Geniş Spektrumlu β-laktamaz Üreten Escherichia coli'ye Karşı Dört Farklı Antibiyotiğin In Vitro Etkinliği

AMAÇ: Özellikle, geniş spektrum ß-laktamaz (GSBL) üreten Escherichia coli suşlarının sebep olduğu idrar yolları enfeksiyonları giderek artan bir sıklıkta görülmekte ve tedavi yetersizlikleriyle birlikte komplikasyonlara yol açabilmektedir. GSBL üreten mikroorganizma için risk faktörlerine sahip hastalarda, uygun ampirik tedavi seçimi oluşabilecek komplikasyonların önlenmesinde önemlidir. Bu çalışmada; idrar kültürlerinden izole edilen GSBL üreten E. coli suşlarının tigesiklin, ertapenem, cefoperazone + sulbactam (sulperazon) ve levofloksasin antibiyotiklerine karşı MİK (minimum inhibisyon konsantrasyonu) düzeylerinin araştırılması amaçlanmıştır. YÖNTEMLER: 2010 yılında, TOBB ETÜ Hastanesi Klinik Mikrobiyoloji Laboratuvarında idrar örneklerinden izole edilen 87 GSBL üreten E. coli suşu konvansiyonel yöntemler ile tanımlanmıştır. Antibiyotik duyarlılık testleri Vitek-32 (BioMerieux, France) kullanılarak araştırılmıştır. Bu suşların GSBL üretimi çift disk sinerji testi ile doğrulanmıştır. Tanımlanmış olan GSBL üreten E.coli suşlarının antibiyotiklere karşı MİK (minimum inhibisyon konsantrasyonu) düzeyleri ve duyarlılıkları E- Test kullanılarak araştırılmıştır. BULGULAR: GSBL üreten E. coli suşlarında levofloksasinin MİK aralığı 0,01- >32 μg/ml ve sulperazon MİK aralığı 0,190-128 μg/ml olarak belirlenmiştir. Her iki antibiyotiğin MİK50 ve MİK90 değerleri sırası ile GSBL üreten E. coli suşlarında levofloksasinin MİK aralığı 0,01- >32 μg/ml ve sulperazon MİK aralığı 0,190-128μg/ml olarak belirlenmiştir. Her iki antibiyotiğin MİK50 ve MİK90 değerleri sırası ile 12, ≥32, 12, 32 μg/ml bulunmuştur. Tigesiklin için MİK aralığının 0,190-25 μg/ml ve MİK50 ve MİK90 değerlerinin sırası ile 0,50 ve 1 μg/ml; ertapenem için MİK aralığının 0,004-0,75 μg/ml ve MİK50 ve MİK90 değerlerinin sırası ile 0,047 ve 0,250 μg/ml olduğu saptanmıştır. Çalışmamızda; ertapeneme karşı direnç saptamazken tigesiklinde %1,15, sulperazonda %10,3 direnç ve %18,4 intermediate MİK düzeyi saptarken, levofloksasinde %24 duyarlı ve %76 dirençli belirlenmiştir. SONUÇ: Levofloksasinde saptanan %75,9luk direnç oranı nedeniyle özellikle GSBL üreten suşlarla enfeksiyon gelişme riski yüksek hastalarda amprik tedavi seçiminde kinolonların tercih edilmemesi uygun olacaktır. Bu suşların tedavisinde ertapenem ve tigesiklin etkin seçenekler olarak görülmüştür. Sulperazon da saptanan %10,3 direnç ve %18,4 intermediate MİK değerleri nedeniyle uygun hastalarda duyarlılık sonuçlarına göre tercih edilebilir. GSBL üreten E. coli suşlarla oluşan enfeksiyonlarda bu enfeksiyonlara ait risk faktörleri taşıyan hastalara uygun ve etkili amprik tedavi başlanması oluşabilecek komplikasyonların önlenmesi açısından önem taşımaktadır.

In vitro activity of four different antibiotics against extended-spectrum β-lactamase producing Escherichia coli

OBJECTIVE: Urinary tract infections due to wide spectrum ß-lactamase (GSBL) producing Escherichia coli strains are especially seen with increasing prevalence and may lead to complications with treatment insufficiencies. In patients having risk factors for GSBL producing microorganism, the selection of an appropriate ampirical treatment is important in preventing the complications that may be seen. In this study, MIC (minimum inhibition concentration) values of GSBL producing E. coli strains obtained from urine cultures, against tigecyclin, ertapenem, cefoperazone+ sulbactam (sulperazon) and levofloxacin antibiotics were aimed to be investigated. METHODS: In 2010, 87 GSBL producing E. coli strains isolated from urine cultures in TOBB ETÜ Hospital Clinical Microbiology Laboratory were identified with conventional methods. Antibiotic sensitivity tests were investigated by using Vitek-32 (BioMerieux, France). GBSL production of these strains was confirmed by double disc synergy test. Identified GSBL producing E.coli strains MIC levels and sensitivities against antibiotics were investigated by using E- Test. RESULTS: In GSBL producing E.coli strains, MIC of levofloxacin range of 0,01- >32 μg/ml and MIC range of sulperazon were found to be MIC range 0.190-128 μg/ml. MIC50 and MIC90 values of both antibiotics were found to be 12, ≥32, 12, 32 μg/ml. MIC range of tigecycline was found to be 0.190-25 μg/ml and MIC50 and MIC90 values were found to be 0.50-1 μg/ ml, respectively. MIC range of ertapenem was found to be 0,004-0,75 μg/ml and MIC50 and MIC90 values were found to be 0.047-0.250 μg/ml, respectively. In our study, while no resistance against ertapenem was found, 1.15% resistance in tigecycline, 10.3% resistance and 18.4% intermediate MIC level was found in sulperazon, and also 24.1% sensitive and 75.9% resistant strains were determined in levofloxacin. CONCLUSION: Due to the 75.9% resistivity ration detected in levofloxacin; for patients especially at risk for infection development with GSBL producing strains, it will be appropriate not to prefer quinolons for empirical treatment selection. In the treatment of these strains, ertapenem and tigecycline are seen as active choices. Due to 10.3% resistance and 18.4% intermediate MIC value detected in sulperazon, it may be preferred in appropriate patients according to sensitivity results. In infections caused by GSBL producing E. coli strains; initiation of appropriate and effective empirical treatment to the patients with risk factors belonging to these infections is important in regard to prevent the complications that may form.

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