ABSTRACT

Objective:

Resistant gram-negative bacterial infections that cause hospital-acquired infections are becoming increasingly problematic. Due to the carbapenem resistance that develops in these bacteria, treatment options are restricted, the duration of hospitalization is longer and the mortality increases. This requires the addition of options such as tigecycline and colistin to treatment. The aim of this study is to determine the susceptibility of gram-negative bacteria isolated from various clinical specimens in a private hospital and to determine the appropriate antibiotics in patients.

Methods:

In our study, 1109 bacterial strains which were produced in various clinical samples were examined in Private Kadıköy Florence Nightingale Hospital between February 2018 and February 2019. Bacteria in the samples are defined in accordance with the recommendations of the manufacturer of the conventional methods, Vitec 2 (Biomeriux, France) automated system. Sensitivity tests were performed by Vitec 2 (Biomeriux, France) automated system and interpreted according to EUCAST criteria. The data were retrospectively evaluated.

Results:

The most common samples of the study were blood and urine. The most effective antibiotics for Escherichia coli (50.9%), based on the type and sensibility of the identified bacterides, were meropenem (99.6%), imipenem (99.2%), fosfomycin (98.5%), amikacin (96.7%), colistin (98.3%), tigecycline (96.7%). Klebsiella spp. the most effective antibiotics were amikacin (95.2%) and meropenem (92.6%), imipenem (92%), colistin (95.8%) and tigecycline (96.7%). The most effective antibiotics for Proteus spp. were meropenem (95.7%), piperacillin/tazobactam (95.7%) and phosphomycin (91.2%). The sensitivity of tigecycline was found to be 15.4%. The most effective antibiotics for Enterobacter spp. were imipenem (100%), amikacin (100%) and ciprofloxacin (93.1%). The most effective antibiotics for Pseudomonas aeruginosa were amikacin (80.3%), ciprofloxacin (77.4%), colistin (94.7%) was determined.

Conclusion:

Each center is supposed to know the distribution of gram-negative bacteria, resistance patterns and changes in years, isolated from their own clinical samples. In order to prevent hospital infections and antibiotics, there must be an antibiotic management plan under the responsibility of the infection control committee that is applied by the hospital.

Keywords: Clinical samples, gram-negative bacteria, antibiotic susceptibility

References

Clark NM, Patterson J, Lynch P. Antimicrobial resistance among Gram-negative organisms in the intensive care unit. Curr Opin Crit Care 2003;9:413-23.

Gür D. Hastane infeksiyonları ve antimikrobiyal ilaçlara çoğul dirençli Gram-negatif bakteriler. Hastane İnfeksiyonları Dergisi 2000;4:218-21.

Özmen E, Geyik MF, Uluğ M, Çelen MK, Hoşoğlu S, Ayaz C. Yatan Hastalardan İzole Edilen Gram Negatif Bakteriler ve Antibiyotik Dirençlerinin Değerlendirilmesi. Düzce Tıp Dergisi 2010;12:32-9.

Çakır N. Gram-negatif etkili antibakteriyel ajanlar ve klinik kullanımları. In Ulusoy S, Leblebicioğlu H, Arman D (editörler). Önemli ve Sorunlu Gram Negatif Bakteri İnfeksiyonları. Ankara: Bilimsel Tıp Yayınevi 2004;387-461.

Özkurt Z, Erol S, Kadanali A, Ertek M, Ozden K, Tasyaran MA. Changes in antibiotic use, cost and consumption after and antibiotic restriction policiy applied by infectious disease specialists. Jpn J Infect Dis 2005;58:338-43.

Erbay A, Colpan A, Bodur H, Cevik MA, Samore MH, Ergönül O. Evaluation of antibiotic use in a hospital with an antibiotic restriction policy. Int J Antimicrob Agents 2003;21:308-12.

Walker B, Barrett S, Polasky S, Galaz V, Folke C, Engström G, et al. Environment. Looming global-scale failures and missing institutions. Science 2009;325:1345-6.

Ni W, Li Y, Guan J, Zhao J, Cui J, Wang R, Liu Y. Inhibitors on Colistin Resistance in Multidrug-Resistant Gram-Negative Bacteria. Antimicrob Agents Chemother 2016;60:3215-8.

Petrosillo N, Giannella M, Antonelli M, Antonini M, Barsic B, Belancic L, et al. Clinical experience of colistin-glycopeptide combination in critically ill patients infected with Gram-negative bacteria. Antimicrob Agents Chemother 2014;58:851-8.

Sümerkan B. Gram negatif bakterilerde antibiyotik duyarlılık testleri ve sonuçların yorumu. In Ulusoy S, Leblebicioğlu H, Arman D (editörler). Önemli ve Sorunlu Gram Negatif Bakteri İnfeksiyonları. Ankara: Bilimsel Tıp Yayınevi 2004;387-461.

Arman D. Türkiye’de hastane infeksiyonu kontrolüne yönelik çalışmalar. Hastane İnfeksiyonları Dergisi 1997;1:44-52.

European Commitee on Antimicrobial Susceptibility Testing. Breakpoint Tables for Interpretation of MICs and Zone Diameters, Versions 1.3 and 2.0.

Gönüllü N, Canberk MB, Filiz Ö, Altınkum S, Küçükbasmacı Ö, Aygün G, et al. Çeşitli klinik örneklerden üretilen Escherichia coli kökenlerinde antibiyotik duyarlılıkları ve beta-laktam direnç fenotipleri. Ankem Derg 2008;22:64-8.

Şahin İ, Şencan İ, Kaya D, Gülcan A, Öksüz Ş. Hastane infeksiyonu etkeni üropatojen Escherichia coli izolatlarının çeşitli antibiyotiklere direnç durumu. Ankem Derg 2004;18:193-5.

Yılmaz G, Taşdan İ, Kaymakçı S. Ankara Üniversitesi Tıp Fakültesi Hastanelerinde 2013 yılında saptanan hastane infeksiyonu etkeni mikroroganizmaların direnç oranları. Hastane İnfeksiyonları Dergisi 2014;18:175-82.

Hacıseyitoğlu D, Çağ Y, Başgönül, Özer S. Çeşitli Klinik Örneklerden İzole Edilen Escherichia coli ve Klebsiella pneumoniae İzolatlarının Antibiyotiklere Direnç Durumu.Türk Mikrobiyol Cem Derg 2014;44:101-6.

Mengeloğlu FZ, Taş T, Koçoğlu E, Bucak Ö. Determination of Susceptibility to Tigecycline in Extended Spectrum Beta-laktamase Producing Escherichia coli Isolates. Abant Medical Journal 2013;2:87-90.

Korten V. Gram negatif etkenler ve sürveyans: MYSTIC Türkiye 2000–2003 sonuçları. 6. Febril Nötropeni Sempozyumu. Ankara: Kongre Kitabı 2005:67-70.

Kaygusuz S, Apan TZ, Kılıç D. Toplum kaynaklı üriner sistem infeksiyonu etkeni GNB’lerde çeşitli antibiyotiklere direnç. Ankem Derg 2001;15:753-9.

Işık F, Arslan U, Tuncer İ. Klinik örneklerden soyutlanan Klebsiella türlerinde genişlemiş spektrumlu beta-laktamaz varlığı ve antibiyotik duyarlılığı. İnfeksiyon Derg 2007;21:33-8.

Demirci M, Cicioğlu Arıdoğan B, Arda M. Poliklinik hastalarının idrar kültürlerinden izole edilen gram negatif çomakların antibiyotiklere duyarlılığı. Ankem Derg 2000;14:576-9.

Zhang Z, Chen M, Yu Y, Pan S, Liu Y. Antimicrobial susceptibility among grampositive and gram-negative blood-borne pathogens collected between 2012-2016 as part of the Tigecycline Evaluation and Surveillance Trial. Antimicrobial Resistance and Infection Control 2018;7:152.

Özger HS, Karaşahin Ö, Telli G, Dizbay M. Nozokomiyal Klebsiella türleri arasında karbapenem direnç sıklığı ve fenotipik yöntemlerle direncin değerlendirilmesi. Flora Dergisi 2012;17:103-10.

Parisi SG, Bartolini A, Santacatterina E, Castellani E, Ghirardo R, Berto A, et al. Prevelance of Klebsiella pneumoniae strains producing carbapenemases and increase of resistance to colistin in an Italian teaching hospital from January 2012 to December 2014. BMC Infect Dis 2015;15:244.

Kurtoğlu MG, Bozkurt H, Güdücüoğlu H, Bayram Y, Berktaş M. Klinik örneklerden izole edilen Proteus mirabilis suşlarının antimikrobial ajanlara duyarlılıkları. Genel Tıp Dergisi 2008;18:23-6.

Greer ND. Tigecycline (Tygacil): the first in the glycylcycline class of antibiotics. Proc (Bayl Univ Med Cent) 2006;19:155-61.

Olaitan AO, Morand S, Rolain JM. Mechanisms of polymyxin resistance: acquired and intrinsic resistance in bacteria. Front Microbiol 2014;5:643.

Bell JM, Gottlieb T, Daley DA, Coombs GW, Australian Group on Antimicrobial Resistance. Australian Group on Antimicrobial Resistance (AGAR) Australian Gram-negative Sepsis Outcome Programme (GNSOP) Annual Report 2015. Commun Dis Intell 2018;42:2209-6051.

Acar A, Karaahmetoğlu G, Akalın H, Altay FA. Pooled prevalence and trends of antimicrobial resistance in Pseudomonas aeruginosa clinical isolates over the past 10-years in Turkey: A meta-analysis. J Glob Antimicrob Resist 2019;10:64-70.

Akalın H. Kolistin. Aankem Derg 2007;21:26-8.

Kwa A, Kasiakou SK, Tam VH, Falagas ME. Polymiyxin B similarities to and differences from colistin (polymyxin E). Expert Rev Anti Infect Ther 2007;5:811-21.

Li J, Turnidge J, Milne R, Nation RL, Coulthard K. In vitro pharmacodynamic properties of colistin and colistin methanesulfonate against Pseudomonas aeruginosa isolates from patients with cystic fibrosis. Antimicrob Agents Chemother 2001;45:781-5.

Çelik N, Savaş G, Soylu A. Hastanemizde 2011-2013 yılları arasında infeksiyon etkeni olarak kabul edilen Pseudomonas aeruginosa suşlarının antibiyotik direnç oranları. Hastane İnfeksiyonları Dergisi 2014;18:175-82.

Giamarellos-Bourboulis EJ, Xirouchaki E, Giamarellou H. Interactions of colistin and rifampin on multidrug-resistant Acinetobacter baumannii. Diagn Microbiol Infect Dis 2001;40:117-20.

Gordon NC, Png K, Wareham DW. Potent synergy and sustained bactericidal activity of a vancomycin colistin combination versus multidrug-resistant strains of Acinetobacter baumannii. Antimicrob Agents Chemother 2010;54:5316-22.

Urban C, Mariano N, Rahal JJ. In vitro double and triple bactericidal activities of doripenem, polymyxin B and rifampin against multidrug-resistant Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli. Antimicrob Agents Chemother 2010;54:2732-4.

Poudyal A, Howden BP, Bell JM, Gao W, Owen RJ, Turnidge JD, et al. In vitro pharmacodynamics of colistin against multidrugresistant Klebsiella pneumoniae. J Antimicrob Chemother 2008;62:1311-8.

Öncül O. Kolistin: Endikasyon ve Klinik Kullanım. Ankem Derg 2012;26:12-8.

Hawley JS, Murray CK, Jorgensen JH. Colistin heteroresistance in Acinetobacter and its association with previous colistin therapy. Antimicrobial Agents of Chemother 2008;52:351-2.

Cai Y, Chai D, Wang R, Liang B, Bai N. Colistin resistance of Acinetobacter baumannii: clinical reports, mechanisms and antimicrobial strategies. J Antimicrob Chemother 2012;67:1607-15.

Evaluation of Antibiotic Resistance in Gram-Negative Bacteria Isolates in a Private Hospital

ABSTRACT

References