The medical journal "Health of Ukraine. Surgery, Orthopedics, Traumatology, Intensive Care" No. 4, 2020, published the first part of an article by I. Bereznyakov, MD, Professor, Head of the Department of Therapy at the Kharkiv Medical Academy of Postgraduate Education, and President of the Ukrainian Association for the Appropriate Use of Antibiotics, dedicated to the state of antibiotic resistance in Ukraine based on the results of the AURA study.

Unfortunately, Ukraine currently lacks a national program for surveillance and combating antibiotic resistance, and reliable data on the spread of antibiotic-resistant strains in the country are available only for pneumococci and Haemophilus influenzae . From December 2018 to May 2019, the Institute of Microbiological Research (Kyiv) medical laboratory conducted a study (the AURA study) to monitor antibiotic resistance in Ukraine, with the support of Arterium Corporation.

The material for microbiological studies consisted of pathological contents from wounds associated with skin and soft tissue infections, intra-abdominal infections, and bone and joint infections. Samples were obtained in various cities across Ukraine. Over a six-month period, a total of 554 samples were obtained for microbiological analysis, from which 800 bacterial isolates were isolated. The isolates were tested for susceptibility to 23 antibacterial agents. The AURA study did not aim to determine the titer or assess the etiological significance of the isolated microorganisms.

Of the 800 isolated microorganisms, 453 (56.6%) were gram-positive, 344 (43%) were gram-negative bacteria, and 3 (0.4%) were Candida fungi.

Gram-positive bacteria . Of the 453 Gram-positive bacterial isolates, the majority were staphylococci, enterococci, and streptococci. More than a third of the Staphylococcus isolates were methicillin-resistant, including species such as S. haemolyticus, S. epidermidis , and S. aureus (MRSA). MRSA has been shown to be resistant to all β-lactam antibiotics (except fifth-generation cephalosporins, such as ceftaroline), and to show less than 50% susceptibility to azithromycin, clarithromycin, clindamycin, erythromycin, levofloxacin, ciprofloxacin, and gentamicin.

Among enterococci, Enterococcus faecalis was isolated most frequently, while Enterococcus faecium, Enterococcus avium, and Enterococcus raffinosus were isolated significantly less frequently. E. faecalis demonstrated low susceptibility to levofloxacin, ciprofloxacin, and amikacin; high susceptibility was demonstrated towards both glycopeptides, linezolid, tigecycline, fosfomycin, and nitrofurantoin. Two vancomycin-resistant E. faecalis isolates exhibited a resistance phenotype, which in both cases was VanB; They were susceptible to fosfomycin and fluoroquinolones (levofloxacin and ciprofloxacin), one of the two – to teicoplanin or nitrofurantoin, both – were resistant to linezolid, tigecycline, penicillin and amikacin. In E. faecium, 100% susceptibility was established to vancomycin, linezolid and tigecycline; extremely low (<20%) – to levofloxacin, ciprofloxacin, amoxicillin/clavulanate, piperacillin/tazobactam.

Among Streptococcus, isolates of Streptococcus agalactiae, Streptococcus pyogenes, Streptococcus anginosus, Streptococcus mitis, Streptococcus salivarius, Streptococcus constellatus and others were identified. Their sensitivity was high to the tested β-lactams, linezolid, tigecycline, teicoplanin, nitrofurantoin, co-trimoxazole, chloramphenicol, daptomycin and vancomycin.

Gram-negative bacteria. Most of the isolated gram-negative microorganisms belonged to the Enterobacteriaceae family and non-fermenters. Escherichia coli demonstrated high susceptibility (92-94%) to nitrofurans, polymyxin, fosfomycin, and carbapenems (meropenem and ertapenem), with slightly lower susceptibility (87%) to third-generation inhibitor-protected cephalosporins (cefoperazone/sulbactam). One-third of the isolated E. coli isolates produced extended-spectrum β-lactamases (ESBLs) and were resistant to third-, fourth-, and fifth-generation cephalosporins and protected aminopenicillins. They were also resistant to fluoroquinolones but retained sensitivity to carbapenems and nitrofurantoin, cefoperazone/sulbactam, fosfomycin, and colistin. One E. coli isolate produced metallo-β-lactamase and was resistant to all β-lactam antibiotics (including carbapenems), fluoroquinolones, aminoglycosides, co-trimoxazole, and nitrofurantoin and retained sensitivity only to colistin and fosfomycin.

Klebsiella spp. ( K. pneumoniae, K. oxytoca, K. aerogenes ) retain high sensitivity only to colistin (98%) ; the level of sensitivity to fosfomycin and meropenem did not exceed 75-80%, and to drugs of other classes it was even lower.

The isolated Proteus spp. isolates were susceptible to meropenem, cefoperazone/sulbactam and piperacillin/tazobactam, ertapenem and ceftazidime.

In general, meropenem (89%) was found to be an active antibiotic against ESBL-producing enterobacteria, followed by fosfomycin (80%) and ertapenem (71%).

Pseudomonas spp. ( P. aeruginosa, P. putida, P. stutzeri ) retained high susceptibility only to colistin (93%), followed by fosfomycin (73%). The susceptibility of Pseudomonas spp. to other antibiotics, in particular carbapenems, did not reach 30%.

Acinetobacter spp. ( A. baumannii, A. johnsonii, A. haemolyticus ), like Pseudomonas isolates, retained high sensitivity only to colistin (99%).

The article will be continued in the next issue of "Health of Ukraine. Surgery, Orthopedics, Traumatology, Intensive Care."