KOLİSTİN DİRENÇLİ ACINETOBACTER BAUMANNII TEDAVİSİNDE SIRA DIŞI BİR ANTİBİYOTİK KOMBİNASYON TEDAVİSİ: TRİMETOPRİM-SÜLFAMETOKSAZOL VE KOLİSTİN KOMBİNASYONU

Acinetobacter baumannii ventilatör ilişkili pnömoni, kan dolaşımı infeksiyonları, cerrahi alan infeksiyonları ve idrar yolu infeksiyonları gibi çeşitli infeksiyonlara yol açan önemli bir nozokomiyal patojen olarak kabul edilmektedir. A.baumannii izolatlarına karşı artan direnç endişe konusudur. Çoklu ilaç dirençli Gram negatif patojenlere karşı kolistin etkili bir ajandır. Ancak artan maruziyet kolistine direncin ortaya çıkmasına yol açarak bu patojene karşı tedavi seçeneklerini sınırlamıştır. Kolistinin tigesiklin, ampisilin-sulbaktam, rifampin ve karbapenem ile kombinasyonu bu suşların neden olduğu infeksiyonlarda diğer tedavi seçenekleridir. Çalışmamızda yoğun bakım ünitesinde takip edilen sadece trimetoprim- sülfametoksazole (SXT) duyarlı bir A.baumannii suşuna bağlı gelişen ventilatör ilişkili pnömoni olgusunda kullanılan kolistin ve SXT kombinasyon tedavisi bildirilmiştir. Çoklu antibiyotik dirençli A.baumannii infeksiyonlarında geleneksel olmayan antibiyotikler ile kolistin kombinasyonu umut verici alternatif tedavi olabilmektedir. Kolistin ve SXT tedavisi ile kür sağlanan bu olgu, başka seçeneğin olmadığı durumlarda Acinetobacter türlerine karşı etkili olmayan SXT'nin kolistin ile kombinasyonunun tedavide düşünülebileceğini vurgulamak için sunulmuştur

An Unusual Antibiotic Combination Therapy for Treatment of Colistin Resistant Acinetobacter baumannii: Trimethoprim-Sulfamethoxazole and Colistin Combination

An Unusual Antibiotic Combination Therapy for Treatment of Colistin Resistant Acinetobacter baumannii: Trimethoprim-Sulfamethoxazole and Colistin CombinationAcinetobacter baumannii is regarded as an important nosocomial pathogen causing various infections including ventilator-associated pneumonia, bloodstream infections, surgical site infections, and urinary tract infections. There is growing concern about increased resistance to Acinetobacter baumannii isolates. Colistin is an effective agent against multidrugresistant (MDR) gram-negative pathogens. However, increased exposure has led to emergence of colistin resistance, limiting the therapeutic options against this pathogen. Colistin, in combination with other agents such as tigecycline, ampicillinsulbactam, rifampin, and carbapenems are alternative treatment options for infections caused by these strains. In our study, combination therapy with colistin and trimethoprim-sulfamethoxazole (SXT) was used for ventilator-associated pneumonia due to A.baumannii only susceptible to SXT followed in intensive care unit. Combinations of colistin with non-traditional antibiotics might be promising alternatives for treatment of MDR strains of A.baumannii infections. This patient who was cured with colistin and SXT treatment was presented to emphasize that despite being usually ineffective against Acinetobacter spp., when no other option exists, SXT combined with colistin might be considered

___

  • 1. Al-Sweih NA, Al-Hubail MA, Rotimi VO. Emergence of tigecycline and colistin resistance in Acinetobacter species isolated from patients in Kuwait hospitals, J Chemother 2011;23(1):13-6. https://doi.org/10.1179/joc.2011.23.1.13
  • 2. Arroyo LA, Mateos I, Gonzalez V et al. In vitro activities of tigecycline, minocycline, and colistin-tigecycline combination against multi- and pandrug-resistant clinical isolates of Acinetobacter baumannii group, Antimicrob Agents Chemother 2009;53(3):1295-6. https://doi.org/10.1128/AAC.01097-08
  • 3. Boucher HW, Talbot GH, Bradley JS et al. Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America, Clin Infect Dis 2009;48(1):1-12. https://doi.org/10.1086/595011
  • 4. Bshabshe AA, Joseph MRP, Hussein AA, Haimour W, Hamid ME. Multidrug resistance Acinetobacter species at the intensive care unit, Aseer Central Hospital, Saudi Arabia: a one year analysis, Asian Pac J Trop Med 2016;9(9):903-8. https://doi.org/10.1016/j.apjtm.2016.07.016
  • 5. Clinical breakpoints (Bacterial v6.0 and Fungal v8.0). The European Committee on Antimicrobial Susceptibility Testing: http:// www.eucast.org/clinical_breakpoints.
  • 6. Dizbay M, Altuncekic A, Sezer BE et al. Colistin and tigecycline susceptibility among multidrug-resistant Acinetobacter baumannii isolated from ventilator-associated pneumonia, Int J Antimicrob Agents 2008;32(1):29- 32. https://doi.org/10.1016/j.ijantimicag.2008. 02.016
  • 7. Dobrewski R, Savov E, Bernards AT et al. Genotypic diversity and antibiotic susceptibility of Acinetobacter baumannii isolates in a Bulgarian hospital, Clin Microbiol Infect 2006;12(11):1135-7. https://doi.org/10.1111/j.1469-0691.2006.01530.x
  • 8. Doi Y, Husain S, Potoski BA, McCurry KR, Paterson DL. Extensively drug-resistant Acinetobacter baumannii, Emerg Infect Dis 2009;15(6):980-2. https://doi.org/10.3201/eid1506.081006
  • 9. Eser OK, Ergin A, Hascelik G. Antimicrobial resistance and existence of metallo-blactamase in Acinetobacter species isolated from adult patients, Mikrobiyol Bul 2009;43(3): 383-90.
  • 10. Falagas ME, Vardakas KZ, Roussos NS. Trimethoprim/sulfamethoxazole for Acinetobacter spp.: areview of current microbiological and clinical evidence, Int J Antimicrob Agents 2015;46(3):231-41. https://doi.org/10.1016/j.ijantimicag.2015.04.002
  • 11. Garcia-Penuela E, Aznar E, Alarcon T, LópezBrea M. Susceptibility pattern of Acinetobacter baumannii clinical isolates in Madrid vs. Hong Kong, Rev Esp Quimioter 2006;19(1):45- 50.
  • 12. Garonzik SM, Li J, Thamlikitkul V et al. Population pharmacokinetics of colistin methanesulfonate and formed colistin in critically ill patients from a multicenter study provide dosing suggestions for various categories of patients, Antimicrob Agents Chemother 2011;55(7):3284-94. https://doi.org/10.1128/AAC.01733-10
  • 13. Gündoğdu A, Ulu Kılıç A, Kılıç H, Alp Meşe E. Kolistin dirençli gram-olumsuz mikroorganizmaların klinik ve epidemiyolojisi: Hastanelerde yeni tehdit, 6. Türkiye EKMUD Kongresi Kitabı, s.37 Antalya (2016).
  • 14. Hawley JS, Murray CK, Griffith ME et al. Susceptibility of Acinetobacter strains isolated from deployed U.S. military personel, Antimicrob Agents Chemother 2007;51(1): 376-8. https://doi.org/10.1128/AAC.00858-06
  • 15. Hejnar P, Kol B. E. Sezer ve ark. 38 Acinetobacter strains (phenotype classification, antibiotic susceptibility and production of b-lactamases) isolated from haemocultures from patients at the Teaching Hospital in Olomouc, Acta Univ Palacki Olomuc Fac Med 1999;142:73-7.
  • 16. Hornsey M, Wareham DW. In vivo efficacy of glycopeptide-colistin combination therapies in a Galleria mellonella model of Acinetobacter baumannii infection, Antimicrob Agents Chemother 2011;55(7):3534-7. https://doi.org/10.1128/AAC.00230-11
  • 17. http://www.saglikaktuel.com/d/file/ulusal_ozet_raporu_22_07_2016.pdf
  • 18. Ko KS, Suh JY, Kwon KT et al. High rates of resistance to colistin and polymyxin B in subgroups of Acinetobacter baumannii isolates from Korea, J Antimicrob Chemother 2007;60(5):1163-7. https://doi.org/10.1093/jac/dkm305
  • 19. Maragakis LL, Perl TM. Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options, Clin Infect Dis 2008;46(8):1254-63. https://doi.org/10.1086/529198
  • 20. Mezzatesta ML, Trovato G, Gona F et al. In vitro activity of tigecycline and comparators against carbapenem-susceptible and resistant Acinetobacter baumannii clinical isolates in Italy, Ann Clin Microbiol Antimicrob 2008;7:4. https://doi.org/10.1186/1476-0711-7-4
  • 21. Nastro M, Rodriguez CH, Monge R et al. Activity of the colistin-rifampicin combination against colistin- resistant, carbapenemaseproducing Gram-negative bacteria, J Chemother 2014;26(4):211-6. https://doi.org/10.1179/1973947813Y.00000 00136
  • 22. O’Hara JA, Ambe LA, Casella LG et al . Activities of vancomycin-containing regimens against colistin-resistant Acinetobacter baumannii clinical strains, Antimicrob Agents Chemother 2013;57(5): 2103-8. https://doi.org/10.1128/AAC.02501-12
  • 23. Quinteira S, Grosso F, Ramos H et al. Molecular epidemiology of imipenemresistant Acinetobacter haemolyticus and Acinetobacter baumannii isolates carrying plasmid-mediated OXA-40 from a Portuguese hospital, Antimicrob Agents Chemother 2007;51(9):3465-6. https://doi.org/10.1128/AAC.00267-07
  • 24. Rozenberg-Arska M, Dekker AW, Verhoef J. Colistin and trimethoprim-sulfamethoxazole for the prevention of infection in patients with acute non-lymphocytic leukaemia. Decrease in the emergence of resistant bacteria, Infection 1983;11(3):167-9. https://doi.org/10.1007/BF01641298
  • 25. Santimaleeworagun W, Wongpoowarak P, Chayakul P, Pattharachayakul S, Tansakul P, Garey KW. In vitro activity of colistin or sulbactam in combination with fosfomycin or imipenem against clinical isolates of carbapenem-resistant Acinetobacter baumannii producing OXA-23 carbapenemases, Southeast Asian J Trop Med Public Health 2011;42(4):890-900.
  • 26. Tasina E, Haidich AB, Kokkali S et al. Efficacy and safety of tigecycline for the treatment of infectious diseases: a meta-analysis, Lancet Infect Dis 2011;11(11):834-44. https://doi.org/10.1016/S1473-3099(11)70177-3
  • 27. Timurkaynak F, Can F, Azap OK, Demirbilek M, Arslan H, Karaman SO. In vitro activities of non-traditional antimicrobials alone or in combination against multidrug-resistant strains of Pseudomonas aeruginosa and Acinetobacter baumannii isolated from intensive care units, Int J Antimicrob Agents 2006;27(3):224-8. https://doi.org/10.1016/j.ijantimicag.2005.10.012
  • 28. Vidaillac C, Benichou L, Duval RE. In vitro synergy of colistin combinations against colistin-resistant Acinetobacter baumannii, Kolistin dirençli Acinetobacter baumanii tedavisinde sıra dışı bir antibiyotik kombinasyon tedavisi: Trimetoprim-Sülfametoksazol ve kolistin kombinasyonu 39 Pseudomonas aeruginosa, and Klebsiella pneumoniae isolates, Antimicrob Agent Chemother 2012;56(9):4856-61. https://doi.org/10.1128/AAC.05996-11
  • 29. Yilmaz GR, Dizbay M, Guven T et al. Risk factors for infection with colistin-resistant gram-negative microorganisms: a multicenter study, Ann Saudi Med 2016;36(3):216-22. https://doi.org/10.5144/0256-4947.2016.216