Treatment Combinations and Prognosis in Multiple Resistant Acinetobacter baumannii and Carbapenem Resistant Klebsiella pneumonıae/oxytoca Isolates

Öz

Multi-drug-resistant (MDR) gram-negative bacterial infections are one of the most important causes of prolonged hospitalization and mortality in patients followed up in the İntensive Care Unit (ICU). In our study, we retrospectively scanned the blood and tracheal aspirate cultures (TAC) of patients hospitalized in the ICUs of our hospital. We investigated the effects of demographic characteristics, comorbid conditions, treatment combinations and time of treatment on survival of 83 patients with MDR Acinetobacter baumannii and Klepsiella pneumoniae/oxytoca strains in culture samples from 450 cases. Of the patients, 48 (57.83%) were male, and 35 (42.17%) were female. Of all cases, the average age (years) was average±SD (Min-Max), 76.24±13 (23-96). Length of stay in intensive care, the average (day) was 25.61±19.1 (1-107). Cerebrovascular Dısease (CVD) was the most common (20%) comorbidity. A. baumannii was grown in 31 (37.3%) patients, K. pneumoniae was grown in 50 (60.3%) patients, and K. oxytoca was grown in 2 (2.4%) patients. Age (p=0.793), sex (p=0.429), length of hospital stay (p=0.097), number of comorbidities (p=0.553), treatment combinations (p=0.727), pathogen type (p=0.622), growth in blood culture and/or TAC (p=0.369), there was no statistically significant difference indicating that factors such as increased mortality. It was observed that intubation (p=0.004) and duration of treatment of 7 days or less (p=0.001) significantly reduced survival. In the treatment of MDR Acınetobacter and Klebsıella, ıntubatıon and duratıon of treatment affected survıval, but than combınatıon.

Anahtar Kelimeler

• multiple resistance
• carbapenem resistant
• acinetobacter baumannii
• klebsiella pneumoniae/oxytoca
• colimycin
• tigecycline

Kaynakça

1. References 1. Souli M, Gallani I, Giamarellou H. Emergence of extensively drug resistant and pan-drug resistant Gram negative bacilli in Europe. Eurosurveillance 2008, 13 (47):20.
2. 2. Akçam FZ. Karbapenem Dirençli Enterobakteriler:Nasıl Başa Çıkılır? FLORA 2019;24(2):75-86.
3. 3. Temel A, Eraç B. Küresel bir tehdit: Acinetobacter baumannii, antimikrobiyal dirençte güncel durum ve alternatif tedavi yaklaşımları. Turk Hij Den Biyol Derg, 2020; 77(3): 367-378
4. 4. Sheu CC, Chang YT, Lin SY, et al. Infections caused by carbapenem-resistant Enterobacteriaceae: An update on therapeutic options. Front Microbiol. 2019;10:80.
5. 5. Bal Ç. Beta-laktamazlar: güncel durum. FLORA 2003;8:111-23.
6. 6. Usluer G. Çoklu dirençli patojenler: epidemiyoloji ve kontrol. FLORA 2002;7:135-41.
7. 7. Logan LK, Weinstein RA. The epidemiology of carbapenem- resistant enterobacteriaceae: the impact and evolution of a global menace. J Infect Dis 2017;215:28-36.
8. 8. Eser F, Yılmaz GR, Güner R, Koçak Tufan Z, Güven T, Açıkgöz ZC ve ark. Karbapenem dirençli Enterobacteriacae infeksiyonları: risk faktörleri. Akd Tıp D 2018;2:144-51.

9. 9. Wroblewska MM, Rudnicka J, Marchel H, Luczak M. Multidrug-resistant bacteria isolated fram patients hospitalised in intensive care units. Int J Antimicrob Agents 2006; 27: 285-9.
10. 10. Akan Ö, Uysal S. Çoklu Dirençli Acınetobacter baumannıı ve Karbapenem Dirençli Klebsıella pneumonıae İzolatlarında Tigesiklinin İn Vitro Etkinlik Durumu. MİKROBİYOL BÜL 2008; 42: 209-215.
11. 11. Dizbay M, Tunccan OG, Karasahin O, Aktas F. Emergence of carbapenem resistant Klebsiella spp. infections in a Turkish university hospital: Epidemiology and risk factors J Infect Dev Ctries 2014; 8 (1):44-9.
12. 12. Tijet N, Sheth PM, Lastovetska O, Chung C, Patel SN, Melano RG. Molecular characterization of Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae in Ontario, Canada, 2008-2011. PloS One 2014;9(12):e116421.
13. 13. Clinical and Laboratuary Standards Institute. 2010. Performance standards for antimicrobial susceptibility testing: 20th informational supplement document M100-S20. Wayne PA: Clinical and Laboratory Standards Institute CLSI, (2010).
14. 14. Paul M, Carmeli Y, Durante-Mangoni E. Combination therapy for carbapenem resistant Gram-negative bacteria. J Antimicrob Chemother 2014;69(9):2305-9.
15. 15. Lee GC, Burgess DS. Treatment of Klebsiella pneumoniae carbapenemase (KPC) infections: a review of published case series and case reports. Ann Clin Microbiol Antimicrob 2012; 13:11:32.
16. 16. Bacakoğlu F, Korkmaz Ekren P, Taşbakan MS, Başarık B, Pullukçu H, Aydemir Ş, Gürgün A, Kaçmaz Başoğlu Ö. Solunumsal Yoğun Bakım Ünitesinde Çoklu Antibiyotik Dirençli Acınetobacter Baumannıı Enfeksiyonu. Mikrobiyol Bul 2009; 43: 575-585.
17. 17. Doi Y, Husain S, Potoski BA, McCurry KR, Paterson DL. Extensively drug-resistant Acinetobacter baumannii. Emerg Infect Dis 2009; 15(6): 980-2.
18. 18. Joly-Guillou ML. Clinical impact and pathogenicity of Acinetobacter. Clin Microbiol Infect 2005; 11(11):868-73.
19. 19. Towner KJ. Acinetobacter: an old friend, but a new enemy. J Hosp Infect 2009; 73(4): 355-63.
20. 20. Kuzucu Ç, Yetkin F, Görgeç S, Ersoy Y. Genişlemiş Spektrumlu Beta-Laktamaz Üreten Escherichia coli ve Klebsiella spp. Suşlarının Ertapenem ve Diğer Karbapenemlere Karşı Duyarlılıklarının Araştırılması. Mikrobiyol Bul 2011; 45(1): 28-35.
21. 21. Park Jin Ju, et al. Colistin monotherapy versus colistin-based combination therapy for treatment of bacteremia in burn patients due to carbapenem-resistant gram negative bacteria. https://doi.org/10.1016/j.burns.2020.06.014
22. 22. M. Paul, G.L. Daikos, E. Durante-Mangoni, D. Yahav, Y. Carmeli, Y.D. Benattar, et al. Colistin alone versus colistin plus meropenem for treatment of severe infections caused by carbapenem-resistant Gram-negative bacteria: an open-label, randomised controlled trial. Lancet Infect Dis, 18 (2018), pp. 391-400
23. 23. Gölboyu B, Dülgeroğlu O, Ekinci M, Baysal p, Kenan Murat3 Yoğun bakım ünitesinde çoklu ilaç dirençli Acinetobacter Baumanni enfeksiyonu gelişiminde rol oynayan predispozan faktörler. Tepecik Eğit. ve Araşt. Hast. Dergisi 2015; 25(3):157-164.