Evaluation of risk factors associated with fluoroquinolone-resistant Escherichia coli and Klebsiella pneumoniae urinary tract infections
Öz
Aim: The increased
antimicrobial resistance rates limit oral empirical treatment options in
urinary tract infections. Determining risk factors associated with antibiotic
resistance is important in terms of empirical antibiotic selection. We aimed to
evaluate fluoroquinolone resistance and risk factors in Escherichia coli (E. coli)
and Klebsiella pneumoniae (K. pneumoniae) strains isolated from urine cultures.
Materials and Methods: A total of 76 patients who were admitted to the outpatient urology
clinic were analyzed retrospectively from January 2015 through December 2017.
Possible risk factors associated with fluoroquinolone resistance were analyzed
statistically.
Results: Sixty (78.9%) of the patients were female and 16 (21.1%) were male and
mean age was 54.1 ± 19.6 years. The fluoroquinolone resistance was 55.3% and
extended spectrum beta-lactamase positivity rates were 15.8%. Complicated
urinary tract infection (p=0.009), urolithiasis (p=0.014), uropathology
(p=0.002), urological intervention (p=0.040) and prior antibiotic use
(p<0.001) were significantly associated with fluoroquinolone resistance. The
weak positive correlation was found between complicated urinary tract
infection, urolithiasis, uropathology, urological intervention and
fluoroquinolone resistance and prior antibiotic use was showed moderately
positive correlation with fluoroquinolone resistance (p<0.05). Prior
antibiotic use is identified as an independent risk factor for fluoroquinolone
resistance (p=0.005).
Conclusion: Identification of preventable factors leading to antibiotic resistance
and taking the necessary precautions are important both in empirical
antibiotherapy selection and in decreasing resistance rates together with
rational antibiotic use.
Anahtar Kelimeler
Fluoroquinolone resistance risk factors urinary tract infection.
Kaynakça
- Tekin A, Deveci Ö, Dal T, Tekin R, Özekinci T, Dayan S. Üropatojen Escherichia coli izolatlarına fosfomisin ve bazı antibiyotiklerin in vitro etkinliği. Ankem Derg 2012; 26 (2): 61-68.
- Fasugba O, Gardner A, Mitchell BG, Mnatzaganian G. Ciprofloxacin resistance in community- and hospital-acquired Escherichia coli urinary tract infections: a systematic review and meta-analysis of observational studies. BMC Infect Dis. 2015; 15: 545.
- Soydan S, Karadağ G, Çalışkan E, Kale E. In vitro susceptibility analysis of Escherichia coli strains isolated from urinary tract infections to fosfomycin, nitrofurantoin and ciprofloxacin. Mediterr J Infect Microb Antimicrob. 2015; 4: 3.
- Aykan ŞB, Çiftçi İH. Türkiye’de İdrar Kültürlerinden İzole Edilen Escherichia coli Suşlarının Antibiyotiklere Direnç Durumu: Bir Meta-Analiz. Mikrobiyol Bul 2013; 47 (4): 603-618.
- Gupta K, Hooton TM, Naber KG, et al. Infectious Diseases Society of America; European Society for Microbiology and Infectious Diseases. International clinical practice guideline for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011; 52 (5): e103–120.
- Dalhoff A. Global fluoroquinolone resistance epidemiology and implications for clinical use. Interdiscip Perspect Infect Dis 2012;2012:976273.
- Shah A, Justo JA, Bookstaver PB, Kohn J, Albrecht H, Al-Hasan MN. Application of Fluoroquinolone Resistance Score in Management of Complicated Urinary Tract Infections. Antimicrob Agents Chemother. 2017; 61 (5). pii: e02313-16.
- The European Committee on Antimicrobial Susceptibility Testing. Ref: Breakpoint tables for interpretation of MICs and zone diameters. Version 7.1, 2017. http://www.eucast.org (15/04/2018).
- Paterson DL, Bonomo RA. Extended-spectrum beta-lactamases: a clinical update. Clin Microbiol Rev 2005;18 (4): 657-686.
- Kratochwill L, Powers M, McGraw MA, King L, O'Neill JM, Venkat A. Factors associated with ciprofloxacin resistant Escherichia coli urinary tract infections in discharged ED patients. Am J Emerg Med. 2015; 33 (10): 1473-1476.
- de Lastours V, Fantin B. Impact of fluoroquinolones on human microbiota. Focus on the emergence of antibiotic resistance. Future Microbiol. 2015; 10 (7): 1241-1255.
- World Health Organisation. Antimicrobial resistance: global report on surveillance. 2014. http://www.who.int/drugresistance/documents/surveillancereport/en/. (13/04/2018).
- Dalhoff A. Resistance surveillance studies: a multifaceted problem-the fluoroquinolone example. Infection. 2012; 40: 239–262.
- Nicoletti J, Kuster SP, Sulser T, et al. Risk factors for urinary tract infections due to ciprofloxacin-resistant Escherichia coli in a tertiary care urology department in Switzerland. Swiss Med Wkly 2010;140: w13059.
- Pepin J, Plamondon M, Lacroix C, Alarie I. Emergence of risk factors for ciprofloxacingentamicin-resistant Escherichia coli urinary tract infections in a region of Quebec. Can J Infect Dis Med Microbiol 2009; 20 (4): e163–168.
- Li J, Xie S, Ahmed S, et al. Antimicrobial Activity and Resistance: Influencing Factors. Front Pharmacol. 2017; 8: 364.
- Sommer MO, Dantas G. Antibiotics and the resistant microbiome. Curr Opin Microbiol. 2011; 14 (5): 556-563.
- Fantin B, Duval X, Massias L, et al. Ciprofloxacin dosage and emergence of resistance in human commensal bacteria. J Infect Dis. 2009; 200 (3): 390-398.
- Morgan DJ, Okeke IN, Laxminarayan R, Perencevich EN, Weisenberg S. Nonprescription antimicrobial use worldwide: a systematic review. Lancet Infect Dis. 2011; 11: 692-701.
Üriner sistem enfeksiyonlarından izole edilen Escherichia coli ve Klebsiella pneumoniae suşlarında florokinolon direncini etkileyen risk faktörlerinin değerlendirilmesi
Öz
Amaç: Antimikrobiyal direnç oranlarındaki artış, üriner sistem
enfeksiyonlarında oral ampirik tedavi seçeneklerini kısıtlamaktadır. Dirençle
ilgili risk faktörlerini belirlemek, ampirik antibiyotik seçimine yol
göstermesi açısından önemlidir. Çalışmamızda, polikliniğe ayaktan başvuran
hastaların idrar kültürlerinden izole edilen Escherichia coli (E. coli) ve
Klebsiella pneumoniae (K. pneumoniae) suşlarında florokinolon direnci ve risk
faktörlerini değerlendirmeyi amaçladık.
Gereç ve Yöntem:
Ocak 2015-Aralık 2017 tarihleri arasında üroloji
polikliniğine başvuran ve idrar kültüründe E. coli ve K. pneumoniae üremesi
olan 76 hastanın demografik verileri geriye dönük olarak değerlendirildi.
Florokinolon direncine etki edebilecek olası risk faktörleri istatistiksel
olarak incelendi.
Bulgular:
Hastaların 60 (%78.9)’ ı kadın ve 16 (% 21.1)’ i
erkekti ve yaş ortalaması 54.1 ± 19.6 yıl olarak bulundu. Florokinolon direnci
%55.3, genişlemiş spektrumlu beta-laktamaz pozitifliği %15.8 olarak saptandı.
Florokinolon direnci açısından komplike idrar yolu enfeksiyonu (p = 0.009),
üriner sistem taşı (p = 0.014), üropatoloji (p = 0.002), ürolojik girişim
öyküsü (p = 0.040) ve önceden antibiyotik kullanım öyküsü (p<0.001) anlamlı
bulundu. Üriner sistem taşı, üropatoloji, ürolojik girişim öyküsü ve komplike
idrar yolu enfeksiyonu varlığı ile florokinolon direnci arasında zayıf derecede
pozitif yönde; önceden antibiyotik kullanım öyküsü ile florokinolon direnci
arasında ise orta derecede pozitif yönde ve istatistiksel olarak anlamlı
korelasyon bulundu (p<0.05). Son 6 ay içinde antibiyotik kullanımı öyküsü,
florokinolon direnci açısından bağımsız risk faktörü olarak bulundu (p=0.005).
Sonuç: Antibiyotik direncine neden olan önlenebilir faktörlerin
belirlenerek gerekli önlemlerin alınması, hem ampirik antibiyoterapi seçiminde
yol gösterici olması hem de akılcı antibiyotik kullanımı ile birlikte direnç
oranlarını azaltabilmek açısından önemlidir.
Anahtar Kelimeler
Direnç florokinolon risk faktörleri üriner sistem enfeksiyonu.
Kaynakça
- Tekin A, Deveci Ö, Dal T, Tekin R, Özekinci T, Dayan S. Üropatojen Escherichia coli izolatlarına fosfomisin ve bazı antibiyotiklerin in vitro etkinliği. Ankem Derg 2012; 26 (2): 61-68.
- Fasugba O, Gardner A, Mitchell BG, Mnatzaganian G. Ciprofloxacin resistance in community- and hospital-acquired Escherichia coli urinary tract infections: a systematic review and meta-analysis of observational studies. BMC Infect Dis. 2015; 15: 545.
- Soydan S, Karadağ G, Çalışkan E, Kale E. In vitro susceptibility analysis of Escherichia coli strains isolated from urinary tract infections to fosfomycin, nitrofurantoin and ciprofloxacin. Mediterr J Infect Microb Antimicrob. 2015; 4: 3.
- Aykan ŞB, Çiftçi İH. Türkiye’de İdrar Kültürlerinden İzole Edilen Escherichia coli Suşlarının Antibiyotiklere Direnç Durumu: Bir Meta-Analiz. Mikrobiyol Bul 2013; 47 (4): 603-618.
- Gupta K, Hooton TM, Naber KG, et al. Infectious Diseases Society of America; European Society for Microbiology and Infectious Diseases. International clinical practice guideline for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011; 52 (5): e103–120.
- Dalhoff A. Global fluoroquinolone resistance epidemiology and implications for clinical use. Interdiscip Perspect Infect Dis 2012;2012:976273.
- Shah A, Justo JA, Bookstaver PB, Kohn J, Albrecht H, Al-Hasan MN. Application of Fluoroquinolone Resistance Score in Management of Complicated Urinary Tract Infections. Antimicrob Agents Chemother. 2017; 61 (5). pii: e02313-16.
- The European Committee on Antimicrobial Susceptibility Testing. Ref: Breakpoint tables for interpretation of MICs and zone diameters. Version 7.1, 2017. http://www.eucast.org (15/04/2018).
- Paterson DL, Bonomo RA. Extended-spectrum beta-lactamases: a clinical update. Clin Microbiol Rev 2005;18 (4): 657-686.
- Kratochwill L, Powers M, McGraw MA, King L, O'Neill JM, Venkat A. Factors associated with ciprofloxacin resistant Escherichia coli urinary tract infections in discharged ED patients. Am J Emerg Med. 2015; 33 (10): 1473-1476.
- de Lastours V, Fantin B. Impact of fluoroquinolones on human microbiota. Focus on the emergence of antibiotic resistance. Future Microbiol. 2015; 10 (7): 1241-1255.
- World Health Organisation. Antimicrobial resistance: global report on surveillance. 2014. http://www.who.int/drugresistance/documents/surveillancereport/en/. (13/04/2018).
- Dalhoff A. Resistance surveillance studies: a multifaceted problem-the fluoroquinolone example. Infection. 2012; 40: 239–262.
- Nicoletti J, Kuster SP, Sulser T, et al. Risk factors for urinary tract infections due to ciprofloxacin-resistant Escherichia coli in a tertiary care urology department in Switzerland. Swiss Med Wkly 2010;140: w13059.
- Pepin J, Plamondon M, Lacroix C, Alarie I. Emergence of risk factors for ciprofloxacingentamicin-resistant Escherichia coli urinary tract infections in a region of Quebec. Can J Infect Dis Med Microbiol 2009; 20 (4): e163–168.
- Li J, Xie S, Ahmed S, et al. Antimicrobial Activity and Resistance: Influencing Factors. Front Pharmacol. 2017; 8: 364.
- Sommer MO, Dantas G. Antibiotics and the resistant microbiome. Curr Opin Microbiol. 2011; 14 (5): 556-563.
- Fantin B, Duval X, Massias L, et al. Ciprofloxacin dosage and emergence of resistance in human commensal bacteria. J Infect Dis. 2009; 200 (3): 390-398.
- Morgan DJ, Okeke IN, Laxminarayan R, Perencevich EN, Weisenberg S. Nonprescription antimicrobial use worldwide: a systematic review. Lancet Infect Dis. 2011; 11: 692-701.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 20 Eylül 2019 |
| Gönderilme Tarihi | 15 Mayıs 2018 |
| Yayımlandığı Sayı | Yıl 2019Cilt: 58 Sayı: 3 |
