Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2018, vol. 27, nr 3, March, p. 401–407

doi: 10.17219/acem/68545

Publication type: original article

Language: English

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Severe infections caused by multidrug-resistant non-fermentative bacilli in southern Poland

Agnieszka Chmielarczyk1,A,B,C,D,F, Monika Pobiega1,B,C, Grzegorz Ziółkowski2,B, Monika Pomorska-Wesołowska3,B, Dorota Romaniszyn1,C, Lech Krawczyk2,E, Jadwiga Wójkowska-Mach1,A,E,F

1 Chair of Microbiology, Jagiellonian University Medical College, Kraków, Poland

2 Higher School of Medicine in Sosnowiec, Poland

3 Department of Microbiology, Analytical and Microbiological Laboratory, KORLAB Non-public Healthcare Center, Ruda Śląska, Poland

Abstract

Background. The impact of multidrug-resistant organisms (MDROs), including non-fermentative bacilli (NFBs), is rising and underestimated, especially in intensive care units (ICUs). The growing prevalence of multidrug resistance (MDR) and extensive drug resistance (XDR) is challenging for clinicians, as the treatment options are limited.
Objectives. The purpose of this study was to analyze the extent of the epidemiological problem of multidrugresistant, extensively drug-resistant and pandrug-resistant (PDR) non-fermentative bacilli isolated from pneumonia and bloodstream infections (BSIs) in patients hospitalized in southern Poland.
Material and Methods. This study included 253 NFBs belonging to Acinetobacter sp. (ACI), Pseudomonas sp. (PAR), and Stenotrophomonas sp. (STM). The microorganisms were identified, and susceptibility testing was performed using a semi-automatic system. The different patterns of resistance were defined as MDR, XDR, or PDR strains. Epidemiological typing of A. baumannii from ICUs was performed by repetitive polymerase chain reaction (rep-PCR).
Results. More than half of the strains (57.7%) were isolated within ICUs. ACI-strains came significantly more often from ICU wards. The highest prevalence of ACI and PAR was found in pneumonia, whereas STM dominated in BSIs. ACIs were more frequently resistant than other pathogens to all studied antibiotics except colistin (n = 76; 58.9%), and they belonged to the XDR category. DiversiLab demonstrated the presence of 2 dominant clones in the ACI group, both classified as European Clone 2 (EUII).
Conclusion. Our results indicate serious potential therapeutic problems related to high antibiotic resistance of ACI isolates. The stratification of drug resistance (MDR/XDR/PDR) may become an important tool for the assessment of public health epidemiology and microbiological hazards at the local, national, and international level. It allows clear presentation of the issues concerning the epidemiology of highly resistant bacilli, and the exchange of information between medical staff and local representatives of public health for the implementation of effective measures to reduce drug resistance.

Key words

pneumonia, multidrug resistance, non-fermentative bacilli, bloodstream infections

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