Scientific Journal of Kurdistan University of Medical Sciences
مجله علمي دانشگاه علوم پزشكي كردستان
SJKU
General
http://sjku.muk.ac.ir
54
journal54
1560-652X
2345-4040
sjku
10.61186/sjku
en
jalali
1401
7
1
gregorian
2022
10
1
27
4
online
1
fulltext
fa
بررسی الگوی حساسیت آنتیبیوتیکی و جهشهای پورین غشای خارجی در ایزولههای بالینی کلبسیلا پنومونیه
Antimicrobial Susceptibility Pattern and Mutations of Outer Membrane Porin in Clinical Isolates of Klebsiella pneumoniae
میکروبیولوژی
Microbiology
پژوهشي اصیل
Original Research
<span style="font-size:12pt"><span style="line-height:normal"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:"Times New Roman",serif"><b><span lang="FA" style="font-family:"B Zar"">زمینه و هدف:<i> </i></span></b><i><span lang="FA" style="font-family:"B Zar"">کلبسیلا پنومونیه</span></i><span lang="FA" style="font-family:"B Zar""> یکی از شایعترین علل عفونت‏ های اکتسابی از جامعه و عفونت‏ های بیمارستانی است و در طول زمان مکانیسم ‏های مقاومتی متعددی را کسب کرده است. هدف از این مطالعه ارزیابی الگوی مقاومت آنتی‏بیوتیکی ایزوله‏ های بالینی <i>کلبسیلا پنومونیه</i> و بررسی جهش در پورین </span><span dir="LTR" style="font-size:11.0pt">Ompk35</span><span lang="FA" style="font-family:"B Zar""> به عنوان یکی از مهم‏ترین مکانیسم‏ های مقاومت به آنتی‏بیوتیک ‏های بتالاکتام بود.</span><b><span lang="FA" style="font-family:"B Zar""></span></b></span></span></span></span></span>
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<span style="font-size:10pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:"Courier New""><b><span lang="AR-SA" style="font-size:12.0pt"><span style="font-family:"B Zar"">مواد و روشها</span></span></b><span dir="LTR" lang="X-NONE" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">:</span></span><span lang="AR-SA" style="font-size:12.0pt"><span style="font-family:"B Zar""> در این مطالعه</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span style="font-family:"B Zar"">مقطعی</span></span><span lang="FA" style="font-size:12.0pt"><span style="font-family:"B Zar""> همبستگی</span></span><span lang="AR-SA" style="font-size:12.0pt"><span style="font-family:"B Zar""> 100 ایزوله ادراری <i>کلبسیلا پنومونیه</i> از بیماران بستری در بیمارستان میلاد مورد بررسی قرار گرفت. آزمایش حساسیت آنتیبیوتیکی با استفاده از روش دیسک دیفیوژن انجام شد. </span></span><span lang="FA" style="font-size:12.0pt"><span style="font-family:"B Zar"">ژن‏های </span></span><i><span dir="LTR" lang="X-NONE" style="font-size:11.0pt"><span style="font-family:"Times New Roman",serif">ompK35</span></span></i><span lang="FA" style="font-size:12.0pt"><span style="font-family:"B Zar""> با روش </span></span><span dir="LTR" lang="X-NONE" style="font-size:11.0pt"><span style="font-family:"Times New Roman",serif">PCR</span></span> <span lang="FA" style="font-size:12.0pt"><span style="font-family:"B Zar"">شناسایی و توالی‏یابی شدند و جهش‏ها با استفاده از نرم افزار </span></span><span dir="LTR" lang="X-NONE" style="font-size:11.0pt"><span style="font-family:"Times New Roman",serif">Mega</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span style="font-family:"B Zar"">نسخه 3</span></span><span dir="LTR" lang="X-NONE" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">.</span></span><span lang="AR-SA" style="font-size:12.0pt"><span style="font-family:"B Zar"">7</span></span><span dir="LTR" lang="X-NONE" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">.</span></span><span lang="AR-SA" style="font-size:12.0pt"><span style="font-family:"B Zar"">3 </span></span><span lang="FA" style="font-size:12.0pt"><span style="font-family:"B Zar"">شناسایی شد. </span></span><span lang="AR-SA" style="font-size:12.0pt"><span style="font-family:"B Zar"">برای تجزیه و تحلیل داده‏ ها، از نرم افزار </span></span><span dir="LTR" lang="X-NONE" style="font-size:11.0pt"><span style="font-family:"TimesNewRoman",serif">SPSS</span></span> <span lang="AR-SA" style="font-size:12.0pt"><span style="font-family:"B Zar"">نسخه 20 و آزمون مجذورکای استفاده شد.</span></span><span lang="AR-SA" style="font-size:12.0pt"><span style="font-family:"B Zar""></span></span></span></span></span></span></pre>
<span style="font-size:12pt"><span style="line-height:normal"><span style="tab-stops:45.8pt 91.6pt 137.4pt 183.2pt 229.0pt 274.8pt 320.6pt 366.4pt 412.2pt 458.0pt 503.8pt 549.6pt 595.4pt 641.2pt 687.0pt 732.8pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:"Times New Roman",serif"><b><span lang="FA" style="font-family:"B Zar"">یافته­ ها:</span></b> <span lang="FA" style="font-family:"B Zar"">بالاترین میزان مقاومت نسبت به آمیکاسین (74%) و پس از آن لووفلوکساسین (69%) مشاهده شد. میزان مقاومت به سفپیم، جنتامیسین، سیپروفلوکساسین، مروپنم و سفتریاکسون به ترتیب 62، 58، 53، 41 و 35 درصد بود. بیشترین حساسیت نسبت به ایمیپنم (80%) مشاهده شد. جهشهای متعددی در ژنهای رمز کننده پورین </span><span dir="LTR" style="font-size:11.0pt">Ompk35</span><span lang="FA" style="font-family:"B Zar""> مشاهده شد.</span><span lang="FA" style="font-family:"B Zar""> در بین ایزوله ‏ها، 70 درصد دارای جهش در پروتئین </span><span dir="LTR" style="font-size:11.0pt">Ompk35</span><span lang="FA" style="font-family:"B Zar""> و دو ایزوله دارای پنج جهش به ‏طور همزمان بودند.</span> <span lang="FA" style="font-family:"B Zar"">بین مقاومت به آنتی‏بیوتیک‏ های مورد مطالعه و جنسیت رابطه معنی‏داری مشاهده نشد (</span><i>P</i>>0.05<span lang="FA" style="font-family:"B Zar"">).</span><span lang="AR-SA" style="font-size:10.0pt"><span style="font-family:"Courier New""></span></span></span></span></span></span></span></span>
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<span style="font-size:10pt"><span style="direction:rtl"><span style="unicode-bidi:embed"><span style="font-family:"Courier New""><b><span lang="FA" style="font-size:12.0pt"><span style="font-family:"B Zar"">نتیجه ­گیری</span></span></b><b><span lang="FA" style="font-size:12.0pt"><span style="font-family:"B Zar"">:</span></span></b> <span lang="FA" style="font-size:12.0pt"><span style="font-family:"B Zar"">یافتههای ما نشان دهنده شیوع بالای مقاومت آنتیبیوتیکی و فراوانی بالای جهشهای پورین در ایزولههای <i>کلبسیلا پنومونیه</i> است. همچنین وجود جهشهای مشابه بین ایزولهها نشان میدهد که ممکن است از یک منبع سرچشمه گرفته باشند.</span></span><span lang="X-NONE" dir="LTR" style="font-size:12.0pt"></span></span></span></span></span></pre>
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<span style="font-size:10pt"><span style="font-family:"Courier New""><b><span lang="X-NONE" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Background and Aim: </span></span></b><i><span lang="X-NONE" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Klebsiella pneumoniae</span></span></i><span lang="X-NONE" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"> is one of the most common causes of community-acquired and nosocomial infections and has acquired numerous resistance mechanisms over time.<b> </b></span></span><span lang="EN" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">The aim of this study was to </span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">evaluate </span></span><span lang="EN" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">the antibiotic resistance pattern of clinical isolates of <i>K. pneumoniae</i> and investigate the mutations in Ompk35 p</span></span><span lang="X-NONE" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">orin</span></span><span lang="EN" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"> as one of the most important mechanisms of resistance to beta-lactam antibiotics.</span></span><span dir="RTL" lang="AR-SA" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"></span></span></span></span></pre>
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<span style="font-size:10pt"><span style="font-family:"Courier New""><b><span lang="X-NONE" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Materials and Methods:</span></span></b> <span lang="EN" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">In this </span></span><span lang="X-NONE" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">cross</span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">-</span></span><span lang="X-NONE" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">sectional </span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">correlation </span></span><span lang="EN" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">study, 100 urinary isolates of <i>K</i></span></span><i><span lang="X-NONE" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">.</span></span></i><i><span lang="EN" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"> pneumoniae</span></span></i><span lang="EN" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"> from the patients admitted to Milad Hospital were </span></span><span lang="X-NONE" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">evaluated</span></span><span lang="EN" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">. Antibiotic susceptibility testing was performed using disk diffusion method. Using PCR method, <i>ompK35</i> genes were detected, sequenced and<i> </i>the<i> </i></span></span><span lang="X-NONE" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">mutations were identified</span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"> by</span></span><span lang="X-NONE" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"> us</span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">e</span></span> <span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">of </span></span><span lang="X-NONE" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Mega software (version 3.7.3)</span></span><span class="fontstyle51" style="font-family:"AdvOT0d9ab1db.I",serif"><span style="color:black"><span style="font-weight:normal"><span style="font-style:normal"><span lang="X-NONE" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">.</span></span></span></span></span></span><span lang="EN" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"> SPSS software version 20 and Chi-square test were used for data analysis.</span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"></span></span></span></span></pre>
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<span style="font-size:10pt"><span style="font-family:"Courier New""><b><span lang="X-NONE" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Results:</span></span></b> <span lang="EN" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">The highest resistance rate belonged to amikacin (74%) followed by levofloxacin (69%). Resistance rates to cefepime, gentamicin, ciprofloxacin, meropenem,</span></span> <span lang="X-NONE" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">and</span></span><span lang="EN" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"> ceftriaxone were 62, 58, 53, 41, and 35%, respectively. The highest sensitivity rate belonged to imipenem (80%). Numerous mutations were observed in the Ompk35 porin encoding gene</span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">s</span></span><span lang="EN" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">. Among the isolates, 70% harbored mutations in Ompk35 protein and two isolates had five mutations simultaneously.</span></span> <span lang="EN" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">There was no significant relationship between resistance to the antibiotics and gender in our study (<i>P</i>>0.05).</span></span><span dir="RTL" lang="AR-SA" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"></span></span></span></span></pre>
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<span style="font-size:10pt"><span style="font-family:"Courier New""><b><span lang="X-NONE" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Conclusion:</span></span></b> <span lang="EN" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Our findings indicated a high prevalence rate of antibiotic resistance and high frequency of porin mutations among <i>K. pneumoniae </i>isolates. </span></span><span lang="X-NONE" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Also, the presence of similar mutations </span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">in the</span></span><span lang="X-NONE" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"> isolates suggests that they may have </span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">a common </span></span><span lang="X-NONE" style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">origin.</span></span></span></span></pre>
کلبسیلا پنومونیه, عوامل ضد میکروبی, پورین, مقاومت آنتی بیوتیکی
Klebsiella pneumoniae, Antimicrobial agents, Porin, Drug resistance
13
26
http://sjku.muk.ac.ir/browse.php?a_code=A-10-6345-1&slc_lang=fa&sid=1
Maryam
Bayramnezhad
مریم
بایرام نژاد
maryambayramnezhad@yahoo.com
5400319475328460051993
5400319475328460051993
No
M.Sc, Department of Biology, Islamshahr Branch, Islamic Azad University, Islamshahr, Iran
کارشناس ارشد، گروه زیست شناسی، واحد اسلامشهر، دانشگاه آزاد اسلامی، اسلامشهر، ایران.
Maryam
Ghane
مریم
قانع
ghane@iiau.ac.ir
5400319475328460051994
5400319475328460051994
Yes
Assistant professor, Department of Biology, Islamshahr Branch, Islamic Azad University, Islamshahr, Iran
استادیار، گروه زیست شناسی، واحد اسلامشهر، دانشگاه آزاد اسلامی، اسلامشهر، ایران،
Elham
Asadi
الهام
اسدی
elham.asadi.2@gmail.com
5400319475328460051995
5400319475328460051995
No
Assistant professor, Department of Biology, Islamshahr Branch, Islamic Azad University, Islamshahr, Iran
استادیار، گروه زیست شناسی، واحد اسلامشهر، دانشگاه آزاد اسلامی، اسلامشهر، ایران،