Year 2019 Vol. 27 No 2




Vitebsk State Medical University 1, Vitebsk,
Minsk Scientific and Practical Center of Surgery, Transplantation and Hematology 2, Minsk,
The Republic of Belarus

Objective. To establish factors of phenotypic and genotypic resistance of the most problematic infectious agents in the intensive care unit.
Methods. A comprehensive examination of 224 clinical isolates from the sputum of 99 patients in the intensive care unit was performed. Carbapenemase genes in Klebsiella pneumonia isolates were detected by real-time polymerase chain reaction and minimum inhibitory concentrations of antibiotics for microorganisms were determined in planktonic form and biofilm form by the method of double serial dilutions.
Results. In the structure of the studied isolates the most common were Acinetobacter spp. (32.6%), Klebsiella pneumonia (33.5%), Pseudomonas aeruginosa (14.7%). 91.4% of Klebsiella pneumoniae isolates possessed genes of resistance and in most cases – OXA-48 (80%). All the studied isolates moderately or well formed the biofilm, among the studied microorganisms Proteus mirabilis demonstrated this ability best of all. All isolates both in plankton form and in the form of biofilm were sensitive to tigecycline (100%) and resistant to carbapenems in 94.7%, to cephalosporins – in 100% of cases. For 90% of the studied isolates the minimum inhibitory concentration for tigecycline and ciprofloxacin in the biofilm does not change and increases for moxifloxacin in 1.3 times, for meropenem – 1.2 times.
Conclusions. The factors of phenotypic and genotypic resistance of the most problematic infectious agents in the intensive care unit have been established. Most of the carbapenemresistant Klebsiella pneumoniae isolates (88.5%) had gene associations: OXA-48 and CTX-M (37.1%), NDM and CTX-M (2.9%), NDM and OXA-48 (37.1%), CTX-M and OXA-48 (11.4%). The identification of resistance genes that determine the synthesis of carbapenemazes and cefalosporinazes eliminates the antibiotics that are destroyed by these enzymes from the algorithms of antibacterial therapy.

Keywords: antibiotic resistance, Klebsiella pneumoniae, Acinetobacter spp., Pseudomonas aeruginosa, biofilm formation, resistance genes
p. 188-195 of the original issue
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Address for correspondence:
210009, The Republic of Belarus,
Vitebsk, Frunze Avenue, 27а,
Vitebsk State Medical University,
Department of Anesthesiology and Resuscitation
With a Course of the Faculty of the Advanced
Training and Retraining of Specialists.
Tel. mobile +375291460799,
Viktoryia Yu. Ziamko
Information about the authors:
Ziamko Viktoryia Yu., Post-Graduate Student of the Department of Anesthesiology and Resuscitation with a Course of the Faculty of the Advanced Training and Retraining of Specialists, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
Okulich Vitaly K., PhD, Associate Professor of the Clinical Microbiology Department, Vitebsk State Medical University, Vitebsk, Republic of Belarus.
Dzyadzko Alexander M., MD, Head of the Intensive Care Unit, Minsk Scientific and Practical Center of Surgery, Transplantation and Hematology, Minsk, Republic of Belarus.
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