Bir eğitim ve araştırma hastanesinde artan sıklıkta izole edilen Corynebacterium striatum izolatlarının değerlendirilmesi

Öz

Amaç: Corynebacterium striatum izolatları insan deri ve mukoz membranlarının normal flora üyesidirler ve çevrede yaygın olarak bulunurlar. Uzun yıllar mikrobiyolojik kültürlerde ürediklerinde kontaminant olarak kabul edilmişlerdir. Son yıllarda immünsupresif hasta sayısının, uygulanan invaziv işlemlerin ve geniş spektrumlu antibiyotik kullanımının artması, C. striatum izolatlarına bağlı enfeksiyon ve salgınların sayısında artışa neden olmuştur. Bu çalışmada hastanemizde son beş yıldır mikrobiyolojik kriterlere göre etken olarak kabul edilen C. striatum izolatları ve antibiyotik duyarlılıkları değerlendirilmiş ve izolasyon sıklığı hızla artan bu fırsatçı patojene dikkat çekilmeye çalışılmıştır. Yöntemler: Hastanemiz Tıbbi Mikrobiyoloji Laboratuvarına gönderilen çeşitli klinik örneklerin Gram boyalı preparatları hazırlanmış ve uygun besiyerlerine ekimleri yapılmıştır. Gram boyamada lökosit ve/ veya bakteri izlenen, kültürde baskın ya da saf üreme gösteren, tekrarlayan kültürlerde üreyen izolatlar etken olarak kabul edilmiş bu kriterleri karşılamayan üremeler kontaminasyon ya da kolonizasyon olarak raporlanmıştır. Tür düzeyinde identifikasyon 2010-2013 yılları arasında Vitek 2 bioMerieux, France ; 2014 yılında Bruker Microflex MS Bruker Daltonics, Bremen, Germany sistemleri ile yapılmıştır. Bulgular: Mikrobiyolojik kriterlere göre etken olarak kabul edilip raporlanan C. striatum izolatlarının sayısı 2010-2014 yılları arasında sırasıyla 52, 73, 191, 199, 231 toplam 746 bildirilmiştir. Bu izolatlardan 369 %49,5 ’u yara, 149 %20,0 ’u trakeal aspirat, 140 %18,8 ’ı kan, 38 %5,1 ’i steril vücut sıvısı, 31 %4,2 ’i idrar, 19 %2,5 ’u abse örneklerinden izole edilmiştir. En sık izolasyon YBÜ’lerinden %37,9 yapılmıştır. Antibiyotik duyarlılık testi sonuçlarına göre tüm etkenlerin çoklu dirençli oldukları izlenmiştir. 2010-2013 yılları arasında CLSI rehberine göre yapılan değerlendirmede siprofloksasin direnci %83,0, penisilin direnci %80,0, rifampicin direnci %79,1, klindamisin direnci %73,2, tetrasiklin direnci %69,9, eritromisin direnci %41,2 ve gentamisin direnci %17,6 bulunurken tüm suşların vankomisin ve linezolide duyarlı olduğu izlenmiştir. 2014 yılında EUCAST rehberine göre yapılan değerlendirmede ise tüm suşların sadece vankomisin ve linezolide duyarlı iken diğer tüm antibiyotiklere dirençli oldukları izlenmiştir. Sonuç: C. striatum izolatları klinik mikrobiyoloji laboratuvarında gittikçe daha sık karşılaştığımız bir patojen halini almaktadır. Özellikle immünsupresif ve/veya uzun süreli geniş spektrumlu antibiyotik tedavisi alan hastalarda, tanıda atlanılması, ölümcül sonuçlara yol açabilir. Bu çalışma ile hastanemizde artan sıklıkta karşılaştığımız bu çoklu dirençli etkene dikkat çekilmeye çalışılmıştır. Özellikle riskli hasta gruplarında mikrobiyolojik kriterlere göre enfeksiyon etkeni olabileceği düşünülen Corynebacterium izolatları mutlaka tür düzeyinde tanımlanmalı, duyarlılık testleri yapılmalı ve gerekli tedavi düzenlenmelidir

Anahtar Kelimeler

• Corynebacterium striatum, çoklu ilaç direnci, enfeksiyon etkeni, kontaminasyon, kolonizasyon

Evaluation of the Corynebacterium striatum isolated with increasing frequency in one of the training and research hospital

Öz

Objective: Corynebacterium striatum strains are members of the normal flora of skin and mucous membranes, and commonly found in the environment. They have been regarded as contaminant for a long time when they reproduce in microbiological cultures. Lately, increase in the number of immunosuppressive patients and invasive procedures, and more frequent use of wide-spectrum antibiotics caused an increase in the number of reported infections and epidemics related to C. striatum strains. In this study, C. striatum isolates which are regarded as the infectious agents according to the microbiological criteria and their susceptibility to antibiotics were evaluated in our hospital for the last five years period and it was tried to attract the attention to this opportunistic pathogen having rapidly increasing isolation frequency. Methods: Various clinical samples sent to our hospital’s Medical Microbiology Laboratory were Gram stained, and cultured in appropriate agars. The strains with leucocytes and/or bacteria on Gram stain, dominant or absolute growth in culture, and growth in the repeated cultures were regarded as infectious agents while bacterial growths not fulfilling those criteria were reported as contamination or colonization. Identification of the agents at stain level was performed with Vitek 2 bioMerieux, France system between 2010 and 2013, and with Bruker Microflex MS Bruker Daltonics, Bremen, Germany system in 2014.Results: The numbers of C. striatum strains that were regarded and reported as infectious agents according to microbiological criteria between 2010 and 2014 were 52, 73, 191, 199, and 231, respectively total 746 . Among those, 369 49.5% strains were isolated from wounds, 149 20.0% from tracheal aspirates, 140 18.8% from blood, 38 5.1% from sterile body fluids, 31 4.2% from urine, and 19 2.5% from abscesses. The agents were most frequently isolated from ICU patients 37.9% . According to the antibiotic susceptibility test results it was observed that all agents were multiresistant. In the evaluation performed according to CLSI guidelines between the years 2010 and 2013 the ciprofloxacin, penicillin, rifampicin, clindamycin, tetracycline, and gentamycin resistance were found as 83.0%, 80.0%, 79.1%, 73.2%, 69.9%, 41.2%, 17.6% respectively and also it was observed that all the strains were susceptible to vancomycin and linezolid. In the evaluation performed according to EUCAST guideline in 2014 it was observed that all strains were susceptible only to vancomycin and linezolid, and resistant to all other antimicrobials. Conclusion: C. striatum isolates are becoming more and more frequently seen pathogens in the clinical microbiology laboratory. Missing their diagnosis as pathogens particularly in immunosuppressive patients and/ or in the ones on long-term treatment with widespectrum antibiotics may result in mortality. In this study, we tried to draw attention to this opportunistic, multiresistant pathogen with an increasing isolation rate in our hospital. Corynebacterium strains that may act as infectious agents according to microbiological criteria particularly in risky patient groups must be identified at strain level, their antimicrobial susceptibility tests must be performed, and the patients must be treated accordingl.

Anahtar Kelimeler

• Corynebacterium striatum, multidrug resistance, infectious agent, contamination, colonization

Kaynakça

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