Karbapenem dirençli ve karbapenem duyarlı pseudomonas aeruginosa kökenlerinin antibiyotik duyarlılıklarının karşılaştırılması ve karbapenem dirençli kökenlerde bazı karbapenemaz genlerinin araştırılması
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Tarih
2020
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Hatay Mustafa Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Karbapenem dirençli (CRPA) ve karbapenem duyarlı (CSPA) P. aeruginosa kökenlerinin diğer antibiyotiklere duyarlılıklarının karşılaştırılması ve karbapenem dirençli olan kökenlerdeki karbapenemaz genlerinin varlığının tespit edilmesi amaçlandı. Çalışmaya 50 adet CRPA ve aynı dönemde izole edilen 251 tane CSPA dahil edildi. Antibiyotik duyarlılıkları otomatize sistem kullanılarak saptandı. CRPA kökenlerindeki karbapenemaz genlerinin (blaIMP, blaSPM, blaAIM, blaNDM, blaOXA-48, blaKPC) varlığı multipleks polimeraz zincir reaksiyonu yöntemiyle araştırıldı. Kökenlerin en fazla yara (%32,6), idrar (%30,6) ve balgam (%16,9) örneklerinden ve yoğun bakım üniteleri dışındaki diğer kliniklerden izole edildiği tespit edildi. Kökenlerin en dirençli olduğu antibiyotikler netilmisin (%41,5), levofloksasin (36,5), piperasilin (%33,2) ve piperasilin/tazobaktam (%31,9) idi. İmipenem ve meropenem direnç oranları sırasıyla %15,6 ve %11,9 olarak bulundu. CRPA'lar amikasin, aztreonam, gentamisin, netilmisin, tobramisin, siprofloksasin, levofloksasin, sefepim, seftazidim, piperasilin, piperasilin/tazobaktama CSPA olanlardan daha dirençli olarak saptanmıştır (p<0,001). CSPA ve CRPA kökenlerde kolistine dirençte farklılık olmadığı tespit edilmiştir (p=1). CRPA kökenlerinde amikasin, aztreonam, seftazidim, siprofloksasin, kolistin, sefepim, gentamisin, levofloksasin, netilmisin, piperasilin, tobramisin, piperasilin/tazobaktam MİK değerleri CSPA olanlara göre daha yüksek saptandı dolayısıyla daha dirençli bulundu (p<0,001). Çoğul ilaca direnç (MDR) oranı %14,6 ve CRPA grupta MDR oranı daha fazla bulundu (P<0,001). CRPA kökenler içinde blaIMP, blaVIM, blaSPM, blaNDM, blaKPC, blaAIM ve blaOXA genleri arasında bir kökende blaIMP, üç kökende de blaVIM geni pozitif olarak bulundu. Sonuç olarak çalışmamızda karbapenem direnci ve MDR oranı ülkemizdeki oranlardan daha az oranda bulunmuştur. Daha önce hastanemizde yapılan çalışmalardaki oranlara göre de yıllar içinde oranların artmadığı görülmüştür. CRPA'ların CSPA'lara göre diğer antibiyotiklere de daha dirençli olduğu bulunmuştur. Çalışmamızda karbapenemazlardan IMP ve VIM tipi enzimler bulunmuştur. Hastanemizde yapılan diğer çalışmalarla birlikte bu çalışma hastanemizde izole edilen P. aeruginosa'larda karbapenemazların yaygın olmadığını göstermiştir. Bu enzimlerin epidemiyolojik olarak tanımlanması direnç yayılımını önlemede önemlidir ve bunları kodlayan genlerin tespiti; tedavide kullanılacak uygun antibiyotiklerin seçilmesinde yol gösterecektir.
It was aimed to compare the sensitivity of carbapenem resistant (CRPA) and sensitive P. aeruginosa (CSPA) strains to other antibiotics and to determine the presence of carbapenemase genes in carbapenem resistant strains. Fifty CRPA and 251 CSPA isolated in the same period were included into the study. Antibiotic susceptibilities were determined using the automated system. The presence of carbapenemase genes (blaIMP, blaSPM, blaAIM, blaNDM, blaOXA-48, blaKPC) in CRPA strains were investigated by multiplex polymerase chain reaction method. It was determined that the strains were isolated most frequently from wound (32.6%), urine (30.6%) and sputum (16.9%) samples and from the clinics other than intensive care units. Antibiotics which the strains were most resistant, were netilmicin (41.5%), levofloxacin (36.5%), piperacillin (33.2%) and piperacillin/tazobactam (31.9%). The resistance rates of imipenem and meropenem were found 15,6% and 11,9% respectively. CRPA isolates were found to be more resistant to amikacin, aztreonam, gentamicin, netilmicin, tobramycin, ciprofloxacin, levofloxacin, cefepime, ceftazidime, piperacillin, piperacillin / tazobactam than CSPA (p<0,001). No difference in resistance to colistin was found in CSPA and CRPA strains (p=1). Amikacin, aztreonam, ceftazidime, ciprofloxacin, colistin, cefepime, gentamicin, levofloxacin, netilmycin, piperacillin, tobramycin, piperacillin/tazobactam MIC values of CRPA strains were found to be higher than MIC values of CSPA strains so they were found to be more resistant (p<0,001). The multidrug resistance (MDR) rate was 14.6% and the MDR rate was higher in the CRPA group. the In CRPA strains, among blaIMP, blaVIM, blaSPM, blaNDM, blaKPC, blaAIM and blaOXA genes, blaIMP was found in one strain and blaVIM gene in three strains. In conclusion, carbapenem resistance and MDR rate in our study, were found to be lesser than the rates in our country. It was observed that the rates weren't increased over the years compared to the previous studies in our hospital. It was found that CRPA were also more resistant to other antibiotics than CSPA. IMP and VIM type enzymes were found in our study. Together with other studies conducted in our hospital, this study showed that carbapenemases were not common in P. aeruginosa strains isolated in our hospital. Identifying these enzymes epidemiologically is important in preventing the spread of resistance and detection of genes encoding them will guide the selection of appropriate antibiotics which will be used in treatment.
It was aimed to compare the sensitivity of carbapenem resistant (CRPA) and sensitive P. aeruginosa (CSPA) strains to other antibiotics and to determine the presence of carbapenemase genes in carbapenem resistant strains. Fifty CRPA and 251 CSPA isolated in the same period were included into the study. Antibiotic susceptibilities were determined using the automated system. The presence of carbapenemase genes (blaIMP, blaSPM, blaAIM, blaNDM, blaOXA-48, blaKPC) in CRPA strains were investigated by multiplex polymerase chain reaction method. It was determined that the strains were isolated most frequently from wound (32.6%), urine (30.6%) and sputum (16.9%) samples and from the clinics other than intensive care units. Antibiotics which the strains were most resistant, were netilmicin (41.5%), levofloxacin (36.5%), piperacillin (33.2%) and piperacillin/tazobactam (31.9%). The resistance rates of imipenem and meropenem were found 15,6% and 11,9% respectively. CRPA isolates were found to be more resistant to amikacin, aztreonam, gentamicin, netilmicin, tobramycin, ciprofloxacin, levofloxacin, cefepime, ceftazidime, piperacillin, piperacillin / tazobactam than CSPA (p<0,001). No difference in resistance to colistin was found in CSPA and CRPA strains (p=1). Amikacin, aztreonam, ceftazidime, ciprofloxacin, colistin, cefepime, gentamicin, levofloxacin, netilmycin, piperacillin, tobramycin, piperacillin/tazobactam MIC values of CRPA strains were found to be higher than MIC values of CSPA strains so they were found to be more resistant (p<0,001). The multidrug resistance (MDR) rate was 14.6% and the MDR rate was higher in the CRPA group. the In CRPA strains, among blaIMP, blaVIM, blaSPM, blaNDM, blaKPC, blaAIM and blaOXA genes, blaIMP was found in one strain and blaVIM gene in three strains. In conclusion, carbapenem resistance and MDR rate in our study, were found to be lesser than the rates in our country. It was observed that the rates weren't increased over the years compared to the previous studies in our hospital. It was found that CRPA were also more resistant to other antibiotics than CSPA. IMP and VIM type enzymes were found in our study. Together with other studies conducted in our hospital, this study showed that carbapenemases were not common in P. aeruginosa strains isolated in our hospital. Identifying these enzymes epidemiologically is important in preventing the spread of resistance and detection of genes encoding them will guide the selection of appropriate antibiotics which will be used in treatment.
Açıklama
Anahtar Kelimeler
Mikrobiyoloji, Microbiology
