STREPTOCOCCUS AGALACTİAE KLİNİK İZOLATLARINDA ANTİBİYOTİKLERE DUYARLILIK

Yıl 2007, Cilt: 16 Sayı: 1, 23 - 28, 01.03.2007

Mehmet Ölçü Duygu Eşel

Öz

Grup B streptokoklar (GBS), yenidoğanlarda, gebe kadınlarda ve alt hastalığı olan erişkinlerde önemli infeksiyon etkenlerinden biridir. GBS’ler penisiline duyarlıdır ve tanı konduğunda tedavide ilk seçenek penisilin olmalıdır. Duyarlı olduğu diğer antibiyotikler ampisilin, vankomisin, teikoplanin, birinci, ikinci ve üçüncü kuşak sefalosporinler, imipenem ve meropenemdir. GBS’lerdeki klindamisin ve eritromisin direnci % 15-20 oranında olup bu oran giderek artmaktadır. 30 Temmuz 2005 ile 04 Ekim 2006 tarihleri arasında Erciyes Üniversitesi Tıp Fakültesi Hastaneleri’ne başvuran hastalara ait klinik örneklerden izole edilen 131 S. agalactiae suşu çalışmaya alındı. Tüm GBS izolatlarının penisilin G, seftriakson ve vankomisine duyarlı olduğu saptanmıştır. GBS izolatlarında tetrasiklin, eritromisin ve klindamisin direnci sırasıyla % 90, % 14,5 ve % 13 oranlarında belirlenmiştir. Bölgemizde GBS suşlarında penisilin G ve seftriaksona direnç problemi yoktur ve bu antibiyotikler GBS infeksiyonlarında ilk tercih olma özelliklerini sürdürmektedir. Eritromisin direncinin geçmişteki çalışmalara oranla 2 kat arttığı tespit edilmiş olup, bu tür antibiyotikler beta-laktam alerjisi dışında tercih edilmemelidir

Anahtar Kelimeler

Streptococcus agalactiae, antibiyotik duyarlılığı, serotiplendirme

Antibiotic Susceptibilities of Clinical Streptococcus agalactiae Isolates

Öz

Group B streptococci (GBS) is one of the leading couses of infection in newborns, in pregnant women, and in patients with underlying diseases. GBS are sensitive to penicilin, that’s why, penicilin must be the first choice in the treatment. Other antibiotics which GBS are sensitive to are; ampicillin, vancomycin, teicoplanin, first, second and third generation cephalosporins, imipenem and meropenem. Clindamycin and erythromycin resistance rates are 15-20 % and they are increasing worldwide. One hundred thirty one S.agalactiae strains, isolated from the clinical samples of patients applied to Erciyes University Medical Faculty Hospitals between the dates of 30th July 2005 and 4th October 2006, were included to the study. It was determined that all GBS isolates were susceptible to penicillin G, ceftriaxone and vancomycin. Among strains, tetracycline, erythromycin and clindamycin resistance rates were determined as 90 %, 14,5 % and 13 % respectively. In our region there is no resistance problem to penicillin G and ceftriaxone among GBS and they are still the first choice in GBS infections. It was determined that the erythromycin resistance doubled in comparison with the past studies and these kinds of antibiotics should not be preferred except for beta-lactam allergy

Anahtar Kelimeler

Streptococus agalactiae, antibiotic susceptibly, serotyping

Kaynakça

• Edwards MS, Baker CJ. Streptococcus agalactiae (group B streptococcus). In: Mandell GL, Douglas RC, Bennett JE, eds. Principles and Practice of Infectious Diseases. 5th ed. Philadelphia: Churchill Livingstone, 2000: 2156-2164
• Main EK, Slagle T. Prevention of early-onset invasive neonatal group B streptococcal disease in a private hospital setting: the superiority of culture-based protocols. Am J Obstet Gynecol 2000; 182: 1344-1347
• Schuchat A. Group B streptococcus. Lancet, 1999; 353: 51-56 4. Farley MM. Group B streptococcal disease in non pregnant adults. Clin Infect Dis 2001; 33: 556-561
• Pratt-Rippin K. Pezzlo M. Identification of commonly isolated aerobic gram-positive bacteria. In: Isenberg HD (ed). Clinical Microbiology Procedures Handbook, American Society for Microbiology, Washington, 1992: 1.20.12
• NCCLS Methods for Dilution Antimicrobial Disk Susceptibility Tests for Bacteria That Grow Aerobically; Approved Standard-8th ed. NCCLS document M7-A6 (ISBN 1-56238-486- 4). NCCLS 940 West Valley Road, Suite 1400, Wayne, Pennsylvania 19087-1898 USA, 2003
• CLSI. Performance Standards for Antimicrobial Susceptibility Testing; Sixteenth Informational Supplement. CLSI document M100-S16 (ISBN 1-56238-588-7). Clinical and laboratory standards institute, 940 West Valley Road, Suite 1400, Wayne, Pennsylvania 19087-1898 USA, 2006
• Schuchat A. Epidemiology of group B streptococal disease in the United States: shifting paradigms. Clin Microbiol Rev 1998; 11: 497-513 9. Ruess M, Muller U, Sander A, Berner R. Antimicrobial susceptibility patterns of Streptococcus agalactiae in a German university hospital. Scand J Infect Dis 2000; 32: 623-626
• Uh Y, Jang IH, Hwang GY, et al. Serotypes and genotypes of erythromycin-resistant group B streptococci in Korea. J Clin Microbiol 2004; 42: 3306-3308 11. Croak A, Abate G, Goodrum K, Modrzakowski M. Predominance of serotype V and frequency of erythromycin resistance in Streptococcus agalactiae in Ohio. Am J Obstet Gynecol 2003; 188: 1148-1150
• Dogan B, Schukken YH, Santisteban C, Boor KJ. Distribution of serotypes and antimicrobial resistance genes among Streptococcus agalactiae isolates from bovine and human hosts. J Clin Microbiol 2005; 43: 5899-5906
• Aitmhand R, Moustaoui N, Belabbes H, Elmdaghri N, Benbachir M. serotypes and antimicrobial susceptibility of group B streptococcus isolated from neonates in Casablanca. Scand J Infect Dis 2000; 32: 339-340
• Sweih NA, Jamal M, Kurdia M, Abduljabar R, Rotimi V. Antibiotic susceptibility profile of group B streptococcus (Streptococcus agalactiae) at the maternity hospital, Kuwait. Med Princ Pract 2005; 14: 260-263
• Eren A, Küçükercan M, Oğuzoğlu N, Ünal N, Karateke A. The carriage of group B streptococci in Turkish pregnant women and its transmission rate in newborns and serotype distribution. Turk J Pediatr 2005; 47: 28-33
• Matsubara K, Nishiyama Y, Katayama K, et al. Change of antimicrobial susceptibility of group B streptococci over 15 years in Japan. J Antimicrob Chemother 2001; 48: 579-582
• Motlova J, Strakova L, Urbaskova P, Sak P, Sever T. Vaginal & rectal carriage of Streptococcus agalactiae in the Czech Republic: incidence, serotypes distribution and susceptibility to antibiotics. Indian J Med Res 2004; 119: 84-87
• Hsueh PR, Teng LJ, Lee LN, et al. High incidence of erythromycin resistance among clinical isolates of Streptococcus agalactiae in Taiwan. Antimicrob Agents Chemothe 2001; 45: 3205-3208
• Eşel D, Karaca N, Telli M, Sümerkan B. Klinik örneklerden izole edilen Streptococcus agalactiae suşlarında duyarlılık. Ankem Derg 2001; 15: 678-682