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Objective: Infections of Pseudomonas aeruginosa and Acinetobacter baumannii are one of the greatest concerns for hospitalized patients, particularly those in intensive care units (ICUs). The aim of this study was to determine the antimicrobial resistance percentages and to assess empirical treatment options for bloodstream infections due to P. aeruginosa and A. baumannii strains in ICU patients. Methods: Resistance percentages of strains isolated in JanuaryDecember 2010 and JanuaryDecember 2011 were separately analyzed and compared. The differences in resistance percentages between two intervals was statistically analyzed. Results: A statistically significant decrease was found in the resistance percentage of piperacillin-tazobactam, cefoperazone-sulbactam, ceftazidime, ciprofloxacin, gentamicin, amikacin and netilmicin in the second period compared with the first (p values were 0.0059, 0.0000, 0.0048, 0.00350, 0.0000, 0.0000, 0.0003, respectively) for P. aeruginosa strains. Whereas resistance percentage of aztreonam was increased (p value was 0.0155). Resistance percentage of imipenem was found similar. ÖZET Amaç: Pseudomonas aeruginosa ve Acinetobacter baumannii enfeksiyonları özellikle yoğun bakım ünitesinde (YBÜ) yatan hastalar için en önemli sorunlardan birisidir. Bu çalışmanın amacı, YBÜ hastalarında kan dolaşımı enfeksiyonlarına sebep olan P. aeruginosa ve A. baumanni etkenlerinin antimikrobiyal direnç paternlerini belirlemek ve ampirik tedavi protokollerinin uygunluğunu değerlendirmektir. Yöntemler: Ocak-Aralık 2010 ve Ocak-Aralık 2011 tarihlerinde YBÜ’de yatan hastalara ait hemokültür örneklerinde üreyen suşların direnç oranları ayrı ayrı incelenerek karşılaştırıldı. Bu iki zaman aralığı arasında direnç oranlarındaki farklılıklar karşılaştırılarak istatistiksel olarak analiz edildi. Bulgular: P. aeruginosa suşlarının piperasilintazobaktam, sefaperazon sulbaktam, seftazidim, siprofloksasin, gentamisin, amikasin ve netilmisine direnç oranlarında 2011 yılında 2010 yılına oranla azalma olduğu saptandı (p değerleri sırasıyla, 0,0059, 0,0000, 0,0048, 0,0350, 0,0000, 0,0000, 0,0003). Buna karşılık, aztreonam direnç oranında artış saptandı (p değeri, 0,0155). İmipenem direncinin benzer oranlarda Geliş Tarihi / Received : Kabul Tarihi / Accepted : İletişim / Corresponding Author : Berrin UZUN İzmir Katip Çelebi Üni., Atatürk Eğitim ve Araştırma Hast., Tıbbi Mikrobiyoloji Lab., İZMİR Tel : +90 232 244 44 44-1982 E-posta / E-mail : berrinuzun@gmail.com 31.07.2013 02.01.2014 Türk Hijyen ve Deneysel Biyoloji Dergisi DOI ID : 10.5505/TurkHijyen.2014.68916 Uzun B, Güngör S, Sezak N, Afşar İ, Şerifhan-İlgün M, Demirci M. Yoğun bakım hastalarının kan kültürlerinden izole edilen Pseudomonas aeruginosa ve Acinetobacter baumannii izolatlarının antibiyotik direnç yüzdelerindeki değişim. Turk Hij Den Biyol Derg, 2014; 71(1): 1-8. Changes in resistance percentage to antibiotics in Pseudomonas aeruginosa and Acinetobacter baumannii strains isolated from blood cultures of intensive care unit patients Cilt 71  Sayı 1  2014 2 Nosocomial infections pose a threat in difficult to treat patients, especially in the high-risk departments such as Intensive Care Units (ICUs) (1). Bloodstream infections are being reported as a leading cause of morbidity and mortality worldwide. Moreover, bloodstream infections represent about 15% of all nosocomial infections and causes of health care costs (2, 3). Pseudomonas aeruginosa and Acinetobacter baumannii are nonfermentative gram-negative bacteria that have minimal nutritional requirements and can survive on a wide variety of surfaces and in aqueous environments. Infections with P. aeruginosa or A. baumannii are of greatest concern for hospitalized patients, particularly those in ICUs, where these opportunistic pathogens are capable of developing severe invasive infections in critically ill and immunocompromised patients (4). In recent years, multiple antimicrobial resistance patterns of these bacteria have become as a major problem and a factor that complicates the treatment (5). Uncontrolled and intensive use of antimicrobials is one of the most important reasons for the increase of resistant strains. Each hospital should have data about their antimicrobial susceptibility patterns of nonfermentative bacteria to choose appropriate empirical treatment regimens for reducing morbidity and mortality. To have data about resistance percentage is required not only for assessment of treatment options but also to monitor the spread of resistant organisms or resistance genes throughout the hospital and community. Therefore each hospital must regularly follow their isolates, determine resistance percentage of antibiotics and regulate their own empirical treatment protocols according to these results (6). The present study was designed for this aim. INTRODUCTION RESISTANCE OF PSEUDOMONAS AERUGINOSA AND ACINETOBACTER BAUMANNII Turk Hij Den Biyol Derg olduğu görüldü. A. baumannii suşlarının sefepim ve amikasin direnç oranlarında ikinci periyotta ilkine oranla istatistiksel olarak anlamlı azalma saptandı (p değerleri, 0,0003 ve 0,0000). Ampisilin-sulbaktam, piperasilintazobaktam ve imipeneme karşı direnç oranlarında artış saptandı (p değerleri sırasıyla, 0,0003, 0,0210, 0,0033). Her iki bakteri türünde de kolistine direnç saptanmadı. A. baumannii izolatlarında tigesiklin direnci saptanmadı. Sonuç: Her hastanenin özellikle yoğun bakım birimlerinden izole edilen suşların antibiyotik direnç paternlerinin aktif sürveyansla takibi, ampirik tedavi yaklaşımlarını belirlemeye hizmet eder. Bu çalışmada antibiyotik kullanım politikasının hastane enfeksiyonları ile mücadelede önemli bir adım olduğu vurgulanmıştır. Sonuç olarak, direnç oranlarını azaltmak için, enfeksiyon kontrol önlemleri alınmalı, ampirik tedavi rejimleri sürekli gözden geçirilmeli ve aktif surveyans verilerine göre belirlenmelidir. Anahtar Sözcükler: Acinetobacter baumannii, Pseudomonas aeruginosa, antibiyotik direnci, kan kültürü, yoğun bakım ünitesi In A.baumannii strains, a statistically significant decrease was found in resistance percentage of cefepime and amikacin in the second period compared with the first (p values were 0.0003, 0.0000). Resistance percentage of ampicillin-sulbactam, piperacillin-tazobactam and imipenem was increased (p values were 0.0003, 0.0210, 0.0033). There was no colistin resistance determined in both species. Tigecycline resistance was not found in A. baumannii isolates. Conclusion: Active surveillance of antibiotic resistance percentages of isolated strains especially in ICUs serves to determine empirical treatment regimens in every institution. The present study emphasized that antibiotic usage policy is an important step to combat hospital infections. Consequently, infection control measures should be taken, empirical treatment regimens should be constantly reviewed, and should be determined according to active surveillance data in order to decrease resistance percentages.

türk hijyen ve deneysel biyoloji dergisi/türk hijiyen ve deneysel biyoloji dergisi

Changes in resistance percentage to antibiotics in Pseudomonas aeruginosa and Acinetobacter baumannii strains isolated from blood cultures of intensive care unit patients