Zuhal KALAYCI ÇEKİN, Mustafa BEHÇET, Fatma AVCIOĞLU, Yusuf AFŞAR, Ersin ŞENTÜRK, Muhammet KURTOĞLU

Kan Kültürü Örneklerinden İzole Edilen Gram Negatif Bakterilerin Antibiyotik Direnç Profillerinin İncelenmesi

Amaç: Son yıllarda geniş spektrumlu antibiyotiklerin yaygın kullanımı nedeniyle çoklu ilaca dirençli bakterilerde meydana gelen artışlar dünya çapında acil bir sorun haline gelmiştir. Bu çalışmada kan kültürü örneklerinden izole edilen Gram negatif bakterilerin antimikrobiyal direnç paternlerinin saptanarak ampirik tedavi ve antibiyotik kullanım politikalarına katkıda bulunulması amaçlanmıştır. Gereç ve Yöntemler: Laboratuvarımıza Haziran 2018-Haziran 2021 tarihleri arasında gönderilen kan kültüründen izole edilen 495 Gram negatif bakteri izolatı retrospektif olarak incelenmiştir. Bakterilerin identifikasyonu için konvansiyonel yöntemler ve tam otomatize cihaz (VITEK2, bioMerieux, Fransa) kullanılmıştır. Tiplendirme sonrasında izolatların antibiyotik duyarlılık testleri, VITEK2 sistemi ile yapılmış, EUCAST (European Committee on Antimicrobial Susceptibility Testing) kriterlerine göre yorumlanmıştır. Bulgular: Gram negatif izolatlar, sıklıkla yoğun bakım servislerinden izole edilmiştir (%39). Gram negatif bakteriyemilerde saptanan etkenler sıklık sırasına göre; Escherichia coli %33,9, Klebsiella pneumoniae %19,1, Acinetobacter spp. %18,5, Pseudomonas spp. %10,3 ve Enterobacter spp. %4,6 bulunmuştur. E.coli’ de daha az direnç karbapenemlere (meropenem %0, imipenem %2,9 ve ertapenem %3,7) , tigesikline %1,8, ve amikasine karşı %2 saptanmıştır. Enterobacterales izolatlarında daha az direnç oranları sırasıyla karbapenemlere (%6,8-14,5) amikasine (%10,6) ve tigesikline (%15,9) karşı bulunmuştur. Pseudomonas spp.’de daha az direnç amikasine (%11,8) ve karbapenemlere (%13,7-22,7) karşı saptanmıştır. Sonuç: Karbapenemler, amikasin ve tigesiklin dışındaki bazı antibiyotiklere direnç oranlarının yüksek oranda saptanması, hastalara ampirik antibiyotik tedavinin dikkatli şekilde uygulanması gerektiğini göstermektedir. Bu sonuçların hastanemizde akılcı antibiyotik kullanımına ve ampirik tedavi seçimine katkı sağlayacağı kanaatindeyiz.

Anahtar Kelimeler:

Antibiyotik direnci, Kan Kültürü, Gram Negatif Bakteriler

Investigation of Antibiotic Resistance Profiles of Gram Negative Bacteria Isolated from Blood Culture Samples

Aim: Due to the widespread use of broad-spectrum antibiotics in recent years, the increase in multidrug resistant bacteria has become an urgent problem worldwide. In this study, it was aimed to determine the antimicrobial resistance patterns of Gram negative bacteria isolated from blood culture samples and to contribute to empirical treatment and antibiotic use policies. Material and Methods: 495 Gram negative bacteria isolates isolated from blood cultures sent to our laboratory between June 2018 and June 2021 were retrospectively analyzed. Traditional methods and a fully automated device (VITEK2, bioMerieux, France) were used for the identification of bacteria. After typing, antibiotic susceptibility tests of microorganisms were performed with the VITEK2 system, interpreted according to EUCAST (European Committee on Antimicrobial Susceptibility Testing) criteria. Results: Gram-negative isolates were frequently isolated from intensive care units (39%). In order of frequency, the agents detected in Gram-negative bacteremias were; Escherichia coli 33.9%, Klebsiella pneumoniae 19.1%, Acinetobacter spp. 18.5%, Pseudomonas spp. 10.3% and, Enterobacter spp. 4.6%. Less resistance was found in E.coli against carbapenems (meropenem 0%, imipenem 2.9% and ertapenem 3.7%), tigecycline 1.8%, and amikacin 2%. Less resistance rates in Enterobacterales isolated were found against carbapenems (6.8-14.5%), amikacin (10.6%) and tigecycline (15.9%),respectively. Less resistance was detected against amikacin (11.8%) and carbapenems (13.7-22.7%) in Pseudomonas spp. Conclusion: The high rates of resistance to some antibiotics other than carbapenems, amikacin and tigecycline indicate that empirical antibiotic therapy should be applied carefully to the patients. We are of the opinion that these results will contribute to the rational use of antibiotics and the choice of empirical treatment in our hospital.

Keywords:

Antibiotic resistance, Blood culture, Gram negative bacteria,

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