Çocuklarda toplum kökenli metisiline duyarlı ve metisiline dirençli staphylococcus aureus taşıyıcılık sıklığı ve risk faktörleri
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Date
2012
Authors
Çakır, Deniz
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Uludağ Üniversitesi
Abstract
Bu çalışmanın amacı Bursa ilinde kreşe ve ilköğretim okullarına giden sağlıklı çocuklarda metisilin duyarlı (MSSA) ve metisilin dirençli Staphylococcus aureus (MRSA) sıklığını, kolonizasyonla ilişkili risk faktörlerini, MSSA ve MRSA izolatlarının antibiyotik duyarlılığını ve MRSA izolatlarının moleküler özelliklerini belirlemektir.Mart-Nisan 2008 arasında Bursa ilinde 1004 sağlıklı çocukta burun/boğazda MSSA ve MRSA taşıyıcılığı araştırıldı. Burun ve boğaz sürüntüleri S. aureus üretmek için besiyerine ekildi, ailelere anket soru formu doldurtuldu. Antibiyotik duyarlılık testi disk difüzyon yöntemi ile gerçekleştirildi. Tüm MRSA izolatlarına PZR ile SCCmec tiplendirmesi ve PVL geni varlığını araştırmak için moleküler analiz yapıldı.S. aureus, MSSA ve MRSA taşıyıcılığı sırasıyla %39, %38.7 ve %1.2 oranında saptandı. Kreşe devam etmek dışında (odds oranı (OO), 2.252; 95% güven aralığı (GA), 1.267-4.016) diğer olası risk faktörleri ile kolonizasyon arasında ilişki saptanmadı. Beklenenin aksine kronik hastalık varlığı koruyucu faktör olarak saptandı (OO, 2.252; 95% GA, 1.267-4.016). Antiiyogramı yapılan 423 MSSA izolatı arasında penisilin direnci %91 (385/423), eritromisin direnci %10.4 (44/423), klindamisin direnci %0.6 (3/423) idi. İndüklenebilir klindamisin direnci %9.7 (41/423), eritromisin dirençli MSSA izolatlarında indüklenebilir klindamisin direnci ise (pozitif D-test) %93.2 (41/44) idi. MRSA izolatlarında vankomisin, gentamisin, rifampisin, klindamisin direnci saptanmadı. Yapılan moleküler analizler sonucunda toplam 12 MRSA izolatının hepsinde SCCmec tip IV pozitif saptanırken, sadece 1 izolatta PVL geni pozitifliği saptandı.Sonuç olarak bölgemizde çocuklarda MSSA kolonizasyonu yüksek ancak MRSA kolonizasyonu ise düşük oranda saptandı. İndüklenebilir direnç durumu dikkate alındığında bölgemizde toplum kökenli orta ya da ciddi seyirli S. aureus enfeksiyonlarının ampirik tedavisinde klindamisin dikkatli kullanılmalıdır. Eritromisin direnci saptandığında indüklenebilir klindamisin direncini saptamak için D-test mutlaka yapılmalıdır.
The aim of our study was to determine the carriage rate of methicillin sensitive Staphylococcus aureus (MSSA) and methicillin resistant Staphylococcus aureus (MRSA) in children attending day care center and schools in Bursa province, to evaluate risk factors associated with MSSA and MRSA colonization, to detect antibioitic susceptibility of MSSA and MRSA isolates and to investigate molecular characterization of MRSA isolates.During March and April 2008, nasal and throat carriage of MSSA and MRSA surveillance was conducted among 1004 healthy children who were attending daycare centers and schools in Bursa. Nasal and throat swab samples were cultured to isolate S. aureus, a questionnaire was administered, and antimicrobial susceptibility was assessed using a disk diffusion test. All MRSA isolates were detected for molecular tests, including Panton-Valentine leukocidin (PVL) genes polymerase chain reaction (PCR), and staphylococcal cassette chromosome mec (SCCmec) typing.The overall prevalences of S. aureus, MSSA and MRSA carriage were 39.9%, 38.7%, 1.2% respectively. There were no significant associations between potential risk factors and MRSA/MSSA colonization except for attending day care center (odds ratio (OR), 2.252; 95% confidence interval (CI), 1.267-4.016). Unexpectedly, chronic health problem was a significant protective factor (OR, 1.629; 95% CI, 1.072-2.481). Among the 423 MSSA isolates, antibiotic resistance to penicillin was 91% (385/423) and clindamycin resistance was 0.6% (3/423). Erythromycin resistance was present in 44 of 423 MSSA isolates (10.4%). Inducible clindamycin resistance was present in 41 of 423 MSSA isolates (9.7%). Inducible clindamycin resistance (positive D test) was detected in 41 of the 44 erythromycin-resistant MSSA isolates (93.2%). Clindamycin, gentamycin, vancomycin, rifampin resistance was not detected in MRSA isolates. As a result of molecular analysis performed on a total of 12 MRSA isolates, all of them were positive for SCCmec type IV, PVL gene was positive in only one strain.We conclude that the rate of colonization by MSSA is high in children but colonization with MRSA is not common in our areas. Clindamycin should be avoided using in moderately to severe diseases caused by community acquired S. aureus. However, if the S. aureus isolates are erythromycin resistant, D-test should be carried out for detection of inducible clindamycin resistance.
The aim of our study was to determine the carriage rate of methicillin sensitive Staphylococcus aureus (MSSA) and methicillin resistant Staphylococcus aureus (MRSA) in children attending day care center and schools in Bursa province, to evaluate risk factors associated with MSSA and MRSA colonization, to detect antibioitic susceptibility of MSSA and MRSA isolates and to investigate molecular characterization of MRSA isolates.During March and April 2008, nasal and throat carriage of MSSA and MRSA surveillance was conducted among 1004 healthy children who were attending daycare centers and schools in Bursa. Nasal and throat swab samples were cultured to isolate S. aureus, a questionnaire was administered, and antimicrobial susceptibility was assessed using a disk diffusion test. All MRSA isolates were detected for molecular tests, including Panton-Valentine leukocidin (PVL) genes polymerase chain reaction (PCR), and staphylococcal cassette chromosome mec (SCCmec) typing.The overall prevalences of S. aureus, MSSA and MRSA carriage were 39.9%, 38.7%, 1.2% respectively. There were no significant associations between potential risk factors and MRSA/MSSA colonization except for attending day care center (odds ratio (OR), 2.252; 95% confidence interval (CI), 1.267-4.016). Unexpectedly, chronic health problem was a significant protective factor (OR, 1.629; 95% CI, 1.072-2.481). Among the 423 MSSA isolates, antibiotic resistance to penicillin was 91% (385/423) and clindamycin resistance was 0.6% (3/423). Erythromycin resistance was present in 44 of 423 MSSA isolates (10.4%). Inducible clindamycin resistance was present in 41 of 423 MSSA isolates (9.7%). Inducible clindamycin resistance (positive D test) was detected in 41 of the 44 erythromycin-resistant MSSA isolates (93.2%). Clindamycin, gentamycin, vancomycin, rifampin resistance was not detected in MRSA isolates. As a result of molecular analysis performed on a total of 12 MRSA isolates, all of them were positive for SCCmec type IV, PVL gene was positive in only one strain.We conclude that the rate of colonization by MSSA is high in children but colonization with MRSA is not common in our areas. Clindamycin should be avoided using in moderately to severe diseases caused by community acquired S. aureus. However, if the S. aureus isolates are erythromycin resistant, D-test should be carried out for detection of inducible clindamycin resistance.
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Keywords
Çocuklar, Metisilin dirençli Staphylococcus aureus, Metisilin duyarlı Staphylococcus aureus, Taşıyıcılık, Children, Methicillin resistant Staphylococcus aureus, Methicillin sensitive Staphylococcus aureus, Carriage
Citation
Çakır, D. (2012). Çocuklarda toplum kökenli metisiline duyarlı ve metisiline dirençli staphylococcus aureus taşıyıcılık sıklığı ve risk faktörleri. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.