Kutbettin DEMİRDAĞ, Mehmet ÇABALAK, Müge ÖZGÜLER

Yoğun bakımda izole edilen pseudomonas spp. suşlarında metallo-beta-laktamaz sıklığının araştırılması

Haziran-Aralık 2008 arasında hastanemiz yoğun bakım ünitesinde hastalardan alınan kültür örneklerinden infeksiyon etkeni olarak izole edilen çoğul dirençli 43 Pseudomonas spp. suşunda metallo-beta-laktamaz (MBL) üretimi, modifiye Hodge testi ve kombine disk (IPM-EDTA) yöntemi ile araştırılmıştır. Kombine disk (IPM-EDTA) yöntemi ile 43 suşun 34’ünde, modifiye Hodge testi ile 43 suşun 16’sında MBL üretimi tespit edilmiştir. Hastanelerde, fenotipik yöntemlerle Pseudomonas suşlarında MBL üretiminin tespit edilmesi, hem bu etkenlerle oluşan infeksiyonların tedavisinde yol gösterici olacak hem de erken başlatılacak kontrol önlemleriyle infeksiyon kontrolüne katkı sağlayacaktır.

The frequency of metallo-beta-lactamase production in pseudomonas spp. strains isolated from intensive care unit

In the present study, we evaluated the frequency of metallo-beta-lactamase (MBL) production in 43 multidrug resistant Pseudomonas spp. strains isolated from intensive care unit of our hospital during June and December 2008. The MBL production was examined by modified Hodge test and combined disc (IMP- EDTA) test. Thirty four and sixteen out of 43 strains were found MBL positive by IMP-EDTA and by modified Hodge test, respectively. Consequently, detecting MBL production in Pseudomonas strains by phenotypical methods will provide guidance for treatment of infections and may be helpful for infection control by early initiate relevant control measures.

PDF

___

1. Altoparlak U, Aktas F, Celebi D, Ozkurt Z, Akcay MN. Prevalence of metallo-b-lactamases among Pseudomonas aeruginosa and Acinetobacter baumannii isolated from burn wounds and in vitro activities of antibiotic combinations against these isolates, Burns 2005;31(6):707-10. http://dx.doi.org/10.1016/j.burns.2005.02.017 PMid:16129224
2. Ambler RP. The structure of beta-lactamases, p.321-31, Philos Trans R Soc London Ser B (London) (1980).
3. Behera B, Mathur P, Das A, Kapil A, Sharma V. An evaluation of four different phenotypic techniques for detection of metallo-beta-lactamase producing Pseudomonas aeruginosa, Indian J Med Microbiol 2008;26(3):233-7. http://dx.doi.org/10.4103/0255-0857.39587 PMid:18695320
4. Blondell-Hill E, Henry DA, Speert DP: Pseudomonas, “Murray PR, Baron EJ, Jorgensen JH, Landry ML, Pfaller MA (eds). Manual of Clinical Microbiology, 9th ed., Vol 1” kitabında s.734-48, ASM Press, Washington, DC (2007).
5. Bush KG, Jacoby GA, Medeiros AA. A functional classification scheme for beta-lactamases and its correlation with molecular structures, Antimicrob Agents Chemother 1995;39(6):1211-33. PMid:7574506 PMCid:162717
6. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Fifteenth Informational Supplement, CLSI document M100-S15, CLSI, Wayne, PA (2005).
7. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Nineteenth Informational Supplement, CLSI document M100-S19, CLSI, Wayne, PA (2009).
8. Falagas ME, Karageorgopoulos DE. Pandrug resistance (PDR), extensive drug resistance (XDR), and multidrug resistance (MDR) among Gram-negative bacilli: need for international harmonization in terminology, Clin Infect Dis 2008;46(7):1121-2. http://dx.doi.org/10.1086/528867 PMid:18444833
9. Gayyurhan E, Zer Y, Mehli M, Akgün S. Yoğun bakım Ünitesi hastalarından izole edilen Pseudomonas aeruginosa suşlarının antibiyotik duyarlılıkları ve metallo-beta-laktamaz oranlarının belirlenmesi, İnfeksiyon Derg 2008;22(1):49-52.
10. Ito H, Arakawa Y, Ohsuka S, Wacharotayankun R, Kato N, Ohta M. Plasmid-mediated dissemination of the metallo-b-lactamase gene blaIMP among clinical isolated strains of Serratia marcescens, Antimicrob Agents Chemother 1995;39(4):824-9. PMid:7785978 PMCid:162636
11. Jack GW, Richmond MH. A comparative study of eight distinct beta-lactamases synthesized by gram-negative bacteria, J Gen Microbiol 1970;61(1): 43-61. PMid:5489064
12. Jesudason MV, Kandathil AJ, Balaji V. Comparison of two methods to detect carbapenemase and metallo-beta-lactamase-production in clinical isolates, Indian J Med Res 2005;121(6):780-3. PMid:16037624
13. Lee K, Chong Y, Shin HB, Kim YA, Yong D, Yum JH. Modified Hodge test and EDTA-disk synergy tests to screen metallo-b-lactamase-producing strains of Pseudomonas and Acinetobacter species, Clin Microbiol Infect 2001;7(2):88-91. http://dx.doi.org/10.1046/j.1469-0691.2001. 00204.x PMid:11298149
14. Lee K, Lim YS, Yong D, Yum JH, Chong Y. Evaluation of the Hodge test and the imipenem-EDTA double-disk-synergy test for differentiating metallo-beta-lactamase-producing isolates of Pseudomonas spp. and Acinetobacter spp., J Clin Microbiol 2003;41:4623-9. http://dx.doi.org/10.1128/JCM.41.10.4623-4629.2003 PMid:14532193 PMCid:254300
15. Livermore DM. b-Lactamases in laboratory and clinical resistance, Clin Microbiol Rev 1995;8(4):557-84. PMid:8665470 PMCid:172876
16. Matsumura N, Minami S, Watanabe Y, Iyobe S, Mitsuhashi S. Role of permeability in the activities of b-lactams against gram-negative bacteria which produce a group 3 b-lactamase, Antimicrob Agents Chemother 1999;43(8):2084-6. PMid:10428944 PMCid:89422
17. McGowan JE Jr. Resistance in nonfermenting gram-negative bacteria: multidrug resistance to the maximum, Am J Infect Control 2006;34(5):29-37. http://dx.doi.org/10.1016/j.ajic.2006.05.226 PMid:16813979
18. Öztürk R. Çoklu ilaca dirençli Pseudomonas aeruginosa, Burkholderia cepacia, Stenotrophomonas maltophilia ile oluşan infeksiyon hastalıklarında antimikrobik tedavi, ANKEM Derg 2008;22(Ek 2):36-43.
19. Sarı H, Özer S, Gençer S, Batırel A, Balkan İ, Karagöz G. Karbapenemlere dirençli gram negatif basil izolatlarında imipenem-EDTA disk yöntemi ve modifiye Hodge testi ile metallo-beta-laktamaz varlığının araştırılması, Flora 2007;12(4):176-84.
20. Sesli-Çetin E, Tetik T, Kaya S, Arıdoğan BC. Acinetobacter baumannii ve Pseudomonas aeruginosa izolatlarında metallo-beta-laktamaz üretiminin dört farklı fenotipik yöntemle araştırılması, İnfeksiyon Derg 2009;23(2):51-5.
21. Shibata N, Doi Y, Yamane K et al. PCR typing of genetic determinants for metallo-b-lactamases and integrases carried by gram-negative bacteria isolated in Japan, with focus on the class 3 integron, J Clin Microbiol 2003;41(12):5407-13. http://dx.doi.org/10.1128/JCM.41.12.5407-5413.2003 PMid:14662918 PMCid:309014
22. Şimşek M, Sultan N. Pseudomonas aeruginosa ve Acinetobacter türlerine ait klinik izolatlarda metallo-beta-laktamaz yapımının farklı feonotip yöntemlerle incelenmesi, Türk Klinik Lab Derg 2010;1(1):11-16.
23. Toraman ZA, Yakupoğulları Y, Kizirgil A. Detection of metallo-beta-lactamase production and antibiotic resistance with E-test method in Pseudomonas, Acinetobacter and Klebsiella strains in Turkey, J Infect Chemother 2004;10(5):257-61. http://dx.doi.org/10.1007/s10156-004-0333-3 PMid:16163458
24. Waley SG. b-Lactamase: mechanism of action, “Page MI (ed). The Chemistry of b-Lactams” kitabında s.198-228, Blackie Academic and Professional, London (1992).
25. Wirth FW, Picoli SU, Cantarelli VV et al. Metallo-beta-lactamase-producing Pseudomonas aeruginosa in two hospitals from southern Brazil, Braz J Infect Dis 2009;13(3):170-2. http://dx.doi.org/10.1590/S1413-86702009000300003 PMid:20191191
26. Yan JJ, Hsueh PR, Ko WC et al. Metallo-beta-lactamases in clinical Pseudomonas isolates in Taiwan and identification of VIM-3, a novel variant of the VIM-2 enzyme, Antimicrob Agents Chemother 2001;45(8):2224-8. http://dx.doi.org/10.1128/AAC.45.8.2224-2228.2001 PMid:11451678 PMCid:90635
27. Yan JJ, Wu JJ, Tsai SH, Chuang CL. Comparison of the double-disk, combined disk, and Etest methods for detecting metallo-beta-lactamases in gram-negative bacilli, Diagn Microbiol Infect Dis 2004;49(1):5-11. http://dx.doi.org/10.1016/j.diagmicrobio. 2004.01.002 PMid:15135493