Üriner Sistem Enfeksiyonlu Bireylerden İzole Edilen Escherichia coli ve Klebsiella pneumoniae Suşlarında CTX-M, TEM ve SHV Tipi Genişlemiş Spektrumlu Beta-Laktamaz Aktivitesinin Otomatize Sistem ve Moleküler Yöntemlerle Araştırılması

Abstract

Amaç: Bu çalışmada, Kars Harakani Devlet Hastanesi’ne idrar yolları yakınması ile başvuran bireylere ait idrar örneklerinden izole edilen Escherichia coli ve Klebsiella pneumoniae suşları arasında GSBL pozitifliğinin otomatize identifikasyon sistemi ve moleküler yöntemlerle araştırılması amaçlandı. Materyal ve Metot: Çalışmaya, Nisan-Ağustos 2019 tarihleri arasında örneklenen 5000 idrar örneği dâhil edildi. Örnekler, Mac Conkey ve %7 koyun kanlı agarda kültüre edildikten sonra elde edilen izolatların identifikasyonu BD Phoenix™ 100 ID paneli, antibiyotik duyarlılıkları ve GSBL aktiviteleri ise AST paneli ile belirlendi. İzolatların CTX-M, TEM ve SHV genleri PCR ile analiz edildi. Bulgular: İdrar örneklerinden %19,5 oranında aerobik bakteriyel etken kültür pozitifliği elde edildi ve bunların 120 (%13,33)’sinin GSBL aktivitesi olduğu saptandı. GSBL pozitif izolatların 102 (%85)’si E. coli ve 14 (%11,67)’ü K. pneumoniae olarak identifiye edildi. GSBL pozitifliği toplamda idrar örneklerinde %2,4, E. coli ve K. pneumoniae için ise sırasıyla %2,04 ve %0,28 olarak belirlendi. İzolatların, beta laktam grubu antibiyotiklere toplam direnci %57,46 belirlenirken, en yaygın dirençlilik sefalosporinlere (%92,53) ve en yaygın duyarlılık ise karbapenemlere (%47,19) karşı saptandı. PCR ile GSBL pozitif izolatların %90,52’sinde en az bir veya birden fazla direnç geni saptandı ve en yaygın saptanan direnç geni CTX-M idi. GSBL pozitifliği ile yaş grupları arasında istatistiksel olarak anlamlı bir ilişki saptanamazken, hastaların cinsiyetleri arasında %21,9 oranında pozitif yönde bir ilişki saptandı. Sonuç: GSBL kaynaklı enfeksiyonların insidansının azaltılmasında risk faktörlerinin ortadan kaldırılmasının yanı sıra enfeksiyöz etkenlerin identifikasyonu, ilgili GSBL profillerinin çıkarılması ve bu modellerine göre geliştirilecek doğru antibiyotik tercihi oldukça önemlidir. Sınırlı bir lokasyonda, Kars yöresinde, yapılan bu sistematik çalışmanın bu yönde fayda sağlayacağı umulmaktadır.

Keywords

• insan
• idrar
• GSBL
• kültür
• Phoenix
• PCR
• E. coli
• K. pneumoniae

Investigation of CTX-M, TEM and SHV Type Extended Spectrum Beta-Lactamase Activity with Automated System and Molecular Methods in Escherichia coli and Klebsiella pneumoniae Strains Isolated from Individuals with Urinary Track Infections

Abstract

Aim: This study aimed to investigate ESBL positivity among E. coli and K. pneumoniae strains isolated from urine samples belonging to individuals who applied to Kars Harakani State Hospital with urinary tract complaints by automated identification system and molecular methods. Material and Method: 5.000 urine samples obtained between April and August 2019 were included. The samples were cultured on Mac Conkey and 7% sheep blood agar, identification was done by ID panel of BD Phoenix ™ 100 and antibiotic susceptibility and ESBL activities were determined by AST panel. CTX-M, TEM and SHV genes were analyzed by PCR. Results: 19.5% aerobic bacteria culture positivity was obtained from the urine samples and 120 (13.33%) of them were found to have ESBL activity. 102 (85%) of the isolates were identified as E. coli and 14 (11.67%) as K. pneumoniae. The ESBL positivity was obtained 2.4% for total urine samples, and 2.04% and 0.28% for E. coli and K. pneumoniae, respectively. While the total resistance to beta-lactam antibiotics was 57.46%, the most common resistance was observed against cephalosporins (92.53%) and the most common sensitivity (47.19%) was to carbapenems. At least one or more resistance genes were detected in 90.52% of ESBL positive isolates by PCR and CTX-M was the most common resistance gene. While there was no statistically significant relationship between ESBL positivity and age groups, however, a positive relationship was found between ESBL and gender of the patients at a rate of 21.9%. Conclusion: In addition to eliminating risk factors in reducing the incidence of ESBL-related infections, identification of microorganism, disclosure of relevant ESBL profiles and the right antibiotic preference to be developed according to these emerged models are important. It is hoped that this systematic study carried out in a limited location in Kars region of Turkey will benefit in this context.

Keywords

• Human
• Urine
• ESBL
• Culture
• Phoenix
• PCR
• E. coli
• K. pneumoniae

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