بررسي فنوتيپي و ژنوتيپي مقاومت نسبت به فلوركينولون ها در جدايه هاي كلبسيلا پنومونيه از موارد عفونت هاي ادراري در شهرستان بجنورد

Phenotypic and genotypic evaluation of fluoroquinolones resistance in Klebsiella pneumoniae isolates from urinary tract infections in Bojnourd city

ﺧﻼﺻﻪ ﻣﻘﺪﻣﻪ ﻋﻔﻮﻧﺖ ﻣﺠﺎري ادراري ﯾﮑﯽ از ﻣﻌﻤﻮلﺗﺮﯾﻦ و راﯾﺞﺗﺮﯾﻦ ﻋﻔﻮﻧﺖﻫﺎي ﺑﺎﮐﺘﺮﯾﺎﯾﯽ ﻣﯽﺑﺎﺷﺪ ﺑﻪ ﻃﻮري ﮐﻪ ﻧﺴﺒﺖ ﻗﺎﺑﻞ ﺗﻮﺟﻬﯽ از ﻣﺮاﺟﻌﻪ ﮐﻨﻨﺪﮔﺎن ﺑﻪ ﺑﯿﻤﺎرﺳﺘﺎنﻫﺎ )ﺣﺪود 40-30 درﺻﺪ( را ﺑﻪ ﺧﻮد اﺧﺘﺼﺎص ﻣﯽدﻫﺪ. ﻇﻬﻮر ﻣﻘﺎوﻣﺖ در ﺑﺮاﺑﺮ ﺳﻔﺎﻟﻮﺳﭙﻮرﯾﻦﻫﺎ، ﻓﻠﻮروﮐﯿﻨﻮﻟﻮنﻫﺎ و ﺗﺮي ﻣﺘﻮﭘﺮﯾﻢ-ﺳﻮﻟﻔﺎﻣﺘﻮﮐﺴﺎزول، ﮐﻪ اﻏﻠﺐ ﺟﻬﺖ درﻣﺎن ﻋﻔﻮﻧﺖﻫﺎي ﻋﻤﻮﻣﯽو ﺑﯿﻤﺎرﺳﺘﺎﻧﯽ اﺳﺘﻔﺎده ﻣﯽﺷﺪ، درﻣﺎن ﻣﻮﺛﺮ اﯾﻦ ﺑﯿﻤﺎريﻫﺎ را ﺑﻪ ﺗﺄﺧﯿﺮ اﻧﺪاﺧﺖ و ﻣﺘﻌﺎﻗﺒﺎً ﻣﻨﺠﺮ ﺑﻪ اﻓﺰاﯾﺶ واﮔﯿﺮي و ﻣﺮگ و ﻣﯿﺮ ﺑﯿﻤﺎران در اﺛﺮ اﯾﻦ ﻋﻔﻮﻧﺖﻫﺎ ﮔﺮدﯾﺪ. روش ﮐﺎر در اﯾﻦ ﻣﻄﺎﻟﻌﻪ 30 ﻧﻤﻮﻧﻪ از ﮐﺸﺖﻫﺎي ﻣﺜﺒﺖ داراي ﻋﻔﻮﻧﺖ ادراري ارﺟﺎع ﺷﺪه ﺑﻪ آزﻣﺎﯾﺸﮕﺎه ﺑﯿﻤﺎرﺳﺘﺎن اﻣﺎم رﺿﺎ ﺷﻬﺮﺳﺘﺎن ﺑﺠﻨﻮرد، ﻣﻮرد ﺑﺮرﺳﯽ ﻗﺮار ﮔﺮﻓﺖ. ﺑﺮرﺳﯽ ﻣﻘﺎوﻣﺖ و ﺣﺴﺎﺳﯿﺖ ﺟﺪاﯾﻪﻫﺎ ﺑﺎ روش دﯾﺴﮏ دﯾﻔﯿﻮژن اﻧﺠﺎم ﮔﺮدﯾﺪ. ﻫﻤﭽﻨﯿﻦ ﺣﻀﻮر ژن qnrA ﺑﻪ روش ﻣﻮﻟﮑﻮﻟﯽ ﺑﺎ ﭘﺮاﯾﻤﺮﻫﺎي اﺧﺘﺼﺎﺻﯽ ﺑﺮرﺳﯽ ﮔﺮدﯾﺪ. ﻧﺘﺎﯾﺞ ﻧﺘﺎﯾﺞ ﺣﺎﺻﻠﻪ از اﯾﻦ ﭘﮋوﻫﺶ ﻧﺸﺎن ﻣﯽدﻫﺪ ﮐﻪ ﻣﯿﺰان ﻣﻘﺎوﻣﺖ ﻓﻨﻮﺗﯿﭙﯽ ﺟﺪاﯾﻪﻫﺎ ﻧﺴﺒﺖ ﺑﻪ آﻧﺘﯽ ﺑﯿﻮﺗﯿﮏﻫﺎي ﻧﺎﻟﯿﺪﯾﮑﺴﯿﮏ اﺳﯿﺪ، ﻟﻮوﻓﻠﻮﮐﺴﺎﺳﯿﻦ و ﺳﯿﭙﺮوﻓﻠﻮﮐﺴﺎﺳﯿﻦ ﺑﻪ ﺗﺮﺗﯿﺐ 26/66 ،%43/33% و 40%ﺑﻮد. ﻫﻤﭽﻨﯿﻦ در ﺑﺮرﺳﯽ ژﻧﻮﺗﯿﭙﯽ ﺟﺪاﯾﻪﻫﺎ ﻧﺴﺒﺖ ﺑﻪ ژن ﻣﻮرد ﻣﻄﺎﻟﻌﻪ 6/66 % ﻣﺸﺎﻫﺪه ﺷﺪ ﻧﺘﯿﺠﻪ ﮔﯿﺮي ﺑﺮاﺳﺎس ﻧﺘﺎﯾﺞ ﻣﻄﺎﻟﻌﻪي ﺣﺎﺿﺮ ﻣﯽﺗﻮان ﮔﻔﺖ ﮐﻪ ﻣﯿﺰان ﻣﻘﺎوﻣﺖ ﺑﺮ ﻋﻠﯿﻪ آﻧﺘﯽ ﺑﯿﻮﺗﯿﮏﻫﺎي ﻣﺘﻌﻠﻖ ﺑﻪ ﺧﺎﻧﻮادهي ﻓﻠﻮرﮐﯿﻨﻮﻟﻮنﻫﺎ ﻫﻨﻮز ﺑﻪ ﻃﻮر ﮔﺴﺘﺮدهاي ﺑﺎﻻ ﻧﻤﯽﺑﺎﺷﺪ. ﮐﻠﻤﺎت ﮐﻠﯿﺪي

Introduction: Urinary tract infection (UTI) is one of the most common bacterial infections, accounting for a significant proportion of hospital clients (about 30-40%). The emergence of resistance to cephalosporins, fluoroquinolones and trimethoprim-sulfamethoxazole which were often used to treat general and nosocomial infections, delayed effective treatment of these diseases and subsequently resulted in increased infections and mortality of patients. Methods: In this study, 30 specimens of positive cultures of urinary tract infection which were referred to Imam Reza Hospital laboratory in Bojnourd were studied. The resistance and susceptibility of the isolates were determined by disc diffusion method. The presence of QnrA gen was assessed by molecular methods with specific primers. Results: The phenotypic resistance of isolates to nalidixic acid, levofloxacin and ciprofloxacin were 43.33%, 26.66% and 40%, respectively. Also, genotypic analysis of the isolates showed 6.66% of the studied genes. Conclusion: Based on the results of the present study, it can be said that resistance to antibiotics belonging to the fluoroquinolones is not yet widely high