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Occurrence of ESBL strains in Hospital Pisek, Inc.
KOTHÁNKOVÁ, Michaela
Resistance to ATB is becoming a big problem all round the world. Bacterial resistance occurs naturally or is obtained by gene mutations where genetic information is transmitted between genera or species. These strains are then resistant to antibiotics that are otherwise effective. The biggest problem is that in these cases the treatment is prolonged, the mortality and morbidity of the patients increases and the costs of the treatment as well. The initial theoretical part is devoted to the characteristics and types of effects of antimicrobial agents, beta-lactam antibiotics, antibiotic resistence, where resistance transfer process, multiresistance and resistance mechanisms are described. Further, this part is dedicated to beta-lactamases and their classification, broad-spectrum beta-lactamases (ESBL) and their producers, especially the genus Klebsiella, the genus Escherichia, the genus Enterobacter and the genus Proteus. The last chapter of this part is focused on the impact of resistance to therapy and treatment options. A methodical part of this work was performed at the Department of Clinical Microbiology of Písek Hospital, Inc., where the detection of ESBL positive strains of the genus Klebsiella, Escherichia, Enterobacter and Proteus was observed during one year (January-December 2016). This part focuses on microbes of the mentioned genera and their antibiotic susceptibility. For susceptibility testing, this is a disk diffusion test based on the inhibition zone and a bouillon microdilution method, which is based on minimum inhibitory concentration. Further, this part also deals with an ESBL production test where a screening test using Brilliance ESBL agar chromogenic soil and method of detection ESBL and AmpC production (known as the MAST test) are described. The last chapter of this part is dedicated to quality control. In the practical part of the thesis, we can compare the incidence of bacteria genus Klebsiella, genus Escherichia, genus Enterobacter, genus Proteus and their production of ESBL. Further, this part is focused on the distribution of isolates with ESBL production according to the type of hospital department, the highest incidence was found in the department of aftercare and department of social beds. This section also describes the distribution of ESBL-producing isolates according to the type of clinical material, where there was a huge catch in the urine. It was also compared the number of ESBL producers in the hospital and the community where it was found 85% incidence in the hospital, which was expected.
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Surveillance of bacterial strains producing broad-spectrum beta-lactamase.
VLASOVÁ, Martina
In the first part of my thesis I focus on mapping problems associated with antibiotic therapy and subsequent development of antibiotic resistance. Tracking resistance is based primarily on data collection and evaluation of the results set sensitivity from around the world. Antibiotic resistance is a natural phenomenon that can be observed in the evolution of microbes as one of the mechanisms of adaptation to new conditions in the environment. For this work I have chosen the following research questions. Do the incidence of ESBL strains in the České Budějovice Hospital a.s. increase over time? Are these values comparable to those achieved in another region, namely in Moravian hospitals the University Hospital of Olomouc, Ostrava University Hospital and Regional University Hospital of T. Bata in Zlin? The data collection I made in collaboration with the laboratory technicians and doctors at Hospital?s Bacteriology Laboratory in České Budějovice. Bacteries tested for the detection of ESBL production originated from biological materials, witch came from patients of hospital in České Budějovice. The first objective was to compare the results achieved in the České Budějovice Hospital in the period of 2007 to 2012. If we look at the total number of ESBL strains that have been isolated since 2007, values have upward trend. While in 2007 there were only 64 strains a year later, the number more than doubled. In 2010, the value soared to 281 tribes and in the year 2012, the number was 321 tribes. The incidence of ESBL strains in 2007 increased about five times. In the long term we can say the numbers have increasing tendency and the range of each species in the production of ESBL has significantly changed. In 2007, it was K. pneumoniae strains that dominated the statistics, but over time the strains of E. coli came forefront. Values of 2012 suggest that the presence of ESBL strains of K. pneumoniae is again almost equal to the number of E. coli strains. The second objective was to compare the results of the 2012 with study of the Prevalence of ESBL-positive Enterobacteriaceae in large Moravian hospitals. In the general overview of ESBL producers values in Hospital České Budějovice (5.23%) are comparable to those in Ostrava (4.9%) and in Zlín (4.3%). Number of strains in the Hospital in Olomouc (11.8%) is about twice as high as the numbers in České Budějovice. In this comparison the České Budějovice Hospital is one of the hospitals with a lower incidence of ESBL producers. The České Budějovice Hospital is below the national average, which originate from an elaborate system of care for patients with colonization or infection with ESBL strains, and from therapy control system using antibiotic center. These results may serve to the Hospital in České Budějovice for statistical purposes, and also for proposals for improving patient care. In the discussion, I pointed out the danger of the spread of resistant strains of bacteria in the community and also the associated risks that mentioned bacteria mean for patients injured in mass accidents or disasters. In these cases, number of infections including ESBL producers can penetrate through open wounds into the affected body. Unlike conventional sensitive bacteria those strains are resistant to commonly used antibiotics and thereby endanger the lives of people affected by the accident.
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