Genişlemiş Spektrumlu Beta-Laktamaz Üreten Enterobacteriaceae İzolatlarına Karşı Seftazidim- Avibaktam’ın in Vitro Etkinliğinin Araştırılması

Öz

Amaç: Tüm dünyada son yıllarda Enterobacteriaceae ailesi üyeleri arasında çoklu ilaç direncine sahip izolatlar artış göstermekte ve enfeksiyonların tedavisinde zorluklara yol açmaktadır. Bu çalışmanın amacı, Genişlemiş Spektrumlu Beta-Laktamaz Üreten ve karbapenem dirençli Enterobacteriaceae izolatlarına karşı seftazidim-avibaktam’ın in vitro etkinliğinin araştırılmasıdır. Yöntem: Çalışmaya, laboratuvarımıza gönderilen çeşitli örneklerden izole edilen, genişlemiş spektrumlu beta-laktamaz üreten 114 Enterobacteriaceae türü dahil edildi. İzolatların tanımlanması ve antimikrobiyal duyarlılıkları otomatize sistemler kullanılarak gerçekleştirildi. İzolatların seftazidim avibaktama duyarlılıklarının saptanması amacıyla CAZ/AV 10/4 mg (Bioanalyse) ile disk difüzyon testi; zon çaplarının değerlendirilmesi için European Committee on Antimicrobial Susceptibility Testing (EUCAST) rehberi kullanılmıştır. Bulgular: Çalışmaya 42 tanesi (%36.8) Escherichiae coli ve 72 tanesi (%63,2) Klebsiella pnemoniae olmak üzere toplam 114 tane Enterobacterales suşu dahil edildi. Suşların %44.7’si idrar örneklerinden izole edilmiştir. Tüm izolatların 67 (%58.8)’si karbapenemlere duyarlı iken, 47 (%41.2)’si karbapenemlere dirençli olarak bulundu. 103 tanesi (%90,4) ceftazidim avibactama duyarlı iken, 11 tanesi (%9,6) dirençli olarak saptandı. Sonuç: Genişlemiş spektrumlu beta-laktamaz üreten veya metallo-β-laktamaz dışında karbapenem dirençli Enterobacteriaceae suşları için mevcut en iyi tedavi seçeneği, mümkün olduğunda ve fiyatın kullanımına izin verdiği durumlarda seftazidime-avibaktamdır.

Anahtar Kelimeler

• Genişletilmiş spekturumlu beta-laktamaz
• karbapenem
• Enterobacteriaceae
• Seftazidim-Avibaktam

Investigation of In Vitro Activity of Ceftazidime-Avibactam against Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae Isolates

Öz

Objectives: In recent years, isolates with multi-drug resistance have increased among Enterobacteriaceae family members all over the world, and has led to difficulties in the treatment of infections. The aim of this study was to investigate the in vitro efficacy of ceftazidime-avibactam against extended spectrum beta-lactamase producing and carbapenem-resistant Enterobacteriaceae isolates. Methods: A total of 114 extended-spectrum beta-lactamase-producing Enterobacteriaceae species isolated from various samples sent to our laboratory were included in the study. Identification and antimicrobial susceptibility of isolates were performed using automated systems. Disc diffusion test with CAZ/AV 10/4 mg (Bioanalyse) to determine the susceptibility of isolates to ceftazidime avibactam; European Committee on Antimicrobial Susceptibility Testing (EUCAST) guideline was used for the evaluation of zone diameters. Results: A total of 114 Enterobacterales strains, 42 (36.8%) Escherichiae coli and 72 (63.2%) Klebsiella pneumoniae, were included in the study. 44.7% of the strains were isolated from urine samples. While 67 (58.8%) of all isolates were susceptible to carbapenems, 47 (41.2%) were found to be resistant to carbapenems. While 103 (90.4%) were susceptible to ceftazidime avibactam, 11 (9.6%) were found to be resistant. Conclusion: Ceftazidime-avibactam is the best available treatment for extended-spectrum beta-lactamase-producing or carbapenem-resistant strains of Enterobacteriaceae other than Metallo-β-lactamase, when available and price permits.

Anahtar Kelimeler

• Extended spectrum beta-lactamase
• carbapenem
• Enterobacteriaceae
• Ceftazidime-Avibactam

Kaynakça

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