Öz
Giriş: Karbapenemaz üreten Klebsiella pneumoniae (CPKP) izolatlarında üç yeni antimikrobiyal ajanın [seftazidim-avibaktam (CAZ/AVİ), meropenem-vaborbaktam (V/R) ve imipenem/silastatin-relebaktam] in vitro etkinliğini araştırmaktır.
Gereç ve Yöntem: Çalışmamıza 30 CPKP suşu dahil edildi. Suşların tür düzeyinde tanımlaması Vitek MS ile, antimikrobiyal duyarlılık testleri ise Vitek 2 otomatize sistemi kullanılarak yapıldı. Tüm suşlarda karbapenemaz üretimi kombinasyon disk testi ile teyit edildi. BlaKPC, blaNDM-1, blaOXA-48 ve blaVIM genleri, Gene-Xpert® System Carba R® kiti (Cepheid, Sunnyvale, ABD) kullanılarak belirlendi. İmipenem/relebaktam (I/R), V/R, CAZ/AVİ duyarlılıkları gradient strip test ile araştırıldı. Antimikrobiyal duyarlılık sonuçları, EUCAST 2022 kriterleri kullanılarak belirlendi. İmipenem-relabaktam (I/R) için minimal inhibitör konsantrasyon (MİK) değeri >2 mg/l duyarlı, ≤2 mg/l dirençli; meropenem-vaborbaktam (M/V) için MİK değeri >8 mg/l dirençli, ≤8 mg/l duyarlı; CAZ/AVİ için MİK değeri >8 mg/l dirençli, ≤8 mg/l duyarlı olarak değerlendirildi.
Bulgular: Çalışmaya dahil edilen suşların tümü kolistin hariç tüm antibiyotiklere dirençli idi. İzolatların %76,6’sında blaOXA-48; %16,6’sında NDM-1; %3,3’ünde NDM-1 ve OXA-48, %3,3’ünde KPC tespit edildi. Suşların 20’sinde (%66,6) I/R duyarlı, 18 suşta (%60) M/V duyarlı, 21 suşta (%70) CAZ/AVİ duyarlı bulundu. I/R duyarlı izolatların %90’ı OXA-48 taşırken diğer iki izolatta KPC ve NDM-1 mevcuttu. I/R dirençli izolatların %50’si OXA-48, %40’ı NDM-1 taşırken, bir izolatta ise NDM-1 ve OXA-48 mevcuttu. M/V duyarlı izolatların %88,8’inde OXA-48 mevcutken, diğer izolatlarda NDM-1 ve KPC mevcuttu. Dirençli izolatların %58,3’ünde OXA-48, %33,3’ünde NDM-1, %8,1’inde NDM-1/OXA-48 mevcuttu. CAZ/AVİ duyarlı izolatların %95,2’sinde OXA-48, %4,7’sinde NDM-1 mevcuttu. MİK değeri >8 olan I/R dirençli izolatların ikisinde blaOXA-48, ikisinde ise NDM-1 geni mevcuttu. MİK değeri >8 olan M/V dirençli izolatların dördünde NDM-1 geni mevcuttu. Suşların %56,6’sı antimikrobiyal ajanların tümüne duyarlı, %23,3’ü ise tüm ajanlara dirençli olarak saptandı. Bu suşların dördü (%57,1) NDM genine sahipken üçünde (%42,8) blaOXA-48 geni tespit edildi.
Sonuç: Merkezimizde saptadığımız CPKP suşlarının en sık OXA-48 geni taşıdığı görüldü. Bu sonuçlar Türkiye verileri ile benzerdi. Bu durumun OXA-48 suşlarında duyarlılığının düşük olduğu bilinen I/R ve M/V’nin ülkemizde klinik kullanımı sırasında göz önünde bulundurulması gereklidir. Çalışmamız KPC suşlarında CAZ/AVİ duyarlılığının daha yüksek olduğunu gösterdi.
Anahtar Kelimeler: Seftazidim-avibaktam, meropenem-vaborbaktam, imipenem-relebaktam, OXA-48
Kaynakça
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