INTRODUCTION Catheter-associated urinary tract infections (CAUTI) are the most common nosocomial infections. The worldwide data show the increasing resistance to conventional antibiotics among urinary tract pathogens. AIM To evaluate the adequacy of initial antimicrobial therapy in relation to the antimicrobial resistance of pathogens responsible for CAUTI in Clinical Center of Banja Luka. METHODS A retrospective study on major causes of CAUTI, antibiotic resistance and treatment principles was conducted at four departments of the Clinical Center of Banja Luka from January 1st, 2000 to April 1st, 2003. RESULTS The results showed that 265 patients had developed CAUTI. The seven most commonly isolated microorganisms were, in descending order: E. coil (31.0%), Pseudomonas aeruginosa (13.8%), Proteus mirabilis (12.9%), Gr. Klebsiella-Enterobacter (12.3%), Enterococcus spp. (5.2%), Pseudomonas spp. (4.3%), Serratia spp. (4.0%). The most common pathogens were highly resistant to ampicillin (64-100%), gentamycin (63-100%), and trimethoprim-sulfamethoxazole (68-100%), while some bacterias, like Pseudomonas aeruginosa and Serratia spp. showed rates of ciprofloxacin resistance as high as 42.8% and 72.7%, respectively. In 55.5% of the cases, the initial antibiotic therapy was inadequate, and was corrected latter on. There were no standard therapeutic protocols for this type of nosocomial infections. CONCLUSION The results of this study emphasized an urgency of the prevention and introduction of clinical protocols for better management of CAUTI. Treatment principles should better correspond to the antibiotic sensitivity of uropathogens.

Sažetak. U trendu porasta ukupnih troškova za zdravstvo, kontinuirano praćenje upotrebe lijekova и zdravstenom sistemu omogućava sagledavanje zdravstvenog stanja stanovništva, farmakoterapijskih navika doktora i trendova и propisivanju, stepena racionalnosti upotrebe lijekova, te upoređivanja istih sa svjetskim kretanjima. Cilj ovog rada je bio da se analizira upotreba lijekova koji se izdaju na teret Fonda zdravstvenog osiguranja Republike Srpske и periodu 2003-2004. godina. Retrospektivnom studijom analizirana je upotreba lijekova sa pozitivne liste Fonda zdravstvenog osiguranja Republike Srpske 2003-2004. godine. Podaci su obrađeni prema ATC/DDD metodologiji, a rezultati izraženi brojem DDD/1.000 osiguranih lica/dan. Prikazana su i materijalna izdvajanja za lijekove sa pozitivne liste, izraženo и milionima konvertibilnih maraka. U 2004. godini je došlo do porasta upotrebe lijekova od 21% izraženo brojem DDD, a materijalna izdvajanja su porasla za 25% и odnosu na prethodnu godinu. Najveéa je upotreba lijekova и grupama za kardiovaskularne bolesti (ACE inhibitori i Ca blokatori), lijekova koji djeluju na sistem za varenje i metabolizam (antidijabetici i antiulkusici), koji djeluju na nervni sistem (antiepileptici i anksiolitici), te sistemski antiinfektivi. U obe godine najveéi su troškovi bili izdvojeni za lijekove и liječenju kardiovaskularnih oboljenja. Porast upotrebe lijekova, kao i povećanje troškova и zdravstvu zahtijeva detaljnu analizu, primjenom farmakoekonomskih metoda koje bi trebalo da pomognu pri donošenju odluka о raspodjeli raspoloživih sredstava. Na osnovu ovakvih podataka država тога kontinuirano da prilagođava zdravstevnu politiku и skladu sa standardnim kliniâkim smjernicama i medicini zasnovanoj na dokazima, kako bi farmakoterapiju učinila racionalnom i dostupnom cjelokupnom stanovništvu.

Using ATC/DDD methodology, we analyzed antibiotic utilization in the Clinical Centre of Banja Luka, one of the largest clinical centres in Bosnia and Herzegovina, during the war and postwar period (1994–2000), as well as the role of drug donations on doctors' prescribing decisions. The retrospective analysis of antibiotic utilization (group J according to the Anatomical Therapeutical Chemical – ATC classification) was based upon the data provided from the hospital computer centre and calculated as the number of defined daily doses (DDD) per 100 bed days. The pharmacoepidemiological analysis showed that the total use of antibiotics changed markedly; in the war year of 1994, as well as in 1998, antibiotics were the second most frequently used group of drugs (19.7% and 14.1% of total drug utilization respectively), while in the following years antibiotics were considerably less used. These dynamics were significantly influenced by drug donations, the percentage of which in the overall antibiotic supply in 1996 was 91.5%, while in 1999 and in 2000 it decreased considerably to 46.8% and 45.6%, respectively. The most widely prescribed antibiotics were penicillins, aminoglycosides, sulphonamides and tetracyclines. Among these, the aminopenicillins, co‐trimoxazole, gentamicin and tetracyclines were mainly (70–100%) supplied as a drug donations. However, macrolides, cephalosporins and quinolones were less used due to fact that they were considerably less often delivered through drug donations. It can be concluded that the drug donations had a significant impact on prescribing practice and the rational use of antibiotics in the Clinical Centre studied.