Erişkin hastalarda toplum kaynaklı üriner sistem enfeksiyonlarından izole edilen Escherichia coli suşlarının antibiyotik duyarlılıklarının yıllara göre değişimi 2010-2014

Abstract

Amaç: Üriner sistem enfeksiyonları ÜSE , toplumda en sık görülen enfeksiyon hastalıklarından biridir. ÜSE’nin etkenleri arasında Gram negatif çomaklar ve özellikle de %70-80 görülme sıklığı ile Escherichia coli ilk sırada yer almaktadır. Üriner sistem enfeksiyonları için çoğu zaman kültür ve antimikrobiyal duyarlılık testleri beklenmeden ampirik tedaviye başlanmaktadır. Çalışmamızda, hastanemize üriner sistem enfeksiyonu şikayeti ile başvuran hastalara ait idrar örneklerinden izole edilen E. coli suşlarının ampirik tedavide sık kullanılan antibiyotiklere duyarlılıklarındaki değişim incelenmiştir. Yöntemler: Hastanemiz laboratuvarına 1 Ocak 2010 – 30 Aralık 2014 tarihleri arasında çeşitli polikliniklerden gönderilen idrar örneklerine ait sonuçlar retrospektif olarak incelenmiştir. ÜSE ön tanısı konulan hastalardan uygun şartlarda alınan orta akım idrar örnekleri 0,4 mm çaplı kalibre öze ile %5 koyun kanlı agar ve EMB agara ekilerek aerop koşullarda 37°C’de 24-48 saat inkübe edilmiştir. E. coli suşlarının identifikasyonu konvansiyonel yöntemlerle yapılmış ve antibiyotik duyarlılıkları ve fenotipik genişlemiş spektrumlu beta laktamaz GSBL doğrulaması disk difüzyon yöntem ile güncel Klinik ve Laboratuvar Standardları Enstitüsü CLSI standardlarına göre değerlendirilmiştir. Bulgular: Toplam 99.997 örneğin 17.857 %17,8 ’sinde üreme saptanmış ve bunların 11.594 64,9 ’si E. coli olarak tanımlanmıştır. İdrar kültürü örneklerinden E. coli üremesi saptanan hastaların %72,5 8401 ’i kadın, %27,5 3193 ’i erkektir. E. coli suşlarının en duyarlı olduğu antibiyotikler fosfomisin %99,6 , nitrofurantoin %96,7 ve norfloksasin %80,6 olarak tespit edilmiştir. Amoksisilin/ klavulanik asit, ampisilin/sulbaktam, ampisilin ve sefuroksimin direncinde yıllar içinde azalma olduğu gözlenmiştir. Siprofloksasin, levofloksasin, norfloksasin, nitrofurantoin, sefazolinin direncinde ve GSBL oranlarında ise yıllar içinde artış olduğu görülmüştür. Sonuç: Sonuç olarak hastanemizde izole edilen toplum kökenli üropatojen E. coli suşları için nitrofurantoin %3,3 ve fosfomisinin %0,4 düşük direnç oranları ile ÜSE tedavisinde en etkili antibiyotikler olduğu izlenmiştir

Keywords

• E. coli, fosfomisin, üriner sistem enfeksiyonları

The antibiotic susceptibility changes of the Escerichia coli strains isolated from community-acquired urinary tract infections in adults according to the years 2010-2014

Abstract

Objective: Urinary tract infections UTI are one of the most common infectious diseases in the community. Gram- negative bacilli and especially with the prevalence of %70-80, Escherichia coli are in the first place among the effects of UTI. Most of the time for urinary tract infections empirical treatment is started without waiting the culture and antimicrobial susceptibility tests. In our study the susceptibility changes of the E. coli strains isolated from urine samples of the patients who applied to our hospital with the complaints of urinary tract infections to the antibiotics which are frequently used in empirical treatment were examined for the last five years period. Methods: The results of urine samples sent to the laboratory of our hospital from various clinics between 1 January 2010 - 30 December 2014 were analyzed retrospectively. Medium current urine samples which were taken from UTI prediagnosed patients at appropriate conditions, were inoculated on 5% sheep blood agar and EMB agar with 0.4 mm diameter calibrated loop and were incubated in aerobic conditions at 37°C for 24-48 hours.The identification of E. coli strains were made by conventional methods and their antibiotic sensitivity and phenotypic extended spectrum beta –lactamase ESBL confirmation was evaluated by the disk diffusion method according to the current Clinical and Laboratory Standards Institute CLSI standards. Results: Reproduction has been detected in 17.857 17,8% from the total of 99.997 examples and 11.594 64,9% of them have been identified as E. coli. The 72.5% of patients having E. coli reproduction from urine culture samples 8401 were female and 27.5% 3193 were male. The antibiotics that the E. coli strains were mostly sensitive were detected as fosfomycin 99.6% . nitrofurantoin 96.7% and norfloxacin 80.6% . It was observed that there was a decrease in the resistance of amoxicillin/clavulanic acid, ampicillin/sulbactam, ampicillin and cefuroxime over the years. On the hand it was seen that there was an increase in the resistance of ciprofloxacin, levofloxacin, norfloxacin, nitrofurantain, cefazolin and ESBL rates within the years. Conclusion: As a result, for the E. coli strains isolated in our hospital from community-acquired urinary, nitrofurantoin 3.3% and the fosfomycin 0.4% with urinary pathogen low rate of resistance were observed to be the most effective antibiotics in the treatment of UTI.

Keywords

• E. coli, fosfomycin, urinary tract infections

References

1. 1. Bhatia A, Zahoor S. Staphylococcus aureus enterotoxins: a review. J Clin Diag Res, 2007; 1(2): 188-97.
2. 2. Sepin-Özen N, Tuğlu-Ataman Ş, Seyman D, Aldağ H, Emek M. Antalya ili gıda çalışanlarında nazal Staphylococcus aureus taşıyıcılığının ve MRSA oranlarının üç farklı yöntem kullanılarak incelenmesi. Türk Hij Den Biyol Derg, 2013; 70(2): 51–8.
3. 3. Dinges MM, Orwin PM, Schlievert PM, Exotox-ins of Staphylococcus aureus. Clin. Microbiol Rev, 2000; 13(1): 16-34.
4. 4. Schelin J, Wallin-Carlquist N, Cohn MT, Lindqvist R, Barker GC, Radström P. The formation of Staphylococcus aureus enterotoxin in food environments and advances in risk assessment. Virulence, 2011; 2(6): 580-92.
5. 5. Soriano JM, Font G, Molto JC, Manes J. Enterotoxigenic staphylococci and their toxins in restaurant foods. Trends Food Sci Tech, 2002; 13: 60–7.
6. 6. Wertheim HFL, Melles DC, Vos MC, Willem VL, Belkum AV, Verbrugh HA, et al. The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis, 2005; 5: 751–62.
7. 7. Can HY, Çelik TH. Detection of enterotoxigenic and antimicrobial resistant S. aureus in Turkish cheeses. Food Control, 2012; 24: 100-3.
8. 8. Erol İ, İşeri Ö. Stafilokokal enterotoksinler. AÜ Vet.Fak Derg, 2004; 51: 239-45.

9. 9. Balaban N, Rasooly A. Staphylococcal enterotoxins. Int. J Food Microbiol, 2000; 61: 1–10.
10. 10. Hennekinne JA, Buyser MLD, Dragacci S. Staphylococcus aureus and its food poisoning toxins: characterization and outbreak investigation. FEMS Microbiol Rev, 2012; 36: 815–36.
11. 11. Sutherland J, Varnam A. Enterotoxin-producing Staphylococcus, Shigella, Yersinia, Vibrio, Aeromonas and Pseudomonas. In: Blackburn CW, McClure PJ, eds. Foodborne Pathogens. Washington: CRC Press. 2002: 384-415.
12. 12. Rall VLM, Sforcin, JM, Augustini VCM, Watanabe MT, Fernandes jr. Detection of enterotoxin genes of Staphylococcus spp. isolated from nasal cavities and hands of food handlers. Braz. J Microbiol, 2010; 41: 59-65.
13. 13. İşeri Ö, Erol İ. Hindi etinden kaynaklanan başlıca bakteriyel infeksiyon ve intoksikasyonlar. AÜ Vet Fak Derg, 2009; 56: 47-54.
14. 14. Loir YL, Baron F, Gautier M. Staphylococcus aureus and food poisoning. Genet Mol Res, 2003; 2(1): 63-76.
15. 15. Jones TF, Kellum ME, Porter SS, Bell M, Schaffner W. An outbreak of community-acquired foodborne illness caused by methicilin resistant Staphylococcus aureus. Emerg Infect Dis, 2002; 8(1): 82-4.
16. 16. Bystron J, Molenda J, Bania J, Kosek-Paszkowska K, Czerw M. Occurrence of enterotoxigenic strains of Staphylococcus aureus in raw poultry meat. Polish J Vet Sci, 2005; 8: 37-40.
17. 17. Morandi S, Brasca M, Lodi R, Cremonesi P, Castiglioni B. Detection of classical enterotoxins and identification of enterotoxin genes in Staphylococcus aureus from milk and dairy products, Vet Microbiol, 2007; 124. 66–72.
18. 18. Ertaş N, Gönülalan Z, Yıldırım Y, Kum E. Detection of Staphylococcus aureus enterotoxins in sheep cheese and dairy desserts by multiplex PCR technique. Int J Food Microbiol, 2010; 142: 74–7.
19. 19. Alişarlı M, Sancak YC, Akkaya L, Elibol C. Bazı sütlü gıdalarda Staphylococcus aureus'un izolasyonu, termonükleaz aktivitesi ve enterotoksijenik özelliklerinin araştırılması. Turk J Vet Anim Sci, 2003; 27(6): 1457-62.
20. 20. Demirel NN, Karapınar M. İzmir ilinde satılan bazı peynirlerde S. aureus enterotoksinlerinin ELISA yöntemi ile belirlenmesi. Gıda, 2006; 31(1): 37-41.
21. 21. Normanno G, La Salandra G, Dambrosio A, Quaglia NC, Corrente M, Parisi A, et al. Occurrence, characterization and antimicrobial resistance of enterotoxigenic Staphylococcus aureus isolated from meat and dairy products. Int J Food Microbiol, 2007; 115: 290–6.
22. 22. Çepoğlu H, Vatansever L, Bilge Oral N. Isolation of staphylococci from food handlers and investigation of their enterotoxigenicity and susceptibility to some antibiotics, Kafkas Univ Vet Fak, 2010; 16: 1-5.
23. 23. Atanassova V, Meindl A, Ring C. Prevalence of Staphylococcus aureus and staphylococcal enterotoxins in raw pork and uncooked smoked ham comparison of classical culturing detection and RFLP-PCR. Int J Food Microbiol, 2001; 68: 105–13.
24. 24. Hacıbektaşoğlu A, Eyigün CP, Özsoy MF. “Gıda Elleyicileri”nde burun ve boğaz portörlüğü, Mikrobiyol Bul, 1993; 27: 62-70.
25. 25. Yücel N, Anıl Y. Çiğ süt ve peynir örneklerinden Staphylococcus aureus ve koagülaz negatif stafilokokların identifikasyonu ve antibiyotik duyarlılığı. Türk Hij Den Biyol Derg, 2011; 68(2): 73–8.
26. 26. Kato Y, Matsunaga S, Misuna Y, Ushioda H, Yamamoto T, Kaneuchi C. Isolation and characterization of Staphylococcus aureus in rats trapped at restaurants in buildings in downtown Tokyo. J Vet Med Sci, 1995; 57: 499–502.
27. 27. Wertheim HF, Melles DC, Vos MC, Belkum AV, Verbrugh HA, Nouwen JL. The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis, 2005; 5(12): 751-62.
28. 28. Aycicek H, Aydogan H, Kucukkaraaslan A, Baysallar M, Basustaoglu AC. Assessment of the bacterial contamination on hands of hospital food handlers. Food Control, 2004; 15(4): 253-9.
29. 29. Pala K, Ozakın C, Akış N, Sınırtaş M, Gedikoğlu S, Aytekin H. Asymptomatic carriage of bacteria in food workers in Nilufer district, Turk J Med Sci, 2010; 40(1): 133-9.
30. 30. Gündüz T, Limoncu ME, Çümen S, Arı A, Etiz S, Tay Z. The Prevalence of intestinal parasites and nasal S. aureus carriage among food handlers. J Environ Health, 2008; 70(10): 64-7.
31. 31. Al Bustan MA, Udo EE, Chugh TD. Nasal carriage of enterotoxin-producing Staphylococcus aureus among restaurant workers in Kuwait City. Epidemiol Infect, 1996; 116(3): 319-22.
32. 32. Acco M, Ferreira FS, Henriques JAP, Tondo EC. Identification of multiple strains of Staphylococcus aureus colonizing nasal mucosa of food handlers. Food Microbiol, 2003; 20: 489–93.
33. 33. Noor-Azira, AM, Mohammad-Faid, AR, Shuhaimi M, Syafinaz AN, Hamat RA, Malina 0. Staphylococcus aureus in food and nares of food handlers in Kuala Pilah, Malaysia. Pertanika J Trop Agric Sci, 2012; 35(4): 853 - 62.
34. 34. Loeto D, Matsheka MI, Gashe BA. Enterotoxigenic and antibiotic resistance determination of Staphylococcus aureus strains isolated from food handlers in Gaborone, Botswana. J Food Prot, 2007; 70: 12.
35. 35. Udo EE, Al-Mufti S, Albert MJ. The prevalence of antimicrobial resistance and carriage of virulence genes in Staphylococcus aureus isolated from food handlers in Kuwait City restaurants. BMC Res Notes, 2009; 2: 108.
36. 36. Souza PA, Santos DA. Microbiological risk factors associated with food handlers in elementary schools from Brazil. J Food Safety, 2009; 29: 424–9.
37. 37. Saeeda HA, Hamid HH. Bacteriological and parasitological assessment of food handlers in the omdurman area of Sudan. J Microbiol Immunol Infect, 2010; 43(1): 70–3.
38. 38. Ho J, O'Donoghue MM, Boost MV. Occupational exposure to raw meat: a newly-recognized risk factor for Staphylococcus aureus nasal colonization amongst food handlers. Int J Hyg Environ Health, 2014; 217(2-3): 347-53.
39. 39. Dagnew M, Tiruneh M, Moges F, Tekeste Z. Survey of nasal carriage of Staphylococcus aureus and intestinal parasites among food handlers working at Gondar University, Northwest Ethiopia. BMC Public Health, 2012; 12: 837.
40. 40. Lues JFR, Van Tonder I. The occurrence of indicator bacteria on hands and aprons of food handlers in the delicatessen sections of a retail group. Food Control, 2007; 18: 326–32.
41. 41. Soto A, Saldias ME, Oviedo P, Fernandez, M. Prevalence of Staphylococcus aureus among food handlers from a metropolitan university in Chile. Rev Med Chil, 1996; 124: 1142–46.
42. 42. Hatakka M, Björkroth KJ, Asplund K, Mäki-Petäys N, Korkeala HJ. Genotypes and enterotoxicity of Staphylococcus aureus isolated from the hands and nasal cavities of flight-catering employees. J Food Prot, 2000: 1467-609.
43. 43. Figueroa G, Navarrete P, Caro M, Troncoso M, Faúndez G. Carriage of enterotoxigenic Staphylococcus aureus in food handlers. Rev Med Chil, 2002; 130(8): 859-64.
44. 44. Jorda GB, Marucci RS, Guida AM, Pires PS, Manfredi EA. Carriage and characterization of Staphylococcus aureus in food handlers. Rev Argent Microbiol , 2012; 44(2):101-4.
45. 45. Richards MS, Rittman M, Gilbert TT, Opal SM, DeBuono BA, Neill RJ, et al. Investigation of a staphylococcal food poisoning outbreak in a centralized school lunch program. Public Health Rep, 1993; 108(6): 765–71.
46. 46. Kitamoto M, Kito K, Niimi Y, Shoda S, Takamura A, Hiramatsu T, et al. Food poisoning by Staphylococcus aureus at a university festival. Jpn J Infect Dis, 2009; 62: 242-3.
47. 47. Brizzio AA, Tedeschi FA, Zalazar FE. Description of a staphylococcal alimentary poisoning outbreak in Las Rosas, Santa Fe Province, Argentina. Rev Argent Microbiol, 2011; 43(1): 28-32.
48. 48. Wattinger L, Stephan RF, Layer F, Johler S. Comparison of Staphylococcus aureus isolates associated with food intoxication with isolates from human nasal carriers and human infections, Eur J Clin Microbiol Infect Dis, 2012; 31: 455–64.
49. 49. Wei HL, Chiou CS. Molecular subtyping of Staphylococcus aureus from an outbreak associated with a food handler. Epidemiol Infect, 2002; 128: 15-20.
50. 50. Gallina S, Bianchi DM, Bellio A, Nogarol C, Macori G, Zaccaria T, et al. Staphylococcal poisoning foodborne outbreak: Epidemiological investigation and strain genotyping. J Food Prot, 2013; 76(12): 2093–8.
51. 51. Colombari V, Mayer MD, Laicini ZM, Mamizuka E, Franco BD, Destro MT, et al. Foodborne outbreak caused by Staphylococcus aureus: phenotypic and genotypic characterization of strains of food and human sources. J Food Prot, 2007; 70(2): 489-93.
52. 52. Borges LJ, Campos MR, Cardoso JL, André MC, Serafini ÁB. Molecular epidemiology of microorganisms isolated from food workers and enteral feeding of public hospitals, J Food Sci, 2010; 75(7): 449-54.
53. 53. Argudín MA, Mendoza MC, González-Hevia MA, Bances M, Guerra B, Rodicio MR. Genotypes, exotoxin gene content, and antimicrobial resistance of Staphylococcus aureus strains recovered from foods and food handlers. Appl Environ Microbiol, 2012; 78(8): 2930-5.
54. 54. Demirel Zorba NN, Kaptan M. Consumer food safety perceptions and practices in a Turkish community. J Food Prot, 2011; 74(11): 1922–9.
55. 55. Campos AKC, Cardonha AMS, Pinheiro LBG, Ferreira NR, Azevedo PRM, Stamford TLM. Assessment of personal hygiene and practices of food handlers in municipal public schools of Natal, Brazil. Food Control, 2009; 20: 807–10.
56. 56. Baş M, Ersun AŞ, Kıvanç G. The evaluation of food hygiene knowledge, attitudes and practices of food handlers in food businesses in Turkey. Food Control, 2006; 17: 317–22.
57. 57. Lynch RA, Phillips ML, Elledge BL, Hanumanthaiah S, Boatright DT. A preliminary evaluation of the effect of glove use by food handlers in fast food restaurants. J Food Prot, 2005; 68(1): 187-90.
58. 58. Erdoğan H, Arslan H. Otel personelinin burun ve boğaz kültüründe Staphylococcus aureus taşıyıcılığının araştırılması ve risk faktörlerinin irdelenmesi. Klimik Derg, 2011; 24(2): 90-3.
59. 59. Anonymous. 17.12.2011 tarih ve 28145 sayılı Resmi Gazete’de yayımlanan Gıda Hijyeni Yönetmeliği. Ankara: T.C. Gıda, Tarım ve hayvancılkık Bakanlığı. http://Mevzuat.Basbakanlik.Gov.Tr/Metin. Aspx?Mevzuatkod=7.5.15592&Mevzuatıliski= 0&Sourcexmlsearch=G%C4%B1d. (Erişim tarihi: 1.12.2014).
60. 60. Anonymous. Gıda teknolojisi. Personel hijyeni 86ISG005. Ankara: T.C. Milli Eğitim Bakanlığı. 2011; 1-74. http://www.megep.meb.gov.tr/ mte_program_modul/moduller_pdf/Personel%20 Hijyeni.pdf Erişim tarihi: 1.12.2014).