Yasemin BAYRAM, Cennet RAGBETLİ, Mehmet PARLAK, Nesrin CEYLAN, Hüseyin GÜDÜCÜOĞLU, Suat ÖZLÜK, Görkem YAMAN

CHRYSEOBACTERIUM INDOLOGENES'İN NEDEN OLDUĞU İDRAR YOLU ENFEKSİYONU

Bu çalışmada 1 yaşındaki erkek hastada Chryseobacterium indologenes idrar yolu enfeksiyonu vakası sunulmuştur. Bu olguda yapılan idrar kültürü incelemesinde 24. saatte sarı-turuncu pigment oluşturan, kolonileri düzgün kenarlı olan, katalaz, indol, eskulin hidrolizi ve oksidaz testleri pozitif olarak bulunan mikroorganizma tespit edilmiştir. Aynı örnekte ikinci mikroorganizma olarak Candida albicans üremesi saptanmıştır. Her iki mikroorganizma sayısı da 100.000 Colony Forming Unit/mililitre üzerinde saptanmıştır. Bu mikroorganizmaların hızlı tanımlanması için laboratuarımızda BD Phoenix 100 (Becton Dickinson, USA) otomatize sistem kullanılmıştır. Antibiyotik dirençlerinin tespiti için European Committee on Antimicrobial Susceptibility Testing 2014 kılavuzunda nonfermenter bakteriler için tanımlanan kriterler kullanılmıştır. C. indologenes suşu tanımlandıktan sonra MALDI-TOF MS (Bruker Microflex LT System) ile Maltepe Üniversitesi Mikrobiyoloji Laboratuvarı'nda konfirme edilmiştir. C. indologenes amikacin, gentamicin, aztronenam, ceftazidime, cefepime, piperacillin, piperacillin tazobactama karşı dirençli bulunurken ciprofloxacin ve trimethoprim-sulfamethoxazole duyarlı bulunmuştur. C. albicans için gradient testi (Liofilchem. srl, İtalya) ile yaılan antimikotik duyarlılık testinde ise flusitozin, amfoterisin B, vorikonazol, flukonazol, itrakonazole karşı duyarlı olarak tespit edilmiştir. Hastaya trimethoprim sulfamethoxazole ve kaspofungin tedavisi başlanmıştır. Ateş sorunu çözülünce ve idrar kültürü negatif gelene kadar tedavisine devam edilmiştir. C. indologenes, nadir rastlanan bir etiyolojik ajan olmasına rağmen hidronefrozun eşlik ettiği idrar yolları enfeksiyonlarında akılda tutulmalıdır.

Urinary Tract Infection by Chryseobacterium indologenes

We report a case of a one-year-old boy with uriner infection by C. indologenes. In this case, a microorganism was a yellow-orange pigment, forming colonies with smooth edges, catalase and oxidase positive in the examination of 24th hours of urine culture. Candida albicans was isolated of the second microorganism in the same samples. Both microorganisms were determined on 100,000 Colony Forming Unit / milliliter. Phoenix 100 BD (Becton Dickinson, USA) automated system is used in laboratory for rapid identification of these microorganisms. Antibiotic resistance criteria of bacterias defined by European Committee on Antimicrobial Susceptibility Testing 2014 guide of nonfermentatives. After identification of C. indologenes strains confirmed by MALDI-TOF MS (Bruker Microflex LT System) in Microbiology Laboratory, Maltepe University. C. indologenes were found to resistant of amikacin, gentamicin, aztroneam, ceftazidime, cefepime, piperacillin, piperacillin tazobactam but sensitive of ciprofloxacin and trimethoprim sulfamethoxazole. C. albicans has been identified as sensitive flucytosine, amphotericin B, voriconazole, fluconazole, itraconazole capsofungin in antifungal susceptibility testing by gradient test (Liofilchem.srl, Italy). Trimethoprim sulfamethoxazole and caspofungin therapies were initiated to this patient. This treatment was continued of high fever problem solved and until negative urine culture. Although a rare etiological agent of C. indologenes should be kept in mind of people together with other diseases such as hydronephrosis in urinary track infections.

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