Bayraktar Banu, Pelit Süleyman, Bulut Mehmet Emin, Aktaş Elif
Department of Medical Microbiology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Sisli Etfal Hastan Tip Bul. 2019 Mar 25;53(1):70-75. doi: 10.14744/SEMB.2018.60352. eCollection 2019.
Extended-spectrum beta-lactamases (ESBLs) have been detected more frequently in members of the family, particularly and . Infections caused by ESBL-producing bacteria are often resistant to treatment with various antibiotic classes and accompanied by increased complication risks, mortality, and costs. In this study, blood culture results were analyzed to determine the change in the ESBL production rate and antibiotic susceptibilities in and isolates over a period of 3 years.
The results of blood cultures sent to our laboratory between February 2014 and August 2016 were examined retrospectively. Repeat isolates from the same patient were not included when antibiotic susceptibility rates and clinical distributions were calculated. BD Bactec FX automated blood culture system (Becton Dickinson, Sparks, MD, USA) was used to examine the blood cultures. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (Bruker Daltonics, Bremen, Germany) was used to identify microorganisms. For antibiotic susceptibility tests (AST) and ESBL detection Kirby Bauer disk diffusion method or Phoenix automated system (Becton Dickinson, Sparks, MA, USA) was used. When the AST results were evaluated, Clinical and Laboratory Standards Institute breakpoints were used for 2014 and 2015, and European Committee on Antimicrobial Susceptibility Testing breakpoints were used for 2016.
During the 3-year period, 224 (35%) of 632 and 137 (31%) of 439 isolates were determined to be ES BL-producers. The ESBL-positive isolate percentage for and for 2014, 2015, and 2016 was 23%, 36%, 48% and 23%, 32%, 37%, respectively. The increase in ESBL was statistically significant for both (p<0.001) and (p=0.011). ESBL-positive and strains were most sensitive to carbapenem-class antibiotics, amikacin, and colistin. While there was no meropenem-resistant strain, 5 (3.3%) ertapenem-resistant and 1 (0.7%) imipenem-resistant ESBL strains were detected. The ESBL strain resistance rate to ertapenem, imipenem, and meropenem was 12%, 11.2%, and 11.1%, respectively. The resistance rates of K. pneumonia strains to ertapenem, imipenem, meropenem, and piperacillin-tazobactam increased significantly over the study period (p<0.001).
Monitoring ESBL rates and the antibiotic susceptibility of and strains of bloodstream infections is of the utmost importance in guiding empiric antibiotic therapies and patient management.
在某家族成员中，尤其是[具体成员1]和[具体成员2]，超广谱β-内酰胺酶（ESBLs）的检出频率更高。产ESBLs细菌引起的感染通常对多种抗生素类药物治疗耐药，并伴有并发症风险、死亡率和成本增加。在本研究中，分析了血培养结果，以确定[具体细菌1]和[具体细菌2]分离株在3年期间ESBL产生率和抗生素敏感性的变化。
回顾性检查2014年2月至2016年8月送至我们实验室的血培养结果。计算抗生素敏感性率和临床分布时，不包括同一患者的重复分离株。使用BD Bactec FX自动血培养系统（美国马里兰州斯帕克斯市BD公司）检查血培养。采用基质辅助激光解吸电离飞行时间质谱（德国不来梅市布鲁克道尔顿公司）鉴定微生物。抗生素敏感性试验（AST）和ESBL检测采用 Kirby Bauer纸片扩散法或Phoenix自动系统（美国马萨诸塞州斯帕克斯市BD公司）。评估AST结果时，2014年和2015年使用临床和实验室标准协会的断点，2016年使用欧洲抗菌药物敏感性试验委员会的断点。
在3年期间，632株[具体细菌1]中有224株（35%）和439株[具体细菌2]中有137株（31%）被确定为产ESBLs菌株。2014年、2015年和2016年[具体细菌1]和[具体细菌2]的ESBL阳性分离株百分比分别为23%、36%、48%和23%、32%、37%。[具体细菌1]和[具体细菌2]的ESBL增加在统计学上均有显著意义（[具体细菌1]，p<0.001；[具体细菌2]，p=0.011）。ESBL阳性的[具体细菌1]和[具体细菌2]菌株对碳青霉烯类抗生素、阿米卡星和黏菌素最敏感。虽然没有美罗培南耐药菌株，但检测到5株（3.3%）厄他培南耐药和1株（0.7%）亚胺培南耐药的ESBL[具体细菌1]菌株。[具体细菌1]菌株对厄他培南、亚胺培南和美罗培南的耐药率分别为12%、11.2%和11.1%。在研究期间，肺炎克雷伯菌菌株对厄他培南、亚胺培南、美罗培南和哌拉西林-他唑巴坦的耐药率显著增加（p<0.001）。
监测血流感染中[具体细菌1]和[具体细菌2]菌株的ESBL率和抗生素敏感性对于指导经验性抗生素治疗和患者管理至关重要。
