Providencia rettgeri’de OXA-48 ve NDM-1 Karbapenemaz Genlerinin Birlikte Üretimi: İlk Bildirim
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Dosyalar
Tarih
2018
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Öz: Ülkemiz, OXA-48 benzeri karbapenemaz üreten Klebsiella ve Escherichia coli için endemik bir bölge olarak kabul edilmektedir. Son yıllarda Enterobacteriaceae türleri arasında bu direncin yayıldığı veya diğer karbapenemazlarla birlikte ortaya çıktığı görülmektedir. Bu çalışmada, OXA-48 ve NDM-1 karbapenemazları birlikte üreten iki Providencia rettgeri izolatı bildirilmektedir. Nisan 2017 tarihinde, hastanemizin yanık ünitesinde yatarak tedavi gören 68 yaşında kadın hastanın idrar kültüründe ve Kasım 2017 tarihinde aynı ünitede yatan 35 yaşında erkek hastanın enfekte yanık yarasında kolistin ve tigesiklin dışında tüm antibiyotiklere dirençli olan P.rettgeri izole edilmiştir. İzolatların imipenem ve meropenem minimum inhibitör konsantrasyonları (MİK) ? 32 ?g/ml; kolistin ve tigesiklin MİK düzeyleri ise sırasıyla 1 ve 0.5 ?g/ ml olarak belirlenmiştir. Multipleks polimeraz zincir reaksiyonu (PCR) yöntemi ile her iki izolatın blaOXA-48 ve blaNDM-1 karbapenemaz ve blaTEM genişlemiş spektrumlu beta-laktamaz genleri taşıdığı saptanmış ve DNA dizileme yöntemi sonrası TEM tipi beta-laktamaz geninin blaTEM-1 olduğu tespit edilmiştir. “Pulsed field gel electrophoresis (PFGE)” analizi sonucunda aynı birimde, yaklaşık yedi aylık bir zaman aralığı ile farklı hastalardan elde edilen bu iki P.rettgeri izolatının aynı genotipte olduğu görülmüştür. Hastaların tıbbi öyküleri ve çevre kültürlerinin geriye doğru analizi sonrasında, P.rettgeri suşunun iki hasta arasında bulaşını açıklayabilecek bilgiye ulaşılamamıştır. Hastaneye ait enfeksiyon kontrol önlemlerinin güçlendirilmesi sonrasında son olgunun tanımlanmasından günümüze üç aydan fazla bir süre içinde çevre kültürlerinde ve klinik örneklerde yeni bir P.rettgeri izolasyonu saptanmamıştır. Bu çalışmada, günümüze kadar sadece üç Enterobacteriaceae türünde bildirilmiş olan OXA-48 ve NDM-1 karbapenemaz birlikteliğinin horizontal olarak diğer türlere de yayıldığı ve klonal yayılımla hastanelerde büyüyebilecek bir sorun olma potansiyeli gösterdiği vurgulanmıştır. Moleküler epidemiyolojik yöntemlerin etkili kullanımı, bu tür nadir ancak tedavisi sorunlu olabilecek patojenlerin hastanede yayılımını aydınlatabilecek dinamiklerinin saptanması için önemli bilgiler sağlayacaktır.
Öz: Our country is the epicenter of the OXA-48-like carbapenemase-producing Klebsiella and Escherichia coli; and in the recent years, the concern has been increasing due to both spreading of this resistance to other members of Enterobacteriaceae family and acquiring other carbapenemases by the OXA-48- producing strains. In this study, OXA-48 and NDM-1 co-production was presented in Providencia rettgeri. Two P.rettgeri strains that were resistant to all antimicrobials except colistin and tigecyclin, were isolated from two patients in the burn unit of our hospital, including one from the urine sample of a 68 years female in April 2017, and the other from a burn wound swab of a 35 years old male, in November 2017. Minimal inhibitory concentrations (MICs) of the isolates for imipenem and meropenem were measured as ? 32 ?g/ml; and for colistin and tigecyclin were 1 ve 0.5 ?g/ml, respectively. Multiplex PCR analysis showed that both strains were carrying blaOXA-48 and blaNDM-1 carbapenemases, and blaTEM extended spectrum beta-lactamase genes. By using DNA sequence analysis, the TEM gene was typed as blaTEM-1. The Pulsed Field Gel Electrophoresis (PFGE) analysis indicated that these two strains which were consecutively isolated from two different patients in a single unit within about seven months were genetically indistinguishable. No significant data that could explain the spread of these isolates was obtained from our retrospective analysis of the medical records including the results of environmental surveillance cultures, and patients’ history. Nevertheless, hospital infection control committee enforced the infection control measures in that unit, and no further isolation was observed within three months period following the last isolation, neither from environmental nor from clinical samples. With this study, it was emphasized that the co-production of OXA-48 and NDM-1 carbapenemases which was reported from only three Enterobacteriaceae species up to date was ongoing for spreading to other species by using horizontal route, and also showing a potential to be a growing problem in the hospitals, by clonal expansion (vertical route). Effectively using of the molecular epidemiological methods will provide useful data to better understand the transmission dynamics of such rare, but problematic species in hospitals.
Öz: Our country is the epicenter of the OXA-48-like carbapenemase-producing Klebsiella and Escherichia coli; and in the recent years, the concern has been increasing due to both spreading of this resistance to other members of Enterobacteriaceae family and acquiring other carbapenemases by the OXA-48- producing strains. In this study, OXA-48 and NDM-1 co-production was presented in Providencia rettgeri. Two P.rettgeri strains that were resistant to all antimicrobials except colistin and tigecyclin, were isolated from two patients in the burn unit of our hospital, including one from the urine sample of a 68 years female in April 2017, and the other from a burn wound swab of a 35 years old male, in November 2017. Minimal inhibitory concentrations (MICs) of the isolates for imipenem and meropenem were measured as ? 32 ?g/ml; and for colistin and tigecyclin were 1 ve 0.5 ?g/ml, respectively. Multiplex PCR analysis showed that both strains were carrying blaOXA-48 and blaNDM-1 carbapenemases, and blaTEM extended spectrum beta-lactamase genes. By using DNA sequence analysis, the TEM gene was typed as blaTEM-1. The Pulsed Field Gel Electrophoresis (PFGE) analysis indicated that these two strains which were consecutively isolated from two different patients in a single unit within about seven months were genetically indistinguishable. No significant data that could explain the spread of these isolates was obtained from our retrospective analysis of the medical records including the results of environmental surveillance cultures, and patients’ history. Nevertheless, hospital infection control committee enforced the infection control measures in that unit, and no further isolation was observed within three months period following the last isolation, neither from environmental nor from clinical samples. With this study, it was emphasized that the co-production of OXA-48 and NDM-1 carbapenemases which was reported from only three Enterobacteriaceae species up to date was ongoing for spreading to other species by using horizontal route, and also showing a potential to be a growing problem in the hospitals, by clonal expansion (vertical route). Effectively using of the molecular epidemiological methods will provide useful data to better understand the transmission dynamics of such rare, but problematic species in hospitals.
Açıklama
Anahtar Kelimeler
Kaynak
Mikrobiyoloji Bülteni
WoS Q Değeri
Q4
Scopus Q Değeri
Q4
Cilt
52
Sayı
3
