| Sažetak | Cilj istraživanja: Cilj istraživanja je otkriti najčešće izolate iz hemokultura i njihovu osjetljivost kod bolesnika koji su liječeni na kardio Jedinici intenzivnog liječenja Klinike za anesteziologiju, reanimatologiju i intenzivno liječenje KBC Split u godini 2015. poradi osmišljavanja što bolje empirijske antimikrobne terapije za određene uzročnike.
Materijal i metode: Retrospektivnim, kohortnim istraživanjem obuhvaćeni su svi pacijenti s pozitivnim hemokulturama na kardio JIL-u Klinike za anesteziologiju, reanimatologiju i intenzivno liječenje KBC Split. Od ukupnog broja pacijenata na kardio JIL-u (432) u 2015. godini, njih 6,71% imalo je pozitivne testove hemokulture.
Rezultati: U istraživanje je bilo uključeno 29 (6,71%) pacijenata s pozitivnim hemokulturama od njih ukupno 432 na kardio JIL-u. Uzorak za hemokulturu je češće uzet iz periferne krvi nego iz CVK, 40 puta se uzeo iz periferne krvi, a 17 iz CVK. Od uputnih dijagnoza najčešća je bila koronarna bolest s učestalošću od 24,14%, a od otpusnih respiracijska insuficijencija od koje je bilo liječeno ukupno 20,69% pacijenata. Najčešći izolat iz hemokultura među gram pozitivnima je bio meticilin rezistentni Staphylococcus epidermidis te na idućem mjestu koagulaza negativni stafilokok i MSSE. Od gram negativnih uzročnika najzastupljeniji je bio Acinetobacter baumannii. Najčešći izolat u 2015.godini u kardio JIL-u bio je MRSE, što podrazumijeva da je izrazito važno imati spremne antibiotike u liječenju toga izolata. Najuspješnijima su se pokazali vankomicin, teikoplanin, rifampicin i linezolid. Vankomicin, linezolid te rifampicin u 100% slučajeva rješavaju infekcije uzrokovane koagulaza negativnim stafilokokima. Teikoplanin se pokazao mogućim izborom u 75% slučajeva. U liječenju protiv methicilin susceptible staphylococcus epidermidis (MSSE) djelotvornima su se pokazali vankomicin, oksacilin, linezolid, tetraciklini, kombinacija amoksicilina i klavulanske kiseline te teikoplanin. Za najčešćeg uzročnika među gram negativnim bakterijama kolistin se pokazao djelotvornim u svim slučajevima, dok se kotrimoksazol pokazao kao moguća zamjena, ali samo s učinkovitošću od 38%. Na kombinaciju ampicilina i sulbaktama pokazao je umjerenu osjetljivost u 25% slučajeva.
Zaključak: Zaključeno je da su tri najčešća izolata na kardio JIL-u KBC Split meticilin rezistentni Staphylococcus epidermidis, Acinetobacter baumannii i Serratia marcescens. U liječenju protiv MRSE najuspješniji su se pokazali vankomicin, teikoplanin, rifampicin i linezolid. Kolistin se pokazao djelotvornim u svim slučajevima uzrokovanih A.baumannii. Kod Serratie marcescens najdjelotvornijima su se pokazali gentamicin, kotrimoksazol, ciprofloksacin, cefepim te kombinacija piperacilina i tazobaktama. |
| Sažetak (engleski) | Objective: The main aim of the thesis was to discover the most common pathogens isolated from blood cultures and their resistance at patients which were treated at cardio ICU of Department of anesthesiology, reanimatology and intensive care University Hospital Centre Split in 2015 in order to design better empirical antimicrobial therapy for certain pathogens.
Patients and methods: Research was conducted as retrospective cohort. All patients with positive blood cultures treated in cardio ICU of Department of anesthesiology, reanimatology and intensive care University Hospital Centre Split were included. Twenty nine out of the total number of patients (432) in 2015 had positive blood culture tests.
Results: The study included 29 patients with positive blood cultures from a total number of 432 patients on cardio ICU (6.71%). A sample of blood cultures is often taken from the peripheral blood than from CVC; 40 times are taken from the peripheral blood, and 17 of the CVC. The most common referral diagnosis accounting for 24.14% was coronary heart disease, and the most common discharge diagnosis was respiratory insufficiency. The most common pathogens from blood cultures among gram-positive was methicillin-resistant Staphylococcus epidermidis and in the next place coagulasis negative staphylococcus and methiclin susceptible staphylococcus epidermidis (MSSE). Most common gram negative pathogen was Acinetobacter baumannii. The most common isolated pathogen in 2015 in cardio ICU was MRSE, which means that it's extremely important to have ready antibiotics in the treatment of that pathogen. Vancomycin, teicoplanin, rifampicin and linezolid proved to be the most successful. Vancomycin, linezolid and rifampicin in 100% of cases were successful in infections caused by coagulase-negative staphylococci. Teicoplanin proved to be a possible choice in 75% of mentioned infections. Vancomycin, oxacillin, linezolid, tetracycline, a combination of amoxicillin and clavulanic acid, and teicoplanin proved to be effective treatment against MSSE. For the most common gram negative pathogen colistin is effective, in all cases, while cotrimoxazole proved to be possible, but only with the efficiency of 38%. On combination of ampiciline and sulbactam he showed 25% of moderatly sensitive.
Conclusion: We concluded that the three most common isolated pathogens in the cardio ICU KBC Split were methicillin-resistant Staphylococcus epidermidis, Acinetobacter baumannii, and Serratia marcescens. In therapy against MRSE the most successful proved to be vancomycin, teicoplanin, rifampicin and linezolid. Colistin is effective, in all infections caused by A.baumannii. The most effective antibiotic agents against Serratia marcescens were gentamicin, co-trimoxazole, ciprofloxacin, cefepime, and a combination of piperacillin and tazobactam. |
