TÜLİN GÜVEN GÖKMEN, Mümtaz GÜRAN, Gökçe BENK, Suna KIZILYILDIRIM, Fatih KÖKSAL

Yanık ünitesinde kısa-dönem/uzun-dönem Acinetobacter baumannii salgını

Çalışmanın hedefi hastanemiz yanık ünitesinde görülen Acinetobacter baumannii salgınının kaynağının, mekanizmasının ve kontrol stratejisinin başarısının irdelenmesidir. Aynı birimdeki bir önceki salgında bir klinik örnekten izole edilen ve indeks suş olarak adlandırılan 3 yıllık suşa ek olarak yanık ünitesinde çevresel örneklerden izole edilen karbapenemlere dirençli 11 A.baumannii suşu çalışmaya alınmıştır. İzolatlar fenotipik olarak tanı konduktan sonra OXA tipi beta-laktamaz genlerinin tanımlanması için tip-spesifik-multipleks-PCR yöntemi ile çalışılmıştır. Suşlar arasındaki klonal ilişkiler PFGE yöntemi ile araştırılmıştır. İndeks suş da dahil bütün izolatlar karbapenem dirençli bulunmuştur. blaOXA-51-like geni bütün izolatlarda tespit edilirken 3 suşta blaOXA-51-like genine ek olarak blaOXA-24-like geni de tespit edilmiştir. PFGE çalışması sonunda izolatlar 2 yakın ilişkili alt-grub içerisinde yer almıştır ve indeks suşun da en kalabalık grubla % 100 ilişkili olduğu görülmüştür. Bu çalışma özellikle karbapenem dirençli A.baumannii suşlarının kolonizasyonu ile sonuçlanan başarısız bir dezenfeksiyon işlemi örneğini göstermiştir. Karbapenem direnci açısından ülkemizdeki antibiyotik kullanım politikalarının tekrardan gözden geçirilmesi gerektiği, dezenfeksiyon açısından ise yeni yöntemlerin geliştirilmesinin yararlı olacağı düşünülmüştür.

Short-term/long-term Acinetobacter baumannii outbreak in burn unit

The aim of the study was to examine the source, mechanism and success of control strategy of an Acinetobacter bau - mannii outbreak seen at burn unit of our hospital. Furthermore mechanism of transmisson of resistance genes among A.bau - mannii strains were examined in addition to phenotypical/genotypical investigation of resistance. Eleven carbapenem resistant A.baumannii strains which were isolated from the environmental samples of the burn unit in addition to the 3 years old stra - in named as index strain isolated from a clinical sample from a previous outbreak of the same unit were included in the study. After phenotypical identification of isolates a type-specific-multiplex-PCR method was used to determine the genes of OXA type beta-lactamases (blaOXA). Clonal relations between strains were investigated by PFGE method. All of the isolates including the index strain were found to be carbapenem resistant. While all of the isolates had the blaOXA-51-like gene, 3 of strains there were blaOXA-24-like gene in addition to blaOXA-51-like gene. At the end of PFGE, isolates were placed in 2 closely-related sub-groups and the index strain was seen to be 100 % related with the most membered cluster. This study demonstrates an unsuccesfull model of disinfection process resulting with colonization of carbapenem resistant A.baumannii strains in a burn unit. We tought that reconsideration of antibiotic usage policies in terms of carbapenem resistance and development of new methods in terms of disinfection could be useful.

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