Resistance States of Nonfermentative Gram Negative Bacteria Isolated from Blood Cultures to Various Antibiotics

Year 2021, Volume: 5 Issue: 1, 44 - 49, 30.04.2021

Yeliz Tanrıverdi Çaycı Gülşah Karacan Demet Gür Vural Kemal Bilgin Asuman Bırıncı

https://doi.org/10.34084/bshr.844478

Abstract

Objective: Aim of this study is to identify nonfermentative Gram-negative bacteria isolated from blood cultures of patients undergoing treatment in various clinics in our hospital,to examine antimicrobial resistance profiles
Methods: June 2016 – June 2019 blood cultures sent to the Microbiology Laboratory were retrospectively evaluated. Blood cultures were tested in BacT/Alert (BioMerieux, France) automated system of. Identification of growth microorganisms were tested in Vitek MS (BioMérieux, France) automated system and antibiotic sensitivity determined on Mueller - Hinton (BioMérieux, France) agar by disk diffusion method and Vitek2 Compakt (BioMerieux, France) automated system. Antibiotic susceptibility rates were evaluated according to EUCAST (European Committee on Antimicrobial Susceptibility Testing) criteria.
Results: Over a period of 3 years, 668 nonfermentative bacteria were isolated from blood cultures. The 299 (45%) of the microorganisms isolated are Acinetobacter spp. and 270 of them were identified as Acinetobacter baumannii. And 189 (28%) of them were Pseudomonas spp. and 164 of them were identified as Pseudomonas aeruginosa. Stenotrophomonas maltophilia was isolated from 42 (6%) specimen. Acinetobacter spp. has the highest resistance rates against levofloxacin and ciprofloxacin as 76%. Pseudomonas spp. has the highest resistance rates against piperacillin as 32%. All Stenotrophomonas maltophilia isolates were found to be sensitive to trimethoprim/ sulfomethoxazole.
Conclusion: Antibiogram results of nonfermentative Gram negative bacteria in blood cultures obtained in our hospital, is important to shed light on the antimicrobial resistance patterns that will occur in the coming years. Blood-stream infection factors and sensitivity tests should be followed continuously and effective treatment protocols should be applied

Keywords

Nonfermentative bacteria, antibiotic resistance, blood culture

Kan Kültürlerinden İzole Edilen Nonfermentatif Gram Negatif Bakterilerin Çeşitli Antibiyotiklere Direnç Durumları

Abstract

Amaç:Bu çalışmadaki amacımız, hastanemizde çeşitli kliniklerde tedavi görmekte olan hastaların kan kültürlerinden izole edilen nonfermentatif gram negatif bakterileri tanımlamak, antimikrobiyal direnç profillerini incelemektir.
Yöntem:Tıbbi Mikrobiyoloji laboratuvarına Haziran 2016 – Haziran 2019 tarihleri arasında gönderilen kan kültürleri retrospektif olarak değerlendirildi. Kan kültürleri otomatize sistem ile BacT/Alert (BioMerieux, Fransa) çalışıldı. Üreyen mikroorganizmaların tanımlanması Vitek MS (BioMérieux, Fransa) ile antibiyotik duyarlılıkları Mueller- Hinton (BioMérieux, Fransa) agarda disk difüzyon yöntemi ve VITEK 2 (BioMerieux, Fransa) otomatize sistemle belirlenmiştir.Antibiyotik duyarlılık oranları EUCAST (European Committee on Antimicrobial Susceptibility Testing) kriterlerine göre değerlendirilmiştir.
Bulgular: Laboratuvarımızda3 yıllık sürede kan kültürlerinden 668 nonfermentatif bakteri izole edildi.İzole edilen mikroorganizmaların 299’u (%45) Acinetobacter spp. ve bunların 270 tanesi Acinetobacter baumanniiolarak tespit edildi. 189’ u (%28) Pseudomonas spp. ve bunların 164 tanesi Pseudomonas aeruginosa olarak tespit edildi.42’ sini (%6)Stenotrophomonas maltophilia, geriye kalan 138’ ini (%21) diğer nonfermentatif bakteriler oluşturmaktadır. Acinetobacter spp. en yüksekdirenç oranlarılevofloksasin ve siprofloksasin için %76 olarak saptanmıştır. Pseudomonas spp. en yüksek direnç oranları piperasilin için %32 olarak saptanmıştır. Stenotrophomonas maltophilia’ ların hepsi trimetoprim/ sülfometoksazol’ e duyarlı saptanmıştır.

Sonuç:Hastanemizde elde ettiğimiz kan kültürlerindeki nonfermentatif bakterilerin antibiyotik direnç sonuçları, gelecek yıllarda oluşacak antimikrobiyal direnç paternlerine ışık tutması bakımından önem taşımaktadır.Kan dolaşımı enfeksiyonu etkenlerinin ve duyarlılık testlerinin devamlı olarak takip edilerek etkin tedavi protokollerinin uygulanması gerekmektedir.

Keywords

kan kültürü, gram negatif nonfermentatif bakteri, antimikrobiyal direnç

References

• 1. Kirn TJ, Weinstein MP. Update on blood cultures: how to obtain, process, report, and interpret. Clin Microbiol Infect. 2013; 19: 513-20.
• 2. Durmaz G, Us T, Aydinli A, et al. Optimum detection times for bacteria and yeast species with the Bactec 9120 aerobic blood culture system: Evaluation for a 5-year period in a Turkish university hospital. J Clin Microbiol. 2003; 41(2): 819-21.
• 3. Ding JG, Sun QF, Li KC, et al. Retrospective analysis of nosocomial infections in the intensive care unit of a tertiary hospital in China during 2003 and 2007. BMC Infect Dis. 2009; 9: 115.
• 4. Kim YK, Pai H, Lee HJ, et al. Bloodstream infections by extendedspectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in children: epidemiology and clinical outcome. Antimicrob Agents Chemother. 2002; 46(5): 1481-91.
• 5. Chmielarczyk A, Pobiega M, Romaniszyn D, et al. Multi-locus sequence typing (MLST) of non-fermentative Gram-negative bacilli isolated from bloodstream infections in southern Poland. Folia Microbiol (Praha). 2017;63(2):191-6. https://doi.org/10.1007/s12223-017-0550-7
• 6. Bilman FB, Ayaydın Z, Turhanoğlu M, ve ark. Bir eğitim ve araştırma hastanesinde yoğun bakımlardan izole edilen nonfermentatif gram-negatif mikroorganizmaların direnç profilleri, J Clin Exp Invest. 2014;5(3):391-6. http://dx.doi.org/10.5799/ahinjs.01.2014.03.0426 PMID: 24046538
• 7. Çetin ES, Kaya S, Taş T, ve ark. Cerrahi alan infeksiyonlarında mikroorganizma profili ve antibiyotik duyarlılık durumu, ANKEM Derg. 2006;20(2):89-93
• 8. Goel N, Wattal C, Oberoi JK, et al. Trend analysis of antimicrobial consumption and development of resistance in nonfermenters in a tertiary care hospital in Delhi. J Antimicrob Chemother. 2011;66(7):1625-30. http://dx.doi.org/10.1093/jac/dkr167 PMID:21586594
• 9. Gültekin E, Uyanık MH, Hancı H, ve ark. Kan kültürlerinden izole edilen nonfermentatif gram negatif bakterilerin çeşitli antibiyotiklere duyarlılıkları.ANKEM Derg. 2014;28(3):79-85.
• 10. Kılıç D, Kuzucu Ç, Erdinç FŞ, ve ark. Hastane kaynaklı infeksiyonlardan izole edilen gram-negatif aerob basillerin antibiyotik duyarlılıkları. Hastane İnfeksiyonları Derg. 2001;5(1):43-8. http://www.hastaneinfeksiyonlaridergisi.org/ managete/fu_folder/2001-01/html/2001-5-1- 043-048.htm
• 11. McGowan JE Jr. Resistance in nonfermenting gram-negative bacteria: multidrug resistance to the maximum. Am J Infect Control. 2006;34(5):29- 37.
• 12. Nazir A, Peerzada BY, Sana I. Spectrum of non-fermenting gram negative bacilli isolated from patients with blood stream infections in a tertiary care hospital in North India. Int J Res Med Sci. 2019;7(5):1762.
• 13. Bhargava D, Kar S, Saha M. Prevalence of Non-Fermentative Gram Negative Bacilli Infection in Tertiary Care Hospital in Birgunj, Nepal. IntJCurrMicrobiolAppSci. 2015;4(7):301–7. https://www.ijcmas.com/vol-4-7/Dipak Bhargava, et al.pdf
• 14. Quinn JP. Clinical Problems Posed by Multiresistant Nonfermenting Gram-Negative Pathogens Author ( s ): John P . Quinn Source : Clinical Infectious Diseases , Vol . 27 , Supplement 1 . Bacterial Resistance : Laboratory Explanations and Clinical Consequences ( Aug). 2016;27.
• 15. Agarwal S, Kakati B, Khanduri S, et al. Emergence of carbapenem resistant nonfermenting gram-negative bacilli isolated in an ICU of a tertiary care hospital. J Clin Diagnostic Res. 2017;11(1):4-7.
• 16. Gautam V, Singhal L, Ray P. Burkholderia cepacia complex: Beyond pseudomonas and acinetobacter. Indian J Med Microbiol. 2011 [cited 2019 Aug 23];29(1):4.:http://www.ncbi.nlm.nih.gov/pubmed/21304187
• 17. Yüce P, Demirdağ K, Kalkan A, ve ark. Kan kültürlerinden izole edilen mikroorganizmalar ve antibiyotik duyarlılıkları. Ankem Derg. 2005; 19(1): 17-21.
• 18. Anbumani N, Kalyani J, Mallika M. Distribution and antimicrobial susceptibility of bacteria isolated from blood cultures of hospitalized patients in a tertiary care hospital. Indian Journal of Practising Doctor. 2008; 5(1): 5-6.
• 19. Chaudhury N, Paul V, Misra RN, et al. Evaluating the Trends of Bloodstream Infections by Nonfermenting Gram Negative Bacilli among the Patients in a Tertiary Care Hospital of Western Part of India and its Antibiogram. Int.J.Curr.Microbiol.App.Sci. 2019; 8(1): 1149-1162.
• 20. Savcı Ü, Özveren G, Yenişehirli G, ve ark. Klinik örneklerden izole edilen Acinetobacter baumannii suşlarının invitro duyarlılık durumları. Turk Journal of Clin and Lab. 2015;6:24-9.
• 21. Nguyen L, Garcia J, Gruenberg K, et al. Multidrug-Resistant Pseudomonas Infections: Hard to Treat, But Hope on the Horizon? Curr Infect Dis Rep. 2018;20:23.
• 22. E. Tacconelli (Infectious Diseases, DZIF Center, Tübingen University, Germany) and N. Magrini (WHO, EMP Department). Global Priority List Of Antibiotic-Resistant Bacteria to Guide Research, Discovery, and Development Of New Antibiotics. WHO. 2015.
• 23. European Centre for Disease Prevention and Control. Annual Epidemiological Report 2016 - Healthcareassociated infections acquired in intensive care units. Stockholm: ECDC; 2016 [cited Nisan, 2019]. https://ecdc.europa.eu/en/publications-data/ healthcare-associated-infections-acquired-intensivecare-units-annual.
• 24. Ergül AB, Işık H, Ay Altıntop Y, et al. A retrospective evaluation of blood cultures in a pediatric intensive care unit: A three year evaluation. Turk Pediatri Ars 2017; 52: 154-61.
• 25. Şirin MC, Ağuş N, Yılmaz N,ve ark. Yoğun bakım ünitelerinde yatan hastaların kan kültürlerinden izole edilen mikroorganizmalar ve antibiyotik duyarlılıkları. Turk Hij Den Biyol Derg. 2017; 74(4): 269-278
• 26. Diekema DJ, Hsueh P, Mendes RE, et al. The Microbiology of Bloodstream Infection: 20-Year Trends from the SENTRY Antimicrobial Surveillance Program. Antimicrobial Agents and Chemotherapy.2019; 63:e00355-19
• 27. Sambyal, SS, Kaur, A, Soodan P. Changing antibiotic sensitivity pattern in gram negative nonfermenting isolates: A study in a tertiary care hospital. Blood. 2015;34, 48-57.
• 28. Gür H, Hazırolan G. Kan Kültürlerinden İzole Edilen Nonfermentatif ID Gram Negatif Bakterilerin Dağılımının ve Antibiyotik Duyarlılık Profillerinin Belirlenmesi. ANKEM Dergisi. 2019; 33(2), 49-57.
• 29. Chang YT, Lin CY, Chen YH, et al. Update on infections caused by Stenotrophomonas maltophilia with particular attention to resistance mechanisms and therapeutic options. Front Microbiol. 2015; 6:893–912.
• 30. Velázquez-Acosta C, Zarco-Márquez S, Jiménez-Andrade MC, et al. Stenotrophomonas maltophilia bacteremia and pneumonia at a tertiary-care oncology center: a review of 16 years. Support Care Cancer. 2018; 26:1953–60.
• 31. Tseng CC, Fang WF, Huang KT, et al. Risk factors for mortality in patients with nosocomial Stenotrophomonas maltophilia pneumonia. Infect Control Hosp Epidemiol. 2009; 30:1193–202.
• 32. Nicodemo AC, Araujo MR, Ruiz AS, et al. In vitro susceptibility of Stenotrophomonas maltophilia isolates: comparison of disc diffusion, etest and agar dilution methods. J Antimicrob Chemother. 2004; 53:604–8.
• 33. Hand E, Davis H, Kim T, et al. Monotherapy with minocycline or trimethoprim/sulfamethoxazole for treatment of Stenotrophomonas maltophilia infections. J Antimicrob Chemother. 2016; 71:1071–5.
• 34. Rizek C, Ferraz JR, van der Heijden IM, et al. In vitro activity of potential old and new drugs against multidrug-resistant gram-negatives. J Infect Chemother. 2015; 21:114–7.
• 35. Toleman MA, Bennett PM, Bennett DM, et al. Global emergence of trimethoprim/sulfamethoxazole resistance in Stenotrophomonas maltophilia mediated by acquisition of sul genes. Emerg Infect Dis. 2007; 13:559–65.
• 36. Gales AC, Seifert H, Gur D, et al. Antimicrobial susceptibility of Acinetobacter calcoaceticus–Acinetobacter baumannii complex and Stenotrophomonas maltophilia clinical isolates: results from the SENTRY antimicrobial surveillance program (1997–2016). In Open forum infectious diseases.2019;6(1):34-46.
• 37. Sadıç B, Başaran S, Şimşek SY ve ark. Stenotrophomonas maltophilia: Antimikrobik Duyarlılık Testi Sonuçları ve Seftazidimin Moksifloksasinle Kombinasyonunun In Vitro Etkinliği. Klimik Journal/Klimik Dergisi. 2019; 32(1).
• 38. Arabacı Ç, Yanılmaz Ö, Uzun B. Çeşitli Klinik Örneklerden İzole Edilen Stenotrophomonas maltophilia Suşlarının Antibiyotik Duyarlılıkları. ANKEM Derg, 2019;33(2), 58-64.