Analysis of the structure and antibiotic resistance of etiologically significant pathogens of chronic lower respiratory tract infection in children with cystic fibrosis living in Dnipro
Background. Chronic infectious inflammation of the lower respiratory tract, which is formed on the basis of a genetic defect in the first years of life, is a key factor in patients with cystic fibrosis (CF) and determines the prognosis of the disease. The spectrum of microorganisms that are identified from the lower respiratory tract is very specific for CF, but there are dynamic changes, regional differences in phenotypes and sensitivity to antibiotics. The purpose of the study was to monitor the results of a microbiological study of sputum in children from Dnipro with CF, to determine the characteristics of the local profile of pathogens, their sensitivity to antibiotics and spectrum changes for the period from 2008 to 2019. Materials and methods. The study involved 37 children with CF aged 1 to 18 years. All patients with CF underwent a microbiological examination of sputum with a determination of the species of the isolated bacterial strains and sensitivity to antibiotics. There were also analyzed 1257 results of a microbiological study of sputum in patients with CF — residents of the Dnipropetrovsk region for 2008–2018. Results. It has been revealed that over the past 10 years in the structure of etiologically significant pathogens of chronic lower respiratory tract infection in children with CF, a gradual increase in the share of Staphylococcus aureus and Pseudomonas aeruginosa has been observed with a decrease in the prevalence of Haemophilus influenzae. Candida albicans and Aspergillus fumigatus were sown more often that other fungi. It was established that most of the isolated strains of Staphylococcus aureus were resistant to unprotected aminopenicillins, carboxypenicillins, first- and second-generation cephalosporins. The mucoid strains of Pseudomonas aeruginosa were characterized by a fairly high level of antibiotic resistance to protected third- and fourth-generation cephalosporins, fluoroquinolones. Conclusions. For the observation period from 2008 to 2019, the species composition of the microbiota of the respiratory tract in children with CF in Dnipro did not change, but the ratio of microorganisms sown was significantly changed. Staphylococcus aureus and Pseudomonas aeruginosa remain the leading pathogens of lower respiratory tract infections in patients with CF; however, an increase in the resistance of these pathogens to modern antibacterial drugs is noted. Determining the level of resistance of microorganisms in a particular patient contributes to the adequate selection of antibacterial drugs for the treatment of exacerbations of chronic bronchopulmonary infection in accordance with the developed treatment protocols and prevents the selection of resistant strains of microorganisms.
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