© Borgis - Postępy Nauk Medycznych 11/2014, s. 783-786
*Joanna Krzowska-Firych1, Agata Kozłowska1, Taral Sukhadia2, Lamis Karolina Al-Mosawi2
Zakażenia szpitalne wywołane przez lekooporne bakterie
Hospital-acquired infections caused by antibiotic resistant bacteria
1Department of Infectious Diseases, Medical University, Lublin
Head of Department: Krzysztof Tomasiewicz, MD, PhD
2Clinical Research Association for Infectious Diseases (CRAID), Department of Infectious Diseases, Medical University, Lublin
CRAID Coordinator: Joanna Krzowska-Firych, MD, PhD
Streszczenie
Na świecie zakażenia szpitalne stanowią istotną przyczynę zachorowalności i śmiertelności, zwłaszcza jeżeli czynnikiem etiologicznym są lekooporne drobnoustroje. W Europie w ostatnich dekadach odnotowuje się stały wzrost częstości zakażeń szpitalnych wywołanych przez bakterie oporne na antybiotyki, co powoduje wzrost kosztów leczenia, niepowodzeń terapeutycznych i zgonów. Szacuje się, że rocznie w krajach Unii Europejskiej u około 4 100 000 hospitalizowanych pacjentów występują zakażenia szpitalne. Liczba zgonów będących bezpośrednim następstwem tych zakażeń wynosi około 37 000. Ponad 70% bakterii będących przyczyną zakażeń szpitalnych wykazuje oporność na co najmniej jeden antybiotyk. Lekooporność drobnoustrojów stanowi zatem poważny problem w aspekcie zdrowia publicznego. Spośród bakterii Gram-dodatnich głównymi patogenami są oporne na wankomycynę enterokoki (VRE), pneumokoki i metycylinooporne szczepy Staphylococcus aureus (MRSA). Zjawisko wielolekooporności występujące wśród bakterii Gram-ujemnych stanowi poważne i rosnące zagrożenie dla hospitalizowanych pacjentów, zwłaszcza w oddziałach intensywnej terapii.
W tym artykule omówiono zagadnienia dotyczące problematyki lekooporności wśród drobnoustrojów szpitalnych stanowiących istotne zagrożenie dla pacjentów placówek służby zdrowia.
Summary
Hospital acquired infections (HAIs) caused by antibiotic resistant bacteria are a significant cause of morbidity and mortality worldwide. In recent decades the incidence of HAI with antibiotic resistant bacteria has increased remarkably. The percentages of antimicrobial resistance continued to increase in Europe leading to mounting healthcare costs, failed treatment and deaths. Approximately 4 100 000 patients are estimated to acquire a healthcare-associated infection in the European Union (EU) every year. The number of deaths occurring as a direct consequence of these infections is estimated to be at least 37 000. More than 70% of the bacteria that causes HAIs are resistant to at least one antibiotic. Antimicrobial resistance (AMR) is a serious threat to public health. Among Gram--positive bacteria vancomycin-resistant enterococci (VRE), pneumococcal infections, and methicillin-resistant Staphylococcus aureus (MRSA) are the most important. Multidrug--resistant Gram-negative bacteria pose a serious and rapidly emerging threat to patients in healthcare settings, and are especially prevalent in intensive therapy units (ITUs).
This review details the main aspects of drug-resistant bacteria being a serious threat to patients in healthcare settings.
INTRODUCTION
Hospital acquired infections (HAIs) also known as a nosocomial infections are a significant cause of morbidity and mortality worldwide, especially if the causative organism has developed resistance to a number of antimicrobial agents (1).
Approximately 4 100 000 patients are estimated to acquire a healthcare-associated infection in the European Union (EU) every year. The number of deaths occurring as a direct consequence of these infections is estimated to be at least 37 000. About 5-10% of patients admitted to acute care hospitals and long-term care facilities in the United States develop a hospital--acquired infection, with an annual total of more than one million people (2).
Antimicrobial resistance (AMR) is a serious threat to public health. More than 70% of the bacteria that causes HAIs are resistant to at least one antibiotic. In recent decades the incidence of HAI with antibiotic resistant bacteria has increased remarkably and the fight against HAI has become of critical concern to clinicians worldwide. Antibiotic resistance is a critical challenge for infective disease management. The percentages of AMR, especially multidrug resistance (MDR), continued to increase in Europe leading to mounting healthcare costs, failed treatments, and deaths. Data from the European Antimicrobial Resistance Surveillance Network (EARS-Net) indicate that the proportion of strains of major pathogens isolated from blood or cerebrospinal fluid (CSF) with resistance to important antimicrobial agents exceeds 10% or even 25% in several countries, with the highest figures seen in southern and eastern Europe (3, 4).
Multidrug-resistance (MDR) was defined as acquired non-susceptibility to at least one agent in three or more antimicrobial categories. Extensively drug-resistance (XDR) was defined as non-susceptibility to at least one agent in all but two or fewer antimicrobial categories and pandrug-resistance (PDR) was defined as non-susceptibility to all agents in all antimicrobial categories (3).
Gram-positive and Gram-negative bacteria are both affected by the emergence and rise of antimicrobial resistance and this problem continues to grow (3).
Gram-positive resistance
Vancomycin-resistant enterococci (VRE) were first described in Europe in 1988 and have rapidly spread worldwide. Enterococci are a part of the normal human faecal flora. The main sites of colonization in the hospitalized patients are soft tissue wounds, ulcers, and the gastrointestinal tract. Enterococci were reported as the second most common cause of nosocomial infection in the US. Infections with these pathogens have been associated with poor outcomes (5).
There are six recognized phenotypes of vancomycin resistance: VanA, VanB, VanC, VanD, VanE, and VanG. Human enterococcal infections are mainly caused by 2 species: Enterococcus faecalis and Enterococcus faecium, which express the VanA or VanB phenotype. The most common nosocomial infections produced by these pathogens are urinary tract infections (associated with instrumentation and antimicrobial resistance) followed by intra-abdominal and pelvic infections. They also cause surgical wound infections, bacteriemia, endocarditis, neonatal sepsis, and rarely meningitis (6, 7).
The data from multicentre study from Poland revealed that among urinary tract pathogens Gram-positive cocci were isolated more frequently from a hospital setting (14.1%) and the most common were Enterococcus spp. (8.5%). Three strains of E. faecalis from hospital expressed high-level aminoglycoside resistance (HLAR) (8). The incidence of human VRE infections in European countries is low (1-3%) compared with the high and rising rate in the US (9). An important feature in the emergence of the enterococci as a cause of nosocomial infections is their increasing resistance to a wide range of antibiotics both instrinsic and acquired resistance. Recommendations for controlling vancomycin resistance include reducing the use of drugs known to increase the risk of enterococcal infection (e.g. third-generation cephalosporins), limiting vancomycin use, applying accurate microbiological identification methods, and maintaining hand-washing procedure (8-10).
Pneumococcal resistance
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Piśmiennictwo
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