2017-2021 Yılları Arasında Bir Devlet Hastanesinde Erişkin Hastalardan İzole Edilen Acinetobacter spp. Antimikrobiyal Direnç Oranları

Amaç: Acinetobacter türleri, özellikle hastanede yatan hastalarda ve konak savunması bozulmuş hastalarda son derece ciddi enfeksiyonlara yol açmaktadır. Son yıllarda tespit edilen birçok antibiyotiğe karşı yüksek direnç oranları, farklı hastalıkların tedavisinde ciddi sorunlar yaratmıştır. Polikliniklerde ayaktan tedavi edilen veya servislerde veya yoğun bakım ünitelerinde (YBÜ) yatan hastalardan izole edilen Acinetobacter türlerinin çeşitli antimikrobiyal tedavilere karşı antibiyotik direnç profillerini incelemeyi amaçladık. Gereç ve Yöntem: Bandırma Devlet Hastanesi Klinik Mikrobiyoloji Laboratuvarında 2017-2021 yılları arasında toplanan 533 klinik örnekten izole edilen Acinetobacter suşlarının antibiyotik direnci retrospektif olarak değerlendirildi. İzolatların tanımlanması ve antibiyotik duyarlılık testleri BD Phoenix (Becton Dickinson, ABD) otomatik sistemi ile yapıldı. Sonuçlar:Acinetobacter suşlarının çoğu solunum salgılarından (%32.5) ve idrardan (%24.4) izole edilmiştir. Türlerin %63.8'i Acinetobacter baumannii, %34.9'u Acinetobacter baumannii kompleksi, %1.1'i diğer Acinetobacter spp., %0.2'si Acinetobacter lwoffii'dir. Antibiyotiklere direnç oranları şu şekilde bulundu: Siprofloksasin %91,1, meropenem %91,3, imipenem %89,2, gentamisin %82,5, trimetoprim-sülfametaksasol %78,6, amikasin %66,3 (2020'de en yüksek), aztreonam %99,0 (2020'de önemli ölçüde azaldı), seftriakson %100, ampisilin %100, amoksisilin-klavulanat %100, ertapenemisin %100, sefuroksim %100, netilmisin %62.5, nitrofurantion %100, kolistin %4.7 ve levofloksasin %87.1. Serviste ve yoğun bakım ünitesinde yatan hastalardan alınan örneklerde Siprofloksasin, Levofloksasin, Meropenem, İmipenem'e karşı daha dirençli bulundu. Sonuç: Acinetobacter enfeksiyonlarına karşı kolistin direncinin düşük olduğu gözlenmiş, bu nedenle tedavilerde kolistinden yararlanılabilir. Servislerde ve yoğun bakım ünitelerinde enfeksiyon kontrol önlemleri alınmalı ve enfeksiyonun yayılmasını önlemek için akılcı antibiyotik kullanım politikaları uygulanmalıdır.

Anahtar Kelimeler:

acinetobacter, acinetobacter baumanii, hastane enfeksiyonu

Antimicrobial Resistance Rates of Acinetobacter spp. Isolated from Adult Patients in a State Hospital Between 2017-2021

Objective: Acinetobacter species lead to extremely serious infections, particularly in hospitalized patients, and in patients with impaired host defense. The high rates of resistance against several antibiotics detected in recent years have created serious issues in treatments of different diseases. We aimed to examine antibiotic resistance profiles of Acinetobacter species isolated from patients who are treated as outpatients in polyclinics or hospitalized in services or intensive care units (ICU), against various antimicrobial therapies. Materials and Methods: Antibiotic resistance of Acinetobacter strains isolated from 533 clinical samples collected between 2017-2021 years in Bandırma State Hospital Clinical Microbiology Laboratory were evaluated retrospectively. The identification of isolates and antibiotic susceptibility tests were performed by BD Phoenix (Becton Dickinson, USA) automated system. Results: Most of Acinetobacter strains were isolated from respiratory secretions (32.5%) and from urine (24.4%). Of species, 63.8% were Acinetobacter baumannii, 34.9% Acinetobacter baumannii complex, 1.1% other Acinetobacter spp., 0.2% Acinetobacter lwoffii. Resistance rates to antibiotics were found as following: ciprofloxacin 91.1%, meropenem 91.3%, imipenem 89.2%, gentamicin 82.5%, trimethoprim-sulfamethaxasol 78.6%, amikacin 66.3% (highest in 2020), aztreonam 99.0% (significantly decreased in 2020), ceftriaxone 100%, ampicillin 100%, amoxicillin-clavulanate 100%, ertapenemicin 100%, cefuroxime 100%, netilmicin 62.5%, nitrofurantion 100%, colistin 4.7% and levofloxacin 87.1%. The samples collected from patients hospitalized in service and ICU were found more resistant against Ciprofloxacin, Levofloxacin, Meropenem, Imipenem, Trimethoprim/Sulfamethoxazole, Gentamicin and Amikacin (P<0.0001). Conclusion: Colistin resistance against Acinetobacter infections was observed to be low, hence colistin could be utilized in treatments. Infection control measures have to be taken in services and ICU, and rational antibiotic use policies should be applied so as to prevent the spread of infection.

Keywords:

acinetobacter, acinetobacter baumanii, nosocomial enfection,

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