Karbapenem Dirençli Pseudomonas aeruginosa İzolatlarında Metallo

Amaç: Bu çalışmada nozokomiyal enfeksiyon etkeni olarak izole edilen, karbapenemlere dirençli 29 Pseudomonas aeruginosa izolatında metallo beta-laktamaz üretiminin belirlenmesi ve üç farklı fenotipik yöntemin sonuçlarının karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: Pseudomonas aeruginosa izolatları konvansiyonel yöntemler ile tanımlanmış, antibiyotik duyarlılık testleri Clinical and Laboratory Standards Institue standartlarına göre Kirby-Bauer disk difüzyon yöntemi kullanılarak yapılmıştır. Karbapenem direncini doğrulamak için imipenem E test ve meropenem E test (AB BIODISK, Solna, İsveç) kullanılmıştır. Metallo beta-laktamaz üretimini belirlemek için metallo beta-laktamaz E test (AB BIODISK, Solna, İsveç), modifiye Hodge testi ve imipenem-EDTA kombine disk testi kullanılarak sonuçlar polimeraz zincir reaksiyonu sonuçları ile karşılaştırılmıştır. Bulgular: Karbapenemlere dirençli 29 izolatta polimeraz zincir reaksiyonu ile IMP, VIM, GIM, SIM ve SPM tipi metallo beta-laktamaz enzim geni bulunamamıştır. Fenotipik testlerden kombine disk testi ile altı izolat, E test ile iki izolat pozitif sonuç vermiştir. Modifiye Hodge testi ile 10 izolat pozitif sonuç vermiş, iki izolatta ise sonuç belirlenememiştir. Polimeraz zincir reaksiyonu sonuçları ile metallo beta-laktamaz E test sonuçları arasındaki farkın istatistiksel olarak anlamlı olmadığı belirlenmiştir (p> 0,05). Polimeraz zincir reaksiyonu ile kombine disk testi sonuçları arasındaki farkın anlamlı olduğu (p:0,023 ) ve yine polimeraz zincir reaksiyonu ile modifiye Hodge testi sonuçları arasında farkın anlamlı olduğu saptanmıştır (p< 0,001). Sonuç: Bulgularımıza göre; karbapenemlere dirençli P. aeruginosa izolatları için metallo beta-laktamaz tarama testi olarak metallo betalaktamaz E testin kullanılması uygundur, ancak pozitif sonuçların moleküler yöntemler ile doğrulanması gereklidir

Investigation of Metallo Beta-lactamase Production in Carbapenem Resistant Pseudomonas aeruginosa Isolates

Objective: In this study; we aimed to determine metallo beta-lactamase production in 29 Pseudomonas aeruginosa isolates resistant to carbapenems that isolated as a cause of nosocomial infection and to compare the three different phenotypic methods for screening of metallo beta-lactamase production. Material and Methods: P.aeruginosa isolates were identified by conventional methods. Antibiotic susceptibility tests were performed by Kirby-Bauer disk diffusion method according to the standards of Clinical and Laboratory Standards Institute. Imipenem and meropenem E tests (AB Biodisk, Sweden) were used for verification of carbapenem resistance. Metallo beta-lactamase E test (AB Biodisk, Sweden), modified Hodge test and imipenem-EDTA combined disk test were used for detection of metallo beta-lactamase production and the results of these tests were compared with polymerase chain reaction results. Results: IMP, VIM, GIM, SIM and SPM type genes were negative for all isolates with polymerase chain reaction. As a screening test for metallo beta-lactamase enzymes, combined disk test and E test detected positivity for six and two isolates, respectively. Modified Hodge test yielded 10 positive and two undetermined results within 29 isolates. There were no statistical difference between metallo beta-lactamase E test results and polymerase chain reaction results (p> 0,05 ). But, there were significantly statistical difference between polymerase chain reaction results and combined disk test (p:0,023 ) and modified Hodge test (p

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