{"id":22120,"date":"2021-04-30T18:16:44","date_gmt":"2021-04-30T15:16:44","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=22120"},"modified":"2021-06-02T14:01:32","modified_gmt":"2021-06-02T11:01:32","slug":"hastane-ve-toplum-kokenli-infeksiyonlardan-izole-edilen-pseudomonas-aeruginosa-suslarinda-antibiyotik-direnci-kuzey-kibrista-guncel-durum","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2021\/04\/30\/hastane-ve-toplum-kokenli-infeksiyonlardan-izole-edilen-pseudomonas-aeruginosa-suslarinda-antibiyotik-direnci-kuzey-kibrista-guncel-durum\/","title":{"rendered":"Hastane ve Toplum K\u00f6kenli \u0130nfeksiyonlardan \u0130zole Edilen Pseudomonas aeruginosa <\/i>Su\u015flar\u0131nda Antibiyotik Direnci: Kuzey K\u0131br\u0131s\u2019ta G\u00fcncel Durum"},"content":{"rendered":"

G\u0130R\u0130\u015e<\/b><\/h2>\n

Bakterilerin antibiyotiklere diren\u00e7 geli\u015ftirmesi son y\u0131llarda d\u00fcnya \u00e7ap\u0131nda morbidite ve mortaliteyi art\u0131ran ciddi bir sorun haline gelmi\u015ftir (1). Pseudomonas aeruginosa,<\/i> \u00f6zellikle hastane kaynakl\u0131 infeksiyonlarda ve geni\u015f spektrumlu antibiyotik kullan\u0131m\u0131n\u0131n, invazif uygulamalar\u0131n ve hasta-sa\u011fl\u0131k personelinin temas s\u0131kl\u0131\u011f\u0131n\u0131n daha \u00e7ok oldu\u011fu yo\u011fun bak\u0131m \u00fcnitelerinde \u00f6nemli bir tehdit etkeni olarak g\u00f6r\u00fclmektedir (2). \u0130nsan flora elemanlar\u0131ndan biri olan P. aeruginosa<\/i>, ba\u011f\u0131\u015f\u0131kl\u0131k sistemi bask\u0131lanm\u0131\u015f hastalarda \u00fcriner sistem, solunum sistemi, yan\u0131k, g\u00f6z ve yara infeksiyonlar\u0131na neden olabilen f\u0131rsat\u00e7\u0131 bir patojendir. P. aeruginosa<\/i> d\u00fcnya genelinde nozokomiyal infeksiyonlar\u0131n %10-15\u2019inden sorumludur (3). D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6) taraf\u0131ndan 2017 y\u0131l\u0131nda yay\u0131nlanan raporda, insan sa\u011fl\u0131\u011f\u0131n\u0131 tehdit eden ve tedavide yeni antibiyotiklere ihtiya\u00e7 duyulan en kritik patojenler listesinin ba\u015f\u0131nda karbapeneme diren\u00e7li P. aeruginosa <\/i>oldu\u011fu vurgulanm\u0131\u015ft\u0131r (4).<\/p>\n

P. aeruginosa <\/i>bir\u00e7ok antibiyoti\u011fe do\u011fal olarak diren\u00e7lidir. Bunun yan\u0131 s\u0131ra hem toplum hem de hastanelerde yanl\u0131\u015f ve uygun olmayan antibiyotik kullan\u0131m\u0131, diren\u00e7 geli\u015fimini art\u0131rmakta, hastanelerdeki yo\u011fun antibiyotik bask\u0131s\u0131yla birlikte diren\u00e7li su\u015flar\u0131n ortaya \u00e7\u0131kmas\u0131na ve yay\u0131lmas\u0131na neden olmaktad\u0131r (5). Duyarl\u0131 izolatlar\u0131n tedavi sonras\u0131nda diren\u00e7 kazanmas\u0131 ve P. aeruginosa <\/i>su\u015flar\u0131nda \u00e7oklu ila\u00e7 direnci (\u00c7\u0130D) geli\u015fmesi infeksiyonlar\u0131n tedavisini gittik\u00e7e zorla\u015ft\u0131rmaktad\u0131r. Antips\u00f6domonal penisilinler ve sefalosporinler, aminoglikozidler, florokinolonlar ve karbapenemler gibi s\u0131n\u0131rl\u0131 say\u0131daki antibiyoti\u011fin P. aeruginosa<\/i>\u2019ya etkili olmas\u0131 nedeniyle, bu ila\u00e7lara kar\u015f\u0131 geli\u015fen diren\u00e7 oranlar\u0131n\u0131n takibi ve kontrol\u00fc \u00f6nem ta\u015f\u0131maktad\u0131r. P. aeruginosa<\/i> su\u015flar\u0131n\u0131n duyarl\u0131l\u0131k oranlar\u0131 farkl\u0131 \u00fclkeler, b\u00f6lgeler, hastaneler, hatta farkl\u0131 hastane servisleri aras\u0131nda farkl\u0131l\u0131k g\u00f6stermektedir (6). Bu nedenle diren\u00e7 paternlerinin rutin olarak takip edilmesi ve tedavilerin yerel epidemiyolojik veriler \u0131\u015f\u0131\u011f\u0131nda antibiyotik duyarl\u0131l\u0131k testleri yap\u0131larak uygulanmas\u0131 gerekmektedir. \u00d6zellikle ampirik tedavi verilmesi gereken durumlarda, b\u00f6lge veya hastanede yap\u0131lm\u0131\u015f diren\u00e7 da\u011f\u0131l\u0131m\u0131 \u00e7al\u0131\u015fmalar\u0131n\u0131n dikkate al\u0131nmas\u0131n\u0131n tedavinin ba\u015far\u0131s\u0131nda rol oynad\u0131\u011f\u0131 bilinmektedir. \u00a0<\/span><\/p>\n

Kuzey K\u0131br\u0131s\u2019ta hastane ve toplum k\u00f6kenli bakteriyel patojenlerin antibiyotik diren\u00e7 profilleri hakk\u0131nda \u00e7ok az veri bulunmaktad\u0131r. \u00dclke \u00e7ap\u0131nda aktif s\u00fcrveyans \u00e7al\u0131\u015fmalar\u0131 yap\u0131lmad\u0131\u011f\u0131ndan b\u00f6lge ve hastane baz\u0131nda diren\u00e7li bakteri prevalans\u0131 bilinmemekle birlikte, toplumda sirk\u00fcle eden su\u015flar ve bu su\u015flar\u0131n ta\u015f\u0131d\u0131\u011f\u0131 diren\u00e7 genleri hen\u00fcz karakterize edilmemi\u015ftir. P. aeruginosa <\/i>tedavisinde kullan\u0131lan antimikrobiyal ajanlara kar\u015f\u0131 olu\u015fan diren\u00e7 geli\u015fimiyle ilgili bilgilerin g\u00fcncellenmesi y\u00f6n\u00fcnden yeni verilere ihtiya\u00e7 duyulmaktad\u0131r. Bu \u00e7al\u0131\u015fmada, Kuzey K\u0131br\u0131s\u2019ta bulunan bir hastanenin Mikrobiyoloji Laboratuvar\u0131na, Eyl\u00fcl 2016-Ekim 2019 tarihleri aras\u0131nda \u00e7e\u015fitli poliklinik ve kliniklerden g\u00f6nderilen \u00f6rneklerden izole edilen P. aeruginosa <\/i>su\u015flar\u0131n\u0131n, kullan\u0131lan antibiyotiklere diren\u00e7 oranlar\u0131n\u0131n tespit edilmesi ve bu konudaki literat\u00fcre ve ampirik tedavi modelleri olu\u015fturulmas\u0131na katk\u0131da bulunulmas\u0131 ama\u00e7lanm\u0131\u015ft\u0131r.\u00a0<\/span><\/p>\n

Y\u00d6NTEMLER<\/b><\/h2>\n

\u00c7al\u0131\u015fmam\u0131zda, hastanemizin Mikrobiyoloji Laboratuvar\u0131nda Eyl\u00fcl 2016-Ekim 2019 tarihleri aras\u0131nda \u00e7e\u015fitli klinik numunelerden izole edilen 504 P. aeruginosa<\/i> su\u015fu retrospektif olarak de\u011ferlendirmeye al\u0131nm\u0131\u015ft\u0131r. Laboratuvar\u0131m\u0131za gelen \u00f6rnekler rutin olarak kanl\u0131 ve \u201ceosin methylene blue\u201d (EMB) agara ekilmi\u015f ve aerobik ortamda 24-48 saat 35-37\u00b0C\u2019de ink\u00fcbe edilmi\u015ftir. \u00dcreme g\u00f6zlenen \u00f6rneklerin identifikasyon ve antibiyotik duyarl\u0131l\u0131k testleri BD Phoenix\u2122 100 (BD Diagnostic Instrument Systems, Becton Dickinson Co., Sparks, Maryland, ABD) tam otomatize bakteri tan\u0131mlama sistemi taraf\u0131ndan, \u201cEuropean Committee on Antimicrobial Susceptibility Testing\u201d (EUCAST) kriterlerine g\u00f6re belirlenmi\u015ftir. Besiyerlerinde \u00fcreyen su\u015flardan \u00fcretici firman\u0131n \u00f6nerileri do\u011frultusunda 0.45-0.55 McFarland s\u00fcspansiyonlar\u0131 haz\u0131rlan\u0131p, Phoenix NMIC\/ID-400 ve UNMIC\/ID-401 panellerinde \u00e7al\u0131\u015f\u0131lm\u0131\u015ft\u0131r. \u0130zole edilen <\/b>P. aeruginosa<\/i> su\u015flar\u0131nda amikasin, aztreonam, sefepim, seftazidim, siprofloksasin, gentamisin, kolistin, imipenem, meropenem ve piperasilin\/tazobaktam antibiyotik duyarl\u0131l\u0131klar\u0131 dikkate al\u0131nm\u0131\u015ft\u0131r. Orta duyarl\u0131 olarak belirlenen izolatlar diren\u00e7li olarak kabul edilmi\u015ftir. Ayn\u0131<\/b> hastaya ait tekrarlayan izolatlar \u00e7al\u0131\u015f<\/b>ma d\u0131\u015f\u0131 tutulmu\u015ftur.\u00a0<\/span><\/p>\n

P. aeruginosa<\/i> su\u015flar\u0131 ba\u015fta y\u0131llar olmak \u00fczere, geldi\u011fi hastane servis\/poliklini\u011fi, \u00f6rnek t\u00fcr\u00fc, ba\u015fvuru t\u00fcr\u00fc (yatan\/ayaktan), cinsiyet ve ya\u015f gibi demografik \u00f6zellikler kullan\u0131larak k\u0131yaslanm\u0131\u015ft\u0131r. \u0130statistiksel analizler SPSS for Windows. Version 15.0 (Statistical Package for the Social Sciences, SPSS Inc., Chicago, IL, ABD) program\u0131yla Pearson \u03c72 <\/b>testi kullan\u0131larak yap\u0131lm\u0131\u015ft\u0131r. Kullan\u0131lan testler i\u00e7in p<<\/i>0.05 de\u011feri istatistiksel olarak anlaml\u0131 kabul edilmi\u015ftir. 2016-2019 y\u0131llar\u0131 i\u00e7in elde edilen antimikrobiyal diren\u00e7 verileri, 2010-2014 y\u0131llar\u0131 aras\u0131nda hastanemizde elde edilen verilerle (7) kar\u015f\u0131la\u015ft\u0131r\u0131lm\u0131\u015ft\u0131r.<\/p>\n

BULGULAR<\/b><\/h2>\n
\"\"<\/a>

Tablo 1. <\/strong>P. aeruginosa<\/i> Su\u015flar\u0131n\u0131n Izole Edildi\u011fi \u00d6rneklerin Kliniklere G\u00f6re Da\u011f\u0131l\u0131m\u0131<\/p><\/div>\n

\"\"<\/a>

Tablo 2.<\/strong>. P. aeruginosa<\/i> su\u015flar\u0131n\u0131n izole edildi\u011fi \u00f6rnek t\u00fcrlerine g\u00f6re da\u011f\u0131l\u0131m\u0131<\/p><\/div>\n

\"\"<\/a>

Tablo 3.<\/strong> \u0130zole Edilen 504 P. aeruginosa<\/i> Su\u015funun Antibiyotik Diren\u00e7 Oranlar\u0131<\/p><\/div>\n

\u00c7e\u015fitli k\u00fclt\u00fcr \u00f6rneklerinden (idrar, balgam, derin trakeal aspirat, kan, kateter ucu, apse\/yara materyali, beyin omurilik s\u0131v\u0131s\u0131, bron\u015f lavaj, \u00fcretral ak\u0131nt\u0131) izole edilen ve infeksiyon etkeni olarak kabul edilen toplam 504 P. aeruginosa <\/i>su\u015fu \u00e7al\u0131\u015fmaya dahil edilmi\u015ftir. \u0130ncelenen su\u015f say\u0131s\u0131 Eyl\u00fcl 2016-Eyl\u00fcl 2017 tarihleri aras\u0131nda 154 (%30.6), Ekim 2017-Eyl\u00fcl 2018 aras\u0131nda 174 (%34.5) ve Ekim 2018-Ekim 2019 aras\u0131nda ise 176 (%34.9) idi. Hastalar ba\u015fvuru t\u00fcr\u00fcne g\u00f6re de\u011ferlendirildi\u011finde, 357 (%70.8)\u2019sinin yatan, 147 (%29.2)\u2019sinin ise ayaktan hasta oldu\u011fu belirlenmi\u015ftir. Ya\u015flar\u0131 0-96 aras\u0131nda de\u011fi\u015fen hastalardan 263 (%52.2)\u2019\u00fcn\u00fcn erkek, 241 (%47.8)\u2019inin ise kad\u0131n oldu\u011fu tespit edilmi\u015ftir. Hastalar\u0131n ya\u015f gruplar\u0131na g\u00f6re da\u011f\u0131l\u0131m\u0131nda >65 grubunda 250 (%49.6), 45-65 grubunda 135 (%26.8), 15-44 grubunda 67 (%13.3) ve <15 grubunda 52 (%10.3) hasta oldu\u011fu g\u00f6r\u00fclm\u00fc\u015ft\u00fcr.<\/p>\n

P. aeruginosa<\/i> su\u015flar\u0131n\u0131n izole edildi\u011fi \u00f6rneklerin en s\u0131k g\u00f6nderildi\u011fi b\u00f6l\u00fcmler %35.9 oran\u0131yla yo\u011fun bak\u0131m servisi ve %8.3 oran\u0131yla g\u00f6\u011f\u00fcs hastal\u0131klar\u0131 ve alerji servisi olarak belirlenmi\u015ftir. Su\u015flar\u0131n izole edildi\u011fi \u00f6rneklerin g\u00f6nderildi\u011fi kliniklere g\u00f6re da\u011f\u0131l\u0131m\u0131 Tablo 1\u2019de g\u00f6sterilmi\u015ftir. Su\u015flar\u0131n %37.3 oran\u0131yla b\u00fcy\u00fck bir \u00e7o\u011funlu\u011fu idrar, %17.9\u2019u derin trakeal aspirat, %17.9\u2019u apse\/yara materyali, %14.1\u2019i balgam, %6.3\u2019\u00fc kan, %4.6\u2019s\u0131 kateter ucu ve %1.9\u2019u di\u011fer (\u00fcretral ak\u0131nt\u0131\/s\u00fcr\u00fcnt\u00fc, beyin omurilik s\u0131v\u0131s\u0131 ve bron\u015f lavaj) k\u00fclt\u00fcrlerinden izole edilmi\u015ftir. Su\u015flar\u0131n izole edildi\u011fi \u00f6rnek t\u00fcrlerine g\u00f6re da\u011f\u0131l\u0131m\u0131 Tablo 2\u2019de g\u00f6sterilmi\u015ftir.<\/p>\n

\"\"<\/a>

\u015eekil 1.<\/strong> P. aeruginosa <\/i>su\u015flar\u0131n\u0131n y\u0131llara g\u00f6re antimikrobiyallere diren\u00e7 oranlar\u0131 (2016-2019).<\/p><\/div>\n

\"\"<\/a>

\u015eekil 2.<\/strong> P. aeruginosa<\/i> su\u015flar\u0131n\u0131n 2010-2014 ve 2016-2019 y\u0131llar\u0131 i\u00e7erisinde izlenen diren\u00e7 profilleri kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131.<\/p><\/div>\n

\"\"<\/a>

\u015eekil 3.<\/strong> P. aeruginosa <\/i>su\u015flar\u0131n\u0131nda y\u0131llara g\u00f6re izlenen \u00e7oklu ila\u00e7 direnci (2016-2019).<\/p><\/div>\n

Antibiyotik diren\u00e7 profilleri de\u011ferlendirildi\u011finde, hastanemizde en y\u00fcksek diren\u00e7 aztreonam (%47.7) ve sefepim (%32) antibiyotiklerinde g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Su\u015flar\u0131n antibiyotik duyarl\u0131l\u0131klar\u0131 incelendi\u011finde ise \u00e7al\u0131\u015fmaya al\u0131nan su\u015flar en \u00e7ok amikasin (%94.7), kolistin (%87.8) ve gentamisine (%86.5) duyarl\u0131 bulunmu\u015ftur. Test edilen t\u00fcm antibiyotiklere diren\u00e7 durumu Tablo 3\u2019te g\u00f6sterilmi\u015ftir. Y\u0131llara g\u00f6re P. aeruginosa <\/i>antimikrobiyal diren\u00e7 oranlar\u0131 de\u011ferlendirildi\u011finde, sefepim direncinin her y\u0131l istatistiksel olarak anlaml\u0131 d\u00fczeyde artt\u0131\u011f\u0131 g\u00f6zlenmi\u015ftir (p<<\/i>0.05; p=<\/i>0.011). Bunun yan\u0131 s\u0131ra, imipenem direncinde Eyl\u00fcl 2016-Eyl\u00fcl 2018 tarihleri aras\u0131nda art\u0131\u015f g\u00f6r\u00fcl\u00fcrken, Ekim 2018-Ekim 2019 d\u00f6neminde ise anlaml\u0131 bir d\u00fc\u015f\u00fc\u015f saptanm\u0131\u015ft\u0131r (p<<\/i>0.05). Seftazidim ve piperasilin\/tazobaktam direnci s\u0131ras\u0131yla %26.3 ve %19.7 olarak saptanm\u0131\u015f, her y\u0131l art\u0131\u015f olmas\u0131na ra\u011fmen istatistiksel olarak anlaml\u0131 bulunmam\u0131\u015ft\u0131r (s\u0131ras\u0131yla p<\/i>>0.05). Aztreonam, siprofloksasin, meropenem ve gentamisin direnci incelendi\u011finde ise, 2016-2018 y\u0131llar\u0131 aras\u0131nda art\u0131\u015f, 2018-2019 y\u0131llar\u0131 aras\u0131nda ise bir d\u00fc\u015f\u00fc\u015f g\u00f6r\u00fclmesine ra\u011fmen istatistiksel olarak anlaml\u0131 bulunmam\u0131\u015ft\u0131r (s\u0131ras\u0131yla p><\/i>0.05). P. aeruginosa <\/i>su\u015flar\u0131n\u0131n y\u0131llara g\u00f6re antimikrobiyallere diren\u00e7 oranlar\u0131 \u015eekil 1\u2019de verilmi\u015ftir.<\/p>\n

\u00c7al\u0131\u015fmam\u0131zda elde etti\u011fimiz 2016-2019 verileri, hastanemizde 2010-2014 y\u0131llar\u0131 aras\u0131nda klinik \u00f6rneklerden izole edilen 186 P. aeruginosa <\/i>su\u015funun antibiyotik diren\u00e7 verileriyle (7) kar\u015f\u0131la\u015ft\u0131r\u0131lm\u0131\u015ft\u0131r. Analiz sonu\u00e7lar\u0131 de\u011ferlendirildi\u011finde, son \u00fc\u00e7 y\u0131lda \u00f6zellikle imipenem (%11.8\u2019den %26.4\u2019e), meropenem (%6.5\u2019ten 24.6\u2019ya), sefepim (%4.9\u2019dan %32\u2019ye), piperasilin\/tazobaktam (%6.5\u2019ten 19.7\u2019ye), seftazidim (19.5\u2019ten 26.3\u2019e) ve siprofloksasin (18.8\u2019den 25.6\u2019ya) direncinde \u00f6nemli bir art\u0131\u015f saptanm\u0131\u015ft\u0131r. Hastanemizde son \u00fc\u00e7 y\u0131lda izole edilen su\u015flar\u0131n kolistin, amikasin, gentamisin ve aztreonam duyarl\u0131l\u0131klar\u0131nda, \u00f6nceki y\u0131llara g\u00f6re, \u00f6nemli bir de\u011fi\u015fiklik izlenmemi\u015ftir. P. aeruginosa <\/i>su\u015flar\u0131n\u0131n 2010-2014 ve 2016-2019 y\u0131llar\u0131 i\u00e7erisinde izlenen diren\u00e7 paternlerinin kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131 \u015eekil 2\u2019de g\u00f6sterilmi\u015ftir.\u00a0<\/span><\/p>\n

\u00c7al\u0131\u015fmam\u0131z\u0131n verileri \u00c7\u0130D profilleri a\u00e7\u0131s\u0131ndan de\u011ferlendirildi\u011finde, 2016-2019 y\u0131llar\u0131 aras\u0131nda \u00c7\u0130D P. aeruginosa<\/i> oran\u0131 %19.2 olarak belirlenmi\u015ftir. Eyl\u00fcl 2016-Ekim 2017 aras\u0131nda \u00c7\u0130D P. aeruginosa<\/i> oran\u0131 %16.9, Ekim 2017-Eyl\u00fcl 2018 aras\u0131nda %22.4, ve Ekim 2018-Eyl\u00fcl 2019 aras\u0131nda %18.2 olarak saptanm\u0131\u015ft\u0131r. Y\u0131llar aras\u0131nda izlenen \u00c7\u0130D P. aeruginosa<\/i> oranlar\u0131 \u015eekil 3\u2019te g\u00f6sterilmi\u015ftir.<\/p>\n

\u0130RDELEME<\/b><\/h2>\n

Diren\u00e7li hastane infeksiyonlar\u0131 etkeni Gram-negatif patojenler aras\u0131nda P. aeruginosa<\/i>, <\/i>son y\u0131llarda antibiyotiklere \u00e7oklu diren\u00e7 g\u00f6stererek klinisyenlerin tedavi se\u00e7eneklerini giderek azaltmaktad\u0131r (8,9). Kuzey K\u0131br\u0131s genelinde aktif s\u00fcrveyans yap\u0131lmamakla birlikte, hastanelerde ve toplumda sirk\u00fcle eden infeksiyon etkenlerinin diren\u00e7 profilleri hakk\u0131nda literat\u00fcrde yeterli veri bulunmamaktad\u0131r. Bu nedenle \u00e7al\u0131\u015fmam\u0131zda, hastanemizde son \u00fc\u00e7 y\u0131lda izole edilen P. aeruginosa <\/i>izolatlar\u0131nda g\u00f6r\u00fclen diren\u00e7 oranlar\u0131 incelenmi\u015ftir.<\/p>\n

P. aeruginosa <\/i>infeksiyonlar\u0131nda etkenin izole edildi\u011fi \u00f6rnek t\u00fcrlerini inceleyen \u00e7al\u0131\u015fmalarda, P. aeruginosa<\/i> su\u015flar\u0131n\u0131n\u0131n %38.2-60.6 oran\u0131nda solunum yolu, %18-27.8 idrar, %5.3-22 kan ve %6.3-18 apse\/yara kaynakl\u0131 oldu\u011fu g\u00f6sterilmi\u015ftir (10-12). Bu \u00e7al\u0131\u015fmada ise, 504 P. aeruginosa <\/i>su\u015funun %37.3\u2019\u00fc idrar, %17.9\u2019u derin trakeal aspirat, %17.9\u2019u apse\/yara materyali, %14.1\u2019i balgam, %6.3\u2019\u00fc kan, %4.6\u2019s\u0131 kateter ucu ve %1.9\u2019u di\u011fer materyal (\u00fcretral ak\u0131nt\u0131\/s\u00fcr\u00fcnt\u00fc, beyin omurilik s\u0131v\u0131s\u0131 ve bron\u015f lavaj) k\u00fclt\u00fcrlerinden izole edilmi\u015ftir.\u00a0<\/span><\/p>\n

T\u00fcrkiye\u2019de daha \u00f6nce yap\u0131lan s\u00fcrveyans \u00e7al\u0131\u015fmalar\u0131nda, antimikrobiyal duyarl\u0131l\u0131k oranlar\u0131nda hastanelerdeki antibiyotik kullan\u0131m politikalar\u0131na ve hastane servislerine g\u00f6re de\u011fi\u015fiklik g\u00f6steren bir tablo ortaya konulmu\u015ftur. 2007-2019 y\u0131llar\u0131 aras\u0131 yap\u0131lan antibiyotik diren\u00e7 oranlar\u0131 de\u011ferlendirmelerinde, \u03b2-laktam antibiyotiklerinden sefepim, seftazidim, piperasilin\/tazobaktam, aztreonam, imipenem ve meropenem direnci s\u0131ras\u0131yla %10.4-45, %8.5-42, %5.2-53, %7.8-33.3, %7.8-53.1 ve %23.9-54.1 olarak bildirilmi\u015ftir (13-20). \u00d6zellikle yo\u011fun bak\u0131m \u00fcnitelerinde yatan hastalardan izole edilen P. aeruginosa <\/i>su\u015flar\u0131nda diren\u00e7 oranlar\u0131n\u0131n daha y\u00fcksek oldu\u011fu belirlenmi\u015ftir (21). \u00c7al\u0131\u015fmam\u0131zda ise, 2016-2019 y\u0131llar\u0131 aras\u0131nda hastane kliniklerimizde izlenen hastalarda \u03b2-laktam antibiyotik direnci paternleri sefepim, seftazidim, piperasilin\/tazobaktam, aztreonam, imipenem ve meropenem i\u00e7in s\u0131ras\u0131yla %32, %26.3, %19.7, %47.7, %26.4 ve %24.6 olarak saptanm\u0131\u015ft\u0131r. \u00d6zellikle y\u0131llar i\u00e7inde diren\u00e7 da\u011f\u0131l\u0131m\u0131 incelendi\u011finde, sefepim direncinde bu s\u00fcre\u00e7te her y\u0131l art\u0131\u015f oldu\u011fu g\u00f6r\u00fclm\u00fc\u015ft\u00fcr. Sefepim, hastanemizde nadir kullan\u0131lmakla birlikte %32 oran\u0131nda en diren\u00e7li ikinci antibiyotik olarak tespit edilmi\u015ftir. Aztreonam ise \u00fclkemizde son y\u0131llarda P. aeruginosa<\/i> tedavisinde kullan\u0131lmayan bir antibiyotiktir. \u00c7al\u0131\u015fmaya al\u0131nan su\u015flarda g\u00f6r\u00fclen %47.7 aztreonam direncinin, Pseudomonas<\/i> t\u00fcrlerinde g\u00f6r\u00fclen plazmid kontrol\u00fcndeki geni\u015flemi\u015f spektrumlu \u03b2-laktamaz (GSBL) ve kromozomal ind\u00fcklenebilir \u03b2-laktamaz (IBL) sentezini ind\u00fckleyebilen ve tedavide aktif kullan\u0131mda olan di\u011fer antibiyotik gruplar\u0131ndan kaynakl\u0131 oldu\u011fu d\u00fc\u015f\u00fcn\u00fclmektedir.\u00a0<\/span><\/p>\n

P. aeruginosa<\/i> infeksiyonlar\u0131 tedavisinde en etkin \u03b2-laktam grubu antibiyotikler olarak bilinen karbapenemlere d\u00fcnya \u00e7ap\u0131nda duyarl\u0131l\u0131k azalmas\u0131 rapor edilmi\u015ftir (22-24). \u00c7al\u0131\u015fma verilerimiz incelendi\u011finde, izolatlar\u0131n imipenem direncinde 2016-2018 y\u0131llar\u0131 aras\u0131nda art\u0131\u015f, fakat 2018-2019 y\u0131l\u0131nda anlaml\u0131 bir d\u00fc\u015f\u00fc\u015f saptanm\u0131\u015ft\u0131r. Buna ra\u011fmen, Kuzey K\u0131br\u0131s\u2019ta 2010-2014 y\u0131llar\u0131 aras\u0131ndaki hastanemizdeki diren\u00e7 profillerini rapor eden \u00e7al\u0131\u015fma verileriyle 2016-2019 \u00e7al\u0131\u015fma sonu\u00e7lar\u0131m\u0131z kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda, son \u00fc\u00e7 y\u0131lda imipenem ve meropenem direncinde, s\u0131ras\u0131yla %11.8\u2019den %26.4\u2019e ve %6.5\u2019den %24.7\u2019ye, \u00f6nemli bir art\u0131\u015f oldu\u011fu g\u00f6zlenmi\u015ftir (7).\u00a0<\/span><\/p>\n

Kinolon grubu antibiyotikler P. aeruginosa <\/i>infeksiyonlar\u0131n\u0131n tedavisinde tek ba\u015flar\u0131na veya di\u011fer antibiyotiklerle kombinasyon tedavisi \u015feklinde kullan\u0131lmaktad\u0131r. T\u00fcrkiye genelinde yap\u0131lan baz\u0131 \u00e7al\u0131\u015fmalarda siprofloksasin i\u00e7in diren\u00e7 oran\u0131 %7.2-47 olarak bildirilmi\u015ftir (25). \u00c7al\u0131\u015fmam\u0131zda hastanemizin siprofloksasin direnci %25.6 olarak belirlenmi\u015f, 2016-2018 y\u0131llar\u0131 aras\u0131nda art\u0131\u015f g\u00f6zlemlenmesine ra\u011fmen istatistiksel olarak anlaml\u0131 bulunmam\u0131\u015ft\u0131r. Ruh ve arkada\u015flar\u0131 (7)\u2019n\u0131n Kuzey K\u0131br\u0131s\u2019ta 2016\u2019da yapt\u0131klar\u0131 ara\u015ft\u0131rmayla kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda 2010-2014 y\u0131llar\u0131nda saptanan %18.8 oran\u0131yla siprofloksasin direncinde \u00fclkemizde son \u00fc\u00e7 y\u0131lda bir art\u0131\u015f tespit edilmi\u015ftir.<\/sup><\/p>\n

T\u00fcrkiye\u2019de aminoglikozid direnci prevalans\u0131na y\u00f6nelik yap\u0131lan \u00e7al\u0131\u015fmalar, Gram-negatif bakterilerde aminoglikozidlere kar\u015f\u0131 direncin d\u00fc\u015f\u00fck oranlarda oldu\u011funu ortaya koymu\u015ftur. Aminoglikozid duyarl\u0131l\u0131\u011f\u0131na y\u00f6nelik \u00fclkede yap\u0131lan \u00e7al\u0131\u015fmalar incelendi\u011finde Beh\u00e7et ve arkada\u015flar\u0131 (26) amikasine %11.6, gentamisine %19.7 oran\u0131nda diren\u00e7 saptam\u0131\u015flard\u0131r. Benzer veriler Say Co\u015fkun ve Co\u015fkun (16)\u2019un 2018 y\u0131l\u0131nda yapm\u0131\u015f oldu\u011fu ara\u015ft\u0131rmada %19 ve %30, T\u00fcmer ve arkada\u015flar\u0131 (11)\u2019n\u0131n 2015\u2019teki sonu\u00e7lar\u0131na g\u00f6re %12 ve %28.8 amikasin ve gentamisin direnci olarak belirtilmi\u015ftir. \u00c7al\u0131\u015fmam\u0131zda ise amikasin ve gentamisin diren\u00e7 profilleri %5.3 ve %13.5 olarak saptanm\u0131\u015f ve amikasinin, di\u011fer incelemelere paralel olarak, hastanemizde izole edilen su\u015flar\u0131n en duyarl\u0131 oldu\u011fu antibiyotikler aras\u0131nda oldu\u011fu tespit edilmi\u015ftir (27,28). 2016-2019 y\u0131llar\u0131 aras\u0131nda diren\u00e7 paternlerinde istatistiksel olarak anlaml\u0131 bir art\u0131\u015f g\u00f6zlemlenmedi\u011fi gibi, 2010-2014 verileriyle kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda da \u00f6nemli bir diren\u00e7 art\u0131\u015f\u0131 e\u011filimi olmad\u0131\u011f\u0131 g\u00f6r\u00fclm\u00fc\u015ft\u00fcr.<\/p>\n

Kolistin, \u00f6zellikle diren\u00e7li organizmalar\u0131n etken oldu\u011fu infeksiyonlar\u0131n tedavisinde etkili olan, fakat ciddi nefrotoksik yan etkiye sahip bir ajand\u0131r. Yan etkilerine ra\u011fmen, alternatif se\u00e7eneklerin olmamas\u0131ndan dolay\u0131 g\u00fcn\u00fcm\u00fczde tedavide kullan\u0131lmaktad\u0131r. \u00c7al\u0131\u015fmam\u0131zda inceledi\u011fimiz 504 P. aeruginosa <\/i>su\u015funun 55 (%12.2)\u2019inde kolistin direnci saptanm\u0131\u015ft\u0131r. Bu oran T\u00fcrkiye\u2019den ve d\u00fcnyadan bildirilen diren\u00e7 oranlar\u0131n\u0131n \u00fczerindedir. Durmaz ve arkada\u015flar\u0131 (29)\u2019n\u0131n 2015 y\u0131l\u0131nda yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada P.aeruginosa <\/i>su\u015flar\u0131nda kolistin direnci %7, U\u011fur ve Gen\u00e7 (14)\u2019in 2019\u2019da yapt\u0131\u011f\u0131 \u00e7al\u0131\u015fmada bu oran %5 ve Demirel (30)\u2019in yine 2019\u2019da yay\u0131mlad\u0131\u011f\u0131 \u00e7al\u0131\u015fmada %7 olarak bildirilmi\u015ftir. Ruh ve arkada\u015flar\u0131 (7)\u2019n\u0131n Kuzey K\u0131br\u0131s\u2019ta 2016 y\u0131l\u0131nda yapt\u0131klar\u0131 ara\u015ft\u0131rma verileriyle (7) kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda 2010-2014 y\u0131llar\u0131 aras\u0131nda %10.9 oran\u0131nda seyreden kolistin direncinde \u00fclkemizde son \u00fc\u00e7 y\u0131lda \u00f6nemli bir art\u0131\u015f tespit edilmemi\u015ftir. Kuzey K\u0131br\u0131s\u2019ta 2014-2015 y\u0131llar\u0131 aras\u0131 klinik \u00f6rneklerde antibiyotik direncini inceleyen bir di\u011fer \u00e7al\u0131\u015fmada ise, P.aeruginosa <\/i>su\u015flar\u0131nda kolistin direnci %13.3 olarak belirtilmi\u015ftir (31). \u201cClinical and Laboratory Standards Institute\u201d (CLSE)-EUCAST polimiksin e\u015fik de\u011fer belirleme \u00e7al\u0131\u015fma grubu, kolistin duyarl\u0131l\u0131\u011f\u0131n\u0131n belirlenmesi i\u00e7in s\u0131v\u0131 mikrodil\u00fcsyon y\u00f6ntemini referans y\u00f6ntem olarak belirlemi\u015ftir (32). Kolistin duyarl\u0131l\u0131\u011f\u0131n\u0131n bu y\u00f6ntem kullan\u0131larak teyit edilmemesi \u00e7al\u0131\u015fmam\u0131z\u0131n k\u0131s\u0131tl\u0131l\u0131\u011f\u0131d\u0131r.<\/p>\n

Hastane ve toplum k\u00f6kenli infeksiyonlar\u0131n tedavisinde antibiyotik duyarl\u0131l\u0131k testlerinin ve s\u00fcrveyans verilerinin \u00f6nemi t\u00fcm d\u00fcnyada yap\u0131lan ara\u015ft\u0131rmalarda belirtildi\u011fi gibi \u00e7al\u0131\u015fmam\u0131z verileriyle de a\u00e7\u0131k\u00e7a ortaya konmu\u015ftur. Antibiyotik direncinin \u00fclkeler, \u015fehirler, hastaneler ve hatta hastane servisleri aras\u0131nda ve y\u0131ldan y\u0131la de\u011fi\u015fiklik g\u00f6sterebilece\u011fi g\u00f6z \u00f6n\u00fcnde bulundurulmal\u0131 ve her merkezde aktif s\u00fcrveyans uygulanmal\u0131d\u0131r. \u00c7al\u0131\u015fmam\u0131zda P. aeruginosa<\/i> su\u015flar\u0131n\u0131n izole edildi\u011fi \u00f6rneklerin en s\u0131k g\u00f6nderildi\u011fi b\u00f6l\u00fcm yo\u011fun bak\u0131m servisi olarak belirlenmi\u015ftir.\u00a0<\/span><\/p>\n

Sonu\u00e7 olarak, hastanemizde izole edilen su\u015flar\u0131n en duyarl\u0131 oldu\u011fu antibiyotikler kolistin ve amikasin olarak saptanm\u0131\u015ft\u0131r. \u00dclkemizde son \u00fc\u00e7 y\u0131lda, 2010-2014 diren\u00e7 oranlar\u0131yla kar\u015f\u0131la\u015ft\u0131r\u0131ld\u0131\u011f\u0131nda, hastane ve toplum k\u00f6kenli P. aeruginosa <\/i>su\u015flar\u0131nda sefepim, seftazidim, siprofloksasin, piperasilin\/tazobaktam ve karbapenem direncinde \u00f6nemli bir art\u0131\u015f g\u00f6zlenmi\u015ftir. Artan diren\u00e7li infeksiyonlar\u0131n kontrol\u00fcnde, hastanemiz infeksiyon kontrol komitesi taraf\u0131nca uygulamaya al\u0131nan personel hizmet i\u00e7i e\u011fitimi, izolasyon tedbirleri ve antibiyotik t\u00fcketim verilerinin takibi gibi uygulamalar\u0131n \u00f6nemli bir rol\u00fc bulunmaktad\u0131r. 1 Nisan 2016 tarihi itibariyle Kuzey K\u0131br\u0131s\u2019ta re\u00e7etesiz antibiyotik kullan\u0131m\u0131n\u0131n engellenmesine y\u00f6nelik \u00e7\u0131kar\u0131lan kanun olmakla birlikte, g\u00fcn\u00fcm\u00fczde irrasyonel antibiyotik kullan\u0131m\u0131 devam etmektedir. Hastane \u0130nfeksiyon Kontrol Komitesi diren\u00e7li infeksiyonlar\u0131n kontrol\u00fcne y\u00f6nelik \u00e7al\u0131\u015fmalar\u0131n\u0131 s\u00fcrd\u00fcrmesine ra\u011fmen, Kuzey K\u0131br\u0131s T\u00fcrk Cumhuriyeti Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 nezdinde denetim yap\u0131lmamas\u0131ndan dolay\u0131 halen re\u00e7etesiz antibiyotik temin etmek m\u00fcmk\u00fcnd\u00fcr. Bu gibi s\u00fcrveyans \u00e7al\u0131\u015fmalar\u0131n\u0131n Kuzey K\u0131br\u0131s\u2019ta faaliyet g\u00f6steren her hastanede yap\u0131lmas\u0131 gerekti\u011fi, buna ek olarak diren\u00e7 geli\u015fimine yol a\u00e7an genetik mekanizmalar\u0131n ara\u015ft\u0131r\u0131lmas\u0131n\u0131n \u00fclkemizde antibiyotik kullan\u0131m politikalar\u0131na katk\u0131 sa\u011flayaca\u011f\u0131 ve antibiyotik direnci kontrol\u00fcnde rol oynayaca\u011f\u0131 kanaatindeyiz.<\/p>\n","protected":false},"excerpt":{"rendered":"

G\u0130R\u0130\u015e Bakterilerin antibiyotiklere diren\u00e7 geli\u015ftirmesi son y\u0131llarda d\u00fcnya \u00e7ap\u0131nda morbidite ve mortaliteyi art\u0131ran ciddi bir sorun haline gelmi\u015ftir (1). Pseudomonas aeruginosa, \u00f6zellikle hastane kaynakl\u0131 infeksiyonlarda ve geni\u015f spektrumlu antibiyotik kullan\u0131m\u0131n\u0131n, invazif uygulamalar\u0131n ve hasta-sa\u011fl\u0131k personelinin temas s\u0131kl\u0131\u011f\u0131n\u0131n daha \u00e7ok oldu\u011fu yo\u011fun bak\u0131m \u00fcnitelerinde \u00f6nemli bir tehdit etkeni olarak g\u00f6r\u00fclmektedir (2). \u0130nsan flora elemanlar\u0131ndan biri olan […]<\/p>\n","protected":false},"author":2,"featured_media":22699,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5129],"tags":[5052,4240,4301,5182],"class_list":["post-22120","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ozgun-arastirma","tag-infeksiyonlar","tag-kuzey-kibris-turk-cumhuriyeti","tag-mikrobiyal-ilac-direnci","tag-pseudomonas-aeruginosa-2"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/22120","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=22120"}],"version-history":[{"count":5,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/22120\/revisions"}],"predecessor-version":[{"id":22853,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/22120\/revisions\/22853"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/22699"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=22120"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=22120"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=22120"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}