Klinik örneklerden izole edilen beta-hemolitik streptokok suşları, özellikleri ve antibiyotik duyarlılığı

Yıl 2020, , 38 - 42, 02.01.2020

Çiğdem Arabacı , Kenan Ak

https://doi.org/10.28982/josam.672119

Öz

Amaç: Beta Hemolitik Streptococcus (BHS) türleri, idrar yolu enfeksiyonu, cilt/yumuşak doku enfeksiyonları, tonsillofarenjit gibi üst solunum yolu enfeksiyonları, yenidoğanda menenjit, sepsis ve pnömoni gibi birçok enfeksiyonda rol oynar. Bu çalışmanın amacı klinik örneklerden izole edilen BHS türlerini, enfeksiyon özelliklerini ve antibiyotik duyarlılık profillerini belirlemektir.

Yöntemler: Laboratuvarımızda Ocak 2014 - Haziran 2019 tarihleri arasında, 1110 (%87) ayaktan ve 166 (%13) yatarak tedavi gören hastadan izole edilen 1276 beta hemolitik streptokok (BHS) suşu, özellikleri ve 320 suşun antimikrobiyal duyarlılığı retrospektif olarak incelendi. Çalışmanın tipi kesitsel çalışmadır. 

Bulgular: Toplam 1276 BHS izolatının; %48,6 grup B, %33,9 grup A, %9,6 grup F, %5,7 grup C ve %2,2 grup G BHS idi. İncelenen BHS enfeksiyonlarının; %42,9'u idrar yolu enfeksiyonu, %34,6'sı tonsillit/tonsillofarenjit, %15,7'si cilt/yumuşak doku enfeksiyonu, %3' ü kan dolaşımı enfeksiyonu ve %1'i menenjit, pnömoni, konjonktivit ve peritonit idi. %2,8 Grup B Streptokok izolatı vajinal kolonizasyon olarak kabul edildi. Hastaların %11,2'sinde birden fazla altta yatan hastalık vardı. Tüm izolatlar penisilin, vankomisin, linezolid ve tigesikline duyarlıydı. Eritromisin, klindamisin ve tetrasiklin direnci Grup A Streptokok ve Grup B Streptokok için sırasıyla %5, %2, %40 ve %34, %11, %90 olarak belirlendi.

Sonuç: Erken tanı ve uygun antibiyoterapi streptokok enfeksiyonlarının tedavisinde önemli parametrelerdir. Beta-hemolitik streptokoklarda penisilin direnci olmasa da, klinik başarısızlıkların varlığı, özellikle Grup B Streptokok 'da penisilin Minimal İnhibitör Konsantrasyonu (MİK) değerlerinin artışı, makrolid ve florokinolon direncinin artması nedeniyle antibiyotik duyarlılığının yakından izlenmesi gerektiğini düşünüyoruz.

Anahtar Kelimeler

Antibiyotik duyarlılığı, Enfeksiyon, Beta hemolitik Streptococcus spp

Destekleyen Kurum

Yok

Teşekkür

Yok

Beta hemolytic Streptococci strains isolated from clinical specimens, their characteristics and antibiotic susceptibility

Öz

Aim: Beta Hemolytic Streptococcus (BHS) species play a role in many infections, such as urinary tract infection, skin/soft tissue infections, neonatal meningitis, sepsis, pneumonia as well as upper respiratory tract infections like tonsillopharyngitis. The aim of this study was to determine the types of BHS species, their infectious characteristics and antibiotic susceptibility profiles in clinical specimens. 

Methods: In this cross-sectional study, infectious features of 1276 streptococcus strains isolated from 1110 (87%) outpatients and 166 (13%) inpatients between January 2014 and June 2019 at our laboratory and antimicrobial susceptibility of the 320 strains were analyzed retrospectively. 

Results: Retrospective analysis of 1276 BHS isolates revealed that 48.6% were group B, 33.9% were group A, 9.6% were group F, 5.7% were group C and 2.2% were group G BHS. Among isolated BHS infections, 42.9% caused urinary tract infection, 34.6% caused tonsillitis/tonsillopharyngitis, 15.7% were isolated from skin/soft tissue infections, 3% were found in the bloodstream, and 1% in meningitis, pneumonia, conjunctivitis, and peritonitis. About 2.8% Group B Streptococcus were considered vaginal colonization. Among all patients, 11.2% had more than one underlying disease. All isolates were susceptible to penicillin, vancomycin, linezolid and tigecycline. Erythromycin, clindamycin, and tetracycline resistance rates were determined as 5%, 2%, 40% respectively for Group A and 34%, 11%, 90%, respectively for Group B Streptococcus.

Conclusion: Early diagnosis and appropriate antibiotherapy are important parameters in the management of streptococcal infections. Although there is no penicillin resistance in beta-hemolytic streptococci, we think that antibiotic susceptibility should be closely monitored due to increasing clinical failures, penicillin Minimal inhibitory concentration (MIC) values, and macrolide and fluoroquinolone resistance, especially in Group B Streptococcus.

Anahtar Kelimeler

Antibiotic susceptibility, Infection, Beta Hemolytic Streptococcus spp

Kaynakça

• 1. Facklam R. What Happened to the Streptococci: Overview of Taxonomic and Nomenclature Changes. Clin Microbiol Rev. 2002;15(4):613–30.
• 2. Oppegaard O, Mylvaganam H, Kittang BR. Beta- haemolytic group A, C and G streptococcal infections in Western Norway: a 15-year retrospective survey. Clin Microbiol Infect. 2015;21:171-7.
• 3. Cossette AC, Carignan A, Mercier A, Desruisseaux, C,Valiquette L, Pe´pin J. Secular trends in incidence of invasive beta hemolytic streptococci and efficacy of adjunctive therapy in Quebec, Canada, 1996- 2016. Plos One. 2018;13(10):e0206289.
• 4. The European Committee on Antimicrobial Susceptibility Testing EUCAST 2018. http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Breakpoint_tables/v_8.1_Breakpoint_Tables.pdf. Accessed 24 Dec 2019.
• 5. Steward CD, Raney PM, Morrell AK, Williams PP, McDougal LK, Jevitt L, et al. Testing for induction of clindamycin resistance in erythromycin resistant isolates of Staphylococcus aureus. J Clin Microbiol. 2005;43(4):1716-21.
• 6. Nelson G, Pondo T, Toews KA, Farley MM, Lindegren ML, Lynfield ML, et al. Epidemiology of Invasive Group A Streptococcal Infections in the United States, 2005–2012. Clin Infec Diseases. 2016:63(4);478-86.
• 7. Hupp JA, Kallstrom G, Myers JP. Streptococcus pyogenes: Review of 68 Episodes Over 10-Year Period in a Large Community Teaching Hospital Bacteremia in Adults in the 21st Century: Review of 68 Episodes Over 10-Year Period in a Large Community Teaching. Infect Dis Clin Pract. 2018;26(1):31–4.
• 8. Takakura S, Gibo K, Takayama Y, Shiiki S, Narita N. Clinical characteristics of Streptococcus pyogenes, Streptococcus agalactiae and Streptococcus dysgalactiae subsp. equisimilis bacteremia in adults: A 15-year retrospective study at a major teaching hospital in Okinawa, Japan. Open Forum Infect Dis. 2017;4(1):559.
• 9. Eren Topkaya A, Balıkçı A, Aydın F, Hasçelik G, Kayman T, Kesli R, et al. Türkiye'de invaziv streptokok enfeksiyonlarının epidemiyolojisi, klinik ve mikrobiyolojik özellikleri: 2010-2011. Mikrobiyol Bul. 2014;48(1):1-13.
• 10. Hoban DJ, Nauta J. Clinical and Bacteriological Impact Of Clarithromycin In Streptococcal Pharyngitis: Findings From A Meta-Analysis Of Clinical Trials. Drug Des Devel Ther. 2019;13:3551-8.
• 11. Ünlü F, Özgenç O, Arı A, Coşkuner SA, Avcı M. Boğaz dışı klinik örneklerden izole edilen streptokok suşları ve oluşturdukları enfeksiyonların özellikleri. Med Bull Haseki. 2017;55:292-8.
• 12. Wang P, Tong JJ, Ma XH, Song FL, Fan L, Guo CM, et al. Serotypes, Antibiotic Susceptibilities, and Multi-Locus Sequence Type Profiles of Streptococcus agalactiae Isolates Circulating in Beijing, China. Plos One. 2015;10(3):e0120035.
• 13. Yılmaz Karadağ F, Hızel K, Gelişen O. Doğum eylemindeki gebelerde Grup B Streptokok kolonizasyonu. J Turk Soc Obstet Gynecol. 2013;10(1):16-20.
• 14. Karadeniz M, Akın Ekmekçioğlu Y, Öztürk R, Tokuç G, Özgüner A. Gebelerde ve yenidoğan bebeklerinde Grup B Streptokok (St. Agalactiae) sıklığının araştırılması. South Clin Ist Euras.1998;9:683-6.
• 15. Shayanfar N, Mohammadpour M, Hashemi-Moghadam SA, Ashtiani MT, Mirzaie AZ, Rezaei N. Group B streptococci urine isolates and their antimicrobial susceptibility profiles in a group of Iranian females: prevalence and seasonal variations. Acta Clin Croat. 2012;51(4):623-6.
• 16. Oppegaard O, Mylvaganam H, Skrede S, Christoffer P, Kittang BR. Emergence of a Streptococcus dysgalactiae subspecies equisimilis stG62647-lineage associated with severe clinical manifestations. Sci Rep. 2017;7:7589.
• 17. Srikala VS, Sharma KK, Ramakrishna N, Katyarmal DT, Jayaprada R. Biochemical and serological characterisation of beta haemolytic streptococci from various clinical samples in a tertiary care hospital, South India. J Clin Sci Res. 2019;8:16-23.
• 18. Shahin AV, Saba M, Greene JN. A Retrospective Chart Review on the Clinical Characteristics and Outcomes of Cancer Patients With Group C, F, or G β-Hemolytic Streptococcal Infections. Infect Dis Clin Pract. 2019;27(4):205-10.
• 19. Gogineni VK, Modrykamien A. Lung Abscesses in 2 Patients With Lancefield Group F Streptococci (Streptococcus milleri Group). Respiratory Care. 2011;56(12):1966-9.
• 20. Bonofiglio L, Gagetti P, García Gabarrot G, Kaufman S, Mollerach M, Toresani I, et al. Susceptibility to β-lactams in β-hemolytic streptococci. Rev Argent Microbiol. 2018;50(4):431-5.
• 21. Seki T, Kimura K, Reid ME, Miyazaki A, Banno H, Jin W, et al. High isolation rate of MDR group B streptococci with reduced penicillin susceptibility in Japan. J Antimicrob Chemother. 2015;70:2725-8.
• 22. Wang YH, Chen CL, Hou JN, Wang YR, Lin TY, Wang MH, et al. Serotype distribution and resistance genes associated with macrolide and fluoroquinolone resistance in Streptococcus agalactiae isolates from a hospital in southern Taiwan. Biomed J. 2015;38(3):215-20.
• 23. Lee WT, Lai MC. High prevalence of Streptococcus agalactiae from vaginas of women in Taiwan and its mechanisms of macrolide and quinolone resistance. J Microbiol Immunol Infect. 2015;48(5):510-6.
• 24. Wang P, Ma Z, Tong J, Zhao R, Shi W, Yu S, et al. Serotype distribution, antimicrobial resistance, and molecular characterization of invasive group B Streptococcus isolates recovered from Chinese neonates. Int J Infect Dis. 2015;37:115-8.