Antibiotic Sensitivity of Streptococcus Agalactiae Strains Isolated From Clinical Samples

Year 2020, , 20 - 25, 30.04.2020

Tuğba Ayhancı , Şeyda Durna , Özlem Aydemir , Mehmet Köroğlu , Mustafa Altındiş

https://doi.org/10.34084/bshr.706295

Abstract

Introduction: Although Streptococcus agalactiae is a member of human normal body flora, it can cause serious infections, especially in the newborn and in the presence of certain predisposing factors. The aim of this study wasto evaluate the susceptibility and clinical properties of S.agalactiae isolates isolated from various clinical specimens.
Methods: Antibiotic susceptibilities of 494 S. agalactiae isolates isolated from clinical specimens sent to Sakarya University Medical Faculty Training and Research Hospital between 2017-2019 were analyzed retrospectively. All isolated bacteria were identified by conventional methods and mass spectrophotometry (VITEK-MS®, bioMérieux, France). Antibiotic susceptibility tests were performed with VITEK 2® (bioMérieux, France) system according to EUCAST recommendations.
Results: When the demographic characteristics of the patients were examined; 364 (73.6 %) were female and 130 (26.3 %) were male. The average age; 48.6 ± 18.5 in female patients and 60.4 ± 17.0 in male patients. Sample distribution of isolates (n = 494); 349 (70 %) urine were 95 (19.2 %) wounds, 14 (2.8 %) vagen, 13 (2.6 %) blood, 10 (2 %) sterile body fluid, 4 (0.8 %) tracheal aspirate, 2 (0.4 %) sputum, 2 (0.4 %) aspiration specimens, 2 (0.4 %) urethral culture. Antimicrobial susceptibility analysis revealed that all strains were susceptible to penisiline, ampicilin, vancomycin, daptomycin, teicoplanin and linezolid; erythromycin, trimethoprim/sulfamethoxazole, tigecycline and tetracycline susceptibilities were 334 (67.6 %), 442 (89.5 %), 482 (97.5 %), 154 (31.2 %) respectively.. In 47 (9.5 %) of the isolates, inducible type MLSb phenotype was determined.
Conclusion: S. agalactia strains were most frequently isolated from urine specimens and female patients. Increasing resistance to bacillin and erythromycin, an alternative to penicillin, which causes serious infections in pregnant women and immunosuppressive individuals should not be ignored and treatment should be directed according to antibiotic susceptibility test results.

Keywords

Group B Streptococcus, Streptococcus agalactiae, antibiotic resistance

Klinik Örneklerden İzole Edilen Streptococcus Agalactiae Suşlarinin Antibiyotik Duyarliliklari

Abstract

Giriş: Streptococcus agalactiae, insan normal vücut florası üyesi olmasına rağmen özellikle yenidoğanda ve bazı predispozan faktörlerin varlığında ciddi enfeksiyonlara sebep olabilmektedir. Bu çalışmada, çeşitli klinik örneklerden izole edilen S. agalactiae izolatlarının antibiyotiklere duyarlılıklarının ve klinik özelliklerinin değerlendirilmesi amaçlanmıştır.
Yöntem: 2017-2019 yılları arasında Sakarya Üniversitesi Tıp Fakültesi Eğitim ve Araştırma Hastanesi’ne gönderilen klinik örneklerden izole edilen 494 S. agalactiae izolatının antibiyotik duyarlılıkları retrospektif olarak incelenmiştir. İzole edilen tüm bakterilerin identifikasyonu konvansiyonel yöntemler ve kütle spektrofotometresi ile (VITEK-MS®, bioMérieux, Fransa) yapılmıştır. Antibiyotik duyarlılık testleri VITEK 2® (bioMérieux, Fransa) sistemi ile EUCAST önerilerine göre gerçekleştirilmiştir.
Bulgular: Hastaların demografik özellikleri incelendiğinde; 364’’ünün (% 73,6) kadın, 130’nun (% 26.3) erkek olduğu görülmüştür. Yaş ortalaması; kadın hastalarda 48,6 ±18,5, erkek hastalarda 60,4 ±17, bulunmuştur. İzolatların (n=494) örnek dağılımı; 349 (% 70) idrar, 95 (% 19,2) yara, 14 (% 2,8) vagen, 13 (% 2,6) kan, 10 (% 2) steril vücut sıvısı, 4 (% 0,8) trakeal aspirat, 2 (% 0,4) balgam, 2 (% 0,4) aspirasyon, 2 (% 0,4) üretral kültür örneği şeklindedir. Antibiyotik duyarlılıkları incelendiğinde tüm suşların penisilin, ampisilin, vankomisin, daptomisin, teikoplanin ve linezolide duyarlı olduğu; eritromisin, trimetoprim/sülfametoksazol tigesiklin ve tetrasiklin duyarlılıklarının ise sırasıyla; 334 (% 67,6), 442 (% 89,5), 482 (% 97,5), 154 (% 31,2) olduğu saptanmıştır. Çalışmaya alınan izolatların 47’sinde (% 9,5) indüklenebilir tipte MLSB fenotipi belirlenmiştir.
Sonuç: S. agalactiae suşları, en sık idrar örneklerinden ve kadın hastalardan izole edilmiştir. Bakterinin gebelerde ve immun supresif kişilerde ciddi enfeksiyonlara neden olduğu, penisiline alternatif olan klindamisin ve eritromisine karşı direncin giderek artış göstermesi göz ardı edilmemeli ve tedavi antibiyotik duyarlılık test sonuçlarına göre yönlendirilmelidir.

Keywords

B grubu Streptokok, Streptococcus agalactiae

References

• 1. Cengiz AB. Yenidoğan Sepsisi. J Pediatr Inf. 2009; 3(4): 174-81.
• 2. Morgan JA, Cooper DB. Pregnancy, group b streptococcus. Auth P, Rusgo A (ed). Stat Pearls Publishing, [Internet] Florida; (2018).
• 3. Sambola A, Miro JM, Tornos MP, et al. Streptococcus agalactiae infective endocarditis: analysis of 30 cases and review of the literature. Clin Infect Dis. 2002; 34(12): 1576-84.
• 4. Bolukaoto JY, Monyama CM, Chukwu MO, et al. Antibiotic resistance of Streptococcus agalactiae isolated from pregnant women in Garankuwa, South Africa Bolukaoto. BMC Res Notes. 2015; 8: 364.
• 5. The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 9.0, 2019. http://www.eucast.org. 6. Schuchat A. Group b streptococcus. Lancet. 1999; 2; 353(9146): 51-6.
• 7. Başustaoğlu A. Klinik Mikrobiyoloji (Manual of Clinical Microbiology). 9.baskı, s.415, Atlas Yayınları, Ankara, (2009).
• 8. Atalay A, Ölçü M, Perçin D. Antibiotic susceptibilities and serotyping of cinical Streptococcus agalactiae isolates. Balkan Med J. 2011; 28(4): 362-5.
• 9. Savcı Ü, Şahin M, Toprak S, ve ark. Antimicrobial resistance pattern of Streptococcus agalactiae strains: five years evaluation of single center. J Health Sci Med. 2018; 1(2): 25-8. 10. Farley MM. Group B streptococcal disease in nonpregnant adults. Clin Infect Dis. 2001; 33(4): 556-61.
• 11. Arpin C, Daube H, Tessier F, et al. Presence of mefA and mefE genes in Streptococcus agalactiae. Ant Antimicrob Agents Chemother.1999; 43(4): 944–6.
• 12. Gygax SE, Schuyler JA, Trama JP, et al. Detection of erythromycin and clindamycin resistance genes in group b streptococcal clinical isolates and cervicovaginal-rectalswabs. Microb Drug Resist. 2007; 13(2): 119-23.
• 13. Zeng X, Kong F, Hui W, et al. Simultaneous detection of nine antibiotic resistance-related genes in Streptococcus agalactiae using multiplex PCR and reverse lineblot hybridization assay. Antimicrob Agents Chemother. 2006; 50(1): 204-9.
• 14. Khan AS, Walsh A, Crowleyet B. Role of efflux in macrolide resistance in β-hemolytic streptococci of groups a, b, c and g collected in an Irish teaching hospital. J Med Microbiol. 2011; 60(2): 262-4.
• 15. Quiroga M, Pegels E, Oviedo P, et al. Susceptibility patterns and prevalence of GBS isolated from pregnant women in Misiones, Argentina. Alexandria Journal of Medicine2008; 39(1): 245-50.
• 16. Heelan JS, Hasenbein ME, McAdam AJ. Resistance of group b streptococcus to selected antibiotics, including erythromycin and clindamycin. J Clin Microbiol. 2004; 42(3): 1263-4. 17. Melo SC, Santos NC, Olıveıra M, Scodro BL, Cardoso RF, Pádua RAF, et al. Antımıcrobıal Susceptıbılıty Of Streptococcus Agalactiae Isolated From Pregnant Women. Rev Inst Med Trop Sao Paulo. 2016; 58: 83
• 18. Boswihi SS, Udo EE, Al-Sweih N. Serotypes and antibiotic resistance in group b streptococcus isolated from patients at the Maternity Hospital, Kuwait. J Med Microbiol. 2012; 61(1): 126-31.
• 19. Gherardi G, Imperi M, Baldassarri L, et al. – Molecular epidemiology and distribution of serotypes, surface proteins, and antibiotic resistance among group b streptococci in Italy. J Clin Microbiol. 2007; 45(9): 2909-16.
• 20. Hraoui M, Boutiba-Ben B, Rachdi M, et al. Macrolide and tetracycline resistance in clinical strains of Streptococcus agalactiae isolated in Tunisia. J Med Microbiol. 2012; 61(8): 1109-13.
• 21. Emaneın M, Mırsalehıan A, Beıgvıerd R, et al. Incidence of macrolide and tetracycline resistance among Streptococcus agalactiae strains isolated from clinical samples in Tehran, Iran MAEDICA – a Journal of Clinical Medicine. 2014; 9(2): 157-61.
• 22. Eren A, Kucukercan M, Oguzoglu N, et al. The carriage of group b streptococci in Turkish pregnant women and its transmission rate in newborns and serotype distribution. The Turk J Pediatr. 2005 ;47(1): 28-33.
• 23. Esel D, Karaca N, Telli M, ve ark. Klinik örneklerden izole edilen Streptococcus agalactiae suşlarında duyarlılık. ANKEM Derg. 2001;15(4): 678-82.
• 24. Yenisehirli G, Bulut Y, Demirturk F, ve ark. Antimicrobial susceptibilities and serotype distribution of Streptococcus agalactiae strains isolated from pregnant women. Mikrobiyol Bul. 2006; 40(3): 155-60.
• 25. Arisoy AS, Altinisik B, Tunger O, et al. Maternal carriage and antimicrobial resistance profile of Group B Streptococcus. Infection. 2003; 31(4): 244-6.