| Abstract | Kultura krvi je i pored svojih određenih ograničenja najvažnija dijagnostička metoda kojom se mogu izolirati uzročnici bakterijemije i sepse, a test osjetljivosti izoliranih bakterija na antibiotike predstavlja važan rezultat za pravilan odabir terapije i uspješno provođenje liječenja. U ovom istraživanju, provedenom za peroid od 1. 1. 2011. do 31. 12. 2015. godine korišteni su podatci pacijenata hospitaliziranih u Općoj bolnici Virovitica, a hemokulture obrađene u mikrobiološkom laboratoriju Zavoda za javno zdravstvo Virovitičko - podravske županije gdje je ukupno obrađeno 3207 hemokultura prema pravilima struke, standardiziranim metodama izolacije i identifikacije bakterija. Prema rezultatima istraživanja pozitivnih hemokultura je bilo 484 (15,1 %), prema spolu: 16,1 % kod pacijenata ženskog spola, odnosno 14,2 % kod pacijenata muškog spola, a prema dobi, najveći broj pozitivnih hemokultura bio je kod bolesnika iznad 65 godina života (53,9 %). Prema etiologiji najčešći uzročnici sepse su Gram negativne bakterije (58,4 %), zatim Gram pozitivne bakterije (40,6 %) i gljive (1,0 %). Najčešće izolirana vrsta je Esherichia coli (25,6 %), zatim koagulaza negativan Staphylococcus spp. (19,1 %) i Staphylococcus aureus (10,5 %). Promatarajući osjetljivost pojedinih uzročnika na antibiotike primjećuje se pojava otpornih izolata i njihov značajan porast negdje od sredine promatranog razdoblja. Posebice treba istaknuti E.coli ESBL kada je udio ESBL izolata za 2011. godinu iznosio 5,0 %, za 2012. – 3,7 %, za 2013. - 4,5 %, dok je u 2014. godinu udio porastao na 44,4 %, te 2015. iznosio 26,1 %. Sličan trend pratila je i Klebsiellla pneumoniae, kada 2011. godine nije zabilježen niti jedan ESBL izolat, 2012. godine udio ESBL izolata je iznosio 43,0 %, 2013. i 2014. godine narastao na 50,0 %, dok je 2015. iznosio 60,0 % od ukupnog broja izoliranih K. pneumoniae. U 2011. godini izolirano je 50,0 % multiplorezistentnih Acinetobacter baumannii (MRAB) izolata dok je trend rezistencije bio istaknut u 2013., 2014. i 2015. godini kada je broj MRAB izolata iznosio 100,0 %. Povećana otpornost, u nešto manjoj mjeri prisutna je i kod izolata Pseudomonas aeruginosa, dok S. aureus nije pokazivao značajan porast multirezistencije u promatranom razdoblju. Kod sepse uzrokovane višestruko otpornim izolatima smanjena je mogućnost uspješnog antimikrobnog liječenja, što posljednjih godina postaje sve veći problem, te je zbog toga nužno poduzimati sve potrebite mjere koje bi sprječavale širenje takvih mikroorganizama, odnosno smanjio njihov udio u etiologiji sepse. |
| Abstract (english) | Despite of its specific limitations, blood culture is the most important diagnostic method that can isolate the cause of bacteremia and sepsis, and a sensitivity test of isolated bacteria to antibiotics presents an important result for the proper choice of therapy and successful implementation of treatment. In this study conducted during the period of 1. 1. 2011 - 31. 12. 2015 the data of patients hospitalized at the General Hospital of Virovitica were used, and blood cultures were processed in the microbiological laboratory of the Department of Public Health of Virovitica -Podravina County, where a total of 3207 blood cultures were processed in accordance with professional rules, standardized methods of isolation and identification of bacteria. According to the results of the study, there were 484 (15,1 %) of positive blood cultures, by gender, 16,1 % in female patients, and 14,2 % in male patients, and by age the highest number of positive blood cultures was observed in patients over 65 years of age (53,9 %). According to the etiology, the most common causes of sepsis are Gram - negative bacteria (58,4 %), followed by Gram - positive bacteria (40,6 %) and fungi (1,0 %). Most commonly isolated species is Esherichia coli (25,6 %), followed by coagulase - negative Staphylococcus spp. (19,1 %) and Staphylococcus aureus (10,5 %). When examining the sensitivity of certain causes to antibiotics one can notice the appearance of resistant isolates and their significant increase starting somewhere in the middle of the observed period. In particular E. coli ESBL should be mentioned, when the percentage of ESBL isolates in 2011 was 5,0 %, in 2012 – 3,7 %, in 2013 - 4,5 %, while in 2014 the percentage increased to 44,4 %, and in 2015 decreased to 26,1 %. A similar tendency was observed in case of Klebsiella pneumoniae, when in 2011 not a single ESBL isolate was registered, in 2012 the percentage of ESBL isolates was 43,0 %, which increased in 2013 and 2014 to 50,0 %, and in 2015 presented 60,0 % of the total number of isolated K. pneumoniae. In 2011 50,0 % of Multi - resistant Acinetobacter baumannii (MRAB) isolates were isolated, while the resistance tendency was highlighted in 2013, 2014 and 2015, when the percentage of MRAB isolates increased to 100,0 %. Increased resistance to a lesser extent can be found in isolates of Pseudomonas aeruginosa, while S. aureus didn't show a significant increase of multiple resistance in the observed period. In case of sepsis caused by multiple resistant isolates the possibility of a successful antimicrobial treatment is reduced, which becomes a growing problem in the recent years, and therefore it is important to take all necessary measures to prevent the dissemination of such microorganisms, or to reduce their percentage in the etiology of sepsis. |
