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Vojnosanitetski pregled
2017, vol. 74, br. 10, str. 954-962
jezik rada: engleski
vrsta rada: izvorni naučni članak
doi:10.2298/VSP151216270I

Creative Commons License 4.0
Uzročnici pneumonije udružene sa ventilatornom potporom bolesnika i njihova rezistencija na antibiotike u pulmološkoj jedinici intenzivnog lečenja
aHemofarm AD, Research and Development Department, Belgrade
bInstitut za plućne bolesti, Sremska Kamenica
cInstitute for Pulmonary Diseases of Vojvodina, Clinic for Urgent Pulmonology, Intensive Care Unit, Sremska Kamenica + University of Novi Sad, Faculty of Medicine, Novi Sad
dUniverzitet u Beogradu, Medicinski fakultet, Institut za medicinsku statistiku i informatiku
eUniverzitet u Kragujevcu, Medicinski fakultet

e-adresa: vlada.cekic@yahoo.com

Sažetak

Uvod/Cilj. Incidencija pneumonije udružene sa ventilatornom potporom bolesnika (VAP), njeni uzročnici i njihova rezistencija razlikuju se između zemalja i jedinica intenzivne nege (JIN). U Evropi je u poslednjih deset godina došlo do progresivnog porasta rezistentnih bakterija. Međutim, ne postoji dovoljno podataka za JIN u Srbiji. Ciljevi rada bili su da se ispita etiologija i rezistencija uzročnika VAP na antibiotike u JIN, da se ispita da li postoji razlika između uzročnika ranog i kasnog VAP i da se utvrdi letalitet kod bolesnika sa VAP nakon 30 i 60 dana hospitalizacije. Metode. Retrospektivno kohortno ispitivanje je bilo sprovedeno u pulmološkoj JIN. Bili su uključeni svi odrasli bolesnici sa dijagnostikovanim VAP od 2009. do 2014. godine. Rezultati. Glavni uzročnici VAP bili su gram negativne bakterije (80,3%). Najčešće je bio izolovan Acinetobacter spp (59,8%). Zabeležen je statistički značajan porast incidencije oboljevanja usled Klebsiella pneumoniae (8,9% vs 25,6%; p = 0,019). Najzastupljeniji su bili ekstremno rezistentni (XDR) sojevi bakterija (78,7%). Kasni VAP je dijagnostikovan kod 81,1% bolesnika bez razlike u patogenima u poređenju sa ranim VAP. Acinetobacter spp je bio osetljiv na tigeciklin i kolistin uz statistički značajan porast rezistencije na ampicilin/ sulbaktam (30,2% vs 58,6%; p = 0,01). Rezistencija Pseudomonas aeruginosa i Klebsiella pneumoniae na karbapeneme iznosila je 38%, odnosno 11%. Kod meticilin-rezistentnog Staphylococcus aureus nije postojala rezistencija na vankomicin i linezolid. Nisu utvrđene razlike u letalitetu između bolesnika sa ranim i kasnim VAP posle 30 i 60 dana hospitalizacije. Zaključak. Gram negativne bakterije bile su glavni uzročnici VAP, od kojih je najzastupljeniji bio XDR soj Acinetobacter spp. Bolesnici sa ranim i kasnim VAP imali su iste uzročnike. Nije bilo razlike u letalitetu između te dve grupe bolesnika tokom 60 dana hospitalizacije.

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