Pseudomonas aeruginosa Suşlarında Beta-Laktam, Aminoglikozid ve Siprofloksasin Grubu Antibiyotiklere Karşı Direncin Belirlenmesi

G ünümüzde geniş spekturumlu antibiyotiklerin yaygın kullanımına bağlı olarak Pseudomonas aeruginosa’ da yüksek oranda antibiyotik direnci gelişmektedir. Böylece etken olduğu enfeksiyonların tedavisinde zorluklar yaşanmaktadır. Çalışmamızda Ankara’ daki üç farklı hastaneden izole edilen P. aeruginosa suşlarının beta-laktam, aminoglikozid ve siprofloksasin grubu antibiyotiklere karşı olan dirençlilikleri incelenerek çoklu ilaç dirençli suşlar ve antibiyotip grupları belirlendi. Böylece etkeni P. aeruginosa olan enfeksiyonların tedavisinde kullanılabilecek en etkili antibiyotiklerin belirlenmesi amaçlandı. 69 P. aeruginosa suşu ile aztreonam, meropenem, imipenem, amikasin, tobramisin, piperasilin, seftazidim, sefepim ve siprofloksasine karşı direnç durumları incelendi. P. aeruginosa suşlarında en yüksek direnç oranın aztreonama %66.6 karşı olduğu görülürken, en etkili antibiyotiğin amikasin %5.7 olduğu belirlendi. Ayrıca, P. aeruginosa suşlarında %36 oranında çoklu ilaç direnci saptandı. Bu bağlamda, aminoglikozid ve siprofloksasinin kombine antibiyotik tedavisinin dirençli P. aeruginosa suşlarında etkili olacağı düşünülmektedir

Anahtar Kelimeler:

Pseudomonas aeruginosa, Antibiyotik direnci, Antibiyotip, Çoklu ilaç direnci

Determination of Resistance in Pseudomonas aeruginosa Strains Against Beta-Lactam, Aminoglycoside and Ciprofloxacin Group Antibiotics

Nowadays, due to widespread use of broad range spectrum antibiotics in treatments, Pseudomonas aerugi- nosa developed high levels of resistance to these antibiotics. Therefore it is challenging to treat the infec- tions caused by P. aeruginosa. In this study, multi-drug resistant strains and antibiotype groups were identified by investigating resistance in P. aeruginosa strains isolated from three different hospitals in Ankara, against beta-lactam, aminoglycoside and ciprofloxacin. Thus, it was aimed that the most effective antibiotics for treat- ment of P. aeruginosa sourced infections were determined. Sixty-nine P. aeruginosa strains were investigated for resistance against aztreonam, meropenem, imipenem, amikacin, tobramycin, piperacillin, ceftazidime, ce- fepime and ciprofloxacin. It was found that the highest resistance rate was against aztreonam 66.6% and the most effective antibiotic was found to be amikacin 5.7% . Additionally, the rate of multi-drug resistance in P. aeruginosa strains was determined as 36%. Although, 18 antibiotype groups were identified in P. aeruginosa strains, the highest antibiotype rate was observed in antibiotype 8 which was intermediate to aztronem and sensitive to other 8 antibiotics. In this respect, the combined treatment of aminoglycoside and ciprofloxacin is thought to be effective against resistant P.aeruginosa strains.

Keywords:

Pseudomonas aeruginosa, Antibiotic resistance, Antibiotype, Multi-drug resistance,

PDF

___

1. R. Mittal, S. Aggarwal, S. Sharma, S. Chhibber, K. Harjai, Urinary tract infections caused by Pseudomonas aeruginosa: A minirewiev, J. Inf. Public Health, 2 (2009) 101-111.
2. E. Akduman, A. Karadeniz, A. Balıkçı, A. E. Topkaya, Antimicrobial Susceptibility of Pseudomonas aeruginosa strains isolated from clinical specimens, Maltepe Med J, 5 (2013) 12-16.
3. W. E. Wagner, B. H. Iglewski, P. aeruginosa biofilms in CF infections, Clinic Rev. Allerg. Immunol., 35 (2008) 124-134.
4. G. Meletis, M. Bagkeri, Pseudomonas aeruginosa: Multidrug-resistance development and treatment options, InTech J, chap. 2, (2013) 33-56.
5. B. Yucesoy Dede, Hastane infeksiyonu etkeni olan Pseudomonas aeruginosa suslarının beta-laktamaz yapımı ve cesitli antimikrobiyallere duyarlılıkları, Specialist Thesis, Sağlık Bakanlığı Haydarpaşa Numune Eğitim ve Araştırma Hastanesi İnfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Kliniği, (2006) 72.
6. C. Ustun, Antibacterial resistance rates of carbapenem resistant and sensitive nosocomial Pseudomonas aeruginosa strains, Ankem Derg, 24 (2010)
7. E. B. Hirsch, V. H. Tam, Impact of multi-drug resistant Pseudomonas aeruginosa infection on patient outcomes, Expert. Rev. Pharmacoecon Outcomes Res., 10 (2010) 1.
8. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing;Seventeenth Informational Supplement.M100-S17. National Committee for Clinical Laboratory Standards, Wayne, Pa, 2005.
9. T. Strateva, D. Yordanov, Pseudomonas aeruginosa-a phenomenon of bacterial resistance, J. Med. Microbio, 58 (2009) 1133.
10. B. Uzun, S. Gungor, N. Sezak, I. Afsar, M. S. Ilgun, M. Demirci, Changes in resistance percentage to antibiotics in Pseudomonas aeruginosa and Acinetobacter baumannii strains isolated from blood cultures of intensive care unit patients, Turk Hij. Den. Biyol. Derg., 21 (2014) 1.
11. A. Pitondo-Silva, V. Vicente Martins, A. F. Tonelli Fernandes, E. Guedes Stehling, High level of resistance of aztreonam and ticarcillin in Pseudomonas aeruginosa isolated from soil of different crops in Brazil, Sci. Total Environ., 473 (2014), 155.
12. J-M. Rodriguez-Martinez, L. Poirel, P. Nordmann, Molecular epidemiology and mechanisms of carbapenem resistance in Pseudomonas aeruginosa, Antimicrob. Agents Chemother., 53 (2009) 4783.
13. H. Pai, J-W. Kim, J. Kim, J. H. Lee, K. W. Choe, N. Gotoh, Carbapenem resistance mechanisms in Pseudomonas aeruginosa clinical isolates, Antimicrob. Agents Chemother., 45 (2001) 480.
14. D. J. Wolter, D. Acquazzino, R. V. Goering, P. Sammut, N. Khafal, N. D. Hanson, Emergence of carbapenem resistance in Pseudomonas aeruginosa isolates from a patient cyctic fibrosis in the absence of carbapenem therapy, Clin. Infect Dis., 46 (2008) 137.
15. P. Khuntayaporn, P. Montakantikul, P. Mootsikapun, V. Thamlikitkul, M. T. Chomnnawang, Prevalence and genotypic relatedness of carbapenenm resistance among multidrug-resistant P. aeruginosa in tertiary hospitals across Thailand, Ann. Clin. Microbiol. Antimicrob., 11 (2012) 1
16. J. A. Karlowsky, M. E. Jones, D. C. Draghi, C. Thornsberry, D. F. Sahm, G. A. Volturo, Prevalence and antimicrobial susceptibilities of bacteria isolated from blood culture of hospitilazed patients in the United States in 2002, Ann. Clin. Microbio.l Antimicrob., 3 (2004) 1.
17. E. Riera, G. Cabot, X. Mulet, M. Garcia-Castillo, R. Campo, C. Juan, R. Canton, A. Oliver, Pseudomonas aeruginosa carbapenem resistance mechanisms in Spain: impact on the activity on imipenem, meropenem and doripenem, J Antimicrob Chemother., (2011) 1.
18. P. Ekincioglu, D. Percin, Susceptibility to antibiotics of clinical isolates of Pseudomonas aeruginosa, J Healt Sci, 22 (2013) 141.
19. M. Cosar, I. Tuncer, U. Arslan, The antimicrobial resistance profile of Pseudomonas aeruginosa strains isolated from blood cultures, Turkish J. Inf., 23 (2009) 47.
20. M. Patel, B. Lavingia, A. Patel, K. Patel, Susceptibility trends of Pseudomonas from ocular lesions, Gujarat Med. J., 64 (2009) 67.
21. E. Tuncoglu, G. Yenisehirli, Y. Bulut, Antibiotic resistance in clinically isolated Pseudomonas aeruginosa, Ankem, 23 (2009) 54.
22. A. H. Asghar, Antimicrobial susceptibility and metallo-beta-lactamase production among Pseudomonas aeruginosa isolated from Makkah Hospitals, Park. J. Med. Sci., 28 (2012) 781.
23. C. E. Ozturk, H. Turkmen Albayrak, A. Altınoz, H. Ankaralı, Antibiotic resistance and beta-lactamase rates in Pseudomonas aeruginosa strains, Ankem Derg., 24 (2010) 117.
24. A. L. P., Freitas A. L. Barth, Antibiotic resistance and molecular typing of Pseudomonas aeruginosa: focus on imipenem, BJID, 6 (2002) 1.
25. J. Koprnova, P. Beno, J. Korcova, M. Mrazova, E. Grey, A. Liskova, A. Harnicarova, M. Karvaj, S. Koval, V. Zak, M. Danaj, A. Streharova, E. Mitterpachova, J. Miklosko, A. Ondrusova, J. Riedl, E. Kaiserova, V. Prokopova, M. Hornova, J. Payer, B. Rudinsky, l. Pevalova, M. Bencelova, J. Hanzen, L. Macekova, J. Csölleyova, V. Jr. Krcmery, Bacteremia due to Pseudomonas aeruginosa: results from a 3-year national study in the Slovak Republic, J. Chemother., 17 (2005) 470.
26. T. Lamia, K. Bousselmi, B. R. Saida, M.A. Allah, Epidemiological profile and antibiotic susceptibility of Pseudomonas aeruginosa isolates within the burned patient hospitalized in the intensive care burn unit, Tunis Med, 85 2007 124-7.
27. A. C. Gales, R. N. Jones, J. Turnidge, R. Rennie, R. Ramphal, Characterization of Pseudomonas aeruginosa isolates: occurance rates, antimicrobial susceptibility patterns and molecular typing in the global SENTRY antimicrobial surveillance program, 1997-1999, Clin. Infect. Dis., 32 (2001) 146.
28. V. Aloush, S. Navon-Venezia, Y. Seigman-Igra, S. Cabili, Y. Carmeli, Multidrug resistant Pseudomonas aeruginosa: risk factors and clinical impact, Antimicrob. Agents Chemother., 50 (2006) 43.
29. G. F. Gad, R. A. El-Domany, S. Zaki, H. M. Ashour, Characterization of Pseudomonas aeruginosa isolated from clinical and environmental samples in Minia, Egypt: prevalence, antibiogram and resistance mechanisms, J. Antimicrob. Chemother., 60 (2007) 1010.
30. I. Biswal, B. Singh Arora, D. Kasana, Neetushree, Incidence of multidrug resistant Pseudomonas aeruginosa isolated from burn patients and environmental of teaching institution, J. Clin. Diagn. Res., 8 (2014) 26.
31. Q. Zhang, J. C. Smith, Q. Zhu, Z. Guo, N. E. McDonald, A few year rewiev of Pseudomonas aeruginosa bacteremia in children hospitalized at a single center in southern China, Int. J. Infect. Dis., 16 (2012) 628.
32. M. R. Chang, N. C. P. Carvalho, A. L. L. Oliveira, P. M. F. Moncada, B. A. Moraes, M. D. Asensi, Surveillance of pediatric infections in teaching hospital in Mato Gross do Sul, Brazil, Surveillance in Pediatr. Infect., 7 (2003) 149.
33. Y. Carmeli, N. Troillet, G. M. Eliopoulos, M. H. Samore, emergence of antibiotic resistant Pseudomonas aeruginosa: comparison of risk associated with different antipseudomonal agents, Antimicrob. Agents Chemother., 43 (1999) 1379
34. M. Gul, A. Sensoy, B. Cetin, F. Korkmaz, E. Seber, Investigation of susceptibilityof nosocomial Pseudomonas aeruginosa strains against ceftazidime by E-test and disc diffusion method, Turk Mikrobiol. Cem., 34 (2004) 33.
35. M. Berktas, H. Guducuoglu, A. Cıkman, M. Parlak, G. Yaman, Inducible beta-lactamase activity of nosocomial Pseudomonas aeruginosa strains, Fırat Med. J., 16 (2011) 125.
36. H. Pullukcu, S. Aydemir, A. Turhan, A. Tünger, M. A. Özinel, S. Ulusoy, In vitro antibiotic susceptibility of Pseudomonas aeruginosa isolated from normally sterile specimens: evaluation of 5-year results, Turk. J. Infect., 20 (2006) 111.
37. A. B. Mahmoud, W. A. Zahran, G. R. Hindawi, A. Z. Labib, R. Galal, Prevalence of multidrug-resistant Pseudomonas aeruginosa in patients with nosocomial infections at a university hospital in Egypt, with special reference to typing methods, J. Virol. Microbiol., (2013) 1.