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Antimicrobial susceptibility pattern of acinetobacter spp in the period 2012-2015/Ispitivanje osetljivosti acinetobacter spp na antimikrobne lekove uperiodu 2012-2015. Godine.

UDK 615.281.015.8:579.61

Introduction

The World Health Organization defines antimicrobial resistance as the resistance of microorganisms to a drug that was previously effective. The resistance of bacteria to antibiotics is called antibiotic resistance [1]. Multidrug-resistant (MDR) bacteria is the term used for bacterial strains resistant to three or more groups of antimicrobial drugs. Cross-resistant bacteria are those that have developed resistance to a variety of drugs that have a similar mechanism of action [2]. The main cause for developement of antibiotic resistance is irrational use of antibiotics [3].

Representatives of the genus Acinetobacter are strictly aerobic, gram-negative, immobile (Greek "akinetos" --immobile), catalase positive, indole negative, non-fermentable coccobacilli. Within this genus there are over 20 different species, the most important among them--Acinetobacter calcoaceticus-baumannii complex which is responsible for most human infections [4]. Most of the clinical isolates of Acinetobacter baumannii, which cause infections of hospitalized patients, using genotyping methods, are divided into three European (international) clones, of which the European clone I (EU I) and European clone II (EU II) are most dominant. The permeability of the outer membrane layer of Acinetobacter baumannii (less than 5% in comparison to other gram-negative microorganisms), congenital decreased susceptibility to antibiotics, in combination with rapid acquisition of resistance mechanisms using mutation or genetic elements (plasmids, transposons and insertion sequences) are responsible for rapid emergence of multi-resistant isolates. Another important feature of this microorganism is the ability to survive in wet and dry conditions up to 4 months, with the ability to form a biofilm which plays a significant role. Survival of isolates that have such capability is twice as long (36 vs. 15 days) in comparison to isolates which are not capable to form a biofilm. Isolates that are capable to form biofilms are multiresistant isolates, because a biofilm is a community of well-structured microcolonies which has the ability for long-term survival and causes changes to the genetic material. Colonization by Acinetobacter baumannii precedes the biofilm formation, often in intensive care units [5].

Acinetobacter may be part of normal bacterial flora of the skin and mucous membranes or various secretions of healthy people. Also, Acinetobacter colonizes the oral cavity, the respiratory and gastrointestinal tract. As an opportunistic bacteria it can be a significant cause of serious hospital infections, mainly contaminating catheters and the equipment for mechanical ventilation. Because of this, it commonly causes bacteremia and nosocomial pneumonia in patients on mechanical ventilation, urinary tract infections, infections of the skin and soft tissues, as well as meningitis and endocarditis [4].

These infections are most common in immunocompromised patients, patients with severe underlying disease, and those who have undergone invasive diagnostic procedures. Risk factors for colonization and infection include recent surgery, central venous catheters, tracheostomy, parenteral nutrition and uncontrolled use of broad-spectrum antibiotics (third generation cephalosporins, fluoroquinolones, carbapenems) [4].

Acinetobacter has the ability to survive on various surfaces for long periods of time. These bacteria have a number of mechanisms of resistance, from enzymes that break down the beta-lactam ring, through the modification of the enzyme against aminoglycosides and changing binding site of quinolones, to changing different mechanisms of drug elimination and outer membrane proteins, so that the outcome of treatment of infections caused by Acinetobacter is uncertain. These mechanisms, either individually or in cooperation, define the resistance of Acinetobacter spp to antibiotics. Infection with MDR strains in hospitals further complicates the patients' conditions, especially in intensive care units, prolonging hospitalization and increasing mortality. Hospital mortality of patients with Acinetobacter spp infections accounts for 8-23%, and in intensive care units even for 10-43% [6].

Acinetobacter is resistant to various antibiotics from different groups. Its multiresistant isolates are increasingly common around the world and the infections they cause represent a serious therapeutic problem. Carbapenems (imipenem, meropenem) are P-lactam antibiotics with the broadest spectrum of activity. When they emerged in the 1980s, for a long time they were the first line drugs in the treatment of infections caused by gram-negative nonfermentable pathogens, and they represented a new treatment option for serious infections. However, despite the early efficiency of carbapenem in the treatment of infections caused by Acinetobacter, nowadays increasing carbapenem-resistant Acinetobacter isolates are reported worldwide [4]. Multidrug resistant isolates are resistant to three or more groups of antibiotics that can be applied in the treatment of infections caused by these microorganisms (aminoglycosides, carbapenems and quinolones). Although rare, pandrug resistant isolates have also been described, which show resistance to sulbactam, minocycline, tigecycline and colistin.

Material and Methods

The study was conducted as a retrospective study, analyzing medical records of the patients treated at the Clinic of Infectious Diseases of the Clinical Center of Vojvodina (CCV) in the period from January 1, 2012 to December 31, 2015. It included 1.673 patients diagnosed with bacterial infections. The data were obtained from the medical histories of patients diagnosed with sepsis, urinary infections (complicated urinary tract infections), infections of the skin and subcutaneous tissue, respiratory infections and pneumonia. The analysis of patient material (blood cultures, urine, cerebrospinal fluid culture, wound/ decubitus swabs, throat swabs, cannula/tube swabs and bronchial aspirates) routinely sampled at the Clinic of Infectious Diseases of the CCV in the aforementioned period, was performed to establish the incidence of infestions caused by Acinetobacter spp and antimicrobial resistance.

The inclusion criteria were: clinical picture of bacterial infection, as demonstrated by laboratory findings and X-ray findings of pneumonia.

The results of bacterial isolation and identification and antimicrobial susceptibility test results were obtained from standard reports on bacteriological examination. Isolation and identification was done in the laboratories of the Microbiology Center of the Institute of Public Health of Vojvodina in Novi Sad using standard bacteriological techniques. The causes are shown as the absolute number of isolates, as well as the percentage of their representation in the calendar year when they were isolated. The bacterial susceptibility to antimicrobials was expressed as percentage of resistant and susceptible strains and only primoisolates were analyzed. Susceptibility to antimicrobial drugs was analyzed only if there were more than two isolates in a single year. Strains showing an intermediate degree of susceptibility were classified as resistant, whereas MDR strains showed resistance to three or more groups of antimicrobial drugs.

Results

During the four-year research, 4.460 samples were examined, of which 825 were positive, and 101 Acinetobacter spp were isolated.

During this period, 1.682 blood samples were analyzed and a total of 260/1.682 (15.5%) positive isolates were found. In 2012, there were 64/353 (18.1%); in 2013, 46/474 (97%); in 2014, 62/512 (12.1%); and in 2015, 88/343 (25.6%) isolates. The most commonly identified pathogens from blood cultures were coagulase-negative Staphylococcus spp in 121/260 (46.5%), followed by Staphylococcus aureus 27/260 (10.4%), Escherichia coli 26/260 (10.0%), Acinetobacter spp 14/260 (5.4%), and Streptococcus pneumoniae, Klebsiella pneumoniae, and Streptococcus viridians, each in 12/260 (4.6%). Other agents were present in less than 4%. In 2012, Acinetobacter spp was isolated from blood cultures in 2/64 (3.2%), in 2013, in 1/46 (2.2%), in 2014, in 6/62 (97%), and in 2015, in 5/88 (57%).

During the research period, 1.344 urine cultures were analyzed, and 198/1345 (14.7%) positive isolates were found. In 2012, there were 34/320 (10.6%); in 2013, 47/274 (17.1%); in 2014, 38/372 (10.2%); and in 2015, 79/348 (22.7%) isolates. The most commonly isolated were Escherichia coli in 69/198 (34.8%), Enterococcus spp in 36/198 (18.2%), Klebsiella pneumoniae in 28/198 (14.1%), Proteus mirabilis in 26/198 (13.1%), Pseudomonas aeruginosa in 25/198 (12.6%) and Acinetobacter spp in 7/198 (3.5%). Other causes were found in less than 3%. The incidence of Acinetobacter isolates from positive urine cultures per year was: in 2012, 2/34 (5.9%); in 2013, 0/47 (0%); in 2014, 2/38 (5.3%); in 2015, 2/79 (2.5%).

The test results of 325 samples of cerebrospinal fluid showed that 43 (13.2%) were positive. In 2012, there were 12/70 (17.1%) positive isolates, in 2013, 10/69 (14.5%); in 2014, 13/104 (12.5%); and in 2015 there were 8/82 (9.8%). During the four-year research, the most common microorganism isolated from the cerebrospinal fluid was Streptococcus pneumoniae found in 14/43 (32.6%), followed by coagulase-negative Staphylococcus spp in 12/43 (27.9%); Listeria monocytogenes and Neisseria meningitidis each in 3/43 (6.9%); Acinetobacter spp and Streprococcus viridans each in 2/43 (4.7%). Other causes were found in less than 3%. One isolate of Acinetobacter spp was found in the cerebrospinal fluid during 2012 and 2014, while in 2013 and 2015 not a single positive isolate was found.

The bacteriological examination of 183 wound/ decubitus swabs was performed during the research period. Positive isolates were found in 128/183 (69.9%). In 2012, there were 30/35 (84.6%); in 2013, 34/47 (72.3%); in 2014, 35/63 (55.6%); and in 2015 there were 29/38 (76.3%) positive isolates. The most commonly isolated microorganisms were Acinetobacter spp in 33/128 (25.8%), followed by Staphylococcus aureus in 28/128 (21.9%); Pseudomonas aeruginosa in 26/128 (20.3%); Proteus mirabilis in 14/128 (10.9%); Enterobacter spp in 10/128 (7.8%); Klebsiella pneumoniae in 9/128 (7.0%); and Enterococcus spp in 8/128 (6.25%). Other pathogens were found in less than 6%. The incidence of Acinetobacter spp isolates in wound/decubitus swabs per year was: in 2012, 6/30 (20.0%); in 2013, 10/34 (29.4%); in 2014, 8/35 (22.9 %); and in 2015, 9/29 (31.0%).

During the four-year research period, 770 throat swabs were examined and 124/770 (16.1%) positive isolates were found. In 2012 there were 35/194 (18%); in 2013, 37/232 (15.9%); in 2014, 35/185 (18.9%); and in 2015, 17/159 (10.7%) isolates. The most common isolated pathogen was Staphylococcus aureus found in 61/124 (49.2%). The incidence of Staphylococcus aureus isolates in 2012 was 62.8% (22/35); in 2013, 37.8% (14/37); in 2014, 45.7% (16/35); and in 2015 it was 52.9% (9/17). The incidence of Acinetobacter spp was 14/124 (11.3%), Klebsiella pneumoniae in 13/124 (10.5%), Streptococcus pyogenes in 9/124 (7.3%), Enterobacter spp in 8/124 (6,5%), and Pseudomonas aeruginosa in 5/124 (4.0%). Other pathogens were found in less than 4%. The incidence of Acinetobacter spp isolates in wound/decubitus swabs was as follows: in 2012, 4/35 (11.4%); in 2013, 5/37 (13.5%); in 2014, 3/35 (8. 6%); and in 2015, 2/17 (11.8%).

During the same period, bacteriological tests of 153 swabs taken from cannula tubes and bronchial aspirate were performed, and positive isolates were found in 72/153 (47.1%). In 2012, there were 18/37 (48.6%) positive isolates, in 2013, 21/40 (52.5%); in 2014, 21/59 (35.6%); and in 2015, 12/17 (70.6%) isolates. The most common pathogens were Acinetobacter spp in 32/72 (44.4%), Pseudomonas aeruginosa in 18/72 (25.0%), Klebsiella pneumoniae in 10/72 (13.9%), Enterobacter spp and coagulase negative Staphylococcus spp in 7/72 (9.7%) each, and Stenotrophomonas maltophilia in 6/72 (8.3%). The incidence of Acinetobacter spp per year was: in 2012, 6/37 (16.2%); in 2013, 9/21 (42.9%); in 2014, 7/21 (33.3%); and in 2015, 10/12 (83.3%).

The study showed that the incidence of Acinetobacter spp was highest in swabs taken from cannula/tubes and bronchial aspirate - 32/72 (44.4%), then in wound/decubitus swabs in 33/128 (25.8%) of isolates, in throat swabs in 14/124 (11.3%), in blood cultures in 14/260 (5.4%), in cerebrospinal fluid cultures in 2/43 (4.7%), and the lowest incidence of Acinetobacter spp was found in urine cultures, in 6/198 (3.0%) isolates.

Acinetobacter spp isolates from blood cultures were resistant to all tested antibiotics, except colistin and tobramycin. All Acinetobacter spp isolates from blood tested during 2013, 2014 and 2015, were 100% susceptible to colistin, while in 2012 susceptibility to this antibiotic had not been studied. In the reported period, the susceptibility to tobramycin was 88.9% (Table 1).

Antimicrobial resistance of Acinetobacter spp taken from wound/decubitus swabs during the study period was almost 100% to all tested antibiotics, except colistin and tobramycin. In the examined period, the susceptibility to colistin was 100% and to tobramycin 30.8%. The isolates were susceptible to gentamicin and levofloxacin during 2012, while during 2014 and 2015, resistance to these antibiotics was 100% (Table 2).

Resistance to carbapenem of isolates from the throat swabs was 100%, in all isolates in 2012, 2014 and 2015, while in 2013, it was recorded in three isolates (60%). Susceptibility to ampicillin/sulbactam was not recorded during the first three years of testing, while in 2015 there were no information about susceptibility to this antibiotic. Susceptibility to colistin was 100% in 2013, the only year that focused on examining the susceptibility to this antibiotic. Susceptibility to tobramycin was tested in 2013 and 2014, and it was 100% (Table 3).

Antimicrobial susceptibility of Acinetobacter spp isolated from cannula/tubes swabs and bronchial aspirate during the period of research was recorded only to colistin (100%). The antimicrobial susceptibility to this antibiotic was carried out only in 2015, in 2 isolates. A lower susceptibility (20%) was recorded to ampicillin/sulbactam and 17.4% to tobramycin. Resistance of Acinetobacter spp to other antibiotics was over 82.6%

Discussion

During the past decades, Acinetobacter baumannii has become one of the leading causes of nosocomial infections worldwide. A study that examined the prevalence of infections in intensive care units in 75 countries on five continents, confirmed that infections caused by Acinetobacter baumannii are among the five most frequent infections [5]. In the European countries, it approximately causes from 2% to 10% of all infections caused by gram-negative microorganisms, and in the United States (US) about 2.5% [7]. Our study shows that Acinetobacter spp causes blood infections in 2.2% up to 9.7% of inpatients.

In regard to data from our country, the study of Suljagic and Mirovic in 2006, showed that Acinetobacter spp caused nosocomial blood infections with an incidence of 7.1% [8], which corresponds with our data on blood infections in 2015, with an incidence of 5.7%. In our study, the incidence of Acinetobacter spp in blood cultures was 5.4%, taking the fourth place, behind the cannula/tubes swabs and bronchial aspirate, the wound/decubitus swabs, and throat swabs, whereas according to the results of American authors it was in the second place, after isolates from the respiratory tract, with an incidence of 23.9% [9]. Our results from 2014 are identical with the data from Saudi Arabia, where the incidence was also 9.7%

The lowest incidence of Acinetobacter spp was found in cerebrospinal fluid and urine. Acinetobacter spp was not isolated from urine in 2013, while the highest incidence was recorded in 2012, 5.9%.

During 2013 and 2015, not one strain of Acinetobacter was isolated from the cerebrospinal fluid, and in 2012 and 2015, one isolate was found each year.

During the four-year research, Acinetobacter spp was isolated from wound/decubitus swabs in 25.8% of hospitalized patients. According to literature data, Acinetobacter spp was found in skin swabs of patients who were not hospitalized, from 0.5 to 3%, and in hospitalized patients in up to 75%

The results of our research on the dominance of Acinetobacter spp from wound swabs are similar to the findings of other authors who examined the the dominance of gram negative bacteria from swabs of infected decubital wounds, whose localization is usually near urogenital and the end of gastrointestinal tract [14, 15].

The results of our research on the incidence of Acinetobacter spp in patient material routinely sampled at the Clinic of Infectious Diseases of the CCV, in the period from January 1, 2012, to December 31, 2015, is somewhat similar to the findings from US [9] and Great Britain [16], where the highest percentage of Acinetobacter spp was also isolated from cannula/tubes swabs and bronchial aspirate. In our study, the prevalence ranged from 16.2% in 2012, up to 83.3% in 2015, which shows that Acinetobacter spp is becoming a leading cause of nosocomial infections in our environment.

Multiresistant isolates are increasingly common around the world and represent a serious problem for clinicians [4]. Many isolates of Acinetobacter spp have developed resistance to antibiotics, including until now successful, aminopenicillins, ureidopenicillin, cefamandole and cephalothin, cephamycin, cefoxitin, most of the aminoglycosides, chloramphenicol, tetracycline, and the more recent antibiotics, such as cefotaxime, ceftazidime, imipenem, tobramycin, amikacin, and fluoroquinolones [17].

All strains of Acinetobacter spp from blood cultures in our study, were resistant to carbapenems, piperacillin/tazobactam, aminoglycosides, quinolones. Susceptibility was registered only to colistin and tobramycin. According to the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) study, in the period from 2002 to 2004, resistance to meropenem in Europe was 26.9%, 30.2% to imipenem 66% to ciprofloxacin, and 52.4% to gentamicin [15], while in our study, ten years later, the susceptibility to these antibiotics was not observed, as shown by our results from 2014 and 2015, where resistance was recorded to all antibiotics except colistin and tobramycin. The study of Suljagic and Mirovic, conducted in 2006, examined the resistance of Acinetobacter spp isolated from blood of patients hospitalized in the intensive care units, showed that all isolates were resistant to gentamicin, and 71% to ciprofloxacin, but did not register resistance to imipenem [8]. Rapid development of resistance to carbapenems in the last decade [17] explains existence of differences in the susceptibility of isolates of Acinetobacter spp to imipenem in the aforementioned and our study. All strains of Acinetobacter spp were susceptible to colistin, as shown by studies carried out in Bulgaria from 1999 to 2006, where only colistin proved effective [18]. These strains that are susceptible only to colistin were also described in Korea in a study published in 2008 [19]. In Taiwan, there were isolates that were resistant to all available antibiotics, including colistin [20].

Due to the small number of isolates of Acinetobacter spp from cerebrospinal fluid and urine, data on their susceptibility were not analyzed.

Isolates of Acinetobacter spp from wound swabs in our study indicate that it is a MDR bacteria. The study conducted at the Institute of Public Health of Vojvodina at the Center for Microbiology, included strains of Acinetobacter spp isolated from wound swabs of patients hospitalized at institutes and clinics in CCV in Novi Sad, show that it is a MDR bacteria [4]. The above-mentioned study, recorded a lower rate of resistance to carbapenems of 61.8%, and in our study it was 83.3% in 2012, 100% in 2013 and 2014, and 88.9% in 2015. The emergence of an increasing number of strains resistant to carbapenems caused the empirical use of these antibiotics [21]. Acinetobacter spp in our study did not show resistance to colistin, as found in literature data [22-24]. Susceptibility testing to colistin in our study was conducted in 2013, 2014, and 2015, but not for all isolates.

Susceptibility of isolates from throat swabs to colistin was done only in 2013, when all isolates were susceptible to this antibiotic. Resistance to carbapenems observed in the four-year period was 85.7%. Resistance was recorded in all isolates in 2012, 2014 and 2015, while in 2013 it was recorded in 60% of isolates. A disturbing percentage of resistant isolates of Acinetobacter baumanii to carbapenems in recent years has been observed in Croatia, according to the Committee for Antibiotic Resistance in the Croatian Academy of Medical Sciences, amounting to 90% in major Croatian hospitals [5]. In our study, susceptibility to tobramycin during 2013 and 2014 was 100%, while in 2012 and 2015, susceptibility to this antibiotic was not examined. Almost all isolates were resistant to piperacillin/tazobactam, ampicillin/sulbactam, gentamicin, amikacin, ciprofloxacin and levofloxacin. A combined application of ampicillin/sulbactam, may be effective, especially in hospitals where this agent is rarely used [25]. In our study, the resistance to this antibiotic in the surveyed period was 100%.

High resistance of Acinetobacter spp, isolated from cannula/tubes swabs and bronchial aspirate, to almost all tested antimicrobials except colistin were observed, but susceptibility to this antibiotic was carried out only in the course of 2015, only in 2 isolates. Also, in 2015, susceptibility to ampicillin/ sulbactam and piperacillin/tazobactam was not tested, because since 2015, susceptibility testing to antibiotics is performed according to the EUCAST standard, which does not include testing to these antibiotics. Some authors recommend the use of a combination of ampicillin/sulbactam [4]. In our study, the resistance to this antibiotic was 80%.

Some of the epidemiological studies may have included isolates that were not responsible for infections, but simply colonized ill patients. In terms of resistance, 34% of Acinetobacter isolates in the National Healthcare Safety Network of the United States were resistant to cephalosporins, carbapenems, fluoroquinolones and aminoglycosides [26], as show the findings of antibiotic resistance of Acinetobacter spp isolated from cannula/tubes swabs and bronchial aspirates. In another national surveillance study conducted in the US in 2010, 44.7% and 49.0% were resistant to imipenem and meropenem, respectively, and 5.3% were resistant to colistin in vitro, whereas in our study resistance to colistin was not recorded [27].

Current data indicate that colistin is the main and only therapeutic option, and its unique pharmacokinetic properties have led many to suggest the use a combination of antibiotics. To maintain the susceptibility of colistin, carbapenems, sulbactam, rifampicin and tigecycline have been the most studied, in order to find a combination that would provide the best clinical efficacy and reduce toxicity [27].

Conclusion

Representatives of the genus Acinetobacter are a common cause of infections in hospitalized patients with bacterial infections. During the four-year research, the incidence of Acinetobacter spp isolated from blood cultures was 5.4% (14/260), from urine cultures 3% (6/198), from cerebrospinal fluid cultures 4.7% (2/43), from wounds/decubitus swabs 25.8% (33/128), from throat swabs 11.3% (14/124) and from cannula/tubes swabs and bronchial aspirate 44.4% (32/72). All strains of Acinetobacter spp isolated from patient material during the investigation period were susceptible to colistin (100%). In the examined period, resistance of Acinetobacter spp to P-lactams, carbapenems, aminoglycosides and fluoroquinolones was over 63.6%, except to tobramycin, but only from blood cultures, whith resistance of 11.1%. All strains of Acinetobacter spp were multiresistant.
Abbreviations

Spp   --species
CCV   --Clinical Centre of Vojvodina
MDR   --multidrug resistant
US    --United States


DOI: 10.2298/MPNS1704099M

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Rad je primljen 28. XI 2016.

Recenziran 13. XII 2016.

Prihvacen za stampu 28. XII 2016.

BIBLID.0025-8105:(2017):LXX:3-4:99-106.

Sandra STEFAN MIKIC

University of Novi Sad, Faculty of Medicine

Department of Infectious Diseases

Clinical Center of Vojvodina, Novi Sad

Clinic of Infectious Diseases

Corresponding Author: Prof, dr Sandra Stefan Mikic, Klinicki centar Vojvodine, Klinika za infektivne bolesti, 21000 Novi Sad, Hajduk Veljkova 1-7, E-mail: sandrastefanm@yahoo.co.uk
Table 1. Antimicrobial susceptibility of Acinetobacter spp isolated
from blood

Tabela 1. Osetljivost izolata Acinetobacter spp na antimikrobne
lekove iz hemokultura

                           Acinetobacter spp
Antibiotic                2012
                              S           R
                            N (%)       N (%)

Imipenem                   0 (0.0)    2 (100.0)
Meropenem                  0 (0.0)    2 (100.0)
Piperacillin/Tazobactam    0 (0.0)    2 (100.0)
Gentamicin                 0 (0.0)    2 (100.0)
Amikacin                   0 (0.0)    2 (100.0)
Tobramycin                2 (100.0)    0 (0,0)
Ciprofloxacin              0 (0.0)    2 (100.0)
Levofloxacin               0 (0.0)    2 (100.0)
Colistin                     --          --
Total/Ukupno                  2

                           Acinetobacter spp
Antibiotic                2014
                              S           R
                            N (%)       N (%)

Imipenem                   0 (0.0)    6 (100.0)
Meropenem                  0 (0.0)    6 (100.0)
Piperacillin/Tazobactam    0 (0.0)    6 (100.0)
Gentamicin                 0 (0.0)    6 (100.0)
Amikacin                   0 (0.0)    6 (100.0)
Tobramycin                5 (83.3)    1 (16,7)
Ciprofloxacin              0 (0.0)    6 (100.0)
Levofloxacin               0 (0.0)    6 (100.0)
Colistin                  6 (100.0)    0 (0.0)
Total/Ukupno                  6

                           Acinetobacter spp
Antibiotic                2015
                              S           R
                            N (%)       N (%)

Imipenem                   0 (0.0)    5 (100.0)
Meropenem                  0 (0.0)    5 (100.0)
Piperacillin/Tazobactam      --          --
Gentamicin                 0 (0.0)    4 (100.0)
Amikacin                  1 (20.0)    4 (80.0)
Tobramycin                1 (100.0)    0 (0.0)
Ciprofloxacin              0 (0.0)    5 (100.0)
Levofloxacin               0 (0.0)    5 (100.0)
Colistin                  4 (100.0)    0 (0.0)
Total/Ukupno                  5

Antibiotic                       Total/Ukupno
                               S             R
                             N (%)         N (%)

Imipenem                    0 (0.0)      13 (100.0)
Meropenem                   0 (0.0)      13 (100.0)
Piperacillin/Tazobactam     0 (0.0)      8 (100.0)
Gentamicin                  0 (0.0)      12 (100.0)
Amikacin                    1 (7.7)      12 (92.3)
Tobramycin                  8 (88.9)      1 (11.)
Ciprofloxacin               0 (0.0)      13 (100.0)
Levofloxacin                0 (0.0)      13 (100.0)
Colistin                   10 (100.0)     0 (0.0)
Total/Ukupno                   13

S-susceptible/osetljVo, R-resistant/rezistentno

Table 2. Antimicrobial susceptibility of Acinetobacter spp isolated
from woud/decubitus swabs

Tabela 2. Osetljivost izolata Acinetobacter
spp na antimikrobne lekove iz brisa rana/dekubitusa Acinetobacter spp

                        2012                   2013
Antibiotic         S           R           S            R
                 N (%)       N (%)       N (%)        N (%)

Ampicillin/     0 (0.0)    6 (100.0)    1 (10.0)     9 (90.0)
Sulbactam
Piperacillin/   0 (0.0)    6 (100.0)    0 (0.0)     10 (100.0)
Tazobactam
Imipenem        1 (16.7)   5 (83.3)     0 (0.0)     10 (100.0)
Meropenem       1 (16.7)   5 (83.3)     0 (0.0)     10 (100.0)
Gentamicin      4 (66.7)   2 (33.3)     8 (80.0)     2 (20.0)
Amikacin        0 (0.0)    6 (100.0)    0 (0.0)     10 (100.0)
Tobramycin      2 (33.4)   4 (66.6)     4 (40.0)     6 (60.0)
Ciprofloxacin   0 (0.0)    6 (100.0)    0 (0.0)     10 (100.0)
Levofloxacin    3 (50.0)   3 (50.0)     0 (0.0)     10 (100.0)
Colistin           --         --       10 (100.0)    0 (0.0)
Total/Ukupno       6                       10

                       2014                    2015
Antibiotic          S           R           S           R
                  N (%)       N (%)       N (%)       N (%)

Ampicillin/      0 (0.0)    8 (100.0)    0 (0.0)    5 (100.0)
Sulbactam
Piperacillin/    0 (0.0)    8(100.0)       --          --
Tazobactam
Imipenem         0 (0.0)    8 (100.0)   1 (11.1)    8 (88.9)
Meropenem        0 (0.0)    8 (100.0)   1 (11.1)    8 (88.9)
Gentamicin       0 (0.0)    8 (100.0)    0 (0.0)    9 (100.0)
Amikacin         0 (0.0)    8 (100.0)    0 (0.0)    9 (100.0)
Tobramycin      2 (25.0)    6 (75.0)     0 (0.0)    2 (100.0)
Ciprofloxacin    0 (0.0)    8 (100.0)    0 (0.0)    9 (100.0)
Levofloxacin     0 (0.0)    8 (100.0)    0 (0.0)    9 (100.0)
Colistin        8 (100.0)    0 (0.0)    5 (100.0)    0 (0.0)
Total/Ukupno        8                       9

                    Total/Ukupno
Antibiotic          S            R
                  N (%)        N (%)

Ampicillin/      1 (3.4)     28 (96.6)
Sulbactam
Piperacillin/     0(0.0)     24 (100.0)
Tazobactam
Imipenem         2 (6.1)     31 (93.9)
Meropenem        2 (6.1)     31 (93.9)
Gentamicin      12 (36.4)    21 (63.6)
Amikacin         0 (0.0)     33 (100.0)
Tobramycin       8 (30.8)    18 (69.2)
Ciprofloxacin    0 (0.0)     33 (100.0)
Levofloxacin     3 (9.1)     30 (90.9)
Colistin        23 (100.0)    0 (0.0)
Total/Ukupno        33

S-susceptible/osetljvo, R-resistant/rezistentno

Table 3. Antimicrobial susceptibility of Acinetobacter spp isolated
from throat swabs

Tabela 3. Osetljivost izolata Acinetobacter spp na antimikrobne
lekove iz brisa grla

                                 Acinetobacter spp
Antibiotic                  2012                   2013
                       S           R           S           R
                     N (%)       N (%)       N (%)       N (%)

Imipenem            0 (0.0)    4 (100.0)   2 (40.0)    3 (60.0)
Meropenem           0 (0.0)    4 (100.0)   2 (40.0)    3 (60.0)
Ampicillin/         0 (0.0)    4 (100.0)    0 (0.0)    5 (100.0)
Sulbactam
Piperacillin/       0 (0.0)    4 (100.0)   2 (40.0)    3 (60.0)
Tazobactam
Gentamicin          0 (0.0)    4 (100.0)   2 (40.0)    3 (60.0)
Amikacin            0 (0.0)    4 (100.0)   2 (40.0)    3 (60.0)
Tobramycin             --         --       5 (100.0)    0 (0.0)
Ciprofloxacin       0 (0.0)    4 (100.0)   2 (40.0)    3 (60.0)
Levofloxacin        1 (25.0)   3 (75.0)     0 (0.0)    5 (100.0)
Colistin               --         --       5 (100.0)    0 (0.0)
Total/Ukupno           4                       5

                                  Acinetobacter spp
Antibiotic                  2014                    2015
                        S           R          S           R
                      N (%)       N (%)      N (%)       N (%)

Imipenem             0 (0.0)    3 (100.0)   0 (0.0)    2 (100.0)
Meropenem            0 (0.0)    3 (100.0)   0 (0.0)    2 (100.0)
Ampicillin/          0 (0.0)    3 (100.0)      --          --
Sulbactam
Piperacillin/        0 (0.0)    3 (100.0)      --          --
Tazobactam
Gentamicin           0 (0.0)    3 (100.0)   1 (50.0)    1 (50.0)
Amikacin             0 (0.0)    3 (100.0)   1 (50.0)    1 (50.0)
Tobramycin          3 (100.0)    0 (0.0)       -           -
Ciprofloxacin        0 (0.0)    3 (100.0)   1 (50.0)    1 (50.0)
Levofloxacin         0 (0.0)    3 (100.0)   1 (50.0)    1 (50.0)
Colistin               --          --          --          --
Total/Ukupno            3                      2

                     Acinetobacter spp
Antibiotic              Total/Ukupno
                        S           R
                      N (%)       N (%)

Imipenem            2 (14.3)    12 (85.7)
Meropenem           2 (14.3)    12 (85.7)
Ampicillin/          0 (0.0)    12 (100.0)
Sulbactam
Piperacillin/       2 (16.7)    10 (83.3)
Tazobactam
Gentamicin          3 (21.4)    11 (78.6)
Amikacin            3 (21.4)    11 (78.6)
Tobramycin          8 (100.0)    0 (0.0)
Ciprofloxacin       3 (21.4)    11 (78.6)
Levofloxacin        2 (14.3)    12 (85.7)
Colistin            5 (100.0)    0 (0.0)
Total/Ukupno           14

S-susceptible/osetljVo, R-resistant/rezistentno

Table 4. Antimicrobial susceptibility of Acinetobacter spp isolated
from the cannula/tubes swabs and bronchial aspirate

Tabela 4. Osetljivost izolata Acinetobacter spp na antimikrobne
lekove iz brisa kanile/tubusa i aspirata bronha

                            Acinetobacter Spp
Antibiotic             2012                   2013
                   S           R          S           R
                 N (%)       N (%)      N (%)       N (%)

Ampicillin/     3 (50.0)   3 (50.0)    0 (0.00)   9 (100.0)
sulbactam
Piperacillin/   0 (0.0)    6 (100.0)   0 (11.1)   9 (100.0)
tazobactam
Imipenem        0 (0.0)    6 (100.0)   1 (11.1)   8 (88.9)
Meropenem       0 (0.0)    6 (100.0)   1 (11.1)   8 (88.9)
Gentamicin      0 (0.0)    6 (100.0)   1 (11.1)   8 (88.9)
Amikacin        0 (0.0)    6 (100.0)   0 (0.0)    9 (100.0)
Tobramycin      1 (20.0)   4 (80.0)    0 (0.0)    9 (100.0)
Ciprofloxacin   0 (0.0)    6 (100.0)   0 (0.0)    9 (100.0)
Levofloxacin    0 (0.0)    1 (100.0)   0 (0.0)    9 (100.0)
Colistin           --         --          --         --
Total/Ukupno       6                      9

                            Acinetobacter Spp
Antibiotic             2014                   2015
                   S           R           S           R
                 N (%)       N (%)       N (%)       N (%)

Ampicillin/     1 (20.0)   4 (80.0)       --           --
sulbactam
Piperacillin/   0 (0.0)    6 (85.7)       --           --
tazobactam
Imipenem        1 (14.3)   6 (85.7)     0 (0.0)    10 (100.0)
Meropenem       1 (14.3)   6 (85.7)     0 (0.0)    10 (100.0)
Gentamicin      1 (14.3)   6 (85.7)     0 (0.0)    10 (100.0)
Amikacin        0 (0.0)    7 (100.0)    0 (0.0)    10 (100.0)
Tobramycin      3 (42.9)   4 (57.1)9    0 (0.0)    2 (100.0)
Ciprofloxacin   0 (0.0)    7 (100.0)    0 (0.0)    10 (100.0)
Levofloxacin    0 (0.0)    7 (100.0)    0 (0.0)    10 (100.0)
Colistin           --         --       2 (100.0)    0 (0.0)
Total/Ukupno       7                      10

                     Acinetobacter Spp
Antibiotic             Total/Ukupno
                     S             R
                   N (%)         N (%)

Ampicillin/       4 (20.0)     16 (80.0)
sulbactam
Piperacillin/     0 (0.0)      22 (100.0)
tazobactam
Imipenem          2 (6.3)      30 (93.7)
Meropenem         2 (6.3)      30 (93.7)
Gentamicin        2 (6.3)      30 (93.7)
Amikacin          0 (0.0)      32 (100.0)
Tobramycin        4 (17.4)     19 (82.6)
Ciprofloxacin     0 (0.0)      32 (100.0)
Levofloxacin      0 (0.0)      27 (100.0)
Colistin         2 (100.0)      0 (0.0)
Total/Ukupno         32

S-susceptible/osetjivo, R-resistant/rezistentno
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Title Annotation:Professional article/Strucni clanak
Author:Mikic, Sandra STEFAN
Publication:Medicinski Pregled
Date:Mar 1, 2017
Words:6139
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