In vitro Effectiveness of Lecithin-Containing Antibiotic Lock Solutions on Klebsiella pneumoniae Biofilms

Öz

Aim: Klebsiella pneumoniae which is a gram negative, generally capsulated, non-moving, non-sporing bacteria, nowadays to be an important cause of community-acquired and nosocomial infection. These bacteria can cause catheter related infections by forming biofilm on the surface of catheter. The most effective treatment method of catheter related infection is to remove infectious catheter and start systemic antibiotic treatment but this process can't be practiced in all cases due to the patients’ health conditions. Infectious Diseases Society of America and Centers for Disease Control and Prevention suggest that systemic antibiotic therapy together with antibiotic lock therapy (ALT), as an adjuvant therapy, for patients whose infectious catheter can't be removed.

Material and Methods: In our study, the in vitro efficacy of several antibiotics alone or in combination with lecithin which is a surface active agent, as a 96 hour lock solution on in vitro CVC biofilm model against two biofilm-embedded catheter related bacteremia infection agents Klebsiella pneumoniae strains were investigated.

Results: According to our results, ALT solutions containing lecithin+tobramycin and lecithin+doripenem combinations had an antagonist effect on the biofilm-embedded strains by increasing at least 2-log₁₀ in both strains and ALT solutions containing lecithin+colistin, lecithin+tigecycline and lecithin+ciprofloxacin had less effect than antibiotics alone on the biofilm-embedded strains.

Conclusion: In our study, we believe that because lecithin+tobramycin and lecithin+doripenem combinations showed antagonist activity, the usage of lecithin in daily life as a nutritional supplement will be a guide for clinicians.

Anahtar Kelimeler

• Catheter infections,biofilm,antimicrobial lock therapy,lecithin,Klebsiella pneumoniae

Lesitin İçeren Antibiyotik Kilit Çözeltilerinin Klebsiella pneumoniae Biyofilmi Üzerine in vitro Etkileri

Öz

Amaç: Gram negatif, genellikle kapsüllü, hareketsiz, sporsuz, çomak şeklinde bir bakteri olan Klebsiella pneumoniae günümüzde toplum ve hastane kökenli enfeksiyonların önemli etkenlerinden biridir. Bu bakteri kateter yüzeyinde bir mikrobiyal biyofilm oluşturarak kateter ilişkili enfeksiyonlara neden olabilmektedir. Kateter ilişkili enfeksiyonların tedavisinde en etkili tedavi yöntemi enfekte kateteri çıkarmak ve sistemik antibiyotik tedavisine başlamak olsa da bu işlem hastanın sağlık durumu ile ilgili nedenlerle her zaman yapılamamaktadır. Enfekte kateterin çıkartılamadığı hastalarda sistemik antimikrobiyal tedavi ile birlikte yardımcı bir tedavi seçeneği olarak antibiyotik kilit (AK) tedavisi kullanılması Infectious Diseases Society of America ve Centers for Disease Control and Prevention gibi sağlık kuruluşları tarafından önerilmektedir.

Gereç ve Yöntemler: Çalışmamızda, in vitro yöntemle santral venöz kateter (SVK) modeli oluşturularak biyofilm oluşturduğu tespit edilen iki SVK ilişkili bakteriyemi enfeksiyon etkeni Klebsiella pneumoniae suşuna karşı bir yüzey aktif ajan olan lesitinin tek başına ve çeşitli antibiyotiklerle kombinasyonlarının 96 saatlik etkisi araştırılmıştır.

Bulgular: Çalışmamızdan elde ettiğimiz sonuçlara göre, lesitin+tobramisin ve lesitin+doripenem kombinasyonlarını içeren AK çözeltisinin her iki suş içinde en az 2-log₁₀’luk bir artış sağlayarak biyofilme gömülmüş suşlar üzerinde antagonist etki oluşturduğu, lesitin+kolistin, lesitin+tigesiklin ve lesitin+siprofloksasin içeren AK çözeltilerinin ise her iki suşa ait kateter biyofilm modelinde antibiyotiklerin tek başına oluşturduğu etkiden daha az etki gösterdiği saptanmıştır.

Sonuç: Çalışmamızda lesitin+tobramisin ve lesitin+doripenem kombinasyonlarının antagonist etki göstermesi günlük hayatta tükettiğimiz pek çok üründe gıda takviyesi olarak bulunan lesitinin enfeksiyon hastalıklarının tedavisindeki etkilerinin ortaya koyulması açısından önemli olduğu düşüncesindeyiz.

Anahtar Kelimeler

• Kateter enfeksiyonları,biyofilm,antibiyotik kilit tedavisi,lesitin,Klebsiella pneumoniae

Kaynakça

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