Klinik örneklerden izole edilen Enterococcus faecalis ve Enterococcus faecium suşlarında antibiyotik dirençlerinin değerlendirilmesi: 8 yıllık analiz

Yıl 2025, Cilt: 4 Sayı: 1, 9 - 15, 30.04.2025

Ahmet Mansur , Ayten Gündüz

https://doi.org/10.58651/jomtu.1625684

Öz

Amaç: Enterokoklar gastrointestinal sistem flora elemanlarından olup, gerek hastanede gerekse toplumda endojen kaynaklı enfeksiyonlara neden olurlar. Çoğu enterokok türü aminoglikozidlere ve sefalosporinlere karşı doğal olarak dirençlidir. E. faecium izolatlarının neredeyse tümü ampisiline dirençli olup; kloramfenikol, tetrasiklinler, makrolidler, linkozamidler, glikopeptitler, florokinolonlara karşı yaygın olarak direnç mekanizmaları geliştirmeye devam etmektedirler. Bu çalışmada hastanemiz kliniklerindeki yatan hastalardan mikrobiyoloji laboratuvarına gönderilen farklı kültür örneklerinden izole edilen E. faecalis ve E. faecium suşlarının çeşitli antimikrobiyallere direnç oranlarının retrospektif olarak belirlenmesi amaçlanmıştır.

Materyal ve Metot: Mikrobiyoloji laboratuvarına ocak 2015- Aralık 2022 tarihleri arasında tüm kliniklerden gönderilen yatan hasta kültür örneklerinde üreyen 631 enterokok izolatı (372 E. faecalis ve 259 E. faecium) retrospektif olarak değerlendirilmiştir. İdentifikasyon ve antimikrobiyal duyarlılık testleri (ADT) için Vitek 2 Compact otomatize sistemi (BioMérieux, Fransa) kullanılmıştır. ADT sonuçları Minimum İnhibitör Konsantrasyon (MİK) değerlerine göre European Committee on Antimicrobial Susceptibility Testing (EUCAST) klavuzları ile değerlendirilmiştir. Verilerin istatistiksel analizi için SPSS 17 (SPSS Incorporated, Chicago) programı kullanılmıştır.

Bulgular: E. faecalis ve E. faecium suşları en sık olarak Yoğun Bakım Ünitelerinden (YBÜ) (%61.8) gönderilen örneklerden ve en sık olarak idrar örnekleri (%59.1) ve kan örneklerinden(%30.9) izole edilmiştir. Sekiz yılda izole edilen E. faecalis suşları için vankomisin (%0.5), teikoplanin (%0.5), linezolid (%1.1) ve ampisilin (%1.3); E.faecium suşları için tigesiklin (%3.9) ve linezolid (%4.7) direnç oranı en düşük antimikrobiyaller olarak saptanmıştır.

Sonuç: YBÜ’lerimizde izole edilen enterokok türü çoğunlukla E. faecalis (%59) olduğundan, hastaların kliniğine göre ampisilin veya glikopeptidler öncelikle tercih edilebilecek antimikrobiyallerdir. Linezolid ve tigesiklin ise daha dirençli tür olan E. faecium’un etken olarak izole edildiği enfeksiyonlarda tedavi seçenekleri arasında yer almalıdır. Bu yaklaşım ile antimikrobiyal direnç oranlarının sürekli olarak izlenmesi dirençli izolatlar ile oluşabilecek hastane enfeksiyonlarının önlenmesine katkı sağlayacaktır

Anahtar Kelimeler

Enterococcus faecalis , Enterococcus faecium , Antimikrobiyal direnç

Evaluation of antibiotic resistance in Enterococcus faecalis and Enterococcus faecium strains ısolated from clinical specimens: 8 years of analysis

Öz

Objective: Enterococci are members of the gastrointestinal system flora and cause endogenous infections in the hospital and the community. Most enterococci are naturally resistant to aminoglycosides and cephalosporins. Almost all E. faecium isolates are resistant to ampicillin and continue to develop widespread resistance mechanisms against chloramphenicol, tetracyclines, macrolides, lincosamides, glycopeptides, and fluoroquinolones. This study aimed to retrospectively determine the resistance rates to various antimicrobials of E. faecalis and E. faecium strains isolated from different culture samples sent to the microbiology laboratory from hospitalized patients in our hospital clinics.

Materials and Methods: 631 enterococcal isolates (372 E. faecalis and 259 E. faecium) grown in inpatient culture samples sent to the Microbiology laboratory from all clinics between January 2015 and December 2022 were evaluated retrospectively. Vitek 2 Compact automated system (BioMérieux, France) was used for identification and antimicrobial susceptibility testing (AST). AST results were evaluated according to Minimum Inhibitory Concentration (MIC) values according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. SPSS 17(SPSS Incorporated, Chicago) program was used for statistical analysis of the data.

Results: E. faecalis and E. faecium strains were most frequently isolated from samples sent from Intensive Care Units (ICU) (61.8%) and most frequently from urine samples(59.1%) and blood samples (30.9%). Vancomycin (0.5%), teicoplanin (0.5%), linezolid (1.1%) and ampicillin (1.3%) were found to be the antimicrobials with the lowest resistance rates for E. faecalis strains isolated in eight years; tigecycline (3.9%) and linezolid (4.7%) were found to be the antimicrobials with the lowest resistance rates for E. faecium strains.

Conclusions: Since the majority of enterococcal species isolated in our intensive care units are E. faecalis (59%), the antimicrobials that can be preferred primarily depending on the clinical condition of the patients are ampicillin or glycopeptides. Linezolid and tigecycline should be among the treatment options in infections where the more resistant species E. faecium is isolated as the causative agent. With this approach, continuous monitoring of antimicrobial resistance rates will contribute to the prevention of hospital infections that may occur with resistant isolates.

Anahtar Kelimeler

Enterococcus faecalis , Enterococcus faecium , Antimicrobial resistance

Kaynakça

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