Abstract
The aim of the study was to analyze the structure of nosocomial infectious agents
in cardiosurgical patients and to estimate their resistance to antimicrobial agents over the
last 10 years.
Material and methods. 71 915 samples of clinical material were analyzed in 2002-2011. The ratio
of positive results in different period was from 37.2 to 65.8% (in the mean 48%). Extraction and
identification of microorganisms were according to standard procedures. Sensitivity test to
antimicrobial agents was as directed to NCCLS/CLSI.
Results. It was noticed the decrease of gram-positive microorganisms from 58.3 to 33.6% with
increase of gram-negative bacteria from 33.3 to 62% in 2002-2011, respectively. Among
gram-positive cocci, coagulase negative staphylococci (CNS) was dominating -19.5-42.7%
from all microflora. Enterobacterias (K. pneumoniae, E. coli) dominated among gram-negative
bacteria and non-fermentative gram-negative bacteria (NGNB) - A. baumannii and
P. aeruginosa. The frequency of cryptococcus increased from 4 to 14.1% with following
decrease almost to the baseline from 2002 to 2007. The ratio of methicillin-resistant strains
among CNS was 81.4-94.3%. Vancomycin (98.4-99.8%), linezolid (95.6-100%), daptomycin
and tigecycline (100%) had high activity in respect of CNS. Sensitivity to maxifloxacin
increased from 43.3 to 83.5%. Compared to CNS, sensitivity of S. aureus to oxacillin was significantly
more - 50.8-76.8%. The progressive increase of extended-spectrum beta-lactamase
(ESBL)-producing enteric bacteria - 92.5-95.7% was detected. It makes carbapenems to be
agents of choice to treat infections, induced by the agents. Various mechanisms of resistance
determine high stability level of NGNB to antibiotics. Maximum activity was saved by colistin.
Total activity of fluconazole in regard to Candida spp. did not exceed 67.1% (in 2009) at that
the minimal level of sensitivity was 36.4% in 2011. Voriconazole had more activity. In the same
years, 94.3 and 75.8% of stains had sensitivity to it. All marked stains of cryptococcus had sensitivity
to amphotericin B.
Conclusion. Microbiological monitoring is the first requirement to provide a rational choice for
empiric antimicrobial therapy and also to plan and achieve infection control.
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