Türkiye’de ulusal antimikrobiyal direnç surveyans sisteminin ilk sonuçları

Yıl 2018, Cilt: 75 Sayı: 4, 333 - 344, 01.12.2018

Nilay Çöplü Hüsniye Şimşek Deniz Gür Ayşegül Gözalan Ufuk Hasdemir Zeynep Gülay Gülçin Bayramoğlu Şöhret Aydemir Nezahat Gürler Mete Eyigör Duygu Perçin Dilber Aktaş

Öz

Amaç: Antimikrobiyal direnç ile mücadele için bazı önlemler alınmalıdır, mevcut durumun saptanması da bunlardan biridir. Türkiye’de ulusal antimikrobiyal direnç surveyans sistemi bu hedefle kurulmuştur. Ampirik tedaviyi desteklemek, antimikrobiyal kullanım politikaları oluşturmak, rehber kitaplara veri sağlamak, alınmış olan önlemlerin etkinliğini değerlendirmek için başlangıç bilgilerini sağlamak amaçlanmıştır.Yöntem: Elli beş hastaneden, kan ve beyin omurilik sıvısından izole edilen Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium, Streptococcus pneumoniae, Escherichia coli, Klebsiella pneumoniae ve Pseudomonas aeruginosa izolatlarının direnç verileri toplanmıştır. Antimikrobiyaller ve test yöntemleri uluslararası surveyans sitemleri ile uyumlu olacak şekilde seçilmiştir. Toplanan veriler WHONET programı ile analiz edilmiştir. Bulgular: S. aureus n=1437 ; metisilin direnci %31,5, rifampin, linezolid ve vankomisin direnci sırası ile %65,3; %2,3 ve %0,0, bulunmuştur. E. faecalis n=760 ampisilin direnci %9,7, linezolid, vankomisin, teikoplanin direnci %1’in altında, yüksek düzey YD aminoglikozid %30 civarında bulunmuştur. E. faecium n=756 ampisilin direnci %88,1; linezolid ve teikoplanin %1’den az, vankomisin %17, YD aminoglikozid %50 civarında bulunmuştur. S. pneumoniae n=128 nonmenenjit sınır değerler için eritromisin %32 dışında tüm antimikrobiyaller için direnç %5,2’den düşüktür, menejit sınır değerler için direnç %14,3-44,8’a yükselmiştir. E. coli 2280 ve K. pneumoniae 1307 için genişlemiş spektrumlu beta-laktamaz GSBL direnci sırası ile %51,6 ve %54,0 bulunmuştur. P. aeruginosa 825 direnci %8,4 amikacin ve %36,4 piperacillin arasında değişmektedir. Sonuç: Direnç Türkiye’ye yakın coğrafyadaki ülkelerden yüksek bulunmuş ve zaman içinde artış göstermiş olup bununla mücadele için politikalar geliştirmek gerektiğine işaret etmektedir. Ayrıca, alınan önlemlerin yararlılığını izlemek için de sonuçlar değerli olacaktır

Anahtar Kelimeler

Antimikrobiyal direnç, surveyans, Türkiye

The First Results of National Antimicrobial Resistance Surveillance System in Turkey

Öz

Objective: In order to combat with antimicrobial resistance, some measures should be taken and determination of the current status is one of them. National antimicrobial resistance surveillance system NAMRSS was established for this purpose in Turkey. It was targeted to be useful for guidence of ampirical therapy, create antimicrobial usage policies, provide data to the guidebooks, and supply initial information to evaluate the efficasy of the measures taken. Methods: Data of resistance was collected from 55 hospital, from blood and cerebrospinal fluid isolates, which were S. aureus, E. faecalis and E. faecium, S. pneumoniae, E. coli, K. pneumoniae and P. aeruginosa. The antimicrobials and test methods were chosen in accordance with international surveillance systems. The collected data was analysed by WHONET software. Results: S. aureus 1437 ; meticillin resistance was 31.5%, rifampin, linezolid and vancomycin resistance were 65.3%, 2.3%, and 0.0%, respectively. E. faecalis n=760 resistance of ampicillin was 9.7%, linezolid, vancomycin, teicoplanin were lower than 1%, high level HL aminoglycoside was around 30%. E. faecium n=756 resistance of ampicillin was 88,1%, linezolid, teicoplanin were lower than 1%, vancomycin 17%, HL aminoglycoside was around 50%. S. pneumoniae n=128 with non-meningitis breakpoints; resistance were lower than 5.2% for all antimicrobials other than erythromycin 32% , with meningitis breakpoints: resistance increased to 14,3-44,8%. E. coli 2280 and K. pneumoniae 1307 , extended spectrum beta-lactamase ESBL was 51.6% and 54.0%, respectively. P. aeruginosa 825 resistance were changed in between 8.4% amikacin and 36.4% piperacillin . Conclusion: The resistance was higher among the countries in close geographical region and increased in time, indicating the need for developing policies to combat with it. Besides, the results will also be valuable to monitor the usefulness of the measures taken.

Anahtar Kelimeler

Drug resistance, microbial, surveillance, Turkey

Kaynakça

• 1. Antimicrobial resistance, Global action plan on antimicrobial resistance, http://www.who.int/ antimicrobial-resistance/global-action-plan/en/.
• 2. Global action plan on antimicrobial resistance, http://www.who.int/antimicrobial-resistance/ publications/global-action-plan/en/.
• 3. Aktaş D, Aydemir Ş, Bayram M, Bayramoğlu G, Ceyhan İ, Çöplü N ve ark. Ulusal Antimikrobiyal Direnç Suveyans Sistemi laboratuvar testleri, kalite kontrolü ve kalite güvencesi standart uygulama prosedürleri ve WHONET yazılım programı. Ankara. Şubat 2011 (National Antimicrobial Resistance Surveillance System Laboratory Tests, Quality Control and Quality Assurance Standard Operating Procedures and WHONET software, Ankara, February 2011) ISBN: 978-975-590-347-7. www. uamdss.thsk.gov.tr.
• 4. SURVEILLANCE REPORT. Antimicrobial resistance surveillance in Europe Annual report of the European Antimicrobial Resistance Surveillance Network (EARS-Net) 2010. http://ecdc.europa. eu/en/publications/_layouts/forms/Publication_ DispForm.aspx?List=4f55ad51-4aed-4d32-b960- af70113dbb90&ID=502.
• 5. Central Asian and Eastern European Surveillance of Antimicrobial Resistance, Annual Report 2014. World Health Organization, Regional Office for Europe, 2015. http://www.euro.who. int/_data/assets/pdf_file/0006/285405/CEASERSurveillance-Antimicrobial-Resistance2014. pdf?ua=1.
• 6. Gözalan A, Çöplü N, Aktaş D, Şimşek H, Bahar Erdem G, I Mumcuoğlu. Performance evaluation of the microbiology laboratories in Turkey for culture and antibiotic susceptibility tests and the selection of laboratories to provide data for National Antimicrobial Resistance Surveillance System: Questionnary application. Turk Hij Den Biyol Derg: 2015; 72(3): 175 – 182.
• 7. Antimicrobial Resistance Surveillance Questionnaire for Assessment of National Networks WHO/CDS/ CSR/RMD/2003.1. World Health Organization. http://www.who.int/drugresistance/ whocdscsrrmd20031.pdf?ua=1.
• 8. Clinical and Laboratory Standards Institute, Performance Standards for Antimicrobial Susceptibility Testing. M100S21 Vol.31 No 1, January 2011.
• 9. WHO Collaborating Centre for Surveillance of Antimicrobial Resistance www.whonet.org.
• 10. Akbas E, Cöplü N, Simsek H, Esen B, Sezgin B. Laboratory evaluation of susceptibility tests for National Antimicrobial Resistance Surveillance System (NAMRSS) in Turkey. Turk Hij Den Biyol Derg, 2018; 75(1): 1-12. DOI ID : 10.5505/ TurkHijyen.2018.89166.
• 11. Çöplü N, Gülay Z, Temel F, Şimşek H, Göl N, Aktaş D. The First External Quality Assurance Laboratory Proficiency Assesment Study of National Antimicrobial Resistance Surveillance System in Turkey. Turk Hij Den Biyol Derg, 2018; 75(2): 117 – 126 doi: 10.5505/TurkHijyen.2018.10437.
• 12. Loveday HP, Wilson JA, Pratt RJ, Golsorkhi M, Tingle A, Bak A, et. al. epic 3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. J Hosp Infect, 2014, 86 (Supp 1), 1-70. http://dx.doi. org/10.1016/S0195-6701(13)60012-2.
• 13. Winsor G, Patel M. Combined infection trainingshould we be concerned about its impact on infection prevention and control training of microbiologists in the UK? J Hosp Infect 2015, 91 (4), 302-305. http://dx.doi.org/10.1016/j. jhin.2015.09.003.
• 14. National Antimicrobial Resistance Surveillance System 2011 Annual Report. file:///C:/ Documents%20and%20Settings/hst/Belgelerim/ Downloads/UAMDSS_2011_Raporu.pdf.
• 15. European Antimicrobial Resistance Surveillance System, Annual Report 2008 On-going surveillance of S.pneumoniae, S. aureus, E.coli, E. faecium, E. faecalis, K. pneumoniae, P. aeruginosa. http://ecdc.europa.eu/en/healthtopics/ antimicrobial-resistance-and-consumption/ antimicrobial_resistance/publications-documents/ Documents/2008_EARSS_Annual_Report.pdf.
• 16. Gagliotti C, Balode A, Baquero F, Degener J, Grundmann H, Gür D, et.al. The EARS-Net Participants (Disease Specific Contact Points for AMR). Escherichia coli and Staphylococcus aureus: bad news and good news from the European Antimicrobial Resistance Surveillance Network (EARS-Net, formerly EARSS), 2002 to 2009. Euro Surveill. 2011;16(11):pii=19819. Available online: http://www.eurosurveillance.org/ViewArticle. aspx?ArticleId=19819.
• 17. Kızılarslanoğlu MC, Sancak B, Yağcı S, Hasçelik G, Ünal S. Evaluation of methicillin-resistant Staphylococcus aureus bacteremia and comparison of prognosis according to vancomycin MIC values: Experience of the Last Ten Years. Mikrobiyol Bul 2013; 47(2): 199-210.
• 18. Surveillance Report Antimicrobial resistance surveillance in Europe 2011 http://ecdc.europa.eu/en/publications/_layouts/ forms/Publication_DispForm.aspx?List=4f55ad51- 4aed-4d32-b960-af70113dbb90&ID=719.
• 19. Borg MA, de Kraker M, Scicluna E, van de SandeBruinsma N, Tiemersma E, Monen J et. al. Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in invasive isolates from southern and eastern Mediterranean countries. J Antimicrob Chemother 2007, 60, 1310–1315. doi:10.1093/jac/ dkm365.
• 20. Yang Q, Xu Y, Xie X, Wang H, Hu Y, Ni Y, et.al. Antimicrobial resistance surveillance on hospitaland community-acquired pathogens in 10 teaching hospitals in China. Chinese Journal of Nosocomiology, 2009, 09 http://en.cnki.com.cn/ Journal_en/E-E055-ZHYY-2009-09.html .
• 21. Gülmez D, Hasçelik G. Comparison of microdilution method and phoenix automated system for testing antimicrobial susceptibilities of Enterococcus Strains. Mikrobiyol Bul, 2011;45(1):21-27.
• 22. Borg MA, Tiemersma E, Scicluna E, van de SandeBruinsma N, de Kraker M, Monen J, et al. Prevalence of penicillin and erythromycin resistance among invasive Streptococcus pneumoniae isolates reported by laboratories in the southern and eastern Mediterranean region. Clin Microbiol Infect 2009; 15: 232–7.
• 23. Borg MA, van de Sande-Bruinsma N, Scicluna E, de Kraker M, Tiemersma E, Monen J, et al. Antimicrobial resistance in invasive strains of Escherichia coli from southern and eastern Mediterranean laboratories. Clin Microbiol Infect 2008; 14: 789–796.