KİSTİK FİBROZİS VE KİSTİK FİBROZİS DIŞI HASTALARDAN İZOLE EDİLEN ACHROMOBACTER TÜRLERİ İLE İLGİLİ RETROSPEKTİF ANALİZ

Öz

Achromobacter türleri Gram negatif, katalaz, oksidaz ve sitrat pozitif, fermentatif olmayan bakterilerdir. Toplum kökenli ya da hastane kaynaklı enfeksiyonlara sebep olabilmektedir. Hem immünokompetan hem de immün yetmezlikli kişilerde enfeksiyonlara sebep olabilmekle birlikte kistik fibrozis (KF) hastalarını enfekte etmeleri durumunda, KF hastalarının akciğer fonksiyonlarını kötüleştirdiğinden ve daha sık pulmoner alevlenmeye neden olduğundan bu hasta grubunda özellikle önem taşımaktadır. Bu retrospektif çalışmada, Marmara Üniversitesi Eğitim ve Araştırma Hastanesi’nde 2017-2021 yıllarında Achromobacter türleri izole edilen hastaların verileri analiz edilmiştir. Altta yatan hastalıkların varlığına göre Achromobacter türlerinin izolasyon sıklığı, hastalara ait demografik veriler ve antimikrobiyal duyarlılık sonuçları irdelenmiştir. İzolatların tür düzeyinde tanımlaması, matriks ile desteklenmiş lazer desorpsiyon/iyonizasyon uçuş zamanı kütle spektrometresi (MALDI-TOF MS, VITEK MS, BioMérieux, Fransa) ile yapılmıştır. Antimikrobiyal duyarlılık testleri, disk difüzyon metodu ile çalışılmıştır. İstatistiksel analizler için SPSS (Statistical Package for Social Sciences) for Windows 24.0 programı kullanılmıştır. Toplam 148 hastadan 318 Achromobacter izolatı elde edilmiştir. Hastaların %29.7’si kistik fibrozis (KF); %70.3’ü ise KF dışı hastalar olmasına rağmen izolatların %51.6’sı KF hastalarına aittir (P=0.63). En sık gönderilen örnek türü, solunum yollarına ait örnekler olup (%78), KF hastalarında gönderilen örneklerin tümü solunum örneği iken; KF dışı hastalarda bu oran %54.5’tir (P<0.05). Solunum yolu örneklerini %10 oranında idrar, %5.7 kan ve %6.3 diğer örnekler takip etmiştir. Hastaların 47’sinde (%31’inde) tekrarlayan Achromobacter üremesi saptanmıştır. Hasta başına tekrarlayan örnek sayısı 4.6 (2-28) olup KF hasta grubunda 22 hastada (%50), KF dışı hasta grubunda 25 hastada (%32.5) tekrarlayan izolasyon olmuştur. Tüm izolatlarda, KF izolatlarında ve diğer izolatlarda direnç oranları sırasıyla piperasilin/tazobaktam için %25.6, %30.4 ve %21.9; meropenem için %40.0, %61.1 ve %18.0 (P<0.05);trimetoprim/sülfametaksazol için %44.7, %68.2 ve %12.5 (p<0.05) olarak belirlenmiştir. Achromobacter hakkındaki çalışmalar oldukça kısıtlı olmakla birlikte, son yıllarda görülme sıklığı artmaktadır; bu bakteri hakkında daha fazla bilgiye ve araştırmaya ihtiyaç vardır. Çalışmamız verileri, literatüre katkıda bulunarak Achromobacter türlerinde artan antimikrobiyal direncin önemine dikkat çekmektedir.

Anahtar Kelimeler

• Achromobacter
• direnç
• kistik fibrozis
• kistik fibrozis dışı
• cystic fibrosis
• non-cystic fibrosis
• resistance

Retrospective analysis of Achromobacter species isolated from cystic fibrosis and non-cystic fibrosis patients

Öz

Achromobacter species are Gram negative, catalase, oxidase and citrate positive, non-fermentative bacteria. It can cause community-acquired or hospital-acquired infections. Although it can cause infections in both immunocompetent and immunocompromised individuals, in cystic fibrosis (CF) patienst it has particular importance since it may be related with worsen lung functions and frequent pulmonary exacerbations. In this retrospective study, the data of patients who Achromobacter species were isolated in Marmara University Training and Research Hospital between 2017-2021 were analyzed. The isolation rate of Achromobacter species according to the presence of underlying diseases, demographic data of the patients and antimicrobial susceptibility results of the strains were examined. Identification of the isolates at the species level were done by matrix assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS, VITEK MS, BioMérieux, France). Antimicrobial susceptibility tests were studied by the disc diffusion method. SPSS (Statistical Package for Social Sciences) for Windows 24.0 program was used for statistical analysis. A total of 318 Achromobacter isolates were obtained from 148 patients. 29.7% of patients had cystic fibrosis (CF); although 70.3% were non-CF patients, 51.6% of the isolates belonged to CF patients (P=0.63). The most frequently sent sample type is respiratory tract samples (78%), while all samples sent in CF patients are respiratory samples; this rate was 54.5% in patients without CF (P<0.05). Respiratory samples were followed by 10% urine, 5.7% blood and 6.3% other samples. Recurrent Achromobacter growth was detected in 47 (31%) of the patients. The number of repetitive samples per patient was 4.6 (2-28) and there was repeated isolation in 22 patients (50%) in the CF group and in 25 patients (32.5%) in the non-CF group. Resistance rates in all isolates, CF isolates, and other isolates were 25.6%, 30.4%, and 21.9% for piperacillin/tazobactam, respectively; 40.0%, 61.1%, and 18.0% (P<0.05) for meropenem; 44.7%, 68.2% and 12.5% (p<0.05) for trimethoprim/sulfamethoxazole. Although studies on Achromobacter are quite limited, its incidence has been increasing in recent years; more information and research on this bacterium is needed. The data of our study draws attention to the importance of increasing antimicrobial resistance in Achromobacter species by contributing to the literature.

Anahtar Kelimeler

• Achromobacter
• direnç
• kistik fibrozis
• kistik fibrozis dışı
• cystic fibrosis
• non-cystic fibrosis
• resistance

Kaynakça

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