Erişkin Yoğun Bakım Ünitelerinde Karbapenem Dirençli Klebsiella pneumoniae ile Kolonizasyon/Enfeksiyon Gelişimi ve Karbapenemaz Tiplerinin Dağılımı

Karbapenem dirençli Enterobacteriaceae üyelerinin neden olduğu enfeksiyonların sıklığı tüm dünyada giderek artmakta olup mortalite oranları oldukça yüksektir. Bu kökenler ile oluşan enfeksiyonların ve kolonize hastaların hızlı tespiti, enfeksiyon kontrol protokollerinin uygulanması açısından oldukça önemlidir. Çalışmamızda erişkin yoğun bakım ünitelerinde yatan hastalarda karbapenem dirençli Klebsiella pneumoniae kökenleri ile gelişen kolonizasyon/enfeksiyon oranları ve karbapenemaz tiplerinin araştırılması amaçlanmıştır. Bu çalışmaya erişkin yoğun bakım ünitelerinde yatan hastalardan Haziran-Aralık 2017 tarihleri arasında rektal sürüntü örneklerinden ve klinik örneklerden izole edilen karbapenem dirençli K.pneumoniae (KD-Kp) kökenleri dahil edilmiştir. Kökenlerin antibiyotik duyarlılıkları VITEK2 otomatize sistemi ile çalışılmıştır. Karbapenemazların fenotipik tespitinde NG CARBA-5 immunokromayöntemi üreticinin önerileri doğrultusunda çalışılmıştır. Karbapenemaz genlerinin (OXA-48, IMP, VIM, KPC, NDM) varlığı spesifik primerler kullanılarak PCR yöntemi ile araştırılmıştır. Çalışma süresi içerisinde 344 hastaya ait tarama kültüründen 51 adet ve aynı döneme ait klinik örneklerden 30 adet KD-Kp üremiştir. Hastaların en az üçte birinde birden fazla gen pozitifliği gözlemlenmiştir. Enfeksiyon gelişen 17 hastanın geçmiş üç ay içerisinde bu mikroorganizma ile kolonize olduğu saptanmıştır. Enfeksiyon saptanan 4 hastanın tarama kültürleri negatif iken 9 hastada tarama kültürü olmaksızın KD-Kp enfeksiyonu gelişmiştir. Buna göre yoğun bakım ünitelerimizde kolonizasyon/enfeksiyon oranı %33,3 saptanmıştır. Yoğun bakım ünitelerimizde OXA-48 ve NDM türü enzimler % 60’lar düzeyindedir. İlginç olan daha önceki yıllarda gözlemlemediğimiz KPC tipi enzimin hem klinik hem de tarama kültürlerinden saptanmış olmasıdır. Yoğun bakım ünitelerimizde enfeksiyon/kolonizasyon oranı azımsanmayacak düzeyde olup kolonize hastaların yaklaşık üçte birinde enfeksiyon gelişebileceği belirlenmiştir.

Development of Colonization/Infection with Carbapenem Resistant Klebsiella pneumoniae and Distribution of Carbapenemase Types in Adult Intensive Care Units

The incidence of infections caused by carbapenem-resistant Enterobacteriaceae is increasing worldwide and, mortality rates are high. Rapid detection of infections and colonized patients with these strains is very important for the implementation of infection control protocols. In this study, we aimed to investigate the colonization/infection rates and carbapenemase types due to carbapenem-resistant Klebsiella pneumoniae in patients hospitalized in adult intensive care units. Carbapenem-resistant K.pneumoniae (CRKP) strains isolated from the rectal swab and clinical samples between JuneDecember 2017 from patients hospitalized in adult intensive care units were included in this study. Antibiotic susceptibility of the strains was studied by VITEK2 automated system. In the phenotypic determination of carbapenemases, NG CARBA-5 immunochromatographic method was studied according to the manufacturer’s recommendations. The presence of carbapenemase genes (OXA-48, IMP, VIM, KPC, NDM) was investigated by PCR method using specific primers. During to study period, 51 CR-Kp from the screening culture of 344 patients and 30 CR-Kp from clinical samples were produced. More than one gene positivity was observed in at least one-third of the patients. Seventeen patients who developed infection were colonized with this microorganism in the past three months. Four patients with infection had negative screening cultures, while nine patients developed CRKP infection without screening culture. Accordingly, colonization/infection rate in our intensive care units was determined as 33.3%. In our intensive care units, OXA-48 and NDM enzymes are 60 %. Interestingly, the KPC type enzyme, which we did not observe in previous years, was detected from both clinical and screening cultures. The infection / colonization rate in our intensive care units is not negligible and, approximately one third of colonized patients may develop the infection.

Kaynakça

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