Kan Kültürlerinden İzole Edilen Nonfermentatif ID Gram Negatif Bakterilerin Dağılımının ve Antibiyotik Duyarlılık Profillerinin Belirlenmesi

Nonfermentatif Gram negatif bakteriler bakteriyemiye neden olan önemli enfeksiyon etkenlerinden biridir. Çalışmamızda Hacettepe Üniversitesi Tıp Fakültesi Hastanesi Merkez Mikrobiyoloji Laboratuvarı’nda Aralık 2017 - Aralık 2018 tarihleri arasında kan kültürü örneklerinden izole edilen 355 nonfermentatif Gram negatif bakterinin dağılımı ve antibiyotik duyarlılık profilleri retrospektif olarak araştırılmıştır. Kan kültürleri BD BACTEC FX otomatize sisteminde en fazla beş gün inkübe edilmiştir. Mikroorganizmaların identifikasyonu konvansiyonel yöntemler ve matriks aracılı lazer dezorpsiyon iyonizasyon uçuş zamanı kütle spektrometresi (MALDI-TOF MS) ile yapılmıştır. Antibiyotik duyarlılık testleri Pseudomonas aeruginosa için otomatize sistem ile, P.aeruginosa dışındaki bakteriler için disk difüzyon yöntemi kullanılarak yapılmıştır. İzolatların, 191’i (% 53.8) Pseudomonas spp., 118’i (% 33.2) Acinetobacter spp., 35’i (% 9.8) Stenotrophomonas maltophilia, altısı Achromobacter spp., üçü Chryseobacterium spp., biri Empedobacter brevis ve biri Herbaspirullum aquaticum olarak tanımlanmıştır. En sık izole edilen etkenin erişkin servislerinde P.aeruginosa iken, pediatri servislerinde S.maltophilia olduğu; erişkin yoğun bakım servislerinde de pediatri yoğun bakım servislerinde de en sık izole edilmiş etkenin P.aeruginosa olduğu tespit edilmiştir. Antibiyotik duyarlılık testleri sonucunda en yüksek direnç oranları Acinetobacter baumannii izolatlarında tespit edilmiştir. P.aeruginosa ve diğer izole edilen nonfermentatif Gram negatif bakterilerin direnç oranları A.baumannii’ye göre daha düşük bulunmuştur. Sonuç olarak kan kültürlerinden izole edilen nonfermentatif mikroorganizmaların çeşitliliği, dağılımı ve antibiyotik duyarlılık profilleri hastaneler arasında farklılıklar gösterebileceğinden hastanelerin kendi verilerini değerlendirmesi ampirik tedavinin yönlendirilmesinde önemli rol oynayabilir.

Detection of Distribution and Antibiotic Susceptibility Profiles of Nonfermentative Gram Negative Bacteria Isolated from Blood Cultures

Nonfermentative Gram negative bacteria are one of the important infectious agents causing bacteremia. In this study, the distribution and antibiotic susceptibility profiles of 355 nonfermentative Gram negative bacteria that are isolated from blood culture samples in the Central Microbiology Laboratory of Hacettepe University Medical Faculty Hospital between December 2017 and December 2018 were investigated retrospectively. Blood cultures were incubated for a maximum of five days by using BD BACTEC FX automated system. Identification of microorganisms was performed by using conventional methods and matrix-mediated laser desorption ionization flight time mass spectrometry (MALDI-TOF MS). Antibiotic susceptibility tests were performed by using an automated system for Pseudomonas aeruginosa and the disk diffusion method for bacteria other than P.aeruginosa. Of the isolates, 191 (53.8 %) were Pseudomonas spp., 118 (33.2 %) were Acinetobacter spp., 35 (9.8 %) were Stenotrophomonas maltophilia, six were Achromobacter spp., three were Chryseobacterium spp., one was Empedobacter brevis and one was Herbaspirullum aquaticum. The most common isolated agent was P.aeruginosa in adult services, while S.maltophilia was found in pediatric services. In both pediatric intensive care services and adult intensive care services, P.aeruginosa was the most commonly isolated agent. As a result of antibiotic susceptibility tests, the highest resistance rates were determined in Acinetobacter baumannii isolates. The resistance rates of P.aeruginosa and other isolated non-fermentative Gram negative bacteria were lower than those of A.baumannii. In conclusion, the diversity, distribution and antibiotic susceptibility profiles of microorganisms isolated from blood cultures may show differences between hospitals. The evaluation of hospitals’ own data may play an important role in directing empirical treatment.

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