Trend in Antibiotic Resistance of Extended-Spectrum Beta-Lactamase-Producing Escherichia Coli and Klebsiella Pneumoniae Bloodstream Infections
Yıl: 2019 Cilt: 53 Sayı: 1 Sayfa Aralığı: 70 - 75 Metin Dili: İngilizce DOI: 10.14744/SEMB.2018.60352 İndeks Tarihi: 24-06-2020
Trend in Antibiotic Resistance of Extended-Spectrum Beta-Lactamase-Producing Escherichia Coli and Klebsiella Pneumoniae Bloodstream Infections
Öz: Objectives: Extended-spectrum beta-lactamases (ESBLs) have been detected more frequently in members of the Enterobacteriaceae family, particularly Escherichia coli and Klebsiella pneumoniae. Infections caused by ESBL-producing bacteria are often resistantto 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 E. coliand K. pneumoniae isolates over a period of 3 years.Methods: 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 werecalculated. A BD Bactec FX automated blood culture system (Becton Dickinson and Company, Franklin Lakes, NJ, USA) was used toexamine the blood cultures. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (Product name?; BrukerDaltonics, Inc., Billerica, MA, USA) was used to identify microorganisms. For antibiotic susceptibility tests (AST) and ESBL detection,the Kirby Bauer disk diffusion method or a Phoenix automated system (Becton Dickinson and Company, Franklin Lakes, NJ, USA)was used. When the AST results were evaluated, Clinical and Laboratory Standards Institute breakpoints were used for 2014 and2015, and European Committee on Antimicrobial Susceptibility Testing breakpoints were used for 2016.Results: During the 3-year period, 224 (35%) of 632 E. coli and 137 (31%) of 439 K. pneumoniae isolates were determined to be ESBL-producers. The ESBL-positive isolate percentage for E. coli and K. pneumoniae for 2014, 2015, and 2016 was 23%, 36%, 48% and23%, 32%, 37%, respectively. The increase in ESBL was statistically significant for both E. coli (p<0.001) and K. pneumoniae (p=0.011).ESBL-positive E. coli and K. pneumoniae strains were most sensitive to carbapenem-class antibiotics, amikacin, and colistin. Whilethere was no meropenem-resistant strain, 5 (3.3%) ertapenem-resistant and 1 (0.7%) imipenem-resistant ESBL E. coli strains weredetected. The ESBL K. pneumoniae 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).Conclusion: Monitoring ESBL rates and the antibiotic susceptibility of E. coli and K. pneumoniae strains of bloodstream infectionsis of the utmost importance in guiding empiric antibiotic therapies and patient management.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- 1. Orsini J, Mainardi C, Muzylo E, Karki N, Cohen N, Sakoulas G. Microbiological profile of organisms causing bloodstream infection in critically ill patients. J Clin Med Res 2012;4:371–7.
- 2. Fennell J, Vellinga A, Hanahoe B, Morris D, Boyle F, Higgins F, et al. Increasing prevalence of ESBL production among Irish clinical Enterobacteriaceae from 2004 to 2008: an observational study. BMC Infect Dis 2012;12:116.
- 3. Falcone M, Vena A, Mezzatesta ML, Gona F, Caio C, Goldoni P, et al. Role of empirical and targeted therapy in hospitalized patients with bloodstream infections caused by ESBL-producing Enterobacteriaceae. Ann Ig 2014;26:293–304.
- 4. Vehreschild MJ, Hamprecht A, Peterson L, Schubert S, Häntschel M, Peter S, et al. A multicentre cohort study on colonization and infection with ESBL-producing Enterobacteriaceae in high-risk patients with haematological malignancies. J Antimicrob Chemother 2014;69:3387–92.
- 5. Färber J, Moder KA, Layer F, Tammer I, König W, König B. Extended-spectrum Beta-lactamase detection with different panels for automated susceptibility testing and with a chromogenic medium. J Clin Microbiol 2008;46:3721–7.
- 6. Marchaim D, Chopra T, Bhargava A, Bogan C, Dhar S, Hayakawa K, et al. Recent exposure to antimicrobials and carbapenem-resistant Enterobacteriaceae: the role of antimicrobial stewardship. Infect Control Hosp Epidemiol 2012;33:817–30.
- 7. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; Twenty-third informational supplement. M100-S23. CLSI, Wayne PA; 2013.
- 8. European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 6.0, 2016. Available at: http://www.eucast.org. Accessed Feb 19, 2019.
- 9. Djuric O, Jovanovic S, Stosovic B, Tosic T, Jovanovic M, Markovic-Denic L. Antimicrobial resistance of selected invasive bacteria in a tertiary care center: results of a prospective surveillance study. J Infect Dev Ctries 2016;10:1325–31.
- 10. Rodríguez-Baño J, Pascual A. Clinical significance of extended-spectrum beta-lactamases. Expert Rev Anti Infect Ther 2008;6:671–83.
- 11. Gur D, Hascelik G, Aydin N, Telli M, Gültekin M, Ogülnç D, et al. Antimicrobial resistance in gram-negative hospital isolates: results of the Turkish HITIT-2 Surveillance Study of 2007. J Chemother 2009;21:383–9.
- 12. Baykal A, Çöplü N, Şimşek H, Esen B, Gür D. Investigation of the Presence of Extended Spectrum Beta-Lactamase, KPC-Type Carbapenemase and Plasmid-Mediated AmpC Beta-Lactamase in E.coli and K.pneumoniae Strains Isolated from Blood Cultures. Mikrobiyol Bül 2012;46:159–69.
- 13. Balcı U, Turhan Ö, Öğünç D, Günseren F, Yalçın AN. Risk Factors and Mortality of Bloodstream Infections Caused by Extended-Spectrum b-Lactamase-Positive Escherichia coli and Klebsiella pneumonia. Klimik Dergisi 2014;27:15–20.
- 14. Sağlam D, Durmaz S, Kılıç H, Atalay MA, Erçal BD, Şarlı Ş, et al. Kan kültürlerinden izole edilen Escherichia coli suşlarında genişlemiş spektrumlu beta-laktamaz sıklığı ve antibiyotik direnç paternleri. ANKEM Derg 2011;25:250–5.
- 15. Uyanık MH, Hancı H, Yazgı H, Karameşe M. Kan kültürlerinden soyutlanan Escherichia coli ve Klebsiella pneumonia suşlarında GSBL sıklığı ve ertapenem dahil çeşitli antibiyotiklere in-vitro duyarlılıkları. ANKEM Derg 2010;24:86–91.
- 16. Kaya O, Akcam FZ, Gonen I, Unal O, Ceylan T. Risk factors for bacteremia due to extended-spectrum beta-lactamase-producing Escherichia coli in a Turkish hospital. J Infect Dev Ctries 2013;7:507–12.
- 17. Abdallah HM, Wintermans BB, Reuland EA, Koek A, al Naiemi N, Ammar AM, et al. Extended-Spectrum β-Lactamase- and Carbapenemase-Producing Enterobacteriaceae Isolated from Egyptian Patients with Suspected Blood Stream Infection. PLoS One 2015;10:e0128120.
- 18. Sangare SA, Maiga AI, Guindo I, Maiga A, Camara N, Dicko OA, et al. Prevalence of ESBL-producing Enterobacteriaceae isolated from blood cultures in Mali. J Infect Dev Ctries 2016;10:1059–64.
- 19. Ndir A, Diop A, Faye PM, Cissé MF, Ndoye B, Astagneau P. Epidemiology and Burden of Bloodstream Infections Caused by Extended-SpectrumBeta-Lactamase Producing Enterobacteriaceae in a Pediatric Hospital in Senegal. PLoS One 2016;11:e0143729.
- 20. Kim YK, Pai H, Lee HJ, Park SE, Choi EH, Kim J, et al. Bloodstream infections by extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in children: epidemiology and clinical outcome. Antimicrob Agents Chemother 2002;46:1481–91.
- 21. Quan J, Zhao D, Liu L, Chen Y, Zhou J, Jiang Y, et al. High prevalence of ESBL-producing Escherichia coli and Klebsiella pneumoniae in community-onset bloodstream infections in China. J Antimicrob Chemother 2017;72:273–80.
- 22. Leistner R, Schröder C, Geffers C, Breier AC, Gastmeier P, Behnke M. Regional distribution of nosocomial infections due to ESBL-positive Enterobacteriaceae in Germany: data from the German National Reference Center for the Surveillance of Nosocomial Infections (KISS). Clin Microbiol Infect 2015;21:255.e1–5.
- 23. Yılmaz N, Köse Ş, Ağuş N, Ece G, Akkoçlu G, Kıraklı C. Yoğun bakım ünitesinde yatan hastaların kan kültürlerinde üreyen mikroorganizmalar, antibiyotik duyarlılıkları ve nozokomiyal bakteriyemi etkenleri. ANKEM Derg 2010;24:12–9.
- 24. Tumbarello M, Spanu T, Sanguinetti M, Citton R, Montuori E, Leone F, et al. Bloodstream infections caused by extended-spectrum-beta-lactamase-producing Klebsiella pneumoniae: risk factors, molecular epidemiology, and clinical outcome. Antimicrob Agents Chemother 2006;50:498–504.
- 25. Yetkin G, Kuzucu Ç, Çalışkan A, Ay S. Kan kültürlerinde üreyen Escherichia coli’lerin antibiyotik duyarlılıkları, GSBL oranları ve hastane birimlerine göre dağılımı. İnönü Üniversitesi Tıp Fakültesi Dergisi 2006;13:147–50.
- 26. Eser OK, Altun Uludağ H, Ergin A, Boral B, Sener B, Hasçelik G. Carbapenem resistance in ESBL positive Enterobacteriaceae isolates causing invasive infections. Mikrobiyol Bul 2014;48:59–69.
- 27. Kuzucu C, Yetkin F, Görgeç S, Ersoy Y. Investigation of the susceptibilities of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella spp. strains to ertapenem and other carbapenems. Mikrobiyol Bul 2011;45:28–35.
- 28. Datta S, Wattal C, Goel N, Oberoi JK, Raveendran R, Prasad KJ. A ten year analysis of multi-drug resistant blood stream infections caused by Escherichia coli & Klebsiella pneumoniae in a tertiary care hospital. Indian J Med Res 2012;135:907–12.
APA | Bayraktar B, PELİT S, Bulut E, AKTAŞ E (2019). Trend in Antibiotic Resistance of Extended-Spectrum Beta-Lactamase-Producing Escherichia Coli and Klebsiella Pneumoniae Bloodstream Infections. , 70 - 75. 10.14744/SEMB.2018.60352 |
Chicago | Bayraktar Banu,PELİT Süleyman,Bulut Emin,AKTAŞ ELİF Trend in Antibiotic Resistance of Extended-Spectrum Beta-Lactamase-Producing Escherichia Coli and Klebsiella Pneumoniae Bloodstream Infections. (2019): 70 - 75. 10.14744/SEMB.2018.60352 |
MLA | Bayraktar Banu,PELİT Süleyman,Bulut Emin,AKTAŞ ELİF Trend in Antibiotic Resistance of Extended-Spectrum Beta-Lactamase-Producing Escherichia Coli and Klebsiella Pneumoniae Bloodstream Infections. , 2019, ss.70 - 75. 10.14744/SEMB.2018.60352 |
AMA | Bayraktar B,PELİT S,Bulut E,AKTAŞ E Trend in Antibiotic Resistance of Extended-Spectrum Beta-Lactamase-Producing Escherichia Coli and Klebsiella Pneumoniae Bloodstream Infections. . 2019; 70 - 75. 10.14744/SEMB.2018.60352 |
Vancouver | Bayraktar B,PELİT S,Bulut E,AKTAŞ E Trend in Antibiotic Resistance of Extended-Spectrum Beta-Lactamase-Producing Escherichia Coli and Klebsiella Pneumoniae Bloodstream Infections. . 2019; 70 - 75. 10.14744/SEMB.2018.60352 |
IEEE | Bayraktar B,PELİT S,Bulut E,AKTAŞ E "Trend in Antibiotic Resistance of Extended-Spectrum Beta-Lactamase-Producing Escherichia Coli and Klebsiella Pneumoniae Bloodstream Infections." , ss.70 - 75, 2019. 10.14744/SEMB.2018.60352 |
ISNAD | Bayraktar, Banu vd. "Trend in Antibiotic Resistance of Extended-Spectrum Beta-Lactamase-Producing Escherichia Coli and Klebsiella Pneumoniae Bloodstream Infections". (2019), 70-75. https://doi.org/10.14744/SEMB.2018.60352 |
APA | Bayraktar B, PELİT S, Bulut E, AKTAŞ E (2019). Trend in Antibiotic Resistance of Extended-Spectrum Beta-Lactamase-Producing Escherichia Coli and Klebsiella Pneumoniae Bloodstream Infections. Şişli Etfal Hastanesi Tıp Bülteni, 53(1), 70 - 75. 10.14744/SEMB.2018.60352 |
Chicago | Bayraktar Banu,PELİT Süleyman,Bulut Emin,AKTAŞ ELİF Trend in Antibiotic Resistance of Extended-Spectrum Beta-Lactamase-Producing Escherichia Coli and Klebsiella Pneumoniae Bloodstream Infections. Şişli Etfal Hastanesi Tıp Bülteni 53, no.1 (2019): 70 - 75. 10.14744/SEMB.2018.60352 |
MLA | Bayraktar Banu,PELİT Süleyman,Bulut Emin,AKTAŞ ELİF Trend in Antibiotic Resistance of Extended-Spectrum Beta-Lactamase-Producing Escherichia Coli and Klebsiella Pneumoniae Bloodstream Infections. Şişli Etfal Hastanesi Tıp Bülteni, vol.53, no.1, 2019, ss.70 - 75. 10.14744/SEMB.2018.60352 |
AMA | Bayraktar B,PELİT S,Bulut E,AKTAŞ E Trend in Antibiotic Resistance of Extended-Spectrum Beta-Lactamase-Producing Escherichia Coli and Klebsiella Pneumoniae Bloodstream Infections. Şişli Etfal Hastanesi Tıp Bülteni. 2019; 53(1): 70 - 75. 10.14744/SEMB.2018.60352 |
Vancouver | Bayraktar B,PELİT S,Bulut E,AKTAŞ E Trend in Antibiotic Resistance of Extended-Spectrum Beta-Lactamase-Producing Escherichia Coli and Klebsiella Pneumoniae Bloodstream Infections. Şişli Etfal Hastanesi Tıp Bülteni. 2019; 53(1): 70 - 75. 10.14744/SEMB.2018.60352 |
IEEE | Bayraktar B,PELİT S,Bulut E,AKTAŞ E "Trend in Antibiotic Resistance of Extended-Spectrum Beta-Lactamase-Producing Escherichia Coli and Klebsiella Pneumoniae Bloodstream Infections." Şişli Etfal Hastanesi Tıp Bülteni, 53, ss.70 - 75, 2019. 10.14744/SEMB.2018.60352 |
ISNAD | Bayraktar, Banu vd. "Trend in Antibiotic Resistance of Extended-Spectrum Beta-Lactamase-Producing Escherichia Coli and Klebsiella Pneumoniae Bloodstream Infections". Şişli Etfal Hastanesi Tıp Bülteni 53/1 (2019), 70-75. https://doi.org/10.14744/SEMB.2018.60352 |