Çeşitli Klinik Örneklerden 2006-2011 Yılları Arasında İzole Edilen Acinetobacter Türleri ve Antibiyotik Duyarlılıkları

Year 2016, Volume: 73 Issue: 1, 25 - 32, 01.03.2016

Cafer Eroğlu Nevzat Ünal Adil Karadağ Hava Yılmaz İbrahim Çağatay Acuner Murat Günaydın

Abstract

Amaç: Son altı yılda, hastanemizde izole edilen Acinetobacter türlerinin dağılımı ve antibiyotik duyarlılıklarının incelenmesi amaçlanmıştır.Yöntem: Çalışmaya; Ondokuz Mayıs Üniversitesi Tıp Fakültesi Hastanesi Merkez Laboratuvarı Bakteriyoloji Subdisiplin Laboratuvarına, Ocak 2006 - Haziran 2011 tarihleri arasında çeşitli kliniklerden gönderilen örneklerden izole edilen Acinetobacter türleri dahil edilmiştir. İzolatların tanımlanmasında ve antibiyotik duyarlılıklarının yöntemler ve Vitek 2 Compact bioMérieux-SA, Fransa otomatize sistemi kullanılmıştır.belirlenmesinde konvansiyonel Bulgular: Çalışma döneminde toplam 3.212 Acinetobacter türü izole edilmiştir. Acinetobacter izolatlarının tür dağılımı ve oranları; Acinetobacter baumannii - Acinetobacter calcoaceticus complex 3006 %93,6 , Acinetobacter lwoffii 83 %2,6 , Acinetobacter junii 27 %0,8 , Acinetobacter haemolyticus 19 %0,6 ve Acinetobacter spp. 77 %2,4 olarak bulunmuştur. En fazla Acinetobacter izolatı 747 %23,2 trakeal aspirat örneğinden ve en çok yoğun bakım ünitesinden gönderilen 705 %21,9 örnekten izole edilmiştir. Son altı yılda seftazidim direnci %70,2’den %82,7’e, sefepim %26,4’dan %79,7’e, imipenem %27,2’den %77,2’ye, meropenem %4,5’ten %77’ye, siprofloksasin %40,4’dan %78,9’a yükselmiştir. 2011 yılı ilk altı aylık dönemde tigesikline %5,9, kolistine %0,2 oranlarında direnç saptanmıştır. Ampisilin-sulbaktam direnç oranlarında belirgin değişim gözlenmemiştir.Conclusion: As of the first half of 2011, when all the findings were evaluated, high-rate of resistance to cefepime, piperacillin-tazobactam, ceftazidime, ceftriaxone, meropenem, imipenem, ciprofloxacin and levofloxacin were determined and it was observed that this level had a tendency to increase. Colistin resistance in Acinetobacter species was observed as minimal. The reduction seen during the years in the resistance rate of gentamycin, an antibiotic from the aminoglycoside group, was attributed to its less frequent use in recent years. As shown in our study, generally antibiotic resistance is gradually increasing in Acinetobacter species. In the future, new antibiotics will be required for the treatment of infections caused by Acinetobacter species. In conclusion, we are in the opinion that rate of appearance of pan-resistant strains which may pose serious problems in the near future should be decelerated by promoting the rational use of antibiotics

Keywords

Acinetobacter, antibiyotik direnci, karbapenemler

Acinetobacter species isolated from various clinical specimens between 2006-2011 years and their susceptibilities against antibiotics

Abstract

Objective: The aim of this study was to investigate the distribution and antibiotic susceptibility of Acinetobacter species isolated in our hospital in the last six years.Method: Acinetobacter species isolated from various clinical samples sent to Ondokuz Mayıs University, Medical Faculty Hospital Central Laboratory, Bacteriology Sub - Discipline Laboratory between January 2006 and June 2011 were included. Conventional methods and Vitek 2 Compact bioMérieux-SE, France automated systems were used for the identification and antibiotic susceptibility of the isolates.Results: During the study period, a total of 3.212 Acinetobacter species were isolated. Species distribution of Acinetobacter isolates and their ratios were found as follows: Acinetobacter baumannii - Acinetobacter calcoaceticus complex n=3006; 93.6% , Acinetobacter lwoffii n=83; 2.6% , Acinetobacter junii n=27; 0.8% , Acinetobacter haemolyticus n=19; 0.6% and Acinetobacter spp. n=77; 2.4% . Acinetobacter isolates were isolated at the most from tracheal aspirate samples n=747; 23.2% and samples sent from intensive care units n=705; 21.9% . Ceftazidime resistance increased from 70.2% to 82.7%; cefepime from 26.4% to 79.7%; imipenem from 27.2% to 77.2%; meropenem from 4.5% to 77% and ciprofloxacin from 40.4% to 78.9% in the last six years. In the first six months of 2011, the resistance ratios to tigecycline and colistin were determined as 5.9% and 0.2% respectively. No significant changes were observed in ampicillin-sulbactam resistance ratios.Conclusion: As of the first half of 2011, when all the findings were evaluated, high-rate of resistance to cefepime, piperacillin-tazobactam, ceftazidime, ceftriaxone, meropenem, imipenem, ciprofloxacin and levofloxacin were determined and it was observed that this level had a tendency to increase. Colistin resistance in Acinetobacter species was observed as minimal. The reduction seen during the years in the resistance rate of gentamycin, an antibiotic from the aminoglycoside group, was attributed to its less frequent use in recent years. As shown in our study, generally antibiotic resistance is gradually increasing in Acinetobacter species. In the future, new antibiotics will be required for the treatment of infections caused by Acinetobacter species. In conclusion, we are in the opinion that rate of appearance of pan-resistant strains which may pose serious problems in the near future should be decelerated by promoting the rational use of antibiotics

Keywords

Acinetobacter, antibiotic resistance, carbapenems

References

• 1. Fishbain J, Anton YP. Treatment of Acinetobacter infections. Clin infect Dis, 2010; 51(1): 79-84. doi: 10.1086/653120
• 2. Allen DM, Hartman BJ. Acinetobacter species. In: Mandel GL, Bennet JE, Dolin R, (eds). Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7 th pres. Philadelphia: Churchill Livingstone, 2009; Pp 222: p. 2881-5.
• 3. Naas T, Nordmann P. Acinetobacter and β-Lactams, In: Antibiogram. Courvalin P, Leclercq R, Rice LB, (eds). Portland: Eska Publishing, ASM Press, 2010;. Pp.32 p.407-20.
• 4. Giamarellou H, Antoniadou A, Kanellakopoulou K. Acinetobacter baumannii: a universal threat to public health? Int J Antimicrob Agents, 2008; 32: 106–19. doi:10.1016/j.ijantimicag.2008.02.013
• 5. Clinical Laboratory Standards Institute (Çeviri ed. D. Gür). Antimikrobik duyarlılık testleri için uygulama standartları; 19. Bilgi Eki, M100-S19, Bilimsel Tıp Yayınevi, Ankara, 2009.
• 6. Lee K, Yong D, Jeong SH, Chong Y. Multidrugresistant Acinetobacter spp.: increasingly problematic nosocomial pathogens. Yonsei Med J, 2011; 52(6): 879-91. http://dx.doi.org/10.3349/ ymj.2011.52.6.879
• 7. Karageorgopoulos DE, Falagas ME. Current control and treatment of multidrug-resistant Acinetobacter baumannii infections. Lancet Infect Dis, 2008; 8(12):751-62. doi:10.1016/S1473-3099(08)70279-2
• 8. Gordon NC, Wareham DW. Multidrug-resistant Acinetobacter baumannii: mechanisms of virulence and resistance. Int J Antimicrob Agents, 2010; 35(3): 219-26. doi:10.1016/j.ijantimicag. 2009.10.024
• 9. Balcı M, Bitirgen M, Kandemir B, Arıbaş ET, Erayman İ. Nozokomiyal Acinetobacter baumannii suşlarının antibiyotik duyarlılığı. ANKEM Derg, 2010; 24(1):28-33.
• 10. Kurtoğlu MG, Opuş A, Kaya M, Keşli R, Güzelant A, Yüksekkaya Ş. Bir eğitim ve araştırma hastanesinde klinik örneklerden izole edilen Acinetobacter baumannii suşlarında antibakteriyel direnç (2008-2010). ANKEM Derg, 2011; 25(1):35-41. doi:10.5222/ankem.2011.35
• 11. Özdem B, Gürelik FÇ, Çelikbilek N, Balıkçı H, Açıkgöz ZC. Çeşitli klinik örneklerden 2007-2010 yıllarında izole edilen Acinetobacter türlerinin antibiyotik direnç profili, Mikrobiyol Bul, 2011; 45(3): 526-34.
• 12. Yavuz MT, Şahin İ, Behcet M, Öztürk E, Kaya D. Çeşitli klinik örneklerden izole edilen Acinetobacter baumannii suşlarının antibiyotik duyarlılıkları. ANKEM Derg, 2006; 20(2): 107-10.
• 13. Balkhy HH, Bawazeer MS, Kattan RF, Tamim HM, Al Johani SM, Aldughashem FA, et al. Epidemiology of Acinetobacter spp.-associated healthcare infections and colonization among children at a tertiary-care hospital in Saudi Arabia: a 6-year retrospective cohort study. Eur J Clin Microbiol Infect Dis, 2012; 31(10): 2645-51. doi 10.1007/ s10096-012-1608-8
• 14. Xia W, Chen Y, Mei Y, Wang T, Liu G, Gu B, et al. Changing trend of antimicrobial resistance among pathogens isolated from lower respiratory tract at a university-affiliated hospital of China 2006-2010. J Thorac Dis, 2012; 4(3): 284-91. doi: 10.3978/j. issn.2072-1439.2012.02.04
• 15. Aral M, Doğan S, Paköz NİE. Çeşitli klinik örneklerden izole edilen Acinetobacter baumannii suşlarının antibiyotiklere direnç oranlarının araştırılması. ANKEM Derg, 2010; 24(4): 215-19.
• 16. Gür D, Gülay Z, Arıkan Akan Ö, Aktaş Z, Kayacan Bal Ç, Çakıcı Ö. Türkiye’de hastane izolatı Gram-negatif bakterilerde yeni beta-laktam antibiyotiklere direnç ve GSBL tipleri: çok merkezli HİTİT sürveyansının sonuçları. Mikrobiyol Bul, 2008; 42(4): 537-44.
• 17. Çıkman A, Parlak M, Gültepe B, Güdücüoğlu H, Berktaş M. Hastane kökenli Acinetobacter baumannii izolatlarında tigesiklin duyarlılığının E-test yöntemiyle araştırılması. ANKEM Derg, 2011; 25(2): 79-83. doi:10.5222/ankem.2011.079
• 18. Kirişci Ö, Özkaya E, Çalışkan A, Özden S, Koçtürk SA. Klinik örneklerden izole edilen Acinetobacter türlerinde direnç profilinin incelenmesi. ANKEM Derg, 2013; 27(3): 140-6.
• 19. Kuşçu F, Öztürk DB, Tütüncü EE, Uslu M, Gürbüz Y, Gülen G ve ark. Çoğul antibiyotik dirençli Acinetobacter baumannii izolatlarında tigesiklin duyarlılık oranlarının E-test yöntemiyle araştırılması. Klimik Derg, 2009; 22(2): 48-51.
• 20. Novan-Venezia S, Leavitt A, Carmeli Y. High tigecycline resistance in multidrug-resistant Acinetobacter baumannii. J Antimicrob Chemother, 2007; 59(4): 772-4.
• 21. Bogiel T, Kwiecinska-Pirog J, Jachna-Sawicka K, Gospodarek E. Carbapenem-resistant Acinetobacter baumannii strains. Med Dosw Mikrobiol, 2010; 62(2): 119-26.
• 22. Uzun B, Güngör S, Sezak N, Afşar İ, Şerifhanİlgün M, Demirci M. Yoğun bakım hastalarının kan kültürlerinden izole edilen Pseudomonas aeruginosa ve Acinetobacter baumannii izolatlarının antibiyotik direnç yüzdelerindeki değişim. Türk Hij ve Den Biyol Derg, 2014; 71(1): 1-8.