Chub O. Evaluation of plasmid-mediated resistance for the optimization of antibiotic therapy of the patients with chronic pyelonephritis combined with type 2 diabetes mellitus.

The thesis has solved several scientific tasks, namely improvement of diagnostic tools and increasing the efficacy of the treatment of patients with chronic pyelonephritis (CP) combined with type 2 diabetes mellitus (DM). This has been achieved through discovering and surmounting of plasmid-mediated antibiotic resistance mechanisms. We have demonstrated that prevalence of the resistance among patients with CP combined with type 2 DM was 31.5%, while among patients with CP without type 2 DM was 25%; however the difference between these groups was not significant. The main factors related with appearance of plasmid-mediated resistance genes were Chronic Kidney Disease stage ІІІ (OR 2,03) and ІV (OR 1,1), hypertension (OR 2,57), history of prostatitis or cystitis, age range above 55 years (OR 3,05), in-patient treatment history (OR 2,02), duration of CP more than 10 years (OR 1,97), history of using antibiotics last year (OR 1,41). Thus, there is a necessity to include evaluation of plasmid-mediated resistance genes into the clinical testing. We also demonstrated in vitro significant relationship of the resistance to aminopenicillins, cephalosporins and fluoroquinolones with an appearance of plasmid-mediated ESBLs and fluoroquinolones resistant genes in bacterial uropathogens. Thus, taking all this things into consideration, we have established the pattern of individual antibiotic prescribing to patients with CP combined with type 2 DM in relation to appearance of plasmid-mediated resistance genes.