Öz
Giriş: Bu çalışmada diyabetik ayak enfeksiyonlarından izole edilen Pseudomonas aeruginosa (P. aeruginosa) suşlarına karşı yara bakımında kullanılan bir antiseptik ajan olan borik asitin etkinliğinin belirlenmesi amaçlanmaktadır.
Gereç ve Yöntem: Çalışmaya Ocak 2010 - Haziran 2015 tarihleri arasında diyabetik ayak enfeksiyonlarından izole edilen toplam 25 adet P. aeruginosa suşu alındı. Bu suşların çeşitli antibiyotiklere duyarlılıkları belirlendi. Borik asitten çeşitli konsantrasyonlarda dilüsyonlar hazırlanarak bu suşların farklı konsantrasyonlarda üremesi test edildi. Çalışmamız Helsinki Deklarasyonu uyarınca yapıldı.
Bulgular: İnkübasyon süresi sonunda 1,6 mg/l borik asit çözeltisinin maruz bırakıldığı tüm izolatlarda üreme gözlendi. 25 mg/l, 50 mg/lve 100 mg/l borik asit çözeltilerinin eklendiği 25 kuyucuğun hiçbirinde üreme gözlenmedi. Üremenin olmadığı en düşük konsantrasyon olan 25 mg/l borik asit konsantrasyonu ile üremenin tespit edildiği diğer konsantrasyonlar arasında anlamlı bir fark gözlenmiştir. Borik asitin P. aeruginosa için minimum inhibitör konsantrasyonu 25 mg/l olarak bulundu. Düşük borik asit konsantrasyonlarında üreyen P. aeruginosa suşlarında yüksek antibiyotik direnci dikkat çekiciydi.
Sonuç: Borik asit, diyabetik ayak enfeksiyonlarından izole edilen P. aeruginosa suşlarına karşı in vitro etkinlik göstermektedir. Maliyeti düşük olan borik asitin P. aeruginosa’nın neden olduğu diyabetik ayak enfeksiyonlarında lokal tedavide uygun bir seçenek olabileceğine inanıyoruz.
Anahtar Kelimeler: Antibiyotik direnci, diyabetik ayak enfeksiyonu, P. aeruginosa, borik asit
Kaynakça
Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, Deery HG, Embil JM, Joseph WS, Karchmer AW, Pinzur MS, Senneville E, Infectious Diseases Society of America. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012;54:e132-73.
Brem H, Sheehan P, Rosenberg HJ, Schneider JS, Boulton AJ. Evidence-based protocol for diabetic foot ulcers. Plast Reconstr Surg. 2006;117:193S-209S; discussion 210S-1S.
Van Battum P, Schaper N, Prompers L, Apelqvist J, Jude E, Piaggesi A, Bakker K, Edmonds M, Holstein P, Jirkovska A, Mauricio D, Ragnarson Tennvall G, Reike H, Spraul M, Uccioli L, Urbancic V, van Acker K, van Baal J, Ferreira I, Huijberts M. Differences in minor amputation rate in diabetic foot disease throughout Europe are in part explained by differences in disease severity at presentation. Diabet med. 2011;28:199-205.
Prompers L, Huijberts M, Schaper N, Apelqvist J, Bakker K, Edmonds M, Holstein P, Jude E, Jirkovska A, Mauricio D, Piaggesi A, Reike H, Spraul M, Van Acker K, Van Baal S, Van Merode F, Uccioli L, Urbancic V, Ragnarson Tennvall G. Resource utilisation and costs associated with the treatment of diabetic foot ulcers. Prospective data from the Eurodiale Study. Diabetologia. 2008;51:1826-34.
Kosinski MA, Joseph WS. Update on the treatment of diabetic foot infections. Clin Podiatr Med Surg. 2007;24:383-96.
Ramakant P, Verma A, Misra R, Prasad K, Chand G, Mishra A, Agarwal G, Agarwal A, Mishra S. Changing microbiological profile of pathogenic bacteria in diabetic foot infections: time for a rethink on which empirical therapy to choose? Diabetologia. 2011;54:58-64.
Savini V, Catavitello C, Bianco A, Balbinot A, D’Antonio F, D’Antonio D. Azole resistant Candida glabrata vulvovaginitis treated with boric acid. Eur J Obstet Gynecol Reprod Biol. 2009;147:112.
Bakker K, Apelqvist J, Schaper NC, International Working Group on Diabetic Foot Editorial Board. Practical guidelines on the management and prevention of the diabetic foot 2011. Diabetes Metab Res Rev. 2012;28:225-31.
Hilton J, Williams D, Beuker B, Miller D, Harding K. Wound dressings in diabetic foot disease. Clin Infect Dis. 2004;39:S100-3.
Brem H, Sheehan P, Boulton AJ. Protocol for treatment of diabetic foot ulcers. Am J Surg. 2004;187:S1-10.
Weintrob AC, Sexton DJ, Calderwood S, Baron EL. Clinical manifestations, diagnosis, and management of diabetic infections of the lower extremities. UpToDate. Waltham, MA. 2014. Available from: https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-management-of-diabetic-infections-of-the-lower-extremities?topicRef=1749&source=see_link
Damir A. Why diabetic foot ulcers do not heal. J Int Med Sci Acad. 2011;24:205-6.
Lautenbach E, Weiner MG, Nachamkin I, Bilker WB, Sheridan A, Fishman NO. Imipenem Resistance Among Pseudomonas aeruginosa Isolates Risk Factors for Infection and Impact of Resistance on Clinical and Economic Outcomes. Infect Control Hosp Epidemiol. 2006;27:893-900.
US Department of Health and Human Services. Agency for Toxic Substances and Disease Registry: Toxicological profile for Lead (update) PB/99/166704. Atlanta: US Department of Health and Human Services. 1999.
De Seta F, Schmidt M, Vu B, Essmann M, Larsen B. Antifungal mechanisms supporting boric acid therapy of Candida vaginitis. J Antimicrob Chemother. 2009;63:325-36.
Nielsen FH, Meacham SL. Growing evidence for human health benefits of boron. Evid. Based Complementary Altern. Med. 2011;16:169-80.
Saha N, Saarai A, Roy N, Kitano T, Saha P. Polymeric biomaterial based hydrogels for biomedical applications. J Biomater Nanobiotechnol. 2011;2:85-90.
Kujath P, Hügelschäffer C. Pseudomonas aeruginosa: pathogenicity, prevention and therapeutic approaches. Zentralbl Chir. 1987;112:558-63.
Adarchenko A, Krasil’nikov A, Sobeshchuk O. Antiseptic sensitivity of clinical strains of Pseudomonas aeruginosa. Antibiot Khimioter. 1989;34:902-7.
Bruchmann S, Dötsch A, Nouri B, Chaberny IF, Häussler S. Quantitative contributions of target alteration and decreased drug accumulation to Pseudomonas aeruginosa fluoroquinolone resistance. Antimicrob Agents Chemother. 2013;57:1361-8.
Römling U, Balsalobre C. Biofilm infections, their resilience to therapy and innovative treatment strategies. J Int Med. 2012;272:541-61.
Youn CK, Jang SJ, Jo ER, Choi JA, Sim JH, Cho SI. Comparative antibacterial activity of topical antiseptic eardrops against methicillin-resistant Staphylococcus aureus and quinolone-resistant Pseudomonas aeruginosa. Int J Pediatr Otorhinolaryngol. 2016;85:80-3.
Kumara D, Fernando S, Kottahachchi J, Dissanayake D, Athukorala G, Chandrasiri N, Damayanthi K, Hemarathne M, Pathirana A. Evaluation of bactericidal effect of three antiseptics on bacteria isolated from wounds. J Wound Care. 2015;24:5-10.
Dudley MN, Ambrose PG, Bhavnani SM, Craig WA, Ferraro MJ, Jones RN, Antimicrobial Susceptibility Testing Subcommittee of the Clinical and Laboratory Standards Institute. Background and rationale for revised Clinical and Laboratory Standards Institute interpretive criteria (breakpoints) for Enterobacteriaceae and Pseudomonas aeruginosa: I. Cephalosporins and aztreonam. Clin Infect Dis. 2013;56:1301-9.
