YARA KÜLTÜRLERİNDEN İZOLE EDİLEN BAKTERİLERİN ANTİMİKROBİYAL DUYARLILIKLARI: ÜÇ YILLIK DEĞERLENDİRME

Yara enfeksiyonları özellikle az gelişmiş ve gelişmekte olan ülkelerde önemli bir sağlık sorunudur. Bu çalışmada etkin tedavi seçimine yardımcı olmak için, yara enfeksiyonuna yol açan mikroorganizmaların ve bunların antimikrobiyal duyarlılık paternlerinin ortaya çıkarılması amaçlanmıştır. Çalışmamızda, 2014-2017 yılları arasında izlenen hastaların mikrobiyoloji laboratuvarına gönderilen yara sürüntü örneklerinden izole edilen mikroorganizmaların retrospektif olarak değerlendirilmesi yapılmıştır. Enfeksiyon etkeni olduğu düşünülen mikroorganizmaların tanımlaması MALDI-TOF MS (bioMérieux, Fransa), antimikrobiyal duyarlılığı ise VITEK-2 (bioMérieux, Fransa) otomatize sistemi ile çalışılmıştır. Toplam 4492 yara örneği değerlendirilmiştir. 2014 yılında % 42.3, 2015 yılında % 54.1, 2016 yılında ise % 65.1 olmak üzere, toplam materyalin % 55’inde etken izole edilmiştir. Yara kültürlerinde en fazla üreyen bakteri Escherichia coli olup bunu Staphylococcus aureus ve Pseudomonas spp. izlemektedir. Yoğun bakım ünitelerinden en sık Pseudomonas spp. (% 16.5) izole edilirken, çocuk servislerinden ve dahili bilimlerden en sık S.aureus (sırasıyla % 31.1 ve % 16.1), cerrahi bilimlerden ise en sık E.coli (% 21.4) izole edilmiştir. Kolistin ve karbapenemler E.coli’de en etkili antimikrobiyaller olarak saptanmıştır. S.aureus’ların % 18.4’ü metisiline dirençli bulunmuş olup, hiçbir suşta glikopeptid ve linezolid direnci görülmemiştir. Her klinikten yara enfeksiyonu etkeni olarak farklı mikroorganizmaların izole edilmiş olması düzenli sürveyans çalışmasının yapılması ve bu doğrultuda akılcı antimikrobiyal kullanımı için antimikrobiyal duyarlılıklarının belirlenmesi gerektiğini göstermiştir.

Antimicrobial Susceptibilities of Bacteria Isolated from Wound Cultures: A Three-Year Evaluation

Wound infections are important health problems especially in underdeveloped and developing countries. In this study, it was aimed to identify the microorganisms causing wound infection and their antimicrobial susceptibility patterns in order to assist in the selection of effective treatment. We retrospectively evaluated the microorganisms isolated from wound swab specimens sent to the microbiology laboratory of patients followed between 2014-2017. The identification of the microorganisms thought to cause infection was done with MALDITOF MS (bioMérieux, France) and the antimicrobial susceptibility with VITEK-2 (bioMérieux, France) automated system. A total of 4492 wound cultures were evaluated. Microorganisms were isolated from 55 % of the specimens; 42 % in 2014, 54.1 % in 2015 and 65.1 % in 2016. The most common bacteria in wound cultures were Escherichia coli, followed by Staphylococcus aureus and Pseudomonas spp. Pseudomonas spp. (16.5 %) was most frequently isolated from intensive care unit. S.aureus was the most frequently isolated bacteria from pediatric and internal medicine units (31.1 % and 16.1 % respectively), and E.coli was most frequently isolated from surgical sciences (21.4 %). Colistin and carbapenems were detected as the most effective antimicrobials against E.coli isolates. Of the S.aureus isolates, 18.4 % were methicillin resistant, and no glycopeptide or linezolid resistance was detected. Isolation of different microorganisms from each clinic has shown that regular surveillance studies and antimicrobial susceptibility testingare a necessity for rational antimicrobial use in this direction.

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  • Bayram Y, Parlak M, Aypak C, Bayram İ. Threeyear review of bacteriological profile and antibiogram of burn wound isolates in Van, Turkey. Int J Med Sci. 2013;10(1):19-23. https://doi.org/10.7150/ijms.4723
  • Bessa LJ, Fazii P, DiGiulio M, Cellini L. Bacterial isolates from infected wounds and their antibiotic susceptibility pattern: some remarks about wound infection. Int Wound J. 2015;12(1):47-52. https://doi.org/10.1111/iwj.12049
  • Bhatt C, Lakhey M. The distribution of pathogens causing wound infection and their antibiotic susceptibility pattern. J Nepal Health Res Council 2006;5(1):22–6.
  • Bjarnsholt T, Kirketerp-Møller K, Jensen PØ et al. Why chronic wounds will not heal: a novel hypothesis. Wound Repair Regen 2008;16:2-10. https://doi.org/10.1111/j.1524-475X.2007.00283.x
  • Cooper RA, Ameen H, Price P, McCulloch DA, Harding KG. A clinical investigation in to the microbiological status of “locally infected” legulcers. Int Wound J. 2009;6:453-62. https://doi.org/10.1111/j.1742-481X.2009.00640.x
  • Copeland-Halperin LR, Kaminsky AJ, Bluefeld N, Miraliakbari R. Sample procurement for cultures of infected wounds: a systematic review. J Wound Care 2016;25(4):4-6, 8-10. https://doi.org/10.12968/jowc.2016.25.Sup4.S4
  • Davies CE, Hill KE, Newcombe RG, et al. A prospectivestudy of themicrobiology of chronic venous legulcer store evaluate the clinical predictive value of tissue biopsies and swabs, Wound Repair Regen 2007;15:17–22. https://doi.org/10.1111/j.1524-475X.2006.00180.x
  • Demling RH, Waterhouse B. The increasing problem of wound bacterial burden and infection in acute and chronic soft-tissue wounds caused by methicillin-resistant Staphylococcus aureus. J Burns Wounds 2007;7:86-98.
  • Dissemond J. Methicillin resistant Staphylococcus aureus (MRSA): diagnostic, clinical relevance and therapy. J Dtsch Dermatol Ges. 2009;6:544-51.
  • Egbe CA, Omoregie R, Igbarumeh IO, Onemu S. Microbiology of wound infections and associated risk factors among patients of a tertiary hospital in Benin City, Nigeria. J Res Health Sci. 2011;11(2):109- 13.
  • Goswami N, Trivedi HR, Goswami APP. Antibiotic sensitivity profile of bacterial pathogens in postoperative wound infections at a tertiary care hospital in Gujarat, India. J Pharm Pharm. 2011;2(3):158- 64. https://doi.org/10.4103/0976-500X.83279
  • Howard RJ, Ravitch MM, Steichen FM. Host against infections. Current problems in surgery. New Eng J Med. 1980;12:1823-30.
  • Mulu A, Moges F, Tessema B, Kassu A. Patterns and multipledrug resistance of bacterial pathogens at university of Gondarteaching hospital, Northwest Ethiopia. Ethiop Med J. 2006;44(2):125- 31.
  • Mulu W, Kibru G, Beyene G, Damtie M. Postoperative nosocomial infections and antimicrobial resistance pattern of bacteria isolates among patients admitted at Felege Hiwot Referral Hospital, Bahirdar, Ethiopia. Ethiop J Health Sci 2012;22(1):7-18.
  • Muluye D, Wondimeneh Y, Ferede G, et al. Bacterial isolates and their antibiotic susceptibility patterns among patients with pus and/or wound discharge at Gondar University hospital. BMC Research Notes 2014;7:619. https://doi.org/10.1186/1756-0500-7-619
  • Ohalete CN, Obi RK, EmeaKoroha MC. Bacteriology of different wound infection and their antimicrobial susceptibility patterns in Imostate Nigeria. World J Pharm Pharm Sci. 2012;1(3):1155-72.
  • Oladeinde BH, Omoregie R, Olley M, Anunibe JA, Onifade AA. A 5 -year surveillance of wound infections at a rural tertiary hospital in Nigeria. African Health Sciences 2013;13(2):351-6.
  • Schmidtchen A, Holst E, Tapper H, Bjorck L. Elastase-producing Pseudomonas aeruginosa degrade plasma proteins and extracellular products of human skin and fibroblasts, and inhibitfibroblast growth. Microb Pathog. 2003;34:47-55. https://doi.org/10.1016/S0882-4010(02)00197-3
  • Schnüriger B, KenjiInaba K, Eberle BM, et al. Microbiological profile and antimicrobial susceptibility in surgical site infections following hollow viscus injury. J Gastrointest Surg. 2010;14:1304– 10. https://doi.org/10.1007/s11605-010-1231-x
  • Senneville E, Melliez H, Beltrand E, et al. Culture of percutaneous bone biopsy specimens for diagnosis of diabetic foot osteomyelitis: Concordance with ulcer swab cultures. Clin Infect Dis. 2006; 42:57-62. https://doi.org/10.1086/498112
  • Taiwo SS, Okesina AB, Onile BA. In vitro antimicrobial pattern of bacterial isolates from wound infection in University of Illorin Teaching Hospital. Afr J Clin Exp Microbiol. 2002;3(1):6-10.
  • TMC-ADTS Kısıtlı Bildirim Tablosu. Türk Mikrobiyoloji Cemiyeti. http://www.tmc-online. org/userfiles/file/26-37.pdf (erişim tarihi 1.4.2017).
  • Wayne PA. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing: 23rd informational supplement (M100-S23) (2013).
  • Wong SY, Manikam R, Muniandy S. Prevalence and antibiotic susceptibility of bacteria from acute and chronic wounds in Malaysian subjects. J Infect Dev Ctries 2015;9(9):936-44. https://doi.org/10.3855/jidc.5882
  • York MK, Sharp SE, Bowler PG, Church DL. Wound/abscess and soft tissue cultures, “LynneShore G, Isenberg HD (eds). Clinical Microbiology Procedures Handbook, 3. baskı” kitabında s. 3.13.1, ASM Press, Washington (2007).