavodu za
mikrobiologiju i parazitologiju, KBC-a Split, u periodu istraživanja.
Rezultati: Ukupno je analizirano 85 karbapenem-rezistentnih izolata K. pneumoniae, od kojih
je 40 produciralo oksacilinazu-48 (OXA-48), a 45 izolata je produciralo Klebsiella pneumoniae
karbapenemazu (KPC). Dokazana je razlika u osjetljivosti na antibiotike između ove dvije
grupe izolata. Svi testirani izolati K. pneumoniae koji produciraju KPC i OXA-48 su rezistentni
na ertapenem. Također, svi KPC-producirajući izolati su potpuno rezistentni i na ostale testirane
karbapeneme (imipenem i meropenem), za razliku od OXA-48-producirajući izolata, od kojih
je 47,5% rezistentno na imipenem te 65% izolata rezistentno na meropenem. Svi testirani KPC
izolati i 97,4% OXA-48 izolata je rezistentno na amikacin, dok je 95,5% KPC i 33,3% OXA48 izolata rezistentno na gentamicin. Svi testirani KPC i 97,5% OXA-48 izolata su rezistentni
na fluorokinolone. Na trimetoprim-sulfometaksazol je rezistentno 95% OXA-48 i 20,5% KPC
izolata. Rezistencija na kolistin iznosi 28,1% za OXA-48 i 14,3% za KPC izolate. Rezistencija
na fosfomicin je 76,2% za KPC i 50% za OXA-48 izolate. Na imipenem-relebaktam je
rezistentno 87,5% OXA-48 i 36,8% KPC izolata. Svi testirani izolati (OXA-48 i KPC) su
osjetljivi na ceftazidim-avibaktam.
Zaključak: Konstantno ispitivanje i praćenje antimikrobne osjetljivosti je iznimno važno kako
bi se pravovremeno primijenila učinkovita antimikrobna terapija. Prema rezultatima ovog
istraživanja, ceftazidim-avibaktam predstavlja najbolju terapijsku opciju za liječenje infekcija
koje uzrokuju karbapenem-rezistentni sojevi K. pneumoniae (bez obzira je li mehanizam
rezistencije produkcija KPC ili OXA-48) u KBC-u Split. |
| Abstract (english) | Objectives: The aim of the research is to determine the epidemiological and microbiological
characteristics of carbapenem-resistant Klebsiella pneumoniae which was isolated from lower
respiratory tract samples of patiens at the University Hospital of Split (UHS) in the period from
January 1st to December 31st, 2022.
Materials and methods: This retrospective, observational study evaluated characteristics of
all isolates of K. pneumoniae that were resistant to carbapenems and isolated from samples of
the lower respiratory tract of inpatients and outpatients at the Department of Microbiology and
Parasitology, University Hospital of Split, during the research period.
Results: A total of 85 carbapenem-resistant K. pneumoniae isolates were analyzed, out of
which 40 produced OXA-48, and 45 isolates produced KPC. The difference in sensitivity to
antibiotics was demonstrated between these two groups of isolates. All KPC- and OXA-48-
producing K. pneumoniae isolates tested were resistant to ertapenem. Also, all KPC-producing
isolates were resistant to other tested carbapenems (imipenem and meropenem), unlike OXA48-producing isolates, out of which 47.5% were resistant to imipenem and 65% of isolates were
resistant to meropenem. All tested KPC isolates and 97.4% of OXA-48 isolates were resistant
to amikacin. while 95.5% of KPC and 33.3% of OXA-48 isolates were resistant to gentamicin.
All tested KPC and 97.5% of OXA-48 isolates were resistant to fluoroquinolones. 95% of
OXA-48 and 20.5% of KPC isolates were resistant to trimethoprim-sulfometaxazole.
Resistance to colistin was 28.1% for OXA-48 and 14.3% for KPC isolates. Fosfomycin
resistance was 76.2% for KPC and 50% for OXA-48 isolates. 87.5% of OXA-48 and 36.8% of
KPC isolates were resistant to imipenem-relebactam. All tested isolates (OXA-48 and KPC)
are susceptible to ceftazidime-avibactam.
Conclusion: Taken together, these data highlight the importance of constant examination and
monitoring of antimicrobal susceptibility in order to apply effective antimicrobial therapy in a
timely manner. According to the results of this research, ceftazidime-avibactam is the best
therapeutic option for the treatment of infections caused by carbapenem-resistant strains of K.
pneumoniae (regardless of whether the mechanism of resistance is the production of KPC or
OXA-48) at the University Hospital of Split. |
