Abstract
Amaç: Pseudomonas aeruginosa, özellikle immünkompromize hastalarda hayati tehlike oluşturan hastane enfeksiyonlarına yol açan fırsatçı bir patojendir. Karbapenemler, çoklu ilaç direnci olan Pseudomonas aeruginosa izolatlarının neden olduğu ciddi enfeksiyonlara karşı son tedavi seçeneği olarak kabul edilmektedir. Karbapenemaz enziminin üretimi karbapenem direncinin ana mekanizmasıdır ve bu enzimler yüksek oranda aktarılabilir olduğundan ve terapötik seçenekleri sınırladığından dünya çapında ciddi bir sağlık sorunu haline gelmiştir. Karbapenemaz üretiminin hızlı tespiti, karbapenemaz üreten izolatların tedavisinin hızlı bir şekilde planlanması ve bu suşların yayılmasının önlenmesi için önemlidir. Bu çalışmada, karbapenem dirençli Pseudomonas aeruginosa izolatlarında karbapenemaz üretiminin Karbapenem inaktivasyon yöntemi ile araştırılması amaçlanmıştır.
Materyal ve Metod: Bu retrospektif kohort çalışmada 2016-2019 yılları arasında …….. Üniversitesi Araştırma ve Uygulama Hastanesi Mikrobiyoloji Laboratuvarına çeşitli kliniklerden gönderilen farklı örneklerden toplam 172 Pseudomonas aeruginosa izolatı değerlendirilmiştir. Toplam 172 izolatın 51'i (%29,7) karbapenem dirençli bulunarak çalışmaya dahil edilmiştir. İzolatların tanımlanması ve antibiyotik duyarlılık testleri Vitek 2 (Biomerieux, Fransa) otomatize sistemi ile gerçekleştirilmiştir. Karbapenem duyarlılıkları ayrıca disk difüzyon yöntemiyle de belirlenmiştir. İzolatlarda karbapenemaz üretimi Karbapenem inaktivasyon yöntemi ile araştırılmıştır.
Bulgular: Örnekler nöroloji (n =10), genel cerrahi (n =8), dahiliye (n =7) ve pediatri (n =6) dahil olmak üzere çeşitli klinik birimlerden gönderilmiştir. İzolatlar yara (n = 17), balgam (n = 15), kan (n = 11), idrar (n = 5) ve beyin omurilik sıvısı (n = 3) örneklerinden tanımlanmıştır. Örneklerin 32'si (%62,8) erkek, 19'u (%37,3) kadın hastalardan elde edilmiştir. Karbapeneme dirençli 51 izolatın 38'i (%74,5) hem imipenem hem de meropeneme dirençli bulunmuştur. Sekiz (%15,7) izolat sadece imipeneme ve beş (%9,8) izolat meropeneme dirençli bulunmuştur. Karbapenem inaktivasyon yöntemi ile 31 (%60,8) izolatta karbapenemaz üretimi tespit edilmiştir.
Sonuç: Karbapeneme dirençli Pseudomonas aeruginosa izolatları arasında karbapenemaz enzimlerinin fenotipik ve genotipik yaklaşımlar kullanılarak hızlı bir şekilde tanımlanması, karbapeneme dirençli izolatların neden olduğu enfeksiyonun bulaşmasını kontrol etmek ve bunlarla ilişkili morbidite ve mortaliteyi kontrol etmek için önemlidir. Bu çalışmada karbapenem inaktivasyon testi, karbapenemaz üretiminin tespitinde kolay ve hızlı uygulanabilmesi açısından laboratuvarda tercih edilebilecek bir yöntem olarak görülmüştür.
Ethical Statement
Bu çalışma Tokat Gaziosmanpaşa Üniversitesi Klinik Araştırmalar Etik Kurulu tarafından karar numarası: 21-KAEK-243 ile onaylanmıştır. Çalışmanın moleküler ayağı malzeme tamamlanmadığı için iptal edilmiştir.
Supporting Institution
Tokat Gaziosmanpaşa Üniversitesi Bilimsel Araştırma Proje birimi. Proje No: 2021/103
Project Number
2021/103
References
- 1. AL-Fridawy RAK, Al-Daraghi WAH, Alkhafaji MH. Isolation and identification of multidrug resistance among clinical and envi-ronmental Pseudomonas aeruginosa isolates. Iraqi J Biotech-nol. 2020;19(2):37-45.
- 2. Feng W, Huang Q, Wang Y, Yuan Q, Li X, Xia P, et al. Changes in the resistance and epidemiological characteristics of Pseu-domonas aeruginosa during a ten-year period. J Microbiol Immunol Infect. 2021 Apr;54(2):261-6.
- 3. Verma N, Prahraj AK, Mishra B, Behera B, Gupta K. Detection of carbapenemase-producing Pseudomonas aeruginosa by phenotypic and genotypic methods in a tertiary care hospital of East India. J Lab Physicians. 2019;11(4):287-91.
- 4. Centers for Disease Control and Prevention. (2019). Antibiotic resistance threats in the United States, 2019. US Department of Health and Human Services, Centres for Disease Control and Prevention.
- 5. Walsh F, Amyes SG. Carbapenem resistance in clinical iso-lates of Pseudomonas aeruginosa. J Chemother. 2007;19(4):376-81.
- 6. Çopur Çiçek A, Ertürk A, Ejder N, Rakici E, Kostakoğlu U, Yıldız İE et al. Screening of Antimicrobial Resistance Genes and Ep-idemiological Features in Hospital and Community-Associated Carbapenem-Resistant Pseudomonas aeruginosa Infections. Infect Drug Resist. 2021;14:1517-26.
- 7. Shaaban M, Al-Qahtani A, Al-Ahdal M, Barwa R. Molecular characterization of resistance mechanisms in Pseudomonas aeruginosa isolates resistant to carbapenems. J Infect Dev Ctries. 2018;11(12):935-43.
- 8. Aktaş E, Malkoçoğlu G, Otlu B, Çiçek AÇ, Külah C, Cömert F, et al. Evaluation of the Carbapenem Inactivation Method for De-tection of Carbapenemase-Producing Gram-Negative Bacteria in Comparison with the RAPIDEC CARBA NP. Microb Drug Re-sist. 2017;23(4):457-61.
- 9. van der Zwaluw K, de Haan A, Pluister GN, Bootsma HJ, de Neeling AJ & Schouls LM. The carbapenem inactivation meth-od (CIM), a simple and low-cost alternative for the Carba NP test to assess phenotypic carbapenemase activity in gram-negative rods, PLoS One 2015;10(3):e0123690.
- 10. Breakpoints tables for interpretation of MICs and zone diame-ters. EUCAST documents version 8.1. European Committee on Antimicrobial Susceptibility Testing, 2018. https://www.eucast.org/clinical_breakpoints
- 11. Silva A, Silva V, Igrejas G, Poeta P. Chapter 17 - Carbapenems and Pseudomonas aeruginosa: mechanisms and epidemiology. Antibiotics and Antimicrobial Resistance Genes in the Environment, Elsevier; 2020 pp. 253-268.
- 12. Ivanova, K. Carbapenemases-types and detection. Probl Inf Parasit Dis. 2014;42(2):9-13.
- 13. Acar A, Karaahmetoğlu G, Akalın H, Altay AF. Pooled preva-lence and trends of antimicrobial resistance in Pseudomonas aeruginosa clinical isolates over the past 10 years in Turkey: A meta-analysis. J Glob Antimicrob Resist. 2019;18:64-70.
- 14. Isik SA, Yenilmez E, Cetinkaya RA, Gorenek L, Kose S. A meta-analysis of antibiotic resistance rates in Pseudomonas aeru-ginosa isolated in blood cultures in Turkey between 2007 and 2017. North Clin Istanb. 2021;8(3):286-97.
- 15. Çolak M, Çakmaklıoğulları EK. Prevalence and antibiotic re-sistance of bacterial pathogens in respiratory tract samples of geriatric patients. J Surg Med. 2021;5(5):472-7.
- 16. Akhi MT, Khalili Y, Ghotaslou R, Kafil HS, Yousefi S, Nagili B, et al. Carbapenem inactivation: a very affordable and highly specific method for phenotypic detection of carbapenemase-producing Pseudomonas aeruginosa isolates compared with other methods. J Chemother. 2017;29(3):144-9.
- 17. Tijet N, Boyd D, Patel SN, Mulvey MR, Melano RG. Evaluation of the Carba NP test for rapid detection of carbapenemase-producing Enterobacteriaceae and Pseudomonas aeruginosa. Antimicrob Agents Chemother. 2013 Sep;57(9):4578-80.
- 18. Gutiérrez S, Correa A, Hernández-Gómez C, De La Cadena E, Pallares C, Villegas MV. Detection of carbapenemase-producing Pseudomonas aeruginosa: Evaluation of the car-bapenem inactivation method (CIM). Enferm Infecc Microbiol Clin (Engl Ed). 2019;37(10):648-51.
- 19. Beig M, Taheri M, Arabestani MR. Comparison of Different Phenotypic Tests versus PCR in the Detection of Car-bapenemase-Producing Pseudomonas aeruginosa Isolates in Hamadan, Iran. Int J Microbiol. 2021:5582615.
- 20. Malkoçoğlu G, Aktaş E, Bayraktar B, Otlu B, Bulut ME. VIM-1, VIM-2, and GES-5 Carbapenemases Among Pseudomonas ae-ruginosa Isolates at a Tertiary Hospital in Istanbul, Turkey. Microb Drug Resist. 2017;23(3):328-34.
- 21. Tufekci EF, Alkateeb A, Kilinc C, Gurbuz M, Altunoglu YC, Baloglu MC, et al. Investigation of metallo-beta-lactamase production in carbapenem- resistant Pseudomonas aerugino-sa isolated in Kastamonu training and Research Hospital, Tur-key. Malays J Microbiol. 2021;17(5): 593-600.
Investigation of Carbapenemase Production Among Carbapenem-Resistant Pseudomonas aeruginosa Isolates
Abstract
Background: Pseudomonas aeruginosa is an opportunist organism that causes potentially life threatening nosocomial infections, particularly in immunocompromised patients. Carbapenems are regarded to be the last line of treatment against severe infections caused by multi drug resistant P. aeruginosa isolates. isolates. Production of the carbapenemase enzyme is the primary mechanism of carbapenem resistance and has become a serious health concern worldwide as these enzymes are highly transferable and limit therapeutic alternatives. Rapid detection of carbapenemase production is important for prompt planning the treatment of car-bapenemase-producing isolates and preventing the spread of these strains. This study aimed to investigate carbapenemase produc-tion in carbapenem resistant Pseudomonas aeruginosa isolates by the Carbapenem inactivation method.
Materials and Methods: In this retrospective study a total of 172 Pseudomonas aeruginosa isolates were obtained from different samples sent from various clinics to Tokat Gaziosmanpaşa University Research and Application Hospital Microbiology Laboratory between 2016-2019 and were evaluated. Of the 172 isolates, 51 (29.7%) were found to be carbapenem- resistant and included in this investigation. Identification and antibiotic susceptibility tests of the isolates were performed with the Vitek 2 (Biomerieux, France) automated system. Carbapenem sensitivities were also determined by the disc diffusion method. Carbapenemase production in isolates was investigated by the Carbapenem inactivation method.
Results: These samples were sent from clinical units, such as neurology (n =10), general surgery (n =8), internal medicine (n =7), and pediatric (n =6). The isolates were identified from wounds (n = 17), sputum (n = 15), blood (n = 11), urine (n = 5), and cerebrospinal fluid (n = 3) samples. Of all the carbapenem –resistant samples 32 (62.8%) were obtained from male, and 19 (37.3%) from female patients. Of the 51 carbapenem resistant isolates, 38 (74.5%) were found to be resistant to both imipenem and meropenem. Eight (15.7%) isolates were found to be resistant to imipenem only, and five (9.8%) isolates were resistant to meropenem. Carbapenemase production was detected in 31 (60.8%) isolates by using using the Carbapenem inactivation method. The antibiotic resistance rates of the carbapenem-resistant isolates were as follows: piperacillin-tazobactam 65%, amikacin 6.8%, gentamicin 15.2%, ceftazidime 34.6%, cefepime 38.3%, ciprofloxacin 26.7%, levofloxacin 24.2%.
Conclusions: Rapid identification of carbapenemase enzymes among carbapenem resistant Pseudomonas aeruginosa isolates using phenotypic and genotypic approaches is important to control the transmission of infection caused by carbapenem-resistant isolates and to control the morbidity and mortality associated with them. In this study, the carbapenem inactivation test was seen as a method that can be preferred in the laboratory in terms of its easy and fast application in the detection of carbapenemase production.
Key Words: Pseudomonas aeruginosa, Carbapenem inactivation method, Antimicrobial resistance
Project Number
2021/103
References
- 1. AL-Fridawy RAK, Al-Daraghi WAH, Alkhafaji MH. Isolation and identification of multidrug resistance among clinical and envi-ronmental Pseudomonas aeruginosa isolates. Iraqi J Biotech-nol. 2020;19(2):37-45.
- 2. Feng W, Huang Q, Wang Y, Yuan Q, Li X, Xia P, et al. Changes in the resistance and epidemiological characteristics of Pseu-domonas aeruginosa during a ten-year period. J Microbiol Immunol Infect. 2021 Apr;54(2):261-6.
- 3. Verma N, Prahraj AK, Mishra B, Behera B, Gupta K. Detection of carbapenemase-producing Pseudomonas aeruginosa by phenotypic and genotypic methods in a tertiary care hospital of East India. J Lab Physicians. 2019;11(4):287-91.
- 4. Centers for Disease Control and Prevention. (2019). Antibiotic resistance threats in the United States, 2019. US Department of Health and Human Services, Centres for Disease Control and Prevention.
- 5. Walsh F, Amyes SG. Carbapenem resistance in clinical iso-lates of Pseudomonas aeruginosa. J Chemother. 2007;19(4):376-81.
- 6. Çopur Çiçek A, Ertürk A, Ejder N, Rakici E, Kostakoğlu U, Yıldız İE et al. Screening of Antimicrobial Resistance Genes and Ep-idemiological Features in Hospital and Community-Associated Carbapenem-Resistant Pseudomonas aeruginosa Infections. Infect Drug Resist. 2021;14:1517-26.
- 7. Shaaban M, Al-Qahtani A, Al-Ahdal M, Barwa R. Molecular characterization of resistance mechanisms in Pseudomonas aeruginosa isolates resistant to carbapenems. J Infect Dev Ctries. 2018;11(12):935-43.
- 8. Aktaş E, Malkoçoğlu G, Otlu B, Çiçek AÇ, Külah C, Cömert F, et al. Evaluation of the Carbapenem Inactivation Method for De-tection of Carbapenemase-Producing Gram-Negative Bacteria in Comparison with the RAPIDEC CARBA NP. Microb Drug Re-sist. 2017;23(4):457-61.
- 9. van der Zwaluw K, de Haan A, Pluister GN, Bootsma HJ, de Neeling AJ & Schouls LM. The carbapenem inactivation meth-od (CIM), a simple and low-cost alternative for the Carba NP test to assess phenotypic carbapenemase activity in gram-negative rods, PLoS One 2015;10(3):e0123690.
- 10. Breakpoints tables for interpretation of MICs and zone diame-ters. EUCAST documents version 8.1. European Committee on Antimicrobial Susceptibility Testing, 2018. https://www.eucast.org/clinical_breakpoints
- 11. Silva A, Silva V, Igrejas G, Poeta P. Chapter 17 - Carbapenems and Pseudomonas aeruginosa: mechanisms and epidemiology. Antibiotics and Antimicrobial Resistance Genes in the Environment, Elsevier; 2020 pp. 253-268.
- 12. Ivanova, K. Carbapenemases-types and detection. Probl Inf Parasit Dis. 2014;42(2):9-13.
- 13. Acar A, Karaahmetoğlu G, Akalın H, Altay AF. Pooled preva-lence and trends of antimicrobial resistance in Pseudomonas aeruginosa clinical isolates over the past 10 years in Turkey: A meta-analysis. J Glob Antimicrob Resist. 2019;18:64-70.
- 14. Isik SA, Yenilmez E, Cetinkaya RA, Gorenek L, Kose S. A meta-analysis of antibiotic resistance rates in Pseudomonas aeru-ginosa isolated in blood cultures in Turkey between 2007 and 2017. North Clin Istanb. 2021;8(3):286-97.
- 15. Çolak M, Çakmaklıoğulları EK. Prevalence and antibiotic re-sistance of bacterial pathogens in respiratory tract samples of geriatric patients. J Surg Med. 2021;5(5):472-7.
- 16. Akhi MT, Khalili Y, Ghotaslou R, Kafil HS, Yousefi S, Nagili B, et al. Carbapenem inactivation: a very affordable and highly specific method for phenotypic detection of carbapenemase-producing Pseudomonas aeruginosa isolates compared with other methods. J Chemother. 2017;29(3):144-9.
- 17. Tijet N, Boyd D, Patel SN, Mulvey MR, Melano RG. Evaluation of the Carba NP test for rapid detection of carbapenemase-producing Enterobacteriaceae and Pseudomonas aeruginosa. Antimicrob Agents Chemother. 2013 Sep;57(9):4578-80.
- 18. Gutiérrez S, Correa A, Hernández-Gómez C, De La Cadena E, Pallares C, Villegas MV. Detection of carbapenemase-producing Pseudomonas aeruginosa: Evaluation of the car-bapenem inactivation method (CIM). Enferm Infecc Microbiol Clin (Engl Ed). 2019;37(10):648-51.
- 19. Beig M, Taheri M, Arabestani MR. Comparison of Different Phenotypic Tests versus PCR in the Detection of Car-bapenemase-Producing Pseudomonas aeruginosa Isolates in Hamadan, Iran. Int J Microbiol. 2021:5582615.
- 20. Malkoçoğlu G, Aktaş E, Bayraktar B, Otlu B, Bulut ME. VIM-1, VIM-2, and GES-5 Carbapenemases Among Pseudomonas ae-ruginosa Isolates at a Tertiary Hospital in Istanbul, Turkey. Microb Drug Resist. 2017;23(3):328-34.
- 21. Tufekci EF, Alkateeb A, Kilinc C, Gurbuz M, Altunoglu YC, Baloglu MC, et al. Investigation of metallo-beta-lactamase production in carbapenem- resistant Pseudomonas aerugino-sa isolated in Kastamonu training and Research Hospital, Tur-key. Malays J Microbiol. 2021;17(5): 593-600.
Details
| Primary Language | English |
|---|---|
| Subjects | Medical Bacteriology |
| Journal Section | Research Article |
| Authors | |
| Project Number | 2021/103 |
| Early Pub Date | March 18, 2024 |
| Publication Date | April 29, 2024 |
| Submission Date | December 14, 2023 |
| Acceptance Date | February 23, 2024 |
| Published in Issue | Year 2024 Volume: 21 Issue: 1 |
Harran Üniversitesi Tıp Fakültesi Dergisi / Journal of Harran University Medical Faculty