Banu BAYRAKTAR, Fesem BAŞARI, Emin BULUT

A grubu beta-hemolitik streptokoklarda antibiyotik duyarlılığı ve makrolid direnç fenotipi

A grubu beta-hemolitik streptokoklar (AGBHS) karakteristik olarak, ciddi nonsüpüratif komplikasyonlar olan akut romatizmal ateş ve akut glomerulonefritin görülebildiği, akut boğaz ve deri infeksiyonlarının başlıca etkenidirler. AGBHS halen penisiline duyarlı olup, makrolidlere karşı dirençte artış görülmektedir. Bu çalışmaya Mart 2004-Ocak 2007 arasında çeşitli klinik örneklerden izole edilmiş olan 72 AGBHS suşu dahil edilmiştir. Disk difüzyon metodu ile penisilin G, ampisilin, eritromisin, klindamisin, kloramfenikol, tetrasiklin, levofloksasin, vankomisin, linezolid ve telitromisin duyarlılık testi yapılmıştır. Ayrıca E test ile penisilin G ve eritromisin MİK değerleri saptanmıştır. D-zon (disk difüzyon) test ile eritromisin dirençli suşlarda makrolid direnç fenotipleri araştırılmıştır. Penisilin G, ampisilin, kloramfenikol, vankomisin, linezolid ve telitromisine tüm AGBHS suşları duyarlı bulunmuştur. Penisilin G ve eritromisinin MİK50 değerleri sırası ile 0.006 µg/ml ve 0.047 µg/ml; MİK90 değerleri 0.012 µg/ml ve 0.125 µg/ml bulunmuştur. Diğer antibiyotiklere direnç oranları: tetrasikline % 31 (n=22), eritromisine % 10 (n=7), klindamisine % 3 (n=2), levofloksasine % 1 (n=1) olarak saptanmıştır. Yedi eritromisin dirençli suşun ikisinde konstitütif MLSB ve beşinde indüklenebilir MLSB fenotipi saptanmıştır. M fenotipi dirence rastlanmamıştır. Sonuç olarak, hastanemizde AGBHS izole edildiğinde tedavi başarısızlıklarını sınırlandırmak açısından makrolid duyarlılık testlerinin ve D-zon testin yapılmasının faydalı olacağı kanaatine varılmıştır. Diğer antibiyotiklere direnç oranlarının da takip edilmesi AGBHS infeksiyonlarının tedavisiyle ilgili uygun önerilerin oluşturulmasını sağlayacaktır.

Anahtar Kelimeler:

Disk difüzyon antimikrobiyal testleri, İlaç direnci, bakteriyel, Makrolidler, Streptococcus, Fenotip, Mikrobiyal duyarlılık testleri, Anti-enfektif ajanlar

Antibiotic susceptibility and macrolide resistance phenotypes in group A beta-haemolytic streptococci

Group A beta-haemolytic streptococci (GABHS) are major causes of acute throat and skin infections, which may characteristically be followed by the severe nonsuppurative complications as rheumatic fever or acute glomerulonephritis. GABHS are still susceptible to penicillin but have shown increasing resistance to macrolides. Seventy-two GABHS strains isolated from various clinical samples between March 2004-January 2007 were included in this study. Antibiotic susceptibility testing for penicillin G, ampicillin, erythromycin, clindamycin, chloramphenicol, tetracycline, levofloxacin, vancomycin, linezolid and telithromycin were performed by disk diffusion method. In addition, MIC values for penicillin G and erythromycin were detected by E test method. Macrolide resistance phenotypes were investigated in erythromycin resistant isolates by double disk (D-zone) test. Our results showed that all of the GABHS were susceptible to penicillin G, ampicillin, vancomycin, linezolid, chloramphenicol and telithromycin. MIC50 values of penicillin G and erythromycin were determined as 0.006 µg/ml and 0.047 µg/ml; and MIC90 values as 0.012 µg/ml and 0.125 µg/ml, respectively. Resistance rates for other antimicrobials were as follows: 1 % (n=1) to levofloxacin, 3 % (n=2) to clindamycin, 10 % (n=7) to erythromycin, and 31 % (n=22) to tetracycline. Among seven erythromycin resistant strains, two had constitutive MLSB and five had inducible MLSB resistance phenotypes. M resistance phenotype was not found. In conclusion, these results suggest that susceptibility test for macrolides and D-zone test should be performed whenever GABHS are isolated in our hospital settings. This approach might limit the therapeutic failures due to macrolide resistance. Monitoring susceptibility rates to other antimicrobials will eventually lead to rationale recommendations for treating GABHS infections.

Keywords:

Disk Diffusion Antimicrobial Tests, Drug Resistance, Bacterial, Macrolides, Streptococcus, Phenotype, Microbial Sensitivity Tests, Anti-Infective Agents,

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