İsmail TOSUN, Ebru ERGEN KILIÇARSLAN, Özlem EROL, Salih CESUR, Alper ÇİFCİ

Hemodiyaliz Hastalarında Rektal Sürüntü Örneklerinde Genişlemiş Spektrumlu Beta-laktamaz Taşıyıcılığı Oranlarının ve Risk Faktörlerinin Belirlenmesi

Amaç: Bu çalışmanın amacı hemodiyaliz tedavisi gören hastalarında rektal sürüntü örneklerinde genişlemişspektrumlu betalaktamaz (GSBL) üreten Enterobacteriacea sıklığı ve GSBL taşıyıcılığı ile ilişkili risk faktörlerininbelirlenmesi idi.Yöntem ve Gereçler: Çalışmaya kronik böbrek yetmezliği nedeniyle hemodiyaliz tedavisi gören 78 hasta ( 43kadın (yaş ortalaması 46± 3,6) 35 erkek (yaş ortalaması 55± 4.3) dahil edildi. Hastalarda GSBL rektal taşıyıcılığı ileilişkili risk faktörleri (cinsiyet, yaş ortalaması, hemodiyaliz süresi ve son 6 ay içinde antibiyotik kullanımı) araştırıldı. P≤ 0.05 istatistiksel olarak anlamlı kabul edildi.Bulgular: Çalışmaya alınan toplam 78 hastanın 30 (%38)unda çift disk sinerji testi ile GSBL pozitif (üreten)Enterobacteriacea türleri (spp.) rektal taşıyıcılığı saptanırken, ESBL kromojenik agar besiyeri ile 26 (%33.3)ındaGSBL pozitifliği saptandı. Hemodiyaliz hastalarının rektal sürüntü örneğinde üreyen Enterobacteriacea sppnin 20si(%66.6) GSBL pozitif E.coli, 7si (%23.3) GSBL pozitif Klebsiella spp., 3ü (%10) GSBL pozitif Proteus spp. olarakbelirlendi.Hemodiyaliz hastalarında GSBL Enterobacteriacea spp. rektal taşıyıcılığı ile son 6 ayda antibiyotik kullanımı arasındaistatistiksel olarak anlamlı ilişki saptandı (P

Determination of Risk Factors Related To The Frequency and Carriage of Ex tended Spectrum Beta-Lactamase (ESBL) In The Rectal Swap Samples Among Hemodialysis Patients

Aim: The aim of the current study is to determine the incidence of extended spectrum beta lactamase producingEnterobacteriaceae (ESBL) in rectal swab samples of patients who are under hemodialysis treatment and to determinethe risk factors related to ESBL carrier state.Material and Methods: Seventy-eight patients (43 female (mean age: 46± 3.6 years) and 35 male (mean age:55± 4.3 years) who are under hemodialysis treatment due to chronic renal failure were included to the study. The riskfactors related to the ESBL rectal carriage in the patients (gender, mean age, duration of hemodialysis, and antibioticuse during last 6 months) were investigated. P≤ 0.05 was accepted as statistically significant.Results: While rectal carriage of ESBL-positive (producing) Enterobacteriaceae species was detected by double discsynergy test in 30 (38%) of a total of 78 patients included in the study, ESBL positivity was found in 26 (33.3%) ofpatients with ESBL chromogenic agar medium. ESBL-positive E.coli was isolated in 20 (66.6%) of the hemodialysispatients and ESBL positive Klebsiella species was isolated in seven (23.3%) cases, and ESBL-positive Proteus specieswas isolated in three (10%) cases.While there was a history of antibiotic use within last six months in 20 (66.7%) of the patients in which ESBL- positive Enterobacteriaceae spp. was detected, there was a history of antibiotic use within last six months in five(10.4%) ESBL-negative patients.A statistically significant correlation was found between rectal carriage of ESBL positive Enterobacteriaceae spp. andantibiotic use within last six months in hemodialysis patients (p

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1. Yılmaz N, Aguş N, Köse Ş, Yurtsever SG, Öner Ö. Geniş spektrumlu beta-laktamaz salgılayan Escherichia coli ve Klebsiella pneumoniae suşlarının ertapenem ve diğer antibiyotiklere duyarlılıkları. Türk Mikrobiyoloji Cemiyeti Dergisi; 2009; 39: 80-84. 2. Eraksoy H, Basustaoglu A, Korten V, Kurt H, Ozturk R, Ulusoy S, Yaman A, Yuce A. Turkish MYSTIC Study Group Susceptibility of bacterial isolates from Turkey- a report from the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Program. J Chemother. 2007; 19:650-7. 3. Schwaber MJ1, Cosgrove SE, Gold HS, Kaye KS, Carmeli Y. Fluoroquinolones protective against cephalosporin resistance in gram- negative nosocomial pathogens. Emerg Infect Dis. 2004 ;10(1):94-9. 4. Yurtman AN, Hoşgör-Limoncu M, Ermertcan Ş, Eraç B. Genişlemiş spektrumlu beta-laktamazların saptanmasında fenotipik yöntemlerin karşılaştırılması. İnfeksiyon Dergisi (Turkish Journal of Infection) 2009; 23 (1): 5-8 5. Pitout JD, Nordmann P, Laupland KB, Poirel L. Emergence of Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBLs) in the community. J Antimicrob Chemother. 2005 ; 56(1):52-9. 6. Tian SF, Chen BY, Chu YZ, Wang S. Prevalence of rectal carriage of extended-spectrum beta-lactamase-producing Escherichia coli among elderly people in community settings in China. Can J Microbiol. 2008 Sep;54(9):781-5. 7. Tschudin-Sutter S, Frei R, Dangel M, Stranden A, Widmer AF. Rate of transmission of extended-spectrum Beta-lactamase- producing enterobacteriaceae without contact isolation. Clin Infect Dis. 2012 ; 55(11):1505-11. 8. Kruse EB, Conrad A, Wenzler-Röttele S, Jonas D, Dettenkofer M, Wolkewitz M, Meyer E, Serr A. Extended-spectrum beta- lactamase-producing Enterobacter cloacae in mobile dialysis units in the medical and surgical departments of a university hospital: a case-control study. J Hosp Infect. 2010; 75(1):33-6. 9. Yip T, Tse KC, Lam MF, Tang S, Li FK, Choy BY, Lui SL, Chan TM, Lai KN, Lo WK. Risk factors and outcomes of extended- spectrum beta-lactamase-producing E. coli peritonitis in CAPD patients. Perit Dial Int. 2006; 26(2):191-7. 10. Kader AA, Kumar A, Kamath KA. Fecal carriage of extended- spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in patients and asymptomatic healthy individuals. Infect Control Hosp Epidemiol. 2007 ; 28(9):1114-6. 11. Castillo García FJ, Seral García C, Pardos De la Gandara M, Millán Lou MI, Pitart Ferré C. Prevalence of fecal carriage of ESBL- producing Enterobacteriaceae in hospitalized and ambulatory patients during two non-outbreak periods. Eur J Clin Microbiol Infect Dis. 2007 ; 26(1):77-8. 12. Jiménez A, Alvarado A, Gómez F, Carrero G, Fajardo C. Jiménez A, Alvarado A, Gómez F, Carrero G, Fajardo C. Risk factors associated with the isolation of extended spectrum betalactamases producing Escherichia coli or Klebsiella pneumoniae in a tertiary care hospital in ColombiaBiomedica. 2014 ;34 Suppl 1:16-22.