Piperacillin / Tazobactam in-vitro Activity in Escherichia coli and Klebsiella pneumoniae Strains with Extended Spectrum Beta-Lactamase Production

Abstract

Piperacillin-tazobactam (TZP) is a frequently preferred agent for the treatment of infections caused by Gram-negative bacteria producing expanded spectrum beta-lactamase (ESBL). However, there are some controversies about the efficacy of Piperacillin-tazobactam in severe infections caused by ESBL producing bacteria. In this study, we aimed to determine the efficacy of TZP in ESBL-positive bacteria isolated from the samples sent to our laboratory. Our medical microbiology laboratory included 548 ESBL producing Escherichia coli and Klebsiella pneumoniae strains from blood, urine, wounds, tracheal aspirate samples from outpatient and outpatient clinics. VITEC 2® was used for bacterial identification, antibiotic susceptibility study and ESBL detection. Our study included 307 (56%) E. coli, 241 (%43.9) K. pneumoniae isolates. When the resistance rates of TZP of isolates are examined; The resistance rate of TZP in E. coli strains was 44.6% and the highest resistance was detected in tracheal aspirates with 47.6%.  In K. peumoniae strains, the resistance rate of TZP was found to be 41%. While there are not enough studies showing the efficacy of TZP in infections caused by ESBL positive bacteria, the existing studies show that the efficacy of these antibiotics changes according to infection site and severity. There is no consensus between CLSI and EUCAST regarding the TZP result notification. Therefore, there is a need for more extensive work in this regard and a reevaluation of the outcome report of the TZP.

Genişlemiş Spektrumlu Beta-laktamaz Üreten Escherichia coli ve Klebsiella pneumoniae Suşlarında Piperasilin/Tazobaktam İnvitro Etkinliği

Öz

Piperasilin-tazobaktam (TZP), genişletilmiş spektrumlu beta-laktamaz (GSBL) üreten Gram-negatif bakterilerin  neden olduğu enfeksiyonların tedavisi için sıklıkla tercih edilen bir ajandır. Bununla birlikte, GSBL üreten bakterilerin neden olduğu ciddi enfeksiyonlara Piperasilin-tazobaktamın etkinliği hakkında tartışmalar vardır. Bu çalışmada, laboratuvara gönderilen örneklerden izole edilen GSBL pozitif bakterilerde TZP'nin etkinliğini belirlemeyi amaçladık. Servis ve poliklinik hastalarına ait kan, idrar, yara, trakeal aspirat örneklerinden izole edilen 548 GSBL pozitif Escherichia coli ve Klebsiella pneumoniae suşu çalışmaya dahil edildi. Bakteri tanımlaması, antibiyotik duyarlılık testleri ve GSBL tespitinde VİTEK 2® otomatize sistemi kullanıldı. Çalışmamıza dahil edilen izolatların 307’si (%56) E. coli, 241’i (%43,9) K. pneumoniae suşu idi. İzolatların TZP direnç oranları incelendiğinde; E. coli suşlarında TZP direnç oranı %44,6 olarak saptanırken en yüksek direnç %47,6 ile trakeal aspirat örneklerinde saptandı. K. peumoniae suşlarında ise TZP direnç oranı %41 olarak bulundu. GSBL pozitif bakterilerin neden olduğu enfeksiyonlarda TZP'nin etkinliğini gösteren yeterli çalışma bulunmamakla birlikte, mevcut çalışmalar bu antibiyotiklerin etkinliğinin enfeksiyon bölgesine ve şiddetine göre değiştiğini göstermektedir. PRP sonuç bildirimi ile ilgili CLSI ve EUCAST arasında bir fikir birliği yoktur. Bu nedenle, bu konuda daha kapsamlı bir çalışmaya ve TZP'nin sonuç raporunun yeniden değerlendirilmesine ihtiyaç vardır.

Anahtar Kelimeler

• Piperasilin-tazobaktam,genişlemiş spektrumlu beta-laktamaz,Escherichia coli

Kaynakça

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