BETA-LACTAMASE LIQUOR ACTIVITY IN ACINETOBACTER PURULENT MENINGOENCEPHALITIS
Objectives. To determine the role of Acinetobacter spp. in the development of purulent meningoencephalitis, to assess the level of beta-lactamase activity (BLA) of liquor and to analyze its clinical significance in neurosurgical patients. Methods. Positive bacteriological liquor samples obtained from 52 patients with purulent meningoencephalitis of neurosurgery department of ME “Vitebsk Regional Clinical Hospital” in 2010-2015 have been studied. Identification and sensitivity of microorganisms were performed by test systems (ATB Expression Microbiological Culture Analyzer). To assess the beta-lactamase activity (BLA) of liquor the test system ”Biolactam” (LTD “Sivital”, the Republic of Belarus) was applied. Results. Gram-positive flora composed 38,60% (95% CI: 25,56-51,63) out of 57 isolated strains, gram-negative microorganisms - 61.40% (95% CI: 48,37-74,44). Gram-positive flora was represented by native Staphylococcus 21,05%, (95% CI: 10,14-31,97) and the family Streptococcaseae 17,54% (95% CI: 7,36-27,73). The Gram-positive bacteria include A. baumannii - 36,84% (95% CI: 23,93-49,76), P. aeruginosa - 12.28% (95% CI: 3,49-21,07), K. pneumonia - 10 53% (95% CI: 2,53-18,74) and Cirtobacter - 1,75%. The median of BLA of liquor (n=17) was equal to 41.82% (95% CI: 27,22-56,44); min 5,60%, max 78,29%. When A. baumannii (n=8), the value BLA of liquor was 43,01% (95% CI: 17,63%-68,49%). Pathogen was resistant to the third/fourth-generation cephalosporin and imipenem in 100% of cases; to meropenem and amikacin - in 83% of cases, to ofloxacin and ciprofloxacin - in 66%, to levofloxacin in 50%, to ampicillin/sulbactam in 0% of cases. Conclusion. In the late postoperative period purulent meningoencephalitis is caused by gram-negative pathogens in 61,40% of cases. The common causative agent of purulent meningoencephalitis is considred to be A. baumannii (36,84%). The value BLA of liquor with A. baumannii (43,01%) is two folds higher than the threshold one (20%). This pathogen reveals high resistance to the third/fourth-generation cephalosporin, carbapenems and fluoroquinolones. High value of BLA of liquor is the guarantor of the pathogen resistance to antibacterial drugs.