Increasing penicillin resistance in pneumococci isolated from cerebrospinal fluid samples: Fifteen-year experience from a teaching hospital

Abstract

Objective: There have been prominent changes in evaluation of resistance patterns of pneumococci and breakpoint values in recent years. We aimed to investigate the penicillin sensitivity of pneumococcal strains isolated from the ce­rebrospinal fluid specimens between the years 1997-2011 in our hospital and determine the MIC values under the light of these changes. Methods: Identification of pneumococci was made with conventional methods in patients with meningitis. MIC values for penicillin G were investigated by E test method in all strains. MIC values of pneumococci strains were evaluated ac­cording to values determined by CLSI for meningitis isolates in 2008. Results: A total of 57 strains were investigated in this study. The MIC range for penicillin was 0.016 - 0.75 μg/ml in S. pneumoniae strains. Seventy five percent of the strains were sensitive and eight strains (14%) had resistance. MIC50 value was sensitive, and a MIC90 value was resistant. The first resistant strain was detected in 2000, and three strains were resistant in the last year. When examined over the years increased resistance was 5.3% in the first five-year period seems to be 28.6% in the last five-year period. Conclusions: Knowledge on penicillin resistance patterns and surveillance is very important in the empirical treatment in pneumococcal meningitis.

Keywords

• S. pneumoniae

Increasing penicillin resistance in pneumococci isolated from cerebrospinal fluid samples: Fifteen-year experience from a teaching hospital

Öz

Amaç: Son yıllarda pnömokok bakterilerine direncin değerlendirilmesinde ve eşik değerlerinde büyük değişimler meydana geldi. Bu değişimler ışığında hastanemizde 1997-2011 yıllarında beyin omurilik sıvısı (BOS) örneklerinden izole edilen pnömokok suşlarında penisilin duyarlılıklarındaki değişimin araştırılması amaçlandı.Yöntemler: Tümü menenjitli hastalardan izole edilen pnömokokların tanımlamaları konvansiyonel yöntemlerle yapıldı. Tüm suşlarda penisilin G için MİK değerleri E test yöntemiyle araştırıldı. 2008 yılından itibaren pnömokoklarda penisilin MİK sınır değerleri, CLSI rehberine göre BOS izolatlarında ≤0,06 μg/ml duyarlı ve ≥0,12 μg/ml dirençli olarak değiştirildi.Bulgular: Çalışmanın kapsadığı dönemde toplam 57 suş araştırmaya dahil edildi. S. pneumoniae suşlarında, penisilin için MİK aralığı 0,016-0,75 μg/ml arasında bulundu. Suşların %75’i duyarlı, sekizi (%14) dirençli olarak tespit edildi. MİK50 değeri duyarlı, MİK90 değeri ise dirençli olarak saptandı. İlk dirençli suş 2000 yılında saptanırken son yıl ise suşların üçü dirençli bulundu. Yıllar içinde direnç artışı irdelendiğinde ilk beş yıllık periyotta %5,3 iken son beş yıllık periyotta %28,6 olduğu görülmektedir.Sonuç: Pnömokok menenjitlerinde penisilin direncinin bilinmesi ve takip edilmesi ampirik tedavi açısından büyük önem taşımaktadır

Anahtar Kelimeler

• S. pneumoniae, penisilin direnci, BOS, sınır değer

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