Abstract
Species of the family Enterobacteriaceae represent the most prevalent group of nosocomial pathogens. In this paper, we report the data on antimicrobial susceptibility of 573 isolates of Enterobacteriaceae collected in 25 hospitals of 18 cities of Russia in 2011–2012 as part of the national multicenter surveillance study on antimicrobial resistance of nosocomial pathogens, «MARATHON». Enterobacteriaceae isolates jointly comprised 33.7% of all bacterial nosocomial isolates. The most abundant species were Klebsiella pneumoniae (16.9%), Escherichia coli (7.9%) and Enterobacter cloacae (2.6%). Most of the isolates were insusceptible to oxyimino-b-lactams: cefotaxime (83.8%), ceftazidime (81.3%), cefepime (79.1%) and aztreonam (80.6%). Production of extended-spectrum b-lactamases (ESBLs) was detected in 78.2% of all isolates, including 90.6% of K. pneumoniae and 82.1% of E. coli. The non-susceptibility rates to carbapenems were: 2.8% to meropenem, 8.4% to imipenem and 14.0% to etrapenem. The majority of carbapenem resistant isolates were K. pneumoniae. 3.7% of all isolates were found to produce carbapenemases of OXA-48 – (3.3%) and NDM-1-group (0.4%). Most of the isolates were insusceptible to tobramycin (74.0%), gentamicin (60.4%), ciprofloxacin (70.5%) and trimethoprim-sulfamethoxazole (63.7%). Among non-b-lactam agents, the lowest resistance rates were observed with fosfomycin (14.1%), tigecycline 15,9%, colistin (16.1%) and amikacin (36,1%). Notably, 11.7% of the isolates were categorised as extensively drug-resistant (XDR).
-
1.
Решедько Г.К., Рябкова Е.Л., Кречикова О.И., Сухорукова М. В., Шевченко О. В., Эйдельштейн М. В., Козлов Р.С., Туркутюков В. Б., Нехаева Г. И., Бочкарев Д. Н., Розанова С.М., Боронина Л. Г., Агапова Е. Д., Марусина Н.Е., Мултых И. Г., Тарабан В. К., Здзитовецкий Д. Э., Сарматова Н. И., Тихонов Ю.Г., Поликарпова С.В. идр. Резистентность к антибиотикам грамотрицательных возбудителей нозокомиальных инфекций в ОРИТ многопрофильных стационаров России. Клин микробиол антимикроб химиотер 2008; 10 (2):96-112.
-
2.
Sukhorukova M., Kozyreva V., Ivanchik N., Edelstein M., Kozlov R. and members of ROSNET study group. Five-year trends in the prevalence and types of ESBLs and antimicrobial susceptibility of ESBLproducing nosocomial strains of Enterobacteriaceae in Russia. Abstr. P716. 20th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID). 2010. Vienna, Austria.
-
3.
Skleenova E., Sukhorukova M., Timokhova A., Martinovich A, Savochkina J., Edelstein M., Kozlov R. Sharp increase in carbapenem-non-susceptibility and carbapenemase production rates in nosocomial Gramnegative bacteria in Russia over the last decade. Abstr. C2-1092. 53rd Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), 2012, Denver, CO, USA.
-
4.
Эйдельштейн М.В., Склеенова Е.Ю., Шевченко О.В., Тапальский Д.В., Азизов И.С., Дсоуза Д.В., Тимохова А. В., Сухорукова М. В., Козырева В. К., Сафронова Е. В., Астахова М. В., Карпов И. А., Шамаева С. Х., Абрамова Н. В., Гординская Н. А., Козлов Р.С. Распространенность и молекулярная эпидемиология грамотрицательных бактерий, продуцирующих металло-бета-лактамазы, в России, Беларуси и Казахстане. Клин микробиол антимикроб химиотер 2012; 14(2):132-52.
-
5.
Livermore DM. Beta-Lactamases in laboratory and clinical resistance. Clin Microbiol Rev 1995; 8 (4):557-84.
-
6.
Leclercq R, Cantón R, Brown DF, Giske CG, Heisig P, MacGowan AP, Mouton JW, Nordmann P, Rodloff AC,Rossolini GM, Soussy CJ, Steinbakk M, Winstanley TG, Kahlmeter G. EUCAST expert rules in antimicrobial susceptibility testing. Clin Microbiol Infect 2013; 19(2):141-60.
-
7.
Pendleton JN, Gorman SP, Gilmore BF. Clinical relevance of the ESKAPE pathogens. Expert Rev Anti Infect Ther 2013; 11 (3):297-308.
-
8.
Edelstein M, Pimkin M, Palagin I, Edelstein I, Stratchounski L. Prevalence and molecular epidemiology of CTX-M extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Russian hospitals. Antimicrob Agents Chemother 2003; 47(12):3724-32.
-
9.
Karaiskos I, Giamarellou H. Multidrug-resistant and extensively drug-resistant Gram-negative pathogens: current and emerging therapeutic approaches. Expert Opin Pharmacother. 2014;15 (10):1351-70.
-
10.
Cantón R, Akóva M, Carmeli Y, Giske CG, GlupczynskiY, Gniadkowski M, Livermore DM, Miriagou V, Naas T, Rossolini GM, Samuelsen Ø, Seifert H, Woodford N, Nordmann P; European Network on Carbapenemases. Rapid evolution and spread of carbapenemases among Enterobacteriaceae in Europe. Clin Microbiol Infect 2012; 18(5):413-31.
-
11.
Shevchenko OV, Mudrak DY, Skleenova EY, Kozyreva VK, Ilina EN, Ikryannikova LN, Alexandrova IA, Sidorenko SV, Edelstein MV. First detection of VIM-4 metallo-b-lactamase-producing Escherichia coli in Russia. Clin Microbiol Infect. 2012; 18(7):E214-7.
-
12.
Ageevets VA, Partina IV, Lisitsyna ES, Ilina EN, Lobzin YV, Shlyapnikov SA, Sidorenko SV. Emergence of carbapenemase-producing Gram-negative bacteria in Saint Petersburg, Russia. Int J Antimicrob Agents 2014; 44(2):152-5.
-
13.
Barantsevich EP, Churkina IV, Barantsevich NE, Pelkonen J, Schlyakhto EV, Woodford N. Emergence of Klebsiella pneumoniae producing NDM-1 carbapenemase in Saint Petersburg, Russia. J Antimicrob Chemother 2013; 68(5):1204-6.
-
14.
Wiegand I, Hilpert K, Hancock RE. Agar and broth dilution methods to determine the minimal inhibitory concentration (MIC) of antimicrobial substances. Nat Protoc 2008; 3(2):163-75.
-
15.
Andrews JM. Determination of minimum inhibitory concentrations. J Antimicrob Chemother 2001; 48(S1):5-16.
-
16.
ISO 20776-1:2006 «Clinical laboratory testing and in vitro diagnostic test systems — Susceptibility testing of infectious agents and evaluation of performance of antimicrobial susceptibility test devices — Part 1: Reference method for testing the in vitro activity of antimicrobial agents against rapidly growing aerobic bacteria involved in infectious diseases.
-
17.
Национальный Стандарт ГОСТ Р ИСО 20776-1-2010 Клинические лабораторные исследования и диагностические тест-системы in vitro. Исследование чувствительности инфекционных агентов и оценка функциональных характеристик изделий для исследования чувствительности к антимикробным средствам. Часть 1. Референтный метод лабораторного исследования активности антимикробных агентов против быстрорастущих аэробных бактерий, вызывающих инфекционные болезни.
-
18.
European Committee on Antimicrobial Susceptibility testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters. Ver. 4.02014 (http://www.eucast.org/clinical_breakpoints/).
-
19.
Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing; Twenty-First Informational Supplement. CLSI document M100-S24. Wayne, PA:2014.
-
20.
European Committee on Antimicrobial Susceptibility testing (EUCAST). EUCAST guideline for the detection of resistance mechanisms and specific resistances of clinical and/or epidemiological importance. V 1.02013 (http://www.eucast.org/resistance_mechanisms/).
-
21.
Эйдельштейн М. В. Выявление бета-лактамаз расширенного спектра у грамотрицательных бактерий с помощью фенотипических методов. Клин микробиол антимикроб химиотер 2001; 3(2):183-9.
-
22.
Dortet L, Poirel L, Nordmann P. Rapid identification of carbapenemase types in Enterobacteriaceae and Pseudomonas spp. by using a biochemical test. Antimicrob Agents Chemother 2012; 56(12):6437-40.
-
23.
Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S, Hindler JF, Kahlmeter G, Olsson-Liljequist B, Paterson DL, Rice LB, Stelling J, Struelens MJ, Vatopoulos A, Weber JT, Monnet DL. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18(3):268-81.