94 KB18 KB192920262004Andlovic, AlenkaČernelč, PeterStrauch, Rikastr. I-179-I-182ISSN:1318-0347COBISSID_HOST:17670361URN:URN:NBN:SI:doc-NLLZXMISslSlovensko zdravniško društvoZdravniški vestnikCiprofloksacinCiprofloxacinCitrobacter FreundiiDrug Resistance, MicrobialDrug TherapyEnterobacteriaceae InfectionsEnterobakteriacealne infekcijeLeukemia, Lymphocytic, AcuteLevkemija limfocitna, akutnaMicrobial Sensitivity TestsMikrobni, občutljivostni testiPrevention And ControlTherapeutic UseZdravilo, rezistenca mikrobnaDelež proti ciprofloksacinu odpornih klic Citrobacter freundii pri bolnikih z akutno levkemijo, ki prejemajo ciprofloksacin zaradi preprečevanja bakterijskih okužb| Percentage of ciprofloxacin-resistant strains of Citrobacter freundii in acuteleukaemia patients with ciprofloxacin prophylaxis|Background. Authors tried to determine an efficiency of ciprofloxacin as infection prophylaxis in patients with acute leukaemia treated at the Department of Haematology in Clinical Center of Ljubljana. Due to cytotoxic chemotherapy, aplasia of bone marrow is inevitable. Therefore, these patients are at high risk for bacterial and fungal infection. The authors have noticed a rise in the number of ciprofloxacin-resistant strains of Citrobacter freundii and decided to find out if ciprofloxacin is still usable in this setting. Patients and methods. 45 patients with acute leukaemia were admitted to the Department of Haematology in the Clinical Center of Ljubljana during the year 2001 and 2002. All the patients received ciprofloxacin 2 x 500 mg on a daily basis. Citrobacter freundii was isolated in 11 patients, to whom we determined the proportion of ciprofloxacin-resistant strains of Citrobacter freundii and other Enterobacteriaceae. Susceptibility testing was done by the NCCCLS standards by the disc diffusion method and minimal inhibitory concentration. Results. C. freundii was isolated in 11 patients with AL. Extended-spectrum beta-lactamases (ESBL) C. freundii was isolated in 6 patients (54.5%). Ciprofloxacin-resistant C. freundii was isolated in 6 patients (54.5%). Six patients (54.5%) had ciprofloxacin-resistant C. freundiiwhich was ESBL positive at the same time. In AL patieuts with C. freundii (n = 11) almost half of isolated bacteria were Gram negative bacilli (45.2%, n=292), mostly from the family of Enterobacteriaceae. More than half of enterobacteria were ciprofloxacin-resistant, one third of them were also ESBL positive. Out of 131 enterobacteria, C. freundii was isolated 37 times. (28.2%). Conclusions. C. freundii was isolated in one fourth of AL patients. Half of the isolates were ciprofloxacin-resistant. The same was true for isolated enterobacteria. (Abstract truncated at 2000 characters)Izhodišča. Avtorji so preverili učinkovitost preprečevanja okužb s ciprofloksacinom pri bolnikih z akutno levkemijo (AL) med zdravljenjem s citostatiki na Kliničnem oddelku za hematologijo (KOH). V zadnjih letih so opazili večjo pogostnost klice Citrobacter freundii (C, freundii), ki je bila odporna proti ciprofloksacinu. Z raziskavo so želeli ugotoviti, kako pogosto se ta klica pojavlja, saj je to pomembno pri odločitvi za nadaljnjo preventivno rabo ciprofloksacina. Predvidevajo, da je delež klic C. freundii majhen in da je ciprofloksacin pri večini bolnikov učinkovit. Bolniki in metode. V obdobju od 02. 08. 2001 do 01. 08. 2002 smo zdravili s citostatiki 45 bolnikov z AL. Vsi so profilaktično prejemali ciprofloksacin 2 x 500 mg na dan. V retrospektivno raziskavo smo zajeli vse bolnike, pri katerih smo iz nadzornih kužnin osamili C. freundii (n = 11) ter preverili občutljivost klicena antibiotike. Občutljivost smo določali po navodilih National Committeefor Clinical Laboratory Standards (NCCLS) z difuzijskim načinom na diskih in z določitvijo minimalne zaviralne koncentracije (MIK). Rezultati. C.freundii smo osamili pri 11 bolnikih, ki se zdravijo zaradi AL. C. freundii,ki izdeluje laktamazo beta z razširjenim spektrom delovanja, smo osamili pri šestih bolnikih (54,5%). Proti ciprofloksacinu odporni C. freundiismo osamili pri šestih bolnikih (54,5%). Pri šestih bolnikih (54,5%) smo osamili klico, ki je odporna proti ciprofloksacinu in izdeluje laktamazo beta z razširjenim spektrom delovanja. Pri bolnikih s C. freundii (n = 11) so skoraj polovico izoliranih klic predstavljali po Gramu negativni bacili (45,2%n =292), predvsem iz družine enterobakterij. Proti ciprofloksacinu je bilo odpornih več kot polovica enterobakterij, tretjina enterobakterij pa je izdelovala laktamaze beta z razširjenim spektrom delovanja. Med 231 enterobakterijami so C. freundii osamili sedemintridesetkrat (28,2%). (Izvleček prekinjen pri 2000 znakih)TEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaSlovensko zdravniško društvo