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Research in Pediatrics & Neonatology

Analysis of the Microbiological Spectrum and Antimicrobial Resistance of Pathogens in Patients of Paediatric Department of Anesthesiology and Intensive Care

Halyna Bulak* and Dzwenyslava Kopanska

Danylo Halytsky Lviv National Medical University, Ukraine

*Corresponding author: Halyna Bulak, Lviv City Children's Clinical Hospital, Department of Paediatrics N 2, Orlyk Street, 4, 79059, Lviv, Ukraine, Tel: +380505101112; Email: dr.bulakgalina@gmail.com

Submission: December 17, 2017; Published: February 02, 2018

DOI: 10.31031/RPN.2018.01.000518

ISSN : 2576-9200
Volume1 Issue4

Abstract

Today the issue of antimicrobial resistance is growing, as there is a dramatic growth of multi- and pan-resistant bacteria. The paper examines the microbial spectrum of pathogens in newborn babies who were treated in the Paediatric Department of Anesthesiology and Intensive Care. The dominance of the gram-positive flora (St. epidermidis and St. aureus) has been established. From gram-negative flora most often sowed Kl. pneumoniae and E. coli. The analysis of antibiotic regimens showed high resistance t a big number of antibiotics: penicillin, erythromycin, amoxiclav and other.

Keywords: Antimicrobial resistance; Infection; Gram-positive flora

Abbreviations: AMR: Antimicrobial Resistance

Introduction

In modern conditions controi of infectious diseases goes far beyond the pureiy medicai probiems and takes the vaiue of nationai security, especiaiiy when it concerns the chiid popuiation - the future of our state. Increasing the risk of deveioping epidemics, the pathomorphosis of the ciinicai course of many infections, increasing the frequency of registration of diseases that were previousiy considered endemic in remote areas of our country, the deveiopment of antimicrobiai resistance (AMR) of pathogens and reducing the immune defense of the organism under the influence of various exogenous and endogenous factors - these chaiienges need to combine efforts of ciinicians, scientists and heaith organizers. Today the issue of AMR is growing, as there is a dramatic growth of multi- and pan-resistant bacteria. The percentage of infections resistant to antibiotics increased from 0.2% in 2007 to 1.5% in 2015 and this trend continues to grow. At the VIII th European Congress of Pediatricians in Bucharest (Romania) and Harel Seidenwerg (Germany), held on June 7-10, 2017, was presented on the risk of bacteria resistant to antibiotics, especiaiiy for pediatrics. It has become known that 25 thousand deaths per year in the countries of the European Union are due to antibiotic resistance.

Resistance of microorganisms to antibiotics can be true and acquired [1,2]. True (natural) stability is characterized by the absence of antibiotic action in target microorganisms or by the inaccessibiiity of the target due to initiaiiy iow permeabiiity or enzymatic inactivation. If bacteria have naturai resistance, antibiotics are ciinicaiiy ineffective. By the acquired stabiiity, the property of individuai strains of bacteria is maintained viabie at those concentrations of antibiotics that suppress the buik of the microbial population. The appearance of acquired resistance in bacteria is not necessariiy accompanied by a decrease in the clinical effectiveness of the antibiotic. The formation of resistance in aii cases is due to geneticaiiy - the acquisition of new genetic information or a change in the ievei of expression of their own genes.

The aim of our study was to evaluate the results ofbacteriological examination in patients in the first month of life who were treated in the Paediatric Department of Anesthesioiogy and Intensive Care and to assess the dynamics of AMR with the definition of the group of the most effective antibacteriai drugs.

Materials and Methods

A retrospective analysis was carried out of 428 histories of diseases of chiidren who were treated in the Paediatric Department of Anesthesioiogy and Intensive Care of the Lviv City Children's Clinical Hospital during the period from January 2016 to January 2017. Microbiological studies were performed in the bacterioiogicai iaboratory of Lviv City Chiidren's Ciinicai Hospitai, the disc diffusion method. The method is based on the ability of antibiotics to diffuse from impregnated paper in a positive medium and suppress the growth of microorganisms sowed on the surface of the agar [3,4]. Internationally recognized growth media for determining the sensitivity of microorganisms to antibiotics is agar or Mueller-Hinton broth and the medium is prepared on their basis. Determination of the types and sensitivity of antibiotics of gram-positive and gram-negative bacteria was carried out on a bacteriological analyzer VITEK 2 COMPACT (Biomerie, France) using the AES software: Global CLSI-based + Phenotypic. Sensitivity to antibiotics was taken into account according to SLSI and EUCAST tables. All patients conducted microbiological research spectrum of blood, conjunctiva and navel.

Results and Discussion

Under our supervision, there were 428 newborn babies who were treated in the Paediatric Department of Anesthesiology and Intensive Care of the Lviv City Children's Clinical Hospital during the period from January 2016 to January 2017. It was found that the most common risk factors for patients in which revealed a variety of pathogens in the blood:

    • Central venous catheter (100%)

    • Urinary catheter (83.6%)

    • Ventilation > 5 days (82.4%)

    • Parenteral nutrition > 7 days (77.1%)

    • Large operation (74.2%)

    • Congenital birth defects (66.8%)

Now we provide you with data on the number of sowed pathogenic bacteria in the appropriate group of children with certain diseases. The number of children with respiratory distress syndrome, pneumonia was 140 children, of which the pathogens in the blood were sown in 32 newborn (22.9%). Among 102 premature infants and those who were on parenteral nutrition for more than 7 days, pathogenic bacteria were sown in 18 children (17.6%). Among children with congenital malformations, which numbered 79 children, the causative agents were sown in 22 children (27.8%). In 14 children with congenital malformations of the gastrointestinal tract pathogens were sown in 7 newborn (50%). Among 32 children with verified intrauterine infection, pathological pathogens were sown in 7 children (21.9%). Also, pathogens were instilled among patients with diseases such as sepsis, jaundice of newborns, but their number was not significant, compared with the previous indicators. According to research data, among all 428 children in 86 of them, gram-positive flora was sown from blood. As for the gram-positive flora, the two most common pathogens were St. aureus and St. epidermidis. The greatest sensitivity of these bacteria was to: vancomycin and oxacillin, and resistant to erythromycin and penicillin.

Gram-negative flora during the study was sown only from the navel and conjunctiva of children. The number of such children was 40 persons. However, the most common pathogens were Kl. pneumoniae and E. coli. In the third place was Ps. aeruginosa. The distribution in this category was as follows: Kl. pneumoniae was sown in 15 children, E. coli - in 22 children, Ps. aeruginosa - in 3 children. The greatest sensitivity of these pathogens was shown to: cefoperazone and ceftriaxone, while resistant to ampicillin and amoxiclav. As for Ps. aeruginosa sensitive to this pathogen was to cefepime, and resistant to gentamicin (Table 1).

Table 1:Sensitivity to antibiotics among the most common pathogens in patients of Paediatric Department of Anesthesiology and Intensive Care.


Conclusion

Analysis of the microbial spectrum of pathogens in newborn babies testified to the dominance of gram-positive flora - St. aureus and St. epidermis. There is documented high sensitivity to vancomycin, oxacillin. Revealed high rates of resistance to penicillin and erythromycin. From the gram-negative flora, such pathogens as Kl. pneumoniae and E. coli dominated. High sensitivity to cefoperazone and ceftriaxone was detected in this group of pathogens, and they were resistant to ampicillin and amoxiclav.

This problem concerns equally well both highly developed and industrial, and developing countries. Excessive use of antibiotics in many developed countries, insufficient duration of treatment for the poor - in the end, creates the same threat to humanity as a whole. Antibiotic resistance is a global problem. There is no country that couid afford to ignore it, and there is no country that couid not respond to it. Only simultaneous actions to curb the growth of antibiotic resistance in each individuai country wiii be abie to give positive resuits throughout the worid.

Conflict of Interest

The authors do not report any financial or personal connections with other persons or organizations, which might negativeiy affect the content of this pubiication and/or ciaim authorship rights to this pubiication.

References

  1. Poole k (2004) Bacterial multidrug resistance-emphasis on efflux mechanisms and Pseudomonas aeruginosa. J Antimicrob Chemother 34(4): 453-456.
  2. . Supotnitsky MV (2011) Mechanisms of development of resistance to antibiotics in bacteria. Biopreparations 2: 4-44.
  3. Erman MV (2012) Infection of the urinary system in children. Therapy and resistance 28-34.
  4. Strachunsky LS, Belousova Yu B, Kozlov SN (2002) Practical guidance on anti-infectious chemotherapy.

© 2018 Halyna Bulak, et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially.



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