Potrošnja antibiotika u bolnicama i stopa otpornosti bakterija Klebsiella pneumoniae i Escherichia coli u Crnoj Gori

Abstract

Inappropriate use of antibiotics leads to an increase in antibiotic resistance. Infections caused by antibiotic-resistant gram-negative bacteria are a serious threat to public health. This study aimed to compare data on inpatient antibiotic consumption with antimicrobial resistance (AMR) rate of Klebsiella pneumoniae and Escherichia coli invasive strains in Montenegro and provide targets for improving antibiotic use. We used the national data on antibiotic consumption from 2009 to 2015, Point Prevalence Survey data on inpatient antibiotic consumption from 2015, and national AMR data on 79 Klebsiella pneumoniae and 68 Escherichia coli isolates collected from 8 hospitals from 2016 to 2018. The most commonly used antibiotics were third-generation cephalosporins with a median annual consumption of 0.66 DDD/1000/day. Ceftriaxone was the most frequently prescribed antibiotic in the treatment of community/hospital acquired infections and surgical/medical prophylaxis. The highest resistance rates were recorded for Klebsiella pneumoniae to ceftriaxone, ceftazidime and gentamicin (93.59%, 90.79% and 89.87%, respectively), and Escherichia coli to aminopenicillins, ceftriaxone and ceftazidime (89.06%, 70.15% and 61.54%, respectively). High consumption of broadspectrum antibiotics in Montenegro is accompanied by the high rate of resistance of Klebsiella pneumoniae and Escherichia coli to these agents. Antibiotic misuse demands the introduction of an antimicrobial stewardship program in Montenegrin hospitals.Neodgovarajuća upotreba antibiotika dovodi do povećanja otpornosti na antibiotike. Infekcije uzrokovane gram-negativnim bakterijama otpornima na antibiotike ozbiljna su prijetnja javnom zdravlju. Ovo istraživanje imalo je za cilj usporediti podatke o potrošnji antibiotika u bolnicama sa stopom antimikrobne rezistentnosti (AMR) invazivnih sojeva Klebsiella pneumoniae i Escherichia coli u Crnoj Gori i osigurati ciljeve za poboljšanje upotrebe antibiotika. Rabili smo nacionalne podatke o potrošnji antibiotika od 2009. do 2015. godine, podatke iz studije presjeka o potrošnji antibiotika u bolnicama u 2015. godini i nacionalne podatke AMR za 79 izolata Klebsiella pneumoniae i 68 izolata Escherichia coli prikupljena iz 8 bolnica od 2016. do 2018. godine. Najčešće primijenjeni antibiotici bili su cefalosporini treće generacije s medijanom godišnje potrošnje od 0,66 DDD/1000/dan. Ceftriakson je najčešće propisivani antibiotik u liječenju izvanbolničkih i bolničkih infekcija te u kirurškoj/medicinskoj profilaksi. Stopa otpornosti Klebsiella pneumoniae bila je najviša na ceftriakson, ceftazidim i gentamicin (93,59%, 90,79% odnosno 89,87%), a Escherichia coli na aminopeniciline, ceftriakson i ceftazidim (89,06%, 70,15% odnosno 61,54%). Visoka potrošnja antibiotika širokog spektra u Crnoj Gori praćena je visokom stopom otpornosti Klebsiella pneumoniae i Escherichia coli na njih. Zlouporaba antibiotika zahtijeva uvođenje programa antimikrobnog upravljanja u crnogorskim bolnicama