Preliminary evaluation of antibiotic susceptibility patterns of pathogens isolated from private laboratory specimens in Ukraine

Antimicrobial Resistance in the Most Common Gram-Positive Isolates from Patients' Biological Samples in a Private Laboratory in Kharkiv: March 24, 2018, to December 31, 2019, n=85

Thus, the examination of urine cultures has de- monstraetd that all isolated strains possessed the highest resistance to antimicrobial drugs of the tetracycline group (100 %) and beta-lactams (100 %), and the resistance to the sulfanilamides was 33.3%, to aminoglycosides and the quinolones amounted to 50%.

Out of 5.7 % samples taked from the urogenital tract during bacteriological examination, 7 pathogens were isolated, of which the strains of S. еpidermidis (28.5%), Streptococcus spp. (28.5%), Candida albicans, Streptococcus an- haemolyticus, S. aureus, each amounted to 14.3%. The antimicrobial resistance was expressed to beta-lactams and tetracyclines.

The isolates of S. еpidermidis demonstrated resistance to beta-lactams (benzylpenicillin, oxacillin, amoxicillin, amoxiclav, cefazolin, cefpodoxime) and tetracyclines (tetracycline, clindamycin).

The strains of Streptococcus spp. were resistant to beta-lactams (cefazolin, cefpodoxime), aminoglycosides (amikacin, gentamycin, tobramycin), and qui- nolones (gatifloxacin, ofloxacin, pefloxacin, ciprofloxacin, levofloxacin, gemifloxacin, norfloxacin).

The isolated strain of Streptococcus anhaemo- lyticus was resistant to cephalosporins (cefazolin, cefepime), macrolides (azithromycin, clarithromycin), and amphenicols (chloramphenicol).

The strains of S. aureus showed resistance to beta-lactams (benzylpenicillin, ampicillin, oxacillin, amoxicillin, cefixime, cefazolin), and tetracyclines (tetracycline, doxycycline). The isolates of Candida albicans were resistant to antifungal agents (fluconazole, itraconazole, nitroxoline, amphotericin).

The Neisseria spp. strains isolated from the oral cavity were resistant to beta-lactams (cefazolin, cefpodoxime, cefuroxime), quinolones (gatifloxacin, ofloxacin, pefloxacin, ciprofloxacin, levofloxacin, norfloxacin), macrolides (azithromycin), and tetracyclines (tetracycline, doxycycline).

In the bacteriological culture obtained from the skin in three analyses, five pathogens were isolated: S. aureus, Streptococcus anhaemolyticus, Candida albicans.

The resistance of S. aureus isolates was detected to beta-lactams (benzylpenicillin, oxacillin, amoxicillin, amoxiclav, cefazolin), tetracyclines (tetracycline, doxycycline), cephalosporins (cefazolin, cefpodoxime), macrolides (azithromycin, roxithromycin, spiramycin), lincosamides (clindamycin, lin- comycin), and sulfanilamides (co-trimoxazole).

In Streptococcus anhaemolyticus strains, resistance was observed against cephalosporins (cephalosporin, cefazolin, cefpodoxime, cefuroxime), aminoglycosides (amikacin, gentamicin, tobramycin), macrolides (azithromycin, roxithromycin, spiramycin), and lincosamides (clindamycin, lincomycin).

The strains of Candida albicans showed resistance to antifungul agents (nystatin, itraconazole, amphotericin, nitroxoline).

Eight pathogens were identified in the bacterial culture tests from the ear: S. aureus (25%), K. pneumonia (25%), S. epidermidis (25%), Streptococcus haemolyticus (12.5%), and P. аeruginosa (12.5%). Also, in two analyses, mould fungi resistant to antifungal agents (fluconazole, itraconazole, clotrimazole, amphotericin, nitroxoline) were isolated. The isolated strains of K. pneumonia were resistant to beta-lactams (amoxicillin, amoxiclav, cefazolin, cefixim, cefpodoxime), tetracyclines (tetracycline, doxycycline), cephalosporins (cefazolin, cefpodoxime, cefuroxime), macrolides (azithromycin), lincosamides (lincomycin), and sulfanilamides (co-trimoxazole). The strains of S. aureus were resistant to beta-lactams, cephalosporins, tetracyclines, macrolides, and lincosamides. The isolates of S. epidermidis were resistant to beta-lactams, and tetracyclines. The strains of Streptococcus haemolyticus were resistant to beta-lactams, tetracyclines, cephalosporins, macrolides, lincosamides, and sulfanilamides. The isolates of P. аeruginosa were also resistant to beta-lactams, tetracyclines, cephalosporins, carbopenems, amphenicolams, and sulfanilamides.

In 34.5 % throat cultures, 35 pathogens were isolated: S. aureus (40%), Neisseria spp. (34.3%), Streptococcus spp. (17.1%), and Candida albicans (8.6%). The strains of Neisseria spp. were the most resistant to the group of beta-lactams (cefazolin) and tetracycline (tetracycline). The isolates of Streptococcus spp. were resistant to aminoglycosides (amikacin, gentamycin, tobramycin) and qui- nolones (gatifloxacin, ofloxacin, pefloxacin). The marked resistance in S. aureus isolates was observed to the groups of tetracyclines (tetracycline) and beta-lactams (oxacillin). The strains of Candida albicans were resistant to antifungals (fluconazole, amphotericin).

During the study of 29.9 % nose cultures, 20 pathogens were isolated, namely S. epidermidis (80%), Streptococcus spp. (15%), and Moraxella spp. (5%), which were resistant to beta-lactams (cefazolin, benzylpenicillin, oxacillin, amoxicillin, amoxiclav, cefazolin, cefpodoxime), aminoglycosides (amikacin, gentamycin, tobramycin), qui- nolones (gatifloxacin, ofloxacin, pefloxacin, ciprofloxacin, levofloxacin), and tetracyclines (tetracycline, doxycycline).

Out of all 87 strains isolated, 27% of the isolates were resistant to antiseptics, of which Streptococcus haemolyticus, Streptococcus anhaemolyticus, K. pneumonia, P. аeruginosa, S. epidermidis, S. aureus were resistant to miramistin (52%), ec- tericid (39%), and chlorophyllipt (8%). Resistance to antiseptics was predominantly evident in 68% of S. aureus isolates: 32% to miramistin, 32% to ecteri- cid, and 4% to chlorophyllipt.

Summarizing all the results, it is evident that the obtained isolates demonstrated resistance to various groups of antimicrobial agents. The highest resistance was observed in the cephalosporin group, accounting for 17.5%, with cefazolin being the most resistant at 38.95%, followed by cefpodoxime at 34.9%, and cefuroxime at 15.7%. In the quinolone group, resistance was noted at 14.2%, with norfloxacin showing the highest resistance at 17.98%, followed by pefloxacin at 17.3%, and ofloxacin at 16.5%. Tetracycline group resistance stood at 11.9%, with higher resistance to tetracycline at 53.8% and doxycycline at 39.3%. The macrolide group exhibited a resistance rate of 6.1%, with azithromycin at 53.3%, roxithromycin at 18.3%, and spiramycin at 18.3%.

Antibiotic resistance to the group of linco- samides was 4.6%, more pronounced to clindamycin at 71.1%. In the aminoglycoside group, it was 4.7%, most of all to gentamycin reaching 34.8%, and to amikacin and tobramycin, reaching 32.6% each.

The resistance was expressed in the group of antifungal agents, composed 2.9%, of which to nitroxoline made up 21.4%, to fluconazole, itraconazole and amphotericin achieved 17.9% each. Resistance to the sulfanilamides was 7.4%; it is noteworthy that resistance to the co-trimoxazole reached up to 100%.

Resistance to antiseptics was 4.2%, mostly to miramistin reaching 46.3%, etericid at 34.1%. Resistance to the bacteriophages amounted to 7.5%, of which to the polyvalent pyobacteriophage reaching 58.1% and to staphylococcal bacteriophage, at 25.7%.

Resistance of the main opportunistic pathogens emphasizes the need for constant microbiological monitoring of the formation and circulation of hospital strains in order to improve the tactics of using antibacterial drugs.

Conclusions

antimicrobial isolate resistance

In the city of Kharkiv, opportunistic pathogens isolated from patients in the private laboratory such as the strains of Staphylococcus aureus, Neisseria spp., Staphylococcus epidermidis, Streptococcus spp of the viridans group were identified. The highly-resistant bacteria were resistant to the such group of antimicrobial drugs as beta-lactams, tetracyclines, aminoglycosides, sulfanilamides.

The emergence and spread which must be considered by doctors when prescribing antibacterial therapy.

The study conducted showed the relevance of the microbial resistance issue to the action of antimicrobial drugs and allowed us to outline the direction for further improvement of the antibiotic resistance preventive measures.

Thus, the identification of the emergence and spread of antimicrobial resistance strains necessitates further microbiological monitoring of the antibiotic-resistant strain circulation based on the special programs (e.g. WHONET) using molecular epidemiology. high frequency of carrying out such studies will allow to resolve the problem of rational antimicrobial therapy and adequately regulate the administration of antibacterial drugs in the outpatient practice, thereby improving the results of treating infections and introducing the correction of existing therapeutic regimens for diseases.

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