Klinik örneklerden izole edilen Enterococcus faecalis ve Enterococcus faecium suşlarında antibiyotik dirençlerinin değerlendirilmesi: 8 yıllık analiz

Abstract

Amaç: Enterokoklar gastrointestinal sistem flora elemanlarından olup, gerek hastanede gerekse toplumda endojen kaynaklı enfeksiyonlara neden olurlar. Çoğu enterokok türü aminoglikozidlere ve sefalosporinlere karşı doğal olarak dirençlidir. E. faecium izolatlarının neredeyse tümü ampisiline dirençli olup; kloramfenikol, tetrasiklinler, makrolidler, linkozamidler, glikopeptitler, florokinolonlara karşı yaygın olarak direnç mekanizmaları geliştirmeye devam etmektedirler. Bu çalışmada hastanemiz kliniklerindeki yatan hastalardan mikrobiyoloji laboratuvarına gönderilen farklı kültür örneklerinden izole edilen E. faecalis ve E. faecium suşlarının çeşitli antimikrobiyallere direnç oranlarının retrospektif olarak belirlenmesi amaçlanmıştır. Materyal ve Metot: Mikrobiyoloji laboratuvarına ocak 2015- Aralık 2022 tarihleri arasında tüm kliniklerden gönderilen yatan hasta kültür örneklerinde üreyen 631 enterokok izolatı (372 E. faecalis ve 259 E. faecium) retrospektif olarak değerlendirilmiştir. İdentifikasyon ve antimikrobiyal duyarlılık testleri (ADT) için Vitek 2 Compact otomatize sistemi (BioMérieux, Fransa) kullanılmıştır. ADT sonuçları Minimum İnhibitör Konsantrasyon (MİK) değerlerine göre European Committee on Antimicrobial Susceptibility Testing (EUCAST) klavuzları ile değerlendirilmiştir. Verilerin istatistiksel analizi için SPSS 17 (SPSS Incorporated, Chicago) programı kullanılmıştır. Bulgular: E. faecalis ve E. faecium suşları en sık olarak Yoğun Bakım Ünitelerinden (YBÜ) (%61.8) gönderilen örneklerden ve en sık olarak idrar örnekleri (%59.1) ve kan örneklerinden(%30.9) izole edilmiştir. Sekiz yılda izole edilen E. faecalis suşları için vankomisin (%0.5), teikoplanin (%0.5), linezolid (%1.1) ve ampisilin (%1.3); E.faecium suşları için tigesiklin (%3.9) ve linezolid (%4.7) direnç oranı en düşük antimikrobiyaller olarak saptanmıştır. Sonuç: YBÜ’lerimizde izole edilen enterokok türü çoğunlukla E. faecalis (%59) olduğundan, hastaların kliniğine göre ampisilin veya glikopeptidler öncelikle tercih edilebilecek antimikrobiyallerdir. Linezolid ve tigesiklin ise daha dirençli tür olan E. faecium’un etken olarak izole edildiği enfeksiyonlarda tedavi seçenekleri arasında yer almalıdır. Bu yaklaşım ile antimikrobiyal direnç oranlarının sürekli olarak izlenmesi dirençli izolatlar ile oluşabilecek hastane enfeksiyonlarının önlenmesine katkı sağlayacaktır

Keywords

• Enterococcus faecalis
• Enterococcus faecium
• Antimikrobiyal direnç

Evaluation of antibiotic resistance in Enterococcus faecalis and Enterococcus faecium strains ısolated from clinical specimens: 8 years of analysis

Abstract

Objective: Enterococci are members of the gastrointestinal system flora and cause endogenous infections in the hospital and the community. Most enterococci are naturally resistant to aminoglycosides and cephalosporins. Almost all E. faecium isolates are resistant to ampicillin and continue to develop widespread resistance mechanisms against chloramphenicol, tetracyclines, macrolides, lincosamides, glycopeptides, and fluoroquinolones. This study aimed to retrospectively determine the resistance rates to various antimicrobials of E. faecalis and E. faecium strains isolated from different culture samples sent to the microbiology laboratory from hospitalized patients in our hospital clinics. Materials and Methods: 631 enterococcal isolates (372 E. faecalis and 259 E. faecium) grown in inpatient culture samples sent to the Microbiology laboratory from all clinics between January 2015 and December 2022 were evaluated retrospectively. Vitek 2 Compact automated system (BioMérieux, France) was used for identification and antimicrobial susceptibility testing (AST). AST results were evaluated according to Minimum Inhibitory Concentration (MIC) values according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. SPSS 17(SPSS Incorporated, Chicago) program was used for statistical analysis of the data. Results: E. faecalis and E. faecium strains were most frequently isolated from samples sent from Intensive Care Units (ICU) (61.8%) and most frequently from urine samples(59.1%) and blood samples (30.9%). Vancomycin (0.5%), teicoplanin (0.5%), linezolid (1.1%) and ampicillin (1.3%) were found to be the antimicrobials with the lowest resistance rates for E. faecalis strains isolated in eight years; tigecycline (3.9%) and linezolid (4.7%) were found to be the antimicrobials with the lowest resistance rates for E. faecium strains. Conclusions: Since the majority of enterococcal species isolated in our intensive care units are E. faecalis (59%), the antimicrobials that can be preferred primarily depending on the clinical condition of the patients are ampicillin or glycopeptides. Linezolid and tigecycline should be among the treatment options in infections where the more resistant species E. faecium is isolated as the causative agent. With this approach, continuous monitoring of antimicrobial resistance rates will contribute to the prevention of hospital infections that may occur with resistant isolates.

Keywords

• Enterococcus faecalis
• Enterococcus faecium
• Antimicrobial resistance

References

1. 1. Teixeira L, Carvalho M, Facklam R. Enterococcus. Manual of Clinical Microbiology. Washington (DC) American Society for Microbiology. 2007:430-42.
2. 2. Arias CA, Murray BE. The rise of the Enterococcus: beyond vancomycin resistance. Nature Reviews Microbiology. 2012;10(4):266-78.
3. 3. Erlandson KM, Sun J, Iwen PC, Rupp ME. Impact of the more-potent antibiotics quinupristin-dalfopristin and linezolid on outcome measure of patients with vancomycin-resistant Enterococcus bacteremia. Clinical Infectious Diseases. 2008;46 (1):30-6.
4. 4. Boccella M, Santella B, Pagliano P, De Filippis A, Casolaro V, Galdiero M, et al. Prevalence and antimicrobial resistance of Enterococcus species: a retrospective cohort study in Italy. Antibiotics. 2021;10(12):1552.
5. 5. Miller WR, Munita JM, Arias CA. Mechanisms of antibiotic resistance in enterococci. Expert review of anti-infective therapy. 2014;12(10):1221-36.
6. 6. Mogokotleng R, Ismail H, Perovic O, Jallow S. A retrospective analysis of culture-confirmed Enterococci Bloodstream infections in South Africa, 2016–2020: a cross-sectional study. Tropical Medicine and Infectious Disease. 2022;8(1):19.
7. 7. Schöneweck F, Schmitz RP, Rißner F, Scherag A, Löffler B, Pletz MW, et al. The epidemiology of bloodstream infections and antimicrobial susceptibility patterns in Thuringia, Germany: a five-year prospective, state-wide surveillance study (AlertsNet). Antimicrobial resistance & infection control. 2021;10:1-9.
8. 8. Gedik T, Kiraz N, Duran H. The change of antibiotic resistance rates over the years in Enterococcus spp. isolated from clinical specimens. Journal of Health Sciences and Medicine. 2023;6(5):1052-8.

9. 9. Koca Ö, Er H, Çekin Y. Evaluation of antibiotic susceptibility in enterococci isolated from blood culture samples. Journal of Medicine and Palliative Care. 2023;4(5):385-8.
10. 10. Pfaller MA, Cormican M, Flamm RK, Mendes RE, Jones RN, editors. Temporal and geographic variation in antimicrobial susceptibility and resistance patterns of enterococci: results from the SENTRY Antimicrobial Surveillance Program, 1997–2016. Open forum infectious diseases; 2019: Oxford University Press US.
11. 11. Şanlı K, Mart Kömürcü SZ, Şahin AS. Yoğun Bakım Ünitesindeki Erişkin Hastaların Kan Kültüründe Üretilen Enterococcus faecalis ve Enterococcus faecium’un Prevalansı ve Antimikrobiyal Duyarlılıkları. Medical Journal of Istanbul Kanuni Sultan Süleyman/İstanbul Kanuni Sultan Süleyman Tıp Dergisi. 2022;14(3).
12. 12. Sig AK, Atik TK, Duran AÇ. Antibiotic resistance of Enterococcus species: 3-year data. Journal of Health Sciences and Medicine. 2021;4(5):670-4.
13. 13. Horner C, Mushtaq S, Allen M, Hope R, Gerver S, Longshaw C, et al. Replacement of Enterococcus faecalis by Enterococcus faecium as the predominant enterococcus in UK bacteraemias. JAC-Antimicrobial Resistance. 2021;3(4):dlab185.
14. 14. Gümüş HH. Prevalence and resistance trends of Gram positive cocci Staphylococcus hylococcus aereus and Enterococcus spp. in a tertiary care hospital. Cukurova Medical Journal. 2023;48(3):1177-86.
15. 15. Ödemiş İ, Köse Ş, Ersan G, Çelik D, Akbulut İ. Evaluation of antibiotic susceptibilities of enterococcus strains isolated from clinical samples of hospitalized patients. Turkish Bulletin of Hygiene and Experimental Biology. 2018;75(4):345-52.
16. 16. Gök ŞM, Türk Dağı H, Kara F, Arslan U, Fındık D. Investigation of antibiotic resistance and virulence factors of Enterococcus faecium and Enterococcus faecalis strains isolated from clinical samples. 2020.
17. 17. Kutlu O, Arabacı Ç. Antibiotic susceptibility pattern of Enterococcus isolates in a five year period at a tertiary care hospital. Journal of Surgery and Medicine. 2019;3(9):644-7.
18. 18. Orhan Z, Kayış A, Küçük B, Aral M. Yoğun Bakım Üniteleri ve Yataklı Servislerde Yatan Hastaların Kültürlerinden Dört Yıllık Süreçte İzole Edilen Enterococcus faecalis ve Enterococcus faecium Suşlarının Antibiyotik Dirençlerinin Araştırılması. Türk Mikrobiyoloji Cemiyeti Dergisi. 2023:174.
19. 19. Bhardwaj SB. Enterococci: an important nosocomial pathogen. Pathogenic bacteria. 2019.
20. 20. Fiore E, Van Tyne D, Gilmore MS. Pathogenicity of enterococci. Microbiology spectrum. 2019;7(4):10.1128/microbiolspec. gpp3-0053-2018.
21. 21. Bender JK, Cattoir V, Hegstad K, Sadowy E, Coque TM, Westh H, et al. Update on prevalence and mechanisms of resistance to linezolid, tigecycline and daptomycin in enterococci in Europe: Towards a common nomenclature. Drug Resistance Updates. 2018;40:25-39.
22. 22. Del Turco ER, Bartoletti M, Dahl A, Cervera C, Pericàs JM. How do I manage a patient with enterococcal bacteraemia? Clinical Microbiology and Infection. 2021;27(3):364-71.
23. 23. Butcu M, Akcay SS, Inan AS, Aksaray S, Engin DO, Calisici G. In vitro susceptibility of enterococci strains isolated from urine samples to fosfomycin and other antibiotics. Journal of Infection and Chemotherapy. 2011;17:575-8.
24. 24. Ayobami O, Willrich N, Reuss A, Eckmanns T, Markwart R. The ongoing challenge of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis in Europe: an epidemiological analysis of bloodstream infections. Emerging Microbes & Infections. 2020;9(1):1180-93.
25. 25. Jones RN, Della-Latta P, Lee LV, Biedenbach DJ. Linezolid-resistant Enterococcus faecium isolated from a patient without prior exposure to an oxazolidinone: report from the SENTRY Antimicrobial Surveillance Program. Diagnostic microbiology and infectious disease. 2002;42(2):137-9.
26. 26. Smith TT, Tamma PD, Do TB, Dzintars KE, Zhao Y, Cosgrove SE, et al. Prolonged linezolid use is associated with the development of linezolid-resistant Enterococcus faecium. Diagnostic Microbiology and Infectious Disease. 2018;91(2):161-3.
27. 27. Dadashi M, Sharifian P, Bostanshirin N, Hajikhani B, Bostanghadiri N, Khosravi-Dehaghi N, et al. The global prevalence of daptomycin, tigecycline, and linezolid-resistant Enterococcus faecalis and Enterococcus faecium strains from human clinical samples: a systematic review and meta-analysis. Frontiers in medicine. 2021;8:720647.
28. 28. Pankey GA. Tigecycline. Journal of Antimicrobial Chemotherapy. 2005;56(3):470-80.
29. 29. Sun Yan SY, Cai Yun CY, Liu Xu LX, Bai Nan BN, Liang BeiBei LB, Wang Rui WR. The emergence of clinical resistance to tigecycline. 2013.
30. 30. Bilgin M, Görgün S, İşler H, Başbulut E. Evaluation of the distribution and antibiotic resistance profiles of enterococcus species isolated from urine cultures. Turkish Bulletin of Hygiene and Experimental Biology. 2021;78(3):265-72.
31. 31. Şimşek M. idrar kültürlerinden izole edilen enterokok suşlarinin tür dağilimlari ve antibiyotik duyarlilikları. Kocatepe Tıp Dergisi. 2019;20(1):177-82.