| Abstract | Cilj istraživanja: Opisati osobitosti detekcije enterobakterija rezistentnih na karbapeneme (KRE) te ispitati učestalost svih enterobakterija, učestalost enterobakterija rezistentnih na karbapeneme, odrediti udio enterobakterija rezistentnih na karbapeneme od ukupno izoliranih enterobakterija i odrediti distribuciju detektiranih karbapenemaza po bakterijskim vrstama.
Nacrt studije: Enterobakterije rezistentne na karbapeneme imaju nekoliko mehanizama rezistencije: posjedovanje enzima koji inaktiviraju karabepeneme hidrolizom, stvaranje efluksne pumpe koja izbacuje karbapeneme iz bakterijske stanice te mutacija ili gubitak porina što onemogućuje ulazak antibiotika u bakterijsku stanicu. Enterobakterije rezistentne na karbapeneme izolirane iz uzoraka posjedovale su enzime OXA-48, KPC, NDM, a bakterijae kod kojih enzimi nisu detektirani rezistenciju su stvorile drugim mehanizmima.
Ispitanici i metode: U razdoblju 18. 5. 2020. - 18. 5. 2023. u Zavodu za kliničku mikrobiologiju i bolničke infekcije Klinike za infektologiju KBC Osijek detektirano je i pohranjeno 206 enterobakterija rezistentnih na karbapeneme, a za testiranje rezistencije korišteni su fenotipski i genotipski testovi. Od fenotipskih testova provedeni su: metoda kombiniranih diskova, Lateral Flow test, CARBA NP test, modificirani Hodgeov test te metoda inaktivacije karbapenema (CIM). Genotipski test korišten za testiranje rezistencije na karbapeneme je eazyplex SuperBug CRE.
Rezultati: Rezultati pokazuju da se broj detektiranih enterobakterija te broj enterobakterija rezistentnih na karbapeneme tijekom trogodišnjeg razdoblja povećao s obzirom da je od ukupnog broja izoliranih enterobakterija u 2020. godini 1,13 % bilo je rezistentno na karbapeneme, 2,40 % u 2021., 4,78 % u 2022. te 9,42 % u 2023. godini.
Zaključak: Istraživanje dovodi do zaključka kako se broj enterobakterija rezistentnih na karbapeneme u promatranom razdoblju povećavao. Rezistencija na karbapeneme najčešće je detektirana kod vrsta K. pneumoniae te E. cloacae koje osim posjedovanja enzima rezistenciju razvijaju uz pomoć drugih mehanizama.
Ključne riječi: enterobakterije, rezistencija, karbapenemi |
| Abstract (english) | Objectives: The aim was to describe the characteristics of the detection of carbapenem-resistant enterobacteria (CRE) and to examine the frequency of all enterobacteria, the frequency of carbapenem-resistant enterobacteria, to determine the proportion of carbapenem-resistant enterobacteria from the total number of isolated enterobacteria, and to determine the distribution of detected carbapenemases by bacterial species.
Study design: Enterobacteria resistant to carbapenems have several resistance mechanisms, among which are the possession of enzymes that inactivate carbapenems by hydrolysis, the creation of an efflux pump that expels carbapenems from the bacterial cell, and mutation or loss of porins that prevent the entry of antibiotics into the bacterial cell. Enterobacteria resistant to carbapenems isolated from the samples possessed the enzymes OXA-48, KPC, NDM, and in the case of bacteria in which the enzymes were not detected, they created resistance by other mechanisms.
Participants and methods: In the period between 18 May 2020 and 18 May 2023, a total of 206 enterobacteria resistant to carbapenems were detected and stored in the Department of Clinical Microbiology and Hospital Infections of the Clinic for Infectology at University Hospital Centre Osijek. Phenotypic and genotypic tests were used to test the resistance of enterobacteria to carbapenems. Among the phenotypic tests, the following were performed: the combined disc method, the Lateral Flow test, the CARBA NP test, the modified Hodge test, and the carbapenem inactivation method (CIM). The genotypic test used for carbapenem resistance testing is the eazyplex SuperBug CRE.
Results: The results show that the number of detected enterobacteria, as well as the number of enterobacteria resistant to carbapenems, increased during the three-year period considering that, of the total number of isolated enterobacteria, 1.13 % were resistant to carbapenems in 2020, 2.40 % in 2021, 4.78 % in 2022 and 9.42 % in 2023.
Conclusion: The research leads to the conclusion that the number of enterobacteria resistant to carbapenems has been increased in the observed period. Resistance to carbapenems is most often detected in the species K. pneumoniae and E. cloacae, which, in addition to possessing enzymes, also develop resistance with the help of other mechanisms. |
