Ankara’daki çeşitli hastanelerden elde edilen Acinetobacter baumannii izolatları arasındaki klonal ilişkinin gösterilmesi ve antibiyotik dirençlerinin belirlenmesi

Öz

Amaç: Acinetobacter baumannii, özellikle yoğun bakım ünitelerinde mortalite ve morbiditeyi arttıran hastane kaynaklı enfeksiyonların en önemli nedenlerinden biridir. Bu bakteri, pnömoni, bakteriyemi, idrar yolu enfeksiyonu, yara enfeksiyonu ve menenjit gibi çeşitli enfeksiyonlardan izole edilebilir. Bu çalışmanın amacı Ankara’daki çeşitli hastanelerden Kasım 2009 ile Aralık 2011 tarihleri arasında elde edilen 99 A. baumannii izolatı arasındaki klonal ilişkiyi göstermek ve antibiyotik dirençlerini belirlemektir. Yöntem: Acinetobacter baumannii izolatlarının tanımlanması ve antibiyotik paternleri VITEK 2 bioMérieux, France sistemi ile yapıldı. Çalışmada antimikrobiyal ajan olarak amikasin, siprofloksasin, tetrasiklin, netilmisin, sulbaktam/ ampisilin, trimetoprim/sulfametoksazol, seftazidim, gentamisin, levofloksasin, meropenem, imipenem, piperasilin, piperasilin/tazobaktam, sefoperazon/ sulbaktam, sefepim, tigesiklin ve kolistin kullanıldı. Acinetobacter izolatlarının klonal ilişkisi Rep-PCR yöntemi ile araştırıldı. Bulgular: Çalışmaya dâhil edilen 99 A. baumannii izolatının %99’u imipeneme ve meropeneme dirençli bulundu. Kolistine dirençli suş saptanmadı %0 . Piperasilin ve piperasilin/tazobaktama tüm suşların dirençli olduğu gözlendi %100 . Siprofloksasine %99, ampisilin/sulbaktama %98, seftazidime %97, sefepime %96, levofloksasine %85, tetrasikline %80, trimetoprim/sulfametoksazole %71, amikasine %59, gentamisin ve netilmisine %56 direnç görüldü. Tigesiklin için dirençliler %5, orta duyarlılar %27 ve duyarlılar ise %68 olarak saptandı. Acinetobacter baumannii izolatlarının dört patern oluşturduğu görüldü. İlk 3 paternin bir grup oluşturduğu ve dördüncü paternden farklı olduğu görüldü. Birinci patern P1 ’de 14 suş, ikinci patern P2 ’de 37 suş, üçüncü patern P3 ’de 36 suş bulunmaktaydı. Dördüncü patern P4 ’de ise 12 suş vardı. İlk üç paternin oluşturduğu grup ile dördüncü paternin farklı oldukları ve aralarında üçten fazla bant farklılığının olduğu görüldü. İlk üç paternin ise aralarındaki bir bant farklılığı ile benzer oldukları görüldü. Ayrıca, her dört paternin kendi içinde bant farkı göstermeksizin aynı oldukları saptandı. Her dört paternde de farklı hastanelerden suşların bulunduğu saptandı. Böylece her dört hastaneye muhtemelen hasta transferleriyle aynı Acinetobacter baumannii suşlarının yayılmış olduğu gösterildi. Sonuç: Bu hastanelerde, çalışmanın devamı olarak A. baumannii’nin direnç mekanizmaları ve direnç genleriyle ilgili araştırma yapılabilir. Ayrıca, hastalara ilişkin risk faktörleri belirlenerek karbapenem ve diğer antibiyotiklerin dirençlerinden sorumlu izolatlara ilişkin epidemiyolojik veriler daha kapsamlı bir şekilde ortaya konulabilir.

Anahtar Kelimeler

• Acinetobacter baumannii, klonal ilişki, rep-PCR, antibiyotik direnci

Evaluation of clonal relationship between Acinetobacter baumannii isolates and determination of resistance to antibiotics which were obtained from different hospitals in Ankara

Öz

Objective: Acinetobacter baumannii is one of the most important cause of hospital acquired infections which raises the rates of mortality and morbidity especially in intensive care units. Acinetobacter baumannii may be isolated from various infections such as pneumonia, bacteremia, urinary track infections, wound infections and meningitis.The aim of this study is to determine the clonal relationship and determination of antibiotic resistances between 99 Acinetobacter baumannii isolates which were obtained from different hospitals in Ankara between November 2009 and December 2011. Method: Identification of A. baumannii isolates and antibiotic susceptibilities were performed by Vitek 2 bioMérieux, France system. In this study, amikacin, ciprofloxacin, tetracyclin, netilmicin, sulbactam/ampicillin, trimethoprim/sulfamethoxazole, ceftazidime, gentamicin, levofloxacin, meropenem, imipenem, piperacillin, piperacillin/tazobactam, cefoperazone/sulbactam, cefepime, tigecycline, and colistin were used as antimicrobial agents. The clonal relationship of Acinetobacter isolates was analysed by Rep-PCR method. Results: Ninety nine percent of A. baumannii isolates was resistant to imipenem and meropenem. There was no resistant strain to colistine 0% . All of the strains were resistant to piperacillin and piperacillin/tazobactam 100% . Ciprofloxacin was 99%, sulbactam/ampicillin 98%, ceftazidime was 97%, cefepime was 96%, levofloxacin was 85%, tetracycline was 80%, trimethoprim/sulfamethoxazole was 71% resistant. Resistance to amikacin was 59% and resistance to gentamicin and netilmicin were both 56%. Five percent of strains were resistant, 27% were intermediate susceptile and 68% were susceptile to tigecycline. There were four patterns. P1, P2 and P3 gathered to one group G1 and they were similar. P4 was different from them. P1 had 14, P2 had 37, P3 had 36 and P4 had 12 strains. There were more than three bands difference between G1 and P4 which showed that they were different strains. Band difference between G1 P1, P2, P3 was only one and this showed us that they were similar. In the other hand, there were not any band diffirence in P1, P2, P3 and P4. All of the patterns were consisted of strains from different hospitals.We determined that the same strains spread to four different hospitals probably by patient transfers. Conclusion: A study can be organized to determine resistance genes and resistance mechanisms of A. baumannii in these hospitals as continuation of this study. Moreover, a comprehensive epidemiologic data can be revealed by determining the risk factors of patients relevant to those responsible isolates for carbapenem and other antibiotics resistance.

Anahtar Kelimeler

• Acinetobacter baumannii, clonal relationship, rep-PCR, antibiotic resistance

Kaynakça

1. 1. Anonymous. http://ec.europa.eu/environment/ water/water-drink/index_en.html (2015).
2. 2. Council Directive 98/83/EC of 3 November 1998 on the quality of water intended for human consumption (OJ L 330, 5.12.1998, p.32-54).
3. 3. Anonymous. http://ec.europa.eu/environment/ water/water-drink/legislation_en.html (2015).
4. 4. Anonymous. http://ec.europa.eu/environment/ water/water-drink/review_en.html (2015).
5. 5. The Commission Directive 2015/1787 of 6 October 2015 amending Annex II and III to Council Directive 98/83/EC on the quality of water intended for human consumption (OJ L 260, 7.10.2015, p.6-17).
6. 6. European Commission-Press release “EU introduces more efficient monitoring of drinking water for better protection of punlic health” Brussels, 28 October 2015.
7. 7. Council Directive 2013/51/EURATOM of 22 October 2013 laying down requirements for the protection of the health of the general public with regard to radioactive substances in water intended for human consumption (OJ L 296, 7.11.2013, p.12- 21).
8. 8. The Ministry of Health, the By-law on Water Intended for Human Consumption, Official Gazette No.25730, dated 17 February 2005. The By-law amendments Official Gazettes 31.7. 2009 dated 27305 numbered, 7.03.2013 dated 28580 numbered and 11.04.2014 dated 28969 numbered.

9. 9. Anonymous. “Emergency case management and risk analysis in drinking water for the protection of public health” Project Fiche – SEI 2009, TR 09/IB/ EN/04-TWL, 2012. (http://www.formin.fi/public/ download.aspx?ID=79205&GUID=%7BAF34C2C1- 4A41-4631-A440-EBD37539BFEC%7D)
10. 10. Anonymous. http://ec.europa.eu/enlargement/ tenders/twinning/index_en.htm 12/01/2016.
11. 11. Anonymous. https://eufunds.gov.mt/en/EU%20 Funds%20Programmes/Other%20Programmes/ Pages/Twinning-Light--Transition-Facility.aspx (2015).
12. 12. Anonymous. “Guidance on instructions for decision-making following non-compliance results in drinking water monitoring”, 2015.
13. 13. Anonymous. “Guidance on identification of contamination in drinking water”, 2015.
14. 14. Anonymous. “Guidance on early warning in drinking water”, 2015.
15. 15. Anonymous. “Guidance on management of emergency cases/crisis in drinking water”, 2015.