Hastanelerde güncel bir sorun: çoklu ilaca direncli Acinetobacter baumannii enfeksiyonlarının tedavisi

Year 2019, Volume: 1 Issue: 2, 37 - 41, 18.04.2019

Metin Özsoy , Meliha Sönmezer , Sami Kınıklı

https://doi.org/10.38053/agtd.526530

Cited By: 1

Abstract

Acinetobacter türleri doğada
yaygın olarak bulunan aerobik, Gram negatif, hareketsiz, fermantasyon yapmayan
bakterilerdir. Bu türler içerisinde Acinetobacter baumannii (A.
baumannii) sağlık bakımıyla ilişkili enfeksiyonlar içerisinde önemli
bir yer tutmaktadır. Hastanelerde özellikle  yoğun bakım üniteleri
olmak üzere, hastanelerin çeşitli birimlerinde ciddi hastane enfeksiyonlarından
sorumlu önemli fırsatçı patojenlerin başında gelmektedir. Yaygın olarak travma,
mekanik ventilasyon ve  girişimsel işlemlere bağlı olarak gelişen pnömoni,
endokardit, menenjit, deri ve yara enfeksiyonları, peritonit ve üriner
sistem  enfeksiyonlarına neden olmaktadır. Son 10 yılda  A.
baumannii suşlarında gittikçe yaygınlaşan çoklu ilaca direnci (3 veya
daha fazla sayıda farklı antibiyotik grubuna direnç görülmesi) nozokomiyal
gram negatif patojenler içerisinde kontrol ve tedavisi en güç olanlardan biri
haline gelmiştir. A. baumannii ile enfekte hastalar sıklıkla
immün yetmezliklidirler ya da hastalık durumları ağır olup, mortalite oranları
oldukça yüksektir. A. baumannii salgınlarının pek çoğu hasta
yatakları, klimalar,  mekanik ventilasyon ekipmanları,  hastane
personelinin elleri veya çevresel kontaminasyonlara bağlı olarak ortaya
çıkmaktadır. A. baumannii infeksiyonlarının artması enfeksiyon
kontrol uygulamalarındaki hatalara bağlıdır. Hastaların bir kısmının A.
baumannii ile enfekte ya da kolonize olduğu durumlarda; hastalar
arasındaki çapraz geçişler kolonizasyon ve/veya salgın oluşumunu artırmaktadır.
Bu derlemede, ÇİD-A. baumanni suşlarının mikrobiyolojisi, tedavisi
ve enfeksiyon kontrol önlemleri tartışılacaktır.

 

Keywords

Acinetobacter baumannii, çoklu ilaca direnç, tedavi, enfeksiyon kontrol önlemleri

A recent problem at hospitals: treatment of multi-drug resistant Acinetobacter baumanii infections

Abstract

Acinetobacter baumannii (A.
baumannii) is one of the most prominent hospital-borne pathogens
encountered worldwide in health institutions, mostly at Intensive Care Units (ICU),
which develops resistance to many antimicrobial classes. A.
baumannii causes pneumonia, urinary tract infections, soft tissue
infections, surgical site infections, catheter infections and bacteremia mostly
in the ICU and inpatients. Infections, which develop with this pathogen are
also often treatment-resistant. Epidemics arising from A.
baumannii, which is resistant to various antimicrobial classes unfold through
cross-infection of such 'reknown' sources as ventilators or the hands of health
workers. The definition of multidrug-resistant (MDR) A. baumannii differs from that in the literature and country but
still the common definition deals with strains, which are resistant to three or
more groups of antibiotics. These groups of antibiotics can be carbapenems,
aminoglycosides and fluoroquinolones. In this review, resistance mechanism and
treatment options in MDR A.baumannii
isolates will be discussed.

Keywords

Acinetobacter baumannii, multi-drug resistant, treatment, infection control measurment

References

• 1. Bergogne-Berezin E, Towner KJ. Acinetobacter spp.as nosocomial pathogens: microbiological, clinical, and epidemilogical features. Clin Microbiol Rev 1996;9:148–165.
• 2. Cisneros JM, Rodriguez-Bano J. Nosocomial bacteremia due to Acinetobacterbaumannii: epidemiology, clinical features, and treatment. Clin. Microbiol. Infect.2002;8:687–693.
• 3. Magiorakos AP, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012 Mar;18(3):268-81. doi: 10.1111/j.1469-0691.2011.03570.x.
• 4. Jain R, Danziger LH. Multidrug-resistant Acinetobacter infections: an emerging challenge to clinicians. Ann. Pharmacother. 2004;38:1449–1459.
• 5. Li J, Nation RL, Milne RW, Turnidge JD, Coulthard K. Evaluation of colistin as an agent against multi-resistant gram-negative bacteria. Int. J. Antimicrob. Agents 2005;25:11–25.
• 6. Parvez F.M., Jarvis W.R. Nosocomial infections in the nursery. Semin Pediatr Infect Dis 1999;10:119–29
• 7. Villegas MV, Hartstein Al. Acinetobacter outbreaks,1977–2000. Infect Control Hosp Epidemiol 2003;24:284–295.
• 8. Koneman EW, Allen SD, Janda WM, Schreckenberger PC, Winn WC, Woods G. Koneman’s Color Atlas and Textbook of Diagnostic Microbiology; 6’th ed. Lippincott Philadelphia. 2006:316–355.
• 9. Seifert H, Baginski R, Schulze A, Pulverer G. The distribution of Acinetobacter species in clinical culture materials. Zentralbl Bakteriol 1993; 279: 544-552.
• 10. Seifert H, Dijkshoorn L, Gerner-Smidt P, et al. Distribution of Acinetobacter species on human skin: comparison of phenotypic and genotypic identification methods. J Clin Microbiol 1997; 35: 2819-2825.
• 11. Peleg AY, Seifert H, Paterson D L. Acinetobacter baumannii: emergence of a successful pathogen. Clin. Microbiol. Rev. 2008; 21, 538–582.
• 12. Pantophlet RA. Lipopolysaccharides of Acinetobacter, pp: 61-98. In: Gerischer U (ed), Acinetobacter Molecular Biology. 2008, Caistr Academic Press, Norfolk, UK.
• 13. Russo TA, Luke NR, Beanan JM, et al. The K1 capsular polysaccharide of Acinetobacter baumannii strain 307-0294 is a major virulence factor. Infect Immun 2010; 78(9): 3993-4000.
• 14. Lee CR, Lee JH, Park M, et al. Biology of Acinetobacter baumannii: Pathogenesis, Antibiotic Resistance Mechanisms, and Prospective Treatment Options. Front Cell Infect Microbiol. 2017; 7: 55.
• 15. Brown S, Amyes S. OXA (beta)-lactamases in Acinetobacter: the story so far. J Antimicrob Chemother 2006; 57: 1–3.
• 16. Lee K, Lee WG, Uh Y et al. VIM- and IMP-type metallo-betalactamase- producing Pseudomonas spp. and Acinetobacter spp. in Korean hospitals. Emerg Infect Diseases 2003; 9: 868–71.
• 17. Heritier C, Poirel L, Lambert T et al. Contribution of acquired carbapenem-hydrolyzing oxacillinases to carbapenem resistance in Acinetobacter baumannii. Antimicrob Agents Chemother 2005; 49: 3198–202.
• 18. Brown S, Young HK, Amyes SG. Characterisation of OXA-51, a novel class D carbapenemase found in genetically unrelated clinical strains of Acinetobacter baumannii from Argentina. Clin Microbiol Infect 2005; 11: 15–23.
• 19. Fournier P, Vallenet D, Barbe V, Audic S, Ogata H, Poirel L, et al. Comparative genomics of multidrug resistance in Acinetobacter baumannii. PLoS Genet. 2006;2:0062–72
• 20. Bou G., et al. 2000. Cloning, nucleotide sequencing, and analysis of the gene encoding an AmpC beta-lactamase in Acinetobacter baumannii. Antimicrob. Agents Chemother. 44:428–432
• 21. Rodríguez-Martínez J. M., et al. 2010. Extended-spectrum cephalosporinase in Acinetobacter baumannii. Antimicrob. Agents Chemother. 54:3484–3488
• 22. Vahaboğlu H, Öztürk R, Aygün G, et al. Widespread detection of PER-1-type extended-spectrum ß-lactamases among nosocomial Acinetobacter and Pseudomonas aeruginosa isolates in Turkey: A nationwide multicenter study. Antimicrob Agents Chemother 1997;41:2265-9.
• 23. Turton JF, Ward ME, Woodford N et al. The role of ISAba1 in expression of OXA carbapenemase genes in Acinetobacter baumannii. FEMS Microbiol Lett 2006; 258: 72–7.
• 24. Cai Y, Chai D, Wang R, Liang B, Bai N. 2012. Colistin resistance of Acinetobacter baumannii: clinical reports, mechanisms and antimicrobial strategies. J Antimicrob Chemother 67:1607–1615. http://dx.doi.org/10 .1093/jac/dks084
• 25. López-Rojas R, McConnell MJ, Jiménez-Mejías ME, DomínguezHerrera J, Fernández-Cuenca F, Pachón J. 2013. Colistin resistance in a clinical Acinetobacter baumannii strain appearing after colistin treatment: effect on virulence and bacterial fitness. Antimicrob Agents Chemother 57:4587–4589.
• 26. Öksüz, L. ve Gürler, N. (2012). Klinik örneklerden izole edilen çoğul dirençli Acinetobacter baumannii suşlarında kolistin, polimiksin B ve tigesiklinin in vitro etkinliği. Türk Mikrobiyoloji Cemiyet Dergisi, 42(1),32-38.
• 27. Li J, Nation RL, Milne RW, Turnidge JD, Coulthard K. Evaluation of colistin as an agent against multi-resistant gram-negative bacteria. Int. J. Antimicrob. Agents 2005;25:11–25.
• 28. Hogg GM, Barr JG, Webb CH. In vitro activity of the combination of colistin and rifampicin against multidrug- resistant strains of Acinetobacter baumannii. J Antimicrob Chemother 1998; 41: 494- 5.
• 29. Chang KC, Lin MF, Lin NT, et al. Clonal spread of multidrug-resistant Acinetobacter baumannii in eastern Taiwan. J.Microbiol. Immunol. Infect. 2012; 45, 37–42.
• 30. Bassetti M, Righi E, Esposito S, Petrosillo N, Nicolini L. Drug treatment for multidrugresistant Acinetobacter baumannii infections. Future Microbiol. 2008 ;3(6):649-60.
• 31. Batirel A , Balkan II, Karabay O, et al. (2014). Comparison of colistin-carbapenem,colistin-sulbactam, and colistin plus other antibacterial agents for the treatment of extremely drug-resistant Acinetobacter baumannii bloodstream infections. Eur. J. Clin. Microbiol. Infect. Dis. 33, 1311–1322.
• 32. Cirioni O, Simonetti O, Pierpaoli E, et al. Colistin enhances therapeutic efficacy of daptomycin or teicoplanin in a murine model of multiresistant Acinetobacter baumannii sepsis. Diagn. Microbiol. Infect. Dis. 2016; 86, 392–398.
• 33. Liang W., Liu X F, Huang J, et al. Activities of colistin- and minocycline-based combinations against extensive drug resistant Acinetobacter baumannii isolates from intensive care unit patients. BMC Infect. Dis. 2011; 11:109.
• 34. Wareham, D. W., Gordon, N. C., and Hornsey, M. In vitro activity of teicoplanin combined with colistin versus multidrug-resistant strains of Acinetobacter baumannii. J. Antimicrob. Chemother. 2011; 66, 1047–1051.
• 35. Yilmaz GR , Guven T, Guner R, et al. Colistin alone or combined with sulbactam or carbapenem against A. baumannii in ventilator-associated pneumonia. J Infect Dev Ctries 2015; 9(5):476-485.
• 36. Navon-Venezia S, Leavitt A, Carmeli, Y. High tigecycline resistance in multidrugresistant Acinetobacter baumannii. J. Antimicrob. Chemother. 2007; 59, 772–774.
• 37. Peleg AY, Adams J, Paterson D L. Tigecycline efflux as a mechanism for nonsusceptibility in Acinetobacter baumannii. Antimicrob. Agents Chemother. 2007; 51, 2065–2069.
• 38. Kim WY, Moon JY, Huh JW, et al. Comparable Efficacy of Tigecycline versus Colistin Therapy for Multidrug-Resistant and Extensively Drug-Resistant Acinetobacter baumannii Pneumonia in Critically Ill Patients. PLoS One. 2016 Mar 2;11(3):e0150642.
• 39. Cheng A, Chuang YC, Sun HY, et al. Excess Mortality Associated With Colistin- Tigecycline Compared With Colistin-Carbapenem Combination Therapy for Extensively Drug-Resistant Acinetobacter baumannii Bacteremia: A Multicenter Prospective Observational Study. Crit Care Med. 2015; 43(6): 1194-204.
• 40. Senok A, Garaween G, Raji A, et al. Genetic relatedness of clinical and environmental Acinetobacter baumanii isolates from an intensive care unit outbreak J Infect Dev Ctries 2015; 9(6):665-9.
• 41. Ushizawa H, Yahata Y, Endo T, et al. A Epidemiological investigation of a nosocomial outbreak of multidrug-resistant Acinetobacter baumannii in a critical care center in Japan, 2011–2012. Jpn J Infect. Dis. 2016; 69, 356.
• 42. Goff DA , Kaye KS. Minocycline: An Old Drug for a New Bug: Multidrug-Resistant Acinetobacter baumannii. CID 2014:59 (Suppl 6). 365-366.
• 43. Dy ME, Nord JA, LaBombardi VJ, Kislak JW. The emergence of resistant strains of Acinetobacter baumannii: clinical and infection control implications. Infect Control Hosp Epidemiol 1999; 20: 565- 67.