Antibiotic sensitivities of Streptococcus pneumoniae, Viridans streptococci and group A hemolytic Streptococci isolated from the maxillary and ethmoid sinuses

Yıl 2006, Cilt: 16 Sayı: 1, 18 - 24, 13.01.2006

Erol Keleş Murat Aral Hayrettin Cengiz Alpay

Öz

O bjectives: To investigate antibiotic sensitivities ot Streptococcus pneumoniae, Viridans streptococci and Group A hemolytic Streptococci isolated trom the cul- ture materials obtained trom the sinuses ot patients undergoing tunctional endo- scopic sinüs surgery due to chronic sinusitis.Patients and Methods: We recruited 93 patients 63 males, 30 temales; mean age 36±17.47; range 19 to 68 years who were undergoing tunctional endoscopic sinüs surgery due to chronic sinusitis into this study. Betore the surgical interven- tion, in order to eliminate a possible contamination trom skin and neighboring struc- tures, nasal mucosa was cleansed with povidone-iodine solution. Nasal smear samples were obtained trom ali the patients betore and after applying povidone- iodine solution. Streptococcus pneumoniae, Viridans streptococci and Group A hemolytic Streptococci that were isolated trom the cultures were tested tor antibi­ otic sensitivity.Results: İn the preoperative nasal smear cultures, total number ot anaerobic bacteria isolated trom 58 patients 62.3% betore applying povidone-iodine was 72, following the application ot povidone-iodine a total ot 16 microorganisms were identitied trom 12 %12.9 patients. Microorganisms were isolated trom 95.6% 89/93 ot the samples obtained trom maxillary sinuses and 91.3% 85/93 ot the samples obtained trom ethmoid sinuses. The most commonly identitied microorganisms trom both sinuses were coagulase - staphylococcus followed by Viridans streptococci, coagulase + staphylococcus, Streptococcus pneumo­ niae and Group A hemolytic streptococci. For the Viridans streptococcal strains that were isolated, 33.3% were resistant to tetracycline, 23.8% to chlorampheni- col, and 19.04% to penicillin. A hemolytic streptococci strains were sensitive to penicilin, ofloxacine, ceftriaxone and cetepime in ali groups; however they had 50% resistance to eritromycin and chloramphenicol and 100% resistance to tetracycline. The resistance pattern ot the isolated Streptococcus pneumoniae strains were as follows: 25% to penicillin, 66.6% to trimethoprim/sulphometaxa- zole, 41.6% to eritromycin, 58.3% to tetracycline, 33.3% to chloramphenicol and 16.6% to ritampin. AH ot the isolated strains were sensitive to vancomycin.Conclusion: We suggested that identitication ot the strains that are resistant to penicillin and other antibiotics is an important tool tor choosing the empirical treatment to the Streptococcus pneumoniae, Viridans streptococci and group A hemolytic streptococci in clinical practice. Viridans streptococci which were fre- quently isolated trom chronic sinusitis patients should be kept in mind.

Anahtar Kelimeler

Chronic sinusitis, Streptococcus pneumoniae, Viridans streptococcus, Group A hemolytic streptococci, antibiotic sensitivity

Maksiller ve etmoid sinüslerden izole edilen Streptokok pnömoni, Streptokok viridans ve A grubu hemolitik Streptokok'larm antibiyotik dirençleri

Öz

Amaç: Kronik sinüzit nedeniyle fonksiyonel endoskopik sinüs cerrahisi hastaların sinüslerinden alınan kültür materyallerinden izole edilen Streptokok pnömoni,Streptokok viridans, A grubu hemolitik streptokok’ların antibiyotik dirençleri araştırıldı.Hastalar ve Yöntemler: Çalışmaya, kronik sinüzit nedeniyle fonksiyonel endoskopik sinüs cerrahisi uygulanan 93 hasta alındı. Cerrahi girişim öncesi nazal mukoza, deri ve komşu yapılar olası bir kontaminasyonu önlemek amacıyla povidone-iodine solüsyonuyla temizlendi. Tüm hastalardan povidone-iodine solüsyonu uygulamadan önce vesonra burun sürüntü örnekleri alındı. Ameliyat sırasında da etmoid sinüsten vemaksiller sinüs ostiumundan kültür için materyal alındı. Kültürlerde izole edilenStreptokok pnömoni, Streptokok viridans ve A grubu hemolitik streptokok’lara antibiyotik duyarlılık testleri yapıldı.Bulgular: Ameliyat öncesi burun sürüntü kültürlerinden povidone-iodine solüsyonu uygulamadan önce 58 hastadan %62.3 72 aerop bakteri üremesi olurken, povidone-iodine solüsyonu uygulandıktan sonra alınan kültürlerde 12hastadan %12.9 toplam 16 izolasyon oldu. Ameliyat sırasında maksiller sinüslerden alınan kültürlerde hastaların %95.6’sında 89/93 , etmoid sinüstenalınan kültürlerde ise %91.3’ünde 85/93 mikroorganizma izole edildi. Her ikisinüste de en sık izole edilen mikroorganizma koagülaz negatif stafilokok, ikinci sıklıkta viridans streptokok’lar daha sonra sırasıyla koagülaz pozitif stafilokok, Streptokok pnömoni ve A grubu hemolitik streptokok idi. İzole edilen viridans streptokok suşunun %33.3’ü tetrasikline, %23.8’i kloramfenikole,%19.04’ü penisiline dirençli bulunurken, A grubu hemolitik streptokok suşununtümü penisilin, ofloksasin, seftriakson, sefepime duyarlı, %50’si eritromisin vekloramfenikole, tamamı tetrasikline dirençli bulundu. İzole edilen Streptokokpnömoni suşlarının %25’i pensiline, %66.6’sı trimetoprim/sülfametoksazole,%41.6’sı eritromisine, %58.3’ü tetrasikline, %33.3’ü kloramfenikole ve%16.6’sı rifampine dirençliydi. İzole edilen suşların tümü vankomisine duyarlıydı.Sonuç: Kronik sinüzitli hastalardan sık olarak izole edilen Streptokok pnömoni,viridans streptokok’lar ve A grubu hemolitik streptokok’ların antimikrobiyal duyarlılıklarının araştırılmasının, klinikte uygulanacak ampirik tedavinin seçilmesindeve kronik sinüzitli hastalarda viridans streptokok’ların tedavide göz önünde bulundurulması gerektiğini düşünüyoruz

Anahtar Kelimeler

Kronik sinüzit, Streptokok pnömoni, viridans streptokok, A grubuHemolitik Streptococ, antibiyotik duyarlılığı

Kaynakça

• Brook I. The importance of lactic acid levels in body fluids in the detection of bacterial infections. Rev Infect Dis 1981;3:470-8.
• Benninger MS, Anon J, Mabry RL. The medical man- agement of rhinosinusitis. Otolaryngol Head Neck Surg 1997;117(3 Pt 2):S41-9.
• Johnson TJ. Infections. In: Cummings CW, Krause CJ, editors. Otolaryngology head and neck surgery. 1th ed. St. Louis: Mosby Company; 1986. p. 887-900.
• Almadori G, Bastianini L, Bistoni F, Maurizi M, Ottaviani F, Paludetti G, et al. Microbial flora of nose and paranasal sinuses in chronic maxillary sinusitis. Rhinology 1986;24:257-64.
• Doyle PW, Woodham JD. Evaluation of the microbiol- ogy of chronic ethmoid sinusitis. J Clin Microbiol 1991;29:2396-400.
• Bochud PY, Calandra T, Francioli P. Bacteremia due to viridans streptococci in neutropenic patients: a review. Am J Med 1994;97:256-64.
• Ginsburg I, Ward PA, Varani J. Can we learn from the pathogenetic strategies of group A hemolytic strepto- cocci how tissues are injured and organs fail in post- infectious and inflammatory sequelae? FEMS Immunol Med Microbiol 1999;25:325-38.
• Yagupsky P, Giladi Y. Group A beta-hemolytic strepto- coccal bacteremia in children. Pediatr Infect Dis J 1987;6:1036-9.
• Shahid NS, Steinhoff MC, Hoque SS, Begum T, Thompson C, Siber GR. Serum, breast milk, and infant antibody after maternal immunisation with pneumo- coccal vaccine. Lancet 1995;346:1252-7.
• Spika JS, Facklam RR, Plikaytis BD, Oxtoby MJ. Antimicrobial resistance of Streptococcus pneumoniae in the United States, 1979-1987. The Pneumococcal Surveillance Working Group. J Infect Dis 1991;163:1273-8.
• Sener B, Hascelik G, Onerci M, Tunckanat F. Evaluation of the microbiology of chronic sinusitis. J Laryngol Otol 1996;110:547-50.
• Benninger MS, Appelbaum PC, Denneny JC, Osguthorpe DJ, Stankiewicz JA. Maxillary sinus punc- ture and culture in the diagnosis of acute rhinosinusi- tis: the case for pursuing alternative culture methods. Otolaryngol Head Neck Surg 2002;127:7-12.
• Brook I. Bacteriology of chronic maxillary sinusitis in adults. Ann Otol Rhinol Laryngol 1989;98:426-8.
• Buzina W, Braun H, Freudenschuss K, Lackner A, Habermann W, Stammberger H. Fungal biodiversity-- as found in nasal mucus. Med Mycol 2003;41:149-61.
• Erkilic S, Aydin A, Bayazit YA, Guldur E, Deniz H, Bayazit N, et al. Histopathologic assessment of fungal involvement of the paranasal sinuses in Turkey. Acta Otolaryngol 2003;123:413-6.
• Karma P, Jokipii L, Sipila P, Luotonen J, Jokipii AM. Bacteria in chronic maxillary sinusitis. Arch Otolaryngol 1979;105:386-90.
• Guiot HF, Corel LJ, Vossen JM. Prevalence of peni- cillin-resistant viridans streptococci in healthy chil- dren and in patients with malignant haematological disorders. Eur J Clin Microbiol Infect Dis 1994;13:645- 50.
• Potgieter E, Carmichael M, Koornhof HJ, Chalkley LJ. In vitro antimicrobial susceptibility of viridans strep- tococci isolated from blood cultures. Eur J Clin Microbiol Infect Dis 1992;11:543-6.
• Doern GV, Ferraro MJ, Brueggemann AB, Ruoff KL. Emergence of high rates of antimicrobial resistance among viridans group streptococci in the United States. Antimicrob Agents Chemother 1996;40:891-4.
• Appelbaum PC. Antimicrobial resistance in Streptococcus pneumoniae: an overview. Clin Infect Dis 1992;15:77-83.
• Perez-Trallero E, Marimon JM, Gonzalez A, Iglesias L. Spain14-5 international multiresistant Streptococcus pneumoniae clone resistant to fluoroquinolones and other families of antibiotics. J Antimicrob Chemother 2003;51:715-9.
• Geslin P, Buu-Hoi A, Fremaux A, Acar JF. Antimicrobial resistance in Streptococcus pneumoni- ae: an epidemiological survey in France, 1970-1990. Clin Infect Dis 1992;15:95-8.