Samsun Bafra Devlet Hastanesi yoğun bakım ünitelerinde endotrakeal aspirat kültüründe üreyen Acinetobacter baumannii suşları ve COVID-19 etkisi (2019-2020)

Amaç: Acinetobacter baumannii, hastane ortamında uzun süre yaşama yeteneğine sahip ventilasyon ile ilişkili pnömoninin önemli bir etkenidir. Bu patojene etkili olan antibiyotiklere karşı artan direnç endişe yaratmaktadır. Bu çalışmada yoğun bakım ünitelerinde endotrekeal aspirat (ETA) kültürlerinde üreyen A. baumannii suşlarının antibiyotik direnç profilleri ve uzun süre ülkemizde en çok vakanın görüldüğü ilimizde COVID-19 pandemisinin direnç profilleri üzerindeki etkisi incelenmiştir. Yöntem: Çalışmamıza, Ocak 2019 ile Aralık 2020 tarihleri arasında Bafra Devlet Hastanesi yoğun bakım ünitelerinden laboratuvarımıza gönderilen ETA örneklerinden izole edilen toplam 74 adet A. baumannii izolatı dahil edilmiştir. Konvansiyonel yöntemler ve yarı otomatik bakteri tanımlama sistemi Vitek-2 (bioMérieux, Fransa) kullanılarak izole edilen A. baumannii suşlarının antibiyotik duyarlılıkları Avrupa Antimikribiyal Duyarlılık Test Komitesi - European Committee on Antimicrobial Susceptibility Testing (EUCAST) standartlarına uygun olarak Vitek-2 sistemi ile test edilmiştir. Bulgular: COVID-19 pandemisi öncesinde 18 hasta ile pandemi döneminde 56 hastanın ortalama yaş ve standart sapmaları sırasıyla 83,0 ± 8,3 ve 70,5 ± 14,9 (p

Acinetobacter baumannii strains grown in endotracheal aspirate culture in Samsun Bafra State Hospital intensive care units and the effect of COVID-19 on Acinetobacter baumannii strains (2019-2020)

Objective: Acinetobacter baumannii is an important causative agent of ventilation-associated pneumonia capable of long-term survival in the hospital setting. Increasing resistance to antibiotics effective against this pathogen is of concern. In this study, the antibiotic resistance profiles of A. baumannii strains grown in endotracheal aspirate (ETA) cultures in intensive care units and the effect of the COVID-19 pandemic on the resistance profiles in our province where the highest number of cases were observed in our country for a long time were investigated. Methods: Our study included 74 A. baumannii isolates isolated from ETA samples that was sent to our laboratory from the intensive care units of Bafra State Hospital between January 2019 and December 2020. Bacteria were identified using conventional methods and a semi automatic bacterial identification system Vitek-2 (bioMérieux, France). The antibiotic susceptibility tests of the isolated strains were studied in accordance with the European Committee for Antimicrobial Susceptibility Testing (EUCAST) standards. Antibiotic susceptibility of A. baumannii strains was tested with Vitek-2 system. Results: The mean age and standard deviations of 18 patients before the COVID-19 pandemic and 56 patients after the pandemic were found to be 83,0 ± 8,3 and 70,5 ± 14,9 (p

PDF

___

1. McConnell MJ, Actis L, Pachón J. Acinetobacter baumannii: human infections, factors contributing to pathogenesis and animal models. FEMS Microbiol Rev, 2013;37(2):130-55.
2. Antimicrobial resistance global report on surveillance: 2014 Summary. Access date: 20.04.2021. Avaible from: https://www.who.int/ drugresistance/documents/surveillancereport /en/.
3. Emel A, Eraç B. Küresel bir tehdit: Acinetobacter baumannii enfeksiyonları, antimikrobiyal dirençte güncel durum ve alternatif tedavi yaklaşımları. Turk Hij Den Biyol Derg, 2020;77(3): 367-78.
4. Bacakoğlu F, Korkmaz Ekren P, Taşbakan MS, Başarik B, Pullukçu H, Aydemir S, ve ark. Solunumsal yoğun bakim ünitesinde çoklu antibiyotik dirençli Acinetobacter baumannii enfeksiyonu. Mikrobiyol Bul, 2009 Oct;43(4):575-85.
5. Piperaki E-T, Tzouvelekis L, Miriagou V, Daikos G. Carbapenem-resistant Acinetobacter baumannii: in pursuit of an effective treatment. Clin Microbiol Infect, 2019;25(8):951-7.
6. Jung J, Park W. Acinetobacter species as model microorganisms in environmental microbiology: current state and perspectives. Appl Microbiol Biotechnol, 2015;99(6):2533-48.
7. Peleg AY, Seifert H, Paterson DL. Acinetobacter baumannii: emergence of a successful pathogen. Clin Microbiol Rev, 2008;21(3):538-82.
8. Mirzaei R, Goodarzi P, Asadi M, Soltani A, Aljanabi HAA, Jeda AS, et al. Bacterial co infections with SARS CoV 2. IUBMB life, 2020;72(10):2097-111.
9. Möhlenkamp S, Thiele H. Ventilation of COVID-19 patients in intensive care units. Herz, 2020;45(4):329-31.
10. Zu ZY, Jiang MD, Xu PP, Chen W, Ni QQ, Lu GM, et al. Coronavirus disease 2019 (COVID-19): a perspective from China. Radiology, 2020;296(2):E15-E25.
11. Russotto V, Cortegiani A, Graziano G, Saporito L, Raineri SM, Mammina C, et al. Bloodstream infections in intensive care unit patients: distribution and antibiotic resistance of bacteria. Infect Drug Resist, 2015;8:287-96.
12. Garnacho-Montero J, Timsit J-F. Managing Acinetobacter baumannii infections. Curr Opin Infect Dis, 2019;32(1):69-76.
13. Sharifipour E, Shams S, Esmkhani M, Khodadadi J, Fotouhi-Ardakani R, Koohpaei A, et al. Evaluation of bacterial co-infections of the respiratory tract in COVID-19 patients admitted to ICU. BMC Infect Dis, 2020;20(1):1-7.
14. Antimicrobial resistance surveillance in Europe. European Centre for Disease Prevention and Control 2013; Access date: 20.04.2021[Available from:https://www.ecdc.europa.eu/sites/ d e f a u l t / f i l e s / m e d i a / e n / p u b l i c a t i o n s / P u b l i c a t i o n s / a n t i m i c r o b i a l - r e s i s t a n c e - surveillance-europe-2013.pdf.
15. Carbapenem-ResistantAcinetobacter. Access date: 20.04.2021. Avaible from: https://www. cdc.gov/drugresistance/pdf/threats-report/ acinetobacter-508.pdf.
16. Wong D, Nielsen TB, Bonomo RA, Pantapalangkoor P, Luna B, Spellberg B. Clinical and pathophysiological overview of Acinetobacter infections: a century of challenges. Clin Microbiol Rev, 2017;30(1):409-47.
17. Boral B, Unaldi Ö, Ergin A, Durmaz R, Eser ÖK. A prospective multicenter study on the evaluation of antimicrobial resistance and molecular epidemiology of multidrug-resistant Acinetobacter baumannii infections in intensive care units with clinical and environmental features. Ann Clin Microbiol Antimicrob, 2019; 18(1):1-9 https://doi. org/10.1186/s12941-019-0319-8.
18. Zarkotou O, Pournaras S, Altouvas G, Pitiriga V, Tziraki M, Mamali V, et al. Comparative evaluation of tigecycline susceptibility testing methods for expanded-spectrum cephalosporin-and carbapenem-resistant Gram-negative pathogens. J Clin Microbiol, 2012;50(11):3747-50.
19. Tacconelli E, Carrara E, Savoldi A, Harbarth S, Mendelson M, Monnet DL, et al. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. Lancet Infect Dis, 2018;18(3):318-27.
20. Şimşek M, Demir C. Determination of Colistin and Tigecycline Resistance Profile of Acinetobacter Baumannii Strains from Different Clinical Samples in a Territory Hospital in Turkey. J Health Sci Med Res, 2020;38(2):81-91.
21. Çalışkan A, Kırışcı Ö. Bir devlet hastanesinde 2013- 2018 döneminde Acinetobacter enfeksiyonlarında antibiyotik duyarlılığı ve çoğul antibiyotik direnci. Turk Hij Den Biyol Derg, 2020;77(4): 487-92.
22. Sharifipour E, Shams S, Esmkhani M, Khodadadi J, Fotouhi-Ardakani R, Koohpaei A, et al. Evaluation of bacterial co-infections of the respiratory tract in COVID-19 patients admitted to ICU. BMC Infect Dis, 2020; 20: 646. Published online 2020 Sep 1.
23. Sağmak-Tartar A, Özer AB, Ulu R, Akbulut A. Endotrakeal aspirat örneklerinden izole edilen bakteriler ve antibiyotik duyarlılıkları: Bir yıllık retrospektif analiz. Klimik Derg, 2018;31(1):56- 60.
24. Gozutok F, Sariguzel F, Celik I, Berk E, Aydin B, Guzel D. Investigation of antimicrobial resistance rates of Acinetobacter baumannii strains from nosocomial infections. Ankem Derg, 2013;27(1):7- 12.
25. Eroğlu C, Ünal N, Karadağ A, Yılmaz H, Acuner İÇ, Günaydın M. Acinetobacter species isolated from various clinical specimens between 2006-2011 years and their susceptibilities against antibiotics. Turk Hij Den Biyol Derg, 2016;73(1):25-32.
26. Karsligil T, Balci I, Zer Y. Antibacterial sensitivity of Acinetobacter strains isolated from nosocomial infections. J Int Med Res, 2004;32(4):436-43.
27. Poirel L, Nordmann P. Carbapenem resistance in Acinetobacter baumannii: mechanisms and epidemiology. Clin Microbiol Infect, 2006;12(9):826-36.
28. Aydemir Ö, Demiray T, Köroğlu M, Aydemir Y, Karabay O, Altindiş M. Yoğun bakım ünitelerinde yatan hastaların endotrakeal aspirat örneklerinden izole edilen bakterilerin tanımlanması ve antibiyotik duyarlılıkları. Online Türk Sağlık Bilimleri Dergisi, 2016;1(4):1-8.
29. Şirin MC, Ağuş N, Yılmaz N, Bayram A, Yılmaz Hancı S, Şamlıoğlu P, et al. Yoğun bakım ünitelerinde yatan hastaların kan kültürlerinden izole edilen mikroorganizmalar ve antibiyotik duyarlılıkları. Turk Hij Den Biyol Derg, 2017;74(4):269-78.
30. Gales AC, Jones RN, Sader HS. Contemporary activity of colistin and polymyxin B against a worldwide collection of Gram-negative pathogens: results from the SENTRY Antimicrobial Surveillance Program (2006–09). J Antimicrob Chemother, 2011;66(9):2070-4.
31. Lob SH, Hoban DJ, Sahm DF, Badal RE. Regional differences and trends in antimicrobial susceptibility of Acinetobacter baumannii. Int J Antimicrob Agents, 2016;47(4):317-23.
32. Eliopoulos GM, Maragakis LL, Perl TM. Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options. Clin Infect Dis, 2008;46(8):1254-63.
33. Şahin AR, Doğruer D, Nazik S, Aktemur A, Öksüz H, Murat A, et al. Hastane kökenli patojenlerde artan antimikrobiyal direnç sorunu: Acinetobacter baumannii. Online Türk Sağlık Bilimleri Dergisi, 2019;4(2):156-69.
34. Hekimoğlu C. BE, Meşe E. Ulusal Sağlik Hizmeti İlişkili Enfeksiyonlar Sürveyans Aği Özet Raporu 2019. Erişim tarihi: 20.04.2021. Erişim adresi: https://www.researchgate.net/ publication/342282560.
35. Gottesman T, Fedorowsky R, Yerushalmi R, Lellouche J, Nutman A. An outbreak of carbapenem-resistant Acinetobacter baumannii in a COVID-19 dedicated hospital. J Infect Prev, 2021 Mar; 3(1): 100113. Published online 2021 Jan 9.
36. McDonald LC. Trends in antimicrobial resistance in health care–associated pathogens and effect on treatment. Clin. Infect. Dis, 2006;42(Supplement_2):S65-S71.
37. Chung DR, Song J-H, Kim SH, Thamlikitkul V, Huang S-G, Wang H, et al. High prevalence of multidrug-resistant nonfermenters in hospitalacquired pneumonia in Asia. Am J Respir Crit Care Med, 2011;184(12):1409-17.
38. Kengkla K, Kongpakwattana K, Saokaew S, Apisarnthanarak A, Chaiyakunapruk N. Comparative efficacy and safety of treatment options for MDR and XDR Acinetobacter baumannii infections: a systematic review and network metaanalysis. J Antimicrob Chemother, 2018;73(1):22- 32.
39. Yadav R, Landersdorfer CB, Nation RL, Boyce JD, Bulitta JB. Novel approach to optimize synergistic carbapenem-aminoglycoside combinations against carbapenem-resistant Acinetobacter baumannii. Antimicrob Agents Chemother, 2015;59(4):2286- 98.
40. Kofteridis DP, Andrianaki AM, Maraki S, Mathioudaki A, Plataki M, Alexopoulou C, et al. Treatment pattern, prognostic factors, and outcome in patients with infection due to pan-drug-resistant gram-negative bacteria. Eur J Clin Microbiol Infect Dis, 2020 May;39(5):965-70.
41. Alhaddad MS, AlBarjas AK, Alhammar LE, Al Rashed AS, Badger-Emeka LI. Molecular characterization and antibiotic susceptibility pattern of Acinetobacter baumannii isolated in intensive care unit patients in Al-Hassa, Kingdom of Saudi Arabia. International Int J Appl Basic Med Res, Jan-Mar 2018;8(1):19-23.