Investigation of Antibiotic Susceptibility Profiles and Beta-Lactamase Activity of Haemophilus influenzae Isolates

Abstract

Haemophilus influenzae is one of the important Gram negative bacterial pathogens which can cause respiratory infections and invasive infections. In this study, antibiotic susceptibility profiles and β-lactamase activity of 480 H.influenzae isolates isolated from different invasive/noninvasive clinical cases in the Central Microbiology Laboratory of Hacettepe University Medical Faculty Hospital between January 2018 and August 2019 were investigated retrospectively. Isolates were identified by using matrix-mediated laser desorption ionization flight time mass spectrometry (MALDI-TOF MS) and antibiotic susceptibility tests were performed with disk diffusion method using Haemophilus Test Medium, according to the Clinical and Laboratory Standards Institute (CLSI) 2018 guidelines. Antibiotic susceptibility against amoxicillin-clavulanate, ampicillin, meropenem, piperacillin-tazobactam, rifampin, cefotaxime, ceftazidime, ceftriaxone, cefuroxime, ciprofloxacin, tetracycline and trimethoprim/sulfamethoxazole were tested. The β-lactamase production of isolates was investigated by using nitrocefin disk. The highest resistance rates for isolates among tested antibiotics were detected respectively against trimethoprim-sulfamethoxazole (30,4 %) and ampicillin (16,2 %). In addition, it was found that of the isolates 7,9 % were β-lactamase negative ampicillin resistant (BLNAR) origin, 8,3 % were β-lactamase positive ampicillin resistant (BLPAR) origin, and 1,9 % were β-lactamase positive amoxicillin / clavulanate resistant (BLPACR). Antibiotic resistance rates in H.influenzae isolates vary between centers and ampicillin resistance and BLNAR rates are progressively increasing. In our study, high rates of ampicillin resistance and BLNAR origin were detected in H.influenzae isolates. Our results suggest that centers should follow epidemiological data regularly in order to guide appropriate antibiotic treatment to be applied to patients in H.influenzae infections.

Keywords

• ampicillin
• beta-lactamase
• BLNAR
• BLPAR
• H.influenzae

Haemophilus influenza Suşlarının Antibiyotik Duyarlılık Profillerinin ve Beta-Laktamaz Aktivitesinin Araştırılması

Abstract

Haemophilus influenzae solunum yolu enfeksiyonlarına ve invaziv enfeksiyonlara neden olabilen önemli Gram negatif bakteriyel patojenlerden biridir. Çalışmamızda Hacettepe Üniversitesi Tıp Fakültesi Hastanesi Merkez Mikrobiyoloji Laboratuvarı’nda Ocak 2018-Ağustos 2019 tarihleri arasında invaziv/invaziv olmayan çeşitli klinik olgulardan izole edilen 480 H.influenzae suşunun antibiyotik duyarlılık profilleri ve β-laktamaz üretimi retrospektif olarak araştırılmıştır. Suşlar matriks aracılı lazer dezorpsiyon iyonizasyon uçuş zamanlı kütle spektrometresi (MALDI-TOF MS) ile tanımlanmış ve in vitro antibiyotik duyarlılık testleri Haemophilus Test besiyeri ile Clinical and Laboratory Standards Institute (CLSI) 2018 dokümanı referans alınarak disk difüzyon yöntemi ile yapılmıştır. Antibiyotik duyarlılık testlerinde amoksisilinklavulanat, ampisilin, meropenem, piperasilin-tazobaktam, rifampin, sefotaksim, seftazidim, seftriakson, sefuroksim, siprofloksasin, tetrasiklin ve trimetoprim-sülfametoksazol test edilmiştir. İzolatların β-laktamaz üretimi nitrosefin diski kullanılarak araştırılmıştır. Suşlar için test edilen antibiyotikler arasında en yüksek direnç oranları sırasıyla trimetoprimsülfametoksazol (% 30,4) ve ampisilinde (% 16,2) tespit edilmiştir. Suşların % 7,9’u β-laktamaz negatif ampisilin dirençli (BLNAR), % 8,3’ü β-laktamaz pozitif ampisilin dirençli (BLPAR), % 1,9’u ise β-laktamaz pozitif amoksisilin/klavulanata dirençli (BLPACR) olarak saptanmıştır. H.influenzae suşlarında antibiyotik direnç oranları merkezler arasında değişiklik göstermekte olup, bu suşlarda ampisilin direnç ve BLNAR oranları gittikçe artmaktadır. Çalışmamızda H.influenzae suşlarında yüksek oranda ampisiline dirençli ve BLNAR köken tespit edilmiştir. Sonuçlarımız H.influenzae enfeksiyonlarında hastalara uygulanacak uygun antibiyotik tedavisini yönlendirmesi açısından merkezlerin düzenli olarak epidemiyolojik verilerini takip etmesi gerekliliğini düşündürmektedir.

Keywords

• ampisilin
• beta-laktamaz
• BLNAR
• BLPAR
• H.influenzae

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