Publication: Solunum yolu enfeksiyonu etkenleri Streptococcus pneumoniae ve Streptococcus pyogenes'in telitromisin ve 11 antimikrobik ilaca in vitro duyarlılığı:E-baskett-II sürveyans çalışmasının Türkiye sonuçları
Abstract
Solunum yolu enfeksiyonlarında tedavinin çoğunlukla ampirik olması nedeniyle kullanımda olan antibiyotiklere karşı direnç oranlarına ilişkin bölgesel verilere gereksinim duyulmaktadır. e-BASKETT-II sürveyansı bu amaçla Eylül 2002 ve Haziran 2003 tarihleri arasında bir çok farklı ülkede yürütülmüş çok merkezli in vitro bir araştırmadır. Bu sürveyansın Türkiye bölümünde, 18 merkezden toplanan 260 Streptococcus pneumoniae ve 312 Streptococcus pyogenes solunum yolu izolatının penisilin G, amoksisilin, sefuroksim, seftriakson, eritromisin, klaritromisin, azitromisin, klindamisin, telitromisin, tetrasiklin, levofloksasin ve vankomisine karşı in vitro duyarlılıkları CLSI önerilerine göre disk difüzyon testi ile araştırılmış ve MİK değerleri mikrodilüsyon testi ile belirlenmiştir. Eritromisine dirençli olan izolatlarda polimeraz zincir reaksiyonu ile makrolid difenç genleri araştırılmıştır. S.pneumoniae'öa izolatların %11.5'i penisiline yüksek, %22.7'si orta dirençli bulunmuş, eritromisin, klaritromisin ve azitromisin için direnç oranı %17.3 olarak belirlenmiştir. İzolatların %21.5'i tetrasikline dirençli bulunmuş; levofloksasin ve vankomisine direnç gözlenmemiştir. Sadece bir izolat telitromisine orta duyarlı (MİK=2|xğ/mL) bulunmuştur. Eritromisine dirençli izolatların %77.8'inde ermB, %17.8'indemefA, bir izolatta ise (%2.2) ermB ve mefA birlikte bulunmuştur. S.pyogenes izolatlarınıri tümü beta-laktamlara ve vankomisine duyarlı bulunmuş, bir izolat levofloksasine orta düzeyde direnç göstermiştir. S.pyogenes'öe makrolidlere direnç izolatların %1.3'ünde gözlenmiş, bunların üçünde mefA geni, bir izolatta da ermB geni saptanmıştır. Telitromisin, makrolidlere dirençli solunum yolu izolatlarında yüksek bir in vitro aktivite göstermiştir. Sonuç olarak e-BASKETT-ll çalışması, ülkemizde solunum yolu enfeksiyonu etkenlerine karşı kullanımda olan çeşitli antimikrobik ilaçlar ile telitromisinin kıyaslandığı en kapsamlı in vitro çalışmalardan birini oluşturmaktadır.
ABSTRACT: In respiratory tract infections, therapy is often empirical and there is a need for local data on the rate of resistance to available antimicrobials. In this multicentre study which is a part of the international e-BASKETT-ll surveillance study, respiratory isolates of Streptococcus pneumoniae (n=260) and Streptococcus pyogenes (n=312) collected between September 2002 and June 2003 from 18 hospitals in Turkey were tested against penicillin G, amoxicillin, cefuroxime, ceftriaxone, erythromycin, clarithromycin, azithromycin, clindamycin, telithromycin, tetracycline, levofloxacin and vancomycin. Antibiotic susceptibilities were determined with disk diffusion method and confirmed with broth dilution method following the CLSI guidelines. Isolates which were resistant to erythromycin were genotyped by polymerase chain reaction. In S.pneumoniae 11.5% of the isolates were highly and 22.7% were intermediately resistant to penicillin. Rate of resistance to erythromycin, clarithromycin, azithromycin was 17.3%, and 21.5% of the isolates were resistant to tetracycline. Resistance to levofloxacin and vancomycin was not observed and only one isolate was found intermediately resistant (MIC=2jxg/mL) to telithromycin. Genotypes in erythromycin-resistant isolates were ermB (77.8%), mefA (17.8%) and/ermB+me/A (2.2%). S.pyogenes isolates were uniformly susceptible to beta-lactams and vancomycin, and only one isolate was intermediately resistant to levofloxacin. Macrolide resistance was observed in 1.3% of the isolates and three out of these harboured the me/A gene. One isolate with an MIC of 4p,g/mL for telithromycin had ermB gene. Telithromycin has demonstrated a good in vitro activity against macrolide-resistant respiratory tract isolates. As a result, e-BASKETT-ll surveillance study has been one of the most extensive in vitro studies comparing telithromycin to available antimicrobial agents for respiratory tract infections in Turkey.
ABSTRACT: In respiratory tract infections, therapy is often empirical and there is a need for local data on the rate of resistance to available antimicrobials. In this multicentre study which is a part of the international e-BASKETT-ll surveillance study, respiratory isolates of Streptococcus pneumoniae (n=260) and Streptococcus pyogenes (n=312) collected between September 2002 and June 2003 from 18 hospitals in Turkey were tested against penicillin G, amoxicillin, cefuroxime, ceftriaxone, erythromycin, clarithromycin, azithromycin, clindamycin, telithromycin, tetracycline, levofloxacin and vancomycin. Antibiotic susceptibilities were determined with disk diffusion method and confirmed with broth dilution method following the CLSI guidelines. Isolates which were resistant to erythromycin were genotyped by polymerase chain reaction. In S.pneumoniae 11.5% of the isolates were highly and 22.7% were intermediately resistant to penicillin. Rate of resistance to erythromycin, clarithromycin, azithromycin was 17.3%, and 21.5% of the isolates were resistant to tetracycline. Resistance to levofloxacin and vancomycin was not observed and only one isolate was found intermediately resistant (MIC=2jxg/mL) to telithromycin. Genotypes in erythromycin-resistant isolates were ermB (77.8%), mefA (17.8%) and/ermB+me/A (2.2%). S.pyogenes isolates were uniformly susceptible to beta-lactams and vancomycin, and only one isolate was intermediately resistant to levofloxacin. Macrolide resistance was observed in 1.3% of the isolates and three out of these harboured the me/A gene. One isolate with an MIC of 4p,g/mL for telithromycin had ermB gene. Telithromycin has demonstrated a good in vitro activity against macrolide-resistant respiratory tract isolates. As a result, e-BASKETT-ll surveillance study has been one of the most extensive in vitro studies comparing telithromycin to available antimicrobial agents for respiratory tract infections in Turkey.