The article describes activities of an antibiotic center at a university hospital in the Czech Republic and presents the results of antibiotic stewardship program implementation over a period of 10 years. It provides data on the development of resistance of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus to selected antibiotic agents as well as consumption data for various antibiotic classes. The genetic basis of resistance to beta-lactam antibiotics and its clonal spread were also assessed. The study showed significant correlations between aminoglycoside consumption and resistance of Escherichia coli and Klebsiella pneumoniae to gentamicin (r = 0.712, r = 0.869), fluoroquinolone consumption and resistance of Klebsiella pneumoniae to ciprofloxacin (r = 0.896), aminoglycoside consumption and resistance of Pseudomonas aeruginosa to amikacin (r = 0.716), as well as carbapenem consumption and resistance of Pseudomonas aeruginosa to meropenem (r = 0.855). Genotyping of ESBL- positive isolates of Klebsiella pneumoniae and Escherichia coli showed a predominance of CTX-M-type; in AmpC-positive strains, DHA, EBC and CIT enzymes prevailed. Of 19 meropenem-resistant strains of Klebsiella pneumoniae, two were identified as NDM-positive. Clonal spread of these strains was not detected. The results suggest that comprehensive antibiotic stewardship implementation in a healthcare facility may help to maintain the effectiveness of antibiotics against bacterial pathogens. Particularly beneficial is the work of clinical microbiologists who, among other things, approve administration of antibiotics to patients with bacterial infections and directly participate in their antibiotic therapy.

中文翻译：

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在大学医院环境中实施抗生素管理

本文介绍了捷克共和国一家大学医院抗生素中心的活动，并介绍了为期10年的抗生素管理计划实施结果。它提供了有关大肠杆菌，肺炎克雷伯菌，铜绿假单胞菌和金黄色葡萄球菌对所选抗生素的抗药性发展情况的数据，以及各种抗生素类别的消费数据。还评估了对β-内酰胺抗生素耐药性的遗传基础及其克隆传播。研究表明，氨基糖苷的消费与大肠杆菌和肺炎克雷伯菌的耐药性之间存在显着相关性对庆大霉素（r = 0.712，r = 0.869），氟喹诺酮类药物的摄入量和肺炎克雷伯菌对环丙沙星的耐药性（r = 0.896），铜绿假单胞菌的氨基糖苷消耗量和对丁胺卡那霉素的耐药性（r = 0.716），以及碳青霉烯的消耗量和耐药性铜绿假单胞菌至美罗培南（r = 0.855）。肺炎克雷伯菌和大肠杆菌的ESBL阳性分离株的基因分型显示出CTX-M型占优势。在AmpC阳性菌株中，DHA，EBC和CIT酶占优势。19株耐美罗培南的肺炎克雷伯菌菌株，其中两个被确定为NDM阳性。没有检测到这些菌株的克隆传播。结果表明，在医疗机构中全面实施抗生素管理可能有助于保持抗生素对细菌病原体的有效性。特别值得一提的是，临床微生物学家的工作尤其是批准向患有细菌感染的患者使用抗生素并直接参与其抗生素治疗。