Güle ÇINAR, İrem Akdemir KALKAN, İsmail BALIK, Zeynep BAYINDIR, Aysun YALÇI, Hüseyin KUTLU, Devran GERÇEKER, Haluk GÜRİZ

Farklı Antibiyotik Kombinasyonlarının Çoklu İlaca Dirençli Gram-Negatif Bakteriler Üzerindeki Etkilerinin Değerlendirilmesi

Amaç: Toplumdan ve özellikle hastaneden izole edilen gram-negatif bakterilerde antibakteriyel ilaçlara direncin artması hem dünyada hem de ülkemizde en önemli sağlık sorunlarından biri haline gelmiştir. Artan antibakteriyel ilaç direnci açısından Acinetobacter cinsi ve Enterobacteriacea ailesi gram-negatif bakteriler arasında önemli bir yere sahiptir. Bu çalışmada, çeşitli antibiyotik kombinasyonlarının in vitro etkilerini E-test yöntemi ile değerlendirmeyi ve çoklu ilaca dirençli Acinetobacter baumannii enfeksiyonlarında ve GSBL ve karbapenemaz salgılayan gram negatif enterik bakteri enfeksiyonlarında kullanılabilecek sinerjik etkili kombinasyonları belirlemeyi amaçladık. Gereç ve Yöntem: Kolistinin trimetoprim-sülfametoksazol, rifampisin, doksisiklin, sulbaktam, imipenem, tigesiklin ve kloramfenikol ile kombinasyonlarının in vitro olarak sinerjistik etkili olup olmadığı, kolistine duyarlı ancak çoklu ilaca dirençli, kolistine ve çoklu ilaca dirençli 20’şer Acinetobacter baumannii ve genişlemiş spektrumlu beta-laktamaz ve karbapenemaz üreten 20 Klebsiella pneumoniae suşunda değerlendirildi. Bulgular: Sinerjistik etki, kolistin-tigesiklin kombinasyonunda tüm çoklu ilaca dirençli bakteri gruplarında en yaygın etki olarak bulundu. Kolistine duyarlı A. baumannii grubunda %80, kolistine dirençli Acinetobacter baumannii grubunda %45 ve Klebsiella pneumoniae grubunda %80 oranında görüldü. Sonuç: Çoklu ilaca dirençli gram-negatif bakterilere bağlı enfeksiyonların uygun tedavisi için daha fazla suş ve farklı antibiyotik kombinasyonları ile daha ileri çalışmalara ihtiyaç duyulsa da, kolistin-tigesiklin, kolistin-sulbaktam, kolistin-rifampisin kombinasyonlarının bu suşlar için in vitro olarak için çok etkili olduğu görüldü ve klinik uygulamalarda yol gösterici olabileceğini düşündük.

Evaluation of the Effects of Different Antibiotic Combinations on Multi-Drug Resistant Gram-Negative Bacteria

Objectives: Increasing resistance to antibacterial drugs in gram-negative bacteria isolated from the community and especially from the hospital has become one of the most important health problems both in the world and in our country. Acinetobacter genus and Enterobacteriacea family have an important place among gram-negative bacteria with increased antibacterial drug resistance. In this study, we aimed to evaluate the in vitro effects of various antibiotic combinations with E-test method and determine synergistic effective combinations that could be used in multidrug resistant Acinetobacter baumannii infections and ESBL and carbapenemase secreting gram-negative enteric bacterial infections. Materials and Methods: It was evaluated whether the combinations of colistin with trimethoprim-sulfamethoxazole, rifampicin, doxycycline, sulbactam, imipenem, tigecycline and chloramphenicol were synergistic effective in vitro in 20 colistin-susceptible but multidrug-resistant, 20 colistin- and multi-drug-resistant Acinetobacter baumannii strains and 20 both extended-spectrum beta-lactamase and carbapenemase-producing Klebsiella pneumoniae strains isolated from various and different clinical samples (sputum, urine, tracheal aspirate, blood, etc.), sent from patients hospitalized in various clinics. Results: The synergistic effect was most common in the colistin-tigecycline combination in all multi-drug resistant bacterial groups, 80% in the colistin-sensitive Acinetobacter baumannii group, 45% in the colistin-resistant Acinetobacter baumannii group, and 80% in the Klebsiella pneumoniae group. Conclusion: Although further studies with more strains and different antibiotic combinations are needed for the appropriate treatment of infections due to multi-drug-resistant gram-negative bacteria, we found that colistin-tigecycline, colistin-sulbactam, colistin-rifampicin combinations are so effective for these strains in vitro and these results can help clinicians in treatment process.

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