Antibiotici i rezistencija bakterijaAntibiotics and bacterial resistanc

Arjana Tambić-Andrašević

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Rije~ Uredni{tvaAntibiotici i rezistencija bakterijaMnoga dostignu}a moderne medicine se zasnivaju na djelotvornosti antibiotika. Intenzivna kemoterapi-ja, invazivni dijagnosti~ki i terapeutski zahvati mogli su se razviti samo zahvaljuju}i uporabi antibiotika uprofilakti~ke i terapijske svrhe. Na`alost, uslijed {iroke uporabe antibiotika bakterije su razvile mehanizmeotpornosti na antibiotike, {to ~esto kompromitira uspjeh antimikrobne terapije. Pra}enje otpornosti bakteri-ja na antibiotike u lokalnim sredinama postala je, stoga, nu`nost kako bi empirijska antimikrobna terapijabila {to bolje osmi{ljena i prilago|ena ne samo o~ekivanim uzro~nicima, ve} i njihovoj osjetljivosti na an-tibiotike u odre|enoj sredini. Pra}enje otpornosti na antibiotike zapo~eto je u Hrvatskoj 1996. g. osnutkom Odbora za pra}enje rezis-tencije bakterija na antibiotike u RH pri Kolegiju za javno zdravstvo Akademije medicinskih znanostiHrvatske (AMZH). Krajem 2008. g. Ministarstvo zdravstva i socijalne skrbi RH izdalo je Nacionalni pro-gram za kontrolu otpornosti bakterija na antibiotike ~iju okosnicu ~ine pra}enje otpornosti na antibiotike,pra}enje potro{nje antibiotika i edukacija o racionalnoj uporabi ovih lijekova. Kako je rezistencija na an-tibiotike globalna prijetnja koja ne poznaje zemljopisne granice, Europa se sve vi{e ujedinjuje i na podru~jukontrole {irenja rezistencije. Krajem 1990-ih zapo~eta su dva zna~ajna europska projekta EuropeanAntimicrobial Resistance Surveillance System (EARSS) i European Surveillance of AntimicrobialConsumption (ESAC) u koje se Hrvatska, s obzirom na ve} postoje}u mre`u mikrobiolo{kih laboratorija,spremno uklju~ila. Sukladno preporukama Europske Unije i u Hrvatskoj je 2006. g. pri Ministarstvuzdravstva i socijalne skrbi RH osnovano interdisciplinarno tijelo koje koordinira sve aktivnosti vezane zaborbu protiv rezistencije (engl. intersectorial coordination mechanism, ICM) pod nazivom Inter-disciplinarna sekcija za kontrolu rezistencije na antibiotike (ISKRA). ISKRA koordinira sve aktivnostinavedene u nacionalnom programu o kontroli otpornosti na antibiotike koje, uz ve} dobro uhodano pra}enjeotpornosti i potro{nje antibiotika uklju~uju i novu inicijativu pisanja nacionalnih smjernica o racionalnojuporabi antibiotika. Do sada su izdane ISKRA hrvatske nacionalne smjernice o meticilin rezistentnomStaphylococcus aureus (MRSA), uroinfekcijama, grlobolji i kirur{koj profilaksi. Sve ove dugogodi{nje aktivnosti u Hrvatskoj dovele su do dobrog uvida u kretanje rezistencije uHrvatskoj. Podaci o trenutnim problemima na podru~ju otpornosti na antibiotike tradicionalno se iznose nasimpozijima o rezistenciji bakterija na antibiotike koji se u Hrvatskoj odr`avaju svake tri godine. U ovom iz-danju Infektolo{kog glasnika objavljena su najzna~ajnija izlaganja sa VI. hrvatskog simpozija o rezistenci-ji bakterija na antibiotike, odr`anog u Zagrebu u o`ujku 2009. g. Kako su za racionalno propisivanje antibi-otika bitni stru~njaci razli~itih struka, Simpozij je svojom temom privukao lije~nike mnogih struka –lije~nike intenzivne medicine, anesteziologe, kirurge, pedijatre, lije~nike op}e medicine, lije~nike mikrobi-ologe, infektologe i farmakologe te mnoge farmaceute. Eminentni europski i hrvatski stru~njaci iznjeli susvoja iskustva u organizaciji kontrole {irenja otpornosti na antibiotike u svojim zemljama i na razini Europete najnovije spoznaje o novim mehanizmima otpornosti na antibiotike u pojedinim bakterijskim vrstama.Jedan od zaklju~aka Simpozija je da trenutno najve}i izazov u lije~enju infektivnih bolesti predstavljaju in-fekcije uzrokovane multiplo, pa i pan-rezistentnim gram-negativnim bakterijama, za koje u dogledno vri-jeme nemamo novih terapijskih rje{enja te je ve}ina ~lanaka ovog izdanja Infektolo{kog glasnika posve}enaupravo toj problematici. Za one koji nisu mogli prisustvovati Simpoziju, a zainteresirani su za najnovija do-ga|anja na podru~ju otpornosti bakterija na antibiotike u Hrvatskoj i svijetu preporu~amo ovaj brojInfektolo{kog glasnika i nadamo se da }e ga ~itatelji na}i zanimljivim i korisnim {tivom.Gost urednik: Prof. dr. sc. Arjana Tambi} Andra{evi}ISSN 1331-2820UDK 616.9142Infektolo{ki glasnik 29:4, 142–143 (2009)Croatian Journal of Infection 29:4, 142–143 (2009)Uvodnik_4_09.qxd  22.3.2010  11:54  Page 142143Infektolo{ki glasnik 29:4, 142–143 (2009)Croatian Journal of Infection 29:4, 142–143 (2009)EditorialAntibiotics and bacterial resistanceMany of the modern medicine achievements are based on the effectiveness of antibiotics. Intensivechemotherapy, invasive diagnostic and therapeutic procedures could have been developed only thanks tothe use of antibiotics in prophylactic and therapeutic indications. Unfortunately due to the wide use of an-tibiotics bacteria have developed mechanisms of resistance to antibiotics which often compromises the suc-cess of antimicrobial therapy. Antibiotic resistance surveillance in local settings became, therefore, neces-sary for creating a meaningful empirical therapy designed to match not only the expected pathogens buttheir local sensitivity patterns as well.  Antibiotic resistance surveillance started in Croatia in 1996 by founding of the Croatian Committee forAntibiotic Resistance Surveillance within the Public Health Board of the Croatian Academy of MedicalSciences. At the end of 2008 the Croatian Ministry for Health and Social Welfare issued the National strate-gy for antibiotic resistance control in which antibiotic resistance surveillance, antibiotic consumption sur-veillance and education on rational use of antibiotics presented essential activities. As antibiotic resistancepresents a global threat that does not recognize geographical borders there are a lot of initiatives in Europeto approach this problem globally through joint internationally coordinated actions. At the end of 1990s twoimportant European projects were launched; the European Antimicrobial Resistance Surveillance System(EARSS) and the European Surveillance of Antimicrobial Consumption (ESAC). Croatia readily joinedboth projects due to the already existing well organized network of microbiology laboratories. In line withthe European Union recommendations an intersectorial coordination mechanism (ICM) namedInterdisciplinarna sekcija za kontrolu rezistencije na antibiotike (ISKRA) was founded in 2006 within theCroatian Ministry of Health. ISKRA coordinates all the activities listed in the national program on antibiot-ic resistance control. Besides well established antibiotic resistance and antibiotic consumption surveillancethese activities include the new initiative of writing national guidelines on rational antibiotic use. So farISKRA national guidelines were developed for methicillin resistant Staphylococcus aureus (MRSA), uri-nary tract infections, sorethroat and surgical prophylaxis. All these yearlong activities in Croatia have led to a very good insight into antibiotic resistance issues inCroatia. Current data on antibiotic resistance are traditionally reported and discussed at the Croatian sym-posia on antibiotic resistance that take place every three years. The most important presentations from theVI Croatian symposium on antibiotic resistance, held in Zagreb in March 2009, are published in this issue ofInfektolo{ki glasnik. As professionals of different medical specialties interested in rational antibiotic pre-scribing the Symposium attracted physicians of different specialties – intensive care physicians, anesthesi-ologists, surgeons, pediatricians, general practitioners, clinical microbiologists, infectious disease doctors,clinical pharmacologists and many pharmacists. Distinguished European and Croatian experts presentedtheir experience in organization of antibiotic resistance control in their countries and in Europe and dis-cussed novel resistance mechanisms in different bacterial species. One of the conclusions of the Symposiumis that the biggest challenge in the treatment of infectious diseases today is the appearance of multi and pan--resistant gram-negative bacteria. For these organisms we do not have any new therapeutic options in thepipeline and therefore the majority of articles in this issue of Infektolo{ki glasnik are devoted to this prob-lem. For those who could not attend the Symposium but are interested in most recent developments in thefield of antibiotic resistance in Croatia and worldwide we recommend this issue of Infektolo{ki glasnik andwe hope that the readers will find it a useful and interesting literature.Guest editor: Prof. Arjana Tambi} Andra{evi}, MD, PhDISSN 1331-2820UDK 616.9Uvodnik_4_09.qxd  22.3.2010  11:54  Page 143

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