Küresel bir tehdit: Acinetobacter baumannii enfeksiyonları, antimikrobiyal dirençte güncel durum ve alternatif tedavi yaklaşımları

Year 2020, Volume: 77 Issue: 3, 367 - 378, 01.09.2020

Aybala Temel Bayri Eraç

Abstract

Acinetobacter baumannii ventilatör ilişkili pnömoni ve kateter ilişkili bakteriyemi başta olmak üzere, idrar yolu enfeksiyonları, yumuşak doku enfeksiyonları, septisemi ve menenjit gibi ciddi enfeksiyonlara neden olan önemli nozokomiyal patojenlerden birisidir. Polisakkarit kapsül, fimbria, Lipit A ve lipopolisakkarit yapı gibi çeşitli virülans faktörlerinin yanı sıra siderofor, sekresyon sistemleri, biyofilm oluşturma özelliği ve antibiyotik direnç genleri bakterinin patogenezine katkı sağlamaktadır. Karbapenemler, aminoglikozitler, sulbaktam, kolistin ve tigesiklin ciddi klinik tablolara neden olan Acinetobacter enfeksiyonlarının tedavisinde sıklıkla kullanılan antimikrobiyal ajanlardır. Karbapenemlere direnç, genellikle çoklu ilaç direnci ÇİD ile birlikte görülmektedir. Dirençli izolatların tedavisinde kullanılan tigesiklin ve kolistine dahi çeşitli merkezlerde artan direnç oranları rapor edilmekte, bu durum A. baumannii enfeksiyonlarının tedavisini ve eradikasyonunu oldukça zorlaştırmaktadır. A. baumannii’de antimikrobiyal direnç durumunun ulaştığı endişe verici boyut, 2018 yılında Dünya Sağlık Örgütü tarafından yayınlanan ‘yeni antibiyotik keşfi gerektiren dirençli bakteriler’ listesinin ilk sırasında bu bakteri türünün yer almasıyla açıkça ortaya konmuştur. Antimikrobiyal dirençle mücadele ve etkin tedavi açısından bakterinin virülans faktörlerinin ve direnç mekanizmalarının daha iyi anlaşılması oldukça önemlidir. Çoklu ilaç dirençli bakterilerle mücadele global bir sağlık problemi haline gelmiş olup A. baumannii’nin de içinde bulunduğu bu tür dirençli mikroorganizmalar ile mücadelede enfeksiyon kontrol önlemleri, akılcı antibiyotik kullanımı ve antivirülans stratejilerinin bütüncül bir yaklaşımla bir arada kullanılması gerekmektedir. Bu bağlamda, kombine antibiyotik kullanımı, eflüks pompa inhibitörleri, antibiyofilm ajanların kullanımı ve faj terapisi gibi alternatif tedavi potansiyeli olduğu düşünülen alanlarda yürütülen araştırmalar büyük önem taşımaktadır. Bu derlemede; A. baumannii’nin patogenezinde rol oynayan faktörler, epidemiyolojik özellikleri ve antibiyotik direnç mekanizmaları hakkında güncel bilgilere yer verilmiş ve bu patojenle mücadelede öne çıkan alternatif tedavi yaklaşımları incelenmiştir

Keywords

Acinetobacter baumannii, antibiyotik direnci, virülans faktörleri

A global threat: Acinetobacter baumannii infections, current condition in antimicrobial resistance and alternative treatment approaches

Abstract

Acinetobacter baumannii is an important nosocomial pathogens that cause serious infections such as ventilator-associated pneumonia, catheterrelated bacteriemia, urinary tract infections, soft tissue infections, septicemia and meningitis. Various virulence factors such as polysaccharide capsule, fimbria, lipid A and lipopolysaccharide structure, siderophore, secretion systems, biofilm formation and antibiotic resistance genes contribute to the pathogenesis of the bacteria. Carbapenems, aminoglycosides, sulbactam, colistin and tigecycline are frequently used antimicrobial agents in Acinetobacter infections. Resistance to carbapenems is usually seen as multidrug resistance MDR . As reported from various centers, the development of resistance to tigecycline and colistin, used in the treatment of MDR isolates, makes treatment of A. baumannii infections more difficult. In 2018, the World Health Organization published ‘global priority list of antibiotic-resistant bacteria requiring new antibiotic discovery’ and A. baumannii has been at the top of this list. The alarming dimension of the antimicrobial resistance in A. baumannii was clearly demonstrated by this report. Understanding of the virulence and resistance mechanisms of the bacterium is essential for effective treatment and fighting antibiotic resistance. In combating MDR bacteria that have become a global health problem such as A. baumannii, infection control preventions, rational antibiotic use and anti-virulence strategies need to be used in a holistic approach. The studies carried on alternative therapies such as combined antibiotic use, efflux pump inhibitors, anti-biofilm agents and phage therapy are of great importance. In this review; the current knowledge about the factors involved in pathogenesis of A. baumannii, its epidemiological characteristics, antibiotic resistance mechanisms and alternative treatment approaches for combating had been evaluated.

Keywords

Acinetobacter baumannii, antibiotic resistance, virulence factors

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