Oktay YAPICI, Hafize YAPICI, Nilüfer Saygılı PEKİNTÜRK, Alper AKGÜNEŞ, Senem AKGÜL, Bora EKİNCİ

Karbapenemaz üreten enterobacteriaceae izolatlarının immünokromatografik kart test RESIST-3 O.K.N. K-SET ile değerlendirilmesi

Amaç: Son yıllarda, Enterobacteriaceae türlerine karşı artan antimikrobiyal direnç küresel bir sorun olmaya devam etmektedir. Bu çalışmada karbapenem dirençli Enterobactericeae suşlarında immünokromatografik yöntem ile OXA-48 benzeri, KPC ve NDM beta-laktamaz karbapenemazlarının varlığının araştırılması amaçlanmıştır. Gereç ve Yöntem: 1 Haziran 2017 ile 31 Mayıs 2018 tarihleri arasında mikrobiyoloji laboratuvarına çeşitli servislerden ve yoğun bakımdan gönderilen 717 Enterobactericeae suşu çalışma kapsamına alındı. Geleneksel yöntemler (koloni morfolojisi, gram boyama vb.) ve otomatize VİTEK-2 sistemi ile tanısı konulan Enterobactericea suşları değerlendirildi. VİTEK-2 sistemi ile antibiyogramı yapılan ve EUCAST önerilerine göre en az bir karbapenem grubu antibiyotiğe dirençli tespit edilen izolatlarda, karbapenem direnç tipi RESIST-3 O.K.N. K-SET (Coris BioConcept, Gembloux, Belgium) immünokromatografik yöntemle değerlendirildi. Bulgular: Değerlendirilmeye alınan Eschericia coli (n=430) ve Klebsiella pneumoniae (n=210), Klebsiella ozanea (n=4), Serratia marcescens (n=50), Serratia odorifa (n=3) arasında 35 karbapenem dirençli suş saptandı. Tespit edilen diğer türler (Salmonella, Enterobacter, Proteus, Citrobacter, Morganella, Yersinia) arasında karbapenem direnci saptanmadı. Enterobactericeae türleri arasında %4,8 (n=35) karbapenemlere direnç tespit edildi. Klebsiella pneumoniae suşları arasında %13,3 (n=28), Eschericia coli suşları arasında %0,9 (n=4) oranında karbapenem direnci tespit edildi. Klebsiella pneumoniae suşlarında (n=28) immünkromatografik yöntemle en fazla OXA-48 benzeri (n=13; %48) enzim direnci gözlendi. OXA -48 benzeri enzim pozitif saplanan bu 13 suşun 9‟u (%69) kolistine duyarlı bulundu. Sonuç: İlerleyen yıllarda mikrobiyoloji alanında daha kısa sürede, daha uygun maliyette, yüksek duyarlılık ve seçiciliğe ait bu tür pratik yöntemlerin kullanım alanının artacağını düşünmekteyiz.

Evaluation of carbapenemases producing enterobacteriaceae by immunochromatographic card test RESIST-3 O.K.N. K-SET assay

Aim: In recent years, Enterobacteriaceae species have rapidly become a global problem due to the increasing antimicrobial resistance. The aim of this study was to investigate the presence of OXA-48 like KPC and NDM beta-lactamase carbapenemases in carbapenem resistant Enterobactericeae strains by immunochromatographic method. Materials and Methods: Between June 1, 2017 and May 31, 2018, 717 Enterobactericeae strains were sent to microbiology laboratory from various services and intensive care units. Enterobactericeae strains diagnosed by conventional methods (colony morphology, gram staining etc.) and VITEK-2 system. According to the EUCAST recommendations, at least one carbapenem group antibiotic-resistant isolates was evaluated by carbapenem resistance type RESIST-3 O.K.N. K-SET (Coris BioConcept, Gembloux, Belgium) by immunochromatographic method. Results: Thirty-five carbapenem resistant strains were detected between Escherichia coli (n=430) and Klebsiella pneumoniae (n=210), Klebsiella ozanea (n=4), Serratia marcescens (n=50) Serratia odorifa (n=3). No other carbapenem resistance was found between the other species identified (Salmonella, Enterobacter, Proteus, Citrobacter, Morganella, Yersinia). Among the Enterobacteriaceae species, resistance to carbapenem was 4.8% (n=35). Carbapenem resistance was detected in 13.3% (n=28) of Klebsiella pneumoniae strains and 0.9% (n=4) of Escherichia coli strains. In Klebsiella pneumoniae strains, resistance to OXA-48 (n=13; 48%) was the most observed by immunochromatographic method. Nine of these 13 strains (69%) were found to be susceptible to colistin. Conclusion: In the following years, we believe that the use of such practical methods of high sensitivity and selectivity will increase in a shorter time in the field of microbiology.

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