KRONİK OBSTRÜKTİF AKCİĞER HASTALIĞININ AKUT ALEVLENMELERİNDE BALGAMDAN İZOLE EDİLEN MORAXELLA CATARRHALIS SIKLIĞI VE ANTİBİYOTİK DUYARLILIĞI

Kronik obstrüktif akciğer hastalığı (KOAH), morbidite ve mortaliteye neden olan progresif , kronik seyirli ve akut alev- lenmelerle seyreden bir hastalıktır. Çalışmamızda KOAH alevlenmelerinde sık görülen etkenlerden olan Moraxella catarrhalisin izolasyon oranı, beta-laktamaz aktivitesi ve antibiyotik duyarlılıkları araştırılmıştır. Çalışmaya, Ekim 2009- Mart 2010 tarihleri arasında Abant İzzet Baysal Üniversitesi Tıp Fakültesi ve İzzet Baysal Devlet Hastanesi Göğüs Hastalıkları ve Tüberküloz Bölümüne başvuran, KOAH alevlenmesi tanısı alan 124 gönüllü hasta alınmıştır. Hastalardan alınan balgam örneklerinde üreyen bakteriler konvansiyonel mikrobiyolojik yöntemler ve API NH test kiti ile tanımlanmıştır. Antibiyotik duyarlılık testleri için agar dilüsyon testi ve E-test yöntemi, beta-laktamaz aktivitesi için nitrosef in testi kullanıl- mıştır. Kültürü yapılan 98 balgam örneğinin 50sinde patojen kabul edilen 51 mikroorganizma üremiştir. Bu bakterilerin % 15i Streptococcus pneumoniae (n:15), % 11.2si Pseudomonas aeruginosa (n:11), % 10.2si Moraxella catarrhalis (n:10), % 6.1i Haemophilus inf luenzae (n:6), % 3ü Escherichia coli (n:3), % 3ü Klebsiellae pneumoniae (n:3) ve, % 3ü Haemophilus parainf luenzae (n:3) olarak bulunmuştur. Bir hastanın balgam kültüründe patojen olarak bilinen iki bakteri (M.catarrhalis ve H.inf luenzae) birlikte üretilmiştir. İzole edilen on M.catarrhalis suşlarının dokuzunda beta-laktamaz testi pozitif olarak sap- tanmıştır. Eritromisin, tetrasiklin, siprof loksasin, sef uroksim ve sef triaksona karşı direnç görülmemiştir. Trimetoprim- sülf a- metoksazol direnci % 10, ampisilin direnci % 90 olarak belirlenmiştir. Elde edilen sonuçlar dünya ve ülkemiz verileri ile uyumlu bulunmuştur.

Frequency and Antibiotic Susceptibility of Moraxella catarrhalis Isolated from Sputum in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a progressive chronic disease that can lead to morbidity and morta- lity which also can have acute exacerbations. In our study, the isolation rate, beta lactamase activity and antibiotic suscepti- bility of Moraxella catarrhalis, one of the most common agents causing COPD exacerbations, is assessed. A hundred and twenty-f our voluntary COPD patients diagnosed with acute exacerbation who were ref erred to Pulmonary Disease and Tuberculosis Department of Izzet Baysal Research Hospital and Abant Izzet Baysal University Medical Faculty during the time period of October 2009 to March 2010 were included the study. Bacteria isolated f rom sputum cultures were identif ied by conventional microbiological methods and API NH test kit. Agar dilution test and E-test method were used f or antibiotic susceptibility testing and nitrocephin test was used f or testing beta-lactamase production. In 50 of the 98 cultured sputum specimens, 51 pathogenic microorganisms were detected. Fif teen percent % of these bacteria were Streptococcus pneumoniae (n:15), 11.2 % were Pseudomonas aeruginosa (n:11), 10.2 % were Moraxella catarrhalis (n:10), 6.1 % were Haemophilus inf luenzae (n:6), 3 % were Escherichia coli (n:3) 3 % were Klebsiella pneumoniae (n:3) and 3 % were Haemophilus parainf - luenzae (n:3). In one patients sputum culture, two pathogenic bacteria were isolated (M.catarrhalis and H.inf luenzae). Beta- lactamase test was positive in nine of the 10 M.catarrhalis strains. No resistance was detected aganist erythromycin, tetracy- cline, ciprof loxacin, cef uroxime and cef triaxone. Resistance aganist trimethoprim-sulf amethoxazole was 10 % and the resis- tance aganist ampicillin was 90 %. Results obtained were in correlation with the data reported f rom the world and Turkey.

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1. Altraja A, Naaber P, Tamm E, Meriste S, Kullamaa A, Leesik H. Antimicrobial susceptibility of common pathogens from community-acquired lower respiratory tract infections in Estonia, J Chemother 2006;18(6):603-9. http://dx.doi.org/10.1179/joc.2006.18.6.603
2. Chan-Yeung M, Ait-Khaled N, White N, Ip MS, Tan WC. The Burden and Impact of COPD in Asia and Africa, Int J Tuberc Lung Dis 2004;8(1):2-14.
3. Clinical and Laboratory Standards Institute. Methods for antimicrobial dilution and disk susceptibility testing of infrequently isolated or fastidious bacteria. Approved guideline M45-A. CLSI, Wayne, PA (2006).
4. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; 19th informational supplement. M100-S18. CLSI, Wayne, PA(2009).
5. Domenech A, Puig C, Martí S et al. Infectious etiology of acute exacerbations in severe COPD patients, J Inf ect 2013;67(6):516-23. http://dx.doi.org/10.1016/j.jinf.2013.09.003
6. Esel D, Altintop Y, Yagmur G, Gokahmetoglu S, Sumerkan B. Evaluation of susceptibility patterns and BRO beta-lactamase types among clinical isolates of Moraxella catarrhalis, Clin Microbiol Inf ect 2007;13(10):1023-5. http://dx.doi.org/10.1111/j.1469-0691.2007.01776.x
7. Fagon JY, Chastre J, Trouillet JL et al. Characterization of distal bronchial microflora during acute exacerbation of chronic bronchitis, Am Rev Respir Dis 1990;142(5):1004-8. http://dx.doi.org/10.1164/ajrccm/142.5.1004
8. Global initiative for chronic obstructive lung disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. (Update 2014). http://www.goldcopd.org/uploads/users/files/GOLD_Report2014_Feb07.pdf
9. Gonullu N, Catal F, Kucukbasmaci O, Ozdemir S, Torun MM, Berkiten R. Comparison of in vitro activities of tigecycline with other antimicrobial agents against Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis in two university hospitals in Istanbul, Turkey, Chemotherapy 2009;55(3):161-7. http://dx.doi.org/10.1159/000214144
10. Gupta N, Arora S, Kundra S. Moraxella catarrhalis as a respiratory pathogen, Indian J Pathol Microbiol 2011;54(4):769-71.
11. Güneş Ş, Eriş FN. Akciğer enfeksiyonlarında Haemophilus influenzae, Moraxella catarrhalis ve Streptococcus pneumoniae suşlarının izolasyon oranları ve antibiyotiklere direnci, Türk Toraks Derg 2000;1(1):46-9.
12. Gür D, Ozalp M, Sümerkan B et al. Prevalence of antimicrobial resistance in Haemophilus influenzae, Streptococcus pneumoniae, Moraxella catarrhalis and Streptococcus pyogenes: results of a multicentre study in Turkey, Int J Antimicrob Agents 2002;19(3):207-11. http://dx.doi.org/10.1016/S0924-8579(02)00003-1
13. Güriz H, Bolatlı T. Moraxella catarrhalis'in alt solunum yolu enfeksiyonlarındaki yeri, Mikrobiyoloji Bult 1995;29(2):142-8.
14. Hsu SF, Lin YT, Chen TL et al. Antimicrobial resistance of Moraxella catarrhalis isolates in Taiwan, J Microbiol Immunol Infect 2012;45(2):134-40. http://dx.doi.org/10.1016/j.jmii.2011.09.004
15. Jorgensen JH, Doern GV, Maher LA, Howell AW, Redding JS. Antimicrobial resistance among respiratory isolates of Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae in the United States, Antimicrob Agents Chemother 1990;34(11):2075-80. http://dx.doi.org/10.1128/AAC.34.11.2075
16. Kartal ED. KOAH akut atağında infeksiyoz etkenler, Güncel Akciğer Hastalıkları Serisi, Bilimsel Tıp Yayınevi, Ankara (2004).
17. Khemiri H, Smaoui H, Kechrid A. Antimicrobial susceptibility of 80 Moraxella catarrhalis strains isolated in the children's hospital of Tunis, Pathol Biol (Paris) 2008;56(3):158-61. http://dx.doi.org/10.1016/j.patbio.2007.09.021
18. Larsen MV, Janner JH, Nielsen SD, Friis-Moller A, Ringbaek T, Lange P. Bacteriology in acute exacerbation of chronic obstructive pulmonary disease in patients admitted to hospital, Scand J Inf ect Dis 2009;41(1):26-32. http://dx.doi.org/10.1080/00365540802484828
19. Memikoğlu KO, Azap A, Kurt Ö, Sözen TH, Tekeli ME. Kronik obstrüktif akciğer hastalığının akut alevlenmesinde Moraxella catarrhalis, S.pneumoniae ve Haemophilus influenzae sıklığı, Ankara Üniversitesi Tıp Fakültesi Mecmuası 2005;58(2):57- 60.
20. Mc Gregor K, Chang BJ, Mee BJ, Riley TV. Moraxella catarrhalis: Clinical significance, antimicrobial susceptibility and BRO betalactamases, Eur J Clin Microbiol Inf ect Dis 1998;17(4):219-34. http://dx.doi.org/10.1007/BF01699978
21. Murray PR, Washington JA. Microscopic and bacteriologic analysis of expectorated sputum, Mayo Clin Proc 1975;50(6): 339-44.
22. Papi A, Bellettato CM, Braccioni F et al. Infections and airway inflammation in chronic obstructive pulmonary disease severe exacerbations, Am J Respir Crit Care Med 2006;173(10):1114-21. http://dx.doi.org/10.1164/rccm.200506-859OC
23. Republic of Turkey Ministry of Health Refik Saydam Hygiene Center Presidency School of Public Health. Turkey National Burden of Disease and Cost Effectiviness Study: National Household Survey 2003, Basic Findings. Ankara, Turkey (2006).
24. Sethi S. Infectious etiology of acute exacerbations of chronic bronchitis, Chest 2000;117(5):380-5. http://dx.doi.org/10.1378/chest.117.5_suppl_2.380S
25. T.C Sağlık Bakanlığı Temel Sağlık Hizmetleri. Türkiye kronik hava yolu hastalıkları (Astım- KOAH) önleme ve kontrol programı (2009-2013). Sağlık Bakanlığı Yayınları, Anıl Matbaacılık, (2009).
26. Ünel N, Oltan N, Ak Ö, Saraç G, Özer S. Kronik obstrüktif akciğer hastalığının akut alevlenmelerinde Moraxella catarrhalis insidansı, Klimik Derg 2000;13(2):51-3.
27. Verduin CM, Hol C, Fleer A, Dijk H, Belkum A. Morexalla catarrhalis: from emerging to established pathogen, Clin Microbiol Rev 2002;15(1):125- 44. http://dx.doi.org/10.1128/CMR.15.1.125-144.200