Investigation of Carbapenemase Production Among Carbapenem-Resistant Pseudomonas aeruginosa Isolates

Öz

Background: Pseudomonas aeruginosa is an opportunist organism that causes potentially life threatening nosocomial infections, particularly in immunocompromised patients. Carbapenems are regarded to be the last line of treatment against severe infections caused by multi drug resistant P. aeruginosa isolates. isolates. Production of the carbapenemase enzyme is the primary mechanism of carbapenem resistance and has become a serious health concern worldwide as these enzymes are highly transferable and limit therapeutic alternatives. Rapid detection of carbapenemase production is important for prompt planning the treatment of car-bapenemase-producing isolates and preventing the spread of these strains. This study aimed to investigate carbapenemase produc-tion in carbapenem resistant Pseudomonas aeruginosa isolates by the Carbapenem inactivation method. Materials and Methods: In this retrospective study a total of 172 Pseudomonas aeruginosa isolates were obtained from different samples sent from various clinics to Tokat Gaziosmanpaşa University Research and Application Hospital Microbiology Laboratory between 2016-2019 and were evaluated. Of the 172 isolates, 51 (29.7%) were found to be carbapenem- resistant and included in this investigation. Identification and antibiotic susceptibility tests of the isolates were performed with the Vitek 2 (Biomerieux, France) automated system. Carbapenem sensitivities were also determined by the disc diffusion method. Carbapenemase production in isolates was investigated by the Carbapenem inactivation method. Results: These samples were sent from clinical units, such as neurology (n =10), general surgery (n =8), internal medicine (n =7), and pediatric (n =6). The isolates were identified from wounds (n = 17), sputum (n = 15), blood (n = 11), urine (n = 5), and cerebrospinal fluid (n = 3) samples. Of all the carbapenem –resistant samples 32 (62.8%) were obtained from male, and 19 (37.3%) from female patients. Of the 51 carbapenem resistant isolates, 38 (74.5%) were found to be resistant to both imipenem and meropenem. Eight (15.7%) isolates were found to be resistant to imipenem only, and five (9.8%) isolates were resistant to meropenem. Carbapenemase production was detected in 31 (60.8%) isolates by using using the Carbapenem inactivation method. The antibiotic resistance rates of the carbapenem-resistant isolates were as follows: piperacillin-tazobactam 65%, amikacin 6.8%, gentamicin 15.2%, ceftazidime 34.6%, cefepime 38.3%, ciprofloxacin 26.7%, levofloxacin 24.2%. Conclusions: Rapid identification of carbapenemase enzymes among carbapenem resistant Pseudomonas aeruginosa isolates using phenotypic and genotypic approaches is important to control the transmission of infection caused by carbapenem-resistant isolates and to control the morbidity and mortality associated with them. In this study, the carbapenem inactivation test was seen as a method that can be preferred in the laboratory in terms of its easy and fast application in the detection of carbapenemase production. Key Words: Pseudomonas aeruginosa, Carbapenem inactivation method, Antimicrobial resistance

Anahtar Kelimeler

• Pseudomonas aeruginosa
• Carbapenem inactivation method
• Antimicrobial resistance

Karbapeneme Dirençli Pseudomonas aeruginosa İzolatlarında Karbapenemaz Üretiminin Araştırılması

Öz

Amaç: Pseudomonas aeruginosa, özellikle immünkompromize hastalarda hayati tehlike oluşturan hastane enfeksiyonlarına yol açan fırsatçı bir patojendir. Karbapenemler, çoklu ilaç direnci olan Pseudomonas aeruginosa izolatlarının neden olduğu ciddi enfeksiyonlara karşı son tedavi seçeneği olarak kabul edilmektedir. Karbapenemaz enziminin üretimi karbapenem direncinin ana mekanizmasıdır ve bu enzimler yüksek oranda aktarılabilir olduğundan ve terapötik seçenekleri sınırladığından dünya çapında ciddi bir sağlık sorunu haline gelmiştir. Karbapenemaz üretiminin hızlı tespiti, karbapenemaz üreten izolatların tedavisinin hızlı bir şekilde planlanması ve bu suşların yayılmasının önlenmesi için önemlidir. Bu çalışmada, karbapenem dirençli Pseudomonas aeruginosa izolatlarında karbapenemaz üretiminin Karbapenem inaktivasyon yöntemi ile araştırılması amaçlanmıştır. Materyal ve Metod: Bu retrospektif kohort çalışmada 2016-2019 yılları arasında …….. Üniversitesi Araştırma ve Uygulama Hastanesi Mikrobiyoloji Laboratuvarına çeşitli kliniklerden gönderilen farklı örneklerden toplam 172 Pseudomonas aeruginosa izolatı değerlendirilmiştir. Toplam 172 izolatın 51'i (%29,7) karbapenem dirençli bulunarak çalışmaya dahil edilmiştir. İzolatların tanımlanması ve antibiyotik duyarlılık testleri Vitek 2 (Biomerieux, Fransa) otomatize sistemi ile gerçekleştirilmiştir. Karbapenem duyarlılıkları ayrıca disk difüzyon yöntemiyle de belirlenmiştir. İzolatlarda karbapenemaz üretimi Karbapenem inaktivasyon yöntemi ile araştırılmıştır. Bulgular: Örnekler nöroloji (n =10), genel cerrahi (n =8), dahiliye (n =7) ve pediatri (n =6) dahil olmak üzere çeşitli klinik birimlerden gönderilmiştir. İzolatlar yara (n = 17), balgam (n = 15), kan (n = 11), idrar (n = 5) ve beyin omurilik sıvısı (n = 3) örneklerinden tanımlanmıştır. Örneklerin 32'si (%62,8) erkek, 19'u (%37,3) kadın hastalardan elde edilmiştir. Karbapeneme dirençli 51 izolatın 38'i (%74,5) hem imipenem hem de meropeneme dirençli bulunmuştur. Sekiz (%15,7) izolat sadece imipeneme ve beş (%9,8) izolat meropeneme dirençli bulunmuştur. Karbapenem inaktivasyon yöntemi ile 31 (%60,8) izolatta karbapenemaz üretimi tespit edilmiştir. Sonuç: Karbapeneme dirençli Pseudomonas aeruginosa izolatları arasında karbapenemaz enzimlerinin fenotipik ve genotipik yaklaşımlar kullanılarak hızlı bir şekilde tanımlanması, karbapeneme dirençli izolatların neden olduğu enfeksiyonun bulaşmasını kontrol etmek ve bunlarla ilişkili morbidite ve mortaliteyi kontrol etmek için önemlidir. Bu çalışmada karbapenem inaktivasyon testi, karbapenemaz üretiminin tespitinde kolay ve hızlı uygulanabilmesi açısından laboratuvarda tercih edilebilecek bir yöntem olarak görülmüştür.

Anahtar Kelimeler

• Pseudomonas aeruginosa
• Karbapenem inaktivasyon yöntemi
• Antimikrobiyal direnç.

Kaynakça

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