Klinik Örneklerden İzole Edilen Anaerop Bakterilerin Tiplendirilmesi ve Antibiyotik Direnç Profillerinin Belirlenmesi

Öz

ÖZ Amaç: Bu çalışmada, çeşitli klinik örneklerden izole edilen anaerop bakterilerin tanımlanması ve gradiyent yöntemi (E-test) ile antibiyotik dirençlerinin belirlenmesi amaçlandı. Yöntem: Çalışma, 15 Ocak-1 Kasım 2021 tarihlerinde gerçekleştirildi. 863 örneğin 213’ü çalışmaya dahil edildi. Anaerop suşlar konvansiyonel yöntemlerle izole edildi ve otomatize sistemle tanımlandı. Antibiyotik duyarlılıkları Clinical and Laboratory Standards Institute (CLSI) kriterlerine göre gradiyent yöntemi ile belirlendi. Bulgular: Örneklerin %10,3’ünde anaerop bakteri, %34,8’inde aerop/fakültatif anaerop bakteri tespit edilirken, %54,9’unda üreme görülmedi. Örneklerin %77’si apse materyaliydi. Anaerop bakterilerin %72,7’si Gram pozitif bakteri, %27,3’ü Gram negatif basildi. En yaygın türler; Cutibacterium (%22,7), Actinomyces (%18,3), Prevotella (%13,7), Bacteroides (%9,1), Anaerococcus (%9,1), Clostridium türleri (%9,1) idi. Sırasıyla, tüm anaerop bakterilerin antibiyotik duyarlılıkları; moksifloksasin (%95,5), piperasilin-tazobaktam (%95,5), amoksisilin-klavulonik asit (%95,5), sefoksitin (%90,9), meropenem (%90,9) klindamisin (%77,3), ampisilin (%59,1) ve metronidazol (%22,7) idi. Gram pozitif basillerin duyarlılık oranları ampisilin, amoksisillin-klavulanik asit, piperasilin-tazobaktam, sefoksitine, moksifloksasin, meropenem için %91,7, klindamisin için %75’di. Gram pozitif koklarda ampisiline duyarlılık %50, amoksisillin-klavulanik asit, piperasilin-tazobaktam, sefoksitin, klindamisin, moksifloksasine duyarlılık %100 iken, meropeneme duyarlılık %75’di. Gram negatif basillerde duyarlılık oranları ampisilin %0,0, amoksisillin-klavulanik asit, piperasilin-tazobaktam, moksifloksasin, meropenem için %100, metronidazol %83,3, sefoksitin için %66,7 ve klindamisin için %50 idi. Sonuç: Çalışmamızda anaerop bakterilerde özellikle metronidazol ve ampisilin için duyarlılık oranlarının düşük olduğu gözlemlendi. Birçok anaerop bakterinin direnç profilinin, son on yılda önemli ölçüde değişmesi, anaerop bakterilerin antimikrobiyal duyarlılıklarını fazla tahmin edilemez hale getirmiştir. Bu sebeple bu konudaki lokal verilerin belli aralıklarla ortaya çıkarılması ve dökümante edilmesi hem ampirik tedavinin şekillenmesi, hem halk sağlığı, hem de surveyans çalışmaları için önemli bir referans oluşturacaktır.

Anahtar Kelimeler

• Anaerop
• Cutibacterium spp.
• antibiyotik konsantrasyon gradiyent yöntemi
• E-test
• metronidazol

Proje Numarası

TTU2020-13333

Identification of Anaerobic Bacteria Isolated From Clinical Samples and Determination of Antibiotic Resistance Profiles

Öz

Objective: In this study, it was aimed to identify anaerobic bacteria isolated from various clinical samples, and to determine their antibiotic resistance by gradient method (E-test). Methods: The study was carried out between January 15 and November 1, 2021. The 213 of 863 samples were included in the study. Anaerobic strains were isolated by conventional methods and identified by an automated system. Antimicrobial susceptibility was determined by the gradient method according to the Clinical and Laboratory Standards Institute (CLSI) criteria. Results: Anaerobic bacteria were detected in 10.3% of the samples, aerobic/facultative anaerobic bacteria were detected in 34.8%, while growth was not observed in 54.9% of the samples. The 77% of the samples were abscess. The 72.7% of anaerobic bacteria were Gram positive bacteria, and 27.3% were Gram negative bacteria. The most common species were; Cutibacterium (22.7%), Actinomyces (18.3%), Prevotella (13.7%), Bacteroides (9.1%), Anaerococcus (9.1%), Clostridium species (9.1%). The antibiotic susceptibilities of all anaerobic bacteria were as following; moxifloxacin (95.5%), piperacillin-tazobactam (95.5%), amoxicillin-clavulanic acid (95.5%), cefoxitin (90.9%), meropenem (90.9%), clindamycin (77.3%), ampicillin (59.1%), and metronidazole (22.7%), respectively. The susceptibility rates of gram positive bacilli were 91.7% for ampicillin, amoxicillin-clavulanic acid, piperacillin-tazobactam, cefoxitin, moxifloxacin, meropenem, and 75% for clindamycin. In Gram positive cocci, susceptibility to ampicillin was 50%, susceptibility to amoxicillin-clavulanic acid, piperacillin-tazobactam, cefoxitin, clindamycin, moxifloxacin were 100%, and to meropenem was 75%. The susceptibility rates for Gram-negative bacilli were 0.0% for ampicillin, 100% for amoxicillin-clavulanic acid, piperacillin-tazobactam, moxifloxacin, meropenem, 83.3% for metronidazole, 66.7% for cefoxitin, and 50% for clindamycin. Conclusion: In our study, it was observed that the sensitivity rates for especially, metronidazole and ampicillin were low among anaerobic bacteria. The resistance profile of many anaerobic bacteria has changed significantly over the past decade, making the antimicrobial susceptibility of anaerobic bacteria unpredictable. For this reason, revealing and documenting local data on this subject at regular intervals will constitute an important reference for both empirical treatment, public health, and surveillance studies.

Anahtar Kelimeler

• Anaerobe
• Cutibacterium spp.
• antibiotic concentration gradient method
• E-test
• metronidazole

Destekleyen Kurum

Bu çalışma Tıpta Uzmanlık Tezi olarak Çukurova Üniversitesi Bilimsel Araştırma Projeleri tarafından TTU2020-13333 No’lu proje ile desteklenmiştir.

Proje Numarası

TTU2020-13333

Etik Beyan

Çukurova Üniversitesi Tıp Fakültesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu’ndan onay alınmıştır (No: 104, Tarih: 02.10.2020).

Kaynakça

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