The change of antibiotic resistance rates over the years in Enterococcus spp. isolated from clinical specimens

Yıl 2023, Cilt: 6 Sayı: 5, 1052 - 1058, 28.09.2023

Tuğba Gedik Nuri Kiraz , Hülya Duran

https://doi.org/10.32322/jhsm.1287070

Öz

Aims: The aim of this study was to retrospectively evaluate the change in antibiotic resistance rates of Enterococcus species isolated from various clinical samples of outpatients and inpatients in our hospital over the years.
Methods: Between January 2018 and December 2021, various clinical samples sent to Tekirdağ Namık Kemal University Hospital Microbiology Laboratory from outpatients, inpatients and intensive care patients were retrospectively examined. The samples were inoculated on 5% sheep blood agar, chocolate agar and EMB agar media according to their types and incubated at 37°C. The blood cultures were performed by BACTEC 1280 System (Becton Dickinson, MA, USA). Bacterial identification and antimicrobial sensitivity tests were made using conventional methods and automated systems.
Results: A total of 417 Enterococcus strains were isolated in our laboratory at four years and included in the study. Of the 417 isolates, 204 (48.9%) were isolated from male patients and 213 (51.1%) from female patients. The mean age of the patients was 57.79±22.9 years (0-96 years). It was determined that 36.9% of the isolates belonged to outpatients, 33.4% to inpatients and 29.7% to intensive care unit patients. Of the 122 enterococci isolates identified as species, 49.2% were typed as Enterococcus faecalis (E. faecalis) and 40.2% as Enterococcus faecium (E. faecium). Of the 417 isolates, 60.4% were isolated from urine samples, 24.2% from blood samples, and 8.9% from wound samples. Considering the total antibiotic resistance rates; ampicillin was 34.9%, ciprofloxacin was 46.4%, vancomycin was 8.4%, tigecline was 3.2%, high-level gentamicin was 49.0%. Linezolid and nitrofurantoin resistance were not detected. Ampicillin and vancomycin resistance rates were determined to have a statistically significant increase within four years. Ampicillin, ciprofloxacin, vancomycin and high-level gentamicin resistance rates were found to be significantly higher in isolates obtained from inpatients and intensive care patients compared to enterococcal isolates obtained from outpatients.
Conclusion: In our study, it was determined that antibiotic resistance in enterococcal isolates, which are the causative agents of infection in our hospital, increased over the years. In this way, determining the change in antibiotic resistance rates is beneficial in determining appropriate antibiotic use policies. It is thought that conducting surveillance studies on antibiotic resistance periodically and taking new measures according to changing antibiotic resistance rates will be beneficial in terms of treatment.

Anahtar Kelimeler

Enterococcus, antibiotic resistance, vancomycin, vancomycin resistant enterococci (VRE)

Kaynakça

• Harvey RA (editors), Cornelissen CN, Fisher BD. Lippincott’s illustrated reviews: Microbiology. 3rd ed. Philadelphia: Williams & Wilkins; 2012:87-88.
• Koneman EW(editors), Allen SD, Janda WM, et al. Color atlas and textbook of diagnostik microbiology, Lippincott, 6th ed. Philadelphia: Williams & Wilkins; 2005:700-711.
• Mert-Dinc B, Aykut-Arca E, Yagcı S, Karabiber N. In-vitro antibotic susceptibility of Enterococcus faecalis and Enterococcus faecium strains isolated from various clinical samples. Turk Hij Den Biyol Derg. 2009;66:117-121.
• Altun D,Erdem G, Coplu N, Çagatay M. Investigation of Enterococcus strains isolated from clinical materials to species level and determination of antibiotic susceptibilities by various methods. ANKEM Derg. 2013;27:130-134.
• Guckan R, Elmas A, Tilgel S, Yuksel G. Antimicrobial resistance rates of Enterococcus strains isolated from various clinical specimens. Int J Basic Clin Med. 2013;1:74-77.
• Gözüböyük G, Uyanık MH, Hancı H, Aktaş O, Özbek A. Kan kültürlerinden izole edilen enterokokların antibiyotik duyarlılıkları. ANKEM Derg. 2013;27(3):107-112.
• Kınıklı S, Cesur S, Hatipoğlu CA, et al. Vankomisine dirençli enterokokların saptanmasında iki farklı kromojenik besiyerinin karşılaştırılması. Turk J Clin Lab. 2019;10(3):319-323.
• Odemiş I, Köse S, Ersan G, Celik D, Akbulut I. Hastanede yatan hastaların klinik örneklerinden izole edilen enterokok suşlarının antibiyotik duyarlılıklarının değerlendirilmesi. Turk Hij Den Biyol Derg. 2018;75(4):345-352.
• The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters, Version 10.0.2020. http://www.eucast.org. (erişim tarihi: 22.06.2022).
• Gok ŞM, Türk Dagı H, Kara F, Arslan U, Fındık D. Investigation of antibiotic resistance and virulence factors of Enterococcus faecium and Enterococcus faecalis strains isolated from clinical samples. Mikrobiyol Bul. 2020;54:26-39.
• Aral M, Pakoz NIE, Aral I, Dogan S. Antibiotic resistance of Enterococcus faecalis and Enterococcus faecium strains isolated from various clinical samples. Türk Hij Den Biyol Derg. 2011;68:85-92.
• Alkan S, Kuloğlu F, Akata F. Enterokok bakteriyemilerinde risk faktorlerinin değerlendirilmesi. KLİMİK Derg. 2016;29(2):65-70.
• Fiore E, Van Tyne D, Gilmore MS. Pathogenicity of Enterococci. Microbiol Spectr. 2019;7(4):10.1128/microbiolspec.GPP3-0053-2018.
• Bhardwaj SB. Pathogenic Bacteria. In: Enterococci: An Important Nosocomial Pathogen, Kirmusaoglu S. Bhardwaj SB (eds). IntechOpen, 1st ed. London; 2019:1-17.
• Sastry S, Clarke LG, Alrowais H, Querry AM, Shutt KA, Doi Y. Clinical appraisal of fosfomycin in the era of antimicrobial resistance. Antimicrob Agents Chemother. 2015;59(12):7355-7361.
• Mataj V, Guney M, Sig AK, et al. An Investigation into bacterial bloodstream infections and antibiotic resistance profiles in a tertiary hospital for a ten-year period. Clin Lab. 2020;66(8):1467-1477.
• Odemis I, Kose S, Ersan G, Celik D, Akbulut I. Evaluation of antibiotic susceptibilities of Enterococcus strains isolated from clinical samples of hospitalized patients. Turk Hij Den Biyol Derg. 2018;75(4):345-352.
• Conceição N, Oliveira CC, Silva PR, Avila BG, Oliveira AG. Trends in antimicrobial resistance among clinical isolates of enterococci in a Brazilian tertiary hospital: a 4-year study. Rev Soc Bras Med Trop. 2011;44(2):177-181.
• Boccella M, Santella B, Pagliano P, et al. Prevalence and antimicrobial resistance of Enterococcus Species: a retrospective cohort study in Italy. Antibiotics (Basel). 2021;10(12):1552.
• Agus N, Sirin MC, Yılmaz N, et al. The change of antibiotic resistance over the years in enterococci isolated from clinical specimens. Ankem Derg. 2014;28:119-23.
• Celik C, Taskın-Kafa AH, Hasbek M, Buyuktuna SA. Antimicrobial resistance in Enterococcus faecalis and Enterococcus faecium bacteria isolated from bloodstream infections: a single-center evaluation. Klimik Derg. 2021;34:37-41.
• Sig AK, Kula Atik T, Çetin Duran A. Antibiotic resistance of Enterococcus species:3-year data. J Health Sci Med. 2021;4(5):670-674.
• Bilgin M, Gorgun S, Isler H, Basbulut E. Evaluation of the distribution and antibiotic resistance profiles of Enterococcus species isolated from urine cultures. Turk Hij Den Biyol Derg. 2021;78(3):265-272.
• Simsek M. Species distribution and antibiotic suscebtibilities of Enterococci strains isolated from urine cultures. KTD. 2019;20:177-182.
• Etiz P, Kibar F, Ekenoglu Y, Yaman A. Evaluation of the Antibiotic Resistance Profiles of Enterococcus Species Isolated from Urine Cultures. Türk Mikrobiyol Cem Derg. 2014;44(3):107-113.
• Calderaro A, Maugeri A, Magazù S, Laganà G, Navarra M, Barreca D. Molecular basis of interactions between the antibiotic nitrofurantoin and human serum albumin: a mechanism for the rapid drug blood transportation. Int J Mol Sci. 2021;22(16):8740.
• Yenisehirli G, Yenisehirli A, Bulut Y, Ozveren G. Antimicrobial resistance of enterococci isolated from urine cultures. Klimik Derg. 2016;29:112-116.
• Ozseven AG, Cetin ES, Arıdogan BC, Ciftci E, Ozseven L. Antimicrobial susceptibility of enterococci isolated from various clinical specimens. ANKEM Derg. 2011;25(4):256-262.
• Iraz M, Ceylan A, Akkoyunlu Y. Antibiotic susceptibility of Enterococcus strains isolated from various clinical samples. ANKEM Derg. 2012;26:176-180.
• Ulusal Antimikrobiyal Direnc Surveyans Sistemi, 2016 Yıllık Raporu. 2016. Turkiye Halk Sagligi Kurumu, Saglik Bakanligi, Ankara, http://uamdss.thsk.gov.tr (Erişim: 22.06.2022).
• Avcıoglu F, Altınoz Aytar A, Ozturk E, Sahin I, Calıskan E. Evaluation of vancomycin-resistant Enterococcus colonization at Duzce Universty research and training hospital. Düzce Tıp Fak Derg. 2016;18(1):8-11.
• European Centre for Disease Prevention and Control. 2020. Antimicrobial resistance in the EU/EEA (EARS-Net)- Annual Epidemiological Report 2019. (Erişim: 22.06.2022).
• Ulusal Saglik Hizmeti Iliskili Enfeksiyonlar Surveyans Agi Ozet Raporu. 2019. Halk Sagligi Genel Müdürlügü, Bulasici Hastalıklar Dairesi Baskanligi. (Erişim: 22.06.2022).
• Ulusal Antimikrobiyal Direnc Surveyans Sistemi, 2019 Yıllık Raporu. 2019. Turkiye Halk Sagligi Kurumu, Saglik Bakanligi, Ankara, http://uamdss.thsk.gov.tr. (Erişim: 22.06.2022).
• Genez H. Klinik orneklerden izole edilen enterokokların virulans faktorlerinin yuksek duzey aminoglikozid direnciyle iliskilendirilmesi. Uzmanlık Tezi, Kocaeli Universitesi, Tip Fakültesi, Tıbbi Mikrobiyoloji Anabilim Dali, Kocaeli, 2021.
• Turk Dagi H, Arslan U, Inci Tuncer E. Antibiotic resistance in enterococci isolated from blood cultures. Türk Mikrobiyol Cem Derg. 2011;41(3):103-106.
• Stefani S, Bongiorno D, Mongelli G, Campanile F. Linezolid resistance in staphylococci. Pharmaceuticals. 2010;3(7):1988-2006.
• Dadashi M, Sharifian P, Bostanshirin N, et al. The global prevalence of daptomycin, tigecycline, and linezolid-resistant Enterococcus faecalis and Enterococcus faecium strains from human clinical samples: a systematic review and meta-analysis. Front Med (Lausanne). 2021;8:720647.
• Kilbas I, Ciftci IH. Antimicrobial resistance of Enterococcus isolates in Turkey: a meta-analysis of current studies. J Glob Antimicrob Res. 2018;12:26-30.
• Ozkan O, Ozbek B, Sınırtas M, Ozakın C. Tigecycline susceptibility among gram negative bacteria. Türk Mikrobiyol Cem Derg. 2011;41(1):42-45.