ÇEŞİTLİ HASTA ÖRNEKLERİNDEN SOYUTULAN STREPTOCOCCUS PNEUMONIAE KÖKENLERİNDE ANTİBİYOTİK DİRENÇ ORANLARI: RETROSPEKTİF DEĞERLENDİRME (2006-2007)

Year 2007, Volume: 21 Issue: 3, 47 - 52, 01.12.2007

Meral Coşkun Ayriz T. Gündüz Can Biçmen Güneş Şenol Serir Aktoğu Özkan

Abstract

Bu çalışmada, 2006 ve 2007 yıllarında, İzmir Dr. Suat Seren Göğüs Hastalıkları ve Cerrahisi Eğitim ve Araştırma Hastanesi Mikrobiyoloji Laboratuvarında soyutulan S. pneumoniae kökenlerinin penisilin ve diğer antibiyotiklere karşı direnç oranları araştırıldı ve retrospektif olarak değerlendirildi. Kültür sonucu S. pneumoniae olarak saptanan toplam 246 örnek (121 balgam, 95 bronş aspirasyon, 11 derin trakeal aspirasyon, 11 plevra, 4 hemokültür, 3 BAL, ve 1 boğaz) değerlendirmeye alındı. Kısaca, her örnek için mikroskopik boyalı inceleme, kültür ve antibiyogram işlemleri yapıldı. Penisilin duyarlılığının değerlendirmesinde, disk difüzyon yöntemiyle oksasilin duyarlılığı incelendi. Oksasilin dirençli (zon çapı ≤19 mm) olan örnekler, penisilin yönünden E-test yöntemiyle MİK değerlerinin saptanması için çalışmaya alındı. Penisilin MİK değerleri ≤0.06 µg/mL olan kökenler duyarlı, 0.12-1.0 µg/mL olan kökenler orta duyarlı (düşük düzey dirençli) ve ≥2.0 µg/mL olan kökenler yüksek düzey dirençli olarak kabul edildi. Toplam 246 S. pneumoniae kökeninde disk difüzyon yöntemiyle 138 köken (%56) penisiline duyarlı (oksasilin zon çapı ≥20 mm) iken, 108 kökende (%44) oksasilin zon çapı ≤19 mm olarak bulundu. MİK değerleri araştırılan toplam 108 kökende, 97 köken (%39.5) orta duyarlı (düşük düzey dirençli) (MİK 0.06- 1 µg/mL), 11 köken (%4.5) ise yüksek düzey penisilin dirençli (MİK ≥ 2.0 µg/mL) olarak bulundu. Diğer antibiyotiklere karşı direnç oranları eritromisin, klindamisin, trimetoprim/sulfometksazol, tetrasiklin, kloramfenikol ve kinolonlar için sırasıyla, %35.1, %29.9, %62.0, %20.1, %6.3 ve %11.3 olarak saptandı. Sonuç olarak, bu verilere göre hastanemizde genel olarak penisilin ve diğer antibiyotiklere direnç oranları literatürde bildirilen direnç oran aralıkları içerisinde saptandı. Ancak, bizim hastanemiz açısından penisiline düşük düzey dirençli kökenlerin artmakta olduğu, yüksek düzey direnç oranında (yak.%4-5) ise anlamlı bir değişme olmadığı görüldü. Penisilin dışındaki antbiyotiklerde ise, hastanemizde soyutulan kökenlerde kinolon direnci (%11.3) diğer çalışmalardan daha yüksek olarak değerlendirildi. Bu bulgulara göre, artan penisilin direnci ve alternatif sağaltımlarda seçilecek ilaçların daha doğru bir şekilde uygulanabilmesi için antibiyotik duyarlılık testlerinin yapılması ve riskli olgularda sağaltım etkinliğinin izlenmesi gerekmektedir.

Keywords

Streptococcus pneumoniae, penisilin direnci, antibiyotik duyarlılığı, minimal inhibisyon konsantrasyonu (MİK)

ANTIBIOTIC RESISTANCE RATES OF S. PNEUMONIA ISOLATES RECOVERED FROM VARIOUS CLINICAL SAMPLES: A RETROSPECTIVE EVALUATION (2006-2007)

Abstract

In this study, investigation and retrospective evaluation of penicillin and antibiotic resistances against S. pneumoniae strains isolated in the Microbiology Laboratory of Izmir Training and Research Hospital for Chest Diseases in the years 2006 and 2007 was intended. A total of 246 samples (121 sputum, 95 bronchial aspiration, 11 deep tracheal aspiration, 11 pleural fluids, 4 hemoculture, 3 BAL and 1 throat swab) were taken into the evaluation. Briefly, microscopic evaluation, culture and in vitro antibiotic susceptibility testing were performed for each sample. Initially, oxacillin susceptibility with disc diffusion method was evaluated in giving penicilin susceptibility report. Penicilin resistance of the samples resistant to oxacillin (zone diameter ≤19 mm), were analyzed by E-test to investigate the penicilin MIC values. Penicilin MIC values of the isolates which were found as ≤0.06 µg/mL, 0.12-1.0 µg/mL and ≥2.0 µg/mL were accepted as susceptible, intermediate sensitive (low level penicillin resistant) and high level penicillin resistant, respectively. Among 246 S. pneumoniae isolates, 138 isolates (56%) were penicillin susceptible (oxacillin zone diameter ≥20 mm) whereas; zone diameters of 108 isolates (44%) were found as ≤19 mm. Investigating the MIC values of these 108 isolates, 97 (39.5%) were intermediate susceptible (low level resistant), 11 (4.5%) were high level resistant to penicilin. Resistance rates for the other anti-microbials such as erythromycin, clindamycin, trimethophrim/sulfamethoxazole, tetracycline, chloramphenicol and quinolones were found as 35.1%, 29.9%, 62.0%, 20.1%, 6.3% and 11.3%, respectively. In conclusion, resistance rates against penicillin and other antibiotics in our hospital were generally evaluated within the ranges of resistance rates previously reported in the literature. However, low level penicillin resistance has been increasing whereas high level resistance rate was seemed to keep the same amount (app.4-5%) previously reported for our hospital. For the antibiotics other than penicillin, quinolone resistance (11.3%) in pneumococci isolated in our hospital was evaluated as higher than the rate previously reported from the other studies in our country. According to these findings and because of increasing pencillin resistance, in vitro antibiotic susceptibility testing and follow-up of antibiotic treatment in patients having risk factors for efficiency are necessary for selecting and application of accurate alternative drugs instead.

Keywords

Streptococcus pneumoniae, penicillin resistance, antibiotic susceptibility, minimal inhibitory concentration (MIC)

References

• 1. Özlü T. Toplum kökenli p nömoniler. Türkiye Klinikleri J Int Med Sci 2005; 1(46):1-12.
• 2. Thornsberry C, Ogilvie P, Kahn J, Mauriz Y. Surveillence of antimicrobial resistance in Streptococcus pneumoniae, Haemophilus influenzae and Morexella catarrhalis in the United States in 1996-1997 respiratory season The Laboratory Investigator Group Diagn Microbiol Infect Dis 1997; 29: 249-57.
• 3. Dowson CG, Hutchison A, Brannigan JA et al. Horizontal transfer of penicilin-binding protein genes in penicilin-resistant clinical isolates of Streptococcus pneumoniae. Proc Natl Acad Sci USA 1989; 86: 8842-6.
• 4. Charpentier E, Toumanen E. Mechanisms of antibiotic resistance and tolerance in Streptococcus pneumoniae. Microb Infect 2000; 2: 1855-64.
• 5. Livermore DM. Beta-lactamases in laboratory and clinical resistance. Clin Microbiol Rev 1995; 8: 557-84.
• 6. Felmingham D, Reinert RR, Hirakata Y, Rodloff A. Increasing prevelance of antimicrobial resistance among isolates of Streptococcus pneumoniae from the PROTEKT survei llance study, an d the competative in vitro activity of the ket olide, te lithromycin. J Antimicrob Chemother 2002; 50 (Supl S1): s25-37.
• 7. Schito GC. Is antimicrobial resistance also subject to globalization? Clin Microbiol Infect 2002; 8 (s3): 1-8.
• 8. Hakenbeck R. Beta-lactam resistant Streptococcus pneumoniae: epidemiology and evolutionary mechanisms. Chemotherapy 1999; 45: 83-94.
• 9. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial disc susceptibility tests. Disc diffusion supplemental tables, M100-S13 (M2-A8), 2003. CLSI/NCCLS, Wayne, Pa.
• 10. Hansman D, Bullen MM. Lancet 1967; ii: 264-265. (Dowson CG ve ark.’n›n Proc Natl Acad Sci USA 1989; 86: 8842-46’de yay›nlanan "Horizontal transfer of penicilin-binding protein genes in penicilin-resistant clinical isolates of Streptococcus pneumoniae. " isimli makalesinin 1 nolu kayna¤›d›r.)
• 11. Jacobs MR, Koornhof HJ, Robins-Browne M et al. Emergence of multiply resistant pneumococci. N Eng J Med 1978; 299:735-40.
• 12. Hoban DJ, Biedenbach DJ, Mutnick AH, Jones RN. Pathogen of occurence and susceptibility patterns associated with pneumonia in hospitalized patients in North America: results of the SENTRY Antimicrobial Surveillance Study (2000). Diagn Microbiol Infect Dis 2003; 45:279-85.
• 13. Hoban DJ, Doern GV, Fluit AC, RousselDelvallez M, Jones RN. Worldwide prevalence of antimicrobial resistance in Streptococcus pneumoniae, Haemophilus influenzae and Morexella catarrhalis in the SENTRY Antimicrobial Surveillance Program, 1997-1999. Clin Infect Dis 2001; 32 (Suppl 2): 81-93.
• 14. Whitney CG, Farley MM, Hadler J, et al. Active Bacterial Core Surveillance Program of the Emerging Infections Program Network. Increasing prevelance of multidrug-resistant Streptococcus pneumoniae in the United States. N Eng J Med 2000; 343: 1917-24.
• 15. Doern GV, Brown SD. Antimicrobial susceptibility among community-acquired respiratory tract pathogens in USA: data from PROTEKT US 2000-01. J Infect 2004; 48: 56-65.
• 16. Jones ME, Blosser-Middleton RS, Critchley IA, Karlowsky JA, Thornsberry C, Sahm DF. In vitro susceptibility of Streptococcus pneumoniae, Haemophilus influenzae and Morexella catarrhalis: a European multicenter study during 2000-2001. Clin Microbiol Infect 2003; 9: 590-9.
• 17. Tunçkanat F, Akan O, Gur D, Akal›n HE. Penicillin resistance in Streptococcus pneumoniae strains. Mikrobiyol Bul 1992; 26: 307-13.
• 18. Gür D, Ozalp M, Sumerkan B, et al. Prevalence of antimicrobial resistance in Haemophilus influenzae, Streptococcus pneumoniae, Morexella catarrhalis and Streptococcus pyogenes: results of a multicentre study in Turkey. Int J Antimicrob Agents 2002; 19: 207-211.
• 19. Gür D, Guciz B, Hascelik G, et al. Streptococcus pneumoniae penicillin resistance in Turkey. J Chemother 2001; 13: 541-5.
• 20. Tuncer ‹, Arslan U, F›nd›k D, Ural O. Klinik örneklerden izole edilen S. pneumoniae sufl- lar›nda artan penisilin direnci ve baz› antibiyotiklere karfl› direnç durumu. ANKEM Derg 2005; 19: 35-38.
• 21. Ö¤ünç D, Öngüt D, Saygan MB, Gökay S, Çolak D, Gültekin M. Pnömoni etkeni Streptococcus pneumoniae sufllar›nda penisilin duyarl›l›¤›. Türk Mikrobiyol Cem Derg 2000; 30:23-25.
• 22. Yeniflehirli G, Sener B. Antibiotic resistance and serotype distribution of Streptococcus pneumoniae strains isolated from patients at Hacettepe University Medical Faculty. Mikroiyol Bul 2003; 37: 1-11.
• 23. Sener B, Köseo¤lu O, Fiflenk I, Hasçelik G, Günalp A. Streptococcus pneumoniae strains resistant to macrolide, lincosamide, streptogramin, oxazolidinone and ketolide. Mikrobiyol Bul 2002; 36: 125-131.
• 24. fienol G, Erer OF, Biçmen C, Akto¤u S. Alt Solunum Yolu ‹nfeksiyonlar›ndan ‹zole Edilen Streptococcus pneumoniae Sufllar›n›n Penisiline Karfl› Direnç Oranlar›. Toraks Dergisi 2001; 2(3): 10-15.
• 25. Appelbaum PC. Resistance among Streptococcus pneumoniae: implications for drug selection. Clin Infect Dis 2002; 34: 1613-20.
• 26. Butler JC, Hoffman J, Cetran MS et al. The continued emergence of drug-resistant Streptococcus pneumoniae in the United States and update from the Centers for Disease Control and Prevention’s Pneumococcal Central Surveillance System. J Infect Dis 1996; 174: 986-93.
• 27. Sener B, Koseo¤lu O, Gur D, Bryskier A. Mechanisms of macrolide resistance in clinical pneumococcal isolates in a university hospital, Ankara, Turkey. J Chemother 2005; 17: 31-5.
• 28. Uncu H, Çolako¤lu fi, Turunç T, Demiro¤lu YZ, Arslan H. K›sa Bildiri: Streptococcus pneumoniae ve Haemophilus influenzae klinik izolatlar›- n›n tedavide kullan›lan antibiyotiklere karfl› in vitro direnç oranlar›. Mikrobiyol Bul 2007; 41: 441-6.