Öz
Giriş: Enterobacteriaceae üyeleri arasındaki antimikrobiyal direnç, çoklu ilaç direncine veya aşırı derecede ilaca dirençli (XDR) duruma ilerlemiş, böylece bağışıklık sistemi baskılanmış hastalar (BSBH) için tedavi seçeneklerini sınırlamıştır. Monoterapi uygulamasının birçok durumda başarısız olduğu kanıtlanmıştır, bu nedenle optimal tedavi için kombinasyon tedavisi gerekir.
Gereç ve Yöntem: Bağışıklık sistemi baskılanmış hastalar arasında XDR patojenlerin insidansı incelendi, bu patojenler β-laktamaz üretimi açısından tarandı ve Nijerya’daki bir Federal Tıp Merkezi’nden izole edilen XDR Enterobacteriaceae’ye karşı antibiyotik kombinasyonunun etkinliği, Klinik ve Laboratuvar Standartları Enstitüsü yöntemleri kullanılarak belirlendi. Piperasilin-tazobaktam (TZP)/amoksisilin-klavulanik asit (AMC) ile seftazidim (CAZ), seftriakson (CRO) ve gentamisinin (GN) herbiri arasındaki sinerjiyi fraksiyonel inhibitör konsantrasyon indekslerini kullanarak belirlemek için Checkerboard testi kullanıldı.
Bulgular: Toplam 68 Enterobacteriaceae üyesi izolat ve 15’i (%22,1) XDR idi. Altmış sekiz izolatın sırasıyla %53,3, %13,3 ve %0’ı geniş spektrumlu β-laktamazlar (ESBL), AmpC ve karbapenemaz üreticileriydi. Meropeneme direnç; XDR E. coli’de %37,5, K. pneumoniae’da %60 ve Enterobacter aerogene’de %100 olarak ifade edildi. XDR E. coli’de %50 ve K. pneumoniae’de %20 oranında ifade edilen kolistin direnci de aynı derecede endişe vericiydi. XDR Enterobacteriaceae’ye karşı olumlu aktiviteleri olan mono antibiyotikler arasında kolistin, tigesiklin ve meropenem bulunmaktaydı. TZP; CAZ ve CRO ile birleştirildiğinde XDR E. coli ve K. pneumoniae için sinerji gözlendi. AMC; CAZ veya GN ile birleştirildiğinde hiçbir sinerji gözlenmedi.
Sonuç: Bu çalışma, BSBH arasında XDR Enterobacteriaceae insidansını göstermiştir ve ESBL ve AmpC β-laktamazın ortak üreticileri de dahil olmak üzere XDR Enterobacteriaceae’ye bağlı enfeksiyonlar için yararlı bir tedavi kombinasyonu olarak TZP artı CAZ veya CRO’yu önermiştir.
Anahtar Kelimeler: Aşırı derecede ilaç direnci, çoklu ilaç direnci, Enterobacteriaceae, bağışıklığı baskılanmış hastalar, ESBL, AmpC, karbapenemaz, Katsina, Nijerya
Kaynakça
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