TÜRKİYE’DE BİR DEVLET HASTANESİNDE 2010-2016 YILLARI ARASINDA PSEUDOMONAS AERUGINOSA ANTİMİKROBİYAL DUYARLILIK SONUÇLARI

Pseudomonas aeruginosa, nozokomiyal pnömoni, dolaşım sistemi infeksiyonları, üriner infeksiyon ve deri infeksiyonları gibi sağlık hizmetleri gerektiren infeksiyon etkenlerinin önemli bir bölümünü oluşturur. Bu çalışma, yıllara göre P.aeruginosa'nın antimikrobiyal duyarlılığının değişimini belirleyerek antimikrobiyal kullanım politikasının oluşturulmasına yardımcı olmayı amaçlamıştır.Hastanemizde 2010-2016 yılları arasında izole edilen P.aeruginosa suşlarının antimikrobiyal duyarlılıkları, örnek türleri ve hastaların demografik verileri retrospektif olarak incelenmiştir. Verileri aktarmak ve analiz etmek için Windows istatistik paket programı PASW Statistics 18 kullanılmıştır. Değişkenler arasındaki ilişkiler ki-kare testi ile analiz edilmiştir.Yatarak tedavi olan, 0-92 yaş aralığında bulunan 350 (% 35.9) kadın ve 625 (% 64.1) erkek hastadan 975 P.aeruginosa suşu izole edilmiştir. Örneklerin çoğunluğunun (529, % 54.3) yoğun bakım ünitesinde yatan hastalara ait olduğu tespit edilmiştir. P.aeruginosa, en sık solunum sistem örneklerinde izole edilmiştir. Ayakta tedavi gören, yaşları 0-95 arasında değişen 127 (% 33.1) kadın ve 257 (% 66.9) erkek hastada üreme saptanmıştır. Kliniklere göre dağılımına bakıldığında en sık pediatri polikliniğinden gelen örneklerde izole edilmiştir. Ayaktan tedavi gören hastaların en sık idrar örneğinde izole edilmiştir. En etkili antibiyotiklerin ayaktan hastalarda amikasin, piperazin-tazobaktam, imipenem ve meropenem, yatarak tedavi gören hastalarda aminoglikozid ve karbapenem olduğu tespit edilmiştir. Yıllara göre yatan hastalarda seftazidim, piperasilin-tazobaktam, gentamisin ve amikasin duyarlılığında artış, ayaktan hastalarda piperasilin-tazobaktam ve siprofloksasin duyarlılığında ise azalma görülmüştür.Klinik sonuçların optimizasyonu için etkili antimikrobiyal tedavinin hızlı başlatılmasının gerekli olduğu göz önüne alındığında, her hastane duyarlılık oranlarını izlemelidir. Böylece ampirik antimikrobik seçimi ve uygun tedavinin belirlenmesi için bir kılavuz oluşturulmalıdır

Pseudomonas aeruginosa Antimicrobial Susceptibility Results at a State Hospital in Turkey (2010-2016)

Pseudomonas aeruginosa constitutes an important part of infections requiring health care services such as nosocomial pneumonia, circulatory infections, urinary infection and skin infections. The present study aimed to help in creating an antimicrobial usage policy by identifying the change of antimicrobial susceptibility of P.aeruginosa according to years. The antimicrobial susceptibility of P.aeruginosa strains isolated between 2010-2016 in our hospital, specimen types and demographic data of the patients were examined retrospectively. PASW Statistics 18 for Windows statistical pack age program was used to transfer and analyze the data. The relation ships among variables were analyzed with the chi-square test. Nine hundred seventy-five P.aeruginosa strains were isolated from 350 (35.9 %) female and 625 (64.1 %) male patients who were in the age range of 0 to 92 years and who were treated as in patients in our hospital between 2010-2016. The majority of the specimens (529, 54.3 %) belonged to the patients from the intensive care unit. P.aeruginosa was most frequently isolated in respiratory tract specimens of in patients. Of the out patients, 127 (33.1 %) were female and 257 (66.9 %) were male and they were aged between 0-95 years. Considering the distribution of the patients according to the outpatient clinics, P.aeruginosa was most frequently isolated in pediatrics. In respect to the out patients P.aeruginosa was most frequently isolated in urine. The most effective antimicrobials were determined to be aminoglycosides and carbapenems for the in patients while they were found to be amikacin, piperacillin-tazobactam, imipenem and meropenem for the out patients. In patients were showed increased sensitivity of ceftazidime, piperacillin-tazobactam, gentamicin and amikacin, for years and outpatients were decreased sensitivity of piperacillin-tazobactam and ciprofloxacin. Considering that the rapid initiation of effective antimicrobial treatment is necessary for the optimization of clinical outcome, each hospital should monitor their susceptibility rates. Thus, a guidelines hould be created for the selection of empirical antimicrobial therapy and determination of appropriate treatment.

Kaynakça

1. Atici S, Soysal A, Kepenekli Kadayifci E ve ark. Healthcare-associated infections in a newly opened pediatric intensive care unit in Turkey: results of four-year surveillance, J Infect Dev Ctries. 2016;10(3):254-9. https://doi.org/10.3855/jidc.7517

2. Chander A, Raza MS. Antimicrobial susceptibility patterns of Pseudomona saeruginosa clinical isolates at a tertiary care hospital in Kathmandu, Nepal, Asian J Pharm Clin Res. 2013;6(3):235-8.

3. Çelik C, Gözel MG, Uysal EB, Bakıcı MZ, Gültürk E. Antimicrobial resistance patterns of Pseudomonas aeruginosa strains isolated from blood stream infections: six-year evaluation, Klimik Derg. 2013;26(3):108-12. https://doi.org/10.5152/kd.2013.31

4. Demirdal T, Şen P, Yula E, Kaya S, Nemli SA, Demirci M. Yoğun bakım ünitelerinden izole edilen Pseudomonas aeruginosa suşlarının direnç profilleri: Beş yıllık değerlendirme, Ortadogu Medical Journal. 2017;9(3):108-12. https://doi.org/10.21601/ortadogutipdergisi.265426

5. Fransén J, Huss FR, Nilsson LE, Rydell U, Sjöberg F, Hanberger H. Surveillance of antibiotic susceptibility in a Swedish Burn Center 1994-2012, Burns. 2016;42(6):1295-303. https://doi.org/10.1016/j.burns.2016.01.025

6. Hong JS, Kim JO, Lee H, Bae IK, Jeong SH, Lee K. Characteristics of metallo-β-lactamase-producing Pseudomonas aeruginosa in Korea, Infect Chemother. 2015;47(1):33-40. https://doi.org/10.3947/ic.2015.47.1.33

7. Hu FP, Guo Y, Zhu DM et al. Resistance trends among clinical isolates in China reported from CHINET surveillance of bacterial resistance, 2005- 2014, Clin Microbiol Infect. 2016;22(Suppl 1):9-14. https://doi.org/10.1016/j.cmi.2016.01.001

8. Kim HS, Park BK, Kim SK et al. Clinical characteristics and outcomes of Pseudomonas aeruginosa bacteremia in febrile neutropenic children and adolescents with the impact of antibiotic resistance: a retrospective study, BMC Infect Dis. 2017;17(1):500. https://doi.org/10.1186/s12879-017-2597-0

9. Köse Ş, Atalay S, Ödemiş İ, Adar P. Çeşitli klinik örneklerden izole edilen Pseudomonas aeruginosa suşlarının antibiyotik duyarlılıkları, ANKEM Derg. 2014;28(3):100-4.

10. Matos EC, Matos HJ, Conceição ML, Rodrigues YC, Carneiro IC, Lima KV. Clinical and microbiological features of infections caused by Pseudomonas aeruginosa in patients hospitalized in intensive care units, Rev Soc Bras Med Trop. 2016;49(3):305-11. https://doi.org/10.1590/0037-8682-0446-2015

11. Munson E, Block TK, Bowles EJ et al. Surveillance of Wisconsin antibacterial susceptibility patterns, WMJ 2016;115(1):29-36.

12. Nichols WW, de Jonge BL, Kazmierczak KM, Karlowsky JA, Sahm DF. In vitro susceptibility of global surveillance isolates of Pseudomonas aeruginosa to ceftazidime-avibactam (INFORM 2012 to 2014), Antimicrob Agents Chemother. 2016;60(8): 4743-9. https://doi.org/10.1128/AAC.00220-16

13. Rodloff AC, Dowzicky MJ. Antimicrobial susceptibility among European gram-negative and grampositive isolates collected as part of the tigecycline evaluation and surveillance trial (2004-2014), Chemotherapy. 2017;62(1):1-11. https://doi.org/10.1159/000445022

14. Sader HS, Huband MD, Castanheira M, Flamm RK. Pseudomonas aeruginosa antimicrobial susceptibility results from four years (2012 to 2015) of the international network for optimal resistance monitoring program in the United States, Antimicrob Agents Chemother. 2017;23:61(3). pii: e02252-16.

15. Tadesse BT, Ashley EA, Ongarello S et al. Antimicrobial resistance in Africa: a systematic review, BMC Infect Dis. 2017;17(1):616. https://doi.org/10.1186/s12879-017-2713-1

16. Tran GM, Ho-Le TP, Ha DT et al. Patterns of antimicrobial resistance in intensive care unit patients: a study in Vietnam, BMC Infect Dis. 2017;17(1): 429. https://doi.org/10.1186/s12879-017-2529-z

17. Tümer S, Kirişçi Ö, Özkaya E, Çalışkan A. Antibiotic susceptibility of Pseudomonas aerugi-nosa strains isolated from various clinical specimens, ANKEM Derg. 2015;29(3):99-104. https://doi.org/10.5222/ankem.2015.099

18. Walkty A, Lagace-Wiens P, Adam H et al. Antimicrobial susceptibility of 2906 Pseudomonas aeruginosa clinical isolates obtained from patients in Canadian hospital sover a period of 8 years: Results of the Canadian Ward surveillance study (CANWARD), 2008-2015, Diagn Microbiol Infect Dis. 2017;87(1):60-3. https://doi.org/10.1016/j.diagmicrobio.2016.10.003

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