Çocuk yaş grubunda burun sürüntüsünde MRSA (Metisiline dirençli staphylococcus aureus) taşıyıcılığının ve risk faktörlerinin belirlenmesi ile MRSA genotiplendirmesi
Küçük Resim Yok
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Maltepe Üniversitesi, Lisansüstü Eğitim Enstitüsü
Erişim Hakkı
CC0 1.0 Universal
info:eu-repo/semantics/openAccess
info:eu-repo/semantics/openAccess
Özet
Giriş: Staphylococcus aureus, hem sağlık bakımı ilişkili (SBİ) hem de toplum kaynaklı (TK) enfeksiyonlara neden olan önemli patojenlerden biridir. Metisilin dirençli Staphylococcus aureus (MRSA) bakteriyemisi, ciddi morbidite ve mortalite ile ilişkilendirilen bakteriyel enfeksiyonlardan biridir. Avrupa’da ve Amerika Birleşik Devletleri’nde (ABD), 2000’li yılların ortasından itibaren, alınan enfeksiyon kontrol önlemlerinin artmasıyla, MRSA enfeksiyonu sıklığında bir miktar azalma sağlanmıştır. Ancak, Asya’da MRSA enfeksiyonlarının sıklığı hala yüksektir. Klinik örneklere ve hastalara ait verilerin yetersiz sorgulanması, SBİ-MRSA izolatlarının TK-MRSA olarak değerlendirilmesine neden olmaktadır. Bu durum TKMRSA’larda antibiyotik duyarlılıklarının yanlış değerlendirilmesine neden olarak ampirik tedavi seçimlerini etkilemektedir. Son yıllarda, antibiyotik kullanım oranlarının yüksek olduğu toplumlarda, MSSA suşlarında da artmış antibiyotik dirençleri gösterilmiştir. Gereç ve Yöntem: Çalışmamızda Maltepe Üniversitesi Tıp Fakültesi Hastanesi Çocuk Sağlığı ve Hastalıkları Poliklinikleri’ne ayaktan başvuran 1-15 yaş arasındaki hastalarda sosyodemografik ve SBİ risk kriterlerine göre MRSA ve MSSA nazal kolonizasyonu riski araştırılmış, metisilin direnci belirlenmesinde sefoksitin disk difüzyon yöntemi ile mecA gen tespiti yöntemleri karşılaştırılmış, MSSA ve MRSA suşlarının antibiyotik duyarlılıkları değerlendirilmiştir. Bulgular: Çalışmamızda S.aureus nazal taşıyıcılığı olmayanların yaş ortalaması MRSA ve MSSA nazal taşıyıcılığı olanlara göre istatistiksel olarak anlamlı derecede düşük bulundu ( p=0,001). Son 3 ayda antibiyotik kullanımının olmaması ve son 1 yıl içinde ailede hastanede yatan birey varlığı MSSA kolonizasyonu için anlamlı risk faktörü olarak bulundu (p=0,012 ve p=0,042); ancak MRSA kolonizasyonu için risk faktörü olarak bulunmadı. Yaştaki bir yıllık artışın ve kronik hastalık varlığının MRSA kolonizasyonunu sırasıyla %17 oranında ve 3.38 kat artırdığı izlendi (p=0,033 ve p=0,014). Gelir seviyesindeki bir düzeylik artışın MSSA nazal taşıyıcılığı riskinin azalttığı görüldü. Hastane başvuru aralığı ayda 1’den dar olanlarda S.aureus taşıyıcılığı anlamlı olarak düşük bulundu (p=0,020), başvuru aralığı ayda 1’den daha geniş olanlarda S.aureus ve MSSA taşıyıcılığı riski anlamlı olarak artmış bulundu (p=0,009 ve p=0,012). S.aureus olduğu doğrulanan örneklerin hepsi teikoplanin, vankomisin, rifampisin, linezolid, kloramfenikol, gentamisin, siprofloksasin ve fusidik asite duyarlı bulundu. MRSA’larda sefoksitin, tetrasiklin ve sefazolin direnci varlığı MSSA’lara göre istatistiksel olarak anlamlı bulundu (p=0,001). MSSA suşlarında penisilin ve sefazolin direnci dışında eritromisin, klindamisin, siprofloksasin, tetrasiklin ve indüklenebilir klindamisin direnci tespit edildi. Sonuç: Çalışmamızda SBİ risk faktörlerinin MSSA suşlarında da artan antibiyotik direncinden sorumlu olabileceğini, in vitro testlerin klinik uyumsuzluk nedeniyle gereksiz geniş spektrumlu antibiyotik kullanımına neden olabileceğini gördük. Hızlı tanıya gidilmesi gereken durumlarda moleküler yöntemlerin kullanılmasının uygun olduğu, uygun tanımlamalarla yapılacak hastane ve toplum kökenli sürveyans çalışmalarının ve izolatların moleküler mikrobiyolojik analizinin MSSA ve MRSA enfeksiyonlarının tedavi ve önlenmesine katkı sağlayacağı sonucuna varıldı.
Introduction: Staphylococcus aureus, is one of the important pathogens, which causing both healthcare associated infections (HCAIs) and community associated (CA) infections. Methicillin resistant Staphylococcus aureus (MRSA) bacteraemia, is an infection, which is related to serious morbidity and mortality. Starting from early 2000s, MRSA infections prevalence in Europe and United States of America (USA), has been slightly decreased due to infection control precautions. Still MRSA infections prevalence is elevated in Asia. Insufficient examination of clinical samples and patient data causes the HCA-MRSA infection isolates to be evaluated as CA-MRSA. This affects empirical treatment choices, by causing misjudgement of antibiotic resistances on CA-MRSA. During recent years amongst societies with higher antibiotic usage, it has shown that antibiotic resistances of MSSA strains are getting higher. Material and Method: In this study, outpatients aged between 1-15 applied to Maltepe University Medical Faculty Paediatrics Department, were analysed by socio-demographic and HCA criteria, for MRSA and MSSA nasal colonization risk, they were compared by using cefoxitin disc diffusion test and mecA gene detection methods to determine methicillin resistance, antibiotic resistances of MSSA and MRSA strains were evaluated. Results: In 146(29%) patients nasal S. aureus carriage, in 13(2.5%) patients MRSA nasal carriage, Methicillin resistance in S.aureus strains is 8.9% was found. Resistance of cefoxitin could not be detected by disc diffusion method in 13 samples with mecA gene. The mean age of those without S.aureus nasal carriage was found to be statistically significantly lower than those with MRSA and MSSA nasal carriage (p = 0.001). The absence of antibiotic use in the last 3 months and the presence of hospitalized individuals in the last 1 year were found to be significant risk factors for MSSA colonization (p = 0.012 and p = 0.042); however, it was not found as a risk factor for MRSA colonization. It was observed that one-year increase in age and presence of chronic disease increased MRSA colonization by 17% and 3.38 fold, respectively (p = 0.033 and p = 0.014). An increase in income level was seen to reduce the risk of MSSA nasal carriage. S.aureus nasal carriage was found to be significantly lower in patients whose hospital admission interval was less than 1 per month (p = 0.020), and the risk of S.aureus and MSSA carriage was significantly increased in those who were larger than 1 per month (p = 0.009 and p = 0.012). All samples confirmed to be S.aureus were susceptible to teicoplanin, vancomycin, rifampicin, linezolid, chloramphenicol, gentamicin, ciprofloxacin and fusidic acid. The presence of cefoxitin, tetracycline and cefazolin resistance in MRSAs was found statistically significant compared to MSSAs (p = 0.001). Other than cefazolin and penicillin resistances, clindamycin, ciprofloxacin, tetracycline, erythromycin and inducible clindamycin resistances were detected in MSSA strains. Conclusion: In our study, we found that SBI risk factors may also be responsible for increased antibiotic resistance in MSSA strains, and in vitro testing may result in unnecessary broad-spectrum antibiotic use due to clinical incompatibility. It was concluded that it is appropriate to use molecular methods in cases where rapid diagnosis is required, and hospital and community-based surveillance studies with appropriate definitions and molecular microbiological analysis of isolates will contribute to the treatment and prevention of MSSA and MRSA infections.
Introduction: Staphylococcus aureus, is one of the important pathogens, which causing both healthcare associated infections (HCAIs) and community associated (CA) infections. Methicillin resistant Staphylococcus aureus (MRSA) bacteraemia, is an infection, which is related to serious morbidity and mortality. Starting from early 2000s, MRSA infections prevalence in Europe and United States of America (USA), has been slightly decreased due to infection control precautions. Still MRSA infections prevalence is elevated in Asia. Insufficient examination of clinical samples and patient data causes the HCA-MRSA infection isolates to be evaluated as CA-MRSA. This affects empirical treatment choices, by causing misjudgement of antibiotic resistances on CA-MRSA. During recent years amongst societies with higher antibiotic usage, it has shown that antibiotic resistances of MSSA strains are getting higher. Material and Method: In this study, outpatients aged between 1-15 applied to Maltepe University Medical Faculty Paediatrics Department, were analysed by socio-demographic and HCA criteria, for MRSA and MSSA nasal colonization risk, they were compared by using cefoxitin disc diffusion test and mecA gene detection methods to determine methicillin resistance, antibiotic resistances of MSSA and MRSA strains were evaluated. Results: In 146(29%) patients nasal S. aureus carriage, in 13(2.5%) patients MRSA nasal carriage, Methicillin resistance in S.aureus strains is 8.9% was found. Resistance of cefoxitin could not be detected by disc diffusion method in 13 samples with mecA gene. The mean age of those without S.aureus nasal carriage was found to be statistically significantly lower than those with MRSA and MSSA nasal carriage (p = 0.001). The absence of antibiotic use in the last 3 months and the presence of hospitalized individuals in the last 1 year were found to be significant risk factors for MSSA colonization (p = 0.012 and p = 0.042); however, it was not found as a risk factor for MRSA colonization. It was observed that one-year increase in age and presence of chronic disease increased MRSA colonization by 17% and 3.38 fold, respectively (p = 0.033 and p = 0.014). An increase in income level was seen to reduce the risk of MSSA nasal carriage. S.aureus nasal carriage was found to be significantly lower in patients whose hospital admission interval was less than 1 per month (p = 0.020), and the risk of S.aureus and MSSA carriage was significantly increased in those who were larger than 1 per month (p = 0.009 and p = 0.012). All samples confirmed to be S.aureus were susceptible to teicoplanin, vancomycin, rifampicin, linezolid, chloramphenicol, gentamicin, ciprofloxacin and fusidic acid. The presence of cefoxitin, tetracycline and cefazolin resistance in MRSAs was found statistically significant compared to MSSAs (p = 0.001). Other than cefazolin and penicillin resistances, clindamycin, ciprofloxacin, tetracycline, erythromycin and inducible clindamycin resistances were detected in MSSA strains. Conclusion: In our study, we found that SBI risk factors may also be responsible for increased antibiotic resistance in MSSA strains, and in vitro testing may result in unnecessary broad-spectrum antibiotic use due to clinical incompatibility. It was concluded that it is appropriate to use molecular methods in cases where rapid diagnosis is required, and hospital and community-based surveillance studies with appropriate definitions and molecular microbiological analysis of isolates will contribute to the treatment and prevention of MSSA and MRSA infections.
Açıklama
Anahtar Kelimeler
MRSA, MSSA, Nazal kolonizasyon, Metisilin direnci, mecA, MRSA, MSSA, Nasal colonisation, Methicillin resistance, mecA
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Pervanlar, A. (2020). Çocuk yaş grubunda burun sürüntüsünde MRSA (metisiline dirençli staphylococcus aureus) taşıyıcılığının ve risk faktörlerinin belirlenmesi ile MRSA genotiplendirmesi. Maltepe Üniversitesi, Lisansüstü Eğitim Enstitüsü, İstanbul.
