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Kan Kültürü Örneklerinden İzole Edilen Gram Negatif Bakterilerin Antibiyotik Direnç Profillerinin İncelenmesi

Yıl 2023, Cilt: 13 Sayı: 1, 80 - 86, 20.01.2023
https://doi.org/10.33631/sabd.1133713

Öz

Amaç: Son yıllarda geniş spektrumlu antibiyotiklerin yaygın kullanımı nedeniyle çoklu ilaca dirençli bakterilerde meydana gelen artışlar dünya çapında acil bir sorun haline gelmiştir. Bu çalışmada kan kültürü örneklerinden izole edilen Gram negatif bakterilerin antimikrobiyal direnç paternlerinin saptanarak ampirik tedavi ve antibiyotik kullanım politikalarına katkıda bulunulması amaçlanmıştır.
Gereç ve Yöntemler: Laboratuvarımıza Haziran 2018-Haziran 2021 tarihleri arasında gönderilen kan kültüründen izole edilen 495 Gram negatif bakteri izolatı retrospektif olarak incelenmiştir. Bakterilerin identifikasyonu için konvansiyonel yöntemler ve tam otomatize cihaz (VITEK2, bioMerieux, Fransa) kullanılmıştır. Tiplendirme sonrasında izolatların antibiyotik duyarlılık testleri, VITEK2 sistemi ile yapılmış, EUCAST (European Committee on Antimicrobial Susceptibility Testing) kriterlerine göre yorumlanmıştır.
Bulgular: Gram negatif izolatlar, sıklıkla yoğun bakım servislerinden izole edilmiştir (%39). Gram negatif bakteriyemilerde saptanan etkenler sıklık sırasına göre; Escherichia coli %33,9, Klebsiella pneumoniae %19,1, Acinetobacter spp. %18,5, Pseudomonas spp. %10,3 ve Enterobacter spp. %4,6 bulunmuştur. E.coli’ de daha az direnç karbapenemlere (meropenem %0, imipenem %2,9 ve ertapenem %3,7) , tigesikline %1,8, ve amikasine karşı %2 saptanmıştır. Enterobacterales izolatlarında daha az direnç oranları sırasıyla karbapenemlere (%6,8-14,5) amikasine (%10,6) ve tigesikline (%15,9) karşı bulunmuştur. Pseudomonas spp.’de daha az direnç amikasine (%11,8) ve karbapenemlere (%13,7-22,7) karşı saptanmıştır.
Sonuç: Karbapenemler, amikasin ve tigesiklin dışındaki bazı antibiyotiklere direnç oranlarının yüksek oranda saptanması, hastalara ampirik antibiyotik tedavinin dikkatli şekilde uygulanması gerektiğini göstermektedir. Bu sonuçların hastanemizde akılcı antibiyotik kullanımına ve ampirik tedavi seçimine katkı sağlayacağı kanaatindeyiz.

Kaynakça

  • Satılmış Ş, Aşgın N. Kan kültüründe sıklıkla izole edilen bakterilerin ve antibiyotik duyarlılık profillerinin yıllara göre dağılımı. Ankem Derg. 2019; 33(3): 95-101.
  • Loonen AJM, Jager CPCde, Tosserams J, Kusters R, Hilbink M, Wever PC, et al. Biomarkers and molecular analysis to improve bloodstream infection diagnostics in an emergency care unit. PloS one. 2014; 9(1): p.e87315.
  • Cohen J, Vincent JL, Adhikari NK, Machado FR, Ancus D, Calandra T, et al. Sepsis: a roadmap for future research. The Lancet infectious diseases. 2015; 15(5): 581-614.
  • Leal HF, Azevedo J, Silva GEO, Amorim AML, Roma LRC, Arraes ACP, et al. Bloodstream infections caused by multidrug-resistant gram-negative bacteria: epidemiological, clinical and microbiological features. BMC infectious diseases. 2019; 19(1): 1-11.
  • Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). Jama. 2016; 315(8): 801-10.
  • Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. New England Journal of Medicine. 2003; 348(16): 1546-54.
  • Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clinical infectious diseases. 2004; 39(3): 309-17.
  • Rodriguez-Creixems M, Alcala L, Munoz P, Cercenado E, Vicente T, Bouza E. Bloodstream infections: evolution and trends in the microbiology workload, incidence, and etiology, 1985-2006. Medicine. 2008; 87(4): 234-49.
  • Diekema DJ, Beekmann SE, Chapin KC, Morel KA, Munson E, Doern GV. Epidemiology and outcome of nosocomial and community-onset bloodstream infection. J clinical microbiology. 2003; 41(8): 3655-60.
  • Diekema DJ, Hsueh PR, Mendes RE, Pfaller MA, Rolston KV, Sader HS, et al. The microbiology of bloodstream infection: 20-year trends from the SENTRY Antimicrobial Surveillance Program. Antimicrobial agents and chemotherapy. 2019; 63(7): e00355-19.
  • Albrecht SJ, Fishman NO, Kitchen J, Nachamkin I, Bilker WB, Hoegg C, et al. Reemergence of gram-negative health care–associated bloodstream infections. Archives of internal medicine. 2006; 166(12): 1289-94.
  • Marra AR, Camargo LF, Pignatari AC, Sukiennik T, Behar PR, Medeiros EA et al. Nosocomial bloodstream infections in Brazilian hospitals: analysis of 2,563 cases from a prospective nationwide surveillance study. Journal of clinical microbiology. 2011; 49(5): 1866-71.
  • O'Neill J. Tackling drug-resistant infections globally: final report and recommendations. Review on Antimicrobial Resistance. United Kingdom: London; 2016.
  • Steven L, Solomon MD, Oliver KB. Antibiotic resistance threats in the United States: stepping back from the brink. American family physician. 2014; 89(12): 938-41.
  • Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States. Atlanta, GA: US; 2019.
  • Shrivastava SR, Shrivastava PS, Ramasamy J. World health organization releases global priority list of antibiotic-resistant bacteria to guide research, discovery, and development of new antibiotics. Journal of Medical Society. 2018; 32(1): 76.
  • Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, et al. Multistate point-prevalence survey of health care–associated infections. New England Journal of Medicine. 2014; 370(13): 1198-208.
  • Holmes CL, Anderson MT, Mobley HL, Bachman MA. Pathogenesis of Gram-negative bacteremia. Clinical Microbiology Reviews. 2021; 34(2): e00234-20.
  • European Committee on Antimicrobial Susceptibility Testing (EUCAST) Breakpoint tables for interpretation of MICs and zone diameters. Version 11, (2021). Available from: http://www.eucast.org
  • Garrouste-Orgeas M, Chevret S, Mainardi JL, Timsit JF, Misset B, Carlet J. A one-year prospective study of nosocomial bacteraemia in ICU and non-ICU patients and its impact on patient outcome. Journal of Hospital Infection. 2000; 44(3): 206-13.
  • Wilson J, Elgohari S, Livermore DM, Cookson B, Johnson A, Lamagni T, et al. Trends among pathogens reported as causing bacteraemia in England, 2004–2008. Clinical Microbiology and Infection. 2011; 17(3): 451-8.
  • Marra AR, Camargo LFA, Pignatari ACC, Sukiennik T, Behar PRP, Medeiros EAS, et al. Nosocomial bloodstream infections in Brazilian hospitals: analysis of 2,563 cases from a prospective nationwide surveillance study. Journal of Clinical Microbiology. 2011; 49(5): 1866-71.
  • Tabah A, Koulenti D, Laupland K, Misset B, Valles J, Carvalho FB, et al. Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study. Intensive care medicine. 2012; 38(12): 1930-45.
  • Mathur P, Varghese P, Tak V, Gunjiyal J, Lalwani S, Kumar S, et al. Epidemiology of blood stream infections at a level-1 trauma care center of India. Journal of laboratory physicians. 2014; 6(1): 22.
  • Sligl WI, Dragan T, Smith SW. Nosocomial Gram-negative bacteremia in intensive care: epidemiology, antimicrobial susceptibilities, and outcomes. International Journal of Infectious Diseases. 2015; 37(1): 129-34.
  • Ergönül Ö, Aydin M, Azap A, Başaran S, Tekin S, Kaya Ş, et al. Healthcare-associated Gram-negative bloodstream infections: antibiotic resistance and predictors of mortality. Journal of Hospital Infection. 2016; 94(4): 381-5.
  • World Health Organization,Central Asian and European Surveillance of Antimicrobial Resistance:Annual report 2020. https://www.euro.who.int/__data/assets/pdf_file/0003/469200/Central-Asian-and-European-Surveillance-of-Antimicrobial-Resistance.-Annual-report-2020-eng.pdf. Erişim tarihi: 27.10.2021
  • Boncagni F, Francolini R, Nataloni S, Skrami E, Gesuita R, Donati A, et al. Epidemiology and clinical outcome of Healthcare-Associated Infections: a 4-year experience of an Italian ICU. Minerva Anestesiol. 2015; 81(7): 765-75.
  • Walsh TR. Emerging carbapenemases: a global perspective. International journal of antimicrobial agents. 2010; 36: 8-14.

Investigation of Antibiotic Resistance Profiles of Gram Negative Bacteria Isolated from Blood Culture Samples

Yıl 2023, Cilt: 13 Sayı: 1, 80 - 86, 20.01.2023
https://doi.org/10.33631/sabd.1133713

Öz

Aim: Due to the widespread use of broad-spectrum antibiotics in recent years, the increase in multidrug resistant bacteria has become an urgent problem worldwide. In this study, it was aimed to determine the antimicrobial resistance patterns of Gram negative bacteria isolated from blood culture samples and to contribute to empirical treatment and antibiotic use policies.
Material and Methods: 495 Gram negative bacteria isolates isolated from blood cultures sent to our laboratory between June 2018 and June 2021 were retrospectively analyzed. Traditional methods and a fully automated device (VITEK2, bioMerieux, France) were used for the identification of bacteria. After typing, antibiotic susceptibility tests of microorganisms were performed with the VITEK2 system, interpreted according to EUCAST (European Committee on Antimicrobial Susceptibility Testing) criteria.
Results: Gram-negative isolates were frequently isolated from intensive care units (39%). In order of frequency, the agents detected in Gram-negative bacteremias were; Escherichia coli 33.9%, Klebsiella pneumoniae 19.1%, Acinetobacter spp. 18.5%, Pseudomonas spp. 10.3% and, Enterobacter spp. 4.6%. Less resistance was found in E.coli against carbapenems (meropenem 0%, imipenem 2.9% and ertapenem 3.7%), tigecycline 1.8%, and amikacin 2%. Less resistance rates in Enterobacterales isolated were found against carbapenems (6.8-14.5%), amikacin (10.6%) and tigecycline (15.9%),respectively. Less resistance was detected against amikacin (11.8%) and carbapenems (13.7-22.7%) in Pseudomonas spp.
Conclusion: The high rates of resistance to some antibiotics other than carbapenems, amikacin and tigecycline indicate that empirical antibiotic therapy should be applied carefully to the patients. We are of the opinion that these results will contribute to the rational use of antibiotics and the choice of empirical treatment in our hospital.

Kaynakça

  • Satılmış Ş, Aşgın N. Kan kültüründe sıklıkla izole edilen bakterilerin ve antibiyotik duyarlılık profillerinin yıllara göre dağılımı. Ankem Derg. 2019; 33(3): 95-101.
  • Loonen AJM, Jager CPCde, Tosserams J, Kusters R, Hilbink M, Wever PC, et al. Biomarkers and molecular analysis to improve bloodstream infection diagnostics in an emergency care unit. PloS one. 2014; 9(1): p.e87315.
  • Cohen J, Vincent JL, Adhikari NK, Machado FR, Ancus D, Calandra T, et al. Sepsis: a roadmap for future research. The Lancet infectious diseases. 2015; 15(5): 581-614.
  • Leal HF, Azevedo J, Silva GEO, Amorim AML, Roma LRC, Arraes ACP, et al. Bloodstream infections caused by multidrug-resistant gram-negative bacteria: epidemiological, clinical and microbiological features. BMC infectious diseases. 2019; 19(1): 1-11.
  • Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). Jama. 2016; 315(8): 801-10.
  • Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. New England Journal of Medicine. 2003; 348(16): 1546-54.
  • Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clinical infectious diseases. 2004; 39(3): 309-17.
  • Rodriguez-Creixems M, Alcala L, Munoz P, Cercenado E, Vicente T, Bouza E. Bloodstream infections: evolution and trends in the microbiology workload, incidence, and etiology, 1985-2006. Medicine. 2008; 87(4): 234-49.
  • Diekema DJ, Beekmann SE, Chapin KC, Morel KA, Munson E, Doern GV. Epidemiology and outcome of nosocomial and community-onset bloodstream infection. J clinical microbiology. 2003; 41(8): 3655-60.
  • Diekema DJ, Hsueh PR, Mendes RE, Pfaller MA, Rolston KV, Sader HS, et al. The microbiology of bloodstream infection: 20-year trends from the SENTRY Antimicrobial Surveillance Program. Antimicrobial agents and chemotherapy. 2019; 63(7): e00355-19.
  • Albrecht SJ, Fishman NO, Kitchen J, Nachamkin I, Bilker WB, Hoegg C, et al. Reemergence of gram-negative health care–associated bloodstream infections. Archives of internal medicine. 2006; 166(12): 1289-94.
  • Marra AR, Camargo LF, Pignatari AC, Sukiennik T, Behar PR, Medeiros EA et al. Nosocomial bloodstream infections in Brazilian hospitals: analysis of 2,563 cases from a prospective nationwide surveillance study. Journal of clinical microbiology. 2011; 49(5): 1866-71.
  • O'Neill J. Tackling drug-resistant infections globally: final report and recommendations. Review on Antimicrobial Resistance. United Kingdom: London; 2016.
  • Steven L, Solomon MD, Oliver KB. Antibiotic resistance threats in the United States: stepping back from the brink. American family physician. 2014; 89(12): 938-41.
  • Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States. Atlanta, GA: US; 2019.
  • Shrivastava SR, Shrivastava PS, Ramasamy J. World health organization releases global priority list of antibiotic-resistant bacteria to guide research, discovery, and development of new antibiotics. Journal of Medical Society. 2018; 32(1): 76.
  • Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, et al. Multistate point-prevalence survey of health care–associated infections. New England Journal of Medicine. 2014; 370(13): 1198-208.
  • Holmes CL, Anderson MT, Mobley HL, Bachman MA. Pathogenesis of Gram-negative bacteremia. Clinical Microbiology Reviews. 2021; 34(2): e00234-20.
  • European Committee on Antimicrobial Susceptibility Testing (EUCAST) Breakpoint tables for interpretation of MICs and zone diameters. Version 11, (2021). Available from: http://www.eucast.org
  • Garrouste-Orgeas M, Chevret S, Mainardi JL, Timsit JF, Misset B, Carlet J. A one-year prospective study of nosocomial bacteraemia in ICU and non-ICU patients and its impact on patient outcome. Journal of Hospital Infection. 2000; 44(3): 206-13.
  • Wilson J, Elgohari S, Livermore DM, Cookson B, Johnson A, Lamagni T, et al. Trends among pathogens reported as causing bacteraemia in England, 2004–2008. Clinical Microbiology and Infection. 2011; 17(3): 451-8.
  • Marra AR, Camargo LFA, Pignatari ACC, Sukiennik T, Behar PRP, Medeiros EAS, et al. Nosocomial bloodstream infections in Brazilian hospitals: analysis of 2,563 cases from a prospective nationwide surveillance study. Journal of Clinical Microbiology. 2011; 49(5): 1866-71.
  • Tabah A, Koulenti D, Laupland K, Misset B, Valles J, Carvalho FB, et al. Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study. Intensive care medicine. 2012; 38(12): 1930-45.
  • Mathur P, Varghese P, Tak V, Gunjiyal J, Lalwani S, Kumar S, et al. Epidemiology of blood stream infections at a level-1 trauma care center of India. Journal of laboratory physicians. 2014; 6(1): 22.
  • Sligl WI, Dragan T, Smith SW. Nosocomial Gram-negative bacteremia in intensive care: epidemiology, antimicrobial susceptibilities, and outcomes. International Journal of Infectious Diseases. 2015; 37(1): 129-34.
  • Ergönül Ö, Aydin M, Azap A, Başaran S, Tekin S, Kaya Ş, et al. Healthcare-associated Gram-negative bloodstream infections: antibiotic resistance and predictors of mortality. Journal of Hospital Infection. 2016; 94(4): 381-5.
  • World Health Organization,Central Asian and European Surveillance of Antimicrobial Resistance:Annual report 2020. https://www.euro.who.int/__data/assets/pdf_file/0003/469200/Central-Asian-and-European-Surveillance-of-Antimicrobial-Resistance.-Annual-report-2020-eng.pdf. Erişim tarihi: 27.10.2021
  • Boncagni F, Francolini R, Nataloni S, Skrami E, Gesuita R, Donati A, et al. Epidemiology and clinical outcome of Healthcare-Associated Infections: a 4-year experience of an Italian ICU. Minerva Anestesiol. 2015; 81(7): 765-75.
  • Walsh TR. Emerging carbapenemases: a global perspective. International journal of antimicrobial agents. 2010; 36: 8-14.
Toplam 29 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makaleleri
Yazarlar

Zuhal Kalaycı Çekin 0000-0001-5293-2940

Mustafa Behçet 0000-0002-5676-6983

Fatma Avcıoğlu 0000-0002-6011-7775

Yusuf Afşar 0000-0003-3316-3618

Ersin Şentürk 0000-0003-3940-3766

Muhammet Kurtoğlu 0000-0002-7057-2501

Yayımlanma Tarihi 20 Ocak 2023
Gönderilme Tarihi 21 Haziran 2022
Yayımlandığı Sayı Yıl 2023 Cilt: 13 Sayı: 1

Kaynak Göster

Vancouver Kalaycı Çekin Z, Behçet M, Avcıoğlu F, Afşar Y, Şentürk E, Kurtoğlu M. Kan Kültürü Örneklerinden İzole Edilen Gram Negatif Bakterilerin Antibiyotik Direnç Profillerinin İncelenmesi. SABD. 2023;13(1):80-6.