ÇEŞİTLİ HASTA ÖRNEKLERİNDEN SOYUTULAN STREPTOCOCCUS PNEUMONIAE KÖKENLERİNDE ANTİBİYOTİK DİRENÇ ORANLARI: RETROSPEKTİF DEĞERLENDİRME (2006-2007)

Öz

Bu çalışmada, 2006 ve 2007 yıllarında, İzmir Dr. Suat Seren Göğüs Hastalıkları ve Cerrahisi Eğitim ve Araştırma Hastanesi Mikrobiyoloji Laboratuvarında soyutulan S. pneumoniae kökenlerinin penisilin ve diğer antibiyotiklere karşı direnç oranları araştırıldı ve retrospektif olarak değerlendirildi. Kültür sonucu S. pneumoniae olarak saptanan toplam 246 örnek (121 balgam, 95 bronş aspirasyon, 11 derin trakeal aspirasyon, 11 plevra, 4 hemokültür, 3 BAL, ve 1 boğaz) değerlendirmeye alındı. Kısaca, her örnek için mikroskopik boyalı inceleme, kültür ve antibiyogram işlemleri yapıldı. Penisilin duyarlılığının değerlendirmesinde, disk difüzyon yöntemiyle oksasilin duyarlılığı incelendi. Oksasilin dirençli (zon çapı ≤19 mm) olan örnekler, penisilin yönünden E-test yöntemiyle MİK değerlerinin saptanması için çalışmaya alındı. Penisilin MİK değerleri ≤0.06 µg/mL olan kökenler duyarlı, 0.12-1.0 µg/mL olan kökenler orta duyarlı (düşük düzey dirençli) ve ≥2.0 µg/mL olan kökenler yüksek düzey dirençli olarak kabul edildi. Toplam 246 S. pneumoniae kökeninde disk difüzyon yöntemiyle 138 köken (%56) penisiline duyarlı (oksasilin zon çapı ≥20 mm) iken, 108 kökende (%44) oksasilin zon çapı ≤19 mm olarak bulundu. MİK değerleri araştırılan toplam 108 kökende, 97 köken (%39.5) orta duyarlı (düşük düzey dirençli) (MİK 0.06- 1 µg/mL), 11 köken (%4.5) ise yüksek düzey penisilin dirençli (MİK ≥ 2.0 µg/mL) olarak bulundu. Diğer antibiyotiklere karşı direnç oranları eritromisin, klindamisin, trimetoprim/sulfometksazol, tetrasiklin, kloramfenikol ve kinolonlar için sırasıyla, %35.1, %29.9, %62.0, %20.1, %6.3 ve %11.3 olarak saptandı. Sonuç olarak, bu verilere göre hastanemizde genel olarak penisilin ve diğer antibiyotiklere direnç oranları literatürde bildirilen direnç oran aralıkları içerisinde saptandı. Ancak, bizim hastanemiz açısından penisiline düşük düzey dirençli kökenlerin artmakta olduğu, yüksek düzey direnç oranında (yak.%4-5) ise anlamlı bir değişme olmadığı görüldü. Penisilin dışındaki antbiyotiklerde ise, hastanemizde soyutulan kökenlerde kinolon direnci (%11.3) diğer çalışmalardan daha yüksek olarak değerlendirildi. Bu bulgulara göre, artan penisilin direnci ve alternatif sağaltımlarda seçilecek ilaçların daha doğru bir şekilde uygulanabilmesi için antibiyotik duyarlılık testlerinin yapılması ve riskli olgularda sağaltım etkinliğinin izlenmesi gerekmektedir.

Anahtar Kelimeler

• Streptococcus pneumoniae, penisilin direnci, antibiyotik duyarlılığı, minimal inhibisyon konsantrasyonu (MİK)

ANTIBIOTIC RESISTANCE RATES OF S. PNEUMONIA ISOLATES RECOVERED FROM VARIOUS CLINICAL SAMPLES: A RETROSPECTIVE EVALUATION (2006-2007)

Abstract

In this study, investigation and retrospective evaluation of penicillin and antibiotic resistances against S. pneumoniae strains isolated in the Microbiology Laboratory of Izmir Training and Research Hospital for Chest Diseases in the years 2006 and 2007 was intended. A total of 246 samples (121 sputum, 95 bronchial aspiration, 11 deep tracheal aspiration, 11 pleural fluids, 4 hemoculture, 3 BAL and 1 throat swab) were taken into the evaluation. Briefly, microscopic evaluation, culture and in vitro antibiotic susceptibility testing were performed for each sample. Initially, oxacillin susceptibility with disc diffusion method was evaluated in giving penicilin susceptibility report. Penicilin resistance of the samples resistant to oxacillin (zone diameter ≤19 mm), were analyzed by E-test to investigate the penicilin MIC values. Penicilin MIC values of the isolates which were found as ≤0.06 µg/mL, 0.12-1.0 µg/mL and ≥2.0 µg/mL were accepted as susceptible, intermediate sensitive (low level penicillin resistant) and high level penicillin resistant, respectively. Among 246 S. pneumoniae isolates, 138 isolates (56%) were penicillin susceptible (oxacillin zone diameter ≥20 mm) whereas; zone diameters of 108 isolates (44%) were found as ≤19 mm. Investigating the MIC values of these 108 isolates, 97 (39.5%) were intermediate susceptible (low level resistant), 11 (4.5%) were high level resistant to penicilin. Resistance rates for the other anti-microbials such as erythromycin, clindamycin, trimethophrim/sulfamethoxazole, tetracycline, chloramphenicol and quinolones were found as 35.1%, 29.9%, 62.0%, 20.1%, 6.3% and 11.3%, respectively. In conclusion, resistance rates against penicillin and other antibiotics in our hospital were generally evaluated within the ranges of resistance rates previously reported in the literature. However, low level penicillin resistance has been increasing whereas high level resistance rate was seemed to keep the same amount (app.4-5%) previously reported for our hospital. For the antibiotics other than penicillin, quinolone resistance (11.3%) in pneumococci isolated in our hospital was evaluated as higher than the rate previously reported from the other studies in our country. According to these findings and because of increasing pencillin resistance, in vitro antibiotic susceptibility testing and follow-up of antibiotic treatment in patients having risk factors for efficiency are necessary for selecting and application of accurate alternative drugs instead.

Keywords

• Streptococcus pneumoniae, penicillin resistance, antibiotic susceptibility, minimal inhibitory concentration (MIC)

Kaynakça

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