Üçüncü basamak bir hastanede Gram pozitif koklar Staphylococcus aereus ve Enterococcus spp. prevalansı ve direnç eğilimleri

Year 2023, Volume: 48 Issue: 3, 1177 - 1186, 30.09.2023

Hatice Hale Gümüş

https://doi.org/10.17826/cumj.1350843

Abstract

Amaç: Antimikrobiyal direnç sessiz bir salgındır. Bu çalışmada Dünya Sağlık Örgütü'nün kan dolaşımı enfeksiyonlarında öncelikli patojenler arasında yer verdiği Staphylococcus aureus (S. aureus), Enterococcus faecium (E. faecium) ve Enterococcus faecalis (E. faecalis) izolatlarının dağılımı ve direnç eğilimlerinin belirlenmesi amaçlandı.
Gereç ve Yöntem: Retrospektif olan bu çalışma, 1 Ocak 2021 ile 31 Mart 2023 tarihleri arasında gerçekleştirildi. Otomatik sistem kullanılarak mikrobiyolojik incelemesi yapılan kan kültürleri (n=1261) ilgili dönemde laboratuvarı bilgi sistemi ile tarandı.
Bulgular: Çalışmaya dahil edilen toplam 941 izolatın %51.9'u S. aureus (n=488), %22.9'u E. faecalis (n=216) ve %25.2'si E. faecium (n=237) idi. Hastaların %89.1'i yatan (n=838), %10.9'u ayaktan (n=103) hastalardı. Hastaların büyük çoğunluğu dahili servislerde (%53.3) ve yoğun bakım ünitelerinde (%35) yatmaktaydı. S. aureus izolatlarında benzilpenisiline direnç oranı %93.8, metisilin'e %44.3, teikoplanine %3.7 ve linezolide %0.4 direnç gösterdi. Vankomisin ve tigesiklin direnci saptanmadı. E. faecalis izolatlarının %5.5'inin ampisiline, %3.3'ünün vankomisine, %3.2'sinin linezolide ve %0.7'sinin tigesikline dirençli olduğu belirlendi. E. faecium suşlarında direnç oranları ampisilin için %90.9, vankomisin için %28.7, tigesiklin için %17.7, linezolid için %4.3 ve teikoplanin için %0.8 olarak belirlendi. Her üç bakterinin duyarlılıkları karşılaştırıldığında, teikoplanin, vankomisin, tigesiklin ve linezolid duyarlılıkları arasında istatistiksel olarak anlamlı farklılık bulunduğu saptandı. Metisilin direnci dahiliye ve yoğun bakım ünitelerinde daha yüksekti. Levofloksasin ve vankomisin direnci yoğun bakım ünitelerinde daha yaygındı.
Sonuç: Metisiline dirençli S. aureus (%44.3), vankomisin (%28.7) ve tigesikline (%17.7) dirençli E. faecium oranları ulusal verilerin oldukça üzerindedir. Kan dolaşımı enfeksiyonlarının tedavisinde klinisyenlere yol gösterecek direnç eğilimlerine ilişkin epidemiyolojik çalışmaların periyodik olarak yapılması gerekmektedir.

Keywords

Enterococcus faecium, Enterococcus faecalis, antimikrobiyal direnç, metisilin direnci, vankomisin direnci, linezolid direnci, tigesiklin direnci, MRSA, VRSA, VRE.

Project Number

None

Prevalence and resistance trends of Gram positive cocci Staphylococcus aereus and Enterococcus spp. in a tertiary care hospital

Abstract

Purpose: Antimicrobial resistance is a silent pandemic. In this study, it was aimed to determine the distribution and resistance trends of Staphylococcus aureus (S. aureus), Enterococcus faecium (E. faecium) and Enterococcus faecalis (E. faecalis) isolates, which are among the priority pathogens of the World Health Organization in bloodstream infections.
Materials and Methods: This was a retrospective study conducted between January 1, 2021 and March 31, 2023. The blood cultures (n=1261), of which microbiologically tested by using an automated system, were screened in the relevant period via laboratory information system.
Results: Of the total 941 isolates, 51.9% were S. aureus (n=488), 22.9% were E. faecalis (n=216), and 25.2% were E. faecium (n=237). Of the patients, 89.1% were inpatients (n=838), and 10.9% were outpatients (n=103). The most of patients were hospitalized in internal medicine departments (53.3%) and in intensive care units (35%). Among S. aureus isolates, the resistance rate to benzylpenicillin was 93.8%, to methicillin 44.3%, to teicoplanin 3.7%, and to linezolid 0.4%. Vancomycin and tigecycline resistances were not detected. Of the E. faecalis isolates, 5.5% were resistant to ampicillin, 3.3% to vancomycin, 3.2% to linezolid, and 0.7% to tigecycline. The resistance rates for E. faecium strains were 90.9% for ampicillin, 28.7% for vancomycin, 17.7% for tigecycline, 4.3% for linezolid, and 0.8% for teicoplanin. When the susceptibilities of all three bacteria were compared, a statistically significant difference was found between teicoplanin, vancomycin, tigecycline and linezolid susceptibilities. The methicillin resistance was higher in internal medicine and intensive care units. The levofloxacin and vancomycin resistance were more prevalent in intensive care units.
Conclusion: MRSA (44.3%), vancomycin (28.7%) and tigecycline (17.7%) resistant E. faecium rates are well above the national data. The epidemiology on resistance trends, which will guide clinicians in the management of bloodstream infections, should be carried out periodically.

Keywords

Enterococcus faecium, Enterococcus faecalis, antimicrobial resistance, methicillin resistance, vancomycin resistance, linezolid resistance, tigecycline resistance, MRSA, VRSA, VRE

Supporting Institution

None

Project Number

None

Thanks

I thank to Prof. Dr. Akgün Yaman and Ass. Prof. Dr. Filiz Kibar for supporting me. And also thank to Ass. Prof. İlker Ünal for helping with the statistical analysis.

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