CONTEMPORARY APPROACHES TO THE CHOICE OF ANTIBIOTIC THERAPY OF NOSOCOMIAL SURGICAL INFECTIONS CAUSED BY ACINETOBACTER BAUMANNII

Abstract

Introduction. Increase in the number of patients requiring the extensive surgical operations with invasive methods of perioperative period care on the background of secondary immunodeficiency as a risk for the development of nosocomial surgical infection (NSI) prompted us to analyze the etiologic role of A. baumannii (Ab) in the development of NSI, to analyze the trends of antimicrobial resistance (AMR) of Ab in the 12-year period (2003–2014) for justify the selection of rational antibacterial therapy (ABT). Material and methods. A non-randomized retrospective (2003–2014) epidemiological research of the results of the local microbiological monitoring (LMM) — seeding of 12243 isolates of pathogens, including the 1325 isolates non-fermenting Gram-negative bacteria (NFGNB), the exciters of NSI in a multidisciplinary 1100- beds Donetsk Regional Clinical Territorial Medical Formation (DRCTMF) had been done. Inclusion criteria were: clinical signs of infection, NFGNB-isolation in 48 hours after admission to the hospital; NFGNB isolates in an amount of not less than 105 CFU/ml. Microbiological investigations of blood, urine, wounds secretions and secretions of drainages were performed using an automated system VITEK®2 compact (bioMerieux Inc, France) with built-in expert program with elements of intelligence Advanced Expert System (AES™). Computer data processing by the program WHONET (v. 5.4). Until 2008, it was used exclusively disk diffusion method, from 2008 it was used selectively. Disk diffusion method (DDM) was used until 2008. From 2008 DDM it was used selectively. Results. From 2010 to 2014 in surgical departments of DRCTMF a significant increasing in the proportion of NFGNB and A. baumannii, as clinically significant etiological factor of the NSI with a critical decreasing of the sensitivity of the pathogens to antibacterial drugs (ABD) with “antipseudomonal activity” — the quinolones, protected penicillins, cephalosporins, carbapenems, aminoglycosides, but with a high sensitivity to colomycin and reducing of the sensitivity to tigecycline, tobramycin were detected. Conclusions. The LMM of nosocomial flora in medical institutions allows to reveal clinically significant pathogens of healthcare-associated NSI, the degree of resistance to the ABD and provides the rationale for the choice of an ABD or combination of ABD for initial empiric antibacterial therapy. A significant increase from 2010 to 2014 in the surgical departments of DRCTMF the proportion of NFGNB and A. baumannii, as clinically significant pathogens of NSI with the critical reduction of sensitivity of these pathogens to ABD with “antipseudomonas activity” corresponds to the global trends that require optimization of AB-therapy by drawing up the lists formulary for exception the ABD with a sensitivity of less than 25%; through the implementation of advanced techniques including continuous infusion of time-dependent antibiotics, combination of antibacterial therapy, extracorporeal antibacterial therapy.