Abstract
Aim:
Stenotrophomonas maltophilia (S. maltophilia )
is a multi-drug resistant non-fermentative Gram negative bacilli that causes
opportunistic infections especially in hospitalized patients. S. maltophilia strains show a high level
of resistance to routinely tested antibiotics such as penicillins, cephalosporins,
aminoglycosides, quinolones and carbapenems therefore the treatment of this
strains is quite difficult. The aim of this study to determine
the resistance patterns of S. maltophilia strains
isolated from various clinical specimens
during a six year period.
Materials
and methods: The
antimicrobial resistance patterns and distribution of 202 S. maltophilia strains isolated from services and outpatients
during a period of six years (2010-2015) were analyzed retrospectively. Identification and antimicrobial susceptibilities of the isolates were
determined by conventional methods and BD Phoenix 100 (Becton-Dickinson, USA)
automated systems. Antibiotic susceptibilities
were established by disk diffusion and were evaluated according to the CLSI
criteria in 2011-2014 and EUCAST criteria in 2015.
Results:
A total of 202
strains were isolated from services (62.4%),
intensive care units (28.7%) and outpatient clinics (8.9%). 122 patients (60.4%)
were male and 80 (39.6%)
of them were female. Respiratory tract
specimens (n=69) were the most common specimens that S. maltophilia strains were isolated. These
strains were found
most resistant to meropenem (92.8%) and most
sensitive to trimethoprim-sulfamethoxazole
(1%).
Conclusion:
Our resistance rates in S. maltophilia strains were found lower for trimethoprim-sulfamethoxazole,
relatively higher for levofloxacin and ciprofloxacin and
similar to the other antibiotics compared with the rate in our
country. Antimicrobial resistance rates of S. maltophilia strains vary among centers. We believe that it is important to determine their resistance rate of each
center for deciding empirical antibiotherapy.
References
- 1. Brooke JS. Stenotrophomonas maltophilia: an emerging global opportunistic pathogen. Clin Microbiol Rev. 2012;25:2-41.
- 2. Nseir S, Di Pompeo C, Cavestri B, et al. Multiple-drug-resistant bacteria in patients with severe acute exacerbation of chronic obstructive pulmonary disease: Prevalence, risk factors, and outcome. Crit Care Med. 2006;34:2959-66.
- 3. Hotta G, Matsumura Y, Kato K, et al. Risk factors and clinical charasteristics of Stenotrophomonas maltophilia bacteremia: a comparison with bacteremia due to other glucose-non fermenters. 2013;87:596-602.
- 4. Gokhan Gozel M, Celik C, Elaldi N. Stenotrophomonas maltophilia infections in adults: Primary bacteremia and pneumonia. Jundishapur J Microbiol. 2015;8:e23569.
- 5. Falagas ME, Kastoris AC, Vouloumanou EK, Dimopoulos G. Community-acquired Stenotrophomonas maltophilia infections: a systematic review. Eur J Clin Microbiol Infect Dis. 2009;28:719-30.
- 6. Jones RN. Global epidemiology of antimicrobial resistance among community-acquired and nosocomial pathogens: a five-year summary from the SENTRY Antimicrobial Surveillance Program (1997-2001). Semin Respir Crit Care Med. 2003;24:121-34.
- 7. Sanchez MB, Hernandez A, Martinez JL. Stenotrophomonas maltophilia drug resistance. Future Microbiol. 2009;4:655-60.
- 8. Dizbay M, Tunçcan ÖG, Maral I, Aktaş F, Şenol E. Five year surveillance of nosocomial Stenotrophomonas maltophi¬lia infections in Gazi University Hospital. Türkiye Klinikleri J Med Sci 2009;29:1406-11.
- 9. Dağı HT, Arslan U, Tuncer İ. Antibiotic Resistance of Stenotrophomonas maltophilia Strains Isolated from Blood Cultures. Ankem Derg 2011;25:27-30.
- 10. Paez JI, Costa SF. Risk factors associated with mortality of infections caused by Stenotrophomonas maltophilia: a systematic review. J Hosp Infect. 2008 ;70:101-8.
- 11. Çaycı YT, Karadağ A, Yılmaz H, Yanık K, Günaydın M. Stenotrophomonas maltophilia Klinik Suşlarında Antimikrobiyal direnç. Türk Mikrobiyol Cem Derg 2013;43:22-5.
- 12. Parkins MD, Floto RA. Emerging bacterial pathogens and changing concepts of bacterial pathogenesis in cystic fibrosis. J Cyst Fibros. 2015;14:293-304.
- 13. Ji Y, Jiang C, Ji J, Luo Y, Jiang Y, Lu Y. Post-cataract endophthalmitis caused by multidrug-resistant Stenotrophomonas maltophilia: clinical features and risk factors. BMC Ophthalmol. 2015;15:14.
- 14. Comez AT, Koklu A, Akcali A. Chronic dacryocystitis secondary to Stenotrophomonas maltophilia and Staphylococcus aureus mixed infection. BMJ Case Rep. 2014;2014 doi: 10.1136/bcr-2014-20364.
- 15. Ucak A, Goksel OS, Inan K, et al. Prosthetic aortic valve endocarditis due to Stenotrophomonas maltophilia complicated by subannular abscess. Acta Chir Belg. 2008;108:258-60.
- 16. Samonis G, Karageorgopoulos DE, Maraki S, et al. Stenotrophomonas maltophilia infections in a general hospital: patient characteristics, antimicrobial susceptibility, and treatment outcome. PLoS One. 2012;7:e37375.
- 17. Flores-Treviño S, Gutiérrez-Ferman JL, Morfín-Otero R, et al. Stenotrophomonas maltophilia in Mexico: antimicrobial resistance, biofilm formation and clonal diversity. J Med Microbiol. 2014;63:1524-30.
- 18. Juhász E, Krizsán G, Lengyel G, Grósz G, Pongrácz J, Kristóf K. Infection and colonization by Stenotrophomonas maltophilia: antimicrobial susceptibility and clinical background of strains isolated at a tertiary care centre in Hungary. Ann Clin Microbiol Antimicrob. 2014;13:333.
- 19. Zer Y, Karaoğlan İ, Çevik S, Erdem M. Stenotrophomonas maltophilia suşlarının antibiyotik duyarlılıklarının irdelenme¬si. Klimik Derg 2009;22:21-4.
- 20. Yıldırım Ş, Yaşar KK, Şengöz G, Yamanlar R, Nayman F, İdin K. Control of Stenotrophomonas maltophilia infection in an adult intensive care unit. Ankem Derg 2009;23:166-71.
- 21. Tekin A, Dal T, Tekin R, et al. Klinik örneklerden izole edilen Stenotrophomonas maltophilia suşlarının in vitro antibiyotik duyarlılık paterni. Düzce Tıp Fakültesi Dergisi 2014;16:4-7.
- 22. Valdezate S, Vindel A, Loza E, Baquero F, Cantón R. Antimicrobial susceptibilities of unique Stenotrophomonas maltophilia clinical strains. Antimicrob Agents Chemother 2001;45:1581-4.
- 23. Farrell DJ, Sader HS, Jones RN. Antimicrobial susceptibi¬lity of a worldwide collection of Stenotrophomonas maltophi¬lia isolates tested against tigecycline and agents commonly used for S. maltophilia infections. Antimicrob Agents Chemother 2010;54:2735-7.
- 24. Ongut G, Ozcan A, Kandiser A, Ogunc D, Colak D, Gultekin M. Çeşitli klinik örneklerden izole edilen Stenotrophomonas maltophilia suşlarının antimikrobiyal duyarlılıklarının E-test ile araştırılması. İnfeksiyon Dergisi 2005;19:425–8.
- 25. Nicodemo AC, Paez JI. Antimicrobial therapy for Stenotrophomonas maltophilia infections, Eur J Clin Microbiol Infect Dis 2007;26:229-37.
Çeşitli klinik örneklerden izole edilen Stenotrophomonas maltophilia suşlarında antibiyotiklere direnç oranı
Abstract
Amaç:
Stenotrophomonas maltophilia, (S. maltophilia ) özellikle hastanede
uzun süre izlenen hastalarda fırsatçı enfeksiyonlara neden olan çoklu ilaca
dirençli non-fermentatif Gram negatif
basildir. Klinik örneklerden izole edilen S.
maltophilia suşları rutinde test edilen penisilin, sefalosporin, aminoglikozid,
kinolon, karbapenem gibi antibiyotiklere yüksek düzeyde çoğul direnç
göstermekte, bu nedenle tedavisi oldukça zor olmaktadır. Çalışmamızda
hastanemizde çeşitli klinik örneklerden izole edilmiş olan S. maltophilia suşlarının direnç profilini belirlemeyi amaçladık.
Yöntem:
Çalışmamızda altı yıllık dönemde servis ve polikliniğe başvuran hastalardan
izole edilmiş 202 S. maltophilia
suşunun dağılımı ve antibiyotik duyarlılığı retrospektif olarak incelenmiştir. Antibiyotik
duyarlılıkları ve suş tanımlama konvansiyonel yöntemler ve BD Phoenix 100
otomatize sistemi (Becton-Dickinson, ABD) kullanılarak belirlenmiştir.
Antibiyotik duyarlılığını belirlemede zon çapları 2010-2014 tarihleri arasında
CLSI, 2015 yılında EUCAST kriterleri doğrultusunda değerlendirilmiştir.
Bulgular: Toplam 202 suşun 126 (%62.4)’sı
servisten, 58 (%28.7)’i yoğun bakım ünitesinden
ve 18 (%8.9)’i poliklinikten takip edilen hastalardan izole edildi. Bu
hastaların 122 (%60.4)’ si erkek, 80 (%39.6)’i kadın hastalardan oluşmaktaydı.
Bu suşlar en sık solunum yolu örneklerinden (n=69) izole edilmiştir. Bu
suşların en duyarlı olduğu antibiyotik %1 (2/193) direnç oranı ile
trimetoprim-sulfametoksazol olarak belirlenmiştir.
Sonuç: S. maltophilia suşlarında
direnç oranlarımız ülkemizde bildirilen oranlarla kıyaslandığında trimetoprim-sulfametoksazol
düşük, levofloksasin ve siprofloksasinde kısmen yüksek, diğer antibiyotiklerde
benzer olduğu bulunmuştur. Direnç oranları merkezler arasında farklılık
gösterebildiğinden; her merkezin kendi direnç oranlarını belirlemesi, hangi hastada stenotrophomonas enfeksiyonunun
düşünülmesi gerektiğinin bilinmesi gibi oldukça önemlidir.
References
- 1. Brooke JS. Stenotrophomonas maltophilia: an emerging global opportunistic pathogen. Clin Microbiol Rev. 2012;25:2-41.
- 2. Nseir S, Di Pompeo C, Cavestri B, et al. Multiple-drug-resistant bacteria in patients with severe acute exacerbation of chronic obstructive pulmonary disease: Prevalence, risk factors, and outcome. Crit Care Med. 2006;34:2959-66.
- 3. Hotta G, Matsumura Y, Kato K, et al. Risk factors and clinical charasteristics of Stenotrophomonas maltophilia bacteremia: a comparison with bacteremia due to other glucose-non fermenters. 2013;87:596-602.
- 4. Gokhan Gozel M, Celik C, Elaldi N. Stenotrophomonas maltophilia infections in adults: Primary bacteremia and pneumonia. Jundishapur J Microbiol. 2015;8:e23569.
- 5. Falagas ME, Kastoris AC, Vouloumanou EK, Dimopoulos G. Community-acquired Stenotrophomonas maltophilia infections: a systematic review. Eur J Clin Microbiol Infect Dis. 2009;28:719-30.
- 6. Jones RN. Global epidemiology of antimicrobial resistance among community-acquired and nosocomial pathogens: a five-year summary from the SENTRY Antimicrobial Surveillance Program (1997-2001). Semin Respir Crit Care Med. 2003;24:121-34.
- 7. Sanchez MB, Hernandez A, Martinez JL. Stenotrophomonas maltophilia drug resistance. Future Microbiol. 2009;4:655-60.
- 8. Dizbay M, Tunçcan ÖG, Maral I, Aktaş F, Şenol E. Five year surveillance of nosocomial Stenotrophomonas maltophi¬lia infections in Gazi University Hospital. Türkiye Klinikleri J Med Sci 2009;29:1406-11.
- 9. Dağı HT, Arslan U, Tuncer İ. Antibiotic Resistance of Stenotrophomonas maltophilia Strains Isolated from Blood Cultures. Ankem Derg 2011;25:27-30.
- 10. Paez JI, Costa SF. Risk factors associated with mortality of infections caused by Stenotrophomonas maltophilia: a systematic review. J Hosp Infect. 2008 ;70:101-8.
- 11. Çaycı YT, Karadağ A, Yılmaz H, Yanık K, Günaydın M. Stenotrophomonas maltophilia Klinik Suşlarında Antimikrobiyal direnç. Türk Mikrobiyol Cem Derg 2013;43:22-5.
- 12. Parkins MD, Floto RA. Emerging bacterial pathogens and changing concepts of bacterial pathogenesis in cystic fibrosis. J Cyst Fibros. 2015;14:293-304.
- 13. Ji Y, Jiang C, Ji J, Luo Y, Jiang Y, Lu Y. Post-cataract endophthalmitis caused by multidrug-resistant Stenotrophomonas maltophilia: clinical features and risk factors. BMC Ophthalmol. 2015;15:14.
- 14. Comez AT, Koklu A, Akcali A. Chronic dacryocystitis secondary to Stenotrophomonas maltophilia and Staphylococcus aureus mixed infection. BMJ Case Rep. 2014;2014 doi: 10.1136/bcr-2014-20364.
- 15. Ucak A, Goksel OS, Inan K, et al. Prosthetic aortic valve endocarditis due to Stenotrophomonas maltophilia complicated by subannular abscess. Acta Chir Belg. 2008;108:258-60.
- 16. Samonis G, Karageorgopoulos DE, Maraki S, et al. Stenotrophomonas maltophilia infections in a general hospital: patient characteristics, antimicrobial susceptibility, and treatment outcome. PLoS One. 2012;7:e37375.
- 17. Flores-Treviño S, Gutiérrez-Ferman JL, Morfín-Otero R, et al. Stenotrophomonas maltophilia in Mexico: antimicrobial resistance, biofilm formation and clonal diversity. J Med Microbiol. 2014;63:1524-30.
- 18. Juhász E, Krizsán G, Lengyel G, Grósz G, Pongrácz J, Kristóf K. Infection and colonization by Stenotrophomonas maltophilia: antimicrobial susceptibility and clinical background of strains isolated at a tertiary care centre in Hungary. Ann Clin Microbiol Antimicrob. 2014;13:333.
- 19. Zer Y, Karaoğlan İ, Çevik S, Erdem M. Stenotrophomonas maltophilia suşlarının antibiyotik duyarlılıklarının irdelenme¬si. Klimik Derg 2009;22:21-4.
- 20. Yıldırım Ş, Yaşar KK, Şengöz G, Yamanlar R, Nayman F, İdin K. Control of Stenotrophomonas maltophilia infection in an adult intensive care unit. Ankem Derg 2009;23:166-71.
- 21. Tekin A, Dal T, Tekin R, et al. Klinik örneklerden izole edilen Stenotrophomonas maltophilia suşlarının in vitro antibiyotik duyarlılık paterni. Düzce Tıp Fakültesi Dergisi 2014;16:4-7.
- 22. Valdezate S, Vindel A, Loza E, Baquero F, Cantón R. Antimicrobial susceptibilities of unique Stenotrophomonas maltophilia clinical strains. Antimicrob Agents Chemother 2001;45:1581-4.
- 23. Farrell DJ, Sader HS, Jones RN. Antimicrobial susceptibi¬lity of a worldwide collection of Stenotrophomonas maltophi¬lia isolates tested against tigecycline and agents commonly used for S. maltophilia infections. Antimicrob Agents Chemother 2010;54:2735-7.
- 24. Ongut G, Ozcan A, Kandiser A, Ogunc D, Colak D, Gultekin M. Çeşitli klinik örneklerden izole edilen Stenotrophomonas maltophilia suşlarının antimikrobiyal duyarlılıklarının E-test ile araştırılması. İnfeksiyon Dergisi 2005;19:425–8.
- 25. Nicodemo AC, Paez JI. Antimicrobial therapy for Stenotrophomonas maltophilia infections, Eur J Clin Microbiol Infect Dis 2007;26:229-37.
Details
| Subjects | Health Care Administration |
|---|---|
| Journal Section | Original article |
| Authors | |
| Publication Date | March 2, 2017 |
| Published in Issue | Year 2017 Volume: 9 Issue: 3 |
e-ISSN: 2548-0251
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