Harran Üniversitesi Hastanesi’nde Yatan Hastaların Kan Kültürlerinden İzole Edilen Acinetobacter Suşlarının Antibiyotiklere Direnç Profili

Öz

Amaç: Acinetobacter baumannii özellikle hastanede yatan ve immün yetmezliği olan hastalarda ciddi bakteremilere sebep olabilen bir bakteridir. Bu çalışmada 2017-2019 yılları arasında Harran Üniversitesi Hastanesi’nde (Urfa, Türkiye) yatan hastaların kan kültürlerinden izole edilen 92 A. baumannii ve 5 A. lwoffii izolatının antibiyotiklere olan direnci incelenmiştir.
Materyal ve Metod: Kan kültürü şişelerinin inkübasyonu için Versa-TREK (Trek Diagnostic System, USA) cihazı kullanıldı. Pasajlar %5 kanlı agara ve eozin metilen blue agara (EMB) yapıldı. Pasajlarda üreyen bakterilerin tanımlanmasında MALDI-TOF MS (Bruker, Germany) ve Vitek 2 compact sistemi (bioMérieux, France) kullanıldı. Meropenem, siprofloksasin, amikasin, gentamisin, tobramisin, tigesiklin ve trimetoprim-sulfametoksazole olan dirençler VITEK 2 compact sistemi ile, EUCAST önerileri temel alınarak değerlendirildi.
Bulgular: A. baumannii suşlarının antibiyotik direnç oranları; siprofloksasine %92, imipeneme %88, meropeneme %88, gentamisine %74, tobramisine %67, trimetoprim-sulfametoksazole %63, amikasine %53, tigesikline %10 şeklinde bulundu. A. lwoffi’nin direnç profili ise siprofloksasine, gentamisine, amikasine ve tobramisine 40%; trimethoprim sulfamethoxazole, imipeneme, meropeneme ve tigesikline 20% şeklinde idi.
Sonuç: Çalışmamız, A. baumannii’nin yüksek antibiyotik direncine sahip olduğunu göstermektedir. Ayrıca A. lwoffii’de artan bir antibiyotik direnç profili görülmektedir. Tigesiklin en duyarlı antibiyotikken, onu amikasin ve tobramisin izlemektedir.
Sonuç: Yeni antibiyotiklere, antibiyotik duyarlılık profillerine çabuk erişim olanağına ve ampirik tedavide doğru antibiyotiklerin seçimine ihtiyaç vardır.

Anahtar Kelimeler

• bakteriyemi
• ilaç direnci
• acinetobacter baumannii
• yoğun bakım üniteleri

Antibiotic Resistance Profile of Acinetobacter Species Isolated from Blood Cultures of Inpatients in Harran University Hospital

Öz

Objectives: Acinetobacter baumannii causes serious blood stream infections especially in immunocompromised and hospitalized patients. In this study, the distribution of antibacterial resistance among 92 A. baumannii isolates and 5 A. lwoffii isolates from blood cultures collected at Harran University Hospital (Urfa, Turkey) from 2017 to 2019 was investigated. Methods: Blood cultures were followed up in Versa-TREK (Trek Diagnostic System, USA) device; Passages were made to 5% blood agar and eosin methylene blue (EMB) agar. Passaged bacteria colonies were identified by MALDI-TOF MS (Bruker, Germany) and VITEK 2 compact system (bioMérieux, France). Sensitivities of Acinetobacter strains to meropenem, ciprofloxacin, amikacin, gentamicin, tobramycin, tigecycline and trimethoprim-sulfamethoxazole were tested by VITEK 2 compact system (bioMérieux, France). The results were evaluated by VITEK 2 device based on EUCAST's guide. Results: The antibiotic resistance rates of A. baumannii strains are as follows; ciprofloxacin 92%, imipenem %88, meropenem 88%, gentamicin 74%, tobramycin 67%, trimethoprim-sulfamethoxazole 63%, amikacin 53%, and tigecycline 10%. The resistance ratio of A. lwoffii strains are ciprofloxacin (40%), gentamicin 40%, amikacin 40%, tobramycin 40%, trimethoprim sulfamethoxazole 20%, imipenem %20, meropenem 20% and tigecycline 20%. Conclusions: Our study suggests A. baumannii strains have high resistance ratios to available antibiotics. A. lwoffii also has an increasing resistance profile. Tigecycline is the most sensitive antibiotic, followed by amikacin and tobramycin. New antibiotics, rapid access to antibiotic sensitivity results and correct selection of empiric antibiotics has clinical importance.

Anahtar Kelimeler

• bacteremia
• intensive care units
• drug resistance
• acinetobacter baumannii

Kaynakça

1. Referans1 Lin MF, Lan CY. Antimicrobial resistance in Acinetobacter baumannii: from bench to bedside. World J. Clin. Cases. 2014;2:787–814. doi: 10.12998/wjcc.v2.i12.787
2. Referans2 Yıldız O. Çoğul Dirençli Gram-Negatiflerde Tedavi Yaklaşımı Acinetobacter Türleri. Yoğun Bakım Dergisi, 2007;7(1):144-150.
3. Referans3 Fournier PE, Richet H. The epidemiology and control of Acinetobacter baumannii in health care facilities. Clin Infect Dis. 2006;42:692–699 doi: 10.1086/500202
4. Referans4 https://www.who.int/news/item/27-02-2017-who-publishes-list-of-bacteria-for-which-new-antibiotics-are-urgently-needed
5. Referans5 Ayobami O, Willrich N, Suwono B, Eckmanns T and Markwart R. The epidemiology of carbapenem-non-susceptible Acinetobacter species in Europe: analysis of EARS-Net data from 2013 to: Antimicrobial Resistance & Infection Control. 2020;9:89 doi: 10.1186/s13756-020-00750-5
6. Referans6 Cisneros J, Rodríguez-Baño J. Nosocomial Bacteremia Due To Acinetobacter baumannii: Epidemiology, Clinical Features and Treatment. Clinical Microbiology and Infection. 2002;8(11):687-693. doi: 10.1046/j.1469-0691.2002.00487.x.
7. Referans7 Uzun B, Güngör S, Yurtsever SG, Afşar İ, Demirci M. Evalution of Resistance to Various Antibiotics in Pseudomonas aeruginosa and Acinetobacter baumannii Strains Isolated from Blood Cultures of Intensive Care Patients. ANKEM Derg; 2012;26(2):55-60. doi:10.5222/ankem.2012.055
8. Referans8 Taşçı L, Güreser AS, Boyacıoğlu Zİ, Karasartova D, Özkan AT. Microorganisms Isolated from Blood Cultures and Their Antimicrobial Susceptibility in Hitit University Corum Training and Research Hospital. FLORA. 2016; 21(1):27-32.

9. Referans9 Demirdal T. Acinetobacter Infections: Microbiological Diagnosis and Resistance. Flora; 2010;15(4):137-146.
10. Referans10 Marra AR, Camargo LFA, Pignatari ACC, Teresa Sukiennik, Behar PRP, Medeiros EAS et al. Nosocomial Bloodstream Infections in Brazilian Hospitals: Analysis of 2,563 Cases from a Prospective Nationwide Surveillance Study. J Clin Microbiol, 2011;49(5): 1866–1871. doi: 10.1128/JCM.00376-11. Epub 2011 Mar 16.
11. Referans11 Ulu-Kılıç A, Ergönül Ö, Çelikbaş AK, Dokuzoğuz B. Predictors of mortality in Acinetobacter baumannii bacteremia. Klimik Dergisi. 2011;24: 162-166. doi:10.5152/kd.2011.40
12. Referans12 Çolakoğlu Ş, Alışkan HE, Göçmen JS. The Antibiotic Susceptibility Profile of Acinetobacter baumannii and Pseudomonas aeruginosa Strains Isolated from the Blood Cultures (2012-2014). Türk Mikrobiyol Cem Derg, 2014;44(4):132-138. doi:10.5222/TMCD.2014.132
13. Referans13 Ghajavand H, Esfahani BN, Havaei A, Fazeli H, Jafari R, Moghim S. Isolation of bacteriophages against multidrug resistant Acinetobacter baumannii. Res Pharm Sci. 2017;12:373–380. doi: 10.4103/1735-5362.213982.
14. Referans14 Coşkun USŞ. Distribution of Microorganisms in Blood Cultures and Their Antibiotic Resistance. Ankem Derg. 2018;32(2):45-52. doi: 10.5222/ankem.2018.045
15. Referans15 Şirin MC, Ağuş N, Yılmaz N, Bayram A, Hancı S, Şamlıoğlu P ve ark. Microorganisms isolated from blood cultures of the patients in intensive care units and their antibiotic susceptibilities. Turk Hij Den Biyol Derg. 2017;74(4): 269-278. DOI ID : 10.5505/TurkHijyen.2017.94899
16. Referans16 Türk Dağı H, Arslan U, Tuncer İ. Antibiotic resistance of Acinetobacter baumannii strains isolated from blood cultures. ANKEM Derg. 2011;25(1):22-26. doi:10.5222/ankem.2011.22
17. Referans17 Liu J, Wang F, Ho M, Chen L, Liu J, Wang J et al. In vitro activity of aminoglycosides against clinical isolates of Acinetobacter baumannii complex and other nonfermentative Gram-negative bacilli causing healthcare-associated bloodstream infections in Taiwan. Journal of Microbiology, Immunology and Infection. 2016;49(6) 918-923. doi: 10.1016/j.jmii.2015.07.010.
18. Referans18 Zhang Z, Chen M, Yu Y, Pan S, Liu Y. Antimicrobial susceptibility among gram-positive and gram-negative blood-borne pathogens collected between 2012-2016 as part of the Tigecycline Evaluation and Surveillance Trial. Antimicrobial Resistance & Infection Control. 2018;7(152). doi: 10.1186/s13756-018-0441-y.
19. Referans19 Alagesan M, Gopalakrishnan R, Panchatcharam SN, Dorairajan S, Ananth TM, venkatasubramanian R. A decade of change in susceptibility patterns of Gram-negative blood culture isolates: a single center study. Germs. 2015;5(3): 65–77. doi: 10.11599/germs.2015.1073.
20. Referans20 Public Health England. Laboratory surveillance of Acinetobacter spp. bacteraemia in England, Wales and Northern Ireland: 2018. Health Protection Report. 2019;13(21).
21. Referans21 Tega L, Raieta K, Ottoviani D, Russo GL, Blanco G, Carraturo A. Catheter-related bacteremia and multidrug-resistant Acinetobacter lwoffii. Emerg Infect Dis. 2007;13(2):355. doi: 10.3201/eid1302.060858
22. Referans22 The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. 2020;Version 10.0: 29-33.
23. Referans23 Girardello R, Cury AP, Franco MRG, Gióia TRD, de Almeida Jr JN, de Araujo MRE et al. Colistin susceptibility testing and Vitek-2™: is it really useless? Diagn Microbiol Infect Dis. 2018;91(4):309-311. doi: 10.1016/j.diagmicrobio.2018.03.019.
24. Referans24 Vourli S, Dafopoulou K, Vrioni G, Tsakris A, Pournaras S. Evaluation of two automated systems for colistin susceptibility testing of carbapenem-resistant Acinetobacter baumannii clinical isolates. Journal of Antimicrobial Chemotherapy. 2017;72(9), 2528–2530. doi: 10.1093/jac/dkx186.