hrvatski

Epidemiologija infekcija uzrokovanih gram-negativnim bakterijama koje produciraju β-laktamaze proširenog spektra, plazmidne AmpC β-laktamaze i karbapenemaze u bolničkih i vanbolničkih pacijenata

Kratki sažetak doktorskog rada: Beta-laktamaze proširenog spektra (ESBL) su enzimi otkriveni u kasnim 1970-tim i ranim 1980-tim godinama među gram-negativnim bakterijama. Cilj istraživanja je ustanoviti prevalenciju ESBL u bolničkoj i izvanbolničkoj sredini, prevalenciju prema dobi i spolu, te prevalenciju ESBL, plazmidnih AmpC beta-laktamaza, te karbapenemaza. ESBL-producirajući izolati su izolovani u 144 bolnička i izvanbolnička uzorka. ESBL-producirajući izolati su većim dijelom porijekla iz mokraće i briseva kirurških rana. U bolničkoj sredini dominantna je ESBL-producirajuća Klebsiella spp., dok je u izvanbolničkoj sredini preovladavala ESBL-producirajuća E. coli. Prema rezultatima, cefuroksim, cefotaksim i ceftazidim su lijekovi koji se ne preporučuju u liječenju infekcija uzrokovanih ESBL-producirajućim bakterijama, sa MIK90≥256 mg/L. Ovo je prvi izvještaj o detekciji blaCTX-M-3, blaCTX-M-28, blaCMY-2 i blaDHA-1 na prostorima Bosne i Hercegovine. Ključne riječi: ESBL, blaCMY-2, blaDHA-1, blaOXA-51, genotipizacija, antimikrobna osjetljivost Short abstract: Extended-spectrum beta-lactamases (ESBLs) are enzymes that have been discovered in the late 1970s and early 1980s among gram-negative bacteria. The aim of this research is to establish prevalence of ESBL in hospital and outside environment, prevalence according to the age and sex, as well as prevalence of ESBL in individual hospital wards. It also includes prevalence of plasmid-mediated AmpC beta-lactamases and carbapenemases. ESBL was detected in 144 in- and outpatient samples, respectively. Both in- and outpatient ESBLs were mostly isolated from urine and surgical wounds. ESBL prevalence was highest in an inpatient Klebsiellaspp. and in outpatient Escherichia coli isolates. Cefuroxime, ceftazidime and cefotaxime were the least potent antibiotics with MIC90 of ≥ 256 mg/L. The CTX-M-15 was most prevalent β-lactamases in the in- and outpatient settings. This is the first report of blaCTX-M-3, blaCTX-M-28, blaCMY-2 and blaDHA-1 detected with the PCR from ESBL-producing isolates in Bosnia and Herzegovina. Key words: ESBL, blaCMY-2, blaDHA-1, blaOXA-51, genotyping, antimicrobial resistance

beta-laktamaze proširenog spektra; plazmidne ampC beta-laktamaze; karbapenemaze; enterobakterije

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