Şükrü ÖKSÜZ, Eda KAYABAŞI, Sare KAYA, Vehbi ASLAN, Nagihan MEMİŞ

ALT SOLUNUM YOLU ÖRNEKLERİNDEN İZOLE EDİLEN NONFERMENTATİF GRAM NEGATİF BAKTERİLERİN ANTİBİYOTİK DUYARLILIKLARI

Amaç: Bu çalışmada, hastanemizde yatarak takip edilmiş hastaların alt solunum yolu örneklerinden izole edilen Acinetobacter spp., Pseudomonasspp., Stenotrophomonas maltophilia suşlarının çeşitli antibiyotiklere direnç oranlarının belirlenmesi ve ampirik antibiyotik tedavisine yolgösterilmesi amaçlanmıştır.Yöntem: Ocak 2019-Ocak 2020 tarihleri arasında laboratuvarımıza gönderilen, nonfermentatif Gram negatif bakteriler (NFGNB)’in izole edildiğialt solunum yolu örnekleri retrospektif olarak incelenmiştir. Bakteri identifikasyonu ve antibiyotik duyarlıkları konvansiyonel mikrobiyolojikyöntemler ve otomatize sistem (Vitek 2, bioMerieux, Fransa) ile belirlenmiştir.Bulgular: Çalışmaya dahil edilen 332 etkenin izole edildiği 207 hastanın %40’ı serviste, %60’ı yoğun bakım ünitesinde takip edilmekteydi.Örneklerin 70’i (%21) balgam, 248’i (%75) derin trakeal aspirat, 14’ü (%4) bronkoalveolar lavajdı. Etkenlerin 160’ı (%48) Pseudomonas spp., 145’i(%44) Acinetobacter spp., 27’si (%8) Stenotrophomonas maltophilia olarak saptanmıştır. Acinetobacter spp. suşlarına en etkili antibiyotiğin kolistin(%98), Pseudomonas spp. suşlarına ise kolistin (%95), amikasin (%85) ve gentamisin (%81) olduğu bulunmuştur. S. maltophilia suşlarında isetrimetoprim-sulfametoksazol (TMP-SXT) (%96) duyarlılığının yüksek olduğu saptanmıştır.Sonuç Acinetobacter spp. ve Pseudomonas spp. suşlarında nefrotoksik etkisi bilinen kolistin ve kombine tedavilerde kullanımı mümkün olanaminoglikozidler dışındaki antibiyotiklere karşı yüksek direnç oranları saptanmıştır. Bu nedenle tedaviye etkenlerin antibiyotik duyarlılıklarıbelirlenerek başlanması gerekmektedir.

ANTIBIOTIC SENSITIVITY OF NONFERMENTATIVE GRAM-NEGATIVE BACTERIA ISOLATED FROM LOWER RESPIRATORY TRACT SPECIMENS

Objective: In this study, it was aimed to determine the resistance rates of Acinetobacter spp., Pseudomonas spp., Stenotrophomonas maltophilia strains isolated from lower respiratory tract samples of patients who were followed up in our hospital, and to guide empirical antibiotic treatment. Methods: Lower respiratory tract samples sent to our laboratory between January 2019 and January 2020, in which nonfermentative gram-negative bacteria (NFGNB) were isolated, were retrospectively analyzed. Bacterial identification and antibiotic susceptibility were determined using conventional microbiological methods and automated system (Vitek 2, bioMerieux, France). Results 332 agents were isolated from 207 patients who were followed up 40% in the service and 60% in the intensive care unit in this study. 70 (21%) of the samples were sputum, 248 (75%) were deep tracheal aspirate, 14 (4%) were bronchoalveolar lavage. 160 (48%) of the agents were Pseudomonas spp., 145 (44%) were Acinetobacter spp., 27 (8%) were S. maltophilia. Most effective antibiotic was determined against Acinetobacter spp. strains as colistin (98%) while most effective antibiotics were found against Pseudomonas spp. starins as colistin (95%), amikacin (85%) and gentamicin (81%). Trimethoprim-sulfamethoxazole (96%) sensitivity was found to be high in S. maltophilia strains. Conclusion: Acinetobacter spp. and Pseudomonas spp. strains have been found to have high resistance rates against antibiotics other than aminoglycosides that can be used in combined therapies and colistin with known nephrotoxic effects. Therefore, the treatments should be started by determining the antibiotic sensitivity of the agents.

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