MURAT TELLİ, Mete EYİGÖR, Berna GÜLTEKİN, NERİMAN AYDIN

Streptococcus pneumoniae’nin menenjit dışı klinik izolatlarında penisilin direnci ile serotip ilişkisi ve bazı antibiyotiklere direnç

Beyin omurilik sıvısı dışındaki klinik örneklerden izole edilen 89 Streptococcus pneumoniae suşunda bazı antibiyotiklere direnç oranları disk difüzyon ve agar dilüsyon metodu ile CLSI kriterlerine göre, penisiline dirençli suşların serotipleri Chers-board metodu kullanılarak kapsül belirginleşmesi (quellung) reaksiyonu ile belirlenmiştir. Oral penisilinler için geçerli kriterlere göre penisiline 12 (% 13) suş dirençli, 30 (% 34) suş orta duyarlı, 47 suş (% 53) duyarlı olarak saptanmıştır. Suşların 36’sı (% 40) eritromisine ve azitromisine, 32’si (% 36) tetrasikline, 27’si (% 30) klindamisine, biri evofloksasine dirençli bulunmuş, vankomisin, linezolid ve telitromisine direnç saptanmamıştır. 12’si penisiline dirençli suşlar olmak üzere 26 (% 29) suşta çoklu ilaç direnci ve bu suşların tamamında eritromisin, 25’inde klindamisin, 22’sinde tetrasiklin, 12’sinde penisilin, birinde levofloksasin direnci saptanmıştır. Penisiline dirençli 12 suşun yedisi serotip 19, ikisi serotip 23, bireri serotip 6, 14 ve serotiplendirilmeyen olarak tanımlanmıştır. Menenjit dışı infeksiyonlardan izole edilen suşlarımızda oral penisilinler için dirençli ve orta duyarlı suşların % 47 oranında bulunması antibiyotik direnç sürveyansının önemini göstermektedir.

Penicillin-resistance and serotypes relationship in streptococcus pneumoniae clinical isolates and resistance to some antibiotics

The resistance rates to some antibiotics of 89 Streptococcus pneumoniae strains isolated from clinical samples other than cerebrospinal fluid were detected with disk diffusion and agar dilution methods according to CLSI quidelines. Serotypes in penicillin-resistant strains detected via Chers-board method using quellung reaction. According to oral penicillin criteria of CLSI, 12 (13 %) isolates were determined as resistant, 30 (34 %) isolates as intermediate resistant and 47 (53 %) isolates as susceptible. Resistance to erythromycin and azithromycin were 40 %, tetracycline 36 %, clindamycin 30 % and levofloxacin 1 %. No resistance to telithromycin, vancomycin or linezolid was found. Multidrug resistant strains (MDR) were 26 (29 %). All penicillin-resistant strains were also MDR. All 26 MDR strains were found as resistant to erythromycin, 25 strains to clindamycin, 22 strains to tetracycline, 12 strains to penicilin and one strain to levofloxacin. Of the 12 penicillin-resistant strains, 7 were found to be serotype 19, 2 serotype 23, and one each of serotypes 6, 14 and non-typable. The ratio (47 %) of penicilin resistant and moderately sensive strains for oral penicillins in strains isolated from infections other than meningitidis, indicates the importance of antibiotic resistance surveillance.

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