Cem ÇELİK, Mustafa Gökhan GÖZEL, Fatma DAYI, Mustafa Zahir BAKICI, Nazif ELALDI, Esra GULTURK

Increasing antimicrobial resistance in nosocomial pathogens; multidrug-resistant extensively drug-resistant and pandrug-resistant Acinetobacter baumannii

Amaç: Bu çalışmada nozokomiyal enfeksiyonlardan izole edilen Acinetobacter spp. suşlarının antimikrobiyal duyarlılıkları tespit edilerek yıllar içerisindeki direnç değişimlerinin karşılaştırılması amaçlanmıştır. Yöntemler: Çalışmamıza 2007-2011 tarihleri arasında Cumhuriyet Üniversitesi Hastanesinde tedavi gören ve nozokomiyal enfeksiyon tanısı konulan hastaların klinik örneklerinden izole edilen Acinetobacter spp. suşları alınmıştır. Suşların tanımlanması ve antimikrobiyal duyarlılık testleri Clinical and Laboratory Standards Institute önerilerine göre otomatize sistem kullanılarak yapılmıştır. Bulgular: Klinik örneklerinden izole edilen toplam 454 Acinetobacter spp. suşu çalışmaya dahil edilmiştir. A. baumannii en sık izole edilen Acinetobacter türü olarak saptandı. İmipenem ve meropenem dirençli suş oranı sırası ile % 31.9 ve % 33.7 olarak saptanırken, piperasilin/tazobaktam, seftazidim, sefepim, amikasin, gentamisin, siprofloksasin, levofloksasin ve tetrasiklin direnç oranları sırası ile % 74,4, % 78.0, % 76.7, % 46.6, % 62.4, % 66.8, % 61.3 ve % 53.9 olarak saptandı. Çok ilaca dirençli (MDR), yaygın ilaç dirençli (XDR) ve tüm ilaçlara dirençli (PDR) A. baumannii oranları sırası % 50.2, % 28.5 ve % 14.0 olarak bulundu. Yıllar içindeki MDR, XDR ve PDR suş oranları değişimleri incelendiğinde, özellikle PDR A. baumannii oranının tehlikeli düzeylerde arttığı görüldü.Sonuç: A. baumannii nozokomiyal enfeksiyonlarda en önemli patojenlerden biridir ve tüm antibiyotiklere karşı artan direnç oranları gelecekte daha çok tedavi başarısızlıklarına neden olacağı muhtemeldir

Anahtar Kelimeler:

Acinetobacter baumannii; antimikrobiyal direnç, nozokomiyal enfeksiyon

Increasing antimicrobial resistance in nosocomial pathogens; multidrug-resistant extensively drug-resistant and pandrug-resistant Acinetobacter baumannii

Objective: The aim of this study was to determine the antimicrobial susceptibility of Acinetobacter baumannii strains, which were isolated from nosocomial infections and compare the changes in resistance rates of isolates over time. Methods: Acinetobacter spp. strains isolated from hospitalized patients diagnosed with nosocomial infection at Cumhuriyet University Hospital between 2007 and 2011 were included in the study. Isolate identification and antibiotic susceptibility test were performed using an automated system according to the Clinical and Laboratory Standards Institute guidelines. Results: In total, 454 Acinetobacter spp. strains were included in this study. A. baumannii was the most frequently isolated Acinetobacter species. Imipenem and meropenem resistance were determined to be 31.9% and 33.7%, respectively, and 74.4%, 78.0%, 76.7%, 46.6%, 62.4%, 66.8%, 61.3% and 53.9% of isolates were resistant to piperacillin-tazobactam, ceftazidime, cefepim, amikacin, gentamicin, ciprofloxacin, levofloxacin and tetracycline respectively. The resistance rates of multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) A. baumannii were 50.2%, 28.5%, and 14.0%, respectively. Changes in MDR, XDR and PDR rates over time were examined. Importantly, PDR A. baumannii have been reached dangerous levels over time. Conclusion: A. baumannii is one of the most important pathogen, particularly in a nosocomial setting. Increasing resistance rates of this group to all antibiotics will likely lead to increased treatment failure in the future.

Keywords:

Acinetobacter baumannii antimicrobial resistance, nosocomial infections,

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