Microbiological analysis as effective tool for optimization of empirical antibiotic therapy in the urological clinic

Aim: to study the features of microbiota in patients of urological departments and to optimize the schemes of antibiotic therapy. Materials and methods. Data of microbiological studies in patients of urological departments in 2017 years were analyzed. Isolation of pathogens was carried out using standard techniques. A disk diffusion test using Mueller-Hinton agar with BioRad disks was used to determine the sensitivity. The statistical analysis was performed using the WHONET 5.4 program. In addition, a comparison with the results of the PCR study was done. Results. A total of 672 etiological pathogens were isolated in whole clinic in 2017 year. From those, 173 pathogens were found in the urological clinic, which accounted for 25.7% of the total number. Gram-negative bacteria predominated and its proportion was 59.23%. Gram-positive bacteria were isolated in 24.4%, and fungi were found in 16.37% of cases. The structure of pathogens isolated from stoma or obtained by catheterization was not significantly different. Most frequently isolated pathogens included @K. pneumonia (22.8%), @E. coli (21.2%), @C. albicans (17%), @P. aeruginosa (11%), @E. aerogenes (6%) and @S. aureus (3 %). @K. pneumonia usually had an unfavorable resistance pattern. E. coli isolated from urine samples had more favorable resistance pattern in comparison to pathogens obtained from stoma. The bacteria which were found in intensive care unit had the increased level of resistance. Conclusion. Gram-negative bacteria predominate in the urological clinic with a relatively high proportion of extended-spectrum beta-lactamase producing organisms. Risk factors for the emergence of multi-resistant pathogens are the treatment in the intensive care unit and the presence of stomas or catheters. The PCR method, carried out in parallel with routine microbiological studies and regular analysis of the overall bacterial spectrum, allows to optimize the starting antibiotic therapy from the first day of the disease. The use of cephalosporins is not justified in the most cases. Aminoglycosides and fluoroquinolones remain effective. The use of either β-Lactamase-protected penicillins or fosfomycin is possible only after obtaining the results of bacteriological study. When prescribing carbapenems, the risk of inefficiency is especially high in patients with stomas/catheters and transferred from the intensive care unit.

urological clinic, antibiotic resistance, antibiotic therapy, polymerase chain reaction