KARBAPENEM DİRENÇLİ Klebsiella pneumoniae VE Escherichia coli İZOLATLARINDA BD PHOENİX CPO YÖNTEMİ İLE KARBAPENEMAZ ÜRETİMİNİN TESPİTİ
Öz
Amaç:Karbapenemaz üreten organizmalar , içerdikleri karbapenemaz enzimleri ile antibiyotiklerin bir çoğuna, bazen tamamına dirençli Gram negatif bakterilerdir. Karbapenemazların hızlı ve doğru saptanması dirençli hastane enfeksiyonlarının erken tespiti ve yayılımının önlenmesi için gereklidir. Çalışmada Moleküler yöntemle karbapenemaz gen tayini yapılmış Escherichia coli ve Klebsiella pneumoniae İzolatları BD Phoenix CPO Detect (Becton Dickinson, ABD) kiti ile çalışılarak testin karbapenemaz varlığı ve sınıflarını doğru saptayabilme durumu değerlendirilmiştir.
Çalışmaya ….. Üniversitesi Hastanesi Merkez Laboratuvarı bakteriyoloji birimine Ocak 2020 – Aralık 2020 tarihleri arasında gönderilen çeşitli klinik örneklerden izole edilen K. pneumoniae ve E. coli suşları dahil edilmiştir. Moleküler test ile İzolatların 64’ü Oxa-48, 6’sı NDM, 2’si NDM+Oxa-48 içerdiği tespit edilen 72 izolat ile karbapenemazlardan KPC, NDM, VIM, OXA-48 ve IMP-1’i içermeyen 16 izolat dahil edilmiştir. K. pneumoniae ve E. coli izolatları matriks aracılı lazer desorpsiyon iyonizasyon uçuş süresi kütle spektrometrisi [“matrix assisted laser desorptionization-time of flight mass spectrophotometry” (MALDI-TOF MS)] (Bruker Daltonics, Almanya) yöntemi ile tanımlanmış ,üretici firma önerileri doğrultusunda BD Phoenix CPO Detect (Becton Dickinson, ABD) kiti ile karbapenemaz durumu araştırılmıştır.
Bulgular: BD Phoenix CPO Detect testinin PCR ile uyumu Oxa-48 geni bulunan izolatlar için %95,3, NDM geni bulunanlar için %100 olarak bulunmuştur. Testin negatif prediktif oranı tüm izolatlarda %88,8, K. pneumoniae izolatlarında %83,3, E. coli izolatlarında %100,0 olarak saptanmıştır.
Sonuç: Enterobacterales, P.auroginosa, A.baumanii karbapenemaz enzimlerini saptayabilen BD Phoenix CPO Detect testinin rutin tanı laboratuvarlarında kullanılması dirençli bakterilerin erken tanı ve doğru tedavisine katkı sağlayacaktır.
Anahtar Kelimeler
BD Phonex CPO Detect Karbapenemaz, Oxa48, klebsiella pneumoniae, Escherichia coli
Destekleyen Kurum
DİCLE ÜNİVERSİTESİ BİLİMSEL ARAŞTIRMA PROJELERİ KOORDİNATÖRLÜĞÜ (DÜBAP )
Proje Numarası
TIP.19.024
Teşekkür
DİCLE ÜNİVERSİTESİ BİLİMSEL ARAŞTIRMA PROJELERİ KOORDİNATÖRLÜĞÜ!Ne DESTEKLERİNDEN DOLAYI TEŞEKKÜR EDERİZ
Kaynakça
- 1. Thomson KS. The immaculate carbapenemase study [Internet]. Vol. 55, Journal of Clinical Microbiology. American Society for Microbiology; 2017. p. 1608–11.
- 2. Elemam A, Rahimian J, Mandell W. Infection with panresistant Klebsiella pneumoniae: A report of 2 cases and a brief review of the literature. Clin Infect Dis 2009 Jul 15;49(2):271–4.
- 3. Venkatachalam I, Teo J, Balm MND, Fisher DA, Jureen R, Lin RTP. Klebsiella pneumonia carbapenemase-producing enterobacteria in hospital, Singapore [Internet]. Vol. 18, Emerging Infectious Diseases. Centers for Disease Control and Prevention; 2012 p. 1381–3.
- 4. Lee GC, Burgess DS. Treatment of Klebsiella Pneumoniae Carbapenemase (KPC) infections: a review of published case series and case reports. Ann Clin Microbiol Antimicrob. 2012 Dec 13;11(1):32. 5. Nordmann P, Naas T, Poirel L. Global spread of carbapenemase producing Enterobacteriaceae. Emerg Infect Dis [Internet]. 2011 [cited 2021 Jun 7];17(10):1791–8.
- 6. Miller S, Humphries RM. Clinical laboratory detection of carbapenem-resistant and carbapenemase-producing Enterobacteriaceae. Expert Rev Anti Infect Ther. 2016 Aug 2;14(8):705–17.
- 7. Nordmann P. Carbapenemase-producing Enterobacteriaceae: Overview of a major public health challenge. Vol. 44, Medecine et Maladies Infectieuses. 2014. p. 51–6.
- 8. De PP, Ng E, Pin T, Lin R, Hart T. Evaluation of BD PhoenixTM CPO Detect Assay for Detection of Carbapenemase Producing Organisms in Clinical Samples in Singapore. Open Forum Infect Dis. 2018 Nov 26;5(suppl_1):S604–5.
- 9. Thomson G, Turner D, Brasso W, Kircher S, Guillet T, Thomson K. High-Stringency Evaluation of the Automated BD Phoenix CPO Detect and Rapidec Carba NP Tests for Detection and Classification of Carbapenemases. Munson E, editor. J Clin Microbiol. 2017 Dec;55(12):3437–43.
- 10. EUCAST. European Committee on Antimicrobial Susceptibility Testing Breakpoint tables for interpretation of MICs and zone diameters- Version 8.0. 2018.
- 11. (CLSI) C and LS institute. M100 Performance Standards for Antimicrobial Susceptibility Testing 28th ed. 2018. Vol. 8, Journal of Services Marketing. 2018. 296 p.
- 12. Tacconelli E, Carrara E, Savoldi A, Kattula D, Burkert F. GLOBAL PRIORITY LIST OF ANTIBIOTIC-RESISTANT BACTERIA TO GUIDE RESEARCH, DISCOVERY, AND DEVELOPMENT OF NEW ANTIBIOTICS http://www.cdc.gov/drugresistance/threat-report-2013/
- 13. Martirosov DM, Lodise TP. Emerging trends in epidemiology and management of infections caused by carbapenem-resistant Enterobacteriaceae. Diagn Microbiol Infect Dis. 2016;85(2):266–75.
- 14. Gülay Z. Antibiyotiklere Direnç Mekanizmaları ve Çözüm Önerileri:Beta-Laktamlara ve Karbapenemlere Direnç. Hastan İnfeksiyonları Derg. 2001;5:210–29.
- 15. Webber MA, Piddock LJV. The importance of efflux pumps in bacterial antibiotic resistance. J Antimicrob Chemother [Internet. 2003 Jan 1;51(1):9–11.
- 16. Cornaglia G, Mazzariol A, Fontana R. The astonishing complexity of antibiotic resistance. Clin Microbiol Infect []. 2000 Dec 1 [cited 2021 Jun 8];6(S3):93–4.
- 17. Philippon A, Jacquier H, Ruppé E, Labia R. Structure-based classification of class A beta-lactamases, an update. Vol. 67, Current Research in Translational Medicine. Elsevier Masson SAS; 2019. p. 115–22.
- 18. Hall BG, Barlow M. Revised Ambler classification of β-lactamases [1]. Vol. 55, Journal of Antimicrobial Chemotherapy. J Antimicrob Chemother; 2005. p. 1050–1.
- 19. Yiş R, Bayram Ed, Yüksel Ergin Ö. bla OXA-48 pozitif K. pneumoniae İzolatlarında Fenotipik Karbapenemaz Üretiminin Modifiye Hodge ve Karbapenemaz İnaktivasyon Testleri ile Değerlendirilmesi. Namık Kemal Tıp Derg 2020;8(1):1–10.
- 20. Süzük Yıldız S, Şimşek H, Bakkaloğlu Z, Numanoğlu Çevik Y, Hekimoğlu CH, Kılıç S, et al. Türkiye’de 2019 Yılı İçinde İzole Edilen Escherichia coli ve Klebsiella pneumoniae İzolatlarında Karbapenemaz Epidemiyolojisi. Mikrobiyol Bul. 2021;55(1):1–16.
- 21. Çakar A, Akyön Y, Gür D, Karatuna O, Özhak Baysan B. Türkiye’de 2014 yılı içinde izole edilen karbapeneme dirençli Escherichia coli ve Klebsiella pneumoniae izolatlarında karbapenemaz varlığının araştırılması. Mikrobiyol Bul. 2016;50(1):21–33.
- 22. Tekintaş Y, Çilli F, Eraç B, Yaşar M, Aydemir S, Hoşgör Limoncu M. Klinik Klebsiella pneumoniae İzolatlarında Karbapenemaz Üretiminin Saptanmasında Polimeraz Zincir Reaksiyonu ve Fenotipik Yöntemlerin Karşılaştırılması. Mikrobiyol Bul. 2017;51(3):269–76.
- 23. Tamma PD, Goodman KE, Harris AD, Tekle T, Roberts A, Taiwo A, et al. Comparing the outcomes of patients with carbapenemase-producing and non-carbapenemase- producing carbapenem-resistant enterobacteriaceae bacteremia. Clin Infect Dis. 2017;64(3):257–64.
- 24. Van Duin D, Paterson DL. Multidrug-Resistant Bacteria in the Community: Trends and Lessons Learned. Vol. 30, Infectious Disease Clinics of North America. W.B. Saunders; 2016. p. 377–90. 25. WHO | Antimicrobial resistance: global report on surveillance 2014. WHO. 2016;http://www.who.int/drugresistance/documents/surveillancereport/en/
- 26. Voets GM, Fluit AC, Scharringa J, Cohen Stuart J, Leverstein-Van Hall MA. A set of multiplex PCRs for genotypic detection of extended-spectrum β-lactamases, carbapenemases, plasmid-mediated AmpC β-lactamases and OXA β-lactamases. Int J Antimicrob Agents. 2011;37(4):356–9.
- 27. Petit M, Caméléna F, Cointe A, Poncin T, Merimèche M, Bonacorsi S, et al. Rapid detection and characterization of carbapenemases in enterobacterales with a new modified carbapenem inactivation method, mCIMplus. J Clin Microbiol. 2020;58(11).
- 28. Papagiannitsis CC, Študentová V, Izdebski R, Oikonomou O, Pfeifer Y, Petinaki E, et al. Matrix-assisted laser desorption ionization-time of flight mass spectrometry meropenem hydrolysis assay with NH4HCO3, a reliable tool for direct detection of carbapenemase activity. J Clin Microbiol [Internet]. 2015 May 1 [cited 2021 Jun 9];53(5):1731–5.
- 29. Pasteran F, Veliz O, Ceriana P, Lucero C, Rapoport M, Albornoz E, et al. Evaluation of the Blue-Carba test for rapid detection of carbapenemases in gram-negative Bacilli. Vol. 53, Journal of Clinical Microbiology. American Society for Microbiology; 2015. p. 1996–8.
- 30. Saad Albichr I, Anantharajah A, Dodémont M, Hallin M, Verroken A, Rodriguez-Villalobos H. Evaluation of the automated BD Phoenix CPO Detect test for detection and classification of carbapenemases in Gram negatives. Diagn Microbiol Infect Dis. 2020;96(2).
- 31. Ong CH, Ratnayake L, Ang MLT, Lin RTP, Chan DSG. Diagnostic accuracy of BD phoenix CPO Detect for carbapenemase production in 190 Enterobacteriaceae isolates. J Clin Microbiol. 2018 Dec;56(12).
Determination of Carbapenemase Production by BD Phoenix CPO Method in Karbapenem Resistant Klebsiella pneumoniae and Escherichia coli Isolates
Öz
Aim:Carbapenemase-producing organisms are Gram-negative bacteria that are resistant to most, sometimes all, antibiotics with their carbapenemase enzymes. Rapid and accurate detection of carbapenemases is essential for the early detection and prevention of resistant nosocomial infections.
Material and Method:The study included 72 isolates, 64 containing Oxa-48, 6 NDM, 2 NDM+Oxa-48 and 16 isolates without carbapenemase, isolated from various clinical samples sent to the bacteriology unit of ……. University Hospital Central Laboratory between January 2020 and December 2020. Carbapenemase enzyme groups were investigated in isolates with the BD Phoenix CPO Detect (Becton Dickinson, USA) kit.
Results:The compatibility of the BD Phoenix CPO Detect test with PCR was 95.3% for Oxa-48 carrying isolates and 100% for those with the NDM gene. The negative predictive rate of the test was 88.8% in all isolates, 83.3% in K. pneumoniae isolates, and 100.0% in E. coli isolates.
Conclusion:The usage of the BD Phoenix CPO Detect test, which can detect carbapenemase enzymes , in routine diagnostic laboratories will contribute to the early diagnosis and correct treatment of resistant bacteria.
Anahtar Kelimeler
BD CPO Detect, carbapenemese, oxa 48, Klebsiella pneumoniae, Escherichia coli
Proje Numarası
TIP.19.024
Kaynakça
- 1. Thomson KS. The immaculate carbapenemase study [Internet]. Vol. 55, Journal of Clinical Microbiology. American Society for Microbiology; 2017. p. 1608–11.
- 2. Elemam A, Rahimian J, Mandell W. Infection with panresistant Klebsiella pneumoniae: A report of 2 cases and a brief review of the literature. Clin Infect Dis 2009 Jul 15;49(2):271–4.
- 3. Venkatachalam I, Teo J, Balm MND, Fisher DA, Jureen R, Lin RTP. Klebsiella pneumonia carbapenemase-producing enterobacteria in hospital, Singapore [Internet]. Vol. 18, Emerging Infectious Diseases. Centers for Disease Control and Prevention; 2012 p. 1381–3.
- 4. Lee GC, Burgess DS. Treatment of Klebsiella Pneumoniae Carbapenemase (KPC) infections: a review of published case series and case reports. Ann Clin Microbiol Antimicrob. 2012 Dec 13;11(1):32. 5. Nordmann P, Naas T, Poirel L. Global spread of carbapenemase producing Enterobacteriaceae. Emerg Infect Dis [Internet]. 2011 [cited 2021 Jun 7];17(10):1791–8.
- 6. Miller S, Humphries RM. Clinical laboratory detection of carbapenem-resistant and carbapenemase-producing Enterobacteriaceae. Expert Rev Anti Infect Ther. 2016 Aug 2;14(8):705–17.
- 7. Nordmann P. Carbapenemase-producing Enterobacteriaceae: Overview of a major public health challenge. Vol. 44, Medecine et Maladies Infectieuses. 2014. p. 51–6.
- 8. De PP, Ng E, Pin T, Lin R, Hart T. Evaluation of BD PhoenixTM CPO Detect Assay for Detection of Carbapenemase Producing Organisms in Clinical Samples in Singapore. Open Forum Infect Dis. 2018 Nov 26;5(suppl_1):S604–5.
- 9. Thomson G, Turner D, Brasso W, Kircher S, Guillet T, Thomson K. High-Stringency Evaluation of the Automated BD Phoenix CPO Detect and Rapidec Carba NP Tests for Detection and Classification of Carbapenemases. Munson E, editor. J Clin Microbiol. 2017 Dec;55(12):3437–43.
- 10. EUCAST. European Committee on Antimicrobial Susceptibility Testing Breakpoint tables for interpretation of MICs and zone diameters- Version 8.0. 2018.
- 11. (CLSI) C and LS institute. M100 Performance Standards for Antimicrobial Susceptibility Testing 28th ed. 2018. Vol. 8, Journal of Services Marketing. 2018. 296 p.
- 12. Tacconelli E, Carrara E, Savoldi A, Kattula D, Burkert F. GLOBAL PRIORITY LIST OF ANTIBIOTIC-RESISTANT BACTERIA TO GUIDE RESEARCH, DISCOVERY, AND DEVELOPMENT OF NEW ANTIBIOTICS http://www.cdc.gov/drugresistance/threat-report-2013/
- 13. Martirosov DM, Lodise TP. Emerging trends in epidemiology and management of infections caused by carbapenem-resistant Enterobacteriaceae. Diagn Microbiol Infect Dis. 2016;85(2):266–75.
- 14. Gülay Z. Antibiyotiklere Direnç Mekanizmaları ve Çözüm Önerileri:Beta-Laktamlara ve Karbapenemlere Direnç. Hastan İnfeksiyonları Derg. 2001;5:210–29.
- 15. Webber MA, Piddock LJV. The importance of efflux pumps in bacterial antibiotic resistance. J Antimicrob Chemother [Internet. 2003 Jan 1;51(1):9–11.
- 16. Cornaglia G, Mazzariol A, Fontana R. The astonishing complexity of antibiotic resistance. Clin Microbiol Infect []. 2000 Dec 1 [cited 2021 Jun 8];6(S3):93–4.
- 17. Philippon A, Jacquier H, Ruppé E, Labia R. Structure-based classification of class A beta-lactamases, an update. Vol. 67, Current Research in Translational Medicine. Elsevier Masson SAS; 2019. p. 115–22.
- 18. Hall BG, Barlow M. Revised Ambler classification of β-lactamases [1]. Vol. 55, Journal of Antimicrobial Chemotherapy. J Antimicrob Chemother; 2005. p. 1050–1.
- 19. Yiş R, Bayram Ed, Yüksel Ergin Ö. bla OXA-48 pozitif K. pneumoniae İzolatlarında Fenotipik Karbapenemaz Üretiminin Modifiye Hodge ve Karbapenemaz İnaktivasyon Testleri ile Değerlendirilmesi. Namık Kemal Tıp Derg 2020;8(1):1–10.
- 20. Süzük Yıldız S, Şimşek H, Bakkaloğlu Z, Numanoğlu Çevik Y, Hekimoğlu CH, Kılıç S, et al. Türkiye’de 2019 Yılı İçinde İzole Edilen Escherichia coli ve Klebsiella pneumoniae İzolatlarında Karbapenemaz Epidemiyolojisi. Mikrobiyol Bul. 2021;55(1):1–16.
- 21. Çakar A, Akyön Y, Gür D, Karatuna O, Özhak Baysan B. Türkiye’de 2014 yılı içinde izole edilen karbapeneme dirençli Escherichia coli ve Klebsiella pneumoniae izolatlarında karbapenemaz varlığının araştırılması. Mikrobiyol Bul. 2016;50(1):21–33.
- 22. Tekintaş Y, Çilli F, Eraç B, Yaşar M, Aydemir S, Hoşgör Limoncu M. Klinik Klebsiella pneumoniae İzolatlarında Karbapenemaz Üretiminin Saptanmasında Polimeraz Zincir Reaksiyonu ve Fenotipik Yöntemlerin Karşılaştırılması. Mikrobiyol Bul. 2017;51(3):269–76.
- 23. Tamma PD, Goodman KE, Harris AD, Tekle T, Roberts A, Taiwo A, et al. Comparing the outcomes of patients with carbapenemase-producing and non-carbapenemase- producing carbapenem-resistant enterobacteriaceae bacteremia. Clin Infect Dis. 2017;64(3):257–64.
- 24. Van Duin D, Paterson DL. Multidrug-Resistant Bacteria in the Community: Trends and Lessons Learned. Vol. 30, Infectious Disease Clinics of North America. W.B. Saunders; 2016. p. 377–90. 25. WHO | Antimicrobial resistance: global report on surveillance 2014. WHO. 2016;http://www.who.int/drugresistance/documents/surveillancereport/en/
- 26. Voets GM, Fluit AC, Scharringa J, Cohen Stuart J, Leverstein-Van Hall MA. A set of multiplex PCRs for genotypic detection of extended-spectrum β-lactamases, carbapenemases, plasmid-mediated AmpC β-lactamases and OXA β-lactamases. Int J Antimicrob Agents. 2011;37(4):356–9.
- 27. Petit M, Caméléna F, Cointe A, Poncin T, Merimèche M, Bonacorsi S, et al. Rapid detection and characterization of carbapenemases in enterobacterales with a new modified carbapenem inactivation method, mCIMplus. J Clin Microbiol. 2020;58(11).
- 28. Papagiannitsis CC, Študentová V, Izdebski R, Oikonomou O, Pfeifer Y, Petinaki E, et al. Matrix-assisted laser desorption ionization-time of flight mass spectrometry meropenem hydrolysis assay with NH4HCO3, a reliable tool for direct detection of carbapenemase activity. J Clin Microbiol [Internet]. 2015 May 1 [cited 2021 Jun 9];53(5):1731–5.
- 29. Pasteran F, Veliz O, Ceriana P, Lucero C, Rapoport M, Albornoz E, et al. Evaluation of the Blue-Carba test for rapid detection of carbapenemases in gram-negative Bacilli. Vol. 53, Journal of Clinical Microbiology. American Society for Microbiology; 2015. p. 1996–8.
- 30. Saad Albichr I, Anantharajah A, Dodémont M, Hallin M, Verroken A, Rodriguez-Villalobos H. Evaluation of the automated BD Phoenix CPO Detect test for detection and classification of carbapenemases in Gram negatives. Diagn Microbiol Infect Dis. 2020;96(2).
- 31. Ong CH, Ratnayake L, Ang MLT, Lin RTP, Chan DSG. Diagnostic accuracy of BD phoenix CPO Detect for carbapenemase production in 190 Enterobacteriaceae isolates. J Clin Microbiol. 2018 Dec;56(12).
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Makaleler |
| Yazarlar | |
| Proje Numarası | TIP.19.024 |
| Yayımlanma Tarihi | 30 Haziran 2022 |
| Gönderilme Tarihi | 24 Aralık 2021 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 12 Sayı: 2 |
Cited By
Investigation of Carbapenemase Resistance Genes in Healthcare-Associated Infectious Enterobacterales Strains
Uludağ Üniversitesi Tıp Fakültesi Dergisi
https://doi.org/10.32708/uutfd.1174332
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