Abstract
The article describes activities of an antibiotic center at a university hospital in the Czech Republic and presents the results of antibiotic stewardship program implementation over a period of 10 years. It provides data on the development of resistance of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus to selected antibiotic agents as well as consumption data for various antibiotic classes. The genetic basis of resistance to beta-lactam antibiotics and its clonal spread were also assessed. The study showed significant correlations between aminoglycoside consumption and resistance of Escherichia coli and Klebsiella pneumoniae to gentamicin (r = 0.712, r = 0.869), fluoroquinolone consumption and resistance of Klebsiella pneumoniae to ciprofloxacin (r = 0.896), aminoglycoside consumption and resistance of Pseudomonas aeruginosa to amikacin (r = 0.716), as well as carbapenem consumption and resistance of Pseudomonas aeruginosa to meropenem (r = 0.855). Genotyping of ESBL- positive isolates of Klebsiella pneumoniae and Escherichia coli showed a predominance of CTX-M-type; in AmpC-positive strains, DHA, EBC and CIT enzymes prevailed. Of 19 meropenem-resistant strains of Klebsiella pneumoniae, two were identified as NDM-positive. Clonal spread of these strains was not detected. The results suggest that comprehensive antibiotic stewardship implementation in a healthcare facility may help to maintain the effectiveness of antibiotics against bacterial pathogens. Particularly beneficial is the work of clinical microbiologists who, among other things, approve administration of antibiotics to patients with bacterial infections and directly participate in their antibiotic therapy.
Highlights
Antibiotic stewardship may be defined as a set of measures leading to rational antibiotic therapy based on the adequate selection of antibacterial agents, appropriate duration of their administration and a suitable route of administration [1,2,3,4]
The results indicate an increase in resistance of Escherichia coli to piperacillin/tazobactam (r = 0.939), gentamicin (r = 0.826), ciprofloxacin (r = 0.816) and cefotaxime (r = 0.734)
The presented data suggest low rates of bacterial resistance at the University Hospital Olomouc, with the only exception being an increased prevalence of meropenem-resistant strains of Pseudomonas aeruginosa. This confirms the importance of antibiotic stewardship and surveillance of antimicrobial resistance, including the use of molecular biology methods, for maintaining the effectiveness of antibiotics and limiting the spread of multidrugresistant bacterial pathogens
Summary
Antibiotic stewardship may be defined as a set of measures leading to rational antibiotic therapy based on the adequate selection of antibacterial agents, appropriate duration of their administration and a suitable route of administration [1,2,3,4].
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