MP336TRANSPLANTATION AND DIALYSIS CENTER BACTERIAL PROFIL EANALYSIS: EIGHTEEN−YEAR REPORT − 1998−2015

Abstract

Introduction and Aims: Objective: To analyze the dynamics of the species composition of bacterial population and change the sensitivity to antibiotics in patients of transplantation and dialysis center. Methods: We have examined the bacteriological tests results of 1282 patients with chronic kidney disease stage 5 (hemodialysis and peritoneal dialysis patients and renal transplant recipients) in 1998-2015. Biomaterial: urine, blood, wound effluent, sputum. In all patients bacteriological tests were performed because of suspected of infection: pyelonephritis, pneumonia, catheter-associated angiosepsis, postoperative wound infection and nonspecific surgical infection. Results: The total incidence of bacterial pathogens in culture of blood, sputum, urine and wound discharge increased significantly (from 61% to 75%). The incidence of pathogens in sputum increased from 27 to 94%, from 4% to 11% in the blood, from 11 % to 39% in wound discharge and from 52% to 71% in the urine from. The results can be in some way due to the change of bacteriological research method. However, the following trends are detected in the composition of the bacterial population: the part of Gram-positive bacteria monoculture has decreased (from 45% to 24%) and Gram-positive bacteria monoculture remained at the same level (37% -40%). At the same time the frequency of the mixed flora is significantly increased (from 10% to 31%). In recent years half of the microbial associations consisted of in 40% Gram-positive and Gram-negative bacteria, in 19% of Gram-positive and fungi, in 19% of Gram-negative and fungi. In other cases observed ternary association. Thus, there has been a fundamental change in the nature of the microflora: the dominance of Gram-positive bacteria changed to Gram-negative, and the nature of the flora is usually mixed. Gram-negative bacteria are the most common bacterial population in recent years. There are Klebsiella pneumonia (37%), E. Coli (28%), P. aeruginosa (17%), Acinetobacterspp. (10%), Enterobacterspp. (8%). Enterococcusspp. (50%), Staphylococcusspp. (44%) and Streptococcusspp. (6%) are found among Gram-positive bacteria. Fungi of the genus Candida were marked in 16% of culture: C. albicans (40%) and C. glabrata (30%), C. krusei (8%). Differentiation to the species level is not performed in 22 %. The part of fungi in monoculture remained approximately at the same level (5-8%). The incidence of C. glabrata and C. Krusei increased. The most common Gram-positive bacteria have a high sensitivity to a number of antibiotics such as vancomycin and linezolidum. The main Gram-negative bacteria is Klebsiella spp. We noted a growth of resistance of Klebsiella spp even to modern antibiotics. Increasing of antibiotic resistance of E. Coli was mentioned. Conclusions: Bacterial profile changes significantly. Over the years, there was a great change in the nature and composition of the bacterial flora in patients of our center. This fact and the growing resistance to antibiotics dictate the need for periodic analysis of bacterial flora in order to improve treatment outcomes.