YOĞUN BAKIM ÜNİTESİNDEN İZOLE EDİLEN KARBAPENEM DİRENÇLİ PSEUDOMONAS VE KLEBSİELLA SUŞLARININ SEFTAZİDİM/AVİBAKTAM DUYARLILIKLARININ SAPTANMASI

Yıl 2023, Cilt: 25 Sayı: 3, 408 - 413, 26.12.2023

Ayşegül Tuna , Hatice Bulut

https://doi.org/10.24938/kutfd.1318977

Öz

Amaç: Giderek artan antibiyotik direnci ile, Pseudomonas aeruginosa ve Klebsiella spp. gibi gram negatif patojenlerin tedavisi zorlaşmakta, mortalite ve morbidite artmaktadır. Bu nedenle dirençli suşlara etkili olabilecek yeni antibiyotikler geliştirilmektedir. Seftazidim/avibaktamın serin karbapenemaz üreten Gram negatif bakterilerde etkinliği kanıtlanmıştır. Bu çalışmada yoğun bakımdaki hastalardan izole edilen karbapenem dirençli Pseudomonas aeruginosa ve Klebsiella spp. suşlarında seftazidim/avibaktam, aminoglikozid (amikasin) ve florokinolon (siprofloksasin) duyarlılığının değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntemler: Eylül 2022-Haziran 2023 tarihleri arasında yoğun bakım ünitesinde yatan hastalardan izole edilen Klebsiella spp. ve Pseudomonas spp. suşlarından karbapenem dirençli olan 43 izolat çalışmaya dahil edildi. Disk diffüzyon testi ile seftazidim/avibaktam duyarlılıklarına bakıldı. European Committee on Antimicrobial Susceptibility Testing kriterlerine göre yorumlandı. İstatistiksel analiz için the statistical package for the Social Sciences version 24.0 (IBM SPSS Inc, Chicago) kullanıldı.
Bulgular: Karbapenem dirençli 33 Klebsiella spp. ve 10 Pseudomonas spp. suşunun tümünde seftazidim/avibaktam duyarlılığı saptandı. Klebsiella spp. ve Pseudomonas spp. suşlarında aminoglikozit (amikasin) direnci sırasıyla %42.4 ve %50, florokinolon (siprofloksasin) direnci ise sırasıyla %6 ve %40 olarak belirlendi.
Sonuç: Komplike üriner sistem enfeksiyonu, komplike intraabdominal enfeksiyonlar, sağlık bakımı ilişkili pnömoni ve ventilatör ilişkili pnömonilerin tedavisinde kullanımı önerilen seftazidim/avibaktamın çalışmamızda saptanan duyarlılık paterni nedeniyle karbapenemaz üreten suşlarda (metallobetalaktamazlar hariç) birincil tedavi seçeneği olması önerilmektedir.

Anahtar Kelimeler

Seftazidim/avibaktam, karbapenemaz, antibiyotik direnci

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

yok

Determination of Ceftazidime/Avibactam Susceptibilities of Carbapenem-Resistant Pseudomonas and Klebsiella Strains Isolated From Intensive Care Unit

Öz

Objective: Increasing antibiotic resistance makes treatment of Gram-negative pathogens such as Pseudomonas aeruginosa and Klebsiella spp. difficult and increases mortality and morbidity. Therefore, new antibiotics that can be effective against resistant strains are being developed. The efficacy of ceftazidime/avibactam has been proven in Gram negative bacteria producing serine carbapenemase. In this study, we aimed to evaluate ceftazidime/avibactam, aminoglycoside, fluoroquinolone susceptibility in carbapenem-resistant Pseudomonas aeruginosa and Klebsiella spp. isolated from intensive care unit patients.
Material and Methods: Between September 2022 and June 2023, 43 carbapenem resistant Klebsiella spp. and Pseudomonas spp. strains isolated from patients hospitalized in the intensive care unit were included in the study. Ceftazidime/avibactam susceptibilities were determined by disk diffusion test. The results were interpreted according to the European Committee on Antimicrobial Susceptibility Testing criteria. The statistical package for the Social Sciences version 24.0 (IBM SPSS Inc, Chicago) was used for statistical analysis.
Results: Ceftazidime/avibactam susceptibility was detected in all 33 carbapenem-resistant Klebsiella spp. and 10 Pseudomonas spp. strains. Aminoglycoside resistance in Klebsiella spp. and Pseudomonas spp. was 42.4% and 50%, respectively, and fluoroquinolone resistance was 6% and 40%, respectively.
Conclusion: Ceftazidime/avibactam, which is recommended for the treatment of complicated urinary tract infections, complicated intra-abdominal infections, healthcare-associated pneumonia and ventilator-associated pneumonia, is recommended to be the primary treatment option for carbapenemase-producing strains (except metallobetalactamases) due to the susceptibility pattern found in our study.

Anahtar Kelimeler

Ceftazidime/avibactam, carbapenemase, antibiotic resistance

Proje Numarası

yok

Kaynakça

• Sakurai A, Dinh AQ, Hanson BM, Shropshire WC, Rizvi SA, Rydell Ket al. Evolving landscape of carbapenem-resistant Pseudomonas aeruginosa at a single centre in the USA. JAC Antimicrob Resist. 2023;5(3):dlad070.
• Lister PD, Wolter DJ, Hanson ND. Antibacterial- resistant Pseudomonas aeruginosa: Clinical impact and complex regulation of chromosomally encoded resistance mechanisms. Clin Microbiol. Rev. 2009;22(4):582-610.
• Oliver A, Mulet X, López-Causapé C, Juan C. The increasing threat of Pseudomonas aeruginosa high- risk clones. Drug Resist Updat. 2015;21-22:41-59.
• Strateva T, Yordanov D. Pseudomonas aeruginosa - a phenomenon of bacterial resistance. J Med Microbiol. 2009;58(Pt 9):1133-48.
• Bush K, Bradford PA. Interplay between β- lactamases and new β-lactamase inhibitors Nat Rev Microbiol. 2019;17(5):295-306. Erratum in: Nat Rev Microbiol. 2019;17(7):459-60.
• Shirley M. Ceftazidime-Avibactam: A Review in the treatment of serious gram-negative bacterial infections. Drugs. 2018;78(6):675-92.
• Giddins MJ, Macesic N, Annavajhala MK, Stump S, Khan S, McConville TH et al. Successive emergence of ceftazidime-avibactam resistance through distinct genomic adaptations in blaKPC-2-harboring Klebsiella pneumoniae sequence type 307 isolates. Antimicrob Agents Chemother. 2018;62(3):e02101- 17.
• Shields RK, Chen L, Cheng S, Chavda KD, Press EG, Snyder A et al. Emergence of ceftazidime- avibactam resistance due to plasmid-borne blaKPC-3 mutations during treatment of carbapenem- resistant Klebsiella pneumoniae infections. Antimicrob Agents Chemother. 2017;61(3):e02097- 16.
• Mueller L, Masseron A, Prod'Hom G, Galperine T, Greub G, Poirel L et al. Phenotypic, biochemical and genetic analysis of KPC-41, a KPC-3 variant conferring resistance to ceftazidime-avibactam and exhibiting reduced carbapenemase activity. Antimicrob Agents Chemother. 2019;63(12):e01111-19.
• Lee YL, Ko WC, Hsueh PR. Geographic patterns of carbapenem-resistant Pseudomonas aeruginosa in the Asia-Pacific Region: Results from the Antimicrobial Testing Leadership and Surveillance (ATLAS) Program, 2015-2019. Antimicrob Agents Chemother. 2022;66(2):e0200021.
• Park JM, Kwon M, Hong KH, Lee H, Yong D. European Committee on Antimicrobial Susceptibility Testing-recommended rapid antimicrobial susceptibility testing of Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus from positive blood culture bottles. Ann Lab Med. 2023;43(5):443-50.
• The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 13.1, 2023. Erişim Tarihi: 28/07/2023 Erişim Adresi: http://www.eucast.org.
• Liao JX, Appaneal HJ, Menon A, Lopes V, LaPlante KL, Caffrey AR. Decreasing antibiotic resistance trends nationally in gram-negative bacteria across United States Veterans Affairs Medical Centers, 2011-2020. Infect Dis Ther. 2023;12(7):1835-48.
• FDA. Drug safety communication: FDA advises restricting fluoroquinolone antibiotic use for certain uncomplicated infections; warns about disabling side effects that can occur together. Press release. Silver Spring: US Food and Drug Administration; 2016.
• Lucchetti-Miganeh C, Redelberger D, Chambonnier G, Rechenmann F, Elsen S, Bordi C et al. Pseudomonas aeruginosa genome evolution in patients and under the hospital environment. Pathogens. 2014;3(2):309-40.
• Dieringer TD, Furukawa D, Graber CJ, Stevens VW, Jones MM, Rubin MA, et al. Inpatient antibiotic utilization in the Veterans' Health Administration during the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol. 2021;42(6):751-3.
• Wang Y, Wang J, Wang R, Cai Y. Resistance to ceftazidime-avibactam and underlying mechanisms. J Glob Antimicrob Resist. 2020;22:18-27.
• Bilgin M, İşler H, Başbulut E, Görgün S. Genişlemiş spektrumlu beta-laktamaz üreten Enterobacteriaceae izolatlarına karşı Seftazidim- Avibaktam’ın in vitro etkinliğinin araştırılması. J Immunol Clin Microbiol. 2023;8(1):17-23.
• Oliva A, Campogiani L, Savelloni G, Vitale P, Lodi A, Sacco F et al. Clinical characteristics and outcome of Ceftazidime/Avibactam-Resistant Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae infections: A retrospective, observational, 2-center clinical study. Open Forum Infect Dis. 2023;10(7):ofad327.
• Arcari G, Oliva A, Sacco F, Di Lella FM, Raponi G, Tomolillo D et al. Interplay between Klebsiella pneumoniae producing KPC-31 and KPC-3 under treatment with high dosage meropenem: a case report. Eur J Clin Microbiol Infect Dis. 2022;41(3):495-500.
• Hoşbul T. , Aydogan C. N. , Kaya S. , Bedir O. , Özcan H. , Gümral R. In vitro activity of ceftazidime-avibactam and colistin against carbapenem-resistant pseudomonas aeruginosa clinical isolates. İst Tıp Fak Derg. 2022; 85(3):355- 61.
• van Duin D, Bonomo RA. Ceftazidime/Avibactam and Ceftolozane/Tazobactam: Second-generation β- lactam/β-lactamase inhibitor combinations. Clin Infect Dis. 2016;63(2):234-41.
• Jorgensen SCJ, Trinh TD, Zasowski EJ, Lagnf AM, Bhatia S, Melvin SM, et al. Real-world experience with ceftazidime-avibactam for multidrug-resistant gram-negative bacterial infections. Open Forum Infect Dis. 2019;6(12):ofz522.
• van Duin D, Lok JJ, Earley M, Cober E, Richter SS, Perez F, et al. Colistin versus ceftazidime-avibactam in the treatment of infections due to carbapenem- resistant Enterobacteriaceae. Clin Infect Dis. 2018;66(2):163-71.
• Camargo JF, Simkins J, Beduschi T, Tekin A, Aragon L, Pérez-Cardona A, et al. Successful treatment of carbapenemase-producing pandrug- resistant klebsiella pneumoniae bacteremia. Antimicrob Agents Chemother. 2015;59(10):5903- 8.
• Wu G, Abraham T, Lee S. Ceftazidime-Avibactam for treatment of Carbapenem-resistant Enterobacteriaceae bacteremia. Clin Infect Dis. 2016;63(8):1147-8.
• Köle M, Sesli Çetin E, Şirin MC, Cicioğlu Arıdoğan B. Seftazidim-Avibaktam, Meropenem ve Kolistinin tek başına ve ikili kombinasyonlarının çeşitli klinik örneklerden izole edilen karbapenem dirençli Klebsiella pneumoniae suşlarına karşı ın vitro etkinliğinin araştırılması. Mikrobiyol Bul. 2022;56(2):230-50.
• Akalın H. Karbapenem dirençli Enterobacteriaceae enfeksiyonlarının tedavisi. Görenek L, editör. Karbapenem Dirençli Gram-Negatif Bakteri Enfeksiyonları. 1. Baskı. Ankara: Türkiye Klinikleri; 2023;45-60