Yoğun bakım hastalarının kan kültürlerinden izole edilen Pseudomonas aeruginosa ve Acinetobacter baumannii izolatlarının antibiyotik direnç yüzdelerindeki değişim

Year 2014, Volume: 71 Issue: 1, 1 - 8, 01.03.2014

Berrin Uzun Serdar Güngör Nurbanu Sezak İlhan Afşar Müjde Şerifhan İlgün Mustafa Demirci

Abstract

Amaç: Pseudomonas aeruginosa ve Acinetobacter baumannii enfeksiyonları özellikle yoğun bakım ünitesinde YBÜ yatan hastalar için en önemli sorunlardan birisidir. Bu çalışmanın amacı, YBÜ hastalarında kan dolaşımı enfeksiyonlarına sebep olan P. aeruginosa ve A. baumanni etkenlerinin antimikrobiyal direnç paternlerini belirlemek ve ampirik tedavi protokollerinin uygunluğunu değerlendirmektir. Yöntemler: Ocak-Aralık 2010 ve Ocak-Aralık 2011 tarihlerinde YBÜ’de yatan hastalara ait hemokültür örneklerinde üreyen suşların direnç oranları ayrı ayrı incelenerek karşılaştırıldı. Bu iki zaman aralığı arasında direnç oranlarındaki farklılıklar karşılaştırılarak istatistiksel olarak analiz edildi. Bulgular: P. aeruginosa suşlarının piperasilintazobaktam, sefaperazon - sulbaktam, seftazidim, siprofloksasin, gentamisin, amikasin ve netilmisine direnç oranlarında 2011 yılında 2010 yılına oranla azalma olduğu saptandı p değerleri sırasıyla, 0,0059, 0,0000, 0,0048, 0,0350, 0,0000, 0,0000, 0,0003 . Buna karşılık, aztreonam direnç oranında artış saptandı p değeri, 0,0155 . İmipenem direncinin benzer oranlarda olduğu görüldü. A. baumannii suşlarının sefepim ve amikasin direnç oranlarında ikinci periyotta ilkine oranla istatistiksel olarak anlamlı azalma saptandı p değerleri, 0,0003 ve 0,0000 . Ampisilin-sulbaktam, piperasilintazobaktam ve imipeneme karşı direnç oranlarında artış saptandı p değerleri sırasıyla, 0,0003, 0,0210, 0,0033 . Her iki bakteri türünde de kolistine direnç saptanmadı. A. baumannii izolatlarında tigesiklin direnci saptanmadı. Sonuç: Her hastanenin özellikle yoğun bakım birimlerinden izole edilen suşların antibiyotik direnç paternlerinin aktif sürveyansla takibi, ampirik tedavi yaklaşımlarını belirlemeye hizmet eder. Bu çalışmada antibiyotik kullanım politikasının hastane enfeksiyonları ile mücadelede önemli bir adım olduğu vurgulanmıştır. Sonuç olarak, direnç oranlarını azaltmak için, enfeksiyon kontrol önlemleri alınmalı, ampirik tedavi rejimleri sürekli gözden geçirilmeli ve aktif surveyans verilerine göre belirlenmelidir.

Keywords

Acinetobacter baumannii, Pseudomonas aeruginosa, antibiyotik direnci, kan kültürü, yoğun bakım ünitesi

Changes in resistance percentage to antibiotics in Pseudomonas aeruginosa and Acinetobacter baumannii strains isolated from blood cultures of intensive care unit patients

Abstract

Objective: Infections of Pseudomonas aeruginosa and Acinetobacter baumannii are one of the greatest concerns for hospitalized patients, particularly those in intensive care units ICUs . The aim of this study was to determine the antimicrobial resistance percentages and to assess empirical treatment options for bloodstream infections due to P. aeruginosa and A. baumannii strains in ICU patients. Methods: Resistance percentages of strains isolated in January- December 2010 and January- December 2011 were separately analyzed and compared. The differences in resistance percentages between two intervals was statistically analyzed. Results: A statistically significant decrease was found in the resistance percentage of piperacillin-tazobactam, cefoperazone-sulbactam, ceftazidime, ciprofloxacin, gentamicin, amikacin and netilmicin in the second period compared with the first p values were 0.0059, 0.0000, 0.0048, 0.00350, 0.0000, 0.0000, 0.0003, respectively for P. aeruginosa strains. Whereas resistance percentage of aztreonam was increased p value was 0.0155 . Resistance percentage of imipenem was found similarIn A.baumannii strains, a statistically significant decrease was found in resistance percentage of cefepime and amikacin in the second period compared with the first p values were 0.0003, 0.0000 . Resistance percentage of ampicillin-sulbactam, piperacillin-tazobactam and imipenem was increased p values were 0.0003, 0.0210, 0.0033 . There was no colistin resistance determined in both species. Tigecycline resistance was not found in A. baumannii isolates. Conclusion: Active surveillance of antibiotic resistance percentages of isolated strains especially in ICUs serves to determine empirical treatment regimens in every institution. The present study emphasized that antibiotic usage policy is an important step to combat hospital infections. Consequently, infection control measures should be taken, empirical treatment regimens should be constantly reviewed, and should be determined according to active surveillance data in order to decrease resistance percentages.

Keywords

Acinetobacter baumannii, Pseudomonas aeruginosa, Antibiotic resistance, Blood culture, Intensive care unit

References

• 1. Ding JG, Sun QF, Li KC, Zheng MH, Miao XH, Ni W et al. Retrospective analy¬sis of nosocomial infections in the intensive care unit of a tertiary hospital in China during 2003 and 2007. BMC Infect Dis, 2009; 9: 115.
• 2. Saghir S, Faiz M, Saleem M, Younus A, Aziz H. Characterization and anti - microbial susceptibility of gram-negative bacteria isolated from bloodstream infections of cancer patients on chemotherapy in Pakistan. Indian J Med Microbiol, 2009; 27: 341-7.
• 3. Vitkauskienė A, Skrodenienė E, Dambrauskienė A, Macas A, Sakalauskas R. Pseudomonas aeruginosa bacteremia: resistance to antibiotics, risk factors, and patient mortality. Medicina (Kaunas), 2010; 46(7): 490-5.
• 4. Karlowsky JA, Draghi DC, Jones ME, Thornsberry C, Friedland IR, Sham DF. Surveillance for antimicrobial susceptibility among clinical isolates of Pseudomonas aeruginosa and Acinetobacter baumannii from hospitalized patients in the United States, 1998 to 2001. Antimicrobial Agents and Chemotherapy, 2003; 47(5): 1681–8.
• 5. Gazi H, Tünger O, Vural S, Ozbakkaloglu B, Sürücüoglu S. In vitro activities of various antibiotic combinations on multiresistant Acinetobacter baumannii strains. J Turk Microbiol Soc, 2007; 37(1): 11-4.
• 6. Micek ST, Lloyd AE, Ritchie DJ, Reichley RM, Fraser VJ, Kollef MH. Pseudomonas aeruginosa Bloodstream Infection: Importance of Appropriate Initial Antimicrobial Treatment. Antimicrob Agents Chemother, 2005; 49 (4): 1306–11.
• 7. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing. 20th Informational Supplement, M100-S20, CLSI, Wayne, PA. 2010
• 8. Karageorgopoulos DE, Kelesidis T, Falagas ME. Tigecycline for the treatment of multidrugresistant (including carbapenem-resistant) Acinetobacter infections: a review of the scientific evidence. J Antimicrob Chemother, 2008; 62(5): 45-55.
• 9. Brusselaers N, Vogelaers D, Blo S. The rising problem of antimicrobial resistance in the intensive care unit. Ann Intensive Care, 2011; 1: 47.
• 10. Rose WE, Rybak M J. Tigecycline: First of a new class of antimicrobial agents. Pharmacotherapy 2006; 26: 1099-110.
• 11. Zer Y, Akın FEO, Namıduru M. The antibacterial activitiy of tigecycline on Acinetobacter baumannii strains. Turkish J Infect, 2007; 21(4): 193-6.
• 12. Pachon Ibanez ME, Jimenez Mejias ME, Pichardo C, Llanos AC, Pachon J. Activity of tigecyline (GAR936) against Acinetobacter baumannii strains, including those resistant to imipenem. Antimicrob Agent Chemother, 2004; 48(11): 4479-81.
• 13. Navon Venezia S, Leavitt A, Carmeli Y. High tigecycline resistance in multidrug-resistant Acinetobacter baumannii. J Antimicrob Chemother, 2007; 59(4): 772-4.
• 14. Azap OK, Arslan H, Ergin F, Inci EK, Yapar Y. In vitro activity of colistin against nonfermentative gram-negative bacilli. J Ankara Uni Fac Med, 2005; 58(2): 65-67.
• 15. Goossens H. Susceptibility of multidrug-resistant Pseudomonas aeruginosa in intensive care units: results from the European MYSTIC study group. Clin Microbiol Infect, 2003; 9(9): 980-3.
• 16. Gür D, Hascelik G, Aydin N, Telli M, Gültekin M, Ogülnç D et al. Antimicrobial resistance in gramnegative hospital isolates: Results of the Turkish HITIT-2 Surveillance Study of 2007. J Chemother, 2009; 21(4):383-9.
• 17. Turner PJ. MYSTIC Europe 2007: activity of meropenem and other broad-spectrum agents against nosocomial isolates. Diagn Microbiol Infect Dis, 2009; 63(2): 217-22.
• 18. Jones RN, Stilwell MG, Rhomberg PR, Sader HS. Antipseudomonal activity of piperacillin/ tazo¬bactam: more than a decade of experience from the SENTRY Antimicrobial Surveillance Program (1997-2007). Diagn Microbiol Infect Dis, 2009; 65(3): 331-4.
• 19. Turner PJ. Trends in antimicrobial susceptibilities among bacterial pathogens isolated from patients hospitalized in European medical centers: 6-year report of the MYSTIC Surveillance Study (1997- 2002). Diagn Microbiol Infect Dis, 2005; 51(4): 281-9.
• 20. Rhomberg PR, Jones RN. Summary trends for the Meropenem Yearly Susceptibility Test Information Collection Program: A 10-year experience in the United States (1999-2008). Diagn Microbiol Infect Dis, 2009; 65(4): 414-26.
• 21. Nakamura A, Hosoda M, Kato T, Yamada Y, Itoh M, Kanazawa K et al. Combined effects of meropenem and aminoglycosides on Pseudomonas aeruginosa in vitro. J Antimicrob Chemother, 2000; 46(6): 901-4.
• 22. Iseri L, Bayraktar MR. Changes in the percentages of antimicrobial resistance among clinical isolates of Pseudomonas aeruginosa between 2002 and 2004 in a tertiary-care teaching hospital in Turkey. New Microbiol, 2008; 31: 351-5.
• 23. Zhanel GG, De Corby M, Laing N, Weshnoweski W, Vashisht R, Tailor F et al. Antimicrobial resistant pathogens in intensive care units in Canada: Results of the Canadian National Intensive Care Unit (CAN-ICU) Study, 2005-2006. Antimicrob Agents Chemother, 2008; 52(4): 1430-7.
• 24. Eldere JV. Multicentre surveillance of Pseudomonas aeruginosa susceptibility patterns in nosoco¬mial infections. J Antimicrob Chemother, 2003; 51(2): 347-52.
• 25. Landman D, Bratu S, Kochar S, Panwar M, Trehan M, Doymaz M et al. Evolution of antimicrobial resistance among Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae in Brooklyn, NY. J Antimicrob Chemother, 2007; 60(1): 78-82.
• 26. Gales AC, Jones RN, Sader HS. Global assessment of antimicrobial activity of polymyxin B against 54731 clinical isolates of gram-negative bacilli: report from the SENTRY antimicrobial surveillance programme (2001-2004). Clin Microbiol Infect, 2006; 12(4): 315-21.
• 27. Ozdem B, Gürelik FÇ, Celikbilek N, Bıcakcı H, Acıkgöz ZC. Antibiotic resistance profiles of Acinetobacter species isolated from several clinical samples between 2007-2010. Mikrobiyol Bult, 2011; 45(3): 526-34.
• 28. Kuscu F, Oztürk D, Tütüncü EE, Uslu M, Gürbüz Y, Gülen G et al. Evaluation of tigecycline susceptibility by E-Test in multidrug-resistant Acinetobacter baumannii isolates. Klimik J, 2009; 22(2): 48-51.
• 29. Ozdemir M, Erayman İ, Gündem NS, Baykan M, Baysal B. Investigation of antibiotic susceptibility of Acinetobacter strains in nosocomial infections. ANKEM J, 2009; 23(3): 127-32.
• 30. Cavallo JD, Hocquet D, Plesiat P, Fabre R, RousselDelvallez M. Susceptibility of Pseudomonas aeruginosa to antimicrobials: a 2004 French multicentre hospital study. J Antimicrob Chemother, 2007; 59: 1021-4.