Research Article
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Kan kültürü örneklerinden izole edilen enterokoklarda antibiyotik duyarlılıklarının değerlendirilmesi

Year 2023, Volume: 4 Issue: 5, 385 - 388, 27.10.2023
https://doi.org/10.47582/jompac.1340041

Abstract

Amaç: Enterokoklarda artan antibiyotik direnci hastanede yatan hastalarda hayatı tehdit eden kan dolaşımı infeksiyonlarının önemli bir nedenidir. Bu çalışmanın amacı, Antalya Eğitim ve Araştırma Hastanesi’nde yatan hastalarda, kan kültürlerinden izole edilen Enterokok suşlarında antibiyotik duyarlılık oranlarının belirlenmesidir.
Yöntem: Hastanemiz servis ve yoğun bakım ünitelerinde (YBÜ) yatan hastaların bilgi işlem sistemi (LIS) üzerinden, 1 Ocak 2018- 30 Aralık 2022 tarihlerinde, kan kültürü örneklerinden izole edilen Enterococcus suşlarının antibiyotik direnç oranları retrospektif olarak incelenmiştir. Kan örnekleri, BacT/ALERT 3D kültürü sisteminde (Biomerieux, France) inkübe edilmiştir. Bakteri identifikasyonu konvansiyonel yöntemler, Matriks Destekli Lazer Dezorpsiyon-İyonizasyon Uçuş Süresi Kütle Spektrometresi (MALDI-TOF MS) ve VITEK 2 (Biomerieux, France) sistemleri kullanılarak yapılmıştır. Antimikrobiyal duyarlılık testleri VITEK 2 (Biomerieux, France) sistemleri ile çalışılmıştır. İzole edilen suşların ampisilin, vankomisin, teikoplanin, yüksek düzey gentamisin direnci (YDGR) ve linezolid duyarlılıkları European Committee on Antimicrobial Susceptibility Testing (EUCAST) kriterlerine göre değerlendirilmiştir. Vankomisine dirençli suşların, mikrodilüsyon gradient strip test (Bioanalyse) ile vankomisin minimal inhibitör konsantrasyon (MİK) değerleri çalışılmıştır.
Bulgular: Kan kültürü örneklerinden toplam 623 enterokok suşu izole edilmiştir. Enterokokların 305’i (%48.9) Enterococcus faecalis, 281’i (%45.6) Enterococcus faecium, 12’si (%1.9) Enterococcus avium, 11’i (%1.8) Enterococcus gallinarum, 7’si (%1.2) Enterococcus casseliflavus, 2’si (%0.4) Enterococcus durans ve 1’i (0.2) Enterococcus hirae olarak tanımlanmıştır. İzole edilen E. faecalis suşlarının ampisilin ve YDGR direnç oranları sırayla 11 (%3.6) ve 72 (%23.6) olarak saptanmış ve bütün suşlar vankomisin, teikoplanin ve linezolide duyarlı bulunmuştur. E. faecium suşlarının ampisilin, vankomisin, teikoplanin ve YDGR direnç oranları sırayla 229 (%81.5), 36 (%12.8), 30 (%10.7) ve 142 (%50.5) olarak saptanmıştır ve bütün suşlar linezolide duyarlı olarak bulunmuştur.
Sonuç: Enterokoklarla oluşan enfeksiyonlarda, identifikasyon ve antibiyotik duyarlılık oranlarının kültür antibiyogram sonuçlarına göre belirlenmesi doğru yaklaşım olacaktır. Kan kültürü örneklerinden izole edilen enterokokların, hastanemize ait güncel duyarlılık oranlarının bilinmesi, klinisyenlerin ampirik tedavi planlanmasına katkı sağlayacaktır.

References

  • Sava IG, Heikens E, Huebner J. Pathogenesis and immunity in enterococcal infections. Clin Microbiol Infect. 2010;(16):533-540.
  • Markwart R, Willrich N, Haller S, et al. The rise in vancomycin-resistant Enterococcus faecium in Germany: data from the German Antimicrobial Resistance Surveillance (ARS). Antimicrob Resist Infect Control. 2019;8(1):147.
  • Gök ŞM, Türk Dağı H, Kara F, Arslan U, Fındık D. Klinik örneklerden izole edilen Enterococcus faecium ve Enterococcus faecalis izolatlarının antibiyotik direnci ve virülans faktörlerinin araştırılması. Mikrobiyol Bul. 2020;54(1):26-39.
  • Tripathi A, Shukla S, Singh A, Prasad K. Prevalence, outcome and risk factor associated with vancomycin-resistant Enterococcus faecalis and Enterococcus faecium at a tertiary care hospital in Northern India. Indian J Med Microbiol. 2016;34(1):38-45.
  • Türk Dağı H, Arslan U, Tuncer Eİ. Kan kültürlerinden izole edilen enterokoklarda antibiyotik direnci. Türk Mikrobiyol Cem Derg. 2011;41(3):103-106.
  • Çelik C, Taşkın-Kafa AH, Hasbek M, Büyüktuna SA. Antimicrobial resistance in Enterococcus faecalis and Enterococcus faecium bacteria ısolated from bloodstream ınfections: A single-center evaluation. Klimik J. 2021;34(1):37-41.
  • Boccella M, Santella B, Pagliano P, et al. Prevalence and antimicrobial resistance of Enterococcus species: a retrospective cohort study in Italy. Antibiotics. 2021;10(12):1552.
  • Mogokotleng R, Ismail H, Perovic O, Jallow S. A retrospective analysis of culture-confirmed Enterococci bloodstream ınfections in South Africa, 2016-2020: a cross-sectional study. Trop Med Infect Dis. 2022;8(1). doi: 10.3390/tropicalmed8010019.
  • Miller WR, Munita JM, Arias CA. Mechanisms of antibiotic resistance in enterococci. Expert Rev Anti Infect Ther. 2014;12(10):1221-1236.
  • Gagetti P, Bonofiglio L, García Gabarrot G, et al. Resistance to β-lactams in enterococci. Rev Argent Microbiol. 2019;51(2):179-183.
  • Schöneweck F, Schmitz RPH, Rißner F, et al. The epidemiology of bloodstream infections and antimicrobial susceptibility patterns in Thuringia, Germany: a five-year prospective, state-wide surveillance study. Antimicrob Resist Infect Control. 2021;10(1):132.
  • Şanlı K. Yoğun bakım ünitesindeki erişkin hastaların kan kültüründe üretilen Enterococcus faecalis ve Enterococcus faecium’un prevalansı ve antimikrobiyal duyarlılıkları. IKSSTD. Published online 2022. doi:10.14744/iksstd.2022.55823
  • Jabbari Shiadeh SM, Pormohammad A, Hashemi A, Lak P. Global prevalence of antibiotic resistance in blood-isolated Enterococcus faecalis and Enterococcus faecium: a systematic review and meta-analysis. Infect Drug Resist. 2019;12:2713-2725.
  • O’Driscoll T, Crank CW. Vancomycin-resistant enterococcal infections: epidemiology, clinical manifestations, and optimal management. Infect Drug Resist. 2015;8:217-230.
  • Vural T, Şekercioğlu AO, Dilara Ö, Meral G, Dilek Ç, Akın Y. Vankomisine dirençli Enterococcus casseliflavus suşu. 13 Ankem Derg. 1998;12(2):113.
  • Khan A, Miller WR, Axell-House D, Munita JM, Arias CA. Antimicrobial susceptibility testing for Enterococci. J Clin Microbiol. 2022;60(9):e0084321.
  • Arundathi HA, Prakash N, Halesh HL, Siddesh KC. Prevalence of high level gentamicin resistance among the clinical ısolates of Enterococci species. J Pure Appl Microbiol. 2022;16(2):1004-1009.
  • Alkan Ceviker S, Gunal O, Koksal E, Aygun C, Kilic SS. Comparison of health care-associated Enterococcus faecium and Enterococcus faecalis bloodstream ınfections. Klimik Derg./Klimik J. 2020;33(1):87-90.
  • Durmaz S, Ozer T. Antibiotic susceptibilities of Enterococci ısolated from blood cultures. Ulutas Med J. 2015;1(4):111.
  • Aktaş G, Bozdoğan B, Derbentli S. In vitro activity of linezolid and dalbavancin against vancomycin-resistant enterococci. Mikrobiyol Bul. 2012;46(3):359-365.

Evaluation of antibiotic susceptibility in enterococci isolated from blood culture samples

Year 2023, Volume: 4 Issue: 5, 385 - 388, 27.10.2023
https://doi.org/10.47582/jompac.1340041

Abstract

Aims: Increased vancomycin resistance in enterococci is an important cause of life-threatening bloodstream infections in hospitalized patients. The aim of this study is to determine the antibiotic susceptibility rates of Enterococcus strains isolated from blood cultures in hospitalized patients in Antalya Training and Research Hospital.
Methods: The antibiotic resistance rates of Enterococcus strains isolated from blood cultures of patients hospitalized in the service and intensive care units (ICU) between 1 January 2018 and 30 December 2022 were examined retrospectively. Blood samples were studied with the BacT/ALERT 3D culture system (Biomerieux, France). Bacterial identification was performed using conventional methods, Matrix Assisted Laser Desorption-Ionization Time-of-Flight Mass Spectrometer (MALDI-TOF MS) and VITEK 2 (Biomerieux, France) systems. Antimicrobial susceptibility tests were performed with VITEK 2 (Biomerieux, France) systems. Ampicillin, vancomycin, teicoplanin, high-level gentamicin resistance (HLGR) and linezolid susceptibility of isolated strains were evaluated according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. Vancomycin minimal inhibitory concentration (MIC) values of vancomycin resistant strains were studied by microdilution gradient strip test (Bioanalyse).
Results: A total of 623 strains of enterococci were isolated from blood culture samples. Of the enterococci, 305 (48.9%) were identified as Enterococcus faecalis, 281 (45.6%) Enterococcus faecium, 12 (1.9%) Enterococcus avium, 11 (1.8%) Enterococcus gallinarum, 7 (1.2%) Enterococcus casseliflavus, 2 (0.4%) Enterococcus durans and 1 Enterococcus hirae (0.2%). Ampicillin and HLGR resistance rates of isolated E. faecalis strains were 11 (3.6%) and 72 (23.6%), respectively, and all strains were found to be susceptible to vancomycin, teicoplanin and linezolid. The ampicillin, vancomycin, teicoplanin and HLGR resistance rates of E. faecium strains were determined as 229 (81.5%), 36 (12.8%), 30 (10.7%) and 142 (50.5%), respectively, and all strains were found to be susceptible to linezolid.
Conclusion: In infections caused by enterococci, identification and determination of antibiotic susceptibility rates according to culture antibiogram results would be the right approach. Knowing the current susceptibility rates of enterococci isolated from blood culture samples in our hospital will contribute for clinicians' planning of empirical treatment.

References

  • Sava IG, Heikens E, Huebner J. Pathogenesis and immunity in enterococcal infections. Clin Microbiol Infect. 2010;(16):533-540.
  • Markwart R, Willrich N, Haller S, et al. The rise in vancomycin-resistant Enterococcus faecium in Germany: data from the German Antimicrobial Resistance Surveillance (ARS). Antimicrob Resist Infect Control. 2019;8(1):147.
  • Gök ŞM, Türk Dağı H, Kara F, Arslan U, Fındık D. Klinik örneklerden izole edilen Enterococcus faecium ve Enterococcus faecalis izolatlarının antibiyotik direnci ve virülans faktörlerinin araştırılması. Mikrobiyol Bul. 2020;54(1):26-39.
  • Tripathi A, Shukla S, Singh A, Prasad K. Prevalence, outcome and risk factor associated with vancomycin-resistant Enterococcus faecalis and Enterococcus faecium at a tertiary care hospital in Northern India. Indian J Med Microbiol. 2016;34(1):38-45.
  • Türk Dağı H, Arslan U, Tuncer Eİ. Kan kültürlerinden izole edilen enterokoklarda antibiyotik direnci. Türk Mikrobiyol Cem Derg. 2011;41(3):103-106.
  • Çelik C, Taşkın-Kafa AH, Hasbek M, Büyüktuna SA. Antimicrobial resistance in Enterococcus faecalis and Enterococcus faecium bacteria ısolated from bloodstream ınfections: A single-center evaluation. Klimik J. 2021;34(1):37-41.
  • Boccella M, Santella B, Pagliano P, et al. Prevalence and antimicrobial resistance of Enterococcus species: a retrospective cohort study in Italy. Antibiotics. 2021;10(12):1552.
  • Mogokotleng R, Ismail H, Perovic O, Jallow S. A retrospective analysis of culture-confirmed Enterococci bloodstream ınfections in South Africa, 2016-2020: a cross-sectional study. Trop Med Infect Dis. 2022;8(1). doi: 10.3390/tropicalmed8010019.
  • Miller WR, Munita JM, Arias CA. Mechanisms of antibiotic resistance in enterococci. Expert Rev Anti Infect Ther. 2014;12(10):1221-1236.
  • Gagetti P, Bonofiglio L, García Gabarrot G, et al. Resistance to β-lactams in enterococci. Rev Argent Microbiol. 2019;51(2):179-183.
  • Schöneweck F, Schmitz RPH, Rißner F, et al. The epidemiology of bloodstream infections and antimicrobial susceptibility patterns in Thuringia, Germany: a five-year prospective, state-wide surveillance study. Antimicrob Resist Infect Control. 2021;10(1):132.
  • Şanlı K. Yoğun bakım ünitesindeki erişkin hastaların kan kültüründe üretilen Enterococcus faecalis ve Enterococcus faecium’un prevalansı ve antimikrobiyal duyarlılıkları. IKSSTD. Published online 2022. doi:10.14744/iksstd.2022.55823
  • Jabbari Shiadeh SM, Pormohammad A, Hashemi A, Lak P. Global prevalence of antibiotic resistance in blood-isolated Enterococcus faecalis and Enterococcus faecium: a systematic review and meta-analysis. Infect Drug Resist. 2019;12:2713-2725.
  • O’Driscoll T, Crank CW. Vancomycin-resistant enterococcal infections: epidemiology, clinical manifestations, and optimal management. Infect Drug Resist. 2015;8:217-230.
  • Vural T, Şekercioğlu AO, Dilara Ö, Meral G, Dilek Ç, Akın Y. Vankomisine dirençli Enterococcus casseliflavus suşu. 13 Ankem Derg. 1998;12(2):113.
  • Khan A, Miller WR, Axell-House D, Munita JM, Arias CA. Antimicrobial susceptibility testing for Enterococci. J Clin Microbiol. 2022;60(9):e0084321.
  • Arundathi HA, Prakash N, Halesh HL, Siddesh KC. Prevalence of high level gentamicin resistance among the clinical ısolates of Enterococci species. J Pure Appl Microbiol. 2022;16(2):1004-1009.
  • Alkan Ceviker S, Gunal O, Koksal E, Aygun C, Kilic SS. Comparison of health care-associated Enterococcus faecium and Enterococcus faecalis bloodstream ınfections. Klimik Derg./Klimik J. 2020;33(1):87-90.
  • Durmaz S, Ozer T. Antibiotic susceptibilities of Enterococci ısolated from blood cultures. Ulutas Med J. 2015;1(4):111.
  • Aktaş G, Bozdoğan B, Derbentli S. In vitro activity of linezolid and dalbavancin against vancomycin-resistant enterococci. Mikrobiyol Bul. 2012;46(3):359-365.

Details

Primary Language English
Subjects Medical Bacteriology
Journal Section Research Articles [en] Araştırma Makaleleri [tr]
Authors

Özlem KOCA

Halil ER 0000-0002-8752-2156

Yeşim ÇEKİN 0000-0003-4393-5618

Early Pub Date October 26, 2023
Publication Date October 27, 2023
Published in Issue Year 2023 Volume: 4 Issue: 5

Cite

AMA KOCA Ö, ER H, ÇEKİN Y. Evaluation of antibiotic susceptibility in enterococci isolated from blood culture samples. J Med Palliat Care / JOMPAC / jompac. October 2023;4(5):385-388. doi:10.47582/jompac.1340041

TR DİZİN ULAKBİM and International Indexes (1d)

Interuniversity Board (UAK) Equivalency: Article published in Ulakbim TR Index journal [10 POINTS], and Article published in other (excuding 1a, b, c) international indexed journal (1d) [5 POINTS]



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