SERRATIA TÜRLERİNİN İDENTİFİKASYONU, KLİNİK DAĞILIMI, ANTİBİYOTİK DUYARLILIĞI

Serratia spp. özellikle yenidoğan, çocuk ve diğer yoğun bakım üniteleri başta olmak üzere hastane infeksiyonu etkenleri arasında önemli yeri olan bir bakteri grubudur. Çalışmada klinik ve polikliniklerden gönderilen farklı örneklerden izole edilen Serratia marcescens ve diğer Serratia türlerinin klinik kökenleri ve antibiyotik duyarlılık sonuçlarının tartışılması amaçlanmıştır. İki yıllık bir dönem içerisinde kliniklerden ve poliklinikten gönderilen farklı materyallerden infeksiyon etkeni olarak izole edilen Serratia suşlarının identifikasyonu MALDI-TOF-MS (Matrix-assisted laser desorption/ionization- time of flight- mass spectrometry, Bruker Daltonics, ABD), duyarlılık testleri ise Phoenix UNMIC-401/ ID Paneli ve NMIC-400/ID Paneli (Becton Dickinson Diagnostic Instrument Systems, Sparks, Md, ABD) ile yapılmıştır. İzole edilen 105 Serratia suşunun 17’si (% 16) poliklinik, 88’i (% 84) klinik ve yoğun bakım hastalarından izole edilmiş olup 89 suş (% 84.7) S.marcescens, beş suş (% 4.7) Serratia ureilytica, dört suş (% 3.8) Serratia liquefaciens, birer suş da Serratia ficaria, Serratia fonticola ve Serratia plymuthica olarak tanımlanırken dört Serratia cinsine ait izolatın sistem tarafından tür identifikasyonu yapılamamıştır. Toplam örneklerin 51’i (% 49) yoğun bakım ünitelerinden gönderilmiş olup bu sayı içerisinde yenidoğan ve çocuk yoğun bakım ünitelerindeki yoğunluk (% 56.8) dikkat çekicidir. Sonuç olarak ciddi bir hastane enfeksiyonu etkeni olarak bilinen Serratia cinsi bakterilerin antibiyotik duyarlılık sonuçlarını sunarak bu bakteri cinsine dikkat çekmek istenmiştir. Serratia cinsi bakterilerin özellikle yoğun bakım hastalarında, yoğun bakım üniteleri içinde ise önemli oranda çocuk yoğun bakım ünitelerinde enfeksiyonlara yol açtıkları ve daha çok pnömoni, idrar yolu enfeksiyonları, sepsis ve yara yeri enfeksiyonlarına neden oldukları görülmektedir. Aynı zamanda çalışmamızda Serratia türlerine karşı sırayla amikasin (% 97), siprofloksasin (% 95), aztreonam (% 93) ve trimetoprim/sülfametoksazol (% 93) en etkili antibiyotikler olarak tespit edilmiştir.

Identification of Serratia Species, Clinical Distribution, Antibiotic Susceptibility

Serratia spp. is a group of bacteria that has an important place among nosocomial infections, especially neonates, children and other intensive care units. The aim of the study is to discuss the clinical origins and antibiotic susceptibility results of Serratia marcescens and other Serratia species isolated from different material specimens sent from inpatient and outpatient clinics. Identification of Serratia strains isolated from different materials for two years was performed by MALDI-TOF-MS (Matrix-assisted laser desorption/ionization- time of flight- mass spectrometry, Bruker Daltonics, USA) Susceptibility tests were done with Phoenix UNMIC-401 / ID Panel and NMI-400 / ID Panel (Becton Dickinson Diagnostic Instrument Systems, Sparks, Md., USA). 17 (16 %) of 105 Serratia spp. strains were isolated from outpatient clinics, 88 (84 %) were isolated from clinical and intensive care patients. Of these, 89 (84.7 %) were S.marcescens, five (4.7 %) were Serratia ureilytica, four (3.8 %) were Serratia liquefaciens, one were Serratia ficaria, Serratia fonicola and, four of them could not be identified to species level by the system. Fifty one (49 %) of the total samples were sent from intensive care units and the tendency to neonatal and pediatric intensive care units (56.8 %) was remarkable. As a result, by presenting their antibiotic susceptibility results, we want to draw attention to this bacterial genus which are known as one of the agent of serious hospital infections. It is seen that Serratia spp. cause infections especially in intensive care units mostly in pediatric intensive care units and cause pneumonia, urinary tract infections, sepsis and wound infections. We have also identified amikacin (% 97), ciprofloxacin (% 95), aztreonam (% 93) and trimethoprim/sulfamethoxazole (% 93) as the most effective antibiotics against Serratia species in our hospital.

Kaynakça

Agyepong N, Govinden U, Ofori AO, Essack SY. Multidrug-resistant gram negative bacterial infections in a teaching hospital in Ghana. Antimicrob Resist Infect Control 2018;7:37. https://doi.org/10.1186/s13756-018-0324-2

Annual epidemiological report 2012: Reporting on 2010 surveillance data and 2011 epidemic intelligence data. European Centre for Disease Prevention and Control, Stockholm, Sweden.

Åttman E, Korhonen P, Tammela O, Vuento R, et al. Serratia marcescens outbreak in a neonatal intensive care unit was successfully managed by rapid hospital hygiene interventions and screening. Acta Paediatr. 2018;107(3):425-9. https://doi.org/10.1111/apa.14132

Baykan M, Özerol İH, Kart H, Baysal B. Bir Serratia sepsisi olgusu. Turgut Özal Tıp Merkezi Derg. 1994;1(3):210-2.

Bayramoğlu G, Buruk K, Dinç U, Mutlu M, Yılmaz G, Aslan Y. Yenidoğan yoğun bakım ünitesinde Serratia marcescens salgınının kısa süreli “PulsedField Gel’’ elektroforez protokolü ile araştırılması. ANKEM Derg. 2008;22(Ek 1):54, J Microbiol Immunol Infect. 2011;44(2):111-5.

Bilgehan H. Klinik Mikrobiyolojik Tanı, s.430, Barış yayınları, İzmir (2009).

Bozkurt H, Güdücüoğlu H, Bayram Y ve ark. Klinik örneklerden üretilen Serratia cinsi bakterilerin çeşitli infeksiyonlardaki rolü ve antimikrobiyallere duyarlılıkları. Van Tıp Derg. 2005;12(3): 182-8.

Cherkaoui A, Hibbs J, Emonet S, et al. Comparison of two matrix-assisted laser desorption ionizationtime of flight mass spectrometry methods with conventional phenotypic identification for routine identification of bacteria to the species level. J Clin Microbiol. 2010;48(4):1169-75. https://doi.org/10.1128/JCM.01881-09

Cullen MM, Trail A, Robinson M, Keaney M, Chadwick PR. Serratia marcescens outbreak in a neonatal intensive care unit prompting review of decontamination of laryngoscopes. J Hosp Infect. 2005;59(1):68-70. https://doi.org/10.1016/j.jhin.2004.08.003

EUCAST (The European Committee on Antimicrobial Susceptibility Testing). Breakpoint tables for interpretation of MICs and zone diameters. Version 8.0, (2018). http://www.eucast.org

Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16(3):128-40. https://doi.org/10.1016/0196-6553(88)90053-3

Gary W. Procop, Deirdre L. Church, Geraldine S. Hall, William M. Janda, Elmer W. Koneman, Paul C. Schreckenberger, Gail L. Woods. Koneman’s Colour Atlas and Textbook of Microbiology Türkçe baskısı, 7. baskı. s.17, Hipokrat kitabevi, Ankara (2017).

Gary W. Procop, Deirdre L. Church, Geraldine S. Hall, William M. Janda, Elmer W. Koneman, Paul C. Schreckenberger, Gail L. Woods. Koneman’s Colour Atlas and Textbook of Microbiology Türkçe baskısı, 7. baskı. s.164-5, Hipokrat kitabevi, Ankara (2017).

Hasçelik G. Mikrobiyolojik tanıda yeni yöntemler. ANKEM Derg. 2013;27(Ek 2):154-6.

Hejazi A, Falkiner FR. Serratia marcescens. J Med Microbiol. 1997;46(11):903-12. https://doi.org/10.1099/00222615-46-11-903

Herra C, Falkiner FR. Serratia marcescens, infectious disease and antimicrobial agents www.antimicrobe.org/b26.asp (Erişim tarihi:19.04.2018)

Kang HY, Kim KY, Kim J, et al. Distribution of conjugative-plasmid-mediated 16S rRNA methylase genes among amikacin-resistant Enterobacteriaceae isolates collected in 1995 to 1998 and 2001 to 2006 at a university hospital in South Korea and identification of conjugative plasmids mediating dissemination of 16S rRNA methylase. J Clin Microbiol. 2008;46(2): 700-6. https://doi.org/10.1128/JCM.01677-07

Khanafari A, Assadi MM, Fakhr FA. Review of prodigiosin, pigmentation in Serratia marcescens. Online J Biol Sci. 2006;6(1):1-13. https://doi.org/10.3844/ojbsci.2006.1.13

Khanna A, Khanna M, Aggarwal A. Serratia marcescens-A rare oppotunistic nosocomial pathogen and measures to limit its spread in hospitalized patients. J Clin Diagn Res. 2013;7(2):243-6.

Liu D, Zhang LP, Huang SF, et al. Outbreak of Serratia marcescens infection due to contamination of multiple-dose vial of heparin-saline solution used to flush deep venous catheters or peripheral trocars. J Hosp Infect. 2011;77(2):175-6. https://doi.org/10.1016/j.jhin.2010.10.003

Lockhart SR, Abramson MA, Beekmann SE, et al. Antimicrobial resistance among Gram-negative bacilli causing infections in intensive care unit patients in the United States between 1993 and 2004. J Clin Microbio. 2007;45(10):3352-9. https://doi.org/10.1128/JCM.01284-07

Matkoski C, Sharp SE, Kiska DL. Evaluation of the Q Score and Q234 Systems for Cost-Effective and Clinically Relevant Interpretation of Wound Cultures. J Clin Microbiol. 2006;44(5):1869-72. https://doi.org/10.1128/JCM.44.5.1869-1872.2006

Mills J, Drew D. Serratia marcescens endocarditis: a regional illness associated with intravenous drug abuse. Ann Intern Med. 1976;84(1):29-35. https://doi.org/10.7326/0003-4819-84-1-29

Nakashima AK, McCarthy MA, Martone WJ, Anderson RL. Epidemic septic arthritis caused by Serratia marcescens and associated with a benzalkonium chloride antiseptic. J Clin Microbiol. 1987;25(6):1014-8.

Neville SA, LeCordier A, Ziochos H, et al. Utility of Matrix Assisted Laser Desorption Ionization– Time of Flight Mass Spectrometry following introduction for routine laboratory bacterial identification. J Clin Microbiol. 2011;49(8):2980-4. https://doi.org/10.1128/JCM.00431-11

Ringrose RE, McKown B, Felton FG, Barclay BO, Muchmore HG, Rhoades ER. A hospital outbreak of Serratia marcescens associated with ultrasonic nebulizers, Ann Intern Med. 1968;69(4):719-29. https://doi.org/10.7326/0003-4819-69-4-719

Sader HS, Farrell DJ, Flamm RK, Jones RN. Antimicrobial susceptibility of Gram-negative organisms isolated from patients hospitalized in intensive care units in United States and European hospitals (2009-2011). Diagn Microbiol Infect Dis. 2014;78(4):443-8. https://doi.org/10.1016/j.diagmicrobio.2013.11.025

Samonis G, Vardakas KZ, Maraki S, et al. Resistance phenotypes and susceptibility of contemporary Serratia isolates in the university hospital of Crete, Greece. Infect Dis. 2017;49(11-12):847-53. https://doi.org/10.1080/23744235.2017.1361546

Sethuraman S, Arunachalam A, Karthikeyan M, Kumar SA, Manidipa S, Senthilraj R. Antimicrobial sensitivity profile of Serratia marcescens strains isolated in government general hospital, Nagapatinam, Tamilnadu, India. Int J Preclinic Pharm Res. 2011;2(1):7-11.

Soltani J, Poorabbas B, Miri N, Mardaneh J. Health care associated infections, antibiotic resistance and clinical outcome: a surveillance study from Sanandaj, Iran. World J Clin Cases 2016;4(3):63- 70. https://doi.org/10.12998/wjcc.v4.i3.63

Stock I, Grueger T, Wiedemann B. Natural antibiotic susceptibility of strains of Serratia marcescens and the S.liquefaciens complex: S.liquefaciens sensu stricto, S.proteamaculans and S.grimesii. Int J Antimicrob Agents 2003;22(1):35-47. https://doi.org/10.1016/S0924-8579(02)00163-2

Tanaka T, Takahashi H, Kobayashi JM, Ohyama T, Okabe N. A nosocomial outbreak of febrile bloodstream infection caused by heparinized-saline contaminated with Serratia marcescens, Tokyo, 2002. Jpn J Infect Dis. 2004;57(5):189-92.

Tıraş Ü, Erdeve Ö, Çamurdan O, Dallar Y. Serratia marcescens: yenidoğan için ölüme sebebiyet veren ciddi bir ajan. T Klin J Med Sci. 2002;22(6):571-3.

Us E, Kutlu HH, Tekeli A, Öcal D, Çırpan S, Memikoğlu KO. Wound and soft tissue infections of Serratia marcescens in patients receiving wound care: a health care-associated outbreak. Am J Infect Control 2017;45(4):443-7. https://doi.org/10.1016/j.ajic.2016.11.015

Van Veen SQ, Claas EC, Kuijper EJ. Highthroughhput identification of bacteria and yeast by matrix-assisted laser desorption ionization –time of flight mass spectrometry in conventional medical microbiology laboratories. J Clin Microbiol. 2010;48(3):900-7. https://doi.org/10.1128/JCM.02071-09

Kaynak Göster