A REPORT OF RARELY OBSERVED RESISTANCE PATTERN TO CARBAPENEMS IN A CLINICAL ISOLATE OF ENTEROBACTER CLOACAE

Rad izvještava o pojavi soja Enterobacter cloacae u kojeg je dokazan rijetko viđen oblik otpornosti na karbapeneme posredovan enzimom IMI-1, skupine A beta-laktamaza. Soj je izoliran iz obriska rane u bolesnika koji je zbog infekcije kirurške rane prethodno liječen meropenemom. Ograničen izbor antibiotika kojima se mogu liječiti infekcije uzrokovane ovakvim uzročnicima upućuje na nužnost točne identifikacije višestruko otpornih gram-negativnih mikroorganizama i otkrivanje njihovih mehanizama otpornosti. Prepoznavanje višestruko otpornih mikroorganizama naglašava važnost kontinuiranoga mikrobiološkog nadzora bolesnika, osobito u jedinicama intenzivnog liječenja. U prikazanoj ustanovi nije bilo sekundarnog širenja ovog soja. Identifikacija novih mehanizama otpornosti pomaže kliničarima u izboru ciljane terapije, a istodobno je nužna za uspješno sprječavanje širenja infekcija izazvanih višestruko otpornim mikroorganizmima.The paper reports on the emergence of strain in which Enterobacter cloacae has demonstrated an unusual form of resistance to carbapenems mediated by enzyme IMI-1, class A beta-lactamase. The strain was isolated from a wound swab in the patient who had a surgical wound infection previously treated with meropenem. Limited choice of antibiotics that can treat infections caused by these pathogens indicates the necessity of accurate identification of multiple resistant gram-negative microorganisms and mechanisms of their resistance. Recognition of multiresistant gram-negative microorganisms emphasizes the importance of continuous microbiological monitoring of patients, especially in intensive care units. In the investigated institution there was no secondary spread of this strain. Identifying new mechanisms of resistance will be helpful to clinicians in selection of targeted therapy, while important for efficient prevention of spreading infections caused by multiple resistant microorganisms

RATIONAL USE OF ANTIMICROBIAL DRUGS IN CLINICAL PRACTICE BY IMPLEMENTING ANTIMICROBIAL STEWARDSHIP PROGRAMS

Prema dosadašnjim istraživanjima neracionalna primjena antimikrobne terapije značajan je problem u bolničkim i vanbolničkim ustanovama. Studije su pokazale da se približno 50 % antimikrobnih lijekova koristi nepotrebno i suboptimalno s obzirom na indikaciju, vrstu antimikrobnog lijeka, te duljinu primjene. Dosadašnja istraživanja su pokazala uzlazni trend prevalencije Clostridium diffi cile pseudomembranoznog kolitisa, bakterijskih patogena rezistentnih na fl uorokinolone i vankomicin rezistentnih enterokoka. Porast multirezistencije gram negativnih bakterija i na karbapeneme opasnost je za sigurnost bolesnika te ostavlja ograničene terapijske mogućnosti zadnje linije obrane poput primjene toksičnog polimiksinskog ntibiotika kolistina. U skladu s time mogućnosti optimalnog infektivnog liječenja već sada postaju ograničavajuće. Prema dosadašnjim radovima uvođenje bolničkog programa praćenja i rukovođenja antimikrobnom terapijom pokazalo se dobrim sredstvom optimalizacije antimikrobne terapije u 81 % studija. Primjena ovoga programa dovela je do značajnog poboljšanja mikrobiološkog ishoda, smanjenja stope antimikrobne rezistencije i nuspojava te kliničkog ishoda poput smanjenja stope mortaliteta i duljine boravka u bolnici. Stoga su Centres for Disease Control and Prevention, Atlanta, USA (CDC) i European Centre for Disease Prevention and Control (ECDC) suglasne da bi zdravstvene ustanove trebale implementirati multidisciplinarni Bolnički program praćenja i rukovođenja antimikrobnom terapijom (engl. Antimicrobic Stewardship Programs - ASP) u svakodnevnu kliničku praksu. Primjena navedenog programa započeta je 1. 12. 2016. g. u Klinici za kardiovaskularne bolesti Magdalena u sklopu Internacionalne kanadske akreditacije (Accreditation Canada International).According to studies, about 50% of antimicrobial drugs are prescribed unnecessarily and inappropriately in hospitals and other healthcare institutions. Besides the high prevalence of Clostridium diffi cile infection, of particular concern is the increase in bacterial pathogen resistance to fl uoroquinolones and vancomycin-resistant enterococci. Additionally, infections due to bacterial pathogens completely resistant to carbapenems are currently emerging in Europe. In this case, therapeutic options are limited to the use of the polymyxin antibiotic colistin, which is old and has many adverse and toxic events. Growing evidence demonstrates that hospital programs dedicated to improving the use of antimicrobial therapy, referred to as Antimicrobial Stewardship Programs (ASP), can optimize treatment of infections, reduce adverse events of antimicrobial therapy, improve patient safety and quality of care, and at the same time signifi cantly reduce hospital costs, mortality rate and length of hospital stay. Therefore, the US Centers for Disease Control and Prevention and European Centre for Disease Prevention and Control recommend that every acute care hospital implement the multidisciplinary ASP in daily clinical practice

RATIONAL USE OF ANTIMICROBIAL DRUGS IN CLINICAL PRACTICE BY IMPLEMENTING ANTIMICROBIAL STEWARDSHIP PROGRAMS

Prema dosadašnjim istraživanjima neracionalna primjena antimikrobne terapije značajan je problem u bolničkim i vanbolničkim ustanovama. Studije su pokazale da se približno 50 % antimikrobnih lijekova koristi nepotrebno i suboptimalno s obzirom na indikaciju, vrstu antimikrobnog lijeka, te duljinu primjene. Dosadašnja istraživanja su pokazala uzlazni trend prevalencije Clostridium diffi cile pseudomembranoznog kolitisa, bakterijskih patogena rezistentnih na fl uorokinolone i vankomicin rezistentnih enterokoka. Porast multirezistencije gram negativnih bakterija i na karbapeneme opasnost je za sigurnost bolesnika te ostavlja ograničene terapijske mogućnosti zadnje linije obrane poput primjene toksičnog polimiksinskog ntibiotika kolistina. U skladu s time mogućnosti optimalnog infektivnog liječenja već sada postaju ograničavajuće. Prema dosadašnjim radovima uvođenje bolničkog programa praćenja i rukovođenja antimikrobnom terapijom pokazalo se dobrim sredstvom optimalizacije antimikrobne terapije u 81 % studija. Primjena ovoga programa dovela je do značajnog poboljšanja mikrobiološkog ishoda, smanjenja stope antimikrobne rezistencije i nuspojava te kliničkog ishoda poput smanjenja stope mortaliteta i duljine boravka u bolnici. Stoga su Centres for Disease Control and Prevention, Atlanta, USA (CDC) i European Centre for Disease Prevention and Control (ECDC) suglasne da bi zdravstvene ustanove trebale implementirati multidisciplinarni Bolnički program praćenja i rukovođenja antimikrobnom terapijom (engl. Antimicrobic Stewardship Programs - ASP) u svakodnevnu kliničku praksu. Primjena navedenog programa započeta je 1. 12. 2016. g. u Klinici za kardiovaskularne bolesti Magdalena u sklopu Internacionalne kanadske akreditacije (Accreditation Canada International).According to studies, about 50% of antimicrobial drugs are prescribed unnecessarily and inappropriately in hospitals and other healthcare institutions. Besides the high prevalence of Clostridium diffi cile infection, of particular concern is the increase in bacterial pathogen resistance to fl uoroquinolones and vancomycin-resistant enterococci. Additionally, infections due to bacterial pathogens completely resistant to carbapenems are currently emerging in Europe. In this case, therapeutic options are limited to the use of the polymyxin antibiotic colistin, which is old and has many adverse and toxic events. Growing evidence demonstrates that hospital programs dedicated to improving the use of antimicrobial therapy, referred to as Antimicrobial Stewardship Programs (ASP), can optimize treatment of infections, reduce adverse events of antimicrobial therapy, improve patient safety and quality of care, and at the same time signifi cantly reduce hospital costs, mortality rate and length of hospital stay. Therefore, the US Centers for Disease Control and Prevention and European Centre for Disease Prevention and Control recommend that every acute care hospital implement the multidisciplinary ASP in daily clinical practice