Yoğun bakım hastalarının kan kültürlerinden izole edilen Pseudomonas aeruginosa ve Acinetobacter baumannii izolatlarının antibiyotik direnç yüzdelerindeki değişim

Öz

Amaç: Pseudomonas aeruginosa ve Acinetobacter baumannii enfeksiyonları özellikle yoğun bakım ünitesinde YBÜ yatan hastalar için en önemli sorunlardan birisidir. Bu çalışmanın amacı, YBÜ hastalarında kan dolaşımı enfeksiyonlarına sebep olan P. aeruginosa ve A. baumanni etkenlerinin antimikrobiyal direnç paternlerini belirlemek ve ampirik tedavi protokollerinin uygunluğunu değerlendirmektir. Yöntemler: Ocak-Aralık 2010 ve Ocak-Aralık 2011 tarihlerinde YBÜ’de yatan hastalara ait hemokültür örneklerinde üreyen suşların direnç oranları ayrı ayrı incelenerek karşılaştırıldı. Bu iki zaman aralığı arasında direnç oranlarındaki farklılıklar karşılaştırılarak istatistiksel olarak analiz edildi. Bulgular: P. aeruginosa suşlarının piperasilintazobaktam, sefaperazon - sulbaktam, seftazidim, siprofloksasin, gentamisin, amikasin ve netilmisine direnç oranlarında 2011 yılında 2010 yılına oranla azalma olduğu saptandı p değerleri sırasıyla, 0,0059, 0,0000, 0,0048, 0,0350, 0,0000, 0,0000, 0,0003 . Buna karşılık, aztreonam direnç oranında artış saptandı p değeri, 0,0155 . İmipenem direncinin benzer oranlarda olduğu görüldü. A. baumannii suşlarının sefepim ve amikasin direnç oranlarında ikinci periyotta ilkine oranla istatistiksel olarak anlamlı azalma saptandı p değerleri, 0,0003 ve 0,0000 . Ampisilin-sulbaktam, piperasilintazobaktam ve imipeneme karşı direnç oranlarında artış saptandı p değerleri sırasıyla, 0,0003, 0,0210, 0,0033 . Her iki bakteri türünde de kolistine direnç saptanmadı. A. baumannii izolatlarında tigesiklin direnci saptanmadı. Sonuç: Her hastanenin özellikle yoğun bakım birimlerinden izole edilen suşların antibiyotik direnç paternlerinin aktif sürveyansla takibi, ampirik tedavi yaklaşımlarını belirlemeye hizmet eder. Bu çalışmada antibiyotik kullanım politikasının hastane enfeksiyonları ile mücadelede önemli bir adım olduğu vurgulanmıştır. Sonuç olarak, direnç oranlarını azaltmak için, enfeksiyon kontrol önlemleri alınmalı, ampirik tedavi rejimleri sürekli gözden geçirilmeli ve aktif surveyans verilerine göre belirlenmelidir.

Anahtar Kelimeler

• Acinetobacter baumannii, Pseudomonas aeruginosa, antibiyotik direnci, kan kültürü, yoğun bakım ünitesi

Changes in resistance percentage to antibiotics in Pseudomonas aeruginosa and Acinetobacter baumannii strains isolated from blood cultures of intensive care unit patients

Öz

Objective: Infections of Pseudomonas aeruginosa and Acinetobacter baumannii are one of the greatest concerns for hospitalized patients, particularly those in intensive care units ICUs . The aim of this study was to determine the antimicrobial resistance percentages and to assess empirical treatment options for bloodstream infections due to P. aeruginosa and A. baumannii strains in ICU patients. Methods: Resistance percentages of strains isolated in January- December 2010 and January- December 2011 were separately analyzed and compared. The differences in resistance percentages between two intervals was statistically analyzed. Results: A statistically significant decrease was found in the resistance percentage of piperacillin-tazobactam, cefoperazone-sulbactam, ceftazidime, ciprofloxacin, gentamicin, amikacin and netilmicin in the second period compared with the first p values were 0.0059, 0.0000, 0.0048, 0.00350, 0.0000, 0.0000, 0.0003, respectively for P. aeruginosa strains. Whereas resistance percentage of aztreonam was increased p value was 0.0155 . Resistance percentage of imipenem was found similarIn A.baumannii strains, a statistically significant decrease was found in resistance percentage of cefepime and amikacin in the second period compared with the first p values were 0.0003, 0.0000 . Resistance percentage of ampicillin-sulbactam, piperacillin-tazobactam and imipenem was increased p values were 0.0003, 0.0210, 0.0033 . There was no colistin resistance determined in both species. Tigecycline resistance was not found in A. baumannii isolates. Conclusion: Active surveillance of antibiotic resistance percentages of isolated strains especially in ICUs serves to determine empirical treatment regimens in every institution. The present study emphasized that antibiotic usage policy is an important step to combat hospital infections. Consequently, infection control measures should be taken, empirical treatment regimens should be constantly reviewed, and should be determined according to active surveillance data in order to decrease resistance percentages.

Anahtar Kelimeler

• Acinetobacter baumannii, Pseudomonas aeruginosa, Antibiotic resistance, Blood culture, Intensive care unit

Kaynakça

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