Çoğul İlaç Dirençli Acinetobacter baumannii İzolatlarının Pulsed-Field Gel Elektroforezis İle Klonal İlişkisinin Araştırılması

Öz

Amaç: Bu çalışma ile, yoğunbakım ünitelerinde yatan hastalardan izole edilen A. baumannii suşlarının antibiyotiklere direnç oranının saptanması ve hastane enfeksiyonu etkeni çoklu ilaç direncine sahip izolatların klonal ilişkisinin, pulsed-field jel elektroforez (PFGE) yöntemi kullanılarak gösterilmesi amaçlandı. Materyal ve Metod: Bir üniversite hastanesi; Anesteziyoloji ve Reanimasyon Yoğunbakım Ünitesi (AYBÜ), Göğüs Hastalıkları Yoğunbakım Ünitesi ve Pediatri Yoğun Bakım Ünitesi’ nde Ocak 2010-Ekim 2011 tarihleri ve AYBÜ’de Temmuz-Kasım 2012 tarihleri arasında takip edilen, A. baumanii ile oluşan, Ventilatör İlişkili Pnömoni (VİP) ve Primer Kan Dolaşımı Enfeksiyonu (PKDE) tanısı alan 69 hasta ve aynı sayıda izolat çalışmaya alındı. Bulgular: Hastaların 63 (%91) tanesi VİP, 6 (%9) tanesi ise PKDE tanısı almıştı. Tüm hastalara YBÜ yatışı boyunca en az iki invaziv girişim uygulanmıştı. Üriner kateterizasyon (%100), mekanik ventilasyon (%94,2) ve periferik venöz kateterizasyon (%91,3) en sık uygulanan invaziv girişimlerdi. Antibiyotik duyarlılıkları imipenem, kolistin ve tigesiklin için E-test, diğer antibiyotikler için disk difüzyonla çalışıldı. Tüm suşlar için en etkili antibiyotik kolistin (%98,6) idi. Daha sonra tigesiklin (%97,1) ve levofloksasin (%69,6) gelmekteydi. Suşların tamamı seftriakson, piperasilin/tazobaktam, meropenem ve imipeneme dirençli bulundu. A. baumannii izolatlarının ApaI ile kesilen genomik DNA’sına yapılan PFGE analizi ile, 69 A. baumannii suşunun 62 (%89,9)’sinin küme içinde olduğu saptandı. Bu suşlar 16 küme içinde yer almakta idi. Suşların 7 (%10,1)’si özgül PFGE profili gösterdi ve suşlar arasında 23 pulsotip saptandı. Sonuç: Çoğul ilaç dirençli A. baumannii izolatlarının kümeleşme oranının yüksek bulunması ve benzer genotipteki izolatların farklı ünitelerdeki hastalardan izole edilmesi bu bakterinin hastanemiz YBÜ’ lerinde endemik duruma geçtiğinin göstergesidir. Önlem alınmadığı takdirde A. baumannii uzun yıllar boyunca hastanelerde kalabilmekte ve hastalar arasında kolaylıkla bulaş olabilmektedir. Özellikle çapraz bulaşın önlenmesi için enfeksiyon kontrol programlarının gerekliliği ve önemi bir kez daha vurgulandı.

Anahtar Kelimeler

• A. baumanni
• direnç
• PFGE

The Investigation of Clonal Relationship Among Multiple Drug Resistant Acinetobacter baumannii Isolates with Pulsed-Field Gel Electrophoresis

Abstract

Aim: With this study, the detection of the resistance rates of A. baumannii strains isolated from the patients in the intensive care units to the antibiotics and the demonstration of the clonal relationship of the isolates with multi-drug resistant of the factor of nosocomial infection were aimed by using the method of pulsed-field gel electrophoresis (PFGE). Material and Methods: A university hospital, 69 patients followed between January 2010-October 2011 at the Intensive Care Unit of Anesthesiology and Reanimation (ICUAR), Intensive Care Unit of Chest Diseases and Pediatric Intensive Care Unit and July-November 2012 at ICUAR and the same number of isolates formed with A. baumannii, Ventilator-Associated Pneumonia (VAP) and diagnosis of Primary Bloodstream Infection (PBI) were enrolled to the study. Findings: 63 (91%) of the patients were diagnosed with VAP and 6 (9%) of them with PBI. At least two invasive interference had been performed to all patients during the staying at the ICU. Urinary catheterization (100%), mechanical ventilation (94.2%), and peripheral venous catheterization (91.3%) were the most frequently performed invasive interferences. Antibiotic susceptibilities to imipenem, colistin and tigecycline were studied with the E-test and to the other antibiotics with the disk diffusion. Colistin was the most effective antibiotic for all of the strains (98.6%). Then, tigecycline (97.1%) and levofloxacin (69.6%) were in second place. All of the strains were resistant to ceftriaxone, piperacillin/tazobactam, meropenem, and imipenem. With the PFGE analysis of A. baumannii isolates performed to the genomic DNA cut with ApaI, it was found that 62 of the 69 A. baumannii strains (89.9%) were within the cluster. These strains were located within 16 clusters. 7 of the strains (10.1%) showed the profiles of specific PFGE and 23 pulsotypes were detected among the strains. Result: Being high of clustering rate of multidrug-resistant A. baumannii isolates and isolating the isolates in similar genotypes from the patients in different units is the indicator of these bacteria to be an endemic situation in the ICUs of our hospital. If precautions are not taken, A. baumannii has been able to remain in the hospitals for many years and can be easily transmitted among the patients. Especially for the prevention of cross-contamination, the necessity and importance of infection control programs have once again emphasized.

Keywords

• A. baumanni
• resistance
• PFGE

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