Distribution of Microorganisms and Antibiotic Resistance Rates Isolated From Blood Cultures: 5-Year Evaluation in a University Hospital in Northern Cyprus

Abstract

Objective: Bloodstream infections (BSI) are considered to be the most important cause of morbidity and mortality. The main purpose of this study is to examine the distribution of microorganisms in blood cultures and the rates of antimicrobial resistance. Method: Microorganisms isolated from 7.866 blood cultures which were sent to our laboratory between January 2016-December 2020 were retrospectively evaluated. Blood culture bottles were incubated in BACTEC 9120 system. Blood samples were taken from the bottles with a sterile syringe and cultured on Eosin-Methylene Blue (EMB) and 5% sheep blood agars if there was a positive signal. The cultivated cultures were left to incubate at 35°C for 24-48 hours. VITEK 2 compact automated system was used for identification and antibiotic susceptibility tests (AST). Results: Reproduction was detected in 691 (8.8%) of blood cultures. There were 56.7% gram-negative, 42.7% gram-positive bacteria and 0.6% Candida species. The most common bacteria isolated are; coagulase negative staphylococci (CNS) (21.1%), Escherichia coli (15.2%), Klebsiella pneumoniae (11.9%) and Staphylococcus aureus (11.4%). The rate of ESBL-Escherichia coli increased in 2020, but this was not statistically significant (p=0.188). ESBL-Klebsiella pneumoniae species showed a significant increase over the years and reached the highest level (69.6%) in 2019. MDR (multi drug resistance) rate for Pseudomonas aeruginosa was determined as 13%. MDR rate for Acinetobacter baumannii was determined as 97%. The rate of methicillin resistant Staphylococcus aureus among patients is 30.4%. Conclusion: It is critical to determine microorganisms and their antibiotic susceptibilities as soon as possible in BSI. Active surveillance systems help manage the BSI.

Keywords

• Blood culture
• infection
• antimictobial susceptibility
• resistant
• Northern Cyprus

Kan Kültürlerinden İzole Edilen Mikroorganizmaların Dağılımı ve Antibiyotik Direnç Oranları: Kuzey Kıbrıs’ta Bir Üniversite Hastanesindeki 5 Yıllık Değerlendirme

Abstract

Amaç: Kan dolaşımı enfeksiyonları (KDE), morbidite ve mortalitenin en önemli nedeni sayılmaktadır. Bu çalışmada, kan kültürlerinde üreyen mikroorganizmaların dağılımını ve antimikrobiyal direnç oranlarını incelemek amaçlanmıştır. Yöntem: Yakın Doğu Üniversitesi (YDÜ) Hastanesi, Mikrobiyoloji Laboratuvarı’na Ocak 2016-Aralık 2020 tarihleri arasında gönderilen 7.866 kan kültüründen izole edilen mikroorganizmalar retrospektif olarak değerlendirmeye alınmıştır. Kan kültür şişeleri BACTEC 9120 otomatize sisteminde inkübe edilmiştir. İnkübasyon sırasında pozitif sinyal elde edilmesi halinde, steril enjektörle kan kültür şişelerinin içerisinden örnek alınarak Eosin-Methylene Blue (EMB) ve %5 koyun kanlı agarlara ekimleri yapıldı. Ekimi yapılan kültürler 24-48 saat süresince 35°C’de etüvde inkübasyona bırakıldı. Üreme saptanan kültürlerdeki mikroorganizmaların identifikasyon ve antibiyotik duyarlılık testleri (ADT) için VİTEK 2 (Biomerieux) kompakt otomatize sitemi kullanıldı. Bulgular: Kan kültürlerinin 691 (%8.8)’inde üreme saptanmıştır. İzole edilen mikroorganizmaların 392 (%56.7)’sini gram negatif bakteriler, 295 (%42.7)’ini gram pozitif bakteriler ve 4 (%0.6)’ünü ise Candida türleri oluşturmaktadır. En sık izole edilen bakteriler sırasıyla; Koagülaz negatif stafilokoklar (KNS) (%21.1), E. coli (%15.2), K. pneumoniae (%11.9), Staphylococccus aureus (%11.4) idi. E. coli dağılımına bakıldığı zaman GSBL oranı 2020 yılında artış göstermiştir fakat bunun istatistiksel olarak anlamlı olmadığı anlaşılmıştır (p=0.188). GSBL pozitif K. pneumoniae türleri ise yıllar içerisinde anlamlı derecede artış göstermiş ve 2019 yılında en yüksek (%69.6) seviyeye ulaşmıştır. Pseudomonas aeruginosa için ÇİD (çoklu ilaç dirençli) oranı %13 olarak belirlenmiştir. Acinetobacter baumannii için MDR oranı ise %97 olarak bulunmuştur. Hastalarımız arasındaki metisilin dirençli Staphylococccus aureus (MRSA) oranı %30.4’dür. Sonuç: KDE’dan izole edilen mikroorganizmaların ve duyarlılıklarının en kısa sürede belirlenmesi kritik öneme sahiptir. Ayrıca, aktif sürveyans sistemleri KDE’nın yönetimine yardımcı olmaktadır.

Keywords

• Kan kültürü
• enfeksiyon
• antimikrobiyal duyarlılık
• direnç
• Kuzey Kıbrıs

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