İsmail Davarcı, Sebahat Aksaray, Mustafa Samastı, Mert Ahmet Kuşkucu, Seniha Senbayrak, M. Esra Kocoglu

Karbapeneme Dirençli Klebsiella pneumoniae Suşlarının Moleküler Epidemiyolojisi

Amaç: Karbapeneme dirençli Klebsiella pneumoniae enfeksiyonları, azalan tedavi imkanlarıyla birlikte önemli bir klinik sorun haline gelmiştir. Bu çalışmada, İstanbul’da elde edilen K. pneumoniae izolatlarındaki karbapenem direnç oranlarını ve buna sebep olan direnç genlerini incelemek amaçlanmıştır. Gereç ve Yöntemler: Bu prospektif çalışmaya, Temmuz 2013—Temmuz 2014 döneminde hastanemize kabul edilen hastalardan elde edilen toplam 1452 K. pneumoniae izolatı dahil edilmiştir. Mikroorganizmaların tanımlanması ve antimikrobiyal duyarlılık testi için VITEK-2 (bioMérieux, MarcyI’Ѐtoile, Fransa) kullanılmıştır. VITEK-2 otomatize sistem ile karbapenem direnci saptanan suşların ertapenem gradient testi ile de ertapeneme dirençli olduğu bulunmuştur. Karbapenem direncine sebep olan genler real time-polymerase chain reaction ile araştırılmıştır. Bulgular: 1452 K. pneumoniae izolatının 45’i (%3,1) karbapeneme dirençliydi. Bunların 32’si (%71,1) blaOXA-48-pozitif, 9’u (%20) blaNDM-pozitif, 1’i (%2,2) blaVIM-1-pozitifti. Hiçbirinde blaKPC ve blaIMP-1 geni mevcut değildi. Karbapenemaz üreten K. pneumonae izolatlarının en duyarlı olduğu antimikrobiyaller amikasin ve gentamisin idi. Tartışma ve Sonuç: Hastanemizde karbapenem direncine sebep olan çeşitli mekanizmalar bulunmaktadır ve blaOXA-48 geninin %71,1 oranında görülmesi dikkat çekicidir. Bu direncin hızla yayılması ve enzimatik direnç genlerinin aktarımı yoluyla yönetimi zor hastane salgınlarına yol açması mümkündür. Bu nedenle enfeksiyon kontrolünde doğru ve hızlı laboratuvar tanı önemlidir. Daha hızlı sonuçlar elde etmek için moleküler yöntemler de fenotipik yöntemler gibi hastane altyapısına dahil edilmelidir.

Molecular Epidemiology of Carbapenemresistant Klebsiella pneumoniae Isolates

Aim: Carbapenem-resistant Klebsiella pneumoniae infection has become an important clinical problem with reduced therapeutic options. This study aimed to investigate the carbapenem resistancerates and responsible resistance genes in K. pneumoniae isolates derived from clinical samples collected in Istanbul.Materials and Methods: This prospective study included a total of 1452 K. pneumoniae isolates frompatients admitted to our hospital between July 2013 and July 2014. VITEK-2 (bioMérieux, MarcyI’Ѐtoile, France) was used for microbial identification and antimicrobial susceptibility testing. Thecarbapenem-resistant isolates identified by VITEK-2 were also found to be resistant to ertapenemby the ertapenem gradient test. Resistance mechanisms of the carbapenem-resistant isolates wereinvestigated using real time-polymerase chain reaction.Results: Of the 1452 K. pneumoniae isolates, 45 (3.1%) were carbapenem-resistant. Of these, 32(71.1%) were blaOXA-48-positive, 9 (20%) blaNDM-positive, and 1 (2.2%) blaVIM-1-positive. None had thegenes blaKPC and blaIMP-1. The greatest susceptibility by the isolated carbapenemase-producing K.pneumoniae was shown to the antimicrobials amikacin and gentamicin.Discussion and Conclusion: In our hospital, there are several mechanisms causing carbapenem resistance, and the blaOXA-48 positivity rate of 71.1% is significant. This resistance may spread rapidly and,through enzymatic resistance gene transfer, lead to hospital epidemics difficult to manage. For thisreason, accurate and rapid laboratory diagnosis is important in infection control. For faster results,molecular methods, as well as phenotypic methods, must be included in the hospital infrastructure.

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