Genişlemiş spektrumlu ß-laktamaz üreten Escherichia coli ve Klebsiella pneumoniae suşlarının etken olduğu üst üriner sistem enfeksiyonlarında ß-laktam / ß-laktamaz inhibitörü ve karbapenem tedavilerinin etkinliğinin retrospektif değerlendirmesi
Küçük Resim Yok
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Namık Kemal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Genişletilmiş spektrumlu ?-laktamaz (GSBL) üreten bakterilerin neden olduğu enfeksiyonlarının oranı küresel olarak giderek artmaktadır. Özellikle 21. yy itibariyle dünya çapında yayılan direnç sorunu bu bakteriler ile gelişen üst üriner sistem enfeksiyonu (ÜÜSE) gelişen klinik durumlarda ön planda karbapenem grubu antibiyotiklerin kullanımının artmasına neden olmaktadır. Bu süreçte karbapenemazlar dahil artan dirençli bakteri sayısı ve yavaş gelişen yeni antibiyotik süreçleri uzmanları tedavilerde farklı antibiyotik tedavilerine yönlendirmiştir. Bu durum ışığında GSBL üreten Enterobacteriaceae bağlı ÜÜSE için etkili bir tedavi alternatifi olarak düşünülen ?-laktam / ?-laktamaz inhibitörlerinin (BL/BLI) mevcut etkinlik kanıtları halen tartışmalıdır. Bu çalışmanın amacı da GSBL üreten Enterobacteriaceae bağlı ÜÜSE' nin tedavisinde karbapenemlere (meropenem/ertapenem) karşı BL/BLI (piperasilin-tazobaktam)' nin etkinliğini belirlemektir. Çalışmamıza Tekirdağ Namık Kemal Üniversitesi Sağlık Uygulama ve Araştırma Hastanesi' ne başvuran, GSBL üreten Escherichia coli (E.coli ) ve Klebsiella pneumoniae ( K. pneumoniae) bağlı gelişen ÜÜSE tanısı konulan ve tedavilerinde karbapenem(meropenem/ertapenem) yada BL/BLI (PİP-TAZ) grubu antibiyotik kullanılan 176 hasta dahil edildi. Hastalara ait yaş, cinsiyet, altta yatan hastalıklar (malignite, DM, kronik böbrek hastalığı, santral sistemi hastalıkları, BPH, vb.), hemogram, böbrek fonksiyon testleri, karaciğer fonksiyon testleri, albümin ve CRP düzeyi; izole edilen mikroorganizma ve antibiyotik duyarlılığı; üriner kateterizasyon varlığı, kateterin tipi ve kateterizasyon nedeni; son bir ay içerisinde bağışıklık baskılayıcı tedavi alımı, nötropeni varlığı, eşlik eden bakteriyemi, komplike edici faktörler (yaş, cinsiyet, malignite, böbrek taşı, BPH vb.), ürolojik girişim ve/veya operasyon, son bir yılda üriner sistem enfeksiyonu (ÜSE) geçirmiş olma, son 3 ay içerisinde antibiyotik kullanma öyküsü, hastane ve/veya yoğun bakım yatış öyküsü verileri kaydedildi. Hasta dağılımlarında 99 (% 56,25) hastanın tedavisinde karbapenem ve 77 (% 43,75) hastada ise PİP-TAZ tedavisi kullanıldı.. Hastaların yaş ortalaması 66,81±13,82 (yıl) olup, 107'si (% 60,8) ?65 yaş grubunda idi. 88( % 50,0) hasta kadın, 88 (% 50,0) hastada erkek idi.. Hastaların 79 (% 44,9) 'unda altta yatan malignite hastalığı olduğu, 75 (% 42,6)'inde ise immunsupresif tedavi aldığı görüldü. Özgül tedavi alan gruplar arasında klinik yanıt, tedavi sonucu (7., 14. ve 30. gün mortalite) üzerinde istatistiksel olarak anlamlı ilişki yoktu (p>0,05). Mortalite üzerine etkisi olan parametreler incelediğinde, tek değişkenli analizlerde anlamlı bulunan tüm parametreler kullanılarak yapılan lojistik regresyon analizi sonucunda; albümin ve trombosit değerinin düşük olması, Charlson komorbidite indeksi ve SOFA skorunun yüksek olması, malignite olması ve immunsupresif tedavi kullanımı ile ölüm durumu arasında anlamlı ilişki olduğu tespit edildi (p<0,05). PİP-TAZ, GSBL üreten E.coli (GSBL-EC) veya K. pneumoniae (GSBL-KP) bağlı ÜÜSE tedavisinde karbapenemlere etkili bir alternatif olabilir. GSBL-EC ve GSBL-KP etken olduğu ÜÜSE hastalarında malignite ve immunsupresyon olması, laboratuvarda trombosit ve albümin düşüklüğü olması, SOFA skoru ve Charlson komorbidite indeks yüksekliği durumları mortalite için bağımsız risk faktörleridir.
The rate of infections caused by extended spectrum ?-lactamase producing bacteria is steadily increasing globally. Especially in the 21st century, the worldwide resistance problem causes an increase in the use of carbapenem group antibiotics in the treatment of UTIs caused by these bacteria. In this duration, the increasing antibiotic resistance including carbapenemases and to slow in the development of new antibiotic led experts to different antibiotic options in the treatment. In the light of this situation, the current evidence of efficacy of ?-lactam / ?-lactamase inhibitors (BL/BLI), which are considered to be an effective treatment alternative for ESBL-producing Enterobacteriaceae-associated UTI, is still controversial. The aim of this study was to determine the effectiveness of BL / BLI(piperacillin-tazobactam) against carbapenems (meropenem/ertapenem) in the treatment of UTI due to ESBL producing Enterobacteriaceae. 176 patients who applied to Tekirdağ Namık Kemal University Education and Research Hospital, diagnosed with UTI caused by ESBL producing E.coli and K. pneumonia and who were treated with carbapenem(meropenem/ertapenem) or BL / BLI (PIP-TAZ) were included in our study. Patients' age, gender, underlying diseases (malignancy, DM, chronic kidney disease, central system diseases, BPH, etc.), hemogram, kidney function tests, liver function tests, albumin and CRP levels, isolated microorganism and their antibiotic susceptibility, presence of urinary catheterization, type of catheter and reason for catheterization, immunosuppressive therapy in the last month, presence of neutropenia, accompanying bacteremia, complicating factors (age, gender, malignancy, kidney stones, BPH, etc.), urological intervention and / or operation, having UTI in the last year, a history of using antibiotics in the last 3 months, and a history of hospitalization and/or intensive care unit admission were recorded. Carbapenem group antibiotic was used in the treatment of 99 (56,25 %) patients and BL / BLI group antibiotic was used in the treatment of 77 (43,75%) patients. The mean age of the patients was 66.81±13.82 (years) and 107 (60.8%) were in the ?65 age group. 88 patients (50.0%) were female and 88 patients (50.0%) were male. 79 of the patients (44.9%) had malignancy, and 75 (42.6%) of them used immunosuppressive agent therapy. There was no statistically significant relationship between the groups receiving targeted therapy in clinical response, treatment outcome, 30-day mortality, and acute phase response (p>0.05). When the parameters that have an effect on mortality are evaluated, as a result of the logistic regression analysis using all the parameters that were significant in the univariate analysis; low albumin level and thrombocytopenia, high Charlson comorbidity index and high SOFA score, malignancy, the use of immunosuppressive therapy were found to have a significant effect on mortality (p <0.05). Our results suggested that PIP-TAZ can be as effective as a carbapenems in the treatment of ESBL-producing Escherichia coli (ESBL-EC) or Klebsiella pneumoniae (ESBL-KP) UUTI. In patients with ESBL-EC and ESBL-KP, malignancy, immunosuppression, thrombocytopenia, low albumin level, high SOFA score and high Charlson comorbidity index are independent risk factors for mortality in patients with UTI.
The rate of infections caused by extended spectrum ?-lactamase producing bacteria is steadily increasing globally. Especially in the 21st century, the worldwide resistance problem causes an increase in the use of carbapenem group antibiotics in the treatment of UTIs caused by these bacteria. In this duration, the increasing antibiotic resistance including carbapenemases and to slow in the development of new antibiotic led experts to different antibiotic options in the treatment. In the light of this situation, the current evidence of efficacy of ?-lactam / ?-lactamase inhibitors (BL/BLI), which are considered to be an effective treatment alternative for ESBL-producing Enterobacteriaceae-associated UTI, is still controversial. The aim of this study was to determine the effectiveness of BL / BLI(piperacillin-tazobactam) against carbapenems (meropenem/ertapenem) in the treatment of UTI due to ESBL producing Enterobacteriaceae. 176 patients who applied to Tekirdağ Namık Kemal University Education and Research Hospital, diagnosed with UTI caused by ESBL producing E.coli and K. pneumonia and who were treated with carbapenem(meropenem/ertapenem) or BL / BLI (PIP-TAZ) were included in our study. Patients' age, gender, underlying diseases (malignancy, DM, chronic kidney disease, central system diseases, BPH, etc.), hemogram, kidney function tests, liver function tests, albumin and CRP levels, isolated microorganism and their antibiotic susceptibility, presence of urinary catheterization, type of catheter and reason for catheterization, immunosuppressive therapy in the last month, presence of neutropenia, accompanying bacteremia, complicating factors (age, gender, malignancy, kidney stones, BPH, etc.), urological intervention and / or operation, having UTI in the last year, a history of using antibiotics in the last 3 months, and a history of hospitalization and/or intensive care unit admission were recorded. Carbapenem group antibiotic was used in the treatment of 99 (56,25 %) patients and BL / BLI group antibiotic was used in the treatment of 77 (43,75%) patients. The mean age of the patients was 66.81±13.82 (years) and 107 (60.8%) were in the ?65 age group. 88 patients (50.0%) were female and 88 patients (50.0%) were male. 79 of the patients (44.9%) had malignancy, and 75 (42.6%) of them used immunosuppressive agent therapy. There was no statistically significant relationship between the groups receiving targeted therapy in clinical response, treatment outcome, 30-day mortality, and acute phase response (p>0.05). When the parameters that have an effect on mortality are evaluated, as a result of the logistic regression analysis using all the parameters that were significant in the univariate analysis; low albumin level and thrombocytopenia, high Charlson comorbidity index and high SOFA score, malignancy, the use of immunosuppressive therapy were found to have a significant effect on mortality (p <0.05). Our results suggested that PIP-TAZ can be as effective as a carbapenems in the treatment of ESBL-producing Escherichia coli (ESBL-EC) or Klebsiella pneumoniae (ESBL-KP) UUTI. In patients with ESBL-EC and ESBL-KP, malignancy, immunosuppression, thrombocytopenia, low albumin level, high SOFA score and high Charlson comorbidity index are independent risk factors for mortality in patients with UTI.
Açıklama
Tıp Fakültesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Ana Bilim Dalı, Enfeksiyon ve Klinik Mikrobiyoloji Bilim Dalı
Anahtar Kelimeler
Klinik Bakteriyoloji ve Enfeksiyon Hastalıkları, Clinical Microbiology and Infectious Diseases
