Antibiotic Susceptibility Pattern And Clinical Features Of Klebsiella Sepsis: An 8-Year Single- Center Experience At Tertiary In Neonatal Intensive Care Unit

Öz

Aim: We aimed to investigate predisposing factors of neonatal sepsis caused by klebsiella strains, clinical features of these cases and antibiotic susceptibility patterns.Materials and Methods: The cases with klebsiella sepsis in the neonatal intensive care unit between 2005 and 2012 were retrospectively analyzed. Demographic and clinical characteristics of the patients were recorded together with their microbiological results.Results: 32 girls 54.2% and 27 boys 45.8% were included in the study. Out of 59 neonates, 46 cases 78% were preterm. Mean gestational age was 33.2±4.3 weeks minimum-maximum: 24-42 weeks ; the birth weight was 1968±794 g minimum-maximum: 730-4000 g . Isolated pathogens from blood cultures were mainly K. pneumoniae n:48, 81% , K. oxytoca n:6, 10% , K. terrigena n:3, 5% and K. ornithinolytica n:2, 4% . The primary diagnoses of the patients were prematurity and respiratory distress syndrome n:17, 29% , severe congenital heart disease n:11, 18% , necrotizing enterocolitis n:8, 13% and major congenital anomaly n:6, 10% . In total, 53 patients 90 % went through more than 2 invasive procedures prior to the development of bacteremia. The mortality rate due to klebsiella infection was found to be 19%. The most effective antibiotics against klebsiella strains were meropenem 97% and ciprofloxacin 91% . Resistance rates were found to be 86% against piperacillin, 85% against ceftazidime, 91% against ceftriaxone and 95% against cephaperozone. 50% of klebsiella strains were resistant to gentamicin and approximately 30% was resistant to amikacin and trimethoprim-sulfamethoxazole.Conclusion: Klebsiella infections associated with health care are mainly caused by K. pneumoniae. Low birth weight, early gestational weeks, invasive interventions and underlying severe illnesses are predisposing newborns to klebsiella infections. Multidrug resistance seems a major problem. Mortality is related to the underlying primary disease.

Anahtar Kelimeler

• Klebsiella,sepsis,newborn,treatment,multi-drug resistance,mortality

Klebsiella Sepsisinin Klinik Özellikleri ve Antibiyotik Duyarlılık Paterni: Üçüncü Düzey Bir Yenidoğan Yoğun Bakım Ünitesindeki 8 Yıllık Deneyimlerimiz

Öz

Amaç: Klebsiella suşlarına bağlı neonatal sepsisdeki predispozan faktörleri, bu olguların klinik özelliklerini ve elde edilen antibiyotik duyarlılık paternlerini araştırmayı amaçladık.Gereç ve Yöntem: 2005-2012 yılları arasında yenidoğan yoğun bakım ünitesinde yatırılarak izlenmiş olan ve kanıtlanmış klebsiella sepsisi tanısı alan olgular geriye dönük olarak incelendi. Hastaların demografik ve klinik özellikleri ile mikrobiyolojik sonuçları kaydedildi.Bulgular: Çalışmaya alınan 59 olgunun 32’si %54.2 kız, 27’si %45.8 erkekti. Olguların 46’sı %78 preterm doğmuştu. Ortalama gebelik yaşı 33.2±4.3 hafta minimum- maksimum: 24-42 hafta ; doğum ağırlığı 1968±794 gr minimum-maksimum: 730-4000 gr idi. Kan kültürlerinden izole edilen etkenlerin başlıca K. pneumoniae n:48, %81 , K. oxytoca n:6, %10 , K. terrigena n:3, %5 ve K. ornithinolytica n:2, %4 olduğu belirlendi. Hastaların primer tanıları preterm ve respiratuar distres sendromu n:17, %29 , ciddi konjenital kalp hastalığı n:11, %18 , nekrotizan enterokolit n:8, %13 ve major konjenital anomali n:6, %10 idi. Bakteriyemi gelişmeden önce olguların 53’üne %90 ikiden fazla invaziv girişim uygulanmıştı. Klebsiella enfeksiyona bağlı mortalite oranının %19 olduğu saptandı. Klebsiella suşlarına karşı en etkili antibiyotikler meropenem %97 ve siprofloksasin %91 idi. Direnç oranlarının piperasiline karşı %86, seftazidime karşı %85, seftriaksona karşı %91, sefaperozona karşı ise %95 olduğu belirlendi. Klebsiella suşlarının %50’si gentamisine dirençli, yaklaşık %30’u ise amikasin ve trimetoprim-sulfametoksazole dirençliydi.Sonuç: Sağlık hizmeti ile ilişkili klebsiella enfeksiyonlarına başlıca K. pneumoniae neden olmaktadır. Düşük doğum ağırlığı, erken gebelik haftalarında doğum, invaziv girişimler ve altta yatan ciddi hastalıklar yenidoğanda klebsiella enfeksiyonlarına yatkınlık oluşturmaktadır. Günümüzde çoklu ilaç direnci önemli bir sorun olmaktadır. Mortalite sepsis ile beraber altta yatan primer hastalık ile ilişkilidir.

Anahtar Kelimeler

• Klebsiella,sepsis,yenidoğan,tedavi,çoklu ilaç direnci,mortalite

Kaynakça

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