Læknablaðið - 15.04.2008, Blaðsíða 11

Kristín
Jónsdóttir
sérfræðingur í lífeindafræði
á sviði sýklafræði
Karl G.
Kristinsson
sérfræöingur í sýklafræði
sýklafræðideild Landspítala
Lykilorð: flúórókínólón, sýkla-
lyfjanotkun, sýklalyfjaónæmi.
s Ý
FRÆÐIGREINAR
KLALYFJANOTKUN
Onæmi fyrir kínólónum hjá
Gram neikvæðum stöfum
á Islandi og tengsl
við sýklalyfjanotkun
Ágrip
Tilgangur: Flúórókínólón eru bakteríudrepandi
lyf og mikið notuð við meðhöndlun alvarlegra
þvagfæra- og öndunarfærasýkinga. Kannanir
sýna að ónæmi gegn flúórókínólónum eykst stöð-
ugt bæði í Evrópu og Bandaríkjunum. Tilgangur
rannsóknarinnar var að skoða ónæmi fyrir
flúórókínólónum hjá algengustu Gram neikvæðu
stöfunum ásamt tengslum þess við notkun flúóró-
kínólóna síðastliðin átta ár.
Efniviður og aðferðir: Rannsóknin náði til allra
stofna Escherichia coli, Klebsiella sp., Proteus sp. og
Pseudomonas aeruginosa sem greindust sem líklegir
sýkingarvaldar í innsendum sýnum á sýkla-
fræðideild Landspítalans á tímabilinu 1.11.2006
til 31.1.2007. Næmispróf voru framkvæmd með
skífuprófum og var næmi fyrir cíprófloxacíni próf-
að hjá öllum stofnunum. Gögn um tíðni ónæmis
síðastliðin ár voru fengin úr skýrslum sýkla-
fræðideildar, en að jafnaði var aðeins prófað fyrir
cíprófloxacín næmi hjá inniliggjandi sjúklingum
og þeim sem höfðu ónæmi fyrir tveimur eða fleiri
lyfjaflokkum. Upplýsingar um sýklalyfjanotkun
fengust frá sóttvarnalækni.
Niðurstöður: Af þeim 1861 stofni sem voru
prófaðir á tímabilinu reyndust 104 vera flúóró-
kínólón-ónæmir stofnar. Þar af voru 91 E. coli
(87%), 8 Klebsiella sp. (8%) og 5 P. aeruginosa
(5%). Enginn flúórókínólón-ónæmur Proteus sp.
greindist. Marktæk jákvæð fylgni var á milli
flúórókínólón-notkunar og tíðni ónæmra E. coli
og Enterobacteriaceae stofna. Tíðni ónæmra E. coli
stofna var 6% en marktækur munur var á tíðninni
eftir aldurshópum (p>0,001). Einnig var marktæk-
ur munur á tíðni E. coli milli kynja en hún var 6%
■■■■■■■■■■ E N G L I S H SUMMARYHBBBIBiaa
Jónsdóttir K, Kristinsson KG
Quinolone resistance in Gram negative rods in lceland
and association with antibiotic use
Objective: Fluoroquinolones are bacteriocidal drugs that
are widely used to treat severe urinary and respiratory
tract infections. Studies show that resistance to
fluoroquinolones is continuously increasing both in Europe
and the United States. The purpose of this study was to
measure the frequency of fluoroquinolone resistance in
the most prevalent Gram negative rods and look at the
correlation with fluoroquinolone use over the last 8 years.
Materials and methods: All strains of Escherichia coli,
Klebsiella sp., Proteus sp. and Pseudomonas aeruginosa
identified from clinical specimens at the Department of
Clinical Microbiology at the Landspitali University Hospital
(LUH) during the time period 1.11.2006 to 31.1.2007.
Antibiotic susceptibility testing was performed by disc
diffusion tests and all strains were tested for ciprofloxacin
susceptibility. Antibiotic resistance data for the last years
were collected from the reports of the Department of
Clinical Microbiology, but ciprofloxacin susceptibility
was usually only tested for specimens from hospitalised
patients and when there was resistance to two or more
antimicrobial agents. Data on antibiotic use/sales was
obtained from the State Epidemiologist at the Directorate
of Health.
Results: Of the 1861 strains tested, 104 fluoroquinolone
resistant strains were identified during the study period,
including 91 E. coli (87%), 8 Klebsiella sp. (8%) and 5 P.
aeruginosa (5%). No fluoroquinolone resistant Proteus sp.
was identified. There was a significant positive correlation
between fluoroquinolone use and the frequency of
resistant strains of E. coli and Enterobacteriaceae. The
frequency of resistant £ coli strains was 6% and it differed
significantly between age groups (p >0.001) and sex, 6%
for females and 11 % for males (p = 0.015). The ratio of
fluoroquinolone resistant £ coli was highest in the LUH
and homes for the elderly.
Conclusion: The frequency of fluoroquinolone resistance
is increasing fast in lceland but is still one of the lowest
compared to the other European countries. The frequency
is highest in the oldest age groups where the use of the
quinolones is the greatest and there was a significant
correlation between the quinolone use and the frequency
of resistance in £ coli and Enterobacteriaceae. The results
highlight the importance of prudent fluoroquinolone
use and the need to monitor fluoroquinolone use and
resistance.
Key words: fluoroquinolones, antibiotic use, antibiotic resistance.
Correspondence: Karl G. Kristinsson, karl@landspitali.is
LÆKNAblaðið 2007/93 279