Sorumlu Yazar)Öz Amaç: Pseudomonas aeruginosa özellikle yoğun bakım ünitelerinde (YBÜ), yatan hastalarda enfeksiyonlara neden olan fırsatçı bir patojendir. Son yıllarda artan antibiyotik direnci P.aeruginosa enfeksiyonlarının tedavisini zorlaştırmaktadır. Bu çalışmanın amacı yoğun bakım ünitelerinden izole edilen P.aeruginosa suşlarının antibiyotik direnç oranlarını saptamaktır. Gereç ve yöntem: Dört yıllık bir süre zarfında yoğun bakım ünitelerinden mikrobiyoloji laboratuvarına gönderilen çeşitli örneklerden izole edilen P.aeruginosa suşları çalışmaya dahil edilmiştir. Bakteri tanımlaması ve antibiyotik duyarlılık testleri konvansiyonel yöntemler ve otomatize sistemler kullanılarak yapılmıştır. Bulgular: Toplam 688 P.aeruginosa suşu çalışmaya dahil edilmiştir. Suşların izole edildiği örnekler arasında endotrakeal aspirat örnekleri ilk sırada (%53,3), idrar örnekleri ikinci sırada (%27) saptanmıştır. İzole edilen P.aeruginosa suşlarının en dirençli olduğu antibiyotik siprofloksasin (%34,7) olarak bulunmuştur. Seftazidime %29,4, sefepime %28,1, karbapenemlere %27,3, piperasilin-tazobaktama %24,6, gentamisine %19,3, amikasine %7,9 oranında direnç tespit edilmiştir. Ayrıca, direnç oranlarının yıllar içinde değiştiği gözlenmiştir. Sonuç: P.aeruginosa suşlarının antimikrobiyal ajanlara direnç oranları hastaneler arasında farklılık göstermektedir. Bu nedenle her hastane belirli aralıklarla kendi antibiyotik direnç profilini gözden geçirmeli ve ampirik tedavi seçeneklerini belirlemelidir. Anahtar kelimeler: Yoğun bakım üniteleri, Pseudomonas aeruginosa, antibiyotik direnci.
Background and objective:We aimed to investigate the effect of “training about the pre-analytical phase” and “technological arrangements in laboratory information systems (LISs) and tube barcoding system”, on decreasing PEs.Materials and methods:PEs in 2013 and 2014 were obtained from the LIS retrospectively in order to evaluate the effect of improvements. Ten quality indicators (QIs) described for pre-analytical phase were calculated. We compared QIs of the “improved year” with the past year. Four quality specification criteria were defined as “unacceptable”, “minimum”, “desirable” and “optimum” for each quality indicator.Results:There was a reduction in all types of PEs related to the improvement strategies. When QIs were considered as quality specifications (QSs), QI-14 (number of samples damaged in transport) and QI-16 (samples improperly stored) were “unacceptable”, QI-8 (samples lost-not received) and QI-12 (samples with insufficient sample volume) were “minimum” and QI-9 (samples collected in inappropriate container) was “desirable” in 2013; QI-10a, 10b (samples hemolyzed), 11a (samples clotted) and 13 (samples with inadequate sample-anticoagulant) were all “optimum” in 2 years.Conclusion:It was shown that continuous education on pre-analytical phase and improvements of the technological infrastructures are the main factors that will enable the control of this phase.
Objectives:To reveal the relationship between clinical and environmental isolates, analyzing both phenotypic and molecular aspects, in an Acinetobacter baumannii (A. baumannii) epidemic, and to use the epidemiological data to determine the source of the epidemic, to identify potential risk factors, and inform the effort to prevent and manage future epidemics.Methods:Acinetobacter baumannii was isolated from 5 clinical samples in Sultan Abdulhamid Han Training and Research hospital, Istanbul, Turkey, for a week period. To determine potential sources of infection we established cultures surveillance. Microbiological identification and antibiotic susceptibility testing of A. baumannii were performed using conventional methods and automated identification system. Multiplex polymerase chain reaction (PCR) and pulsed-field gel electrophoresis (PFGE) were used for carbapenemase gene screening and clonal relationship evaluation.Results:Among the environmental samples, bacterial growth was observed in 3 of the sample cultures. Clinical and environmental samples collected from patients X and Y had phenotypically similar antibiotic susceptibility patterns. The clinical and environmental isolates from patients X and Y comprised the first cluster (6 isolates), the isolates from patient Z formed the second cluster (2 isolates).Conclusion:We detected that all outbreak-related isolates contained the same OXA-type carbapenemase genes. Phenotypic similarity, based on the analysis of antimicrobial susceptibility patterns, was correlated with genotypic similarity. These results suggest that monitoring antimicrobial resistance patterns with daily culture surveillance follow-ups, coupled with the use of amplification based methods to detect that clonal relationships are important for the early identification of outbreaks and rapid deployment of proper countermeasures to halt the spread of the causative agent.
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