Prospektivna studija upotrebe antibiotika i stanja bakterijske rezistencije kofd hospitalizivane dece

Abstract

Rezistencija bakterija predstavlja veliki zdravstveni problem. Poznato je da je neracionalna upotreba antibiotika jedan od najznačajnijih uzroka porasta rezistencije. Posebno su ugrožena deca jer su najčešće izložena ovim lekovima. Cilj ove prospektivne jednogodišnje studije bio je da se utvrdi obim i struktura upotrebe antibiotika na Institutu za zdravstvenu zaštitu dece i omladine Vojvodine u Novom Sadu, kao i da se sagleda rezistencija i multirezistencija najčešće izolovanih bakterija kod dece u zavisnosti od uzrasta, pola, vrste bolesničkog materijala, godišnjih doba i klinike na kojoj su deca smeštena. Obim upotrebe antibiotika procenjen je primenom metode definisane dnevne doze (DDD) na 100 bolesničko-obskrbnih dana (BOD), uz primenu anatomsko-terapijsko-hemijske (ATC) klasifikacije lekova. Za procenu rezistencije i multirezistencije bakterija korišten je softver WHONET 5.4, razvijen od strane Svetske Zdravstvene Organizacije u svrhu ovakvih epidemioloških analiza. Rezultati su prikazani grafički i tabelarno uz statističku procenu razlika. Upotreba antibiotika: Prosečan obim upotrebe antibiotika na IZZZDIOV bio je 37,74 DDD/100BOD, s time što je na Klinici za hirurgiju bila 56,66, na Klinici za pedijatriju kod deca uzrasta do 2 godine 23,17, na Klinici za pedijatriju kod dece uzrasta 2-18 godina 44,10 i na Klinici za habilitaciju i rehabilitaciju 6,04 DDD/100BOD. Obim upotrebe antibiotika tokom zime na nivou celog IZZZDIOV bio je veći u odnosu na leto. Antibiotici su se koristili na svim klinikama i odeljenjima, bez izuzetaka. Bakteriološki nalazi: Od 11942 uzoraka poslatih na mikrobiološku analizu, 18,14% (2168/11952) bilo je bakteriološki pozitivno, s time da su najčešće analizirani bili uzorci krvi i urina. Značajno manje bakterija izolovano je zimi u odnosu na leto. Najčešće izolovana bakterija bila je Escherichia coli, a po učestalosti su sledili: Staphylococcus aureus, koagulaza negativni Staphylococcus spp, Klebsiella spp, Pseudomonas spp, Acinetobacter spp, Enterococcus spp i Enterobacter spp. Bakterije izolovane kod dece uzrasta do 2 godine u proseku su bile u većem procentu rezistentnije i multirezistentnije u odnosu na bakterije izolovane kod starije dece...

Bacterial resistance represents a major healthcare issue. Irrational use of antibiotics is known to be one of the main causes of increase in bacterial resistance. Children are particularly sensitive as they are the most exposed population to antibiotics. The aim of this prospective one-year study was to determine the extent and structure of antibiotic utilization a t the I nstitute for C hild a nd Y outh H ealth C are o f Vojvodina (ICYHCV) in Novi Sad, as well as to examine the resistance and multidrug resistance of the most frequently isolated bacteria in children, depending on their age, gender, type of patient material, the seasons and the clinic where patients were hospitalized. The use of antibiotics was assessed by the method of defined daily dose (DDD) per 100 bed days (BD), using the Anatomical Therapeutic Chemical (ATC) classification of antibiotics. WHONET 5.4 software, developed by the World Health Organization for the purpose of epidemiological analysis, was used to assess resistance and multidrug resistance of the isolated bacteria. The results are shown using graphs and tables, with statistical evaluation of the noted differences. Utilization of antibiotics: The average consumption o f a ntibiotics a t t he ICYHCV w as 3 7.74 D DD/100BD, w ith t he c onsumption a t t he C linic for s urgery o f 56.66, at the Clinic for pediatrics of 23.17 (in children under the age of 2) and 44.10 (in children 2-18 years), and of 6.04 DDD/100BD at the Clinic for rehabilitation. Utilization of antibiotics at the entire ICYHCV during winter was higher compared to summer period. Antibiotics were used at all clinics and departments, without exception. Bacteriological findings: Out of 11942 specimens sent for microbiological analysis, 18.14% (2168/11952) were reported positive. The most frequently analyzed patient materials were blood and urine. Significantly fewer bacteria were isolated during winter compared to summer period. The most commonly isolated bacteria was Escherichia coli, followed by: Staphylococcus aureus, coagulase-negative Staphylococcus spp, Klebsiella spp, Pseudomonas spp, Acinetobacter spp, Enterococcus spp and Enterobacter spp...