Distribution of Multidrug Resistance Bacterial Strains in Lower Respiratory Tract Infections and Comparison of Molecular/Conventional Methods used in diagnosis

Öz

Lower respiratory tract infections (LRTIs) are frequently associated with multidrug-resistant (MDR) bacterial pathogens. This study aimed to investigate the distribution of antimicrobial resistance among bacteria isolated from patients diagnosed with LRTIs and to evaluate the diagnostic performance of a multiplex molecular assay. This was a retrospective, single-center observational study conducted between January 2021 and March 2023. Respiratory specimens were processed using standard microbiological methods. Bacterial identification was performed using MALDI-TOF MS, and antimicrobial susceptibility results were interpreted according to EUCAST guidelines. A total of 3,366 lower respiratory tract specimens were analyzed. The most frequently isolated pathogens were Acinetobacter spp., Klebsiella spp., and Pseudomonas spp., with carbapenem resistance rates of 92%, 74%, and 68%, respectively. In a subgroup of 57 specimens analyzed simultaneously by conventional culture and multiplex real-time PCR, the multiplex PCR assay demonstrated positive predictive values (PPV) of 70–100%, negative predictive values (NPV) of 73.33–100%, and diagnostic accuracy ranging from 75.44% to 100% for bacterial detection. For carbapenem resistance detection, the assay showed a PPV of 100%, an NPV of 73.33%, and an accuracy of 78.95%. These findings highlight the high burden of antimicrobial resistance in LRTIs. The combined use of molecular and conventional methods may improve diagnostic accuracy and support targeted antimicrobial therapy.

Anahtar Kelimeler

• Lower respiratory tract infections
• multidrug-resistant bacteria
• molecular diagnostics
• carbapenem resistance

Destekleyen Kurum

The authors declare that this study received no financial support.

Etik Beyan

The study was approved by Eskisehir Osmangazi University Noninterventional Clinical Research Ethical Committee (Decision no: 32, Date: 22.10.2024).

Alt Solunum Yolu Enfeksiyon Etkeni Çoğul İlaç Dirençli Bakterilerin Dağılımı ve Tanıda Kullanılan Moleküler/ Konvansiyonel Yöntemlerin Karşılaştırılması

Öz

Alt solunum yolu enfeksiyonları (ASYE), sıklıkla çoklu ilaca dirençli (MDR) bakteriyel patojenlerle ilişkilidir. Bu çalışmanın amacı, ASYE tanısı alan hastalardan izole edilen bakterilerde antimikrobiyal direnç dağılımını araştırmak ve çoklu hedefli bir moleküler testin tanısal performansını değerlendirmektir. Bu çalışma, Ocak 2021–Mart 2023 tarihleri arasında yürütülmüş tek merkezli, retrospektif bir gözlemsel araştırmadır. Solunum örnekleri standart mikrobiyolojik yöntemlerle işlenmiştir. Bakteriyel tanımlama MALDI-TOF MS yöntemiyle yapılmış, antimikrobiyal duyarlılık sonuçları EUCAST kılavuzlarına göre değerlendirilmiştir. Toplam 3.366 alt solunum yolu örneği analiz edilmiştir. En sık izole edilen patojenler sırasıyla Acinetobacter spp., Klebsiella spp. ve Pseudomonas spp. olup, karbapenem direnç oranları sırasıyla %92, %74 ve %68 olarak saptanmıştır. Hem konvansiyonel kültür hem de multipleks gerçek zamanlı PCR ile eş zamanlı analiz edilen 57 örnekten oluşan alt grupta, multipleks PCR testinin bakteri tespitindeki pozitif prediktif değeri (PPV) %70–100, negatif prediktif değeri (NPV) %73,33–100 ve tanısal doğruluğu %75,44–100 arasında bulunmuştur. Karbapenem direncinin saptanmasında ise PPV %100, NPV %73,33 ve doğruluk %78,95 olarak belirlenmiştir. Bu bulgular, ASYE’lerde yüksek antimikrobiyal direnç yükünü ortaya koymaktadır. Moleküler ve konvansiyonel yöntemlerin birlikte kullanımı, tanısal doğruluğu artırarak hedefe yönelik antimikrobiyal tedaviyi destekleyebilir.

Anahtar Kelimeler

• Alt solunum yolu enfeksiyonları
• çoklu ilaca dirençli bakteriler
• moleküler tanı
• karbapenem direnci

Destekleyen Kurum

Yazarlar, bu çalışmanın herhangi bir mali destek almadığını beyan etmektedir.

Etik Beyan

Çalışma, Eskişehir Osmangazi Üniversitesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu tarafından onaylanmıştır (Karar no: 32, Tarih: 22.10.2024).

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