ABSTRACT
Objective:
The objective of the study was to investigate the three-year antibiotic susceptibility of Pseudomonas aeruginosa and Acinetobacter baumannii strains isolated from intensive care unit (ICU) specimens and to evaluate the changes in resistance rates.
Materials and Methods:
The resistance profiles of Pseudomonas aeruginosa and Acinetobacter baumannii strains isolated from ICU specimens between January 2015-2018 were analyzed retrospectively and the annual resistance rates were evaluated.
Results:
Acinetobacter baumannii was isolated in 609 and Pseudomonas aeruginosa was isolated in 420 of the ICU specimens over a three-year period. Strains were most frequently isolated from general ICU. The three-year mean resistance of Acinetobacter baumannii and Pseudomonas aeruginosa to colistin, amikacin, gentamycin, imipenem, meropenem, ciprofloxacin, ceftazidime, piperacillin / tazobactam was 0.5%, 79%, 86%, 96%, 96%, 97% 98%, 99% and 5%, 21%, 25%, 35%, 38%, 40%, 42%, 45%, 49% and 53%, respectively. The most effective antibiotics were for Acinetobacter baumannii and Pseudomonas aeruginosa were colistin (99.5% vs 95%) and amikacin (21% vs 79%), respectively.
Conclusion:
It was found that Acinetobacter baumannii strains isolated from ICUs were resistant to many antibiotics and that Pseudomonas aeruginosa isolates were more susceptible. These data are proof that new antibiotics are needed in the treatment of infections caused by Acinetobacter baumannii. It would be appropriate for each hospital to monitor changes in their resistance rates and to update the empirical treatment principles.
Keywords: Acinetobacter baumannii, Pseudomonas aeruginosa, antimicrobial resistance, intensive care unit
References
1
Sader HS, Farrell DJ, Flamm RK, Jones RN. Antimicrobial susceptibility of Gram-negative organisms isolated from patients hospitalized in intensive care units in United States and European hospitals (2009-2011). Diagn Microbiol Infect Dis 2014;78:443-8.
2
Yesilbağ Z, Karadeniz A, Başaran S, Kaya FÖ, et al. Nosocomial infections and risk factors in intensive care unit of a university hospital. J Clin Exp Invest 2015;6:233-9.
3
Dereli N, Ozturk S, Babayigit M, Tutal ZB, Koc F, Gulec H, et al. A 5-Year Evaluation of Invasive Device-Associated Infections Rates in Intensive Care Unit of a Training Hospital in Turkey. Balkan Military Medical 2016;19:19-24.
4
Taş SŞ, Kahveci K. Uzun Süreli Yoğun Bakım Ünitesi ve Palyatif Bakım Merkezinde Hastane Enfeksiyonlarının Sürveyansı; 3 Yıllık Analiz. J Contemp Med 2018;8:55-59.
5
Almasaudi SB. Acinetobacter spp. as nosocomial pathogens: Epidemiology and resistance features. Saudi J Biol Sci 2018;25:586-96.
6
Eroğlu C, Ünal N, Karadağ A, Yılmaz H, Acuner İÇ, Günaydın M. Çeşitli klinik örneklerden 2006-2011 yılları arasında izole edilen Acinetobacter türleri ve antibiyotik duyarlılıkları. Turk Hij Den Biyol Derg 2016;73:25-32.
7
Al Johani SM, Akhter J, Balkhy H, El-Saed A, Younan M, Memish Z. Prevalence of antimicrobial resistance among gram-negative isolates in an adult intensive care unit at a tertiary care center in Saudi Arabia. Ann Saudi Med 2010;30:364-9.
8
Talan L, Güven G, Yılmaz G, Altıntaş ND. Yoğun Bakım Ünitelerinde Kontrol Altına Alınmakta Güçlük Çekilen Mikroorganizmalar: Acinetobacter. Yoğun Bakım Derg 2015;6:44-7.
9
Doi Y, Murray GL, Peleg AY. Acinetobacter baumannii: evolution of antimicrobial resistance-treatment options. Semin Respir Crit Care Med 2015;36:85-98.
10
İnce N, Geyik MF, Özdemir D, Danış A. A Comparison of the Antibiotic Susceptibility Rates Pseudomonas aeruginosa Strains Causing Hospital Acquired Infections According to Years. ANKEM Derg 2014;28:94-9.
11
MacVane SH. Antimicrobial Resistance in the Intensive Care Unit: A Focus on Gram-Negative Bacterial Infections. J Intensive Care Med 2017;32:25-37.
12
Camcıoğlu AE, Saltıoğlu N, Can G, Vehid S, Aygün P, Alisha L, ve ark. Yoğun Bakimda Hastane İnfeksiyonu Geçirmenin Yatış Maliyetine Ve Yatış Süresine Etkisi. 19 Ulusal Halk Sağlığı Kongresi; 2017.
13
Antunes LC, Visca P, Towner KJ. Acinetobacter baumannii: evolution of a global pathogen. Pathog Dis 2014;71:292-301.
14
Bassetti M, Vena A, Croxatto A, Righi E, Guery B. How to manage Pseudomonas aeruginosa infections. Drugs Context 2018;7:212527.
15
Savcı Ü, Özveren G, Yenişehirli G, Bulut Y, Özdaş S. Klinik örneklerden izole edilen Acinetobacter baumannii suşlarının in-vitro duyarlılık durumları. Turk Journal of Clin and Lab 2015;6:24-9.
16
Nguyen L, Garcia J, Gruenberg K, MacDougall C. Multidrug-Resistant Pseudomonas Infections: Hard to Treat, But Hope on the Horizon? Curr Infect Dis Rep 2018;20:23.
17
E. Tacconelli (Infectious Diseases, DZIF Center, Tübingen University, Germany) and N. Magrini (WHO, EMP Department). Global Priority List Of Antibiotic-Resistant Bacteria to Guide Research, Discovery, and Development Of New Antibiotics. WHO. 2015.
18
Centers for Disease Control (CDC). USA. (2018 July 19). Available from: www.cdc.gov/drugresistance/biggest_treat.html
19
Şirin MC, Ağuş N, Yılmaz N, Derici YK, Hancı SY, Bayram A, ve ark. Yoğun bakım ünitelerinden izole edilen Pseudomonas aeruginosa ve Acinetobacter baumannii suşlarında antibiyotik direnç profillerinin yıllar içindeki değişimi. J Clin Exp Invest 2015;6:279-85.
20
Köse Ş, Atalay S, Ödemiş İ, Adar P. Çeşitli klinik örneklerden izole edilen Pseudomonas aeruginosa suşlarının antibiyotik duyarlılıkları, ANKEM Derg 2014;28:100-4.
21
Engin A. Acinetobacter-Associated nosocomial infections in Cumhuriyet University Medical Faculty Research Hospital; Three years’ experience. Cumhuriyet Medical Journal 2017;39:555-63.
22
Demirdal T, Şen P, Yula E, Kaya S, Nemli SA, Demirci M. Yoğun bakım ünitelerinden izole edilen Pseudomonas aeruginosa suşlarının direnç profilleri: Beş yıllık değerlendirme. Ortadogu Tıp Derg 2017;9:108-12.
23
Balcı M, Bitirgen M, Kandemir B, Türk Arıbaş E, Erayman İ. Nozokomiyal Acinetobacter baumannii suşlarının antibiyotik duyarlılığı. Ankem Derg 2010;24:28-33.
24
Lob SH, Hoban DJ, Sahm DF, Badal RE. Regional differences and trends in antimicrobial susceptibility of Acinetobacter baumannii. Int J Antimicrob Agents 2016;47:317-23.
25
Maraki S, Mantadakis E, Mavromanolaki VE, Kofteridis DP, Samonis G. A 5-year Surveillance Study on Antimicrobial Resistance of Acinetobacter baumannii Clinical Isolates from a Tertiary Greek Hospital. Infect Chemother 2016;48:190-8.
26
Central Asian and Eastern European Surveillance of Antimicrobial Resistance Annual report 2017. WHO. 2017.
27
Central Asian and Eastern European Surveillance of Antimicrobial Resistance Annual report 2017. WHO. 2016.
28
Ulusal Hastane Enfeksiyonları Sürveyans Ağı Özet Raporu. T.C. Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu Mikrobiyoloji Referans Laboratuvarları Daire Başkanlığı. 2015.
29
Barış A, Bulut ME, Öncül A, Bayraktar B. Yoğun Bakım Ünitelerinde Yatan Hastalara Ait Klinikİzolatların Tür Dağılımı ve Antibiyotik Duyarlılıkları. Türk Yoğun Bakım Derneği Derg 2017;15:21-7.
30
Yıldız İ, Bayır H, Küçükbayrak A, Yoldaş H, Balcı M, Erkuran MK, et al. Acinetobacter Infection and Resistance Profile of Intensive Care Units In a City of Northwestern Anatolia. Acta Medica Anatolia 2016;4:98-100.
31
Alada DM, Altoparlak Ü, Coşkun MV. Çeşitli Antibiyotik Kombinasyonlarının Acinetobacter Suşları Üzerine İn Vitro Etkinliğinin Araştırılması. Ankem Dergisi 2017;31:23-31.
32
Maragakis LL, Perl TM. Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options. Clin Infect Dis 2008;46:1254-63.
33
Sargın Altunok E, Koc MM. Yoğun Bakım Ünitesinden İzole Edilen Acinetobacter Suşlarının Yıllara Göre Antibiyotik Direnç Oranlarının Karşılaştırılması. ANKEM Derg 2014;28:1-7.
34
Cesur S, Irmak H, Yalçın AN, Berktaş M, Baysan BÖ, Kınıklı S, ve ark. Yoğun bakım ünitesinde yatan hastaların çeşitli kültür örneklerinden izole edilen Acinetobacter baumannii suşlarının antibiyotik duyarlılıkları. OrtadoguTıp Derg 2017;9:51-5.
35
Gur D, Hascelik G, Aydin N, Telli M, Gültekin M, Ögünç D, et al. Antimicrobial resistance in gram-negative hospital isolates: results of the Turkish HITIT-2 Surveillance Study of 2007. Journal of Chemotherapy 2009;21:383-9.
36
Öztürk Bakar Y, Gönüllü N, Akkuş S, Güler MS, Aygün G. Alt Solunum Yolu Örneklerinden İzole Edilen Pseudomonas Aeruginosa Suşlarının Antibiyotik Duyarlılığı. ANKEM Derg 2017;31:92-6.
37
Tümer S, Kirişçi Ö, Özkaya E, Çalışkan A. Çeşitli Klinik Örneklerden İzole Edilen Pseudomonas Aeruginosa Suşlarının Antibiyotik Duyarlılıkları. ANKEM Derg 2015;29:99-104.
38
Gültepe B, Iraz M, Ceylan A, Doymaz MZ. Çeşitli Klinik Örneklerden İzole EdilenPseudomonas Aeruginosa Suşlarının Antibiyotiklere Direnci. ANKEM Derg 2014;28:32-6.
39
Durmaz S, Toka Özer T. Klinik örneklerden izole edilen Pseudomonas aeruginosa suşlarında antibiyotik direnci. Abant Tıp Derg 2015;4:239-42.
40
Varışlı AN, Aksoy A, Baran I, Aksu N. Klinik örneklerden izole edilen Pseudomonas aeruginosa suşlarının yıllara göre antibiyotik direnci. Turk Hij Den Biyol Derg 2017;74:229-36.
41
Sader HS, Farrell DJ, Flamm RK, Jones RN. Antimicrobial susceptibility of Gram-negative organisms isolated from patients hospitalized in intensive care units in United States and European hospitals (2009-2011). Diagn Microbiol Infect Dis 2014;78:443-8.
42
Singkham-In U, Chatsuwan T. In vitro activities of carbapenems in combination with amikacin, colistin, or fosfomycin against carbapenem-resistant Acinetobacter baumannii clinical isolates. Diagn Microbiol Infect Dis 2018;91:169-74.
43
Fritzenwanker M, Imirzalioglu C, Herold S, Wagenlehner FM, Zimmer KP, Chakraborty T. Treatment Options for Carbapenem- Resistant Gram-Negative Infections. Dtsch Arztebl Int 2018;115:345-52.
44
Li T, Sheng M, Gu T, Zhang Y, Yirepanjiang A, Li Y. In vitro assessment of cefoperazone-sulbactam based combination therapy for multidrug-resistant Acinetobacter baumannii isolates in China. J Thorac Dis 2018;10:1370-6.
45
European Committee on Antimicrobial Susceptibility Testing (EUCAST). (2018 November 14). Available from: http://www.eucast.org/ast_of_bacteria/warnings/#c13111
46
CLSI. Performance standarts for antimicrobial susceptibility testing; Twenty third informational. Wayne P. 2016;(Supplement):M100-S26.
