Screening of Rectal Swabs for Carbapenem Non-susceptible Bacteroides fragilis Group Bacteria in Hospitalized Children
Öz
Objective: The aim of this study was to investigate the carbapenem resistance profiles and risk factors for colonization with carbapenem-resistant Bacteroides group CR-B in pediatric patients hospitalized in a tertiary university hospital in Turkey.Material and Methods: A prospective case-control study was performed. Rectal swab specimens n=1361 were collected from 680 hospitalized pediatric patients. All anaerobic colonies isolated from selective medium were identified using MALDI-TOF Vitek MS, bioMérieux automated system and antibiotic susceptibility testing for meropenem by e-test. The presence of the cfiA gene was investigated by PCR method.Results: A total of 1361 rectal swab specimens were collected from all 680 hospitalized children. During the screening period 80 Bacteroides fragilis group BFG microorganisms with a MIC>0.125 mg/L 12% were isolated from rectal swab specimens of 680 patients. Seven different BFG species were recovered, the main species were B.fragilis n=29; 36% , B.ovatus n=16; 20% , B.vulgatus n=13; 16% , P.distasonis n=12; 15% , B.theoiotomicron n=5; 6% , B.uniformis n=4; 5% and B.caccae n=1; 1% . The presence of cfiA gene was detected in 25 31% isolates, while 29 36% isolates were not susceptible to meropenem MIC>2 mg/L . Conclusion: The high carriage rate in our hospitalized children for carbapenem-non-susceptible Bacteroides fragilis group creates a great risk for serious infections and mortality and deserves significant attention
Anahtar Kelimeler
Bacteroides fragilis group carbapenem nonsusceptible children
Kaynakça
- Wexler hm. Bacteroides: the good, the bad, and the nitty-gritty. Clin Microbiol Rev 2007;20:593-621.
- https://doi.org/10.1128/CMR.00008-07
- Snydman dr, Jacobus nV, mcdermott lA, et al. Lessons learned from the anaerobe survey: historical perspective and review of the most recent data (2005- 2007). Clin Infect Dis 2010;50:26-33.
- https://doi.org/10.1086/647940
- Goldstein eJ, finegold Sm, harrell lJ, et al. National survey on the susceptibility of Bacteroides fragilis group: report and analysis of trends in the United States from 1997 to 2004. Antimicrob Agents Chemother 2007;51:1649-55.
- https://doi.org/10.1128/AAC.01435-06
- Nagy E, Urbán E, Nord CE, et al. Antimicrobial sus- ceptibility of Bacteroides fragilis group isolates in Europe: 20 years of experience. Clin Microbiol Infect 2011;17:371-9.
- https://doi.org/10.1111/j.1469-0691.2010.03256.x
- liu cy, huang yt, liao ch, yen lc, lin hy, Hsueh pR. Increasing trends in antimicrobial resis- tance among clinically important anaerobes and Bacteroides fragilis isolates causing nosocomial infec- tions: emerging resistance to carbapenems. Antimicrob Agents Chemother 2008;52:3161-8.
- https://doi.org/10.1128/AAC.00355-08
- Goldstein eJ. Anaerobic bacteremia. Clin Infect Dis 1996; 23:97-101.
- https://doi.org/10.1093/clinids/23.Supplement_1.S97
- Khushi payne tdJ, fosberry A, reading c. Production of metal dependent b-lactamases by clinical strains of Bacteroides fragilis isolated before 1987. J Antimicrob Chemother 1996;37:345-50.
- https://doi.org/10.1093/jac/37.2.345
- The European Committee on Antimicrobial Susceptibility Testing (EUCAST). http://www.eucast. org/fileadmin/src/media/EUCASTfiles/Resistance_ mechanisms/EUCASTdetection_of_resistance_mecha- nisms_v1.0_20131211.pdf
- Kato n, yamazoe K, han cG, ohtsubo e. New insertion sequence elements in the upstream region of cfiA in imipenem-resistant Bacteroides fragilis strains. Antimicrob Agents Chemother 2003;47:979-85.
- https://doi.org/10.1128/AAC.47.3.979-985.2003
- nguyen mh, yu Vl, morris AJ, et al. Antimicrobial resistance and clinical outcome of Bacteroides bacter- emia: findings of a multicenter prospective observa- tional trial. Clin Infect Dis 2000;30:870-6.
- https://doi.org/10.1086/313805
- fernández-canigia l, litterio m, legaria mc, et al. Anaerobe Surveillance Team. First national survey of antibiotic susceptibility of the Bacteroides fragilis group: emerging resistance to carbapenems in Argentina. Antimicrob Agents Chemother 2012;56:1309-14.
- https://doi.org/10.1128/AAC.05622-11
- podglajen I, Breuil J, casin I, collatz e. Genotypic identification of two groups within the species Bacteroides fragilis by ribotyping and by analysis of PCR-generated fragment patterns and insertion sequence content. J Bacteriol 1995;177:5270-5.
- https://doi.org/10.1128/jb.177.18.5270-5275.1995
- Soki J, urban e, Szoke I, fodor e, nagy e. Prevalence of the carbapenemase gene (cfiA) among clinical and normal flora isolates of Bacteroides species in Hungary. J Med Microbiol 2000;49:427-30.
- https://doi.org/10.1099/0022-1317-49-5-427
- edwards r, hawkyard cV, Garvey mt, Greenwood d. Prevalence and degree of expression of the carbap- enemase gene (cfiA) among clinical isolates of Bacteroides fragilis in Nottingham, UK. J Antimicrob Chemother 1999;43:273-6.
- https://doi.org/10.1093/jac/43.2.273
- toprak nu, uzunkaya od, Sóki J, Soyletir G. Susceptibility profiles and resistance genes for carbap- enems (cfiA) and metronidazole (nim) among Bacteroides species in a Turkish University Hospital. Anaerobe 2012;18:169-71.
- https://doi.org/10.1016/j.anaerobe.2011.10.004
- livermore dm, Woodford n. Carbapenemases: a problem in waiting? Curr Opin Microbiol 2000;3:489- 95.
- https://doi.org/10.1016/S1369-5274(00)00128-4
Hastanede Yatan Çocukların Rektal Sürüntülerinde Karbapenem Duyarlı Olmayan Bacteroides fragilis Grup Bakteri Taraması
Öz
Amaç: Bu çalışmanın amacı, Türkiye’de üçüncü düzey bir üniversite hastanesinde yatmakta olan çocuk hastalarda karbapenem dirençli Bacteroides grup KD-B bakteriler ile kolonizasyon için risk faktörlerini ve karbapenem direnç profilini araştırmaktı.Gereç ve Yöntem: Prospektif vaka-kontrol çalışması uygulandı. Hastanede yatmakta olan 680 çocuk hastadan 1361 rektal swab toplandı. Selektif mediumdan izole edilen tüm anaerobik kolonilere identifikasyon için MALDI-TOF Vitek MS, bioMérieux otomatize sistem ve meropenem duyarlılığı için e-test uygulandı. cfiA geni PCR yöntemiyle araştırıldı.Bulgular: Hastanede yatmakta olan 680 çocuk hastadan 1361 rektal swab toplandı. Tarama süresince MIC>0.125 mg/L olan 80 Bacteroides fragilis group BFG bakteri izole edildi. Yedi farklı tür BFG saptandı, sıklık sırasına göre şöyleydi: B.fragilis n=29; %36 , B.ovatus n=16; %20 , B.vulgatus n=13; %16 , P.distasonis n=12; %15 , B.theoiotomicron n=5; %6 , B.uniformis n=4; %5 ve B.caccae n=1; %1 . 25 izolatda %31 cfiA geni saptanırken, meropeneme hassas olmama MIC>2 mg/L 29 izolatda %36 belirlendi.Sonuç: Çalışmamızda, hastanede yatan çocuklarda karbapenem hassas olmayan Bacteroides fragilis grup bakteriler ile kolonizasyon oranları yüksek bulunmuştur ki, bu durum ciddi enfeksiyonların oluşması, artmış mortalite açısından önemlidir ve dikkate alınmalıdır
Anahtar Kelimeler
Kaynakça
- Wexler hm. Bacteroides: the good, the bad, and the nitty-gritty. Clin Microbiol Rev 2007;20:593-621.
- https://doi.org/10.1128/CMR.00008-07
- Snydman dr, Jacobus nV, mcdermott lA, et al. Lessons learned from the anaerobe survey: historical perspective and review of the most recent data (2005- 2007). Clin Infect Dis 2010;50:26-33.
- https://doi.org/10.1086/647940
- Goldstein eJ, finegold Sm, harrell lJ, et al. National survey on the susceptibility of Bacteroides fragilis group: report and analysis of trends in the United States from 1997 to 2004. Antimicrob Agents Chemother 2007;51:1649-55.
- https://doi.org/10.1128/AAC.01435-06
- Nagy E, Urbán E, Nord CE, et al. Antimicrobial sus- ceptibility of Bacteroides fragilis group isolates in Europe: 20 years of experience. Clin Microbiol Infect 2011;17:371-9.
- https://doi.org/10.1111/j.1469-0691.2010.03256.x
- liu cy, huang yt, liao ch, yen lc, lin hy, Hsueh pR. Increasing trends in antimicrobial resis- tance among clinically important anaerobes and Bacteroides fragilis isolates causing nosocomial infec- tions: emerging resistance to carbapenems. Antimicrob Agents Chemother 2008;52:3161-8.
- https://doi.org/10.1128/AAC.00355-08
- Goldstein eJ. Anaerobic bacteremia. Clin Infect Dis 1996; 23:97-101.
- https://doi.org/10.1093/clinids/23.Supplement_1.S97
- Khushi payne tdJ, fosberry A, reading c. Production of metal dependent b-lactamases by clinical strains of Bacteroides fragilis isolated before 1987. J Antimicrob Chemother 1996;37:345-50.
- https://doi.org/10.1093/jac/37.2.345
- The European Committee on Antimicrobial Susceptibility Testing (EUCAST). http://www.eucast. org/fileadmin/src/media/EUCASTfiles/Resistance_ mechanisms/EUCASTdetection_of_resistance_mecha- nisms_v1.0_20131211.pdf
- Kato n, yamazoe K, han cG, ohtsubo e. New insertion sequence elements in the upstream region of cfiA in imipenem-resistant Bacteroides fragilis strains. Antimicrob Agents Chemother 2003;47:979-85.
- https://doi.org/10.1128/AAC.47.3.979-985.2003
- nguyen mh, yu Vl, morris AJ, et al. Antimicrobial resistance and clinical outcome of Bacteroides bacter- emia: findings of a multicenter prospective observa- tional trial. Clin Infect Dis 2000;30:870-6.
- https://doi.org/10.1086/313805
- fernández-canigia l, litterio m, legaria mc, et al. Anaerobe Surveillance Team. First national survey of antibiotic susceptibility of the Bacteroides fragilis group: emerging resistance to carbapenems in Argentina. Antimicrob Agents Chemother 2012;56:1309-14.
- https://doi.org/10.1128/AAC.05622-11
- podglajen I, Breuil J, casin I, collatz e. Genotypic identification of two groups within the species Bacteroides fragilis by ribotyping and by analysis of PCR-generated fragment patterns and insertion sequence content. J Bacteriol 1995;177:5270-5.
- https://doi.org/10.1128/jb.177.18.5270-5275.1995
- Soki J, urban e, Szoke I, fodor e, nagy e. Prevalence of the carbapenemase gene (cfiA) among clinical and normal flora isolates of Bacteroides species in Hungary. J Med Microbiol 2000;49:427-30.
- https://doi.org/10.1099/0022-1317-49-5-427
- edwards r, hawkyard cV, Garvey mt, Greenwood d. Prevalence and degree of expression of the carbap- enemase gene (cfiA) among clinical isolates of Bacteroides fragilis in Nottingham, UK. J Antimicrob Chemother 1999;43:273-6.
- https://doi.org/10.1093/jac/43.2.273
- toprak nu, uzunkaya od, Sóki J, Soyletir G. Susceptibility profiles and resistance genes for carbap- enems (cfiA) and metronidazole (nim) among Bacteroides species in a Turkish University Hospital. Anaerobe 2012;18:169-71.
- https://doi.org/10.1016/j.anaerobe.2011.10.004
- livermore dm, Woodford n. Carbapenemases: a problem in waiting? Curr Opin Microbiol 2000;3:489- 95.
- https://doi.org/10.1016/S1369-5274(00)00128-4
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Ekim 2017 |
| Yayımlandığı Sayı | Yıl 2017 Cilt: 17 Sayı: 4 |