Acinetobacter Baumannii’nin antibiyotik direnç mekanizmaları

Acinetobacter baumannii cins içerisinde infeksiyonlarla en sık ilişkili insan patojenidir. Bu fırsatçı patojen özellikle düşkün hastalarda oldukça ciddi infeksiyonlara neden olup yeni antibiyotiklere hızla direnç geliştirme yeteneğine sahiptir. Yakın geçmişte karbapenemler A.baumannii infeksiyonlarının tedavisinde ilk seçenekti. Ancak son zamanlarda pek çok klinik A.baumannii izolatı karbapenemler de dahil tüm konvansiyonel antibiyotiklere direnç kazanmıştır. Acinetobacter’deki ilaç direncini açıklayan en önemli güncel bulgular duyarlı ve dirençli suşların karşılaştırıldığı genomik analizler ile elde edilmiştir. Genom dizilerinin bir araya getirilmesi sonucunda dirençli ve duyarlı türlerin genom boyutları sırasıyla 3.9 Mb ve 3.2 Mb olarak saptanmıştır. Dirençli suşlarda antimikrobiyal ajanlara dirençle ilişkili olduğu düşünülen 52 gen tanımlanmıştır. Dirençli suşlarda dikkat çekici şekilde bu 52 direnç geninin 45’i direnç adası olarak adlandırılan bir bölgede toplanmıştır. Bu ada da şimdiye kadar bir bakteride tanımlanan en büyük direnç adasıdır. Direnç adasına ek olarak, dirençli suşlarda antimikrobiyal ajanlara dirençle ilişkili efluks pompaları da tanımlanmıştır. Bu derleme A.baumannii’nin direnç mekanizmaları hakkındaki bilgilerimizi tazeleyebilir; ancak onun devrimi gelecekte de devam edecektir.

Antibiotic resistance mechanisms of Acinetobacter Baumannii

Acinetobacter baumannii is the most relevant human pathogen within the genus. This opportunistic human pathogen causes a wide variety of serious infections mostly in compromised patients and it has the ability to develop resistance to new antibiotics extremely rapidly. Carbapenems have been the choice of treatment for A.baumannii infections until recent years. But many clinical isolates of A.baumannii are now resistant to all conventional antimicrobial agents, including carbapenems. Some of the most important recent advances in understanding of resistance in Acinetobacter have come from recent comparison of genomic analysis of resistant strains with susceptible ones. Assembly of the whole genome sequences has estimated genome size of 3.9 and 3.2 Mb for strains resistant and susceptible, respectively. Resistant isolates were found to encode 52 genes predicted to be associated with resistance to antimicrobial agents. Remarkably, 45 of the 52 resistance genes were clustered in a resistance island which is the largest resistance island identified in any bacterial species to date. In addition to the resistance island, efflux pumps associated with resistance to antimicrobial agents in resistant strains were identified. This review may be refresh our knowledge about resistance mechanisms of A.baumannii but its revolution will continue in the future.

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