ÖZAmaç: Bu çalışmada nozokomiyal çoklu ilaç dirençli (ÇİD) Acinetobacter baumannii izolatlarının antibiyotik direnç profilinin belirlenmesi, moleküler düzeyde tiplendirmelerinin yapılması ve dirençli izolatlarda antibiyotik kombinasyonlarının aktivitesinin araştırılması amaçlandı. Gereç ve Yöntemler: Seksen dört ÇİD A. baumannii izolatına karşı tigesiklin (TGC), kolistin (CL), amikasin (AK), siprofloksasin (CIP), meropenem (MR), moksifloksasin (MXF) ve rifampisinin (RF) minimum inhibitör konsantrasyon (MİK) değerleri sıvı mikrodilüsyon yöntemi ile belirlendi. Epidemiyolojik ilişki, AP-PZR ve antibiyotiplendirme ile saptandı. Klonal ilişkisiz kökenlere antibiyotik kombinasyonlarının etkinliği dama tahtası (CB) yöntemi ile belirlendi. Dama tahtası yöntemi sonucunda, en etkin gözlenen kombinasyonun etkinliği, seçilmiş bir kökene karşı zamana bağlı öldürme eğrisi (TK) yöntemi ile de araştırıldı. Bulgular: CIP, RF, MXF, MR, AK'nin direnç oranları sırasıyla; %90.47; %47.62; %22.62; %58.33; %50 olarak belirlendi. TGC ve CL direnci görülmedi. Antibiyotik direnç profillerine göre 25 antibiyotip grubu belirlenirken, 15 farklı patern ayırt edildi. Klonal ilişkisiz 15 ÇİD A. baumannii izolatında CB yöntemiyle en iyi sinerjistik etki CL-RF (%100), CL-MR (%100) ve TGC-RF (%53) kombinasyonlarında gözlendi. Seçilmiş bir kökende TK yöntemiyle CL-RF ve CL-MR ile sinerji gözlendi, TGC-RF ile ise aditif etki saptandı. Sonuç: Bu çalışmada her iki sinerji testi de ÇİD A. baumannii izolatlarına karşı CL ile RF kombinasyonunun tedavide iyi bir seçim olacağını işaret etmiştir. Anahtar kelimeler: Acinetobacter, AP-PZR, dama tahtası, zamana bağlı öldürme eğrisi, tigesiklin, kolistin Objectives: The aim of this study was to determine the antibiotic resistance profile, clonal relation and efficacy of antibiotic combinations in nosocomial multidrug resistant (MDR) Acinetobacter baumannii. Materials and Methods: Antibiotic susceptibilities of 84 MDR A. baumannii against tigecycline (TGC), colistin (CL), amikacin (AK), ciprofloxacin (CIP), meropenem (MR), moxifloxacin (MXF), rifampicin (RF) were determined by microdilution method. Clonal relationship was investigated by genotyping using AP-PCR and antibiotyping. Interactions of antibiotic combinations were tested against clonally unrelated strains by the checkerboard (CB) method. The efficacy of the best combinations was also assesed on a selected isolate by the time-kill (TK) method. Results: CIP, RF, MXF, MR, AK resistance was found as 90.47%; 47.62%; 22.62%; 58.33%; 50% respectively; however; CL and TGC were not ascertained. The isolates were distinguished as 25 different antibiotypes and 15 varied molecular patterns. The best synergistic effect was detected in combinations of CL with RF (100%) and MR (100%), in combinations of TGC with RF (53%) against clonally unrelated 15 MDR A. baumannii isolates by the CB method. While CL-RF and CL-MR showed synergy by TK method like CB, on the other hand TGC-RF indicated additive interactions by TK. Conclusion: In this study, both synergy tests showed...
The present study aimed to evaluate antimicrobial activity of tigecydcline against 84 multidrug resistant (MDR) Acinetobacter spp. strains by disc diffusion and E-test methods. The results of disc diffusion test were compared according to two different interpretation ways. In addition, E-test results and the disc diffusion results that interpreted by both the methods were checked for compatibility. According to the disc diffusion test, 3 strains (3.57%) were found resistant to tigecycline when considering breakpoints suggested by Food and Drug Administration (FDA). On the other hand, none of the strains was found resistant to the evaluation criteria recommended by Jones etal. (2007). Considering E-test results of tigecycline, MIC, and MICG, values of tigecycline for Acinetobacter spp. were 0.75 and 1 mg/l, respectively. Based on FDA defined breakpoints for Enterobacteriaceae, any resistant isolate was detected. In conclusion, although there are some differences in the results, tigecycline was found quite effective on Acinetobacter spp. isolates with reference to the both disc diffusion and the E-test methods.
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