Antibiotic Susceptibility of Stenotrophomonas maltophilia Isolated from Various Clinical Specimens

Öz

Stenotrophomonas maltophilia is an opportunistic emergent pathogen causing hospital-acquired infections and it is resistant to majority of the broad spectrum antibiotics. The aim of this study was to investigate the distribution and antimicrobial susceptibility patterns of S.maltophilia strains isolated in approximately five years. In this study; a total of 53 S.maltophilia strains, isolated from various clinical specimens between January 2014-September 2018 were investigated in terms of antibiotic resistance rates. The isolates were identified and antibiotic susceptibility tests performed by BD Phoenix 100 automated system (Becton Dickinson Diagnostic Systems, Sparks, USA). Out of 53 S.maltophilia strains, 21 % were isolated from outpatient clinics and 79 % from hospitalized patients. And 50 % of hospitalized patients were admitted to the Intensive Care Unit. Antibiotic susceptibilities to trimetoprim-sulfametoksazol (TMP-SXT), levofloxacin and ceftazidim were; 88.6 %, 85 % and 30 %, respectively. When considering the MIC value >2 ug/ml resistant for tigecycline; 83 % of the isolates were susceptible. In our study, it was concluded that third-generation cephalosporins cannot be used in the empirical treatment of S.maltophilia in our hospital due to the detection of the resistance to ceftazidime. Although TMP-SXT and levofloxacin resistance are not yet to be feared, increased resistance rates should be taken into consideration.

Anahtar Kelimeler

• antibiotic susceptibility
• ceftazidime
• levofloxacin
• Stenotrophomonas maltophilia
• trimethoprim-sulfamethoxazole
• tigecycline

Çeşitli Klinik Örneklerden İzole Edilen Stenotrophomonas maltophilia Suşlarının Antibiyotik Duyarlılıkları

Öz

Stenotrophomonas maltophilia, hastane enfeksiyonu etkeni olarak giderek artan sıklıkla karşılaşılan fırsatçı bir patojendir ve geniş spektrumlu antibiyotiklerin çoğuna dirençlidir. Bu çalışmada, yaklaşık beş yıllık süre boyunca izole edilmiş S.maltophilia suşlarının dağılımının ve antibiyotik duyarlılıklarının incelenmesi amaçlanmıştır. Ocak 2014-Eylül 2018 tarihleri arasında çeşitli klinik örneklerden izole edilen toplam 53 S.maltophilia suşunun antibiyotiklere direnç oranları incelenmiştir. Bakteri identifikasyonu ve antibiyotik duyarlılığı için BD Phoenix 100 Otomatize Sistemi (Becton Dickinson Diagnostic Systems, Sparks, ABD) kullanılmıştır. S.maltophilia suşlarının % 21’i poliklinik, % 79’u yataklı servis hastalarına ait örneklerden izole edilmiştir. Yatan hastaların % 50’sinin yoğun bakım ünitesinde tedavi gördüğü gözlenmiştir. Antibiyotik duyarlılıkları sırası ile trimetoprimsülfametoksazol (TMP-SXT), levofloksasin ve seftazidim için, % 88.6, % 85 ve % 30 şeklindedir. Tigesiklin minimum inhibitör konsantrasyon (MİK) değeri 2 mg/l’nin üzerinde dirençli kabul edildiğinde tigesikline % 83 duyarlılık saptanmıştır. Çalışmamızda, seftazidime karşı saptanan direnç nedeniyle, üçüncü kuşak sefalosporinlerin hastanemizde S.maltophilia’nın ampirik tedavisinde kullanılamayacağı sonucuna varılmıştır. TMP-SXT ve levofloksasin direncimiz henüz korkulacak boyutlarda olmamasına rağmen artan direnç oranları açısından dikkat edilmesi gerektiği görülmüştür.

Anahtar Kelimeler

• antibiyotik duyarlılık
• levofloksasin
• seftazidim
• Stenotrophomonas maltophilia
• trimetoprim-sulfametoksazol
• tigesiklin

Kaynakça

1. Brooke JS. Stenotrophomonas maltophilia: an emerging global opportunistic pathogen. Clin Microbiol Rev. 2012;25(1):2-41. https://doi.org/10.1128/CMR.00019-11
2. Brooke JS. New strategies against Stenotrophomonas maltophilia: a serious worldwide intrinsically drugresistant opportunistic pathogen. Expert Rev. Anti Infect. Ther. 2014;12(1):1-4. https://doi.org/10.1586/14787210.2014.864553
3. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. Twenty-fourth informational supplement update. CLSI document M100-S24. Clinical and Laboratory Standards Institute, Wayne, PA (2014).
4. Clinical Microbiology Procedures Handbook 3rd ed. /Third Edition and 2007 update, Lynne S. Garcia. ISBN- 13: 978-1-5558 1-527-1.
5. Corlouer C, Lamy B, Desroches M et al. Stenotrophomonas maltophilia healthcareassociated infection: identification of two main pathogenic genetic backgrounds. J Hosp Infect. 2017;96:183-8. https://doi.org/10.1016/j.jhin.2017.02.003
6. EUCAST. EUCAST Clinical Breakpoint TableVersion 6.0,Valid From 2016-01-01. Basel: EUCAST, 2016. http://www.eucast.org/clinical_breakpoints/.
7. Farrell DJ, Sader HS, Jones RN. Antimicrobial susceptibility of a worldwide collection of Stenotrophomonas maltophilia isolates tested against tigecycline and agents commonly used for S. maltophilia infections. Antimicrob Agents Chemother. 2010;54(6):2735-7. https://doi.org/10.1128/AAC.01774-09
8. Gales AC, Castanheira M, Jones RN, Sader HS. Antimicrobial resistance among Gram-negative bacilli isolated from Latin America: results from SENTRY Antimicrobial Surveillance Program (Latin America, 2008-2010). Diagn Microbiol Infect Dis. 2012;73(4):354-60. https://doi.org/10.1016/j.diagmicrobio.2012.04.007

9. Güzelant A, Kaya M, Güvenç Hİ ve ark. Çeşitli klinik örneklerden beş yılda izole edilen Stenotrophomonas maltophilia suşlarının dağılımı ve antimikrobiyal duyarlılıkları. Türk Mikrobiyol Cem Derg. 2014;44(2):75-9.
10. Hazırolan G, Araz H, Çelikbaş AK, Aksu N. Klinik örneklerden izole edilen Stenotrophomanas maltophilia suşlarının trimetoprim-sülfametoksazol ve levofloksasin direncinde belirgin artış var (2008-2016). Türk Mikrobiyol Cem Derg. 2018;48(2):134-40 https://doi.org/10.5222/TMCD.2018.134
11. Herrera-Heredia SA, Pezina-Cantú C, Garza-González E, et al. Risk factors and molecular mechanisms associated with trimethoprim-sulfamethoxazole resistance in Stenotrophomonas maltophilia in Mexico. J Medical Microbiol. 2017;66(8):1102-9 doi:10.1099/jmm.0.000550 https://doi.org/10.1099/jmm.0.000550
12. Hu LF, Chen GS, Kong QX et al. Increase in the prevalence of resistance determinants to trimethoprim/sulfamethoxazole in clinical Stenotrophomonas maltophilia isolates in China. PLoS One. 2016;11:e0157693. https://doi.org/10.1371/journal.pone.0157693
13. Juhász E, Pongrácz J, Iván M, Kristóf K. Antibiotic susceptibility of sulfamethoxazole-trimethoprim resistant Stenotrophomonas maltophilia strains isolated at a tertiary care centre in Hungary. Acta Microbiol Immunol Hung. 2015;62(3):295-305 https://doi.org/10.1556/030.62.2015.3.7
14. Kandemir İ, Özcan N, Alanbayı Ü, Bozdağ H, Akpolat N, Gül K. Klinik örneklerden izole edilen Stenotrophomonas maltophilia suşlarının dağılımı ve antibimikrobiyal duyarlılıkları. Dicle Tıp Derg. 2016;43(2):237-40.
15. Liu YM, Chen YS, Toh HS, et al. In vitro susceptibilities of non-enterobacteriaceae isolates from patients with intra-abdominal infections in the Asia-Pacific region from 2003 to 2010: Results from the study for monitoring antimicrobial resistance trends (SMART). Int J Antimicrob Agents. 2012;40(Suppl):S11-7. https://doi.org/10.1016/S0924-8579(12)70004-3
16. Milne KEN, Gould IM. Combination antimicrobial susceptibility testing of multidrug-resistant Stenotrophomonas maltophilia from cystic fibrosis patients. Antimicrob Agents Chemother. 2012;56(8):4071-7. https://doi.org/10.1128/AAC.00072-12
17. Özkaya E, Aydın F, Bayramoğlu G, Buruk CK, Sandallı C. Klinik örneklerden izole edilen trimetoprimsülfametoksazole dirençli Stenotrophomonas maltophilia suşlarında integron, sul1-2 ve dfr genlerinin araştırılması. Mikrobiyol Bul. 2014;48(2): 201-12. https://doi.org/10.5578/mb.7262
18. Parkins MD, Elborn JS. Newer antibacterial agents and their potential role in cystic fibrosis pulmonary exacerbation management. J Antimicrob Chemother. 2010;65(9):1853-61. https://doi.org/10.1093/jac/dkq245
19. Safdar A, Rolston KV. Stenotrophomonas maltophilia: changing spectrum of a serious bacterial pathogen in patients with cancer. Clin Infect Dis. 2007;15;45(12): 1602-9. https://doi.org/10.1086/522998
20. Togan T, Özden HT, Azap Ö. Stenotrophomonas maltophilia suşlarına tigesiklin ve kolistinin in vitro duyarlılığı. Flora. 2018;23(1):25-30. https://doi.org/10.5578/flora.43431
21. Türkdağı H, Arslan U, Tuncer İ. Kan kültürlerinden izole edilen Stenotrophomonas maltophilia suşlarının antibiyotik direnci. ANKEM Derg. 2011;25(1):27-30.
22. Usta E, Eroğlu C, Yanık K, Karadağ A, Güney AK, Günaydın M. Klinik Stenotrophomonas maltophilia izolatlarında sınıf 1, 2, 3 integron varlığının ve antibiyotik direnci ile ilişkilerinin araştırılması. Mikrobiyol Bul. 2015;49(1):35-46. https://doi.org/10.5578/mb.8459
23. Wei C, Ni W, Zhao J, Cui J. A Monte Carlo pharmacokinetic/pharmacodynamic simulation to evaluate the efficacy of minocycline, tigecycline, moxifloxacin, and levofloxacin in the treatment of hospital-acquired pneumonia caused by Stenotrophomonas maltophilia. J Infect Dis. 2015;47(12):846-51. https://doi.org/10.3109/23744235.2015.1064542
24. Wei C, Ni W, Cai X, Zhao J, Cui J. Evaluation of trimethoprim/sulfamethoxazole (SXT), minocycline, tigecycline, moxifloxacin, and ceftazidime alone and in combinations for SXT susceptible and SXT-resistant Stenotrophomonas maltophilia by in vitro time-kill experiments. PLoS One. 2016;21:1-9. https://doi.org/10.1371/journal.pone.0152132
25. Zhanel GG, Fontaine S, Adam H, et al. A review of new fluoroquinolones: focus on their use in respiratory tract infections. Treat Respir Med. 2006;5(6):437-65. https://doi.org/10.2165/00151829-200605060-00009