ÖZET
Amaç:
Cinsel temasla bulaşan hastalıklar (CTBH), ekonomik ve sosyal problemlere yol açan en önemli halk sağlığı sorunlarından biridir. Üretrit en sık karşılaşılan CTBH’lerden biridir. Bu nedenle, dirençli mikroorganizmalarla özellikle asemptomatik olarak infekte kişiler enfeksiyonlarını diğer kişilere de bulaştırmaya devam edeceğinden bu etkenlerin izlenmesi çok önemlidir. Çalışmamızda 10 yıllık dönemde üretritli erkek hastalardaki etkenler ve antibiyotiklere duyarlılıkları retrospektif olarak değerlendirilmiştir.
Yöntemler:
Yedi yüz kırk sekiz üretritli erkek hasta çalışmaya dahil edilmiştir. Üretral akıntı ve ejekülat sıvısı örneklerinde N. gonorrhoeae (Biomerieux, Fransa), M. hominis ile U. urealyticum (Mycoplasma IES, Autobio) varlığı ve antibiyotiklere duyarlılıkları araştırılmıştır. Ayrıca C. trachomatis (Ultimed) antijeni varlığı da hızlı kromatografik yöntem ile araştırılmıştır.
Bulgular:
Yedi yüz kırk sekiz hastanın 166’sının (%22,2) incelenen etkenlerin en az biri ile infekte olduğu bulunmuş; hastaların 28’inde mikst enfeksiyon saptanmıştır. En sık saptanan etken U. urealyticum (114 olgu-%58,8) olmuştur; N. gonorrhoeae (43 olgu-%21,6), M. hominis (24 olgu-%12,4) ve C. trachomatis (10 olgu-%5,2) onu izlemiştir. N. gonorrhoeae suşları genellikle sefuroksim, seftriakson, penisilin, levofloksasin, siprofloksasin ve tetrasikline duyarlı bulunmuştur. (%92,3-100). U. urealyticum suşlarının büyük bir çoğunluğu klindamisin (%89,6) ve siprofloksasine (%78,5) dirençli bulunmuştur. Bunlara ilave olarak M. hominis suşları eritromisin (%100), klaritromisin (%90), klindamisin (%70) ve siprofloksasine (%43,8) dirençli bulunmuştur.
Sonuç:
Sonuçlar, geçtiğimiz on yılda da etkenlerin ve antibiyotik direnç modellerinin hala önemli bir halk sağlığı sorunu olduğunu göstermiştir.
References
1
Gaydos C, Maldeis NE, Hardick A, Hardick J, Quinn TC. Mycoplasma genitalium as a contributor to the multiple etiologies of cervicitis in women attending sexually transmitted disease clinics. Sex Transm Dis 2009;36:598-606.
2
Pépin J, Sobéla F, Deslandes S, Alary M, Wegner K, Khonde N, et al. Etiology of urethral discharge in West Africa: the role of Mycoplasma genitalium and Trichomonas vaginalis. Bull World Health Organ 2001;79:118-26.
3
Wi TE, Ndowa FJ, Ferreyra C, Kelly‐Cirino C, Taylor MM, Toskin I, et al. Diagnosing sexually transmitted infections in resource‐constrained settings: challenges and ways forward. J Int AIDS Soc 2019;22:8-18.
4
Rietmeijer CA, Machiha A, Mugurungi O, Kupara V, Rodgers L, Kilmarx PH, et al. The Etiology of Male Urethral Discharge in Zimbabwe: Results from the Zimbabwe STI Etiology Study. Sex Transm Dis 2018;45:56-60.
5
Rossignol L, Feuillepain L, Ngangro NN, Souty C, Fournet N, Le Strat Y, et al. Estimate of male urethritis incidences in France between 2007 and 2017 with a specific focus on Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis infections. BMC Infec Dis 2019;19:561.
6
Srugo I, Steinberg J, Madeb R, Gershtein R, Elias I, Tai J, et al. Agents of non-gonococcal urethritis in males attending an Israeli clinic for sexually transmitted diseases. Isr Med Assoc J 2003;5:24-7.
7
Terkelsen D, Tolstrup J, Johnsen CH, Lund O, Larsen HK, Worning P, et al. Multidrug-resistant Neisseria gonorrhoeae infection with ceftriaxone resistance and intermediate resistance to azithromycin, Denmark, 2017. Eurosurveill 2017;22:17-00659.
8
Takuva S, Mugurungi O, Mutsvangwa J, Machiha A, Mupambo AC, Maseko V, et al. Etiology and antimicrobial susceptibility of pathogens responsible for urethral discharge among men in Harare, Zimbabwe. Sex Transm Dis 2014;41:713-7.
9
WHO. Global action plan to control the spread and impact of antimicrobial resistance in Neisseria gonorrhoeae. World Health Organization, Department of Reproductive Health and Research; 2012. http://apps.who.int/iris/bitstream/ 10665/44863/1/9789241503501_eng.pdf.
10
Affolabi D, Goma E, Sogbo F, Ahotin G, Orekan J, Massou F, et al. Antimicrobial susceptibility profile of Neisseria gonorrhoeae isolated in Cotonou, Benin (2015-2017). Sex Transm Infec 2018;94:20.
11
Waites KB, Katz B, Schelonka RL. Mycoplasmas and Ureaplasmas as neonatal pathogens. Clin Microbiol Rev 2005;18:757-89.
12
Leli C, Mencacci A, Bombaci JC, D’Alò F, Farinelli S, Vitali M, et al. Prevalence and antimicrobial susceptibility of Ureaplasma urealyticum and Mycoplasma hominis in a population of Italian and immigrant outpatients. Infez Med 2012;20:82-7.
13
https://www.cdc.gov/std/gonorrhea/arg/b88-feb-2005.pdf
14
CLSI. Performance standards for antimicrobial susceptibility testing; twenty second informational supplement. CLSI document M100-S22. Wayne PA: Clinical and laboratory standards institute; 2012.
15
Yeshanew AG, Geremew RA. Neisseria gonorrhoae and their antimicrobial susceptibility patterns among symptomatic patients from Gondar town, North West Ethiopia. Antimicrob Resist Infect Control 2018;7:85.
16
Pelit S, Bulut ME, Bayraktar B. Üretrit semptomları olan erkek hastalarda Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum ve Mycoplasma hominis sıklığının araştırılması. Bakırköy Tıp Derg 2017;13:10-3.
17
Latif AS, Gwanzura L, Machiha A, Ndowa F, Tarupiwa A, Gudza-Mugabe M, et al. Antimicrobial susceptibility in Neisseria gonorrhoeae isolates from five sentinel surveillance sites in Zimbabwe, 2015-2016. Sex Transm Infect 2018;94:62-6.
18
Buder S, Dudareva S, Jansen K, Loenenbach A, Nikisins S, Sailer A, et al. Antimicrobial resistance of Neisseria gonorrhoeae in Germany: low levels of cephalosporin resistance, but high azithromycin resistance. BMC Infec Dis 2018;18:44.
19
Goering R, Dockrell H, Zuckerman M, Roitt I, Chiodini PL: Mims’ Medical Microbiology. 5th Edition. US. Elsevier Health Sciences, 2012;245-67.
20
Winn WC, Allen SD, Janda WM. Koneman’s Color Atlas and Textbook of Diagnostic Microbiology. 6th Edition. Philadelphia. Lippincott Company 2006;1023-65.
21
Yarbrough ML, Burnham CA. The ABCs of STIs: an update on sexually transmitted infections. Clin Chem 2016;62:811-23.
22
Aydin D, Küçükbasmaci Ö, Gönüllü N, Aktas Z. Susceptibilities of Neisseria gonorrhoeae and Ureaplasma urealyticum isolates from male patients with urethritis to several antibiotics including telithromycin. Chemotherapy 2005;51:89.
23
Bala M, Ray K, Gupta SM, Muralidhar S, Jain RK. Changing trends of antimicrobial susceptibility patterns of Neisseria gonorrhoeae in India and the emergence of ceftriaxone less susceptible N. gonorrhoeae strains. J Antimicrob Chemother 2007;60:582-6.
24
Al-Sweih NA, Khan S, Rotimi VO. The prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections among men with urethritis in Kuwait. J Infect Public Health 2011;4:175-9.
25
Barbee LA, Khosropour CM, Dombrowski JC, Manhart LE, Golden MR. An estimate of the proportion of symptomatic gonococcal, chlamydial and non-gonococcal non-chlamydial urethritis attributable to oral sex among men who have sex with men: a case-control study. Sex Transm Infect 2016;92:155-60.
26
Hamasuna R, Yasuda M, Ishikawa K, Uehara S, Takahashi S, Hayami H, et al. Nationwide surveillance of the antimicrobial susceptibility of Neisseria gonorrhoeae from male urethritis in Japan. J Infect Chemother 2013;19:571-8.
27
Shigemura K, Okada H, Shirakawa T, Tanaka K, Arakawa S, Kinoshita S, et al. Susceptibilities of Neisseria gonorrhoeae to fluoroquinolones and other antimicrobial agents in Hyogo and Osaka, Japan. Sex Transm Infec 2004;80:105-7.
28
Tanaka M, Nakayama H, Notomi T, Irie SI, Tsunoda Y, Okadome A, et al. Antimicrobial resistance of Neisseria gonorrhoeae in Japan, 1993-2002: continuous increasing of ciprofloxacin-resistant isolates. Int J Antimicrob Agents 2004;24:15-22.
29
Workowski KA, Berman SM, Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep 2010;59:1-90.
30
Deguchi T, Yasuda M, Yokoi S, Ishida KI, Ito M, Ishihara S, et al. Treatment of uncomplicated gonococcal urethritis by double-dosing of 200 mg cefixime at a 6-h interval. J Infect Chemother 2003;9:35-9.
31
Balıkçı A, Aydın D. Neisseria gonorrhoea’de kinolon direnci: İstanbul Tıp Fakültesi 2002-2006. ANKEM Derg 2008;22:145-7.
32
Horner PJ, Martin DH. Mycoplasma genitalium infection in men. J Infect Dis 2017;216:396-405.
33
Beşli Y, Karatuna O, Akyar I. Evaluation of In Vitro Antimicrobial Susceptibility in Ureaplasma urealyticum and Mycoplasma hominis Strains Isolated from Genitourinary Tract Samples. ANKEM Derg 2017;31:97-105.
34
Díaz L, Cabrera LE, Fernández T, Ibáñez I, Torres Y, Obregón Y, Rivero Y. Frequency and antimicrobial sensitivity of Ureaplasma urealyticum and Mycoplasma hominis in patients with vaginal discharge. MEDICC Rev 2013;15:45-7.
35
Rerambiah LK, Ndong JC, Medzegue S, Elisee-Ndam M, Siawaya JD. Genital Mycoplasma infections and their resistance phenotypes in an African setting. Eur J Clin Microbiol Infect Dis 2015;34:1087-90.
36
Schneider SC, Tinguely R, Droz S, Hilty M, Donà V, Bodmer T, Endimiani A. Antibiotic susceptibility and sequence type distribution of Ureaplasma species isolated from genital samples in Switzerland. Antimicrob Agents Chemother 2015;59:6026-31.
37
Skiljevic D, Mirkov D, Vukicevic J. Prevalence and antibiotic susceptibility of Mycoplasma hominis and Ureaplasma urealyticum in genital samples collected over 6 years at a Serbian university hospital. Indian J Dermatol Venereol Leprol 2016;82:37.
38
Zeng X-Y, Xin N, Tong X-N, Wang J-Y, Liu Z-W. Prevalence and antibiotic susceptibility of Ureaplasma urealyticum and Mycoplasma hominis in Xi’an, China. Eur J Clin Microbiol Infect Dis 2016;35:1941-7.
39
Turan H, Özçimen EE, Arslan H. The Frequency and Antimicrobial Susceptibility of Mycoplasma hominis and Ureaplasma urealyticum in Women Patients with Vaginitis. ANKEM Derg 2011;25:17-21.
40
Meral T, Altun HU, Aribaş ET. The Prevalence and Antibiotic Resistance Profiles of Mycoplasma hominis and Ureaplasma urealyticum at a University Hospital ANKEM Derg 2014;28:124-8.
41
Seña AC, Lensing S, Rompalo A, Taylor SN, Martin DH, Lopez LM, et al. Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis infections in men with nongonococcal urethritis: predictors and persistence after therapy. J Infect Dis 2012; 206:357-65.
42
Bilir YA, Pehlivanoglu F, Yasar KK, Sengoz G. Prevalence of Mycoplasma hominis and Ureaplasma urealyticum in patients with urogenital symptoms. Med Bull Haseki 2011;49:99-102.
