Tümer GÜVEN, Gülruhsar YILMAZ, Hatice Rahmet GÜNER, Ayşe Kaya KALEM, Fatma ESER, Mehmet Akın TAŞYARAN

Increasing resistance of nosocomial Acinetobacter baumannii: are we going to be defeated?

To investigate the change of the antibiotic resistance profiles of the nosocomial Acinetobacter baumannii isolates in intensive care units (ICUs) between the years 2008 and 2011. Materials and methods: A. baumannii isolates that were responsible for ICU-acquired nosocomial infections between 2008 and 2011 were included in the study. The susceptibility rates of the antibiotics that are mainly used in the treatment of Acinetobacter infections were compared by years. Clinical and Laboratory Standards Institute criteria were used to determine antimicrobial susceptibility. Results: There were 252 infection episodes detected in 229 hospitalized patients in the ICU that were caused by A. baumannii. Imipenem resistance was found as 98.9% in 2011 whereas it was 54% in 2008. A significant increase was observed for meropenem resistance from 2008 (73.5%) to 2011 (98.9%). Colistin resistance, confirmed by E-test, was found in 4 strains. The resistance rates of other antimicrobial agents were as follows: ampicillin/sulbactam 95.7% and 93.5%, cefoperazone/sulbactam 45.7% and 90.3%, netilmicin 41.7% and 53%, gentamicin 96% and 87.2%, and trimethoprim-sulfamethoxazole 91.7% and 72%, in 2008 and 2011, respectively. The resistance rate to tigecycline increased to 81.3% in 2011 from 12.5% in 2008. Conclusion: The increasing resistance rates to carbapenems and developing resistance to colistin are making the situation more serious and complicated.

Anahtar Kelimeler:

Key words: Acinetobacter, resistance, carbapenem, nosocomial

Increasing resistance of nosocomial Acinetobacter baumannii: are we going to be defeated?

Keywords:

Key words: Acinetobacter, resistance, carbapenem, nosocomial,

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Allen DM, Hartman BJ. Acinetobacter species. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, PA, USA: Churchill Livingstone; 2010.
Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections. Am J Infect Control 1988; 16: 128–140.
Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infection, 1992: a modification of CDC definition of surgical wound infections. Infect Control Hosp Epidemiol 1992; 13: 606–608.
Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008; 36: 309–332.
T.C. Sağlık Bakanlığı. Türkiye Hastane Enfeksiyonları Sürveyans Rehberi. Ankara, Turkey: T.C. Sağlık Bakanlığı; 2010 (report in Turkish; available online at http://hastaneenfeksiyonlari.saglik. gov.tr/dosya/rehber.pdf).
Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing. 15th Informational Supplement. M100–S15. Wayne, PA, USA: CLSI; 2005.
Kempf M, Djouhri-Bouktab L, Brunel JM, Raoult D, Rolain JM. Synergistic activity of sulbactam combined with colistin against colistin-resistant Acinetobacter baumannii. Int J Antimicrob Agents 2012; 39: 180–181.
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: 2070–2074.
Turner PJ. MYSTIC Europe 2007: activity of meropenem and other broad-spectrum agents against nosocomial isolates. Diagn Microbiol Infect Dis 2009; 63: 217–222.
Korten V, Ulusoy S, Zarakolu P, Mete B, Turkish MYSTIC Study Group. Antibiotic resistance surveillance over a 4-year period (2000–2003) in Turkey: results of the MYSTIC Program. Diagn Microbiol Infect Dis 2007; 59: 453–457.
Akıncı E, Mumcuoğlu İ, Öngürü P, Bayazıt FN, Ersoy Şen S, Erbay A, Balaban N, Bodur H. In vitro activity of tigecycline against Acinetobacter baumannii strains isolated from nosocomial infections. Turk J Med Sci 2008; 38: 583–586.
Alp E, Yerer M, Kocagöz S, Metan G, Esel D, Gürol Y, Doğanay M. The risk factors and spread of multidrug-resistant Acinetobacter baumannii in intubated patients in a medical intensive care unit. Turk J Med Sci 2009; 39: 761–769.
Dizbay M, Tozlu Keten D, Arman D. Nozokomiyal gramnegatif mikroorganizmalar: 10 yılda ne değişti? Flora 2010; 15: 105 –111 (article in Turkish).
Mansur A, Kuzucu Ç, Ersoy Y, Yetkin F. İnönü Üniversitesi Turgut Özal Tıp Merkezinde 2008 yılında yatan hastalardan izole edilen Acinetobacter suşlarının antibiyotik duyarlılıkları. Ankem Derg 2009; 23: 177 –181 (article in Turkish).
Özdemir M, Erayman I, Gündem NS, Baykan M, Baysal B. Hastane infeksiyonu etkeni Acinetobacter suşlarının çeşitli antibiyotiklere duyarlılıklarının araştırılması. Ankem Derg 2009; 23: 127–132 (article in Turkish).
Candevir A, Kurtaran B, Kibar F, Karakoç E, Aksu HSZ, Taşova Y. Invasive device-associated nosocomial infections of a teaching hospital in Turkey; four years’ experience. Turk J Med Sci 2011; 41: 137–147.
Kurtoğlu MG, Opuş A, Kaya M, Keşli R, Güzelant A, Yüksekkaya Ş. Bir Eğitim ve Araştırma Hastanesi’nde klinik örneklerden izole edilen Acinetobacter baumannii suşlarında antibakteriyel direnç (2008-2010). Ankem Derg 2011; 25: 35– 41 (article in Turkish).
Tasbakan MS, Pullukcu H, Sipahi OR, Tasbakan MI, Aydemir S, Bacakoglu F. Is tigecycline a good choice in the treatment of multidrug-resistant Acinetobacter baumannii pneumonia? J Chemother 2011; 23: 345–349.
Çevik S, Boşnak V, Namiduru N, Karaoğlan İ, Mete AÖ. Invasive device-associated hospital infection rates, etiological agents, and their antibiotic susceptibilities in the medical intensive care unit of a university hospital in Turkey. Turk J Med Sci 2013; 43: 33–38.
Maragakis LL, Perl TM. Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options. Clin Infect Dis 2008; 46: 1254–1263.
Wood GC, Hanes SD, Croce MA, Fabian TC, Boucher BA. Comparison of ampicillin-sulbactam and imipenem-cilastatin for the treatment of Acinetobacter ventilator-associated pneumonia. Clin Infect Dis 2002; 34: 1425–1430.
Levin AS, Levy CE, Manrique AE, Medeiros EA, Costa SF. Severe nosocomial infections with imipenem-resistant Acinetobacter baumannii treated with ampicillin/sulbactam. Int J Antimicrob Agents 2003; 21: 58–62.
Guner R, Hasanoglu I, Keske S, Kalem AK, Tasyaran MA. Outcomes in patients infected with carbapenem-resistant Acinetobacter baumannii and treated with tigecycline alone or in combination therapy. Infection 2011; 39: 515–8.
Aygencel G, Dizbay M, Çiftçi A, Türkoğlu M. Colistin-resistant Acinetobacter baumannii isolated from ventilator-associated pneumonia: a case report from Turkey. Yoğun Bakım Dergisi 2010; 9: 164–167.
Moffatt JH, Harper M, Harrison P, Hale JD, Vinogradov E, Seemann T, Henry R, Crane B, St Michael F, Cox AD et al. Colistin resistance in Acinetobacter baumannii is mediated by complete loss of lipopolysaccharide production. Antimicrob Agents Chemother 2010; 54: 4971–4977.
Rolain JM, Roch A, Castanier M, Papazian L, Raoult D. Acinetobacter baumannii resistant to colistin with impaired virulence: a case report from France. J Infect Dis 2011; 204: 1146–1147.
Rodriguez CH, Bombicino K, Granados G, Nastro M, Vay C, Famiglietti A. Selection of colistin-resistant Acinetobacter baumannii isolates in postneurosurgical meningitis in an intensive care unit with high presence of heteroresistance to colistin. Diagn Microbiol Infect Dis 2009; 65: 188–191.
Lopez-Rojas R, Jimenez-Mejias ME, Lepe JA, Pachon J. Acinetobacter baumannii resistant to colistin alters its antibiotic resistance profile: a case report from Spain. J Infect Dis 2011; 204: 1147–1148.
Al-Sweih NA, Al-Hubail MA, Rotimi VO. Emergence of tigecycline and colistin resistance in Acinetobacter species isolated from patients in Kuwait hospitals. J Chemother 2011; 23: 13–16.
Taneja N, Singh G, Singh M, Sharma M. Emergence of tigecycline & colistin resistant Acinetobacter baumannii in patients with complicated urinary tract infections in north India. Indian J Med Res 2011; 133: 681–684.