The rise and fall of resistant bacteria

Problem rezistencije bakterija na antibiotike jedan je od vodećih problema današnje medicine. Hrvatska sistematski prati stope rezistencije u najčešćih patogena od 1996. g. te je u ovom radu analizirano kretanje stopa rezistencije u Hrvatskoj u razdoblju od 2000. do 2014. g. Trideset pet hrvatskih mikrobioloških laboratorija (pokrivenost populacije >90 %) slalo je podatke o osjetljivosti kliničkih izolata (ponavljani izolati su isključivani) u Referentni centar Ministarstva zdravlja za praćenje rezistencije gdje su podaci agregirani i analizirani. Otpornost streptokoka grupe A na makrolide pokazuje lagani trend pada. Smanjena osjetljivost pneumokoka na penicilin pokazuje manje oscilacije bez izraženog trenda. Rezistencija na vankomicin je prisutna u E. faecium s trendom porasta u zadnje dvije godine. Rezistencija na cefalosporine 3. generacije i kinolone je u E. coli u blagom, ali stalnom porastu, a u K. pneumoniae je znatno viša, ali ne pokazuje porast zadnjih godina. Rezistencija na karbapeneme je u P. aeruginosa u blagom porastu, a u A. baumannii je naglo porasla od 2008. g. Hrvatska ima dobro organiziranu mrežu za praćenje rezistencije i poznavanje stopa rezistencije je važan prvi korak u kontroli širenja rezistencije. U kontroli širenja rezistencije također je bitno jačati ulogu timova za kontrolu bolničkih infekcija te prepustiti antimikrobnu terapiju timovima za rukovođenje antimikrobnom terapijom.Antimicrobial resistance (AMR) is one of the leading problems in modern medicine. Antibiotic resistance surveillance in Croatia was set up in 1996 and antibiotic resistance rates in most frequent bacterial pathogens were analysed for the period 2000 till 2014. Thirty five Croatian microbiology laboratories (population coverage >90 %) have sent antibiotic sensitivity data for clinical isolates (copy isolates were excluded) to the Ministry of Health Reference Center for Antibiotic Resistance Surveillance where these data were aggregated and analysed. Macrolide resistance in group Astreptococci shows a mild decreasing trend. Penicillin non-susceptibility in pneumococci demonstrates slight oscillations without any trend. Vancomycin resistance was recorded in Enterococcus faecium with increasing trend in the last two years. Resistance to 3rd generation cephalosporins and quinolones is slightly but constantly increasing in E. coli and in K. pneumoniae, although significantly higher, it does not demonstrate increase in the last few years. Carbapenem resistance is slightly increasing in P. aeruginosa and has abruptly increased in A. baumannii since 2008. Croatia has a well organized antibiotic resistance surveillance network and knowing local resistance rates is an important first step in controlling antibiotic resistance. For successful AMR control it is also very important to strengthen the role of infection control teams and to establish antibiotic stewardship teams