Bölgemizdeki tüberküloz dışı mikobakteri enfeksiyonları: Buzdağının sadece görünen yüzü

Öz

Amaç: İmmünsüpresif tedavi rejimleri, ortalama yaşam süresinin uzaması, AIDS gibi hastalıkların artması, tüberküloz dışı mikobakteri (TDM) kaynaklı enfeksiyonların tedavisindeki zorluklar ve fırsatçı patojen olarak bilinen TDM’lerin sağlıklı kişilerde de etken olabilmesi TDM’yi tüm dünyada önemli bir enfeksiyon kaynağı haline getirmiştir. Bu çalışmada, 2015-2022 yılları arasında mikobakteriyoloji laboratuvarında klinik örneklerinden TDM izole edilen hastaların demografik özelliklerinin, enfeksiyon etkeni TDM türlerinin ve ilaç duyarlılık profillerinin retrospektif olarak değerlendirilmesi amaçlanmıştır. Yöntem: Mersin Ü. Hastanesi Tıbbi Mikrobiyoloji Laboratuvarı Mikobakteriyoloji Birimi’nde tüberküloz (TB) şüphesi üzerine alınan örneklerin işlenmesi, kültürü, mikroskopisi ve kültürde üreyenlere Mycobacterium tuberculosis kompleks (MTBK)-TDM ayrımı yapılmıştır. TDM üremesi saptanan hastalarda, ilgili klinisyenden görüş alınıp kontaminant/çevresel TDM olma olasılığı dışlanan izolatlar için TDM identifikasyonu ve ilaç duyarlılık testleri rehberlere uygun olarak yapılmıştır. Bulgular: Mikobakteriyoloji laboratuvarına gelen 25148 örneğin 1685 (%6.7)’inde mikobakteri üremesi tespit edilmiş ve izolatların 1487 (%88.2)’sinde MTBK, 198 (%11.8)’inde TDM üremesi saptanmıştır. Bunlardan 56 hastaya ait 56 izolat hastalık etkeni olarak değerlendirmeye alınmıştır. İzolatların %92.5’i akciğer (AC) örneklerden izole edilmiştir, hastaların yaş ortalaması 60±15.2 ve %66’sı erkek’tir. Çalışmaya dahil edilen 56 izolatın 40’ına tür tanımlaması yapılmıştır. Klinik bilgilerine erişilebilen hastaların %51.3’ünde kanser, romatoid artrit nedeniyle tümör nekroz faktör-alfa tedavisi alma, böbrek yetmezliği, böbrek nakli gibi immünsüpresif durumlar, %51.2’sinde kronik obstrüktif akciğer hastalığı, astım, kistik fibrozis gibi AC hastalıkları, %58.9’unda sigara ve alkol kullanım öyküsü, %17.9’unda diyabet, %25.6’sında hipertansiyon gibi eşlik eden hastalık öyküsü, %25.6’sında D vitamin eksikliği, %23.1’inde hemoptizi öyküsü olduğu tespit edilmiştir. Tanımlaması yapılan izolatlarda en sık tespit edilen beş tür, M. intracellulare, M. szulgai, M. kansasii, M. abscessus ve M. simiae olmuştur. Hızlı ve yavaş üreyen TDM’ler amikasin, klaritromisin, linezolid, moksifloksasine, hızlı üreyen TDM’ler sefoksitine %100 duyarlı bulunmuştur. Sonuç: Tüberküloz dışı mikobakteri enfeksiyonlarında klinik-laboratuvar iş birliği, hızlı ve doğru tanı yanında uygun tedavi rejiminin belirlenmesinde önemli katkılar sağlayacaktır. Çalışmamızda bölge TB laboratuvarı verileri analiz edilerek TDM enfeksiyonlarının epidemiyolojik, demografik özelliklerini, TDM türlerini ve ilaç duyarlılık profillerini belirleyerek hastaların tedavisinde klinisyene yol gösterecek ve literatüre katkı sağlayacak veriler elde edildiği inancındayız.

Anahtar Kelimeler

• Tüberküloz dışı mikobakteri
• identifikasyon
• epidemiyoloji
• ilaç direnci
• duyarlılık

Non- tuberculous mycobacteria infections in our region: Only the tip of the ıceberg

Öz

Aim: Immunosuppressive treatment regimens, prolongation of life expectancy, increase in diseases such as AIDS, difficulties in the treatment of infections caused by non-tuberculous mycobacteria (NTM) and the fact that NTMs, known as opportunistic pathogens, can also be effective in healthy people have made NTM an important source of infection all over the world. This study aimed to evaluate the demographic characteristics of the patients retrospectively whose clinical specimens were isolated from NTM, the infectious agent NTM types and drug susceptibility profiles in the mycobacteriology laboratory between the years 2015-2022. Method: In the mycobacteriology unit of the Medical Microbiology laboratory of Mersin University Hospital, samples with suspected tuberculosis (TB) were processed, cultured, microscopy and Mycobacterium tuberculosis complex (MTBK)-NTM distinction was made. In patients with detected NTM growth, NTM identification and drug susceptibility tests were performed in accordance with the guidelines for the isolates, whose possibility of contaminant/environmental NTM was excluded after obtaining the opinion of the relevant clinician. Results: Mycobacteria growth was detected in 1685 (6.7%) of 25148 samples that were sent to the mycobacteriology laboratory, and MTBK growth was found in 1487 (88.2%) of the isolates, and TDM growth was found in 198 (11.8%) of the isolates. Of these, 56 isolates from 56 patients were evaluated as disease agents. 92.5% of the isolates were isolated from pulmonary samples, the mean age of the patients was 60±15.2 years, and 66% were male. Species identification was made for 40 of the 56 isolates included in the study. Of the patients whose clinical information could be accessed, 51.3% had cancer, tumour necrosis factor alpha therapy for rheumatoid arthritis, immunosuppressive conditions such as kidney failure, kidney transplantation, 51.2% had lung diseases such as COPD, asthma, hypertension cystic fibrosis, 58.9% had a history of smoking and alcohol use, 17.9% had diabetes, 25.6% had a history of concomitant diseases such as, 25.6% had vitamin D deficiency, and 23.1% had hemoptysis. The five most frequently detected species in the isolates identified were M. intracellulare, M. szulgai, M. kansasii, M. abscessus and M. simiae. Fast and slow growing NTMs were found 100% sensitive to amikacin, clarithromycin, linezolid, moxifloxacin, and fast growing NTMs were 100% sensitive to cefoxitin. Conclusion: Clinic-laboratory cooperation in NTM infections will make important contributions to rapid and accurate diagnosis as well as determining the appropriate treatment regimen. We believe that by analyzing the regional TB laboratory data in our study, we obtained data that will guide the clinician in the treatment of patients and contribute to the literature by determining the epidemiological and demographic characteristics, NTM species and drug susceptibility profiles of NTM infections.

Anahtar Kelimeler

• Non-tuberculosis mycobacteria
• identification
• epidemiology
• drug resistance
• susceptibility

Kaynakça

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