Yoğun Bakım Ünitesinde Gelişen Klebsiella pneumoniae Enfeksiyonları: Karbapenem Direnci ve Hasta Mortalitesi ile İlgili Risk Faktörler

Büyüktuna, Seyit Ali; Hasbek, Mürşit; Çelik, Cem; Ünlüsavuran, Meltem; AVCI, Onur; Baltacı, Sevgi; Topçu, Kübra Fırtına; Elaldı, Nazif

doi:10.5578/mb.69679

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…21 In the CAESAR 2018 report, ertapenem resistance was reported as 43%, and imipenem/meropenem resistance was reported as 38% in K. pneumoniae isolates obtained from blood and cerebrospinal fluid samples from Turkey. 22 In our study, it was observed that carbapenem resistance increased from 10% to 100% in the Klebsiella spp. group in a short period of 3 years.…”

Section: Discussionmentioning

confidence: 54%

Bacteriological Profile and Antimicrobial Resistance Pattern Among Healthcare-Associated Infections in a Pediatric Intensive Care Unit

Çetin

Şahin

Kürkçü

et al. 2022

JPA

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Healthcare-associated infections (HAIs) are a global public health issue with clinical and socioeconomic consequences. These infections are important indices for the quality of healthcare services which are serious complications that should be addressed in pediatric intensive care units (PICUs). This study aimed to retrospectively examine the bacterial HAIs, the frequency of isolated pathogen microorganisms, the areas of infection, and the antibiotic susceptibility recorded in the surveillance system in our Pediatric Intensive Care Unit for five years between 01.01.2015 and 31.12.2019. Two thousand five hundred forty-five patients were admitted to the pediatric intensive care unit during the study period and treated. One-hundred ninety HAIs were detected in 99 patients. In the study, gram-negative microorganisms were most commonly seen (160/190). Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella spp. were the most common bacteria. Enterococcus spp. and coagulase-negative staphylococci were the most common gram-positive microorganisms. The mortality rate of a bacterial HAI was 40.4%. There was no resistance against vancomycin in Gram-positive microorganisms. The resistance rate against methicillin was 100% in coagulase-negative staphylococci and 50% in S. aureus strains. The cumulative rate of carbapenem resistance was found as 76.1% in Pseudomonas aeruginosa, 45.2% in Klebsiella spp. and 0% in Escherichia coli. In 2019, the resistance rate against colistin in Klebsiella spp. and Pseudomonas aeruginosa were 46.2% (6/13) and 20% (1/5), respectively. The resistance rate against carbapenem and colistin was 81.1% and 0% in Acinetobacter baumannii. It was observed that the use of carbapenem before an infection episode increased significantly, and the rate of carbapenem resistance reached 100% over the years in Pseudomonas aeruginosa and Klebsiella spp. A significant proportion of the isolates were multidrug-resistant strains, significantly threatening survival. Implementation of effective preventive strategies to combat the emergence of antibiotic resistance is urgently needed.

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Section: Discussionmentioning

confidence: 54%

Bacteriological Profile and Antimicrobial Resistance Pattern Among Healthcare-Associated Infections in a Pediatric Intensive Care Unit

Çetin

Şahin

Kürkçü

et al. 2022

JPA

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“…This gene is now also endemic in the Middle East and North African countries and causes nosocomial epidemics [ 33 ]. Studies conducted in our country showed that OXA-48 was found to be 68.8% and 82.45%, respectively, in CRKP isolates [ 26 , 27 ]. Interestingly, this rate decreased to 40.6% in our study, and it was found at the same rate as KPC.…”

Section: Discussionmentioning

confidence: 99%

Evaluating molecular epidemiology of carbapenem non-susceptible Klebsiella pneumoniae isolates with MLST, MALDI-TOF MS, PFGE

Ibik,

Ejder,

Sevim

et al. 2023

Ann Clin Microbiol Antimicrob

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Background This study aimed to evaluate antibiotic resistance genes and virulence genes and the clonal relationship of the carbapenem-nonsusceptible Klebsiella pneumoniae strains by molecular methods which are isolated from various clinical specimens from patients treated in tertiary care hospital in Turkey. Methods Identification of 32 carbapenem non-susceptible K. pneumoniae were determined by VITEK-2 (BioMérieux, France) automated system. Thirteen colistin-resistant strains were tested with the broth microdilution method. Various antibiotic resistance genes and virulence genes frequently seen in carbapenem-resistant strains were screened by PCR. Immunochromatographic tests used in the rapid diagnosis of carbapenemases were compared with PCR results. In addition, PFGE, MLST and MALDI-TOF MS methods were used to determine the clonal relationship among these strains. Results PCR demonstrated that 31 of the strains carried at least one of the carbapenemase genes. In one strain, the coexistence of blaOXA−48+NDM was shown. The most common resistance genes were determined as blaSHV (84.3%), blaCTX−M−1 (46.8%), blaOXA−48 (40.6%), blaKPC (40.6%), blaTEM (31.2%), blaNDM (18.8%) respectively. Among the virulence genes; magA (68.7%) was the most common, followed by kpn (59.3%) and K2 (9.3%). Immunochromatographic tests were found to be 100% compatible with PCR results. All colistin-resistant isolates were also found to be resistant by colistin broth microdilution. In PFGE analysis, 25 different genotypes were determined and clustering isolates were collected in 5 different clusters and the clustering rate was 35.4%. In MLST analysis, ST101 type was determined as the most common ST type with a rate of 29%. ST101 is followed by ST16, ST307, ST14, ST147, ST309, ST377, ST395 and ST2096, respectively. The compatibility rate between MALDI-TOF MS and VITEK-2 was found 94.3%, in bacterial identification. In MALDI-TOF MS typing, the maximum similarity between the strains was less than 70% and clustering not shown. Conclusion In addition to OXA-48, which is endemic in our country, it has been determined that KPC, which is more common in the world, is becoming increasingly common in our region. ST101 type was determined as the most common type between the strains. To the best of our knowledge, this is the first study that compares these three methods in our country. There may be differences between bacterial identifications made with VITEK-2 and MALDI-TOF MS. In this study, it was observed that MALDI-TOF MS analyses were not compatible with the typing of strains according to PFGE and MLST analysis results.

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“…Karbapenem direnci de bu tip enfeksiyonların tedavisinde sorun oluşturmaktadır. Karbapenem dirençli K. pneumoniae'ye bağlı kan dolaşım enfeksiyonlarında, hassas suşlarla karşılaştırıldığında daha yüksek mortalite oranları bildirilmiştir (13,14) . Bizim hastanemizde de 2012 itibaren giderek artan sıklıkta KDKp suşları izole edilmeye başlanmıştır.…”

Section: Discussionunclassified

“…Hastanemiz verilerinin de bulunduğu çok merkezli HİTİT-2 çalışmasında 2007 yılında K. pneumoniae suşlarında imipeneme direnç oranı %3.8 olarak bulunmuştur (16) . Son yıllarda ülkemizin farklı bölgelerinde yapılan çalışmalarda, KDKp oranları %20-51 arasında bildirilmektedir (14,(17)(18)(19)(20)(21) . Bizim çalışmamızda da, K. pneumoniae suşlarımızda 2012 yılından sonra görülmeye başlayan karbapenem direnci, 2020 yılı sonunda, tüm izole edilen K. pneumoniae suşları içinde KDKp oranımız %7.5 olarak bulunmuştur.…”

Section: Discussionunclassified

Klebsiella pneumoniae Klinik Suşlarında, 2012-2020 Yılları Arasında Karbapenem Direnç Oranlarındaki Değişimin ve Direnç Genlerinin Araştırılması

Telli¹

2022

Turk Mikrobiyol Cemiy Derg

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Sonuç: Hastanemizde, karbapenem dirençli K. pneumoniae suşları yıllar içinde giderek artan oranda bulunmuştur. OXA-48 direnç geni en sık (%38.8) tekil gen olarak bulunmuştur. NDM direnç geni ise ikinci sıklıkta bulunmuştur. Bunun yanında ise OXA-48+NDM ikili gen varlığı hastanemiz en sık (%42.3) direnç mekanizması olarak bulunmuştur. Bu nedenlerle, KDKp suşlarında düzenli epidemiyolojik taramalarının ve direnç mekanizmalarının bölgesel ve ulusal olarak araştırmalarının yapılmasının bu bakteriye bağlı enfeksiyonların tedavisinde ve direncin kontrolünde çok önemli olduğu görülmektedir.

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Yoğun Bakım Ünitesinde Gelişen Klebsiella pneumoniae Enfeksiyonları: Karbapenem Direnci ve Hasta Mortalitesi ile İlgili Risk Faktörler

Cited by 5 publications

References 19 publications

Bacteriological Profile and Antimicrobial Resistance Pattern Among Healthcare-Associated Infections in a Pediatric Intensive Care Unit

Bacteriological Profile and Antimicrobial Resistance Pattern Among Healthcare-Associated Infections in a Pediatric Intensive Care Unit

Evaluating molecular epidemiology of carbapenem non-susceptible Klebsiella pneumoniae isolates with MLST, MALDI-TOF MS, PFGE

Klebsiella pneumoniae Klinik Suşlarında, 2012-2020 Yılları Arasında Karbapenem Direnç Oranlarındaki Değişimin ve Direnç Genlerinin Araştırılması

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