Öz
Giriş: Son yıllarda çok ilaca dirençli (ÇİD) ve yaygın ilaca dirençli (YİD) Pseudomonas aeruginosa suşlarının ortaya çıkması; tedavi zorluğu, yüksek morbidite ve mortalite oranları nedeni ile ciddi bir problem haline gelmiştir. Bu karbapeneme dirençli mikroorganizmaların etken olduğu enfeksiyonlarda tedavi seçenekleri oldukça kısıtlıdır. Seftolozan/tazobaktam (C/T) ve seftazidim/avibaktam (CZA) ÇİD P. aeruginosa suşlarının neden olduğu enfeksiyonların tedavisi için yeni geliştirilmiş sefalosporin/beta-laktamaz inhibitörü kombinasyonlarıdır. Bu çalışmada, ÇİD P. aeruginosa suşlarına karşı C/T ve CZA’nın in vitro duyarlılıklarının araştırılması ve etkililiklerinin karşılaştırılması amaçlanmıştır.
Gereç ve Yöntem: Çok ilaca dirençli olan 32 P. aeruginosa kökeni çalışmaya dahil edildi. Kökenlerin tanımlaması ve antimikrobiyal duyarlılıkları VITEK 2® otomatize sistemi ile yapıldı. Seftolozan/tazobaktam (C/T) ve CZA etkinliği gradiyent strip test ile (Liofilchem MIC strip test, İtalya) tespit edildi. Tüm kökenlerde karbapenemaz üretimi tespiti amacıyla modifiye karbapenemaz inaktivasyon metodu kullanıldı.
Bulgular: İncelemeye alınan kökenlerdeki antibiyotik direnç oranları; amikasin %78, levofloksasin %96,8, siprofloksasin %90,6, gentamisin %71,8 ve netilmisin %78 şeklinde saptandı. İncelenen kökenlerin 7’sinde (%21,8) CZA direnci saptanırken, 10’unda (%31,2) C/T direnci olduğu tespit edildi. Seftazidim/avibaktama dirençli olan tüm kökenlerde C/T’ye de direnç vardı. Üç köken C/T’ye dirençli iken CZA’ya karşı duyarlı idi. Tüm kökenlerde karbapenemaz üretimi saptandı.
Sonuç: Bu çalışmadan elde edilen sonuçlar ÇİD ve karbapenem dirençli P. aeruginosa enfeksiyonlarında CZA ve C/T’nin tedavi alternatifi olabileceğini göstermektedir. Giderek artan ÇİD P. aeruginosa tehdidine karşı bu yeni tedavi seçeneklerinin etkililiğini değerlendirmek için daha fazla in vitro ve in vivo çalışmalara ihtiyaç vardır.
Anahtar Kelimeler: Kolistin, epidemiyoloji, hastane kaynaklı enfeksiyonlar, kurtarma tedavisi, genişlemiş spektrumlu beta-laktamazlar
Kaynakça
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