Öz
Polimiksin E, çoklu ilaç direnci olan mikroorganizmaların tedavisinde kullanılan temel ilaçtır. Kolistinin pozitif yüklü yapısı duyarlılık testlerinde zorluklar yaratmaktadır. Yapılan çalışmalar sonucunda kolistin duyarlılığını belirlemek için altın standart yöntem sıvı mikrodilüsyon yöntemi olarak belirlenmiştir. Ancak bu yöntem henüz ülkemizde birçok merkezde laboratuvar rutinine girememiştir. Bu derlemede amacımız; tedavide oldukça önemli olan kolistin duyarlılığını saptayabilen yöntemleri güncel veriler ışığında inceleyebilmektir. Kolistin molekülünün agara difüzyonunun kısıtlı olması nedeni ile disk difüzyon yöntemi önerilmemektedir. E-test’in referans yöntem ile karşılaştırıldığında güvenilir ve uygun bir alternatif olarak görülebileceğini düşündüren çalışmalar olduğu gibi çok büyük hata oranının %3’ün üzerinde saptayan çalışmalar da mevcuttur. Otomatize yöntemler birçok çalışmada istenilen kategorik uyum ve çok büyük hata oranlarını yakalayamamıştır. Moleküler temelli yöntemler özellikle mcr genini saptamak için kullanılırlar ve özellikle direnç aktarımını belirlemede oldukça önemlidir. Yeni geliştirilen hızlı testler ve kolistin sıvı disk elüsyon gibi yöntemlerin bulguları yüz güldürücüdür, ancak bu alanda daha fazla çalışmaya ihtiyaç vardır.
Anahtar Kelimeler: Kolistin, sıvı mikrodilüsyon, duyarlılık
Kaynakça
Li J, Nation RL, Milne RW, Turnidge JD, Coulthard K. Evaluation of colistin as an agent against multi-resistant Gram-negative bacteria. Int J Antimicrob Agents. 2005;25:11-25.
Batirel A, Balkan II, Karabay O, Agalar C, Akalin S, Alici O, Alp E, Altay FA, Altin N, Arslan F, Aslan T, Bekiroglu N, Cesur S, Celik AD, Dogan M, Durdu B, Duygu F, Engin A, Engin DO, Gonen I, Guclu E, Guven T, Hatipoglu CA, Hosoglu S, Karahocagil MK, Kilic AU, Ormen B, Ozdemir D, Ozer S, Oztoprak N, Sezak N, Turhan V, Turker N, Yilmaz H. Comparison of colistin-carbapenem, colistin-sulbactam, and colistin plus other antibacterial agents for the treatment of extremely drug-resistant Acinetobacter baumannii bloodstream infections. Eur J Clin Microbiol Infect Dis. 2014;33:1311-22.
Kumar H, Chen BH, Kuca K, Nepovimova E, Kaushal A, Nagraik R, Bhatia SK, Dhanjal DS, Kumar V, Kumar A, Upadhyay NK, Verma R, Kumar D. Understanding of Colistin Usage in Food Animals and Available Detection Techniques: A Review. Animals (Basel). 2020;10:1892.
Altınkanar Gelmez G, Hasdemir Gökboğa M, Söyledir G. Kolistin Duyarlılık Testi İçin Diagnostics Colistin MIC-Strip Testinin Değerlendirilmesi. ANKEM Dergisi. 2021;35:9-13.
Orwa JA, Govaerts C, Busson R, Roets E, Van Schepdael A, Hoogmartens J. Isolation and structural characterization of colistin components. J Antibiot (Tokyo). 2001;54:595-9.
Bergen PJ, Li J, Rayner CR, Nation RL. Colistin methanesulfonate is an inactive prodrug of colistin against Pseudomonas aeruginosa. Antimicrob Agents Chemother. 2006;50:1953-8.
Andrade FF, Silva D, Rodrigues A, Pina-Vaz C. Colistin Update on Its Mechanism of Action and Resistance, Present and Future Challenges. Microorganisms. 2020;8:1716.
Bolla JM, Alibert-Franco S, Handzlik J, Chevalier J, Mahamoud A, Boyer G, Kieć-Kononowicz K, Pagès JM. Strategies for bypassing the membrane barrier in multidrug resistant Gram-negative bacteria. FEBS Lett. 2011;585:1682-90.
Falagas ME, Rafailidis PI, Matthaiou DK. Resistance to polymyxins: Mechanisms, frequency and treatment options. Drug Resist Updat. 2010;13:132-8.
Ly NS, Yang J, Bulitta JB, Tsuji BT. Impact of two-component regulatory systems PhoP-PhoQ and PmrA-PmrB on colistin pharmacodynamics in Pseudomonas aeruginosa. Antimicrob Agents Chemother. 2012;56:3453-6.
Fu W, Yang F, Kang X, Zhang X, Li Y, Xia B, Jin C. First structure of the polymyxin resistance proteins. Biochem Biophys Res Commun. 2007;361:1033-7.
Liu YY, Wang Y, Walsh TR, Yi LX, Zhang R, Spencer J, Doi Y, Tian G, Dong B, Huang X, Yu LF, Gu D, Ren H, Chen X, Lv L, He D, Zhou H, Liang Z, Liu JH, Shen J. Emergence of plasmid-mediated colistin resistance mechanism MCR-1 in animals and human beings in China: a microbiological and molecular biological study. Lancet Infect Dis. 2016;16:161-8.
Xavier BB, Lammens C, Ruhal R, Kumar-Singh S, Butaye P, Goossens H, Malhotra-Kumar S. Identification of a novel plasmid-mediated colistin-resistance gene, mcr-2, in Escherichia coli, Belgium, June 2016. Euro Surveill. 2016;21:30280.
Hussein NH, Al-Kadmy IMS, Taha BM, Hussein JD. Mobilized colistin resistance (mcr) genes from 1 to 10: a comprehensive review. Mol Biol Rep. 2021;48:2897-907.
Hindler JA, Humphries RM. Colistin MIC Variability by Method for Contemporary Clinical Isolates of Multidrug-Resistant Gram-Negative Bacilli. J Clin Microbiol. 2013;51:1678-84.
European Committee on Antimicrobial Susceptibility Testing Breakpoint tables for interpretation of MICs and zone diameters Version 13.1, 2023. Last Accessed Date: 12.09.2023. Available from: https://www.eucast. org/fileadmin/src/media/PDFs/EUCAST_files/Breakpoint_tables/v_13.1_Breakpoint_Tables.pdf
CLSI Performance standards for antimicrobial susceptibility testing. Last Accessed Date: 13.09.2023. Available from: https://clsi.org/media/1700/clsi-news-winter-2016.pdf
EUCAST Antimicrobial susceptibility testing of colistin - problems detected with several commercially available products. Last Accessed Date: 13.09.2023. Available from: https://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Warnings/Warnings_docs/Warning_-_colistin_AST.pdf
Wiegand I, Hilpert K, Hancock RE. Agar and broth dilution methods to determine the minimal inhibitory concentration (MIC) of antimicrobial substances. Nat Protoc. 2008;3:163-75.
Landman D, Salamera J, Quale J. Irreproducible and uninterpretable Polymyxin B MICs for Enterobacter cloacae and Enterobacter aerogenes. J Clin Microbiol. 2013;51:4106-11.
Erdeğer J. Antibiyotik Duyarlılık Testleri ve Uygulama Alanları. Etlik Vet Mikrobiyol Derg. 1990;1:1-26.
Hu X, Sun L, Nie T, Yang Y, Wang X, Pang J, Lu X, Li X, Lu Y, Li C, Yang X, Meng Y, Li G, You X. Evaluation of Agar Dilution Method in Susceptibility Testing of Polymyxins for Enterobacteriaceae and Non-Fermentative Rods: Advantages Compared to Broth Microdilution and Broth Macrodilution. Antibiotics (Basel). 2022;11:1392.
CLSI. Performance standards for antimicrobial susceptibility testing. 28th ed. CLSI supplement M100. Wayne, PA: Clinical and Laboratory Standards Institute; 2018.
Dafopoulou K, Zarkotou O, Dimitroulia E, Hadjichristodoulou C, Gennimata V, Pournaras S, Tsakris A. Comparative Evaluation of Colistin Susceptibility Testing Methods among Carbapenem-Nonsusceptible Klebsiella pneumoniae and Acinetobacter baumannii Clinical Isolates. Antimicrob Agents Chemother. 2015;59:4625-30.
Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. Seventeenth informational supplement. Document M100-S17. Wayne, PA: CLSI, 2007.
Paköz NİE, Kaya E, Orhan Z, Kayış A, Aral M. Comparison of disc diffusion, E-test and automated system methods for the determination of resistance to tigecycline and colistin by multiple resistant Acinetobacter baumannii isolates which isolated from different samples. Turk Hij Den Biyol Derg. 2018;75:109-16.
Girardello R, Cury AP, Franco MRG, Di Gióia TR, de Almeida JN Jr, de Araújo MRE, da Silva Duarte AJ, Rossi F. Colistin susceptibility testing and Vitek-2™: is it really useless? Diagn Microbiol Infect Dis. 2018;91:309-11.
Jayol A, Dubois V, Poirel L, Nordmann P. Rapid Detection of Polymyxin-Resistant Enterobacteriaceae from Blood Cultures. J Clin Microbiol. 2016;54:2273-7.
Lescat M, Poirel L, Tinguely C, Nordmann P. A Resazurin Reduction-Based Assay for Rapid Detection of Polymyxin Resistance in Acinetobacter baumannii and Pseudomonas aeruginosa. J Clin Microbiol. 2019;57:e01563-18.
Hu S, Lv Z, Wang Y, Shen J, Ke Y. Novel Quadruplex PCR for detecting and genotyping mobile colistin resistance genes in human samples. Diagn Microbiol Infect Dis. 2021;101:115419.
Ginocchio CC. Role of NCCLS in antimicrobial susceptibility testing and monitoring. Am J Health Syst Pharm. 2002;59(8 Suppl 3):7-11.
Tan TY, Ng LS. Comparison of three standardized disc susceptibility testing methods for colistin. J Antimicrob Chemother. 2006;58:864-7.
Maalej SM, Meziou MR, Rhimi FM, Hammami A. Comparison of disc diffusion, Etest and agar dilution for susceptibility testing of colistin against Enterobacteriaceae. Lett Appl Microbiol. 2011;53:546-51.
CLSI-EUCAST Polymyxin Breakpoints Working Group. 2016. Recommendations for MIC determination of colistin (polymyxin E) as recommended by the joint CLSI-EUCAST Polymyxin Breakpoints Working Group. Available from: http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/General_documents/Recommendations_for_MIC_determination_of_colistin_March_2016.pdf. [Ref list]
Dafopoulou K, Zarkotou O, Dimitroulia E, Hadjichristodoulou C, Gennimata V, Pournaras S, Tsakris A. Comparative Evaluation of Colistin Susceptibility Testing Methods among Carbapenem-Nonsusceptible Klebsiella pneumoniae and Acinetobacter baumannii Clinical Isolates. Antimicrob Agents Chemother. 2015;59:4625-30.
Humphries RM, Green DA, Schuetz AN, Bergman Y, Lewis S, Yee R, Stump S, Lopez M, Macesic N, Uhlemann AC, Kohner P, Cole N, Simner PJ. Multicenter Evaluation of Colistin Broth Disk Elution and Colistin Agar Test: a Report from the Clinical and Laboratory Standards Institute. J Clin Microbiol. 2019;57:e01269-19.
Singhal L, Sharma M, Verma S, Kaur R, Britto XB, Kumar SM, Ray P, Gautam V. Comparative Evaluation of Broth Microdilution with Polystyrene and Glass-Coated Plates, Agar Dilution, E-Test, Vitek, and Disk Diffusion for Susceptibility Testing of Colistin and Polymyxin B on Carbapenem-Resistant Clinical Isolates of Acinetobacter baumannii. Microb Drug Resist. 2018;24:1082-8.
Hogardt M, Schmoldt S, Götzfried M, Adler K, Heesemann J. Pitfalls of polymyxin antimicrobial susceptibility testing of Pseudomonas aeruginosa isolated from cystic fibrosis patients. J Antimicrob Chemother. 2004;54:1057-61.
Lo-Ten-Foe JR, de Smet AM, Diederen BM, Kluytmans JA, van Keulen PH. Comparative evaluation of the VITEK 2, disk diffusion, etest, broth microdilution, and agar dilution susceptibility testing methods for colistin in clinical isolates, including heteroresistant Enterobacter cloacae and Acinetobacter baumannii strains. Antimicrob Agents Chemother. 2007;51:3726-30.
Lee SY, Shin JH, Lee K, Joo MY, Park KH, Shin MG, Suh SP, Ryang DW, Kim SH. Comparison of the Vitek 2, MicroScan, and Etest methods with the agar dilution method in assessing colistin susceptibility of bloodstream isolates of Acinetobacter species from a Korean university hospital. J Clin Microbiol. 2013;51:1924-6.
Chew KL, La MV, Lin RTP, Teo JWP. Colistin and Polymyxin B Susceptibility Testing for Carbapenem-Resistant and mcr-Positive Enterobacteriaceae: Comparison of Sensititre, MicroScan, Vitek 2, and Etest with Broth Microdilution. J Clin Microbiol. 2017;55:2609-16.
Főldes A, Székely E, Voidăzan ST, Dobreanu M. Comparison of Six Phenotypic Assays with Reference Methods for Assessing Colistin Resistance in Clinical Isolates of Carbapenemase-Producing Enterobacterales: Challenges and Opportunities. Antibiotics (Basel). 2022;11:377.
Matuschek E, Åhman J, Webster C, Kahlmeter G. Antimicrobial susceptibility testing of colistin - evaluation of seven commercial MIC products against standard broth microdilution for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter spp. Clin Microbiol Infect. 2018;24:865-70.
Rout B, Dash SK, Sahu KK, Behera B, Praharaj I, Otta S. Evaluation of different methods for in vitro susceptibility testing of colistin in carbapenem resistant Gram-negative bacilli. Access Microbiol. 2023;5:000595.
Tüzemen NÜ, Efe K, Akalın H, Özakın C. Retrospective evaluation of colistin-resistant isolates in automated system by gradient diffusion method and broth microdilution method. Klimik Derg. 2019;32:57-61.
Tanrıverdi Çaycı Y, Çınar C, Bilgin K, Gür Vural D, Birinci A. Comparison of the Results of the Microdilution and Automated System in Determination of Colistin Resistance. J DU Health Sci Inst. 2020;10:297-301.
Fadana V, Thomas T, von Knorring N. Retrospective analysis of Vitek®2 performance compared to manual broth micro-dilution for colistin susceptibility testing of Acinetobacter baumannii complex isolates in South Africa. Afr J Lab Med. 2022;11:1597.
Osei Sekyere J. Mcr colistin resistance gene: a systematic review of current diagnostics and detection methods. Microbiologyopen. 2019;8:e00682.
Gorecki A, Musialowski M, Wolacewicz M, Decewicz P, Ferreira C, Vejmelkova D, Grzesiuk M, Manaia CM, Bartacek J, Dziewit L. Development and validation of novel PCR primers for identification of plasmid-mediated colistin resistance (mcr) genes in various environmental settings. J Hazard Mater. 2022;425:127936.
Leshaba TMS, Mbelle NM, Osei Sekyere J. Current and emerging polymyxin resistance diagnostics: A systematic review of established and novel detection methods. J Appl Microbiol. 2022;132:8-30.
Simner PJ, Bergman Y, Trejo M, Roberts AA, Marayan R, Tekle T, Campeau S, Kazmi AQ, Bell DT, Lewis S, Tamma PD, Humphries R, Hindler JA. Two-Site Evaluation of the Colistin Broth Disk Elution Test To Determine Colistin In Vitro Activity against Gram-Negative Bacilli. J Clin Microbiol. 2019;57:e01163-18.
Özkaçmaz A, Milletli-Sezgin F. Evaluation of colistin susceptibility results in multidrug-resistant Gram-negative bacilli by colistin broth disk elution method. Klimik Derg. 2022;35:155-8.
