Karbapenem Dirençli Enterobacterales Enfeksiyonları ve Rektal Kolonizasyon ile İlişkisi

Yıl 2023, Cilt: 15 Sayı: 3, 313 - 317, 20.10.2023

Özlem Aydemir , Mehmet Köroğlu , Gökçen Ormanoğlu , Tuğba Ayhancı , Yusuf Aydemir , Ertuğrul Güçlü

https://doi.org/10.18521/ktd.1104037

Öz

Amaç: Karbapenem dirençli Enterobacterales (CRE) enfeksiyonlarının tedavi seçenekleri sınırlıdır ve bu enfeksiyonlar yüksek mortalite oranları ile ilişkilidir. CRE ile kolonize olan asemptomatik taşıyıcılar, CRE'nin hastanelerde yayılmasına katkıda bulunur. Bu çalışmada merkezimizde saptanan CRE izolatlarının sıklığının, bu suşlardaki karbapenemaz oranlarının, karbapenemaz genlerinin, antibiyotik direnç profillerinin, rektal CRE kolonizasyon oranlarının belirlenmesi ve CRE enfeksiyonlarının çeşitli klinik özelliklerinin değerlendirilmesi amaçlandı.
Gereç ve Yöntem: Çeşitli örneklerden izole edilen Enterobacterales türleri ve kolonizasyon taraması için gönderilen rektal sürüntü örneklerinden izole edilen Enterobacterales türleri incelenmiştir. Rektal sürüntü örneklerinde CRE kolonizasyonu olan hastalar daha sonra CRE enfeksiyonu gelişimi açısından incelendi. CRE izolatları karbapenemaz üretimi ve karbapenemaz geni varlığı açısından incelenmiştir.
Bulgular: 14521 Enterobacterales (10.161 E. coli ve 4195 K. pneumoniae, 165 Citrobacter) izolatı incelendi. Bu suşların %8.9'unda karbapenem direnci saptanmıştır. Kolonizasyon için değerlendirilen 15695 rektal sürüntü örneğinin %4,7'sinde CRE saptanmıştır. CRE kolonizasyonu olan hastaların %23,4'ünde ilerleyen dönemde rektal sürüntü dışında diğer örneklerde de CRE üremesi saptandı. CRE enfeksiyonlarının
kolonizasyondan ortalama 21 gün sonra geliştiği gözlendi.
Sonuç: CRE enfeksiyonları sadece hastanede yatan hastalarda değil toplum kökenli enfeksiyonlarda da bir etken olarak karşımıza çıkmaya başlamıştır. Çalışmamız ayrıca CRE kolonizasyonunun enfeksiyon gelişimi için önemli bir risk faktörü olabileceğini göstermiştir. Bu nedenle, kolonizasyonu saptamak için erken tarama tespiti, uygun
izolasyon yöntemleriyle CRE enfeksiyonlarını önlemeye veya sınırlamaya yardımcı
olabilir.

Anahtar Kelimeler

Karbapenem Dirençli Enterobacterales, Kolonizasyon, Karbapenemaz

Carbapenem-Resistant Enterobacterales Infections and Their Association with Rectal Colonization

Öz

Objectives: Carbapenem-resistant Enterobacterales (CRE) infections have limited treatment options, and these infections are associated with high mortality rates. Asymptomatic carriers colonized with CRE contribute to the spread of CRE in hospitals. It was aimed to determine the frequency of CRE isolates detected in our center, carbapenemase ratios in these strains, carbapenemase genes, antibiotic resistance profiles, rectal CRE colonization rates and to evaluate various clinical features of CRE infections.
Methods: Enterobacterales species isolated from various specimens and Enterobacterales species isolated from rectal swab specimens sent for colonization screening were examined. Patients with CRE colonization in rectal swab samples were examined for the development of CRE infection at a later time. CRE isolates were examined for carbapenemase production and the presence of carbapenemase gene.
Results: 12,721 Enterobacterales (10,161 E. coli and 2395 K. pneumoniae, 165 Citrobacter) isolates were examined. Carbapenem resistance was detected in 10.3% of these strains. CRE was detected in 4.7% of 15695 rectal swab samples evaluated for colonization. In 23.4% of the patients with CRE colonization, CRE growth was detected in other samples besides the rectal swab in the later period. It was observed that CRE infections developed on average 21 days after colonization.
Conclusion: CRE infections have started to emerge as a factor not only in hospitalized patients but also in community-acquired infections. Our study also showed that CRE colonization could be a significant risk factor for the development of infection. Therefore, early screening detection to detect colonization can help prevent or limit CRE infections with appropriate isolation methods.

Anahtar Kelimeler

Carbapenem-resistant Enterobacterales, colonizations, carbapenemase

Kaynakça

• 1. Dutcher L, Lautenbach EA Deeper Dive: Implications of Identifying More of The Carbapenem-Resistant Enterobacteriaceae Iceberg. J Infect Dis. 2020;221(11):1743-45.
• 2. Pollett S, Miller S, Hindler J, et al. Phenotypic and molecular characteristics of carbapenem-resistant Enterobacteriaceae in a health care system in Los Angeles, California, from 2011 to 2013. J Clin Microbio. 2014;l 52:4003–9.
• 3. Liu Q, Liu L, Li Y et al. Fecal Carriage and Epidemiology of Carbapenem-Resistant Enterobacteriaceae Among Hospitalized Patients in a University Hospital. Infect Drug Resist. 2019;12:3935-42.
• 4. McConville TH, Sullivan SB, Gomez-Simmonds A, et al. Carbapenem-resistant Enterobacteriaceae colonization CRE and subsequent risk of infection and 90-day mortality in critically ill patients, an observational study. PLoSOne. 2017;1210:e0186195.
• 5. Goodman KE, Simner PJ, Tamma PD, Milstone AM. Infection control implications of heterogeneous resistance mechanisms in carbapenem-resistant Enterobacteriaceae CRE. Expert Rev Anti Infect Ther. 2016;141:95-108.
• 6. Centers for Disease Control and Prevention. In: National Center for Emerging and Zoonotic Infectious Diseases, Division of Quality Improvement in Healthcare, eds. Facility guideline for the control of carbapenem-resistant Enterobacteriaceae CRE. http://www.cdc.gov/hai/organisms/cre/ November 2015 update — CRE toolset. Atlanta, GA: Centers for Disease Control and Prevention, 2015
• 7. Tamma PD, Simner PJ. Phenotypic Detection of Carbapenemase-Producing Organisms from Clinical Isolates. J Clin Microbiol. 2018; 5611: e01140-18.
• 8. Van Loon K, Voor In't Holt AF, Vos MC. A Systematic Review and Meta-analyses of the Clinical Epidemiology of Carbapenem-Resistant Enterobacteriaceae. Antimicrob Agents Chemother. 2017; 621:e01730-17.
• 9. World Health Organization WHO (2017) Global Priority List of Antibiotic-Resistant Bacteria to Guide Research, Discovery and Development of New Antibiotics. Available at: http://www.who.int/medicines/publications/globalpriority-list-antibiotic-resistant-bacteria/en/
• 10. Hu F, Guo Y, Yang Y, et al. Resistance reported from China antimicrobial surveillance network CHINET in 2018. Eur J Clin Microbiol Infect Dis. 2019;3812:2275-81. .
• 11. Lacchini S, Sabbatucci M, Gagliotti C, et al. Bloodstream infections due to carbapenemase-producing Enterobacteriaceae in Italy: results from nationwide surveillance, 2014 to 2017. Euro Surveill.2019; 245.
• 12. Hammoudi D, Ayoub Moubareck C, Aires J, et al. Countrywide spread of OXA-48 carbapenemase in Lebanon: surveillance and genetic characterization of carbapenem-non-susceptible Enterobacteriaceae in 10 hospitals over a one-year period. Int J Infect Dis. 2014; 29:139–44.
• 13. Hamzan NI, Yean CY, Rahman RA, et al. Detection of blaIMP4 and blaNDM1 harboring KleCREella pneumoniae isolates in a university hospital in Malaysia. Emerg Health Threats. 2015;8:26011.
• 14. Kelly AM, Mathema B, Larson EL Carbapenem-resistant Enterobacteriaceae in the community: a scoping review. Int J Antimicrob Agents. 2017);50(2):127-134.
• 15. Baran I, Aksu N. Phenotypic and genotypic characteristics of carbapenem resistant Enterobacteriaceae in a tertiary-level reference hospital in Turkey. Ann Clin Microbiol Antimicrob. 2016;15:20.
• 16. Hansen GT.Continuous Evolution: Perspective on the Epidemiology of Carbapenemase Resistance Among Enterobacterales and Other Gram-Negative Bacteria. Infect Dis Ther. 2021;10:75–92.
• 17. Codjoe FS, Donkor ES. Carbapenem Resistance: A Review. Med Sci Basel. 2017; 61:1.
• 18. Pons MJ, Marí-Almirall M, Ymaña B, et al Spread of ST348 KleCREella pneumoniae Producing NDM-1 in a Peruvian Hospital. Microorganisms.2020;8(9):1392.
• 19. Yong D, Toleman MA, Giske CG, et al Characterization of a new metallo-beta-lactamase gene, BlaNDM-1, and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrob Agents Chemother. 2009;5312:5046–54.
• 20. Poirel L, Yılmaz M, Istanbullu A, et al. Spread of NDM-1-producing Enterobacteriaceae in a neonatal intensive care unit in Istanbul, Turkey. Antimicrob Agents. 2014;Chemother 585:2929–33.
• 21. Ece G, Tunç E, Otlu B, at all Detection of blaOXA-48and clonal relationship in carbapenem resistant K. pneumoniae isolates at a tertiary care center in Western Turkey. Turkiye Klinikleri J Med Sci. 2011; 316:1502–6.
• 22. Djahmi N, Dunyach-Remy C, Pantel A, et al. Epidemiology of carbapenemase-producing Enterobacteriaceae and Acinetobacter baumannii in Mediterranean countries. Biomed Res Int. 2014; 2014:305784
• 23. Nordmann P, Poirel L The difficult-to-control spread of carbapenemase producers among Enterobacteriaceae worldwide. Clin Microbiol Infect. 2014;20:821–30
• 24. Tischendorf J, de Avila RA, Safdar N. Risk of infection following colonization with carbapenem-resistant Enterobactericeae: A systematic review. Am J Infect Control. 2016; Epub 02/24.