Son 11 Yılda Haemophilus influenzae Direncindeki Eğilimler: Bir Üçüncü Basamak Hastanenin Deneyimi

Abstract

Bu çalışmada on bir yıllık zaman diliminde üçüncü basamak bir hastane olan merkezimize başvuran hastaların klinik örneklerinde üreyen Haemophilus influenzae (H. influenzae) türlerinin değerlendirilmesi ve antimikrobiyal direnç paternlerinin incelenmesi amaçlanmıştır. 1 Ocak 2014-31 Aralık 2024 tarihleri arasında üreyen H. influenzae türleri retrospektif olarak değerlendirildi. H. influenzae türleri MALDİ-TOF MS (Bruker Daltonik GmbH, Bremen, Almanya) ile tanımlanmış olup Difco H. influenzae Type b antiserumu (Difco-BD®-USA) ile serotipleme yapıldı. H. influenzae izole edilen sadece 21 (%1,4) örnek (10 kan, 5 biyopsi, 3 BOS, 2 vitreus, 1 plevra) invaziv bölgeden olup non-invaziv örnekler içinde en yaygın örnek balgamdı (1179 suş, %81). H. influenzae izolatlarında ampisilin direnci %38,5 idi. Amoxicillin–Clavulanate (AMC) direnci %13,5, sefuroksim direnci %66,6, seftriakson direnci %45,7, kloramfenikol direnci %12,2, klaritromisin direnci %12,7, eritromisin direnci %14,3, levofloksasin direnci %11,5, meropenem direnci %21,2, rifampicin direnci %20,2, tetrasiklin direnci %21 ve Trimethoprim–Sulfamethoxazole (TMP-SMX) direnci %34,3 olarak tespit edildi. Non-Type B suşlarda ampisilin ve TMP-SMX direnci istatistiksel olarak daha yaygın saptandı. Non-invaziv örneklerde TMP-SMX direnci istatistiksel olarak daha yaygın saptandı. Yoğun bakım ünitesi (YBÜ)’nde yatan hastalardaki suşlar ampisilin ve seftriaksona istatistiksel olarak daha dirençli bulundu. Sonuç olarak, H. influenzae'nin antibiyotik direnç oranları ülkeye ve hatta ülke içindeki bölgelere göre zaman içinde değişiklik göstermektedir. Ayrıca antibiyotiklerin direnç durumunda yıllık dalgalanmalar göz önüne alındığında, sürekli güncel yerel ilaç direnci durumunun bilinmesi gereklidir. Bu çalışmada H. influenzae’nın etken olduğu enfeksiyonların tedavisinde ampisilin, seftriakson, sefuroksim ve TMP-SMX direnç oranlarının yüksekliği nedeni ile tedavi seçeneklerinin yeniden düzenlenmesi gerekliliğini ortaya kondu.

Keywords

• Haemophilus influenzae
• ampisilin
• antibiyotik direnci

Trends in Haemophilus influenzae Resistance Over the Past 11 Years: A Tertiary Hospital Experience

Abstract

This study aimed to evaluate retrospectively the species Haemophilus influenzae (H. influenzae) that was isolated from clinical specimens of patients admitted to our tertiary care hospital January 1, 2014, and December 31, 2024 and to investigate their antimicrobial resistance patterns. H. influenzae was identified using MALDI-TOF MS (Bruker Daltonik GmbH, Bremen, Germany) and serotyped using Difco H. influenzae Type b antiserum (Difco-BD®-USA). Only 21 (1.4%) samples (10 blood, 5 biopsy, 3 CSF, 2 vitreous, 1 pleural) isolated with H. influenzae were from invasive sites, and sputum was the most common sample among non-invasive samples (1179 strains,81%). Ampicillin resistance in H. influenzae isolates was 38.5%. Amoxicillin–Clavulanate (AMC) resistance was 13.5%, cefuroxime resistance was 66.6%, ceftriaxone resistance was 45.7%, chloramphenicol resistance was 12.2%, clarithromycin resistance was 12.7%, erythromycin resistance was 14.3%, levofloxacin resistance was 11.5%, meropenem resistance was 21.2%, rifampicin resistance was 20.2%, tetracycline resistance was 21%, and Trimethoprim–Sulfamethoxazole (TMP-SMX) resistance was 34.3%. Ampicillin and TMP-SMX resistance were statistically more prevalent in non-Type B strains. TMP-SMX resistance was statistically more prevalent in non-invasive samples. Strains from patients in the intensive care unit (ICU) were statistically more resistant to ampicillin and ceftriaxone. As a result, rates of antibiotic resistance for H. influenzae vary over time, depending on the country, and even within regions of the same country. Considering the annual fluctuations in antibiotic resistance, it is important to be aware of the current local drug resistance situation. This study revealed the need to reevaluate treatment options due to high resistance rates of ampicillin, ceftriaxone, cefuroxime, and TMP-SMX for treating infections caused by H. influenzae.

Keywords

• Haemophilus influenzae
• ampicilin
• antimicrobial resistance

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