Antibiotic resistance – a new challenge of modern urology
Authors:   Pirogov Russian National Research Medical University, Kotov S.V. ,   Moscow, Russia, Pulbere S.A. ,   Pirogov Russian National Research Medical University; Moscow, Russia, Belomyttsev S.V. ,   Pirogov Russian National Research Medical University; Moscow, Russia, Perov R.A. ,   Pirogov Russian National Research Medical University; Moscow, Russia, Alesina N.V. ,   Pirogov Clinical Hospital № 1; Moscow, Russia, Zheltikova E.A. ,   Pirogov Russian National Research Medical University; Moscow, Russia
Published: February 2021

Introduction. Analyze of the incidence and resistance to antibacterial drugs to microorganisms isolated in urine cultures of patients with urinary tract infections (UTI) from 2012 to 2019. Materials and methods. In the clinic of urology clinical hospital № 1 named after N.I. Pirogov and in the city clinical hospital № 29 named after N.E. Bauman was analyzed the results of 6083 urine cultures in 5027 patients. The traditional standardized inoculation was carried out with a 10 μl loop on the following nutrient media: agar with the addition of 5% sheep blood (Pronadisa, Spain), Levin agar (Pronadisa, Spain), Biggie agar (BD, USA), followed by incubation at 37°C for 18-24 hours. Next, a visual colony count was performed. The sensitivity of the isolated microorganisms to antibiotics was evaluated using a Phoenix bacteriological analyzer (BD, USA) and a disk diffusion method production discs (BD, USA). ESBL producers and carbapenemases were evaluated using a Phoenix bacteriological analyzer (BD, USA) using the double disc method, by the method of inactivation of carbapenems. Results. A high level of resistance among Enterococcus faecalis strains to fluoroquinolones (> 20%) and aminoglycosides (> 35%) was revealed. Among the strains of Escherichia coli, an increase in resistance to the antibacterial group of penicillins (> 80%) was noted, at the same time, an increase in resistance to drugs of the cephalosporins group (> 60%), fluoroquinolones (> 50%) was observed. The appearance of carbapenem-resistant strains is noted. Among the strains of Klebsiella pneumonia, high resistance to fluoroquinolones (> 50%) and cephalosporins (> 45%) was found. A sharp increase in resistance to all used antibacterial drugs is noted. Separately, increase in resistance to carbapenems (27,1%) can be noted. Discussion. According to the results of our study, it can be argued that the most common causative agents of complicated UTI in 2019 were representatives of the Enterococcaceae and Enterobacteriaceaes, there is an increase in the number of strains resistant to certain groups of antibacterial drugs. When comparing the results obtained with the data of the Internet platform «Map of antibiotic resistance. AMR map» shows comparable data on the occurrence and resistance of microorganisms. Of particular concern is the high frequency of bacterial resistance to drugs of the fluoroquinolone group and, therefore, these drugs cannot be used as empirical therapy for patients with complicated UTI. Conclusions. Adhering to the strategy of rational antibiotic therapy, further studying of the problem of antibiotic resistance, identification of resistant strains, monitoring of the of antibacterial drugs prescription at the outpatient stage and in the hospital are necessary. It is necessary to study the epidemiological data and the results of susceptibility to antibiotics in a particular region, this will help us to more accurately select antibiotic therapy and introduce accelerated laboratory diagnosis of bacteria resistance markers into practice.