Öz
Amaç:
Son yıllarda artan karbapenem dirençli Enterobacterales (CRE) enfeksiyon oranlarına bağlı olarak kolistin kullanımı artmaktadır. Çoklu ilaca dirençli Gram-negatif bakteriler ve kolistin direnci aynı anda arttığı için, kolistinin antimikrobiyal duyarlılık testi için doğru bir yöntemin seçimi çok önemlidir. Klinik Laboratuvar Standartları Enstitüsü ve Avrupa Antimikrobiyal Duyarlılık Testleri Komitesi, kolistin minimum inhibitör konsantrasyon testi için standart sıvı mikrodilüsyon (BMD) yönteminin kullanılmasını önermektedir. Bu çalışmada, CRE izolatları üzerinde BD Phoenix, MicroScan ve E-testlerinin kolistin duyarlılığının belirlenmesindeki performansını incelemeyi amaçladık. Mevcut ticari testler, referans BMD yöntemiyle karşılaştırıldı.
Yöntemler:
Ağustos 2017 ile Haziran 2018 arasında Klebsiella pneumoniae (K. pneumoniae), Escherichia coli (E. coli), Enterobacter cloace (E. cloacae) gibi 120 klinik Enterobacterales izolatı toplandı. Kolistin duyarlılığı için BD Phoenix, MicroScan ve E-test kullanıldı. Referans yöntem BMD ile ticari yöntemlerin karşılaştırması yapıldı.
Bulgular:
Çalışma süresi boyunca 108 K. pneumoniae, 10 E. coli, 2 E. cloacae dahil olmak üzere 120 Gram-negatif klinik izolatın kolistin duyarlılığı değerlendirildi. BMD’ye göre izolatlardan 66’sı (%55) kolistine duyarlı, 54’ü (%45) kolistine dirençli idi. BD Phoenix, MicroScan ve E-test ile kolistin duyarlılığı test edildiğinde sırasıyla %90,90, %95,45 ve %96,96 idi.
Sonuç:
Rutin klinik uygulamada, dünya çapında referans yöntemin uygulanması neredeyse imkansızdır ve kolistin duyarlılığının yorumlanması için ticari olarak mevcut sistemler kullanılmaktadır. Çoklu dirençli Gram-negatif enfeksiyonların tedavisi için kolistin kullanımı artmakta ve bu bileşiğe yönelik hassas duyarlılık test yöntemleri için daha fazla ve daha kapsamlı çalışmalar yapılmaktadır. Artan antimikrobiyal direnç karşısında laboratuvarların en azından seçilmiş hasta gruplarında BMD yöntemini kullanmasını öneriyoruz.
Anahtar Kelimeler: Kolistin duyarlılığı, karbapenem dirençli Enterobacterales, sıvı mikrodilüsyonu
Kaynakça
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