‹drar Kültürlerinden Soyutlanan Genifllemifl Spektrumlu Beta-Laktamaz Üreten Escherichia coli Kökenlerinin Fosfomisin, Siprofloksasin, Amikasin ve Trimetoprim-Sulfametoksazol’e Duyarl›l›klar›

Amaç: Özellikle genifllemifl spektrumlu beta-laktamaz (GSBL) üreten Escherichia coli kökenlerinin nedenoldu¤u üriner sistem enfeksiyonlar›n›n tedavisi oldukça güç, mortalite ve morbiditesi de yüksektir. Buenfeksiyonlar genellikle karbapenemlerle tedavi edilmekte ve yüksek tedavi maliyeti görülmektedir.Çal›flmam›zda idrar kültürlerinden soyutlanan GSBL üreten E. coli kökenlerinin fosfomisin, siprofloksasin,amikasin ve trimethoprim-sülfametoksazole duyarl›l›¤›n›n araflt›r›lmas› ve bölgemizdeki üriner sistemenfeksiyonlar›ndan soyutlanan bu kökenlerin genel direnç durumunun belirlenmesi amaçlanm›flt›r.Yöntem ve Gereç: Ocak 2005-Aral›k 2005 tarihleri aras›nda bakteriyoloji laboratuvar›m›za gönderilmifl olanüriner sistem enfeksiyonlar›ndan soyutlanan GSBL üreten kökenler prospektif olarak çal›flmaya al›nm›flt›r.GSBL üretimi çift disk sinerji testi ile belirlenmifltir. GSBL üreten sufllar›n antibiyotik duyarl›l›k testleri “Clinicaland Laboratory Standards Institute (CLSI)” kriterlerine göre disk diffüzyon yöntemiyle yap›lm›flt›r. Kontrolkökeni olarak E. coli ATCC 35218 ve ATCC 25922 kullan›lm›flt›r. Nozokomiyal üriner sistem enfeksiyonu tan›s›Centers of Disease Control and Prevention kriterlerine gore de¤erlendirilmifltir. Veriler SPSS11,0 paketprogram› kullan›larak de¤erlendirilmifltir.Bulgular: 2005 y›l›nda laboratuvar›m›zda soyutlanan 344 GSBL üreten E. coli kökeni (241 nozokomiyal köken, 103 poliklinikhastalar›ndan soyutlanan köken) çal›flmaya dahil edilmifltir. Direnç oranlar› fosfomisin için % 3,5, siprofloksasin için % 76,5,amikasin için % 11 ve trimetoprimsülfametoksazol için % 74.4’tür. Hastane kaynakl› kökenlerde direnç oranlar› s›ras›yla % 4,1, %81,3, % 11,2, % 71 iken poliklinik hastalar›ndan soyutlanan kökenlerde % 1,9, % 65, % 10,7, % 82,5’tur. Siprofloksasin vetrimethoprim-sülfametoksazol için iki grup aras›nda istatistiksel olarak fark vard›r.Sonuç: Ülkemizdeki antibiyotik direnç oranlar›n›n yüksek olmas› nedeniyle, fosfomisin ve amikasinin GSBL üreten E. coli’nin nedenoldu¤u komplike olmayan üriner sistem enfeksiyonlar›n›n tedavisinde ilk seçenekler aras›nda oldu¤unu düflünmekteyiz.

Anahtar Kelimeler:

Üriner sistem enfeksiyonu, GSBL, Escherichia coli, fosfomisin

Susceptibility of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli Urine Isolates to Fosfomycin, Ciprofloxacin, Amikacin and Trimethoprim-Sulfamethoxazole

Aim: Urinary tract infections (UTIs) caused in particular by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli strains are related with high morbidity and mortality, and treatment is quite difficult. These infections generally are treated by carbapenems, and their costs are high. We aimed in this study to investigate the susceptibilities of ESBL-producing E. coli strains isolated from urine cultures to fosfomycin, ciprofloxacin, amikacin and trimethoprim-sulfamethoxazole and to determine the general resistance profile in our region of these strains isolated from UTIs. Materials and Methods: Between January 2005-December 2005, ESBL-producing E. coli strains isolated from urine samples sent from various outpatient and inpatient clinics to the Bacteriology Laboratory of the Department of Microbiology and Clinical Microbiology were included prospectively in the study. ESBL production was detected using the double disk synergy test. Antibiotic susceptibility testing was performed for ESBL-producing isolates by disk diffusion test according to Clinical and Laboratory Standards Institute (CLSI) criteria. Escherichia coli ATCC 35218 and ATCC 25922 were used as control strains. The diagnosis of nosocomial UTIs was established according to the Centers for Disease Control and Prevention criteria. The data were assessed using the SPSS 11.0 packet program. Results: A total of 344 ESBL-producing E. coli isolates (241 nosocomial isolates; 103 outpatient isolates) were included in the study. The rates of resistance were 3.5% for fosfomycin, 76.5% for ciprofloxacin, 11% for amikacin, and 74.4% for trimethoprim-sulfamethoxazole. While resistance rates of nosocomial strains were 4.1%, 81.3%, 11.2%, and 71%, respectively, resistance rates of the strains isolated from outpatients were 1.9%, 65%, 10.7%, and 82.5%, respectively. There were statistically significant differences between the two groups for ciprofloxacin and trimethoprim-sulfamethoxazole. Conclusions: Because of the high antibiotic resistance rates in our country, we think that fosfomycin and amikacin may have priority in the treatment of non-complicated UTIs caused by ESBL-producing E. coli strains due to ease of use and high concentration in the urine.

Keywords:

Urinary tract infections, ESBL, Escherichia coli, fosfomycin,

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