Karbapenemlere dirençli Acinetobacter baumannii izolatlarında moleküler tiplendirme ve karbapenemazların araştırılması

Öz

Amaç: Bu çalışmada karbapenem dirençli A. baumannii’lerde karbapenemazların varlığı ve bunların kromozomal veya plazmid kaynaklı olduğunun araştırılması amaçlanmıştır. Yöntemler: Çalışılan 65 A. baumannii’nin %66’sı yoğun bakım ünitesi YBÜ ’ndeki hastalardan, en çok kandan %37 ve alt solunum yolu örneklerinden %32 izole edilmiştir. Antibiyotik duyarlılıklarını değerlendirmede VITEK 2 otomatize sistemi ve disk difüzyon testi kullanılmıştır. Ayrıca, karbapenemler için MİK değerleri, MİK değerlendirici stripler kullanılarak belirlenmiştir. İzolatlar arasındaki klonal ilişki M13 ve DAF4 primerleri kullanılarak AP-PZR ile değerlendirilmiştir. Karbapenemaz genleri multipleksPZR ile taranmış ve plazmit kaynaklı karbapenemaz araştırılmıştır.Bulgular: İzolatlar tobramisin, netilmisin ve kolistine sırasıyla %98.5, %98.5 ve %96.9 oranında duyarlı bulunmuştur. Diğer antibiyotiklere direnç oranları oldukça yüksek olup %78.5-100.0 arasında saptanmıştır. Tikarsilin, piperasilin, piperasilin+tazobaktam, seftazidim, seftriakson, sefepim, imipenem, meropenem ve siprofloksasin için %100.0; tikarsilin+klavulanik asit, gentamisin, ciprofloxacin, 98.5% to ticarcillin+clavulanic acid, gentamicin, levofloxacin, tetracycline, doxycycline, and trimethoprim-sulfamethoxazole, 93.8% to minocycline, 92.3% to amikacin, and 78.5% to ampicillin+sulbactam. In the study, two different patterns were observed by AP-PCR. Chromosomal OXA-23 and OXA-51 carbapenemase enzyme genes positively were found in all isolates. Plasmids were isolated neither of isolates.Conclusion: Isolates were detected more frequently from hemocultures in ICU. Isolates showed clonal similarity in AP-PCR where M13 and DAF4 primers were used. The presence of the single Acinetobacter clone in our hospital suggests that they all originated from the same source. For this reason, it is concluded that universal infection control measures should be taken in consideration to prevent cross-infection by carbapenem resistant isolates

Anahtar Kelimeler

• Acinetobacter baumannii, oksasilinaz, metallo-beta-laktamaz, PZR

Molecular typing and investigation of carbapenemases in carbapenem resistant Acinetobacter baumannii isolates

Abstract

Objective: In this study, it was aimed to investigate the presence of carbapenemases in carbapenem-resistant A. baumannii strains and their chromosomal or plasmid origin.Methods: Of the total 65 A. baumannii studied, 66% were isolated from patients in intensive care unit ICU ; most of strains were blood 37% and lower respiratory tract samples 32% . VITEK2 automated system and disk diffusion tests were used to evaluate antibiotic susceptibilities. In addition, MIC values for carbapenems were determined using M.I.C. evaluator strips. Clonal relationship between the isolates was assessed by AP-PCR, using M13 and DAF4 primers. Carbapenemase genes were screened by multiplexPCR, and presence of plasmid-borne carbapenemase was investigated.Results: The The isolates were found to be susceptible to tobramycin, netilmicin, and colistin by 98.5%, 98.5% and 96.9%, respectively. The rates of resistance to other antibiotics were quite high, and resistance was found between 78.5% - 100%. The resistance rates were detected as 100% to ticarcillin, piperacillin, piperacillin+tazobactam, ceftazidime, ceftriaxone, sefepime, imipenem, meropenem, and ciprofloxacin, 98.5% to ticarcillin+clavulanic acid, gentamicin, levofloxacin, tetracycline, doxycycline, and trimethoprim-sulfamethoxazole, 93.8% to minocycline, 92.3% to amikacin, and 78.5% to ampicillin+sulbactam. In the study, two different patterns were observed by AP-PCR. Chromosomal OXA-23 and OXA-51 carbapenemase enzyme genes positively were found in all isolates. Plasmids were isolated neither of isolates.Conclusion: Isolates were detected more frequently from hemocultures in ICU. Isolates showed clonal similarity in AP-PCR where M13 and DAF4 primers were used. The presence of the single Acinetobacter clone in our hospital suggests that they all originated from the same source. For this reason, it is concluded that universal infection control measures should be taken in consideration to prevent cross-infection by carbapenem resistant isolates

Keywords

• Acinetobacter baumannii, oxacillinase, metallo-beta-lactamase, PCR

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