Karbapenem Dirençli Enterobacterales Enfeksiyonları ve Rektal Kolonizasyon ile İlişkisi

Abstract

Amaç: Karbapenem dirençli Enterobacterales (CRE) enfeksiyonlarının tedavi seçenekleri sınırlıdır ve bu enfeksiyonlar yüksek mortalite oranları ile ilişkilidir. CRE ile kolonize olan asemptomatik taşıyıcılar, CRE'nin hastanelerde yayılmasına katkıda bulunur. Bu çalışmada merkezimizde saptanan CRE izolatlarının sıklığının, bu suşlardaki karbapenemaz oranlarının, karbapenemaz genlerinin, antibiyotik direnç profillerinin, rektal CRE kolonizasyon oranlarının belirlenmesi ve CRE enfeksiyonlarının çeşitli klinik özelliklerinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Çeşitli örneklerden izole edilen Enterobacterales türleri ve kolonizasyon taraması için gönderilen rektal sürüntü örneklerinden izole edilen Enterobacterales türleri incelenmiştir. Rektal sürüntü örneklerinde CRE kolonizasyonu olan hastalar daha sonra CRE enfeksiyonu gelişimi açısından incelendi. CRE izolatları karbapenemaz üretimi ve karbapenemaz geni varlığı açısından incelenmiştir. Bulgular: 14521 Enterobacterales (10.161 E. coli ve 4195 K. pneumoniae, 165 Citrobacter) izolatı incelendi. Bu suşların %8.9'unda karbapenem direnci saptanmıştır. Kolonizasyon için değerlendirilen 15695 rektal sürüntü örneğinin %4,7'sinde CRE saptanmıştır. CRE kolonizasyonu olan hastaların %23,4'ünde ilerleyen dönemde rektal sürüntü dışında diğer örneklerde de CRE üremesi saptandı. CRE enfeksiyonlarının kolonizasyondan ortalama 21 gün sonra geliştiği gözlendi. Sonuç: CRE enfeksiyonları sadece hastanede yatan hastalarda değil toplum kökenli enfeksiyonlarda da bir etken olarak karşımıza çıkmaya başlamıştır. Çalışmamız ayrıca CRE kolonizasyonunun enfeksiyon gelişimi için önemli bir risk faktörü olabileceğini göstermiştir. Bu nedenle, kolonizasyonu saptamak için erken tarama tespiti, uygun izolasyon yöntemleriyle CRE enfeksiyonlarını önlemeye veya sınırlamaya yardımcı olabilir.

Keywords

• Karbapenem Dirençli Enterobacterales
• Kolonizasyon
• Karbapenemaz

Carbapenem-Resistant Enterobacterales Infections and Their Association with Rectal Colonization

Abstract

Objectives: Carbapenem-resistant Enterobacterales (CRE) infections have limited treatment options, and these infections are associated with high mortality rates. Asymptomatic carriers colonized with CRE contribute to the spread of CRE in hospitals. It was aimed to determine the frequency of CRE isolates detected in our center, carbapenemase ratios in these strains, carbapenemase genes, antibiotic resistance profiles, rectal CRE colonization rates and to evaluate various clinical features of CRE infections. Methods: Enterobacterales species isolated from various specimens and Enterobacterales species isolated from rectal swab specimens sent for colonization screening were examined. Patients with CRE colonization in rectal swab samples were examined for the development of CRE infection at a later time. CRE isolates were examined for carbapenemase production and the presence of carbapenemase gene. Results: 12,721 Enterobacterales (10,161 E. coli and 2395 K. pneumoniae, 165 Citrobacter) isolates were examined. Carbapenem resistance was detected in 10.3% of these strains. CRE was detected in 4.7% of 15695 rectal swab samples evaluated for colonization. In 23.4% of the patients with CRE colonization, CRE growth was detected in other samples besides the rectal swab in the later period. It was observed that CRE infections developed on average 21 days after colonization. Conclusion: CRE infections have started to emerge as a factor not only in hospitalized patients but also in community-acquired infections. Our study also showed that CRE colonization could be a significant risk factor for the development of infection. Therefore, early screening detection to detect colonization can help prevent or limit CRE infections with appropriate isolation methods.

Keywords

• Carbapenem-resistant Enterobacterales
• colonizations
• carbapenemase

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