Antibiotic resistance of the main uropathogens in patients with acute secondary pyelonephritis

Relevance. Pyelonephritis is an infectious and inflammatory disease of the kidneys with predominant damage to the mucous membrane of the pelvis and calyces and/or interstitial tissue. In complicated acute pyelonephritis, the frequency of E. coli isolation is 63,3%. Less common pathogens are Proteus mirabilis (6,1%), Pseudomonas aeruginosa (1,3%), Klebsiella pneumoniae (13,5%). Enterobacteriaceae are characterized by high levels of resistance to many antimicrobial drugs (AMPs). Today, the greatest clinical significance is the increase in resistance of enterobacteria strains to modern cephalosporins and carbapenems.

Purpose of the study. To study the level of resistance of pyelonephritis pathogens to antibacterial drugs of various groups, to identify producers of extended spectrum beta-lactamases and carbapenemases among the causative agents of acute secondary pyelonephritis.

Materials and methods. The medical histories of 305 medical histories of patients who were undergoing inpatient treatment at the uronephrological center of the Regional Clinical Hospital named after Professor S.I. Sergeev, Khabarovsk with an established diagnosis: acute secondary pyelonephritis. The material for laboratory research was the average portion of freely released urine obtained after toileting the genital organs, or urine collected by a catheter using a generally accepted method. Identification of microorganisms was carried out using automatic bacteriological analyzers. Antimicrobial susceptibility was tested using the disk diffusion method. Molecular genetic analysis was carried out using the PCR method.

Results and discussion. The resistance of microorganisms that cause acute secondary pyelonephritis to antibacterial drugs of various groups was assessed. The mechanisms of antibiotic resistance of enterobacteriaceae have been studied. A high prevalence of extended spectrum beta-lactamase producers was revealed. In E. coli isolates. genes of the bla CTX-M-1 cluster predominated (34%). Carbopenemase production was detected in 24% of the analyzed E.coli strains. The vast majority of K. pneumoniae strains produced extended-spectrum beta-lactamases of the bla SHV cluster (87.5%). The frequency of carbapenemase production among K. pneumoniae isolates was 68.7%.

Conclusion. If acute secondary pyelonephritis is suspected and empirical therapy is prescribed, assessment of the local resistance phenotype of the leading pathogens is necessary to exclude from the selection of antibacterial agents to which there is a high level of resistance.