Resistant enterobacteria in Croatia – the role of national antibiotic resistance surveillance

Rezistencija enterobakterija na antibiotike već dugo ugrožava uspjeh empirijske antimikrobne terapije, no posebno zabrinjava pojava izolata rezistentnih na sve raspoložive antibiotike. U Hrvatskoj se rezistencija na antibiotike sustavno prati kroz rad Odbora za praćenje rezistencije Akademije medicinskih znanosti Hrvatske i Referentnog centra Ministarstva zdravlja za praćenje rezistencije (RC) pri Klinici za infektivne bolesti "Dr. Fran Mihaljević" i dio je nacionalnog programa kojeg provodi Interdisciplinarna sekcija za kontrolu rezistencije na antibiotike (ISKRA). U sklopu nacionalnog praćenja RC prikuplja izolate enterobakterija rijetkog fenotipa iz cijele Hrvatske, što je omogućilo uočavanje prvih sojeva s novim mehanizmima rezistencije: prvi izolati s plazmidnim AmpC β-laktamazama opisani su 2003. g., s NDM enzimom 2009. g., a izolati s KPC β-laktamazama 2011. g. Niti jedan od ovih enzima se još nije značajno proširio Hrvatskom. Pravodobno otkrivanje sojeva s novim mehanizmom rezistencije, pogotovo onih koji pokazuju i veliki epidemijski potencijal, poput ST 258 Klebsiella pneumoniae, preduvijet je za uspješno kontroliranje širenja rezistencije.Antibiotic resistance in enterobacteriaceae has for a long time greatly compromised empirical antibiotic therapy but of greatest concern is the emergence of isolates resistant to all available antibiotics. The Committee for Antibiotic Resistance Surveillance of the Croatian Academy of Medical Sciences and the Ministry of Health Reference Center for Antibiotic Resistance urveillance (RC) at the University Hospital for Infectious Diseases jointly conduct national resistance surveillance as a part of the national strategy coordinated by the Interdisciplinary Section for Antimicrobial Resistance Control (ISKRA). RC collects isolates with rare phenotypes from all over Croatia which enables detection of strains with novel resistance mechanisms: the first plasmid mediated AmpC β-lactamases were described in 2003, the first NDM enzyme in 2009 and the first KPC β-lactamase in 2011. None of these enzymes spread throughout Croatia as yet. Timely recognition of emergence of the new resistant strains, particularly the ones with an epidemic potential like the ST 258 Klebsiella pneumoniae, is a paramount in antibiotic resistance control