Antimicrobial Resistance :: Antimicrobial resistance in Russia|
Antimicrobial Resistance in Russia
The antimicrobial resistance of nosocomial and community-acquired pathogens considerably increased all over the world for the last years. Antibiotic resistance is the natural biological response to antimicrobial therapy, which cause the selection, survival and reproduction of resistant bacteria. Resistance to antimicrobial agents has a huge social and economical importance in developed countries either. Infections caused by the resistant strains require prolonged treatment, more often lead to hospitalization and increase its duration as well as deteriorate the prognosis for the patients infected with such organisms. Failure of the first-choice antibiotic treatment prompt them to use the second-choice drugs which are more expensive and less safe and often not available, increasing thereby the treatment expenses as well as the spread of resistant strains in a community.
Talking about the rise of antimicrobial resistance it is necessary to take into a consideration the level of the problem, whether it is global, regional or a local. Above all, it is important to comprehend global tendencies in emerging of resistance. For instance, this is the appearance and spread of the methicillin-resistant S.aureus, penicillin-resistant S.pneumoniae, N.gonorrhoeae, P.aeruginosa and ESBL-producing K.pneumoniae strains. However, antimicrobial resistance is not a total phenomenon involving all bacteria and drugs. S.pyogenes and T.pallidum are always susceptible to β-lactams and H.influenzae - to cefotaxime or ceftriaxone.
In spite of great importance of global trends in antimicrobial resistance, it is crucial to rely on local data obtained in a particular country (i.e. regional data) for design and implementation of antibiotic policy. Levels of resistance vary considerably in different regions of Russian Federation. Thereupon the significance of territorial resistance monitoring and applying its results into clinical practice is beyond any doubts.
Antibacterial resistance data in Russia are disembodied, they are often obtained with methodological deviations what makes them unreliable. Moreover to make the efficient therapy choice it is necessary to know the predominant local resistance mechanisms, which is often lacking.
In Russia antimicrobial susceptibility testing (AST) faces many problems and the most important is the absence of standardized testing methods. The only existing official recommendation «Notification of procedures of AST by disc diffusing method» published by the USSR Ministry of Health in 1983 neither describes the methods of AST of fastidious organisms (S.pneumoniae, H.influenzae, N.gonorrhoeae) nor includes any interpretation criteria for modern, currently using antibiotics (cephalosporins, fluoroquinolones, carbapenems). Moreover, the expertise showed that recommended AGV medium was not suitable for AST for a number of antibiotics (e.g. antifolates).
Thus, the substantial susceptibility data obtained in bacteriological laboratories cannot be analyzed. As well as one should carefully consider publications, which do not have any information about AST methods and interpretation criteria used in the study.
This chapter only contains the results of the surveys carried out in accordance with internationally recognized NCCLS standards. For proper perception and considering relevant clinical practice, discussed microorganisms are divided into community-acquired and nosocomial pathogens.
The last modification date: 12 Jan 2004