Adıyaman?da Diyabetik Ayak Ülserinde Bakteriyel Etiyoloji ve Etkenlere ait Antibiyotik Duyarlılık Sonuçları

Year 2018, Volume: 4 Issue: 2, 158 - 164, 01.01.2018

Ramazan İlyas Öner

Abstract

Amaç: Çalışmamızda diyabetik ayak ülserleri DAÜ gelişen hastalarda izole edilen mikrobiyal ajanları ve bu ajanların antibiyotik duyarlılık profillerini göstermeyi amaçladık.Gereç ve Yöntemler: 100 Hastaya ait diyabetik ayak ülserinden alınan 248 sürüntü örneğinden çalışılan kültür sonuçları retrospektif olarak değerlendirildi. Klinik ve Laboratuvar Standartları Enstitüsü CLSI yönergelerine göre yapılmış olan antimikrobiyal duyarlılık durumları belirlendi. Bulgular: Gram-pozitif koklar GPK %54,7 gram-negatif basillerden GNB %42,4 daha fazla izole edilmişti. En fazla üreyen bakteri S.aureus %20,9 iken, GNB’den en fazla E.coli %9,6 basilleri üremişti. 48 S.aureus izolatından 13 tanesini 27,08 Metisiline dirençli S.aureus MRSA oluşturmaktaydı. Genişlemiş Spektrumlu Beta-Laktamaz GSBL pozitifliği %43,3 olarak saptandı. S.aureus suşları Teikoplanin, Linezolid ve Vankomisine % 100 duyarlılık gösteriyordu. E.coli suşları %95,5 oranında Amikacin ve İmipenem, %90,9 oranında Meropenem ve %81,8 oranında Ertapenem duyarlılığı gösteriyordu. MRSA bütün suşları Teikoplanin, Vankomisin ve Levofloksasin’e duyarlıydı.Sonuç: Çalışmamızda DAÜ enfeksiyonlarında en yaygın olarak S.aureus, Gram-negatif basillerden en sık E.coli saptandı. GPK enfeksiyonlarının ampirik tedavisinde Teikoplanin, Vankomisin ve Linezolid, GNB enfeksiyonlarında ise Amikacin, İmipenem, Meropenem ve Ertanem’in kullanılması daha uygun olabilir. DAÜ tedavisinde izole edilen baskın organizmalara ve yerel antimikrobiyal yatkınlık modellerine dikkat edilmesi gerekmektedir

Keywords

Diyabetik ayak enfeksiyonları, Antibiyotik duyarlılık paterni, Bakteriyel etiyoloji

Bacterial Etiology and Antibiotic Susceptibility of Diabetic Foot Ulcer Infections in Adiyaman

Abstract

Objective: The aim of this study was to investigate the microbial agents isolated in patients who developed diabetic foot ulcer and to present the antibiotic sensitivity profiles of these agents.Material and Methods: Retrospective evaluation was made of the culture results of 248 smear samples taken from 100 patients with diabetic foot ulcer DFU . The antimicrobial sensitivity status was determined according to the Clinic and Laboratory Standards Institute CLSI guidelines.Results: Gram-positive cocci GPC at 54.7% and gram-negative bacilli GNB at 42.4% were the agents most commonly isolated. The most common bacteria determined were S. aureus 20.9% , and of GNB, E. coli 9.6% bacilli. From 48 S. aureus isolates, 13 27.08% were Methicillin-resistant S. aureus MRSA . Extended spectrum beta-lactamase ESBL positivity was determined in 43.3%. All of the S. aureus isolates were 100% sensitive to Vancomycin, Teicoplanin and Linezolid. Antibiotic sensitivity rates of E. coli isolates was 95.5% for Amikacin and Imipenem, 90.9% for Meropenem and 81.8% for Ertapenem. All strains of MRSA were found to be sensitive for Vancomycin, Teicoplanin and Levofloxacin.Conclusion: The most commonly found agents were S. aureus as GPC and E. coli as GNB in DFU infections in our study. Teicoplanin, Vancomycin and Linezolid were determined with 100% sensitivity in gram-positive infections, Amikacin or Gentamycin, or a Carbapenem such as Imipenem, Meropenem or Ertanem for GNB infections can be recommended as a suitable option in the empirical treatment of DFU. Isolating the dominant organisms and determining the local antimicrobial susceptibility patterns of clinical isolates should be considered for effective DFU treatment

Keywords

Diabetic foot infections, Antibiotic sensitivity pattern, Bacterial etiology

References

• Abdulrazak A, Bitar ZI, Al-Shamali AA, Mobasher LA. Bacteriological study of diabetic foot infections. J Diabetes Complicat 2005;19(3):138-41.
• Chan JC, Malik V, JiaW, Kadowaki T, Yajnik CS, Yoon KH, Hu FB. Diabetes in Asia: Epidemiology, risk factors, and pathophysiology. JAMA 2009;301(20):2129-40.
• Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA 2005;293:217-28.
• Richard JL, Sotto A, Lavigne JP. New insights in diabetic foot infection. World J Diabetes 2011;2(2):24-32.
• Prompers L, Schaper N, Apelqvist J, Edmonds M, Jude E, Mauricio D, Uccioli L, Urbancic V, Bakker K, Holstein P, Jirkovska A, Piaggesi A, Ragnarson-Tennvall G, Reike H, Spraul M, Van Acker K, Van Baal J, Van Merode F, Ferreira I, Huijberts M. Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study. Diabetologia 2008; 51:747–55.
• Al Benwan K, Al Mulla A, Rotimi VO. A study of the microbiology of diabetic foot infections in a teaching hospital in Kuwait. J Infect Public Health 2012;5(1):1-8.
• Zubair M, Malik A, Ahmad J. Clinico-microbiological study and antimicrobial drug resistance profile of diabetic foot infections in North India. Foot (Edinb) 2011;21(1):6- 14
• Yoga R, Khairul A, Sunita K, Suresh C. Bacteriology of diabetic foot lesions. Med J Malaysia 2006;61:14-6.
• Deshpande AD, Harris-Hayes M, Schootman M. Epidemiology of diabetes and diabetes-related complications. Phys Ther 2008;88(11):1254-64.
• Boulton AJ. The pathway to foot ulceration in diabetes. Med Clin North Am 2013; 97: 775–90.
• Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. Wayne, Pennsylvania: CLSI 2011.
• Akhi MT, Ghotaslou R, Asgharzadeh M, Varshochi M, Pirzadeh T, Memar MY, Zahedi Bialvaei A, Seifi Yarijan Sofla H, Alizadeh N. Bacterial etiology and antibiotic susceptibility pattern of diabetic foot infections in Tabriz, Iran. GMS Hyg Infect Control 2015;10:Doc02.
• Shankar EM, Mohan V, Premalatha G, Srinivasan RS, Usha AR. Bacterial etiology of diabetic foot infections in South India. Eur J Intern Med 2005;16(8):567-70.
• Gardner SE, Hillis SL, Heilmann K, Segre JA, Grice EA. The neuropathic diabetic foot ulcer microbiome is associated with clinical factors. Diabetes 2013;62(3):923-30.
• Citron DM, Goldstein EJC, Merriam CV, Lipsky BA, Abramson MA. Bacteriology of moderate-to-severe diabetic foot infections and in vitro activity of antimicrobial agents. J Clin Microbiol 2007;45(9):2819-28.
• Yerat RC, Rangasamy VR. A clinicomicrobial study of diabetic foot ulcer infections in South India. Int J Med Public Health 2015;5:236-41.
• Anandi C, Alaguraja D, Natarajan V, Ramanathan M, Subramaniam CS, Thulasiram M, Sumithra S. Bacteriology of diabetic foot lesions. Indian J Med Microbiol 2004;22(3):175-8.
• Pathare NA, Bal A, Talvalkar GV, Antani DU. Diabetic foot infections: A study of microorganisms associated with the different Wagner grades. Indian J Pathol Microbiol 1998;41(4):437-41.
• Ng LS, Kwang LL, Yeow SC, Tan TY. Anaerobic culture of diabetic foot infections: Organisms and antimicrobial susceptibilities. Ann Acad Med Singapore 2008;37(11):936-9.
• Dang CN, Prasad YD, Boulton AJ, Jude EB. Methicillin- resistant Staphylococcus aureus in the diabetic foot clinic: A worsening problem. Diabet Med 2003;20(2):159-61.
• National Institute for Health and Clinical Excellence. NICE clinical guideline 119: inpatient management of diabetic foot problems. London: National Institute for Health and Clinical Excellence, 2011.