Öz
Giriş: Karbapenem dirençli-K. pneumoniae enfeksiyonlarına yeni bir yaklaşım, kombinasyon ilaç tedavilerinin kullanılmasıdır. Ancak, in vitro karbapenem ve kolistin kombinasyonunun oksasilinaz-48 (OXA-48) üreten K. pneumoniae’ye karşı etkinliği hakkında çok az veri mevcuttur. Bu nedenle, bu çalışmada OXA-48 üreten K. pneumoniae suşlarında imipenem ve kolistinin potansiyel sinerjistik aktivitesini değerlendirmek, kolistinin değişen minimum inhibitör konsantrasyonunda (MİK) imipenem MİK’lerinin değişikliklerini araştırmak amaçlanmıştır.
Gereç ve Yöntem: Karbapenem ve kolistin direnç genleri polimeraz zincir reaksiyonu ile araştırıldı. İlk aşamada, sinerjik özellikler dama tahtası birleştirme yöntemi ile belirlenmiştir. İkinci aşamada, değişen kolistin konsantrasyonlarında imipenem MİK’lerinin değişimleri araştırılmıştır.
Bulgular: Kolistin MİK50 2 µg/ml, MİK90 16 µg/ml, imipenem MİK50 32µg/ml, MİK90 128 µg/ml bulundu. FIC formülüne göre izolatların %62,2’si sinerjik ve %37,8’i ilgisizdi. Kolistinin sırasıyla 0,125 µg/ml, 0,25 µg/ml, 0,5 µg/ml, 1 µg/ml, 2 µg/ml olarak sabitlenmesi durumunda özellikle kolistine duyarlı izolatlarda imipenem MİK’lerinde önemli düşüşler gözlendi. Bununla birlikte, kolistin dirençli izolatlarda imipenem MİK’leri, duyarlı düzeylere düşmemiştir.
Sonuç: Bu çalışma, OXA-48 üreten patojenlere bağlı enfeksiyonları tedavi etmeye daha uygun antibiyotik rejimlerinin tasarlanmasını sağlayacak ve bu antibiyotiklere karşı direnç gelişimini uzatacaktır. Hangi tedavi kombinasyonunun mükemmel olduğunu ve bu enfeksiyonların tedavisi için kombinasyon tedavisinin en iyi nasıl kullanılacağını in vitro belirlemek için daha fazla araştırma yapılması gerekmektedir.
Anahtar Kelimeler: Kolistin, imipenem, kombinasyon, Klebsiella pneumoniae, OXA-48
Kaynakça
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